Breaking paradigms in the treatment of psoriasis: Use of botulinum toxin for the treatment of plaque psoriasis

Some studies have demonstrated that neurotransmitters are involved in the pathogenesis of numerous skin conditions, including psoriasis, addressing the close correlation between the skin and the central nervous system. There are reports showing psoriasis improvement after peripheral nervous system injury. In addition, botulinum toxin has been reported as a treatment for several diseases, including psoriasis. This is a proof-of-concept study of botulinum toxin and psoriasis, involving eight patients with stable and recalcitrant plaques of psoriasis vulgaris. The lesions were 5 cm(2)at the maximum. Botulinum toxin Dysport (Ipsen Biopharm, Wrexham, UK), 5 units per cm(2), was administered in one subcutaneous application. Patients were then evaluated at 2 and 4 weeks after treatment. Our results indicated a substantial improvement in all patients, 4 weeks after treatment, with no significant side effects. Our preliminary conclusion is that botulinum toxin represents a novel mechanism for interfering with the immunopathogenesis of psoriasis and improving the quality of life of our patients.Scientific and administrative committee of the International Psoriasis Council (IPC

Color doppler ultrasound assessment of activity in keloids

BACKGROUND The assessment of activity in keloids may be critical for defining their management. There is a lack of clinical scorings designed for the evaluation of keloids and biopsies may be contraindicated. OBJECTIVE To assess the sonographic activity of keloids in comparison with clinical scoring. MATERIALS AND METHODS A retrospective study of the clinical and color Doppler ultrasound (CDU) images of patients medically derived to CDU with the diagnosis of keloid was performed. Activity was evaluated clinically (modified Seattle Scar Scale) and CDU. Keloids were considered active when CDU detected vascularity within the lesion. Statistical analysis was performed (Wilcoxon-Mann-Whitney, Student t-test, and interobserver agreement). RESULTS Thirty-five patients with 42 keloids were evaluated. Color Doppler ultrasound provided the diameters, including depth, and vascularity. On CDU, 76% were active and 24% inactive. Clinically, Observer 1 found 55% and Observer 2 found 88% of active keloids. Interobserver agreement between clinical observers was moderate (k = 0.42). Subclinical fistulous tracts, involvement of the hypodermis, muscle, and calcifications were also found on CDU. CONCLUSION Color Doppler ultrasound can support the assessment of activity in keloids. Clinical evaluation alone can underestimate the activity in keloids. Relevant anatomical and subclinical features can be detected by CDU

Linear immunoglobulin A dermatosis: A case report

En este texto se presenta el caso de una paciente de sesenta y cinco años con sintomatología de dos meses de evolución consistente en prurito y lesiones hiperpigmentadas anulares en tronco, glúteos y extremidades superiores. En el área flexora de las muñecas presenta vesículas sobre base eritematosa y piel sana, sin evidencia de compromiso mucoso. Al estudio histológico se constata dermatitis vesicular subepidérmica con infiltrado inflamatorio de neutrófilos y eosinófilos. La inmunofluorescencia directa muestra depósito lineal y continuo de inmunoglobulina A en zona de membrana basal, compatible con dermatosis por inmunoglobulina A lineal.We present the case of a sixty five year old woman with two months history of pruritus and hyperpigmented annular lesions on the trunk, buttocks and upper extremities. In addition, she presents vesicles with healthy skin on the basis, in the flexor aspect of wrists. No evidence of mucosal involvement. Histological study showed subepidermal vesicular dermatitis with inflammatory infiltrate of neutrophils and eosinophils. Direct immunofluorescence evidenced linear and continuous deposition of immunoglobulin A in basement membrane zone, compatible with linear immunoglobulin A disease