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Ferwerda M, van Beugen S, van Riel PCLM, van de Kerkhof PCM, de Jong EMGJ, Smit JV, Zeeuwen-Franssen MEJ, Kroft EBM, Visser H, Vonkeman HE, Creemers MCW, van Middendorp H, Evers AWM. Measuring the Therapeutic Relationship in Internet-Based Interventions. PSYCHOTHERAPY AND PSYCHOSOMATICS 2016; 85:47-9. [PMID: 26610272 DOI: 10.1159/000435958] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 06/15/2015] [Indexed: 11/19/2022]
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van de Kerkhof PCM. Values and costs in the management of psoriasis. J DERMATOL TREAT 2016; 27:393-4. [PMID: 27552125 DOI: 10.1080/09546634.2016.1218160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mertens JS, Marsman D, van de Kerkhof PCM, Hoppenreijs EPAH, Knaapen HKA, Radstake TRD, de Jong EMGJ, Seyger MMB. Use of Mycophenolate Mofetil in Patients with Severe Localized Scleroderma Resistant or Intolerant to Methotrexate. Acta Derm Venereol 2016; 96:510-3. [PMID: 26582717 DOI: 10.2340/00015555-2297] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To assess the efficacy and safety of mycophenolate mofetil (MMF) in patients with localized scleroderma (LoS) resistant or intolerant to previous treatment with methotrexate (MTX). A case series of patients with LoS treated with MMF. Outcome was assessed through clinical examination. Adverse events were documented. Seven patients with LoS were treated with MMF. Median age at MMF initiation was 15 years (range 7-74 years). Three patients received MMF due to MTX ineffectiveness and 4 due to MTX intolerance. Disease remission was achieved in 4 patients and maintained in one patient. One patient showed a favourable response, but had to discontinue treatment due to elevated liver enzymes. The remaining patient experienced disease progression. MMF was shown to improve the clinical condition of patients with refractory LoS and may be a relatively safe alternative in patients who are intolerant to MTX.
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Zweegers J, Otero ME, van den Reek JMPA, van Lümig PP, Driessen RJ, Kievit W, Seyger MMB, van de Kerkhof PCM, de Jong EMGJ. Effectiveness of Biologic and Conventional Systemic Therapies in Adults with Chronic Plaque Psoriasis in Daily Practice: A Systematic Review. Acta Derm Venereol 2016; 96:453-8. [PMID: 26537336 DOI: 10.2340/00015555-2276] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The efficacy of biologic or conventional systemic therapies for psoriasis has been shown in randomized controlled trials. Effectiveness, however, has been studied in daily practice cohorts, and no aggregation of effectiveness data is available. This systematic review searched PubMed and EMBASE and summarized the real-world evidence on effectiveness of biologics (adalimumab, etanercept, infliximab and ustekinumab) and conventional systemic therapies (acitretin, cyclosporine, fumarates and methotrexate) for the treatment of plaque psoriasis in adults. Thirty-two studies were included. Few data were available on infliximab, ustekinumab and conventional systemics. Results show that biologics and conventional systemics were effective in real-life treatment of psoriasis, with large ranges in the percentage of patients reaching 75% improvement in psoriasis area and severity index score compared with baseline, especially for etanercept and adalimumab treatment. Combination therapies of biologics with conventional systemics, and dose adjustments of biologics were frequently applied strategies and may explain the large range in improvements between cohorts.
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van Rijsingen MCJ, Seubring I, Grutters JPC, Maessen-Visch MB, Alkemade HAC, van Doorn R, Groenewoud H, van de Kerkhof PCM, van der Wilt GJ, Gerritsen MJP. Real-life Data on Patient Characteristics, Cost and Effectiveness of Field-directed Treatment for Actinic Keratoses: An Observational Study. Acta Derm Venereol 2016; 96:346-50. [PMID: 26280988 DOI: 10.2340/00015555-2216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Actinic keratoses (AK) occur frequently; however, real-life clinical data on personalized treatment choice and costs are scarce. This multicentre one-year observational study investigated patient-characteristics, cost and effectiveness of methylaminolaevulinate photodynamic therapy (MAL-PDT), imiquimod (IMI) and 5-fluorour-acil (5-FU) in patients with AKs on the face/scalp. A total of 104 patients preferred MAL-PDT, 106 preferred IMI and 110 preferred 5-FU. At baseline, significant differences between treatment groups were found; most patients were severely affected (mean 32.5 AK in PDT-group, 20.2 in IMI-group, 22.8 in 5-FU-group). A mean reduction in lesions of 81% after MAL-PDT, 82% after IMI and 88% after 5-FU was found after one year. Annual costs were €1,950 for MAL-PDT, €877 for IMI and €738 for 5-FU. These results show that, compared with clinical trials, in the real-life clinical setting AK patients are usually more severely affected and treatment costs are much higher. Furthermore, patient characteristics are important factors in treatment choice.
