Elevated levels of tumor necrosis factor (TNF)-alpha, interleukin (IL)-1 beta and IL-10 in hidradenitis suppurativa skin: a rationale for targeting TNF-alpha and IL-1 beta

P>Background Knowledge about quality of life and sexual health in patients with genital psoriasis is limited. Objectives We studied quality of life and sexual function in a large group of patients with genital psoriasis by means of validated questionnaires. In addition, we evaluated whether sufficient attention is given by healthcare professionals to sexual problems in patients with psoriasis, as perceived by the patients. Methods A self-administered questionnaire was sent to 1579 members of the Dutch Psoriasis Association. Sociodemographic patient characteristics, medical data and scores of several validated questionnaires regarding quality of life (Dermatology Life Quality Index) and sexual health (Sexual Quality of Life Questionnaire for use in Men, International Index of Erectile Function, Female Sexual Distress Scale and Female Sexual Function Index) were collected and analysed. Results This study (n = 487) shows that psoriasis has a detrimental effect on quality of life and sexual health. Patients with genital lesions reported even significantly worse quality of life than patients without genital lesions (mean +/- SD quality of life scores 8 center dot 5 +/- 6 center dot 5 vs. 5 center dot 5 +/- 4 center dot 6, respectively, P < 0 center dot 0001). Sexual distress and dysfunction are particularly prominent in women (reported by 37 center dot 7% and 48 center dot 7% of the female patients, respectively). Sexual distress is especially high when genital skin is affected (mean +/- SD sexual distress score in patients with genital lesions 16 center dot 1 +/- 12 center dot 1 vs. 10 center dot 1 +/- 9 center dot 7 in patients without genital lesions, P = 0 center dot 001). The attention given to possible sexual problems in the psoriasis population by healthcare professionals is perceived as insufficient by patients. Conclusions In addition to quality of life, sexual health is diminished in a considerable number of patients with psoriasis and particularly women with genital lesions have on average high levels of sexual distress. We underscore the need for physicians to pay attention to the impact of psoriasis on psychosocial and sexual health when treating patients for this skin disease

Alterations in leucocyte subsets and histomorphology in normal-appearing perilesional skin and early and chronic hidradenitis suppurativa lesions

Background Current insight into the histopathological course of events during disease progression in hidradenitis suppurativa (HS) is fragmentary. Objectives To identify histological alterations and leucocyte subsets in normal-appearing perilesional skin, and early and chronic HS lesions. Methods In this observational study we examined eight perilesional skin samples, and six early and 10 chronic prototypic HS lesions, as well as skin samples from four healthy donors using in situ immunostaining. Results Perilesional skin showed mild psoriasiform hyperplasia and follicular plugging as well as a low-grade influx of tryptase-positive mast cells, CD3+ T cells, CD138+ plasma cells and factor XIIIa+ dendritic cells. In early HS lesions, neutrophilic abscess formation and influx of mainly macrophages, monocytes and dendritic cells predominated. In chronic disease, the infiltrate expanded with markedly increased frequencies of CD20+ and CD79a+ B cells and CD138+ plasma cells. As in early lesion Conclusions Psoriasiform hyperplasia, follicular plugging and low-grade leucocytic infiltration are already present in normal-appearing perilesional skin. Keratin fibres in the dermis are associated with clinical disease. Early lesions are characterized by neutrophilic abscess formation and influx of mainly histiocytes, and chronic lesions mainly by expansion of B cells and plasma cells in 'pseudo' follicles. Proliferating strands of follicular epithelium may initiate fistula formation. Mast ce