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A rare complication from a common procedure
P3212
P3301
A rare complication from a common procedure Marıa Silvina Gaglio de Grecco, MD, Hospital Vega del Rıo Segura, Cieza, Spain; Eugenia Cutillas-Marco, MD, Hospital Vega del Rıo Segura, Cieza, Spain; Marıa Encarnaci on Gim enez-Cortes, MD, PhD, Hospital Vega del Rıo Segura, Cieza, Spain
Proinflammatory and antiinflammatory cytokines and bone mineral density in psoriatic arthritis Caius Solovan, MD, PhD, Dermatology Department, University of Medicine and Pharmacy ‘‘Victor Babes,’’ Timisoara, Romania; Camelia Ciacli, MD, PhD, Immunology Department, West University ‘‘Vasile Goldis,’’ Arad, Romania
Intralesional corticosteroids are a commonly used therapy in the fields of dermatology. Unlike complications of systemic corticosteroid therapy that have been extensively described, complications of locoregional corticosteroid injection are not well documented. The development of linear hypopigmentation after intralesional triamcinolone acetonide has been reported in the literature as a very rare side effect. The authors present the case of a 6-year-old boy who received intralesional corticosteroids for a granulomatous dermathosis. Following three subsequently injections of triamcinolone, the patient developed distal hypopigmented patches near the area. One month later, subcutaneous atrophy was noted in these patches. Repigmentation and resolution of the atrophy were complete without specific treatment. Evaluation of our patient and the previously reported cases showed that perilesional atrophy or hypopigmentation, or both, is a distinct complication after intralesional or intraarticular administration of corticosteroids, maybe caused by lymphogenous or venous spread of the steroid suspension. Clinicians involved in the use of these therapies need to be aware of this rare side effect so that they can guide their patients appropriately.
We determined proinflammatory (IL-1, IL-6, and TNF-a) and antiinflammatory (IL-4 and IL-13) cytokines in serum and synovial articular fluid at 27 (15 ¼ m, 12 ¼ f) patients with psoriatic arthritis (Casper criteria). The age ranged between 27 and 50 years. Normal subjects were 20 volunteers aged 30 years with no forms of joint, infectious, neoplastic, or autoimmune diseases. The cytokines were determined by the immunoenzimatique ELISA sandwich technique. The bone mineral density was performed by the DEXA method (dual-energy X-ray absorptiometry) at the lumbar level of the vertebral column (L2-L4); osteopenia considered at a score of -1, -2 SD and osteoporosis at a score # -2.5 SD after WHO criteria and National Institutes of Health consensus conference 2006. The serum levels were: IL1 (between 2.67 and 6.99 pg/mL; mean range of 4.6 6 2.45 pg/mL; P \.003-ES, relevant statistical compared to normal subjects), IL-6 (between 6.5 and 15.98 pg/mL; mean range of 11.25 6 4.75 pg/mL; P \ .001-ES, relevant statistical compared to normal subjects) and TNF-a between 2.05 and 4.95 pg/mL; mean range 3.5 6 1.45 pg/mL; P \ .003-ES, relevant statistical compared to normal subjects. The level of proinflammatory cytokines in the articular synovial fluid was: IL-1 between 2.34 and 7.26 pg/mL (mean range 4.8 6 2.46 pg/mL), IL-6 between 11.1 and 31.7 pg/mL (mean range 21.4 6 10.3 pg/mL) and TNF-a between 5.75 and 15.25 pg/mL (mean range 10.5 6 4.75 pg/mL). The seric level of IL-4 was undetectable in majority of patients (n ¼ 20); values of 0.2 pg/mL, 0.3 pg/mL, 0.4 pg/mL, 1.1 pg/mL, 1.2 pg/mL, and 1.4 pg/mL, and in the articular synovial fluid values between 0.20 and 0.50 pg/mL were detected. The seric level of IL-13 was 2.67 and 4.99 pg/ml (mean range 3.22 6 1.45 pg/mL); P \ .01-ES, relevant statistical compared to normal subjects, and in the