1/17. psoriasis of the penis: Koebner reaction. Following oral genital exposure.Today, there is an apparent increase in oral genital activity among heterosexual groups not only in the united states but also globally. As a result, gonococcal pharyngitis was rediscovered, and primary syphilis of the oral cavity has been recognized with increasing frequency. In addition, physicians are seeing a wide variety of traumatic lesions of the genitals from "hickeys" of the labia to dental imprints and ulcerations of the glans penis. Our patient exhibits an interesting phenomenon recognized readily elsewhere on the skin but infrequently diagnosed on the glans penis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/17. psoriasis guttate acuta triggered by varicella zoster virus infection.A 23-year-old man had small desquamative erythematous lesions, round or oval in shape, spread over his entire body, and diagnosed as psoriasis guttate acuta because of clinical and pathological findings. Three weeks before the lesions had started, he was diagnosed as having varicella by his family physician. The psoriatic lesions appeared at the same sites where previously lesions of varicella had appeared. Therefore, VZV infection was regarded as a trigger in this case. We speculate that genetic factors and the change of skin condition are basically involved in the pathogenesis of psoriasis guttate. In addition, one more factor as a trigger is needed to cause the lesions of psoriasis. VZV infection might change the skin condition and induce subsequent immunological disregulation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/17. The Salford psoriasis Index: an holistic measure of psoriasis severity.We have developed, tested and validated a new scoring system for psoriasis: the Salford psoriasis Index (SPI). The SPI incorporates the current clinical extent of psoriasis based on the psoriasis Area and Severity Index (PASI), a score indicating psychosocial disability, and past severity based on treatment history. The resultant three-figure SPI (signs, psychosocial disability, interventions) is a similar paradigm to the TNM (tumour, nodes, metastasis) classification used for cancer staging. The first figure transforms the PASI into a number from 0 to 10 reflecting extent of psoriasis. The second assesses the psychosocial impact of psoriasis on each patient using a 0-10 visual analogue scale. The third figure reflects historical severity of disease as judged by the need for systemic treatment, admission to hospital and number of episodes of erythroderma. The SPI was prospectively employed in assessing 150 consecutive patients with psoriasis. Furthermore, in a separate cohort of 100 patients we tested the Psychosocial Impact Score against a recognized self-report psoriasis-specific measure, the psoriasis Disability Index. There was a strong correlation between the two (r = 0.59, P < 0.001). However, the Psychosocial Impact Score correlated poorly with clinical extent scores such as the PASI (r = 0.28, P < 0.05) and the Self-administered PASI in 72 patients tested (r = 0.19, P = 0.1). There was a high correlation between all six observers in 20 patients for both PASI (r = 0.71; 95% confidence interval, CI 0.51-0.86) and the Extent Score (r = 0.70; 95% CI 0. 56-0.89). We believe that the SPI will be more relevant to real-life categorization of psoriasis severity in that it takes an holistic approach based not only on physician assessment but also psychological disability and treatment resistance.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/17. Cushing's syndrome caused by topical steroid therapy for psoriasis.A 72-year-old woman developed manifestations of Cushing's syndrome after long-term topical steroid therapy for psoriasis. Shortly after tapering the dose of topical steroids she developed signs of adrenal insufficiency (provoked by a urinary tract infection) requiring intravenous administration of a stress dose of hydrocortisone. There have only been a few reports of systemic side effects of topically applied corticosteroids in adults. Considering their serious consequences physicians should be alert to signs of Cushing's syndrome in patients on long-term topical steroid therapy. Furthermore, clobetasol propionate ointment doses exceeding 50 g a week should not be prescribed and use of occlusive dressings should be avoided.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/17. Focal acantholytic dyskeratosis: a snare for the pathologist. Report of two cases associated to psoriasis and fibrous papule of the nose.Two specimens containing clinically inapparent histologic features of acantholytic dyskeratosis (on the base of a fibrous papule of the nose and overlying a psoriatic lesion) are presented. The authors discuss the conduct to be followed by the pathologist in similar cases. The general pathologist should be well trained in dermatopathology since cutaneous biopsies account for 10 to 25% of the specimens submitted for histologic diagnosis or, even, form the major part of the workload (Berry). There is a wall between the physician who submits the skin biopsies (who may be or not a dermatologist) and the pathologist. The clinical information provided by dermatologists is scant and incomplete and physicians who are not dermatologists seldom submit any information. The histological pictures found in skin biopsies are, often, common to several nosological entities and an adequate understanding of their meaning is desirable for a thorough evaluation. We ought to assess it with the maximum scientific severity, searching to solve the puzzle without depreciating the information received. In this report the authors analyse the histopathological approach to the cutaneous lesions of two patients. They displayed the association between acantholytic dyskeratosis (AD) and another cutaneous pathology. Findings like these may obstruct the final diagnosis to be issued by the pathologist.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
