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Background: Geographic stomatitis is an uncommon oral lesion that presents similar clinical, histopathological and genetic features as those of psoriasis. These findings suggest that this lesion may actually represent an oral manifestation of psoriasis. We report one case of geographic stomatitis and discuss a possible connection between this condition and psoriasis.Main observations: A 37-year-old woman presented with red patches, surrounded by a white border on the labial mucosa and a positive family history of psoriasis. Histopathological examination, immunohistochemical analysis with antibodies against CD4, CD8, CD20, CD68, CD31, and Ki-67 and HLA-A*, -B*, -C*, -DRB1*, -DQA1* and -DQB1* genotyping were performed. Histopathological examination revealed parakeratosis, marked elongation of rete ridges with acanthosis and clubbing, exocytosis, Munro microabscesses, pustule of Kogoj, dilated tortuous vessels at the tip of dermal papillae, and predominant superficial and perivascular lymphocytic chronic inflammatory cell infiltrate. Immunohistochemistry analysis revealed a predominant T-cell subepithelial infiltrate. Based on the referred clinicopathological findings and in the absence of cutaneous lesions, the diagnosis of geographic stomatitis was confirmed. Conclusions:This case and theoretical data indicate that geographic stomatitis may be an oral manifestation of psoriasis. Moreover, to improve our understanding, psoriatic patients should routinely undergo a detailed oral examination and patients with geographic stomatitis should routinely be submitted to a cutaneous routine examination. (J Dermatol Case Rep.

In our study, one-third of Brazilian patients with PsO, followed in dermatology settings, were diagnosed with PsA by a rheumatologist. Almost half of subjects with PsA had no previous diagnosis. A collaboration between dermatologists and rheumatologists is greatly needed to establish earlier PsA diagnoses and adequate multidisciplinary management.

Prurigo pigmentosa (PP) is a rare inflammatory disease of the skin of uncertain etiology first reported in Japan. It is typified by recurrent eruptions of itching urticarial macules, papules, vesicopapules, and plaques with a reticular arrangement that quickly resolve leaving a net-like pigmentation. The disease presents specific histopathological features. Herein, 3 cases of PP in Brazilians with no Japanese ancestry are reported and a revision of all previous English-language case reports indexed on PubMed is provided. Two articles with original case reports not listed on PubMed were also included. Our patients are 2 women and 1 man at the ages of 39, 33, and 22 years, respectively. All 3 presented findings in consonance with previous cases of PP and were diagnosed based on clinicopathological correlation. They were successfully treated with oral minocycline or doxycycline. In our literature review, a total of 210 previously reported cases were included. Although PP seemed to be restricted to Japanese patients in the first years after its recognition, the geographic boundaries of the disease are continuously expanding. Korea responded for 83 previous cases and Japan for 53. The mean age was 24.4 years, with 84.3% of the cases occurring between 11 and 30 years of age. The female/male rate was 2.6 and the most affected anatomical sites were back, chest, and neck. We do believe that the rarity of case reports in western countries may represent lack of awareness about the disease by dermatologists and dermatopathologists in these regions.

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HLA-B*58 was associated with GT and HLA-B*57 was possibly associated with psoriasis. This suggested that some GT cases may represent true oral psoriasis and some may represent only GT. Therefore, it is necessary to make this distinction and increase our sample size to improve the correct diagnosis and treatment of these conditions.

PASE (Psoriatic Arthritis Screening and Evaluation) was developed in the English language to screen for inflammatory arthritis among patients with psoriasis. It is 15 item self administered questionnaire with a score from 15 to 75. A higher score indicates a greater risk for inflammatory joint disease. The purpose of this study was to translate, adapt and validate this questionnaire into Brazilian Portuguese (PASE-P). METHODS: 465 patients diagnosed with psoriasis (158 with psoriatic arthritis confirmed by a rheumatologist according to the CASPAR criteria and 307 without) were evaluated in dermatology clinics. We performed the analysis of semantic equivalence in eight steps. For psychometric equivalence, we evaluated the data quality, reliability, construct validity, well-known groups and discriminant characteristics of the items, as well as a ROC curve to determine optimal PASE-P cutoff points in case identification and their sensitivity / specificity. The final version presented excellent reproducibility (CCI = 0.97) and reliability (Cronbach’s alpha> 0.9). A cut-off point of 25 distinguished between patients with and without psoriatic arthritis, with sensitivity of 69.5 and specificity of 86.8. PASE-P proved to be culturally valid and reliable to screen for psoriatic arthritis in Brazilian patients with psoriasis.

Background Psoriatic Arthritis (PsA) may affect up to 40% of patients with psoriasis (PsO). Usually PsO precedes PsA for many years, though PsA is frequently not identified in dermatology clinics. Diagnosis of PsA is based on clinical recognition of arthritis, enthesitis and spondylitis. Objectives To determine the prevalence of PsA in a large cohort of Brazilian patients with PsO attending different dermatology reference centers. Methods A multicenter study was conducted in four universitary dermatology clinics, from January to March 2011. In each center, consecutive patients with a confirmed diagnosis of PsO were evaluated by a rheumatologist. Following detailed musculoskeletal anamnesis and physical examination, subjects were classified as having: isolated PsO, osteoarthritis (OA) and/or chronic myofascial pain (CMP) syndrome, PsA (CASPAR criteria1). Laboratory and x-Ray tests were performed, as needed, according to the rheumatologist clinical judgment. Results A total of 524 PsO patients were evaluated. Mean age was 48.5 ± 14.5yrs, 50% were females and PsO mean duration was 15.4±11.7yrs. The vast majority (79%) had plaque psoriasis and 57.8% required systemic treatment. Isolated PsO was the diagnosis in 45% of patients, whereas 22% manifested OA and/or CMP. A definitive diagnosis of PsA was documented in 175 patients (33%), of which 49% were newly identified by the rheumatologist. Lab and/or x-Ray tests were necessary for the diagnosis of PsA in 42/175 individuals. In 38/175 subjects, PsA was associated with OA and/or CMP. Most PsA patients (72%) had peripheral, 11% axial and 17% both peripheral and axial involvement. Dactilitis occurred in 20% and clinical enthesitis in 30%. Remarkably, PsA patients were older (51 vs 47yrs, p 0.015), had more nail involvement (59 vs 47%, p 0.008), were less likely to be on any systemic treatment (42 vs 56%, p 0.01) and were more frequently using biologic drugs (21 vs 5%, p>0.001) compared with those without PsA. Conclusions We have demonstrated a similar worldwide prevalence of 1/3 of PsA among Brazilian patients with PsO. The identification of new PsA diagnosis by a rheumatologist in half of patients, previously unrecognized at the dermatology setting, points out to the need for shared care between dermatologists and rheumatologists in order to establish earlier PsA diagnosis and adequate multidisciplinary management. References Taylor W, Gladman D, Helliwell P et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 2006; 54:2665–73 Disclosure of Interest None Declared