January 1958

My dear Brother: It does not require a great stretch of the imagination for me to hear you mutter: Didn\u27t I get one of these yellow sheets only a month ago? Why doesn\u27t he get back to work instead of cluttering up my mail? Well, thereby hangs a tale. A few weeks ago I spent an illuminating, and somewhat dismaying, evening with brother Theophilus in the Middle West. He has a good congregation of about five hundred members. It is an average parish, with the usual complement of saints and sinners, with the lines between them shifting back and forth. Theophilus has worked hard and the Lord of the Church has blessed his hands and his voice

Venous Leg Ulceration

Venous leg ulcers are among the most common leg ulcerations. Advancing age, sex, race, phlebitis, family history, obesity, prolonged standing, and number of pregnancies are risk factors. Although the main pathogenetic mechanism is venous hypertension, leading to vein wall damage and thereby a cascade of events resulting in ulceration, there is no consensus about progression from venous hypertension to ulceration

Stress coping mechanisms in smoking psoriatics

AbstractBackgroundThe link between emotional stress and smoking has previously been investigated and results have suggested that smoking is used as a way of dealing with stress. There are many studies indicating the relationship between smoking and psoriasis or emotional stress and psoriasis. However, to our knowledge, the link between smoking associated with emotional stress and psoriasis has not been shown before. Our aim was to investigate psoriatic patients' abilities to cope with stress, the relationship between coping strategies and smoking habit.MethodsNinety-nine individuals with psoriasis (57 females, and 42 males, mean age: 37.4 years) were included in this study. Sociodemographic information including age, sex, smoking habit, etc., was obtained; Psoriasis Area Severity Index (PASI) scores were recorded. The Fagerstrom Test for Nicotine Dependence was used on smoking patients to evaluate smoking habit or the degree of nicotine dependence. The Ways of Coping Questionnaire and Dermatology Life Quality Index were filled out by all patients. Data were assessed by comparing psoriatic smokers with nonsmokers and statistically analysis was carried out with the SPSS 11.5 program.ResultsForty patients (40.4%) were smokers. When comparing the two groups' mechanisms of coping with stress, smokers and nonsmokers coped with stress in similar ways. The seeking social support scores from the Ways of Coping Questionnaire were significantly lower in smokers than nonsmokers (p<0.05), while the Fagerstrom Test for Nicotine Dependence scores were correlated with distrustful approach sub-scores, and PASI only correlated with smokers. The Dermatology Life Quality Index scores were correlated with the PASI and distrustful approach scores in all patients.ConclusionSmoking and nonsmoking psoriatic patients had similar stress coping strategies, except the subgroup seeking social support, and usually used positive ways of coping with stress. Psoriatic patients who smoke might employ smoking to avoid stressful situations. They would benefit from education on adopting healthy stress management and, in turn, developing mature stress coping mechanisms. Future prospective studies are required to address the exact causal link between smoking, psoriasis and psychiatric comorbidity, including stress coping mechanisms

Zosteriform Collagen Nevus in an Infant

No abstract availabl

Adherence to systemic therapy in patients with psoriasis during the COVID-19 pandemic: A multicenter study

Background: Adherence to treatment is important in chronic dermatological diseases. There are limited data regarding the adherence to treatment in patients with psoriasis during the COVID-19 pandemic. Aims: We aimed to determine the rates of adherence to systemic treatments in patients with psoriasis and to identify the causes of non-adherence during the COVID-19 pandemic. Methods: We conducted a cross-sectional multicenter study from May 2021 to August 2021. A questionnaire including items regarding sociodemographic characteristics of the patients, disease-related characteristics, and treatment-related characteristics were filled out by the physicians. The Psoriasis Area Severity Index (PASI), Hospital Anxiety, and Depression Scale, and the Dermatology Life Quality Index were calculated. The rate of adherence and non-adherence to treatment and reasons for non-adherence to treatment were examined. Results: A total of 342 patients with psoriasis were included (182 male/160 female) in the study. The mean age of the patients was 45.9 ± 14.2 years. The average duration of psoriasis was 192 ± 134.7 months. While the rate of adherence to treatment was 57.6%, the rate of non-adherence to treatment was 42.4%. There were no significant differences with respect to adherence to treatment in comparison with oral and injection-therapy groups. The most frequent reasons for non-adherence to treatment were inability to go to the hospital (19.2%), concern about the COVID-19 infection (16.3%), discontinuation of the treatment by the doctor (13.7%), inability to reach the doctor (7.3%), and inability to have access to the medication (7.3%). Conclusion: Adherence to oral and injection therapies was fairly high among our patients with psoriasis during the COVID-19 pandemic. Psoriasis severity and duration of medication use had a negative impact on adherence to treatment

The efficacy and safety of omalizumab in refractory chronspontaneous urticaria: Real-life experience in Turkey

Introduction: This study used real-world data to evaluate the effectiveness and reliability of omalizumab in treating recalcitrant chronic spontaneous urticaria in Turkish patients. Methods: Study data were collected retrospectively from eight tertiary-care hospitals in Turkey. This study included 132 patients with chronic spontaneous urticaria that were resistant to H1 antihistamine treatment in a dose up to four times the licensed dose and were treated with 300 mg/month of omalizumab for 6 months. Results: The mean weekly urticarial activity score (UAS7) after omalizumab treatment improved significantly compared to the pretreatment score (p <0.001). Treatment response was detected primarily in the 1st and 2nd months after treatment. No significant association was observed between omalizumab’s treatment effectiveness and disease-related parameters or laboratory data. The mean dermatology life quality index was 23.12 ± 6.15 before treatment and decreased to 3.55 ± 3.60 6 months after treatment (p <0.001). No side effects were reported in 89.4% (118) of the patients. Conclusion: This study showed that UAS7 decreased significantly and quality of life improved in omalizumab-treated patients. Moreover, treatment effectiveness was mainly observed in the first 2 months after treatment. However, no association was observed between omalizumab treatment effectiveness and disease-related parameters or laboratory data

