Recently Published Documents
German S3‐Guideline on the treatment of Psoriasis vulgaris, adapted from EuroGuiDerm – Part 1: Treatment goals and treatment recommendations
The Relationship between Brain-derived Neurotrophic Factor’s Serum Level and Hospital Anxiety and Depression Scale-depression in Patients with Psoriasis Vulgaris
BACKGROUND: Psoriasis vulgaris is a chronic inflammatory skin disorder that can lead to depression. The involvement of the nervous system in psoriasis was proved by the influence of brain-derived neurotrophic factor (BDNF) in regulating corneocyte homeostasis. Low level of BDNF in patients with psoriasis result in transit amplifying subpopulation of basal keratinocytes not performing their function as inhibitors of keratinocyte proliferation, resulting in acceleration of keratinocyte proliferation. In depressed patients, it is known that levels of BDNF in the serum and hippocampus are low. BDNF level imbalance potentially affects the severity of psoriasis and depression. METHODS: This is an analytical cross-sectional study. The measurement of BDNFs serum level was carried out in the Medan Private Laboratory using a human BDNF (R and D®, USA) kit using the ELISA method. We use hospital anxiety and depression scale (HADS-D) questionnaire to assess depression symptoms. RESULTS: The results of the Spearman correlation test for BDNFs serum level and HADS-D showed p < 0.05, it can be concluded that there is a correlation between BDNFs serum level and HADS-D. The strength of the relationship between HADS-D and BDNFs serum level is −0.537 that shows moderate correlation (r = 0.4 −<0.6). Relationship between HADS-D and BDNFs serum level is −0.537 that shows moderate correlation (r = 0.4 −<0.6). CONCLUSION: This study shows a moderate negative relationship between BDNFs serum level and the degree of symptoms of depression, which the lower level of BDNFs serum will increase the degree of depression symptoms.
Psoriasis is a common dermatological disorder with many risk factors including low calcium levels. The improvement of psoriasis with calcium and Vitamin D3 analogues can implicate a role of calcium levels in triggering or aggravating psoriasis by controlling the proliferation and differentiation of keratinocytes. The objective is to study the calcium levels in various types of psoriasis and to find any correlation between calcium levels and severity of psoriasis. Cross sectional observational study Serum calcium and albumin levels of all psoriatic patients meeting the inclusion criteria were assessed. PASI score was calculated for patients with psoriasis vulgaris. SPSS software, version 21.0 was used. Chi-square test used for significance of study parameters on categorical scale [significance was assessed at 5% level of significance] and Pearson test was used to find correlation. The study included 206 patients of various forms of psoriasis over the period of 1 year, with males outnumbering females. Hypocalcaemia was found in 18.45% of patients, with significant association of hypocalcaemia in psoriasis vulgaris, pustular psoriasis and erythroderma. A moderately strong negative correlation was found between severity of psoriasis vulgaris and serum calcium levels. Association of hypocalcaemia with severe forms of psoriasis can indicate the role of oral or dietary supplements to correct serum calcium levels to prevent the progression of mild, stable forms of disease to severe forms and thus provide a better outcome.
