Scalp psoriasis associated with central centrifugal cicatricial alopecia

AbstractScalp psoriasis is a very common dermatological condition with a variety of presentations, but only rarely presents as severe alopecia. We present a case of a 50-year-old female with many years of recalcitrant hair loss that was thought to be secondary to central centrifugal cicatricial alopecia which was later diagnosed as psoriasis. This case highlights an interesting presentation and rare complication of a common disease

A2ML1 and otitis media : novel variants, differential expression, and relevant pathways

A genetic basis for otitis media is established, however, the role of rare variants in disease etiology is largely unknown. Previously a duplication variant within A2ML1 was identified as a significant risk factor for otitis media in an indigenous Filipino population and in US children. In this report exome and Sanger sequencing was performed using DNA samples from the indigenous Filipino population, Filipino cochlear implantees, US probands, Finnish, and Pakistani families with otitis media. Sixteen novel, damaging A2ML1 variants identified in otitis media patients were rare or low-frequency in population-matched controls. In the indigenous population, both gingivitis and A2ML1 variants including the known duplication variant and the novel splice variant c.4061 + 1 G>C were independently associated with otitis media. Sequencing of salivary RNA samples from indigenous Filipinos demonstrated lower A2ML1 expression according to the carriage of A2ML1 variants. Sequencing of additional salivary RNA samples from US patients with otitis media revealed differentially expressed genes that are highly correlated with A2ML1 expression levels. In particular, RND3 is upregulated in both A2ML1 variant carriers and high-A2ML1 expressors. These findings support a role for A2ML1 in keratinocyte differentiation within the middle ear as part of otitis media pathology and the potential application of ROCK inhibition in otitis media.Peer reviewe

Psoriasis therapy and aortic inflammation — translating statistical to clinical significance

Psoriasis patients are known to have comorbid aortic vascular inflammation, which is one of the leading causes of cardiovascular morbidity and mortality in this population. Many studies report statistically significant improvements in aortic vascular inflammation after use of tumor necrosis factor inhibitors or interleukin-12/23 antagonists. However, the clinical significance in reduction of adverse cardiovascular events in psoriatic patients owing to biologic therapy has not been examined. Regardless of clinically significant cardiovascular benefits, dermatologists should continue to treat psoriasis patients optimally to mitigate the unfavorable effect this disease has on quality of life

Psychological disorders associated with rosacea: Analysis of unscripted comments

Background: Conditions affecting the face are particularly prone to causing psychological comorbidity; patients may be reluctant to inform their physician about their psychological distress. Unscripted comments could provide novel insight regarding the psychological impact of rosacea. Aim: To assess psychologically distressing aspects of rosacea reported in an informal medical setting. Methods: Random sample of 10% of 27,051 posts analyzed, 446 comments addressed psychological effects of rosacea. Comments analyzed for symptoms of depression, anxiety, low confidence/self-esteem, and aspects of rosacea which cause distress, including symptoms, lifestyle change and difficulty with treatments. Brand names were changed to generic equivalent. Results: Symptoms of depression (n = 44) and the desire to end life (n = 6) were mentioned, but no comments expounded on any suicide plan. Anxiousness (n = 7) and negative impact on confidence/self-esteem (n = 5) were mentioned. Symptoms, or clinical manifestations (n = 29), were the most frequently mentioned distress factor, followed by lifestyle change (n = 20). Patients also voiced difficulty with treatments (n = 15). Limitations: Online forums may provide patient perceptions that patients would not share with a doctor, but the sample may not be representative of all rosacea patients. Conclusions: Inquiring about psychological impact of rosacea might be helpful in identifying patients who would benefit from supportive psychological measures

Internet-based survey intervention improves adherence to methotrexate among psoriasis patients

Background While it is known that psoriasis patients have poor adherence to both topical and systemic medications, adherence to methotrexate is not well-characterized, and ways to improve methotrexate adherence have not been addressed. Objective The aim of this study was to evaluate whether a digital intervention improved adherence to oral methotrexate as measured by electronic monitoring. Methods Twenty-nine patients were randomized to receive either weekly digital interventions assessing treatment adherence or no intervention for 24 weeks. Patients received medication bottles with electronic monitoring, and returned at weeks 4, 12, and 24 to evaluate disease severity. Results The intervention group took methotrexate correctly 77.1% of the weeks observed compared to the control group which averaged 64.5%. More intervention patients took methotrexate as directed compared to the control group (78.3% vs 64.2%, p < 0.0001). Patients were most adherent around follow-up visits, with 100% of digital intervention patients and 80% of control patients taking methotrexate correctly during the week of a follow-up visit (p = 0.02). The digital intervention did not significantly improve disease severity in the intervention group compared to the nonintervention group. Conclusions Low cost, scalable digital interventions may have the potential to increase psoriasis patient adherence to methotrexate, although the mechanism for the improvement is not yet well defined