Comparative Study of Quality of Life and Psychological Aspects in Patients with Psoriasis and Hidradenitis Suppurativa

Psoriasis and hidradenitis suppurativa are two common dermatological diseases that affect physical, social, and psychological aspects of the patients’ lives. The aim of this study was to compare quality of life, depression, anxiety, self-esteem, and loneliness in patients with psoriasis and hidradenitis suppurativa. One hundred and eight patients with psoriasis, 113 patients with hidradenitis suppurativa and 116 healthy controls were included in the study. The quality of life, depression, anxiety, and loneliness of the patients as well as their self-esteem were assessed using the Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS), the UCLA loneliness Scale (UCLA-Version 3) and the Rosenberg’s Self-esteem Scale (RSES), respectively. Patients with psoriasis (12.77±4.43) reported a higher mean impairment in DLQI than patients with hidradenitis suppurativa (11.10±6.53, P=0.028), in the univariate comparisons. Patients with psoriasis presented statistically significantly higher levels of anxiety and depression than both patients with hidradenitis suppurativa and healthy controls, while patients with hidradenitis suppurativa also had higher anxiety and depression compared with healthy controls. Patients with psoriasis (46.31±6.36) reported statistically significantly higher loneliness than both patients with hidradenitis suppurativa (43.18±7.40) and controls (40.42±4.41), while the patients with hidradenitis suppurativa also presented higher loneliness in comparison with controls. Lower levels of self-esteem were found in patients with psoriasis (15.08±3.11) compared with both patients with hidradenitis suppurativa (18.89±1.69) and controls (20.25±2.60), while patients with hidradenitis suppurativa also had lower self-esteem than controls. Significant levels of depression, anxiety, and impaired quality of life were strongly associated with disease severity. When patients with mild disease were compared, those with psoriasis presented with both higher levers of loneliness and lower scores for quality of life. Although both psoriasis and hidradenitis suppurativa are associated with impaired quality of life and psychological aspects, significantly worse scores were recorded in patients with psoriasis

Comparative Study of Quality of Life and Psychological Aspects in Patients with Psoriasis and Hidradenitis Suppurativa

Psoriasis and hidradenitis suppurativa are two common dermatological diseases that affect physical, social, and psychological aspects of the patients’ lives. The aim of this study was to compare quality of life, depression, anxiety, self-esteem, and loneliness in patients with psoriasis and hidradenitis suppurativa. One hundred and eight patients with psoriasis, 113 patients with hidradenitis suppurativa and 116 healthy controls were included in the study. The quality of life, depression, anxiety, and loneliness of the patients as well as their self-esteem were assessed using the Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS), the UCLA loneliness Scale (UCLA-Version 3) and the Rosenberg’s Self-esteem Scale (RSES), respectively. Patients with psoriasis (12.77±4.43) reported a higher mean impairment in DLQI than patients with hidradenitis suppurativa (11.10±6.53, P=0.028), in the univariate comparisons. Patients with psoriasis presented statistically significantly higher levels of anxiety and depression than both patients with hidradenitis suppurativa and healthy controls, while patients with hidradenitis suppurativa also had higher anxiety and depression compared with healthy controls. Patients with psoriasis (46.31±6.36) reported statistically significantly higher loneliness than both patients with hidradenitis suppurativa (43.18±7.40) and controls (40.42±4.41), while the patients with hidradenitis suppurativa also presented higher loneliness in comparison with controls. Lower levels of self-esteem were found in patients with psoriasis (15.08±3.11) compared with both patients with hidradenitis suppurativa (18.89±1.69) and controls (20.25±2.60), while patients with hidradenitis suppurativa also had lower self-esteem than controls. Significant levels of depression, anxiety, and impaired quality of life were strongly associated with disease severity. When patients with mild disease were compared, those with psoriasis presented with both higher levers of loneliness and lower scores for quality of life. Although both psoriasis and hidradenitis suppurativa are associated with impaired quality of life and psychological aspects, significantly worse scores were recorded in patients with psoriasis

Combination of 30% salicylic acid peels and mechanical comedo extraction for the treatment of Favre-Racouchot syndrome

No abstract available</p

Bevacizumab-associated sudden onset of multiple monomorphic comedones on the scalp successfully treated with 30% salicylic acid peels.

