Dystrophic nails are frequently found in psoriatic individuals, especially those suffering from arthropathic psoriasis. Subungual hyperkeratosis and pitting are the most typical lesions. It is difficult to assess definitively whether psoriasis is a predisposing factor to the development of fungal infections of the nails.
Stigmatization is defined as having a discrediting mark that leads to social discrimination and alienation. The aim of this study was to estimate the level of stigmatization experienced by patients with psoriasis. A total of 102 individuals with psoriasis were recruited and was assessed using the 6-item Stigmatization Scale and the 33-item Feelings of Stigmatization Questionnaire. In addition, quality of life, stress and depression were evaluated. The majority of patients felt that they were stigmatized by psoriasis. The most bothersome aspect was that other people stared at their skin changes. According to the 33-item questionnaire, anticipation of rejection and feelings of guilt and shame were the major aspects of stigmatization, the level of which correlated significantly with pruritus intensity, stress prior to exacerbation, depressive symptoms and quality of life. In order to decrease the stigmatization level in patients with psoriasis, greater effort is needed to raise awareness in contemporary societies that psoriasis is not contagious, but is a disease like many other chronic conditions.
Onychomycosis is the most common disease of the nails and constitutes about a half of all nail abnormalities. Some factors like increasing age, male sex, repeated nail damage, genetic predispositions and underlying conditions, such as diabetes, immunodeficiency or peripheral arterial disease may predispose to develop onychomycosis. It is also suggested that abnormalities in nail morphology are the predisposing factors to onychomycosis. Psoriasis is one of the most common reasons of disturbed nail morphology and the spectrum of nail changes in psoriasis is very wide. Thus, there were suggestions that dystrophic nails in psoriatic patients lose their natural preventing barrier and therefore are more predisposed to fungal infection. This paper summarizes the knowledge about prevalence of onychomycosis among psoriatic patients and contains a literature review concerning this problem. Most authors report that the prevalence of onychomycosis in psoriatic patients is not higher than that in control population. However, especially yeasts and maybe moulds, probably as concomitant pathogens, are more often isolated from psoriatic patients than from non-psoriatic population. In reasonable cases, the mycological examination is required, especially when the clinical picture of the nails suggests the presence of fungal infection. In these cases, antifungal treatment may be beneficial for psoriatic patients.
Although pruritus is an essential symptom of atopic dermatitis, its complex pathomechanism is not fully understood. The aim of this study was to characterize the clinical pattern of itch in adult subjects with atopic dermatitis. A total of 89 patients (59 females, 30 males) with atopic dermatitis, age range 18-60 years, were included in the study. Each patient completed a questionnaire about clinical features of itch. At the time of examination pruritus was present in 83.1% of patients. The majority of patients experienced itch in the evening (52.8%) and at night (38.2%). In 81% of patients itch caused difficulty in falling asleep. Twenty-five patients (28.1%) experienced itch every day. The main factors exacerbating pruritus were dryness, sweat, physical effort, food and hot baths. The most frequently used management regimes were topical emollients and oral antihistamines, but the long-term effects of these were very limited. There was a positive correlation between intensity of itch and age (r = 0.3, p = 0.004), and between disease duration and intensity of maximal itch (r = 0.22, p = 0.04). Patients with more severe disease reported more intense pruritus.
Uremic pruritus is one of the most bothersome symptoms in patients with chronic renal failure. Its pathogenesis remains unclear. The aim of this study was to evaluate the frequency of uremic pruritus in hemodialysis patients and to correlate its presence and intensity with several clinical parameters. One hundred thirty patients on maintenance hemodialysis were included into the study. The intensity of pruritus was assessed by two methods: visual analog scale and specially adapted questionnaire scoring method. A significantly positive correlation (p < 0.00001) was demonstrated between the two methods for evaluating pruritus. Uremic pruritus was found in 40.8% of patients. An additional 36.1% of patients reported pruritus to have been present in the past during the renal disease period. Itching was generalized in 19% of patients; the remaining subjects suffered from scattered pruritus (50%) or pruritus in a single location (31%). A significant positive relationship (p < 0.02) was demonstrated between the total score of pruritus and duration of the hemodialysis period. Severity of pruritus and sleep disturbance caused by itching also significantly correlated (p < 0.05) with the duration of hemodialysis. Patients hemodialysed on polysulphone membranes more commonly suffered from pruritus than those on hemophane (p < 0.04) or cuprophane (p < 0.03) dialysis membranes. A marked relationship was demonstrated between the intensity of xerosis and prevalence of pruritus. Significantly more patients with very rough skin had pruritus compared to those with rough skin (p < 0.05) and those with slightly dry skin (p < 0.02). Itching was more common in female patients (p < 0.04), but patient age, underlying renal disease and erythropoietin intake did not correlate with the incidence or intensity of pruritus.
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