1/13. Physical illness and the family emotional system: psoriasis as a model.Most physical illnesses are characterized by significant variability in age of onset and severity of clinical course. Although many diseases may occur in the context of a strong family history for the disease, they may also occur when there is no such history. psoriasis has been chosen as a model for demonstrating that variability in age of onset, clinical course, and family history for a given disease may be explained, in part, by factors related to the family emotional system, a concept described by family systems theory (Bowen theory). Links between the clinical manifestations of psoriasis and the family emotional system have important treatment implications.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/13. Case studies in severe psoriasis: A clinical strategy.Individuals with moderate-to-severe psoriasis perceive that the disease exerts profound emotional, social and physical effects on their lives, and a significant percentage report that they do not consider their treatment sufficiently aggressive. A survey of individuals with a variety of chronic diseases reveals that those with psoriasis have the lowest estimation of their health-related quality of life, lower than that of patients with arthritis, congestive heart failure, chronic lung disease or depression. Although psoriasis can be treated effectively, many treatments are associated with long-term risks. Toxicity-sparing treatment strategies that include combination, rotational and sequential regimens can help to control moderate-to-severe psoriasis while reducing risk. algorithms for the treatment of moderate-to-severe psoriasis detail possible options for specific types of psoriasis and for patients with specific needs. The purpose of the algorithms is to make optimum use of phototherapy, traditional cytotoxic and immunosuppressive agents, retinoids, and newer biologic agents.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/13. Bullous pemphigoid in a patient with psoriasis during the course of puva therapy: study by ELISA test.A 65-year-old woman had a history of deep vein thrombosis and depression. psoriasis was diagnosed in 1986 and various topical and systemic therapies, singly or in combination, were prescribed: tar, topical corticosteroids, cyclosporine, etretinate, and methotrexate. Two courses of oral and one course of bath psoralen plus UVA (PUVA) therapy (cumulative dose, 467 J/cm(2)) and UVB (2.96 J/cm(2)) had been given. In January 1999, she developed a flare of generalized psoriasis. In May 1999, therapy with PUVA (8-methoxypsoralen) plus topical acetonide triamcinolone 0.1% was initiated. At the time, she was taking acenocoumarol, lorazepam, and hydroxyzine chlorhydrate. In August 1999, at session 30, when the dose of UVA was 9 J/cm(2), and the total dose was 205 J/cm(2), a bulla appeared on the dorsum of the toe and was controlled with topical antibiotics. Five further sessions of PUVA were given and a generalized itching bullous eruption appeared all over the body. PUVA was stopped and the patient was hospitalized. On physical examination, extensive psoriatic plaques plus vesicles and bullae on the normal skin and on psoriatic lesions were observed all over the body (Fig. 1). Histopathologic study of a lesion showed a subepidermal vesicle containing fibrin, neutrophils, and a few eosinophils. No sunburn cells were observed (Fig. 2). The direct immunofluorescence (DIF) test of perilesional uninvolved skin revealed immunoglobulin g (IgG) (Fig. 3) and C3 at the dermal-epidermal junction. The DIF study using the patient's skin, previously treated with 1 m NaCl, localized the IgG at both the epidermal and dermal sides of the basement membrane zone (Fig. 4). Bullous pemphigoid (BP) was diagnosed and therapy with prednisone (60 mg/day) was started. The disease was well controlled in 3 weeks. The dose of prednisone was tapered and stopped 20 months later, without any recurrence. Study of the antibodies by the indirect immunofluorescence (IIF) test, using monkey esophagus and guinea pig as substrate, was positive at a titer of 1/160 in September 1999. The titer decreased to 1/10 in January 2000, and was negative in July 2000. An enzyme-linked immunosorbent assay (ELISA) test, performed using the commercial kit MBL, which identifies antibodies directed against epitopes of the extracellular fragment NC16 of antigen 2 of BP, was positive at 15 U/mL (normal value, < 9 U/mL) in September 1999, and negative in July 2000 (Table 1).- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/13. Successful treatment of hand and foot psoriasis with efalizumab therapy.hand and foot psoriasis can appear in a plaque-type or pustular-type form. Any form of psoriasis that occurs on the hands and feet can have a debilitating effect on the patient's daily functions. Here we present a case series of patients with plaqueor pustular-type hand and foot psoriasis whose conditions were successfully managed with the biologic agent efalizumab. In many of these patients, the disease was refractory to multiple systemic psoriasis treatments. Treatment with efalizumab was effective and well-tolerated, with few adverse events. Many of the patients described here reported an improvement in both their physical functioning and health-related quality of life. The efficacy of efalizumab in treating these cases of hand and foot psoriasis suggests that it may provide therapeutic benefit.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/13. A syndrome of widened medullary cavities of bone, aortic calcification, abnormal dentition, and muscular weakness (the Singleton-Merten syndrome).Two patients with clinical and radiological features similar to those of Singleton and Merten's patients are described. These patients exhibit features of a unique clinical syndrome of unknown etiology: generalized muscular weakness with secondary hip and foot deformities, progressive calcification of the thoracic aorta beginning in childhood, calcific aortic stenosis leading to heart failure, dysplasia of the teeth, poor physical development, osteoporosis, expanded medullary cavities of the metacarpal and metatarsal bones, and chronic psoriaform skin lesions.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/13. psoriasis, necrobiosis lipoidica, granuloma annulare, vitiligo and skin infections in the same diabetic patient.A diabetic patient is described presenting psoriasis, necrobiosis lipoidica diabeticorum, granuloma annulare, and vitiligo and with a history of recurrent erysipelas and mycotic infections. Scrupulous physical examination excluded further systemic or cutaneous involvement. The immunological workup revealed both phenotypic and functional defects in cellular immunity.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/13. Psoriatic arthritis precipitated by physical trauma.A case of skin psoriasis and psoriatic monoarthritis triggered by physical trauma is reported. Possible pathogenic mechanisms of this phenomenon are discussed.- - - - - - - - - - ranking = 5keywords = physical (Clic here for more details about this article) |
8/13. Occupationally induced psoriasis.psoriasis of the hands may be triggered by work, especially in occupations involving physical trauma or contact with irritants. When limited to the hands and in absence of other typical lesions, diagnosis can be difficult particularly when coexisting with contact eczema. It is necessary to establish diagnostic criteria which help to establish a relationship between clinical manifestations and noxious stimuli at work. Prevention should be directed to early identification of cases and adequate preemployment physical examinations in order to avoid permanent disability.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
9/13. cyclosporine: a new therapeutic option for severe, recalcitrant psoriasis.Severe, recalcitrant psoriasis can be a physically, emotionally, and socially-debilitating disease. cyclosporine is an important new option for the systemic treatment of this dermatologic disorder. cyclosporine, an immunosuppressive agent used in the field of organ transplantation for more than a decade, has demonstrated marked efficacy in treating severe, recalcitrant psoriasis. However, its successful use requires patient education and careful, ongoing patient monitoring.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/13. psoriasis.psoriasis is a chronic skin disease that has multiple presentations. patients frequently present with concerns about the cosmetic changes that psoriasis produces. While psoriasis is rarely life-threatening, it can be very devastating to the affected individual. Consequently, the various presentations of psoriasis need to be known by the health care provider. In addition, other dermatological conditions that may be confused with psoriasis need to be identified as part of the differential diagnosis so that the appropriate treatment may be instituted and potential effects of psoriasis, both physical and emotional, may be minimized.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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