Bevacizumab is a humanized monoclonal antibody against vascular endothelial factor (VEGF) that targets tumor cell angiogenesis and proliferation. Although it is usually well tolerated, many side-effects have been reported. These include hypertension, bleeding, and thromboembolic events among others. Drug-associated cutaneous adverse effects are less common and include itching, exfoliative dermatitis, and acneiform eruptions. A man with bevacizumab-associated monomorphic skin eruption successfully was treated with 30% salicylic acid peels. To the author’s knowledge, this is the first report of open comedones with no further inflammatory acne lesions that developed in a patient treated with bevacizumab. Complete remission of the rash was achieved after performing 30% salicylic peels, and the patient continued the chemotherapy as planned with no need of either dose reduction or discontinuation of bevacizumab. </p

Psychological burden and quality of life in patients with psoriasis

Psoriasis is a chronic, scaling inflammatory dermatosis. The marked visible appearance of the lesions have a negative impact on body image that leads to decreased self-esteem, hence seriously compromising the quality of life of the patient.The clinical picture critically affects the social well-being of the patient since the disease is commonly misunderstood and feared by the social environment as being contagious. The patient feels stigmatized, which further intensifies their lack of self-confidence and self-esteem. Feelings of shame and guilt increase the tendency toward suicidal ideation.At the social level, the stigma, social rejection, feelings of shame, embarrassment and lack of confidence provoked by the disease often lead to the discontinuation of daily activities of daily living, and social withdrawal.As concerns mental impairment, a correlation has been found between mental stress and the clinical severity of symptoms: the more mentally affected the patient, the more severe the dermatologic lesions. Similarly, stressful life events constitute a major risk for the occurrence and recurrence, exacerbating the severity and duration of the symptoms. Depression and anxiety can worsen the disease or cause resistance to treatment or the patient to neglect it, which in turn can lead to expensive and prolonged treatment. Not least, the disease itself contributes to anxiety, depression and psychological stress, thus creating a "vicious circle" that is difficult to manage. Correspondingly, the risk of mental events is also higher in younger patients for whom body image plays an equally significant role. The severity of the disease, side effects of therapy and mental disorders are among the causes that have been attributed to sexual dysfunction reported by some psoriatic patients.The sample of this study consisted of a total of 216 participants: 108 patients with psoriasis (54 men and 54 women) and an equal number of healthy control subjects (54 men and 54 women). Patients found to have high levels of anxiety, depression and low self-esteem compared to healthy controls. Men patients had higher rates of social isolation than women. The clinical severity of the disease was found to significantly affect the psychosocial profile of patients.Psoriasis is a distressing, recurrent disorder that significantly impairs quality of life. Therefore, the recognition and future management of psoriasis may require the involvement of multi-disciplinary teams to manage the physical, psychological and social aspects of the condition, as is the case for systemic, long-term conditions.