Tumor necrosis factor-alpha (TNF-alpha) is a chemokine secreted by T cells which is thought to play a critical role in the pathophysiology of psoriasis. The monoclonal antibody, infliximab, complexes with TNF-alpha, rendering it inactive. A recent clinical trial has reported the clinical benefit and safety of infliximab in moderate to severe plaque psoriasis. We report a case of rapid response and clinical benefit using infliximab in severe pustular psoriasis of von Zumbusch.

W e studied less well-investigated components of the calf muscle pump failure associated with venous disease, including muscle, nerve, movement, and gait abnormalities. 1 We investigated sensory neuropathy and ambulatory foot pressures in patients with chronic venous insufficiency (CVI) to further elucidate the pathogenesis and mechanisms of venous ulceration. Methods. After institutional review board approval and informed consent, 10 patients with active noninfected venous ulcers or a history of such ulcers (CEAP [Clinical-Etiologic-Anatomic-Pathophysiologic] 1 clinical classification 5 or 6) were recruited. No recruited patient had a history of neuropathy or predisposing conditions for neuropathy. Ten age-, sex-, and weight-matched control patients without diabetes or venous disease were also recruited from the same population. All patients had good arterial circulation and walked without assistance. A medical history was obtained and foot, leg, and ulcer examinations were performed on all patients. To evaluate symptoms of peripheral sensory neuropathy, the validated neuropathy symptom score (NSS) 2 was determined. To measure quantitative objective neuropathic changes, we performed quantitative sensory testing of the feet using the validated neuropathy disability score (NDS). 2 As part of the NDS, we used a 10-g monofilament to perform sensory testing of the feet at 6 sites.

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