The study outcomes indicate that ustekinumab could be safe for psoriasis patients since none developed persistent hepatitis or acute liver failure during therapy. However, the re-appearance of plasma HBV DNA requires appropriate monitoring of HBV viral load during ustekinumab treatment.

EditorActinic prurigo (AP) is a chronic idiopathic photodermatosis displaying multiple intensely itchy, hyperkeratotic firm papules and/or nodules over the sun-exposed areas, usually accompanied by excoriation, crusting and lichenification. Classical AP in Native Americans usually begins in childhood, with disease onset at 4-5 years of age. Hereby, we conducted a retrospective study to collect patients with photo-distributed prurigo nodularis-like lesions between 1991 and 2011 in a dermatological tertiary referral centre in Southern Taiwan. A total of 19 patients were recruited and all of them were older than 21 years with Fitzpatrick's skin type of III or IV (Table 1). Ten of them were outdoor workers, including farmers, fishers, construction workers and gardeners. Photoaggravation of the symptoms and numbers of lesions was reported by eight patients (42.1%). Phototesting was performed in nine patients, whereas one patient had reduced minimal erythema dose (MED) to UVA and five patients to UVB. None of them had cheilitis or conjunctivitis. Personal history of atopy, prior widespread eczema, family history of AP or polymorphous light eruption was unremarkable. Histopathology from 18 patients demonstrated epidermal hyperplasia (15/18, 83.3%) with spongiosis (14/18, 77.8%) and parakeratosis (12/18, 60%), most prominent in the persistent lesions.In addition to intensive sun protection measures, treatment was initiated with combination of systemic and topical medications. Topical steroids combined with oral antihistamines were the mainstay of treatment. Systemic steroids, including oral and intramuscular forms, were given in 13 patients for acute exacerbation. Recalcitrant nodular lesions were treated with intralesional steroid injection or cryotherapy, each in five patients. Oral and topical use of doxepin showed significant relief of pruritus in six and three patients, respectively. A transient suppression of new lesions was observed in two of the four patients treated with narrowband UVB phototherapy. Thalidomide 100 mg/day and hydroxychloroquine 200-400 mg/day, each given in two patients for up to 8 weeks, showed limited improvement. One patient did not benefit from treatment with dapsone 100 mg/day for 10 weeks. In spite of every effort, the course of AP seemed to fluctuate with unsatisfying incomplete remission within a mean follow-up period of 52.4 months (range 14 days-13 years).Our results support the existing data from other Asian countries that the adult-onset AP in Asia develops at an older age onset of around 40 years with overwhelmingly male predominance (Table 2). [1][2][3][4][5][6] The association with cheilitis and conjunctivitis seems lower in Asian patients and was absent in our series.

Background Uremic pruritus (UP) is a multifactorial problem that contributes to low quality of life in dialysis patients. The long-term influences of UP on dialysis patients are still poorly understood. This study aims to elucidate the contribution of UP to long-term outcomes. Materials and method We used the Taiwan National Health Insurance Research Database to conduct this study. Patients on chronic dialysis were included and divided into UP and non-UP groups according to the long-term prescription of antihistamine in the absence of other indications. The outcomes include infection-related hospitalization, catheter-related infection, major adverse cardiac and cerebrovascular events (MACCE) and parathyroidectomy. Results After propensity score matching, 14,760 patients with UP and 29,520 patients without UP were eligible for analysis. After a mean follow-up of 5 years, we found that infection-related hospitalization, MACCE, catheter-related infection, heart failure and parathyroidectomy were all slightly higher in the UP than non-UP group (hazard ratio: 1.18 [1.16–1.21], 1.05 [1.01–1.09], 1.16 [1.12–1.21], 1.08 [1.01–1.16] and 1.10 [1.01–1.20], respectively). Subgroup analysis revealed that the increased risk of adverse events by UP was generally more apparent in younger patients and patients who underwent peritoneal dialysis. Conclusion UP may be significantly associated with an increased risk of long-term morbidities.

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Tuberculosis (TB) contributes to a major public health issue worldwide, and its risk increases when the host immune system is impaired. This could be attributed to an underlying chronic disease, an immunologic disorder or use of immunosuppressants. [1][2][3][4][5] Psoriasis is a chronic inflammatory skin disorder that involves a complex interplay of cytokines, immune cells and the cutaneous tissue. In addition to newer biologic agents that target specific molecules in the pathogenesis of psoriasis, the use of traditional immunosuppressants still accounts for a considerable proportion of systemic treatment. 6,7 Muddasani et al estimated that methotrexate (MTX), one of the widely used systemic antipsoriasis drugs, was prescribed in an estimated 2 million visits during a 10-year follow-up period. 8 The risk of TB was higher in psoriasis patients than that in the general population. 9 The systemic therapy for psoriasis, especially those agents with immunosuppressive effects, could contribute to additional risk for TB infection and reactivation. To investigate the real-world association between the traditional systemic anti-psoriasis therapies and the risk of TB, we design this study by using a nationwide population-based cohort with time-varying covariates.

The incidence of herpes zoster in psoriasis patients is higher than in the general population. However, the association between herpes zoster risk and different systemic therapies, especially biologic agents, remains controversial. This study investigated the association between herpes zoster risk and several systemic antipsoriasis therapies. This prospective open cohort study was conducted using retrospectively collected data from the Taiwan National Health Insurance Research Database. We included 92,374 patients with newly diagnosed psoriasis between January 1, 2001, and December 31, 2013. The exposure of interest was the “on-treatment” effect of systemic antipsoriasis therapies documented by each person-quarter. The outcome was the occurrence of newly diagnosed herpes zoster. During a mean follow-up of 6.8 years, 4834 (5.2%) patients were diagnosed with herpes zoster after the index date. Among the systemic antipsoriasis therapies, etanercept (hazard ratio [HR] 4.78, 95% confidence interval [CI] 1.51–15.17), adalimumab (HR 5.52, 95% CI 1.72–17.71), and methotrexate plus azathioprine (HR 4.17, 95% CI 1.78–9.82) were significantly associated with an increased risk of herpes zoster. By contrast, phototherapy (HR 0.76, 95% CI 0.60–0.96) and acitretin (HR 0.39, 95% CI 0.24–0.64) were associated with a reduced risk of herpes zoster. Overall, this study identified an association of both etanercept and adalimumab with an increased risk of herpes zoster among psoriasis patients. Acitretin and phototherapy were associated with a reduced risk.

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