Η ψωρίαση είναι μια χρόνια φλεγμονώδης δερματοπάθεια η οποία, λόγω των εμφανών δερματικών αλλοιώσεων, έχει επίπτωση στην εικόνα του σώματος, με αποτέλεσμα τη μείωση της αυτοεκτίμησης και τη δημιουργία σοβαρών προβλημάτων στην ποιότητα ζωής των ασθενών. Η κλινική εικόνα της νόσου προκαλεί επιφυλακτική και αρνητική στάση από τον κοινωνικό περίγυρο, γεγονός που επιτείνεται όταν λόγω άγνοιας η νόσος θεωρείται λανθασμένα ως μεταδοτική, με αποτέλεσμα οι ασθενείς να βιώνουν κοινωνικό στίγμα, ή και να αυτοστιγματίζονται. Το γεγονός αυτό επιτείνει ακόμα περισσότερο τη μείωση της αυτοπεποίθησης και της αυτοεκτίμησης τους, προκαλεί αισθήματα ντροπής και ενοχής και αυξάνει τα ποσοστά αυτοκτονικού ιδεασμού.Σε κοινωνικό επίπεδο ο στιγματισμός, η κοινωνική απόρριψη, τα συναισθήματα ντροπής, αμηχανίας και έλλειψης εμπιστοσύνης που νοιώθουν λόγω της ασθενείας, οδηγούν συχνά στην διακοπή των δραστηριοτήτων της καθημερινής ζωής καθώς και στην κοινωνική απόσυρση. Όσον αφορά την ψυχική επιβάρυνση, έχει βρεθεί συσχέτιση μεταξύ του ψυχικού στρες και της κλινικής βαρύτητας των συμπτωμάτων της ψωρίασης, καθώς οι ασθενείς με σημαντική ψυχική δυσφορία έχουν σοβαρότερες δερματολογικές βλάβες, ενώ παράλληλα τα στρεσογόνα γεγονότα της ζωής αποτελούν σημαντικό κίνδυνο για την εμφάνιση, την υποτροπή, τη βαρύτητα και τη διάρκεια των συμπτωμάτων. Η κατάθλιψη και το άγχος μπορούν να επιδεινώσουν την νόσο ή να προκαλέσουν αντίσταση στη θεραπεία ή παραμέληση αυτής, οδηγώντας τον ασθενή σε ακριβότερες και μακροπρόθεσμες θεραπείες. Αλλά και η ίδια η νόσος συμβάλλει στη δημιουργία άγχους, κατάθλιψης και ψυχικού στρες και έτσι δημιουργείται «φαύλος κύκλος» που δύσκολα αντιμετωπίζεται. Επίσης, ο κίνδυνος εμφάνισης ψυχικών εκδηλώσεων είναι αυξημένος σε νεότερους ασθενείς, στους οποίους η εικόνα του σώματος παίζει μεγαλύτερο ρόλο. Η βαρύτητα της νόσου, οι παρενέργειες της θεραπείας και οι ψυχικές διαταραχές είναι μερικοί από τους λόγους που μπορούν να οδηγήσουν τους ασθενείς με ψωρίαση σε σεξουαλική δυσλειτουργία. Το δείγμα της παρούσας έρευνας αποτέλεσαν συνολικά 216 συμμετέχοντες: 108 ασθενείς με ψωρίαση (54 άντρες και 54 γυναίκες) και ισάριθμους υγιείς μάρτυρες (54 άντρες και 54 γυναίκες). Οι ασθενείς βρέθηκαν να έχουν υψηλά επίπεδα άγχους, κατάθλιψης και χαμηλή αυτοεκτίμηση συγκριτικά με τους υγιείς μάρτυρες. Οι άντρες ασθενείς παρουσίασαν μεγαλύτερα ποσοστά κοινωνικής απομόνωσης συγκριτικά με τις γυναίκες. Η κλινική βαρύτητα της νόσου βρέθηκε να επηρεάζει σημαντικά το ψυχοκοινωνικό προφίλ των ασθενών. Η ψωρίαση είναι μια υποτροπιάζουσα δερματοπάθεια που επηρεάζει σημαντικά την ποιότητα ζωής των ασθενών. Έτσι, η αναγνώριση και μελλοντική διαχείριση της ψωρίασης μπορεί να απαιτεί την συμμετοχή πολλών ιατρικών ειδικοτήτων προκειμένου να διεκπεραιώσουν διάφορες εκφάνσεις της νόσου