synovial articular fluid values of 2.07 and 14.8 pg/mL (mean range 5.8 6 0.45 pg/mL). The lumbar T score had values of -1.58 and -1.77 SD (mean range -1.68 6 0.06 SD; P \ .01-S, relevant statistical compared to normal subjects).There was a strong negative correlation with seric IL-1(r ¼ - 0.65, R2 ¼ 0.4275), IL-6 (r ¼ -0.57, R2 ¼ 0.3299), and TNF-a (r ¼ -0.65, R2 ¼ 0.4339) and the values of lumbar T score in psoriatic arthritis patients, and a strong positive correlation with the values of the normal subjects. The levels of seric antiinflammatory cytokines IL-13 (while IL-4 was undetectable) were in a strong positive correlation with the values of lumbar T score of psoriatic arthritis patients (r ¼ 0.68, R2 ¼ 0.4729), and with the lumbar T score of healthy subjects (rh ¼ 0.71, Rh2 ¼ 0.5063). The profile of proinflammatory and antiinflammatory cytokines correlated to the values of lumbar T score is a good tool to evaluate psoriatic arthritis patients.
Commercial support: None identified.
Commercial support: None identified.
PSORIASIS AND OTHER PAPULOSQUAMOUS DISORDERS P3300 Obesity, waist circumference, weight change, and the risk of psoriasis (PS) and psoriatic arthritis (PSA) in US women Sandeep Kumar, MD, Brigham and Women’s Hospital, Boston, MA, United States; Abrar Qureshi, MD, MPH, Brigham and Women’s Hospital, Boston, MA, United States; Jiali Han, PhD, Brigham and Women’s Hospital, Boston, MA, United States Psoriasis (PS) is a common debilitating chronic skin disorder with skin and musculoskeletal manifestations that afflicts millions of patients worldwide. Recently, a strong association between increased adiposity, obesity, and psoriasis has emerged. Nurses’ Health Study (NHS) II, the only prospective study published as yet, indicated that increased adiposity and weight gain are strong risk factors for incident psoriasis in younger women, but it had no data on PsA. Here, we present the results of analysis of the NHS I, an ongoing longitudinal study, in older women for PS and psoriatic arthritis (PsA). We prospectively examined the relationships between the body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) measured at baseline (1994), and updated every 2 years, waist and hip circumference, weight change updated biennially since the age of 18 years, and PS and PsA in female US registered nurses over a 14-year period (19942008). The primary outcome was self-reported, physician-diagnosed PS and PsA. A total of 121,700 women for a combined follow-up time of 886,322 person-years were studied, during which there were a total of 2115 cases of PS; of these 809 were newly diagnosed incident cases of PS, and 207 were newly diagnosed incident cases of PsA. There was a graded positive association between baseline and updated BMI and the risk of PS and PsA. In the sensitivity analysis, we restricted the cases to those diagnosed 1998 and onwards. When we analyzed BMI updated every 2 years, for women with a BMI of 18.5 to 24.9, the multivariate (adjusted for age, alcohol consumption, smoking and waist-hip ratio) RRs (relative risk) of incident PS were 1.20 (95% CI, 1.01-1.42) for a BMI of 25.0 to 29.9, 1.62 (95% CI, 1.32-1.99) for a BMI of 30.0 to 34.9, and 2.05 (95% CI, 1.59-2.64) for a BMI of 35.0 or greater (P for 1 unit increment \ .0001). The results for PsA were similar to those for PS with stronger magnitude of association. Weight gain from the age of 18 years, higher waist circumference, hip circumference, and waist-hip ratio were all associated with a higher risk of PS and PsA (P values for trend \ .0001). Contrary to BMI, PS showed stronger magnitude of association than PsA. This large prospective study indicates that increased adiposity and weight gain are strong risk factors for PS and PsA in women. Commercial support: None identified.
