There is a range of psoriasis treatments available, from topical applications to biologic therapy, with corresponding cost variations. The efficacy of each treatment is usually evaluated by objective measures such as the Psoriasis Area and Severity Index (PASI) or subjective measures such as the Dermatology Life Quality Index (DLQI). However, the social and economic impacts of psoriasis, including cost-effectiveness, have not been assessed in Japan. The EuroQol 5-Dimension (EQ-5D) is a generic instrument used worldwide to calculate quality-adjusted life years, on which calculations of treatment cost-effectiveness are based. We conducted a pilot study to determine the cost-effectiveness of psoriasis treatment in Japan. We administered a questionnaire to 133 patients with psoriasis (105 men and 28 women) who visited four university hospitals in Fukuoka Prefecture. The questionnaire covered medical costs, satisfaction and willingness to pay (WTP), and we investigated the relationships between these items. PASI was evaluated by physicians. More participants indicated satisfaction with treatment in the group paying less than ¥5000/month. WTP, PASI and EQ-5D showed little correlation. However, the DLQI and EQ-5D showed a moderate correlation (r = 0.472). WTP seemed more dependent on participants' economic backgrounds. We found that it was difficult to reflect the PASI with the EQ-5D. However, the DLQI may be used to estimate the cost-benefit relationship in patients with psoriasis. This is the first study to evaluate the EQ-5D in patients with psoriasis in Japan.

Erythropoietin-producing hepatocellular receptor-2 (EphA2) overexpression is prevalent in many types of human cancers, and it has been reported that high EphA2 expression is correlated with malignancy. Recent studies revealed that processing of EphA2 by cleaving off the N-terminal portion by membrane-type 1 matrix metalloproteinase (MT1-MMP) promotes invasion via stimulation of Ras in cancer cells in vitro. The objectives of this study were to investigate the presence and role of EphA2 processing in cutaneous squamous cell carcinoma (SCC) tissues. EphA2 (C-terminal and N-terminal) and MT1-MMP expression patterns and levels were analyzed immunohistochemically in SCC (n = 70) and Bowen disease (BD; n = 20). Levels of MT1-MMP and EphA2 expression were evaluated using digital image analysis. Proximity between MT1-MMP and EphA2 in cancer cells and its effect on EphA2 processing were investigated using a combination of in situ proximity ligation assay (PLA) and Western blotting. Immunohistochemical analyses showed that levels of EphA2 N-terminal expression were significantly lower than those of EphA2 C-terminal expression in SCC, whereas levels of EphA2 C- and N-terminal expression were similar in BD. Western blotting showed processed EphA2 fragments in human SCC tissues. Expression levels of MT1-MMP, EphA2, and processed EphA2 fragments were higher in SCC than BD. Proximity between MT1-MMP and EphA2 in SCC was demonstrated by in situ PLA. Our results suggest possible involvement of MT1-MMP processing of EphA2 in invasiveness of cutaneous SCC.

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TNF-a agents and the anti-inflammatory effect of TNF-a blocking agents is not mediated by adiponectin, 1 the alteration of serum adipokines would not be the specific action of TNF-a blocking agents but rather be the result of decreased serum TNF-a levels by the successful psoriasis treatments including ustekinumab and NB-UVB.In conclusion, we demonstrated that improvements of serum levels of adiponectin, leptin and resistin are linked to successful treatment of psoriasis. Because these adipokines are significantly involved in "psoriatic march", adequate control of psoriasis may contribute to the decreased development of metabolic syndrome including cardiovascular disease. REFERENCES1 Peter MJ, Watt P, Cherry L et al. Lack of effect of TNF-alpfa blockade therapy on circulating adiponectin levels in patients with autoimmune disease: results from two independent prospective studies. Ann Rhem Dis 2010; 69: 1687-1690. 2 Karmiris K, Koutroubakis IE, Xidakis C et al. The effect of infliximab on circulating levels of leptin, adiponectin and resistin in patients with inflammatory bowel diease. Eur J Gastroenterol Hepatol 2007; 19: 789-794. 3 Shibata S, Saeki H, Tada Y et al. Serum high molecular weight adiponectin levels are decreased in psoriasis patients. J Dermatol Sci 2009; 55: 62-63. 4 Peters MJ, Watt P, Cherry L et al. Lack of effect of TNF-alpfa blockade therapy on circulating adiponectin levels in patients with autoimmune disease: results from two independent prospective studies. Ann Rhem Dis 2010; 69: 1-687.

chest and groin was also sutured. Eight months later, skin ulcers appeared on the surgical scar of the forehead, nasolabial groove and chest, but not on the groin. Physical examination revealed a large, deep ulceration with elevated edematous borders (Fig. 1c,d). The ulcer was reddish and granular on the surface and surrounded by erythema. Bacterial cultures from superficial pus showed Pseudomonas aeruginosa, for which oral antibiotics resulted in no effect. Laboratory examination showed an increased number of white blood cell counts (10 000/lL with 89% neutrophils) and elevated C-reactive protein (10.9 mg/dL). A skin specimen biopsied from the edematous erythema on the chest showed dense, diffuse infiltration of neutrophils in the dermis and subcutaneous tissue (Fig. 1e). The patient soon died of congestive heart failure.Pyoderma gangrenosum usually occurs between the ages of 20 and 50 years. 1 Our case was an elderly patient with developing PG unassociated with systemic disorders. There are several reports of PG occurring at percutaneous surgical sites, namely, breast surgery, pacemaker implantation, splenectomy, hysterectomy, endoscopic tube insertion, cholecystectomy and cesarean delivery, 1 which suggest that pathergy reaction is implicated as a triggering role in susceptible patients. Pathergy can be seen in approximately 20% of cases, 1 and several speculations, namely, an aberrant immune response to minor trauma, defective cell-mediated immunity, aberrant integrin oscillations on neutrophils and abnormal neutrophil tracking, have been reported. 1-3 In our case, PG was induced at the skin and cartilage recipient sites (face), as well as sites of removed cartilage (chest). In contrast, the skin of the groin sutured after taking full-thickness skin did not result in PG. It is unlikely that PG was induced by the rejection of autologous skin grafts, because PG was also induced on the chest, where a skin graft was not performed. Therefore, it is suggested that the induction of PG is related to the depth of the skin damage. Cases of PG after autologous breast reconstruction have been reported, 4 which support the speculation that invasive operation can induce PG. Our case developed PG 8 months after the operation. Peristomal PG occurs more than 20 years after enterostomy/ colostomy. 5 Thus, PG may occur even after long periods following surgical operation.