Current management of herpes zoster: The European view

The overall incidence of herpes zoster in Europe is approximately 3 per 1000 people per year and more than 10 per 1000 people per year in those aged >80 years. Post herpetic neuralgia (PHN) is a common debilitating complication of herpes zoster, particularly in patients aged >50 years, in persons with severe pain or rash at presentation, and in those with significant prodromal symptoms. Antiviral drugs can effectively control acute symptoms and, if used early enough in the course of the illness, can help prevent the development of PHN and other complications. However, despite this, many patients do not receive such treatment. The economic impact of zoster and PHN is largely underestimated in Europe. Furthermore, there is considerable variation throughout Europe in the management of herpes zoster. Use of antiviral therapy including the newer potent antiviral agents such as brivudin, which requires less frequent administration than acyclovir, is improving patient outcomes in some European countries. However, in many countries, patient awareness of herpes zoster and, as a result, overall antiviral use is low. Guidelines recommending the use of antiviral agents, particularly in patients at risk of developing PHN, are available but are not widely used. More needs to be done to educate the general public and increase awareness among primary healthcare providers of the benefits of timely and appropriate pharmacological therapy in patients with herpes zoster. © 2005 Adis Data Information BV. All rights reserved

Cardiovascular Comorbidities in Patients with Psoriasis: Risk Profile Including Carotide Ultrasonography Assessed in Hospital-based Case Control Study

Psoriasis is a chronic inflammatory disease and its comorbidities have attracted serious interest in recent years. The evidence that psoriasis is associated with systemic inflammation and significantly higher incidence of cardiovascular risk factors was already described. The results of published studies are highly variable, the conclusions are ambiguous and further epidemiological studies are needed for validation of published data. Therefore, we initiated a project aimed at identifying the carriership of cardiovascular risk factors including early stages of atherosclerosis that represent important comorbidities in patients with psoriasis. We carried out a hospital-based case-control study. 189 patients with chronic plaque psoriasis were enrolled as cases. The group consisted of 378 patients with other skin diseases complying with the same restriction criteria were recruited to the study as the controls. All participants underwent physical examination, blood tests, measuring of blood pressure, waist circumference. Furthermore, in the subset of 117 cases and controls (matched 1:2) with no history of cardiovascular disease we evaluated the intima-media thickness (cIMT). The results show higher prevalence of hypertension, hyperlipidaemia, waist circumference, weight, BMI and CRP level in patients with psoriasis than in controls. These parameters have been clearly demonstrated as risk factors for the development of cardiovascular diseases. The associations among psoriasis and diastolic blood pressure, BMI value and LDL cholesterol are statistically significant in the binary data logistic model as well. cIMT in patients  compared to controls was not significant.</p

An International Multi-center Study on Self-assessed and Family Quality of Life in Children with Atopic Dermatitis

Atopic dermatitis (AD) is a common childhood chronic inflammatory skin condition that greatly affects the quality of life (QoL) of affected children and their families. The aim of our study was to assess QoL and family QoL of children with AD from 4 different countries and then compare the data, evaluating the effects of AD severity and age of children. Data on the Children’s Dermatology Life Quality Index (CDLQI) and the Dermatitis Family Impact (DFI) questionnaires and the SCORAD index of 167 AD children 5-16 years old from Ukraine, Czech Republic, Singapore, and Italy was used for the study. SCORAD correlated with the CDLQI in all 4 countries and with DFI in all countries except Singapore. Only in Czech children did the CDLQI correlate with their age. No significant correlations between age and DFI results were found. AD symptoms and expenditures related to AD were highly scored in all countries. Impact of AD on friendship and relations between family members were among the lower scored items, and family problems did not increase proportionately with duration of AD in any of the four countries. Self-assessed health-related QoL of children with AD in our study correlated better in most cases with disease severity than family QoL results. Parents of school children with AD were generally less stressed, tired, and exhausted than parents of preschool children. These data together with results showing that duration of AD in children does not affect relations between parents and other family members is optimistic news for families with children with AD who did not recover until adolescence.</p

Cardiovascular Comorbidities in Patients with Psoriasis: Risk Profile Including Carotide Ultrasonography Assessed in Hospital-based Case Control Study