FEBRUARY 2011
P3302 A global approach to psoriatic patients through PASI score and SKINDEX-29 Francesca Prignano, MD, PhD, Department of Dermatology, Firenze, Italy; Federica Ricceri, MD, Department of Dermatology, Firenze, Italy; Leonardo Pescitelli, MD, Department of Dermatology, Firenze, Italy; Torello Lotti, MD, Department of Dermatology, Firenze, Italy Background: Psoriasis is a chronic immune-mediated inflammatory skin disorder affecting approximately 2% of the population worldwide. Because of its visible manifestations and symptoms, psoriasis has profound effects on health-related quality of life (HRQoL). Objective: Our purpose was to determine the clinical severity of psoriasis and its impact on quality of life in psoriatic patients treated with phototherapy, traditional systemic therapy, or biologic therapy. Methods: One hundred fifty-two patients affected by plaque-type psoriasis or psoriatic arthritis were recruited at a PsoCare center of Florence Department of Dermatology and followed up for 6 months by a dermatologist who registered demographic, biometric, and other relevant data on a case report form. Psoriasis severity was assessed based on the Psoriasis Area and Severity Index (PASI) score and the quality of life using the SKINDEX-29 questionnaire (the revised 29-item version of Skindex). Results: PASI score improved significantly in all patients after 6 months of therapy. The greatest improvement was observed in patients receiving biologics. PASI-75 was obtained by 46.9% of patients on phototherapy and 43.1% on biologics. In terms of quality of life, the responses to the SKINDEX-29 questionnaire, both considered as a whole and as single scales, indicate that treatments have a positive, but not resolving, impact on emotions, symptoms, and functioning. Conclusion: The results of our study confirm the efficacy of antipsoriatic therapy for treating the physical signs of the disease. SKINDEX-29 results did not significantly differ among the three treatment groups. Effective management of patients with psoriasis depends on the appropriate assessment of both the physical and psychosocial impact of the disease. Commercial support: None identified.
J AM ACAD DERMATOL
AB145
P3301
A rare complication from a common procedure Marıa Silvina Gaglio de Grecco, MD, Hospital Vega del Rıo Segura, Cieza, Spain; Eugenia Cutillas-Marco, MD, Hospital Vega del Rıo Segura, Cieza, Spain; Marıa Encarnaci on Gim enez-Cortes, MD, PhD, Hospital Vega del Rıo Segura, Cieza, Spain
Proinflammatory and antiinflammatory cytokines and bone mineral density in psoriatic arthritis Caius Solovan, MD, PhD, Dermatology Department, University of Medicine and Pharmacy ‘‘Victor Babes,’’ Timisoara, Romania; Camelia Ciacli, MD, PhD, Immunology Department, West University ‘‘Vasile Goldis,’’ Arad, Romania
Intralesional corticosteroids are a commonly used therapy in the fields of dermatology. Unlike complications of systemic corticosteroid therapy that have been extensively described, complications of locoregional corticosteroid injection are not well documented. The development of linear hypopigmentation after intralesional triamcinolone acetonide has been reported in the literature as a very rare side effect. The authors present the case of a 6-year-old boy who received intralesional corticosteroids for a granulomatous dermathosis. Following three subsequently injections of triamcinolone, the patient developed distal hypopigmented patches near the area. One month later, subcutaneous atrophy was noted in these patches. Repigmentation and resolution of the atrophy were complete without specific treatment. Evaluation of our patient and the previously reported cases showed that perilesional atrophy or hypopigmentation, or both, is a distinct complication after intralesional or intraarticular administration of corticosteroids, maybe caused by lymphogenous or venous spread of the steroid suspension. Clinicians involved in the use of these therapies need to be aware of this rare side effect so that they can guide their patients appropriately.
