Background Treatment options remain unsatisfactory for patients with palmoplantar psoriasis (PP) and palmoplantar pustular psoriasis (PPP).
Aim To evaluate the therapeutic responses of PP and PPP ...patients that were treated in our psoriasis polyclinic between 2003 and 2007.
Methods This retrospective study comprised PP (n = 62) and PPP (n = 52) patients. Treatments were individualized according to patient compliance and associating systemic diseases. The effect of systemic treatments was grouped as follows: ‘no improvement’: patients unresponsive for the present treatment; ‘partial improvement’: < 50% decrease in severity or affected area; ‘moderate improvement’: 50–75% decrease in severity or affected area, and ‘marked improvement’: > 75% decrease of the disease compared to baseline.
Results In the PP group, 17 of 62 patients showed marked improvement to topical agents, while the remaining patients required systemic agents including oral retinoids (n = 24), local psoralen plus ultraviolet A (PUVA; n = 12), methotrexate (n = 9) and cyclosporine (n = 2). Marked improvement was achieved in 53%, 45%, 47% and 100%, respectively. In these patients, two (n = 10), three (n = 5), or four (n = 5) systemic agents were used alternately.
In the PPP group, 18 of 52 patients achieved marked improvement by topical agents. Patients that required systemic agents were treated with colchicum (n = 19), local PUVA (n = 8), methotrexate (n = 4), oral retinoids (n = 3) and cyclosporine (n = 2). These treatments achieved a marked improvement in 60%, 33%, 57%, 83%, and 50% of the patients, respectively. In the course of the disease, 18 patients required two and 3 patients required three systemic agents alternately.
Conclusions Although the success rates appeared to be high, the high number of patients who required multiple systemic agents emphasized the fact that localized forms of psoriasis were resistant to therapy.
Conflicts of interest
None declared
Introduction
Overweight is a well‐established risk factor for hidradenitis suppurativa (HS). In this cross‐sectional study, we compare HS patients with a high body mass index (BMI) with HS patients ...with a low BMI to investigate differences in disease characteristics.
Materials and method
Patients were recruited from 17 dermatological centres from four continents. A total of 246 patients with a BMI below 25 were compared to 205 patients with a BMI of above 35.
Results
Patients with a high BMI suffered more severe disease (Hurley, physician global assessment, number of areas affected and patient‐reported severity (PRS), P < 0.001 for all). There was no difference in smoking (P = 0.783) nor in family history (P = 0.088). In both low and high BMI patients, early onset of HS was a predictor of positive family history (P < 0.001, for each). For low BMI patients, an increase in BMI significantly increased PRS (P < 0.001). For patients with a high BMI, number of pack‐years significantly increased PRS (P = 0.001). Cluster analysis of eruption patterns was location specific for low BMI patients but severity specific for high BMI patients.
Discussion
Patients with a low and high BMI could represent two clinically different subtypes. We suggest a non‐linear relationship between BMI and impact of HS. As patients go from a low BMI patient to a high BMI patient (or from high to low), eruption patterns and risk factors may change.
Background: Oral isotretinoin treatment might influence the levels of vitamin B 12 and folic acid. Aims and Objectives: The aim of this study is to compare vitamin B 12 and folic acid levels in ...patients with moderate and severe acne vulgaris with those of the healthy control group and to investigate the effect of isotretinoin treatment on these vitamins. Materials and Methods: Patients who completed 6 months of isotretinoin therapy for moderate and severe forms of acne vulgaris and a control group consisting of healthy individuals between February 2011 and March 2012 were included in the study. Before isotretinoin therapy and at 6.- months of the therapy, serum vitamin B 12 and folic acid levels were measured. In the healthy control group, vitamin B 12 and folic acid levels were assessed only once. Results: In total, 120 patients with moderate and severe acne vulgaris who completed 6 months isotretinoin therapy and 100 healthy individuals who constituted the control group were included in the study. Pre-treatment vitamin B 12 values of the patient group were found to be statistically significantly higher (P = 0.002), but any statistically significant difference was not detected in folic acid measurements (P = 0.566). A statistically significant decrease was detected in post-treatment vitamin B 12 and folic acid levels (P < 0.05). Conclusion: Vitamin B 12 /folic acid treatment should be given under medical surveillance before and during isotretinoin therapy. Supplementation of these vitamins should be recommended in cases of their deficiency, so as to decrease the risks of neuropsychiatric and occlusive vascular diseases.
