Mean PASI and DLQI correlate predictably in patients with chronic moderate-to-severe plaque psoriasis undergoing treatment with biological agents. A reduction in PASI of at least 75% can translate to significant quality-of-life improvement in patients treated with these therapies.

Syphilis is a well-known sexually transmitted infection infamous for its protean cutaneous manifestations. Over the last decade, the rate of infection in the USA has risen, particularly among human immunodeficiency virus (HIV)-infected individuals and certain ethnic groups. Although the primary chancre developing at the site of inoculation usually has typical and well-characterized features, cutaneous manifestations of secondary syphilis span a wide spectrum and mimic those of other dermatoses. This may be particularly evident in patients with HIV. Such deviations from the expected typical papulosquamous eruption may present a diagnostic challenge and delay diagnosis and therapy. Given the increasing incidence of syphilis among the immunosuppressed patient population, recognition of atypical cutaneous manifestations is critical for adequate management. We review a range of cutaneous manifestations of secondary syphilis and the skin diseases it may mimic.

Psoriasis is a disease state that may present significant cumulative life course impairment (CLCI). The impact of psoriasis on CLCI can be divided into social factors such as stigmatization, psychological factors such as depression, and physical factors such as pruritis, pain and arthritis. With a bimodal age range at first presentation, psoriasis tends to affect those in the second and fifth decades of life. In accordance with the CLCI model, the age of first presentation may substantially affect an individuals' life course, with younger patients more susceptible to CLCI. Social, psychological, and physical factors also provide protection from CLCI: personality, coping mechanisms, social support, and treatment or therapy may act as positive factors and mitigate these damaging effects. As the time course of most clinical trials encompasses a fraction of a patients' life, the true nature of this impact has not been easily captured. Longitudinal CLCI data in psoriasis is limited and continued life course data is needed.

The photochemistry of estr-4-en-3-ones la,b is solvent dependent, yielding estr-5-en-3-ones 2 in ethyl acetate or 5a-estran-3-ones 3 in alcoholic solvents. Further irradiation of 5a-estran-3-ones 3 in alcoholic solvent yields the 2,3-and 3,4-seco-5a-estrane 3-esters 4 and 5 and the 2,3-secoestr-l-en-3-al ( 6). Photolysis of estra-4,9-dien-3-one 7 yields the photodimer 8 whereas the estra-4,9,ll-trien-3-one 9 yielded polymer.Mr. G. Zuber both of Smith Kline and French Laboratories, for the mass spectra and FT-IR spectra, respectively, Mr. Hassan El-Okdah for experimental assistance, and the NIH for financial support.Supplementary Material Available: Table of anisotropic thermal parameters of 8 (8 pages). Ordering information is given on any current masthead page.

4‐Alkoxy‐1‐methyl‐pyridiniumjodide (I) reagieren über radikalische Zwischenstufen thermisch zum 4‐Pyridon (II) und den Benzyljodiden (III).