Psoriasis is a chronic disease, mediated by the human immune system, based on a polygenic vulnerability, with cutaneous and systemic manifestations and substantial negative effects on the quality of life of patients. The physical and psychological impacts of psoriasis affect all areas of patient's functioning. Likewise, the prevalence of depression and anxiety in patients with psoriasis is significantly higher than that in the general population, and the quality of life is lower when compared to patients with different dermatological conditions. Both anxiety and depression may increase the clinical severity of psoriasis. Although psychiatric disorders in patients with psoriasis may be secondary to the stress due to the shame and social anxiety related to the skin lesions, the high rate of comorbidity has led to hypothesize that there may be common pathophysiological (psychodermatological) mechanisms involved. Inflammation is a key factor, since alterations in inflammatory modulators such as the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system have been described. This narrative review of the literature highlights the psychodermatological aspects of the etiopathogenesis of psoriasis as well as the impact of illness on patients' personal identity, functioning, and professional, social, and family areas.
School-based health centers (SBHCs) are widely credited with increasing students' access to care by making health services affordable and convenient. SBHCs can also provide a qualitatively different type of health care for children and adolescents than that delivered by community providers. Health services offered in a school setting can integrate clinical care with public health interventions and environmental change strategies. This ability to reach outside the walls of the exam room makes SBHCs uniquely positioned to address the multiple determinants of health. We describe innovative California SBHC programs focusing on obesity prevention, asthma, mental health, and oral health that represent new models of health care for children and adolescents.
Further research is needed to increase generalization of the results. Moreover, it would be interesting to match the data from the discussion group with follow-up questionnaires.
BackgroundPsoriasis severity and treatment responsiveness vary by body region, which differentially impacts quality of life (QoL).ObjectiveThe objective of the study was to examine adalimumab efficacy by body region and regional response and QoL relationship.MethodsPatients (n = 1212) with moderate-to-severe psoriasis were randomized 2:1 to 80 mg at week 0, followed by adalimumab 40 mg or placebo every other week for 16 weeks in the double-blind REVEAL study. Psoriasis Area and Severity Index (PASI) responses and Dermatology Life Quality Index outcomes were analyzed.ResultsWeek 16 regional mean PASI improvements were significantly greater with adalimumab (83.1 ± 1.57, 81.3 ± 1.58, 75.7 ± 1.34, and 73.9 ± 1.26% in the trunk, head, upper extremities, and lower extremities, respectively; all p < 0.001 vs. placebo). Likewise, percentages of patients with regional PASI ≥75/≥90/100% reduction from baseline were significantly higher with adalimumab (all p < 0.001); adalimumab responses were greater for the trunk (77.9/65.0/59.1%) and head (74.6/66.1/62.8%; all p ≤ 0.0001 vs. lower) than upper (67.7/45.1/39.6%; p = 0.4, p = 0.04, p = 0.0005, respectively, vs. lower) and lower extremities (65.7/40.0/31.3%). Adalimumab significantly improved Dermatology Life Quality Index scores vs. placebo (8.2- vs 1.7-point decrease from baseline; p < 0.001).LimitationsThe study was a post hoc analysis.ConclusionsAdalimumab treatment resulted in statistically significant and clinically meaningful improvements in disease severity and QoL. QoL improvements were associated with PASI responses in all body regions.Trial RegistrationClinicalTrials.gov identifier NCT00237887.Electronic supplementary materialThe online version of this article (doi:10.1007/s40257-016-0229-x) contains supplementary material, which is available to authorized users.
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