Behçet’s disease (BD) is a chronic, inflammatory multisystemic condition of unknown aetiology. It is clinically characterized by recurrent orogenital ulcerations and skin eruptions; ocular ...manifestations; arthritis; vasculitis and in some cases neurological and large vessel involvement. Aetiology has not been defined, but genetic, environmental, viral, bacterial and immunological factors have been proposed as causative agents. Treatment includes colchicine, thalidomide, steroids and immunosuppressive agents and it is based on the severity of systemic manifestations, such as central nervous system involvement, arterial aneurysms and thrombosis of the major veins. Mortality is related to major system involvement. In this article the different clinical features, the multiple faces of BD and a list of currently suspected aetiological factors of the disease are discussed, and treatment modalities summarized.
Summary
Palmoplantar pustulosis (PPP) is a common chronic and recurrent pustular dermatosis characterized by multiple sterile pustules and erythematous plaques on the palms and soles. The exact cause ...and pathogenesis of the disease remain unknown, and there is still debate about whether PPP is a variant of psoriasis or a distinct condition. A review of the medical literature revealed that a wide range of treatments have been used in the treatment of PPP over the years. The literature in PPP is restricted to case reports or small case series, and there is a lack of well‐documented clinical studies, which makes it difficult to select an ideal therapy for the condition. The purpose of this review is to discuss the current therapy options for PPP, based on results of randomized controlled trials.
Abstract
Subduction zones are pivotal for the recycling of Earth’s outer layer into its interior. However, the conditions under which new subduction zones initiate are enigmatic. Here, we constructed ...a transdisciplinary database featuring detailed analysis of more than a dozen documented subduction zone initiation events from the last hundred million years. Our initial findings reveal that horizontally forced subduction zone initiation is dominant over the last 100 Ma, and that most initiation events are proximal to pre-existing subduction zones. The SZI Database is expandable to facilitate access to the most current understanding of subduction zone initiation as research progresses, providing a community platform that establishes a common language to sharpen discussion across the Earth Science community.
The basins and orogens of the Mediterranean region ultimately result from the opening of oceans during the early break-up of Pangea since the Triassic, and their subsequent destruction by subduction ...accommodating convergence between the African and Eurasian Plates since the Jurassic. The region has been the cradle for the development of geodynamic concepts that link crustal evolution to continental break-up, oceanic and continental subduction, and mantle dynamics in general. The development of such concepts requires a first-order understanding of the kinematic evolution of the region for which a multitude of reconstructions have previously been proposed. In this paper, we use advances made in kinematic restoration software in the last decade with a systematic reconstruction protocol for developing a more quantitative restoration of the Mediterranean region for the last 240 million years. This restoration is constructed for the first time with the GPlates plate reconstruction software and uses a systematic reconstruction protocol that limits input data to marine magnetic anomaly reconstructions of ocean basins, structural geological constraints quantifying timing, direction, and magnitude of tectonic motion, and tests and iterations against paleomagnetic data. This approach leads to a reconstruction that is reproducible, and updatable with future constraints. We first review constraints on the opening history of the Atlantic (and Red Sea) oceans and the Bay of Biscay. We then provide a comprehensive overview of the architecture of the Mediterranean orogens, from the Pyrenees and Betic-Rif orogen in the west to the Caucasus in the east and identify structural geological constraints on tectonic motions. We subsequently analyze a newly constructed database of some 2300 published paleomagnetic sites from the Mediterranean region and test the reconstruction against these constraints. We provide the reconstruction in the form of 12 maps being snapshots from 240 to 0 Ma, outline the main features in each time-slice, and identify differences from previous reconstructions, which are discussed in the final section.
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•First GPlates reconstruction of the Mediterranean region.•Modern orogenic architecture of the Mediterranean region and its tectonic evolution since the Triassic reviewed and restored.•2300 paleomagnetic sites compiled and analyzed.•12 Paleo-Tectonic maps of the Mediterranean region since 240 Ma presented.•We restore the evolution of the Greater Adria continent from break-up to subduction.
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