Psoriasis is a chronic inflammatory disease and its comorbidities have attracted serious interest in recent years. The evidence that psoriasis is associated with systemic inflammation and significantly higher incidence of cardiovascular risk factors was already described. The results of published studies are highly variable, the conclusions are ambiguous and further epidemiological studies are needed for validation of published data. Therefore, we initiated a project aimed at identifying the carriership of cardiovascular risk factors including early stages of atherosclerosis that represent important comorbidities in patients with psoriasis. We carried out a hospital-based case-control study. 189 patients with chronic plaque psoriasis were enrolled as cases. The group consisted of 378 patients with other skin diseases complying with the same restriction criteria were recruited to the study as the controls. All participants underwent physical examination, blood tests, measuring of blood pressure, waist circumference. Furthermore, in the subset of 117 cases and controls (matched 1:2) with no history of cardiovascular disease we evaluated the intima-media thickness (cIMT). The results show higher prevalence of hypertension, hyperlipidaemia, waist circumference, weight, BMI and CRP level in patients with psoriasis than in controls. These parameters have been clearly demonstrated as risk factors for the development of cardiovascular diseases. The associations among psoriasis and diastolic blood pressure, BMI value and LDL cholesterol are statistically significant in the binary data logistic model as well. cIMT in patients  compared to controls was not significant.</p

Hepato-Splenic and Lipid Profile Abnormalities – Do They Exist in Children Affected with Vitiligo?

Autoimmune disturbances and metabolic abnormalities observedin vitiligo, a disease of still unclear etiology, may provide evidence onthe systemic nature of the disease. The aim of the study was to assess functionaland morphological parameters of the liver and spleen, as well as thelipid profile in vitiligo-affected children, in order to ascertain whether anymetabolic abnormalities or structural changes in these organs accompaniedthe course of vitiligo. The study included 34 patients with vitiligo hospitalizedat the Department of Dermatology at the Medical University of Lublin and acontrol group of 35 healthy individuals, aged 7-15 years. Children with the activephase of vitiligo and at least 6 month history of vitiligo lesions were studied.Ultrasound examination of the liver and spleen enabled assessment of thesize and parenchyma of the organs. Liver and spleen functions were assessedby means of the following additional examinations: blood test, transaminases,protein electrophoresis, lipid profile, autoantibodies, and HCV antibodies. Thesize of the liver was not significantly different in the vitiligo and control groups.The ultrasonographic pictures of the spleen revealed no abnormalities in organsize and structure. The concentration of HDL-cholesterol was significantlylower, whereas the concentration of LDL-cholesterol was significantly higherin patients with vitiligo than in healthy controls. The value of the LDL/HDL ratiowas significantly higher in vitiligo patients. The results of our study indicatelipid disturbances in vitiligo-affected children. Since no structural and functionalabnormalities in the liver and spleen were found, it seems likely thatlipid disturbances in vitiligo may result from disturbed metabolic processes inthe adipose tissue as well as from oxidative stress

Dysbiosis of Skin Microbiota in Psoriatic Patients: Co-occurrence of Fungal and Bacterial Communities

Psoriasis is a chronic inflammatory skin disease, whose pathogenesis involves dysregulated interplay among immune cells, keratinocytes and environmental triggers, including microbiota. Bacterial and fungal dysbiosis has been recently associated with several chronic immune-mediated diseases including psoriasis. In this comprehensive study, we investigated how different sampling sites and methods reflect the uncovered skin microbiota composition. After establishing the most suitable approach, we further examined correlations between bacteria and fungi on the psoriatic skin. We compared microbiota composition determined in the same sample by sequencing two distinct hypervariable regions of the 16S rRNA gene. We showed that using the V3V4 region led to higher species richness and evenness than using the V1V2 region. In particular, genera, such as Staphylococcus and Micrococcus were more abundant when using the V3V4 region, while Planococcaceae, on the other hand, were detected only by the V1V2 region. We performed a detailed analysis of skin microbiota composition of psoriatic lesions, unaffected psoriatic skin, and healthy control skin from the back and elbow. Only a few discriminative features were uncovered, mostly specific for the sampling site or method (swab, scraping, or biopsy). Swabs from psoriatic lesions on the back and the elbow were associated with increased abundance of Brevibacterium and Kocuria palustris and Gordonia, respectively. In the same samples from psoriatic lesions, we found a significantly higher abundance of the fungus Malassezia restricta on the back, while Malassezia sympodialis dominated the elbow mycobiota. In psoriatic elbow skin, we found significant correlation between occurrence of Kocuria, Lactobacillus, and Streptococcus with Saccharomyces, which was not observed in healthy skin. For the first time, we showed here a psoriasis-specific correlation between fungal and bacterial species, suggesting a link between competition for niche occupancy and psoriasis. However, it still remains to be elucidated whether observed microbial shift and specific inter-kingdom relationship pattern are of primary etiological significance or secondary to the disease