Introduction
Psoriasis is a chronic, multisystem, inflammatory, disfiguring disease with a high negative impact on quality of life due to comorbid psychological, organic, and sexual consequences.
Aim
To evaluate the psychopathological and sexual aspects of psoriasis vulgaris in patients and their partners compared to healthy controls.
Methods
In the current comparative cross-sectional study, the sample included 220 psoriasis vulgaris patients (110 males and 110 females), their consenting partners, and 220 age- and sex-matched healthy controls. All participants were evaluated for depression and anxiety using the Hospital Anxiety and Depression Scale and for low self-esteem using the Rosenberg's Self-Esteem Questionnaire. Sexual function was assessed in females using the Female Sexual Function Index questionnaire and in males using the International Index of Erectile Function and its abbreviated 5-item version. For male patients suffering from erectile dysfunction, hormonal assessment and penile duplex ultrasound were added.
Main Outcome Measure
The main outcome measures were frequency of depression, anxiety, low self-esteem, and sexual dysfunction in psoriasis vulgaris patients, partners, and controls; the domains of sexual function affected in the studied groups; and the etiology of erectile dysfunction in affected psoriatic males.
Results
Frequency of depression, anxiety, and low self-esteem were significantly higher in psoriasis patients of both sexes compared with controls. Sexual dysfunction followed the same trend of being significantly higher in cases when compared to controls. Females had a significantly higher frequency of sexual dysfunction than males. Sexual dysfunction in both sexes involved multiple domains of the sexual response cycle, with depression and genital affection by psoriasis being risk factors in both sexes and disease severity being an additional risk factor in females. Erectile dysfunction was mainly psychogenic in origin in male patients.
Clinical Implications
Assessment of psychopathological and sexual comorbidities in psoriasis patients and partners should be an integral part of the management plan and should be added to the guidelines of the disease.
Strength & Limitations
This study is of sufficient power to draw solid conclusions. Assessment of the partners and determination of the sexual domains affected by the disease and nature of erectile dysfunction in males are points of novelty. The cross-sectional design is a limitation of the study.
Conclusion
Psoriatic patients of both sexes and their partners suffer from a high burden of psychopathological and sexual consequences that are related to disease distribution and severity.
Background
NB‐UVB has long been the vitiligo management pillar with capability of achieving the main treatment outcomes; repigmentation and stabilization. Its stabilizing effect in dark skin has been debatable. However, randomized controlled trials regarding NB‐UVB ability to control disease activity are lacking.
Purpose
To assess stabilizing effect of NB‐UVB in comparison to systemic corticosteroids, the mainstay in vitiligo stabilization, in skin photo‐types (III‐V).
Methods
This is a multicenter, placebo‐controlled, randomized, prospective study. Eighty patients with active nonsegmental vitiligo (NSV) (Vitiligo disease activity (VIDA) ≥2) were randomized to either NB‐UVB and placebo (NB‐placebo) or NB‐UVB and dexamethasone oral mini‐pulse (OMP) therapy (NB‐OMP) for 6 months. Sixty four patients completed the study, 34 in the NB‐OMP group and 30 in the NB‐placebo group. Patients were evaluated fortnightly according to presence or absence of symptoms/signs of activity.
Results
In spite of earlier control of disease activity observed in the NB‐OMP group, it was comparable in both groups by the end of the study period. Disease activity prior to therapy, but not extent, was found to influence control of activity in both groups. Thus, NB‐UVB is a safe sole therapeutic tool in vitiligo management. Not only does it efficiently achieve repigmentation, but also it is a comparable stabilizing tool for systemic corticosteroids in spite of slightly delayed control.
Conclusion
NB‐UVB is the only well‐established vitiligo therapy that can be used solely whenever corticosteroids are contraindicated or immune‐suppression is unjustified. Nonetheless, its combination with corticosteroids expedites response and improves compliance.
HCV-associated skin lesions are associated with low frequency of Treg cells. They are not related to liver enzymes or viral load; however, they are associated with a more advanced gross liver insult.
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