We determined proinflammatory (IL-1, IL-6, and TNF-a) and antiinflammatory (IL-4 and IL-13) cytokines in serum and synovial articular fluid at 27 (15 ¼ m, 12 ¼ f) patients with psoriatic arthritis (Casper criteria). The age ranged between 27 and 50 years. Normal subjects were 20 volunteers aged 30 years with no forms of joint, infectious, neoplastic, or autoimmune diseases. The cytokines were determined by the immunoenzimatique ELISA sandwich technique. The bone mineral density was performed by the DEXA method (dual-energy X-ray absorptiometry) at the lumbar level of the vertebral column (L2-L4); osteopenia considered at a score of -1, -2 SD and osteoporosis at a score # -2.5 SD after WHO criteria and National Institutes of Health consensus conference 2006. The serum levels were: IL1 (between 2.67 and 6.99 pg/mL; mean range of 4.6 6 2.45 pg/mL; P \.003-ES, relevant statistical compared to normal subjects), IL-6 (between 6.5 and 15.98 pg/mL; mean range of 11.25 6 4.75 pg/mL; P \ .001-ES, relevant statistical compared to normal subjects) and TNF-a between 2.05 and 4.95 pg/mL; mean range 3.5 6 1.45 pg/mL; P \ .003-ES, relevant statistical compared to normal subjects. The level of proinflammatory cytokines in the articular synovial fluid was: IL-1 between 2.34 and 7.26 pg/mL (mean range 4.8 6 2.46 pg/mL), IL-6 between 11.1 and 31.7 pg/mL (mean range 21.4 6 10.3 pg/mL) and TNF-a between 5.75 and 15.25 pg/mL (mean range 10.5 6 4.75 pg/mL). The seric level of IL-4 was undetectable in majority of patients (n ¼ 20); values of 0.2 pg/mL, 0.3 pg/mL, 0.4 pg/mL, 1.1 pg/mL, 1.2 pg/mL, and 1.4 pg/mL, and in the articular synovial fluid values between 0.20 and 0.50 pg/mL were detected. The seric level of IL-13 was 2.67 and 4.99 pg/ml (mean range 3.22 6 1.45 pg/mL); P \ .01-ES, relevant statistical compared to normal subjects, and in the synovial articular fluid values of 2.07 and 14.8 pg/mL (mean range 5.8 6 0.45 pg/mL). The lumbar T score had values of -1.58 and -1.77 SD (mean range -1.68 6 0.06 SD; P \ .01-S, relevant statistical compared to normal subjects).There was a strong negative correlation with seric IL-1(r ¼ - 0.65, R2 ¼ 0.4275), IL-6 (r ¼ -0.57, R2 ¼ 0.3299), and TNF-a (r ¼ -0.65, R2 ¼ 0.4339) and the values of lumbar T score in psoriatic arthritis patients, and a strong positive correlation with the values of the normal subjects. The levels of seric antiinflammatory cytokines IL-13 (while IL-4 was undetectable) were in a strong positive correlation with the values of lumbar T score of psoriatic arthritis patients (r ¼ 0.68, R2 ¼ 0.4729), and with the lumbar T score of healthy subjects (rh ¼ 0.71, Rh2 ¼ 0.5063). The profile of proinflammatory and antiinflammatory cytokines correlated to the values of lumbar T score is a good tool to evaluate psoriatic arthritis patients.
Commercial support: None identified.
Commercial support: None identified.