Evaluation of the efficacy, safety, and side effects of secukinumab in patients with moderate-to-severe psoriasis: Real-world data from a retrospective multicenter study

Background: Clinical studies have demonstrated that IL-17A inhibition with secukinumab is effective for clearing the skin of patients with psoriasis and has a favorable safety profile. Objective: The authors aim to determine whether secukinumab is effective and safe for the treatment of moderate-to-severe chronic psoriasis based on clinical experience with this drug. Method: The authors conducted a multicenter retrospective study in nine referral centers and included patients with psoriasis who had received secukinumab between March 2018 to November 2020. Data on demographic characteristics, Psoriasis Area and Severity Index (PASI) scores, and previous treatments were collected from medical records. Patients were evaluated at 12, 24, and 52 weeks with respect to response to treatment and side effects. Results: In total, 229 patients were recruited for the study. A PASI score improvement of ≥90 points over the baseline was achieved by 79%, 69.8%, and 49.3% of patients at weeks 12, 24, and 52, respectively. The most common adverse events wereCandida infections and fatigue. In total, 74 (32%) patients discontinued treatment by week 52, including due to adverse events, or secondary ineffectiveness. Study limitations: Retrospective design. Conclusions: These findings suggest that secukinumab therapy is reasonably effective in patients with moderate-to-severe psoriasis. Comorbidities and time length of the disease can affect the response to treatment. The rates of adverse events were high in this patient population

Novel C16orf57 mutations in patients with Poikiloderma with Neutropenia: bioinformatic analysis of the protein and predicted effects of all reported mutations

<p>Abstract</p> <p>Background</p> <p>Poikiloderma with Neutropenia (PN) is a rare autosomal recessive genodermatosis caused by <it>C16orf57 </it>mutations. To date 17 mutations have been identified in 31 PN patients.</p> <p>Results</p> <p>We characterize six PN patients expanding the clinical phenotype of the syndrome and the mutational repertoire of the gene. We detect the two novel <it>C16orf57 </it>mutations, c.232C>T and c.265+2T>G, as well as the already reported c.179delC, c.531delA and c.693+1G>T mutations. cDNA analysis evidences the presence of aberrant transcripts, and bioinformatic prediction of C16orf57 protein structure gauges the mutations effects on the folded protein chain.</p> <p>Computational analysis of the C16orf57 protein shows two conserved H-X-S/T-X tetrapeptide motifs marking the active site of a two-fold pseudosymmetric structure recalling the 2H phosphoesterase superfamily. Based on this model C16orf57 is likely a 2H-active site enzyme functioning in RNA processing, as a presumptive RNA ligase.</p> <p>According to bioinformatic prediction, all known <it>C16orf57 </it>mutations, including the novel mutations herein described, impair the protein structure by either removing one or both tetrapeptide motifs or by destroying the symmetry of the native folding.</p> <p>Finally, we analyse the geographical distribution of the recurrent mutations that depicts clusters featuring a founder effect.</p> <p>Conclusions</p> <p>In cohorts of patients clinically affected by genodermatoses with overlapping symptoms, the molecular screening of <it>C16orf57 </it>gene seems the proper way to address the correct diagnosis of PN, enabling the syndrome-specific oncosurveillance.</p> <p>The bioinformatic prediction of the C16orf57 protein structure denotes a very basic enzymatic function consistent with a housekeeping function. Detection of aberrant transcripts, also in cells from PN patients carrying early truncated mutations, suggests they might be translatable. Tissue-specific sensitivity to the lack of functionally correct protein accounts for the main cutaneous and haematological clinical signs of PN patients.</p

The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries.

The contribution of psychological disorders to the burden of skin disease has been poorly explored, and this is a large-scale study to ascertain the association between depression, anxiety, and suicidal ideation with various dermatological diagnoses. This international multicenter observational cross-sectional study was conducted in 13 European countries. In each dermatology clinic, 250 consecutive adult out-patients were recruited to complete a questionnaire, reporting socio-demographic information, negative life events, and suicidal ideation; depression and anxiety were assessed with the Hospital Anxiety and Depression Scale. A clinical examination was performed. A control group was recruited among hospital employees. There were 4,994 participants--3,635 patients and 1,359 controls. Clinical depression was present in 10.1% patients (controls 4.3%, odds ratio (OR) 2.40 (1.67-3.47)). Clinical anxiety was present in 17.2% (controls 11.1%, OR 2.18 (1.68-2.82)). Suicidal ideation was reported by 12.7% of all patients (controls 8.3%, OR 1.94 (1.33-2.82)). For individual diagnoses, only patients with psoriasis had significant association with suicidal ideation. The association with depression and anxiety was highest for patients with psoriasis, atopic dermatitis, hand eczema, and leg ulcers. These results identify a major additional burden of skin disease and have important clinical implications.Peer reviewedFinal Published versio