Itch in psoriasis: epidemiology, clinical aspects and treatment options

F Prignano, F Ricceri, L Pescitelli, T LottiDepartment of Dermatological Sciences, University of Florence,Florence, ItalyBackground: Pruritus is an important symptom in psoriasis vulgaris, may be severe and seriously affect the quality of life of patients, but published data on its frequency and characteristics are limited.Objective: The study objective was to characterize the prevalence of itch in psoriatic patients and the effect of treatment modalities by using a comprehensive itch questionnaire of our own design.Methods: A structured itch questionnaire was given to 90 patients with moderate to severe chronic-plaque psoriasis selected consecutively from the patients visiting the Department of Dermatology of the University of Florence. The questionnaire concerned the areas involved in psoriasis and pruritus, the pruritus characteristics, the worsening and relieving factors and treatment modalities. Itch intensity was reflected by a 10 point visual analog scale (VAS) and the degree of symptoms discriminated between mild (1–3), moderate (4–7) and severe (8–10).Results: Almost 85% of psoriatic patients suffered from itching; the frequency of pruritus was daily and mean intensity by VAS scale was moderate. Presence and intensity of pruritus and body mass index (BMI) were correlated. 40% of patients with pruritus were overweight (BMI > 25 < 30) and 10% obese (BMI > 30). Almost all patients appeared unsatisfied with the available treatment modalities for pruritus in psoriasis. Emollients, topical steroids and calcipotriol cream could relieve pruritus but their effect was temporary. Among the antipsoriatic therapies, phototherapy with narrow band ultraviolet B (nb-UVB) was the most effective treatment in reducing pruritus. Biological therapies, mainly etanercept and efalizumab, proved useful in its control.Conclusions: The questionnaire was a useful tool to characterize itch, and the results might help us to better understand pruritus in psoriasis. The results confirmed the need for a global study of psoriasis with regard to both the cutaneous manifestations and the itch symptom.Keywords: itch, psoriasis, pruritus, epidemiology, phototherapy, etanercept, efalizuma

Plaque psoriasis in children and adolescents – the role of etanercept

Federica Ricceri, Lara Tripo, Leonardo Pescitelli, Francesca PrignanoDivision of Clinical, Preventive and Oncology Dermatology, Department of Critical Care Medicine and Surgery, University of Florence, Florence, ItalyBackground: Childhood-onset psoriasis affects approximately one-third of the psoriatic population. Among many potential treatments of childhood psoriasis, biological agents are emerging as a valuable option in the management of this disease. In Europe, etanercept has recently been approved for children aged 6 years and over. Data from a well-designed clinical trial indicate that in children, etanercept effectively reduces psoriasis symptoms, with beneficial effects evident as early as 4 weeks after the onset of therapy. The treatment is generally well tolerated; mild injection site reactions are the most common adverse events reported in the literature. Published data of etanercept use in children show promising results, but further clinical studies are necessary to confirm its long-term efficacy and safety.Keywords: pediatric psoriasis, anti-TNF-α, etanercep

Organic fouling in forward osmosis: Governing factors and a direct comparison with membrane filtration driven by hydraulic pressure

The fouling behavior of osmotically-driven forward osmosis (FO) is widely believed to be superior with respect to hydraulic pressure-driven membrane applications, based on a number of experiments reported in the literature. However, experimental confounders often exist, preventing fair comparison between the different processes, one being the deployment of non-comparable membranes. This study systematically investigates the conditions influencing organic fouling in FO and compares the behavior in FO and in a hydraulic pressure-driven process, under equivalent conditions. The same state-of-the-art polyamide FO membranes were used in the tests, which were run with real feed solutions and under varying conditions to observe the effect of initial flux, draw solution, and feed ionic composition. The results suggest that initial flux and calcium have the strongest influence on the extent of flux decline and recovery. The influence of different draw solutions in FO becomes apparent when the flux is relatively low. Analysis of the fouling indices and of the effective driving force, as well as direct observation of membranes following fouling, support the conclusion that the fouling behavior of the FO process is not necessarily better compared to an analogous hydraulic pressure-driven one, especially under relevant operational conditions and when the two processes work with similar fluxes

Delayed diagnosis of extrapulmonary tuberculosis in a 32-year-old man with knee pain

A 32-year-old Bangladeshi male was admitted at our emergency department for trauma of the left knee. The radiographs showed absence of fracture, and presence of an indeterminate oval lucency in the proximal tibia. Further examinations were suggested, but the patient refused. 6 months later, the patient re-presented at our emergency department. A CT scan showed progression of musculoskeletal involvement and spread to the liver. This case underlines the importance of considering tuberculosis in the differential diagnosis of indeterminate bone lesions in immigrant patients