No abstract

Thirty-seven in-patients were men (mean age 48); 47 were women (mean age 49), male : female ratio 0.8 : 1 (ns) ( Table 1).In the systemic clinic, men outnumbered women by almost 2 : 1 (s). Although there was an equal gender distribution in those with less severe psoriasis (NB-UVB, topical), it is worth noting that in those with more resistant psoriasis (PUVA), men outnumbered women by 1.6 : 1. This did not reach statistical significance due to small numbers involved.We have not found reference to an association between severe psoriasis and male gender, yet this was our experience. Were our patients unique? Larger studies indicate a similar trend. Several biological studies showed a preponderance of the male gender. [2][3][4] Patients had moderate to severe psoriasis and failed at least one systemic agent. Women were excluded if pregnant or considering conception. In the CHAMPION study (n = 334), male patients outnumbered female patients by 1.9 : 1. 2 In multicentre studies of etanercept male patients outnumbered female patients by 1.7 : 1 (n = 265) 3 and 2.5 : 1 (n = 720). 4 Although women considering conception were excluded it is unlikely to have made a significant difference since mean age was 45 ± 12 years.If men have more severe psoriasis than women how can this be explained? Severe psoriasis is associated with comorbidities, of which cardiovascular disease confers the greatest mortality. In the general population, men are most at risk. 5 The link between inflammatory arthritis and cardiovascular mortality was reported in 1970s. 6 Gelfand showed that the highest relative risk of myocardial infarction is in young patients with severe psoriasis and that young men have increased cardiovascular mortality. 7 The explanation proffered is that the inflammatory cascade, mediated by Th1 and Th17 cells, is similar in atherosclerosis. 8 Smoking and alcohol consumption are higher in men. 9 Smoking increases cardiovascular risk 5 and negatively affects psoriasis. 10 McAleer 11 found that men have more alcohol misuse than women. Seven percent had an elevated alcohol biomarker, carbohydratedeficient transferrin, and 89% were men.Patients with psoriasis often present young and spend years attending for topical, phototherapy and eventually, systemic treatment. In the light of present knowledge we should intervene early -especially in young men -providing education about comorbidities and lifestyle measures that could potentially reduce them.Letters to the Editor epidermis. These features might be related to a block in the S phase of the cell cycle. On the other hand, the calprotectin immunolabelling throughout the epidermis appeared strikingly motheaten indicating severe vacuolar alterations. As seen in other disorders, the Mac 387-positive keratinocytes were either metabolically altered or engaged in a regenerative phase. The combination of these features was interpreted as a sublethal sign. The dermal dendrocyte alterations were reminiscent of the methotrexate-induced changes. 6 In some instances, CAR associated with ant...

Introduction: Psoriasis affects around 2% of children in Europe. The majority of cases is readily managed with topical treatments using corticosteroids without or with calcipotriol. More resistant and extensive moderate-to-severe cases require UVA or UVB phototherapies or conventional systemic treatment including ciclosporin, acitretin and methotrexate. However, these therapies are associated with a low tolerability and potential cumulative long-term adverse effects and toxicities. Areas covered: About 15 years ago, the first biological appeared for the treatment of moderate-tosevere plaque type psoriasis in adult patients. Several years later, the first biologic treatment to be approved in children was etanercept, a soluble receptor that binds both tumor necrosis factor (TNF)-α and β followed by adalimumab, a monoclonal antibody against TNF-α, and currently by ustekinumab, a monoclonal IL12/23 p40 antagonist and, very recently, secukinumab and ixekizumab, both IL17 antagonists. All these biologic treatments brought significantly improved treatment results compared to light-based therapies and conventional treatments and present very good tolerance and safety profiles. Expert opinion: Due to their excellent efficacy and safety profiles ustekinumab, secukinumab and ixekizumab could currently be considered as a first-line treatment options for moderate-to-severe childhood and adolescent psoriasis requiring a systemic treatment.

A woman in her 40s presented to the dermatology department for an evaluation of a pruritic eruption on her back of 5 months duration. She was systemically well, and prior treatment had included topical corticosteroids (mometasone furoate, 0.1%, cream) with subsequent worsening of symptoms. Physical examination revealed multiple erythematous to hyperpigmented plaques comprising concentric rings with associated scale on the upper back (Figure). On further questioning, she disclosed that her 3 children had all been recently treated for tinea capitis.Direct examination of a potassium hydroxide preparation failed to reveal hyphae. A mycological culture revealed Microsporum andouinii. The final diagnosis was tinea corporis of the pseudoimbricata type. Treatment with a 6-week course of oral griseofulvin (500 mg, twice daily) resulted in complete resolution of the lesions with only postinflammatory hyperpigmentation.Tinea pseudoimbricata is a rare subtype of tinea usually caused by Trichophyton tonsurans, Trichophyton mentagrophytes, and some Microsporum species. The name derives from its resemblance to tinea imbricata, an endemic fungal infection of the Southwest Pacific, Central and South America, and Southeast Asia that is caused by Trichophyton concentricum. 1 The ring-within-a-ring appearance, sometimes widespread, can also be confused with erythema gyratum repens. 2 This appearance has been associated with local or systemic immunosuppression, which is frequently associated with the erroneous use of topical corticosteroids. The inhibition of a person's immune response could induce intermittent inflammatory reactions against the dermatophyte, which are responsible for the appearance of the concentric erythematosquamous rings. 3 The treatment of tinea pseudoimbricata relies on long-course oral antifungal treatments, as topical antifungal agents are usually not sufficient. 2,4 This case highlights 2 issues: the first underlines that although a potassium hydroxide preparation is easy to perform and an inexpensive diagnostic method, its sensitivity is often low and interpreter dependent. A superficial or punch biopsy can readily identify the presence of fungal structures using a periodic acid-Schiff staining. However, only a mycological culture or polymerase chain reaction test can identify the specific causative fungus. The second stresses the importance to examine all the relatives of the same household.

No abstract