Psoriasis: investigation of T-lymphocytes in immunological disorders of patients with psoriasis

Psoriasis is one of the most common immune-mediated chronic inflammatory skin diseases, in which proinflammatory cytokines, such as, TNF-α, IL-17, IL-1β, IL-6 and IL-22 play an important pathogenetic role.-The aim of this study is to assess whether proinflammatory cytokines TNF-α, IL-17, IL-1β, IL-6 and IL-22 are released systemically during psoriasis, arguing for a generalized inflammatory reaction. Peripheral blood mononuclear cells (PBMCs) were isolated from 30 patients with psoriasis and from 30 healthy volunteers. Cytokine production was assessed in supernatants after stimulation of PBMCs with microbial stimuli by an enzyme immunoassay. In addition, flow cytometry was used to determine the subsets of monocytes involved and-the intracellular TNF-α production in monocytes. IL-17 levels were-significantly higher in supernatants of PBMCs of psoriatic patients compared to controls after stimulation with PHA (p= 0.042).TNF-α production was-significantly higher in cells of psoriatic patients compared to controls after-stimulation with all stimuli.-A statistically significant difference was observed between-patients and controls for CD14+/CD16+ monocytes (p<0.0001) and CD14-/CD16+ monocytes-(p=0.002). TNF-α produced by monocytes and the absolute counts of CD14-/CD16+ monocytes were greater in psoriatic patients compared to healthy controls.-There is evidence that this subpopulation may be responsible for the increased TNF-α production by monocytes.Η ψωρίαση είναι μία χρόνια φλεγμονώδης δερματοπάθεια, στην οποία οι προφλεγμονώδεις κυτοκίνες, όπως TNF-α, IL-17, IL-1β, IL-6 και IL-22 παίζουν σημαντικό ρόλο στην παθογένεια της. Ο σκοπός αυτής της μελέτης είναι να εκτιμήσει κατά πόσον οι προφλεγμονώδεις κυτοκίνες TNF-α, IL-17, IL-1β,IL-6 και IL-22 απελευθερώνονται συστηματικά κατά τη διάρκεια της ψωρίασης, υποστηρίζοντας μια γενικευμένη φλεγμονώδη αντίδραση. Μονοπύρηνα κύτταρα περιφερικού αίματος (PBMCs) απομονώθηκαν από 30 ασθενείς με ψωρίαση και από 30 υγιείς μάρτυρες. Η παραγωγή της κυτοκίνης εκτιμήθηκε στα υπερκείμενα μετά από διέγερση των PBMCs με μικροβιακούς διεγέρτες και μέτρησή της με την μέθοδο Elisa. Επιπλέον, η κυτταρομετρία ροής χρησιμοποιήθηκε για τον προσδιορισμό των υποσυνόλων των μονοκυττάρων που εμπλέκονται και την παραγωγή ενδοκυτταρικού ΤΝF-α στα μονοκύτταρα. Τα επίπεδα της IL-17 ήταν σημαντικά υψηλότερα στα υπερκείμενα των PBMCs των ψωριασικών ασθενών σε σύγκριση με τους μάρτυρες μετά από διέγερση με ΡΗΑ (p=0,042). Ο TNF-α ήταν στατιστικώς σημαντικά υψηλότερος στα κύτταρα των ψωριασικών ασθενών σε σύγκριση με τους μάρτυρες μετά από διέγερση με όλους τους διεγέρτες. Στατιστικά σημαντική διαφορά παρατηρήθηκε μεταξύ των ασθενών και των μαρτύρων για τα CD14+/CD16+ μονοκύτταρα (p <0,0001) και τα CD14-/CD16+ μονοκύτταρα (p = 0,002). Ο ΤΝF-α που παράγεται από τα μονοκύτταρα και τον απόλυτο αριθμό των CD14-/CD16+ μονοκυττάρων ήταν μεγαλύτερος στους ψωριασικούς ασθενείς σε σύγκριση με υγιείς μάρτυρες. Υπάρχουν ενδείξεις ότι αυτός ο υποπληθυσμός μπορεί να είναι υπεύθυνος για την αυξημένη παραγωγή ΤΝF-α από τα μονοκύτταρα

Genital vulvar lichen sclerosus in monozygotic twin women: a case report and review of the literature

Lichen sclerosus et atrophicus is a skin disease of multifactorial etiology which appears in patients with genetic or hormonal predisposition and autoimmune disease. Genetic predisposition is suggested by familial reports of the disease which involve twins, siblings, and mother-daughter/son series. This is a report of the occurrence of lichen sclerosus et atrophicus in monozygotic twin women, suggesting that inheritance is of relevance in the etiology of this disease

Familial Kaposi’s Sarcoma: A Report of Five Cases from Greece

Introduction. Familial cases of Kaposi’s sarcoma have rarely been reported. Kaposi’s sarcoma is not uncommon in Greece; its incidence is estimated at 0.20 per 100.000 habitants, showing an increased predominance in the Peloponnese, in Southern Greece. Case Report. We describe five cases of familial clustering of KS originating from Greece. Discussion. The pathogenesis of familial Kaposi’s sarcoma is still far from being completely understood. Genetic, environmental, and infectious factors have been incriminated