PSORIASIS AND OTHER PAPULOSQUAMOUS DISORDERS P3300 Obesity, waist circumference, weight change, and the risk of psoriasis (PS) and psoriatic arthritis (PSA) in US women Sandeep Kumar, MD, Brigham and Women’s Hospital, Boston, MA, United States; Abrar Qureshi, MD, MPH, Brigham and Women’s Hospital, Boston, MA, United States; Jiali Han, PhD, Brigham and Women’s Hospital, Boston, MA, United States Psoriasis (PS) is a common debilitating chronic skin disorder with skin and musculoskeletal manifestations that afflicts millions of patients worldwide. Recently, a strong association between increased adiposity, obesity, and psoriasis has emerged. Nurses’ Health Study (NHS) II, the only prospective study published as yet, indicated that increased adiposity and weight gain are strong risk factors for incident psoriasis in younger women, but it had no data on PsA. Here, we present the results of analysis of the NHS I, an ongoing longitudinal study, in older women for PS and psoriatic arthritis (PsA). We prospectively examined the relationships between the body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) measured at baseline (1994), and updated every 2 years, waist and hip circumference, weight change updated biennially since the age of 18 years, and PS and PsA in female US registered nurses over a 14-year period (19942008). The primary outcome was self-reported, physician-diagnosed PS and PsA. A total of 121,700 women for a combined follow-up time of 886,322 person-years were studied, during which there were a total of 2115 cases of PS; of these 809 were newly diagnosed incident cases of PS, and 207 were newly diagnosed incident cases of PsA. There was a graded positive association between baseline and updated BMI and the risk of PS and PsA. In the sensitivity analysis, we restricted the cases to those diagnosed 1998 and onwards. When we analyzed BMI updated every 2 years, for women with a BMI of 18.5 to 24.9, the multivariate (adjusted for age, alcohol consumption, smoking and waist-hip ratio) RRs (relative risk) of incident PS were 1.20 (95% CI, 1.01-1.42) for a BMI of 25.0 to 29.9, 1.62 (95% CI, 1.32-1.99) for a BMI of 30.0 to 34.9, and 2.05 (95% CI, 1.59-2.64) for a BMI of 35.0 or greater (P for 1 unit increment \ .0001). The results for PsA were similar to those for PS with stronger magnitude of association. Weight gain from the age of 18 years, higher waist circumference, hip circumference, and waist-hip ratio were all associated with a higher risk of PS and PsA (P values for trend \ .0001). Contrary to BMI, PS showed stronger magnitude of association than PsA. This large prospective study indicates that increased adiposity and weight gain are strong risk factors for PS and PsA in women. Commercial support: None identified.
FEBRUARY 2011
P3302 A global approach to psoriatic patients through PASI score and SKINDEX-29 Francesca Prignano, MD, PhD, Department of Dermatology, Firenze, Italy; Federica Ricceri, MD, Department of Dermatology, Firenze, Italy; Leonardo Pescitelli, MD, Department of Dermatology, Firenze, Italy; Torello Lotti, MD, Department of Dermatology, Firenze, Italy Background: Psoriasis is a chronic immune-mediated inflammatory skin disorder affecting approximately 2% of the population worldwide. Because of its visible manifestations and symptoms, psoriasis has profound effects on health-related quality of life (HRQoL). Objective: Our purpose was to determine the clinical severity of psoriasis and its impact on quality of life in psoriatic patients treated with phototherapy, traditional systemic therapy, or biologic therapy. Methods: One hundred fifty-two patients affected by plaque-type psoriasis or psoriatic arthritis were recruited at a PsoCare center of Florence Department of Dermatology and followed up for 6 months by a dermatologist who registered demographic, biometric, and other relevant data on a case report form. Psoriasis severity was assessed based on the Psoriasis Area and Severity Index (PASI) score and the quality of life using the SKINDEX-29 questionnaire (the revised 29-item version of Skindex). Results: PASI score improved significantly in all patients after 6 months of therapy. The greatest improvement was observed in patients receiving biologics. PASI-75 was obtained by 46.9% of patients on phototherapy and 43.1% on biologics. In terms of quality of life, the responses to the SKINDEX-29 questionnaire, both considered as a whole and as single scales, indicate that treatments have a positive, but not resolving, impact on emotions, symptoms, and functioning. Conclusion: The results of our study confirm the efficacy of antipsoriatic therapy for treating the physical signs of the disease. SKINDEX-29 results did not significantly differ among the three treatment groups. Effective management of patients with psoriasis depends on the appropriate assessment of both the physical and psychosocial impact of the disease. Commercial support: None identified.
J AM ACAD DERMATOL
AB145