No abstract

No abstract

Psoriasis frequency ranges from 1 to 3 % in white population, and arthritis occurs in 10-40 % of psoriasis patients, representing a relevant health issue. Psoriatic arthritis (PsA) is an inflammatory arthropathy, associated with psoriasis, in which ocular-, intestinal-, metabolic-, and cardiovascular-related manifestations can variably coexist. In order to favor early PsA and psoriasis diagnosis, it is crucial to rule out other conditions that can resemble the disease and delay appropriate therapeutic approach. Therefore, the aim of this review is to focus on PsA and psoriasis differential diagnosis.

Managing psoriasis in the elderly can be difficult for physicians, who must consider comorbidities, the resulting polypharmacy, and progressive functional impairment of several organs. Indeed, topical agents are the first-line treatment for limited disease. Phototherapy is recommended if topical drugs are not sufficient and the patient has multiple comorbidities and risk factors that make them a poor candidate for an oral or injectable systemic agent. The most important pharmacokinetic alteration in the elderly population is the decreased excretory capacity of the kidney; thus, cyclosporine should be considered a last resort treatment, and the administered dose of methotrexate should be lowered according to the reduction in estimated creatinine clearance. Acitretin can be used in the absence of severe renal insufficiency, paying attention to lipid profile, treating eventual hyperlipidemia, and closely monitoring liver enzymes. Available data on biological drugs in the elderly are limited. Biologics are associated with a small but significant overall risk of infections. However, there is no convincing evidence that the relative risk of infection with anti-tumor necrosis factor (TNF)-α therapy increases with age. Nevertheless, the package inserts for biologics recommend caution when administering these medications to the geriatric population, due to the high baseline risk of infection in such patients. Etanercept seems to be well tolerated, possibly because of its lower immunosuppressive characteristics compared with other biologics. However, studies with larger sample sizes are needed to confirm its safety.

The prevalence of skin pain and the molecular mechanisms responsible for pain in psoriasis remain unclear. This study assessed skin pain in 163 patients (98 males, 65 females, range 18-81 years) with plaque psoriasis, evaluating: the subjective/objective features of this symptom compared with clinical severity of the disease; and the role of interleukin (IL)-33, (involved in both psoriasis and pain pathogenesis), in psoriasis-related pain. Clinical measures used were a questionnaire, plaque Physician Global Assessment (PGA) index, pressure algometry to measure pain threshold and tactile/thermal sensitivity test. IL-33 gene expression was examined in vivo (n = 12) in patients skin and through an ex vivo model of nociception using sodium dodecyl sulphate. Of the psoriatic patients 43.6% reported skin pain during the previous week; itchy, unpleasant, aching, sensitive, hot/burning, tender and cramping were the most reported qualities. Patients' pain threshold decreased with increasing PGA index and pain intensity. Sensitivity to touch/heat was reduced in lesional skin, compared with unaffected psoriatic skin. IL-33 expression was increased in lesional skin of patients reporting pain and in the ex vivo system. In conclusion, symptoms of skin pain should be taken into account in the management of psoriasis.

No abstract

Oral minoxidil (OM) has been reported to be effective for androgenetic alopecia (AGA). In this retrospective study, we share our experience of using OM for >24 weeks in 12 patients with female AGA (Ludwig scale I-3-III). Twelve women (aged 18-66 years; mean age 36.66 ± 18.79 years) with AGA (Ludwig scale I-3-III) were recruited. The starting dose of minoxidil was 0.50 mg daily; at 3 months, the dose was increased to 1.50 to 2 mg daily. Efficacy outcome measures were evaluated at baseline and after 24 weeks and included global clinical photography, quantitative digital videotrichoscopic assessment and quality-of-life evaluation. An overall improvement of 38% and 23% in hair density in the frontal and vertex area, respectively, was observed after 24 weeks. The quantitative digital videotrichoscopic evaluation highlighted a statistically significant improvement in the frontal area of the total average hair density and of the total number of hairs per unit area at 24 weeks

No abstract