Background. This study aimed to explore the mechanisms of action of the PSORI-CM01 and Yinxieling formulas in the treatment of patients with psoriasis vulgaris by analyzing gene expression in peripheral blood mononuclear cells (PBMCs). Methods. PBMC samples were collected from 21 patients before and after treatment. The study included nine patients in the PSORI-CM01 treatment group, 12 patients in the Yinxieling treatment group, and nine patients in the healthy control group. Gene expression levels in PBMCs were determined using the Affymetrix gene chip technology. Results. In the PSORI-CM01 group before and after treatment, a total of 668 differentially expressed genes were found, of which 445 were upregulated and 223 were downregulated. Before and after Yinxieling treatment, 657 differentially expressed genes were found, of which 168 were upregulated and 489 were downregulated. Venn analysis showed that 78 genes were not differentially expressed in the PSORI-CM01 group and 74 were not differentially expressed in the Yinxieling group compared with those in the controls. Among these genes, 72 genes were common to both groups, which were the genes on which the two drugs acted jointly. The results of KEGG analysis and Venn analysis on the signalling pathways of drug action in treatment groups showed that haemostasis and pathways involving Rho GTPases were common signalling pathways of drug action in the two groups. Conclusions. By a comparative analysis of the treatment groups, we found that both drugs have a positive effect on patients with psoriasis vulgaris, primarily by regulating the pathways related to platelet activation, aggregation, and blood coagulation. Trial registration: ChiCTR, ChiCTR-TRC-14005185, Registered 8 August 2014, http://www.chictr.org.cn/showproj.aspx?proj=4390
The study aimed to investigate the relationship between carriage of 677C>T polymorphism in the gene of methylene tetrahydrofolate reductase (MTHFR) and plaque psoriasis in patients in Bulgaria. We examined the prevalence of MTHFR C677T genotype in patients with psoriasis, as well as the relationship of the polymorphism with disease severity. Our study covered63 patients with psoriasis and 98psoriasis-free control subjects from northern Bulgaria. MTHFR677C>T genotype was verified by the PCR-RFLP method. There was no significant difference between carriage of TT genotype among the patients and controls: 12.7% versus 10.8 %in controls, OR 1.203, (CI 95% 0465-3.175), p>0.05 respectively. There was a higher PASI score in patients, carriers of TT genotype of MTHFR polymorphism 677C>T than in non-carriers, 28.18versus 24.87 respectively, but not significant. Conclusion: Carriage of TT genotype of MTHFR polymorphism 677C>T was not associated with Psoriasis Vulgaris in the northern Bulgarian population when compared to healthy controls.
ZusammenfassungBei einer pflegebedürftigen Patientin mit chronischer Niereninsuffizienz und Psoriasis vulgaris wurde durch ihre Hautärztin eine Therapie mit Methotrexat verordnet. Die Laborkontrollen sollten über die Hausärztin erfolgen; diese wurden jedoch erst für einen Monat später vereinbart. In der Zwischenzeit hatte der Pflegedienst bereits die erste Methotrexat-Injektion durchgeführt, wonach es zu einer Verschlechterung des Hautzustandes und Schleimhautbeschwerden bei der Patientin kam. Die Hautärztin wies die Patientin daraufhin in eine dermatologische Klinik ein; vorher wurde vom Pflegedienst jedoch eine zweite Methotrexat-Dosis verabreicht. In der Hautklinik wurde aufgrund des Befundes einer erosiven Stomatitis und Vulvitis, einer ausgeprägten Leukopenie und Thrombozytopenie und des Verdachtes auf akutes Nierenversagen eine Methotrexat-Intoxikation diagnostiziert. Die Patientin verstarb wenige Tage später an einem Multiorganversagen.Methotrexat ist zur Induktionstherapie bei mittelschwerer bis schwerer Psoriasis vulgaris zugelassen. Zu den Gegenanzeigen einer Methotrexat-Therapie zählt nach Leitlinie und Fachinformation eine Niereninsuffizienz; ferner sind Laborkontrollen individualisiert vor der Behandlung, nach einer Woche und nach 6 Wochen und danach alle 6–12 Wochen durchzuführen. Unter arzthaftungsrechtlichen Aspekten dürfte der Einsatz von Methotrexat zur Behandlung einer Psoriasis inversa bei einer betagten Patientin mit Niereninsuffizienz als grober Behandlungsfehler zu bewerten sein; die Nichtdurchführung empfohlener Laborkontrollen ist als Befunderhebungsfehler zu werten. Die Fehleranalyse zeigt allerdings, dass der tragische Verlauf der Methotrexatintoxikation bei besserer Kommunikation zwischen den beteiligten Ärzten und Pflegenden möglicherweise hätte verhindert werden können.