6/17. pityriasis alba in a psoriatic location.Three patients with pityriasis alba whose lesions were confined to the knees only are reported. Such cases can be misdiagnosed as psoriasis. The key to the correct diagnosis lies in the physician's awareness of the existence of this variant of pityriasis alba.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/17. Medical nutrition therapy as a potential complementary treatment for psoriasis--five case reports.This research evaluated five case studies of patients with psoriasis following a dietary regimen. There is no cure for psoriasis and the multiple treatments currently available only attempt to reduce the severity of symptoms. Treatments range from topical applications, systemic therapies, and phototherapy; while some are effective, many are associated with significant adverse effects. There is a need for effective, affordable therapies with fewer side effects that address the causes of the disorder. Evaluation consisted of a study group of five patients diagnosed with chronic plaque psoriasis (two men and three women, average age 52 years; range 40-68 years) attending a 10-day, live-in program during which a physician assessed psoriasis symptoms and bowel permeability. Subjects were then instructed on continuing the therapy protocol at home for six months. The dietary protocol, based on Edgar Cayce readings, included a diet of fresh fruits and vegetables, small amounts of protein from fish and fowl, fiber supplements, olive oil, and avoidance of red meat, processed foods, and refined carbohydrates. Saffron tea and slippery elm bark water were consumed daily. The five psoriasis cases, ranging from mild to severe at the study onset, improved on all measured outcomes over a six-month period when measured by the psoriasis Area and Severity Index (PASI) (average pre- and post-test scores were 18.2 and 8.7, respectively), the psoriasis Severity Scale (PSS) (average pre- and post-test scores were 14.6 and 5.4, respectively), and the lactulose/mannitol test of intestinal permeability (average pre- and post-test scores were 0.066 to 0.026, respectively). These results suggest a dietary regimen based on Edgar Cayce's readings may be an effective medical nutrition therapy for the complementary treatment of psoriasis; however, further research is warranted to confirm these results.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/17. Reiter's syndrome of the vulva. The psoriasis spectrum.BACKGROUND--Reiter's syndrome is a disease characterized by crusted, scaling, acral and genital plaques; urethritis or cervicitis; and arthritis, which occur in genetically susceptible patients in response to any of many infections. This disease rarely occurs in women, and specific characterizations of vulvar and cervical lesions are rare. OBSERVATIONS--We describe a 39-year-old woman with a history of mucocutaneous candidiasis that was refractory to oral ketoconazole therapy. She presented with well-demarcated, erythematous, crusted plaques over the vulva, hands, and feet, as well as with cervical lesions and a history of conjunctivitis and iritis. Following the biopsy of characteristic skin lesions, recognition of systemic signs, and cultures that were negative for yeast, her condition was diagnosed as Reiter's syndrome. CONCLUSIONS--Reiter's syndrome of the vulva, vagina, and cervix may not be recognized because of its uncommon occurrence in women and the physician's consequent unfamiliarity with its clinical appearance in the genital area. This disease and pustular psoriasis share many common features and exist on a spectrum. A high index of suspicion and correlation of the many facets of the disease will better enable the clinician to make this diagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/17. methotrexate-induced cirrhosis requiring liver transplantation in three patients with psoriasis. A word of caution in light of the expanding use of this 'steroid-sparing' agent.methotrexate has been used for many years to treat refractory psoriasis. Three cases of methotrexate-induced cirrhosis requiring orthotopic liver transplantation are presented to emphasize the importance of strict adherence to published criteria for patient selection, monitoring of cumulative drug dosages, and the performance of serial liver biopsies. Each patient had been treated with long-term methotrexate therapy (cumulative doses far in excess of 1.5 g) without undergoing serial liver biopsies, contrary to well-established treatment guidelines. Caution must be exercised in using methotrexate as a steroid-sparing agent in the treatment of inflammatory diseases because of its potential to cause severe hepatotoxic effects with long-term usage and cumulative doses above 1.5 g. patients easily become psychologically dependent on the drug, and physicians need to guard against the false sense of security engendered by normal results on liver function studies.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/17. Coexistent discoid lupus erythematosus and psoriasis: a therapeutic dilemma.The author notes that psoriasis is a common condition and primary care physicians should be aware of drugs that can worsen this disease. He describes the case of a patient with coexistent discoid lupus erythematosus (LE) and psoriasis. He discusses therapeutic problems encountered in this case and reviews drugs reported to exacerbate psoriasis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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