Comorbidities in Chilean patients with psoriasis: a Global Healthcare Study on Psoriasis

Background: Psoriasis is a chronic inflammatory skin disease associated with several important medical comorbidities. There are scant data available on the comorbidities of patients with psoriasis in South America. Aim: To examine the comorbidity profile of adult patients with psoriasis in Chile and its association with severity of psoriasis. Methods: This was a multicentre, cross-sectional study involving 16 hospitals and clinics in Chile, which used a 48-item questionnaire to study clinician- and patient-reported outcomes and comorbidities. Inferential analyses were performed by psoriasis severity, using Fisher exact test, Student t-test and multivariable logistic regression. Results: In total, 598 adult patients with psoriasis were included (51.1% male; mean age 49.2 ± 15.1 years); 48.5% mild and 51.4% moderate to severe; Psoriasis Area and Severity Index 11.6 ± 11.5; body surface area 14.7 ± 18.2%. Plaque psoriasis was the most common phenotype (90.2%), followed by guttate (13.4%). Psoriatic arthritis occurred in 27.3% of patients. Comorbidities were reported in 60.2% of all patients with psoriasis. Frequent concomitant diseases were obesity (25.3%), hypertension (24.3%), Type 2 diabetes mellitus (T2DM) (18.7%), dyslipidaemia (17.4%), metabolic syndrome (16.7%) and depression (14.4%). After adjustment, significant associations were found between moderate to severe psoriasis and obesity, T2DM and nonalcoholic fatty liver disease (NAFLD) compared with mild psoriasis. Conclusions: We report a large study of comorbidities, including depression, dyslipidaemia, T2DM and NAFLD, in people with psoriasis in Chile. The prevalence of comorbidities with psoriasis in Chile appears similar to that found in Western countries, and emphasizes the importance of assessing patients with psoriasis for risk factors for and presence of, comorbid disease in a multidisciplinary setting

Eczema herpeticum: A medical emergency in patients with atopic dermatitis

We describe the case of a 13-year-old girl with atopic dermatitis (AD) and severe asthma that presented to the Dermatology clinic with a pruritic skin rash, which appeared concomitantly to common cold symptoms. On examination, there are erythematous, umbilicated papules and vesicles, some with erosions and crusting, surrounding the mouth and areolas; a few lesions are visible on the forearms. The mucous membranes were unaffected, the patient was afebrile, and no lymphadenopathies were present. A diagnosis of eczema herpeticum (HE) was suspected, and a direct fluorescent antibody test was positive for herpes simplex virus. Even when the clinical presentation is characteristic, the eruption might be confused with other infections like impetigo and primary varicella infection. Misdiagnosis can lead to severe complications, including bacteremia and death. EH is considered a medical emergency, and the index of suspicion for this infection should be high among clinicians. Prompt treatment with oral acyclovir should be initiated; in cases of severe disease or immunocompromised patients, hospitalization for systemic antivirals is required. If EH is recognized early it is easily and effectively treated. Any patient with pre-existing skin disease and acute ''blistering'' should be examined to rule out EH

Pyoderma gangrenosum: Classic and emerging therapies

El pioderma gangrenoso es una dermatosis ulceronecrótica que representa un desafío importante parael clínico no solo porque puede simular otras dermatosis, sino porque en general no responde a lostratamientos habituales. Durante el último a˜no han surgido nuevos estudios acerca de la eficacia real de lostratamientos convencionales, tales como la ciclosporina y los glucocorticoides sistémicos. Estos estudioshan demostrado que los tratamientos clásicos son comparables pero insuficientes como monoterapia.Han surgido nuevos tratamientos, como los agentes ahorradores de glucocorticoides, los inhibidores delfactor de necrosis tumoral y la cirugía. Esta revisión es una puesta al día de la evidencia actual para eltratamiento del pioderma gangrenoso.Pyoderma gangrenosum is an ulceronecrotising dermatosis that represents a challenge for any clinician,not only for its ability to mimic other dermatoses but also for its lack of response to treatment. Duringthe past year, there have been new studies about the efficacy of standard therapies, such as cyclosporineand systemic corticosteroids. These studies showed that classic treatment was comparable, but they areinsufficient as monotherapy. That being said, new emerging therapies are becoming important, as the useof corticosteroid-sparing agents, tumour necrosis factor inhibitors or even surgery. This review updatesthe current evidence for the treatment of pyoderma gangrenosum