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The sensitivity, specificity, and positive and negative likelihood ratios were 57.7%, 72.3%, 2.08, and 0.59, respectively. (ROC curves were not plotted for case patients aged 2 years or younger because of the small numbers.)There was significant correlation of serum TARC levels with the SCORAD index (r ¼ 0.538; 95% confidence interval [CI], 0.36-0.68), QOL indices (Infants' Dermatitis QOL: r ¼ 0.823; 95% CI, 0.40-0.96; Children's Dermatology Life Quality Index: r ¼ .380; 95% CI, 0.16-0.57), peripheral eosinophils, and LDH in children older than 2 years but not in the younger age groups (Table II). The correlation with IgE was not significant. In the same age group, for SCORAD index, the correlation was highest with LDH (r ¼ 0.582; 95% CI, 0.40-0.72), followed by serum TARC (r ¼ 0.538; 95% CI, 0.36-0.68), peripheral eosinophils (r ¼ 0.397; 95% CI, 0.19-0.57), and serum IgE (r ¼ 0.331; 95% CI, 0.11-0.52). In concurrence with previous studies, our results suggest that TARC correlates with the severity of AD and QOL indices. 1,5 The sensitivity and specificity were lower than those previously reported (83%-85% and 92%-96%, respectively), possibly due to choosing control individuals with diseases mimicking AD and the use of different enzyme-linked immunosorbent assay systems. 2,4

Fig 1. Skin manifestations of atopic dermatitis on the patient's trunk (A) and alopecia areata on his head (B) at his first visit to our hospital (two months before receiving dupilumab), and 3 months after starting dupilumab treatment (C, D).

Psoriasis is characterized by increased dermal vascularity, indicating that aberrant angiogenesis is associated with the pathogenesis of psoriasis. Data on angiogenesis-related factors in psoriasis patients are limited. We explored serum levels of angiogenesis-related factors in patients with psoriasis, and investigated their association with clinical severity and laboratory data. Psoriasis patients visiting our hospital from April 2013 to April 2018 and healthy controls were included in this study. Serum levels of angiopoietin-1, fibroblast growth factor (FGF)-basic, epidermal growth factor (EGF), platelet endothelial cell adhesion molecule (PECAM)-1, placental growth factor, and vascular endothelial growth factor (VEGF) were measured by LEGENDplex. Serum samples obtained from 10 healthy controls, 18 patients with psoriasis vulgaris (PsV), 24 patients with psoriatic arthritis (PsA), and 13 patients with generalized pustular psoriasis (GPP) were analyzed.The serum angiopoietin-1 level was elevated in the PsV, PsA, and GPP patients. GPP patients had a higher serum VEGF level than healthy controls. In contrast, serum levels of EGF and PECAM-1 were lower in the PsV, PsA, and GPP patients than in healthy controls. The serum FGF-basic level was lower in the PsA and GPP patients than in healthy controls. Serum levels of FGF-basic in PsA and GPP patients, PECAM-1 in PsA patients, and VEGF in GPP patients became closer to the respective levels in healthy controls after systemic therapy. The serum FGF-basic level was positively correlated with the psoriasis area and severity index and the number of circulating eosinophils in GPP patients. The serum VEGF level was correlated positively with the serum C-reactive protein (CRP) level and erythrocyte sedimentation rate, and negatively with the serum albumin level in GPP patients. In conclusion, our exploratory study revealed that psoriasis affects serum levels of certain angiogenesis-related factors. Some of these factors could be biomarkers of treatment outcomes, clinical severity, and systemic inflammation.

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In the pathogenesis of psoriatic arthritis (PsA), mechanical stress is considered a central factor in the development of enthesitis. 1 However, it is not known whether mechanical stress on the hip joints contributes to coxitis in patients with PsA. We herein describe a rare case of PsA presenting with hip joint involvement possibly induced by mechanical stress caused by acetabular dysplasia.A 64-year-old Japanese man presented with scaly erythema on his scalp, lower extremities, back, and right elbow. He had been receiving treatment with topical corticosteroid and vitamin D3 for 20 years. Two years before visiting our hospital, skin lesions spread over his entire body, and he felt pain in his right hip and left ankle at the time of arising from bed and during walking.He took nonsteroidal anti-inflammatory drugs as required, which improved the pain in his left ankle but not that in his right hip. Therefore, he was referred to our hospital. Skin manifestations are shown in Figure 1A-C. Laboratory tests showed that rheumatoid factor was negative and that the serum matrix metalloproteinase-3 level was within the normal range. Serum C-reactive protein level was slightly elevated (0.17 mg/dL. Normal rage;≦0.14 mg/dL). X-ray imaging revealed erosion of the right lesser trochanter of the femur and borderline acetabular dysplasia, although the hip joint space was not narrowed ( Figure 1D). Magnetic resonance imaging (MRI) demonstrated bone marrowedema of the anterior inferior iliac spine and the lateral region of the acetabular roof ( Figure 1E). We consulted with an orthopedist, and he was diagnosed with PsA accompanied by enthesitis of the right rectus femoris muscle. Treatment with brodalumab was started, resulting in amelioration of his right hip pain in 4 weeks. Five months later, his skin manifestations disappeared completely. MRI performed 16 months after commencement of brodalumab demonstrated a decrease in the amount of bone marrow edema ( Figure 1F).Enthesitis is characteristic of spondyloarthritis including PsA, and enthesitis occurs in 23%-53% of PsA patients. 2 It was recently clarified that mechanical stress is a central factor in the development of enthesitis. 1 The Achilles tendon, plantar fascia, and lateral epicondyles are the sites most commonly affected by enthesitis, 2 while only 6.3% of PsA patients present with coxitis. 3 However, the cause of coxitis in patients with PsA has not been discussed well in the previous literature. In our case, the X-ray image revealed borderline acetabular dysplasia. Acetabular dysplasia is an unstable ball-in-socket hip joint that is characterized by a shallow acetabulum that does not cover the femoral head sufficiently. This anatomical aberration produces instability of the hip and increased mechanical stress at the acetabular rim. 4 In our case, mechanical stress caused by acetabular dysplasia possibly contributed to the development of coxitis, which underscores the importance of mechanical stress in the pathogenesis of PsA. In addition, coxitis was successfully trea...

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