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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