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Richters RJH, Hendriks JCM, Uzunbajakava NE, Janssen LD, Falcone D, van Erp PEJ, van de Kerkhof PCM. Responses to sodium dodecyl sulphate as an in vivo human model to study the pathomechanisms underlying sensitive skin. Exp Dermatol 2016; 25:407-9. [PMID: 26896835 DOI: 10.1111/exd.12973] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 12/01/2022]
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Richters RJH, Hoogedoorn L, Uzunbajakava NE, Janssen LD, Tom Nuijs AM, van Erp PEJ, van de Kerkhof PCM. Clinical, biophysical, immunohistochemical, and in vivo reflectance confocal microscopy evaluation of the response of subjects with sensitive skin to home-use fractional non-ablative photothermolysis device. Lasers Surg Med 2016; 48:474-82. [PMID: 26875629 DOI: 10.1002/lsm.22486] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Fractional photothermolysis using professional devices is a well-accepted and a widely used technique for skin rejuvenation. Recently, the technology has also been implemented in devices for home-use. Yet, a subpopulation of consumers exists that reacts excessively to this stimulation and reports "sensitive skin" (SS). OBJECTIVE The goal of this study was to evaluate the response of subjects with SS and NSS to fractional non-ablative photothermolysis to provide additional insights in the pathophysiology of SS. METHODS Subjects with SS and non-sensitive skin (NSS), selected using a proprietary questionnaire were stimulated by applying a home-use fractional non-ablative photothermolysis device. Self-reported perceptions and objective effects were evaluated after 0.5, 8, 24, and 72 hours by clinical, biophysical and immunohistochemical assessment, and in vivo reflectance confocal microscopy (RCM). RESULTS Significantly fewer mast cells were found in SS compared to NSS subjects, 0.5 and 72 hours after stimulus based on tryptase staining, and SS subjects report discomfort more frequently. Immunohistochemical biomarkers revealed new insights in the effects of fractional non-ablative photothermolysis, which were supported by RCM: peri- and interlesional epidermal proliferation, and changes in keratinocyte differentiation. CONCLUSION Previously, we have already reported that SS could be elicited by mechanical and chemical stimuli. Thus, mild yet excessive self-reported perceptions described here supports the hypothesis about existence of generalized skin sensitivity. Furthermore, it supports a view point suggesting involvement of TRPV1 receptors in this phenomenon. While histological evaluation, in line with our previous results points to the role of mast cells in SS, overall, however, fractional non-ablative photothermolysis causes only mild damage, nearly equal in SS and NSS and could be used as an in vivo model for skin regeneration without manipulating the skin barrier. Lasers Surg. Med. 48:474-482, 2016. © 2016 Wiley Periodicals, Inc.
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Lubeek SFK, van der Geer ER, van Gelder MMHJ, van de Kerkhof PCM, Gerritsen MJP. Improving Dermatological Care for Elderly People Living in Permanent Healthcare Institutions: Suggestions from Dutch Dermatologists. Acta Derm Venereol 2016; 96:253-4. [PMID: 26280094 DOI: 10.2340/00015555-2217] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Bartels DJP, van Laarhoven AIM, van de Kerkhof PCM, Evers AWM. Placebo and nocebo effects on itch: effects, mechanisms, and predictors. Eur J Pain 2015; 20:8-13. [PMID: 26417885 DOI: 10.1002/ejp.750] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2015] [Indexed: 12/17/2022]
Abstract
Placebo and nocebo effects have been extensively studied in the field of pain and more recently also on itch. In accordance with placebo research on pain, expectancy learning via verbal suggestion or conditioning has shown to induce placebo and nocebo effects on itch, in which the combination of both procedures seems most promising. Moreover, itch can also be transferred 'contagiously' in which suggestion and social behavioural learning seem to play a role. With regard to predictors of placebo and nocebo responding on itch and contagious itch, preliminary evidence suggests a role for individual psychological characteristics and personality traits regarding negative outcome expectancies. Although findings on placebo and nocebo effects on itch seem comparable to pain, we have only just begun to understand the underlying mechanisms and predictors of placebo and nocebo effects on itch.
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Falcone D, Uzunbajakava NE, Varghese B, de Aquino Santos GR, Richters RJH, van de Kerkhof PCM, van Erp PEJ. Microspectroscopic Confocal Raman and Macroscopic Biophysical Measurements in the in vivo Assessment of the Skin Barrier: Perspective for Dermatology and Cosmetic Sciences. Skin Pharmacol Physiol 2015; 28:307-17. [PMID: 26406586 DOI: 10.1159/000439031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 07/27/2015] [Indexed: 11/19/2022]
Abstract
Skin barrier function, confined to the stratum corneum, is traditionally evaluated using established, noninvasive biophysical methods like transepidermal water loss, capacitance and conductance. However, these methods neither measure skin molecular composition nor its structure, hindering the actual causes of skin barrier change or impairment. At the same time, confocal Raman microspectroscopy (CRS) can directly measure skin molecular composition and structure and has proven itself to be a powerful technique for biomolecular analysis. The aims of this literature review were to evaluate noninvasive biophysical methods in view of CRS and to outline a direction towards more specific and informative skin measurement methods. We address this by investigating, for the first time, the relation between in vivo assessment of the skin barrier using indirect biophysical methods and the actual skin composition and structure as given by CRS, and emphasize the high potential of CRS for dermatology and cosmetic sciences. CRS acceptance in these fields will require close collaboration between dermatologists, skin scientists and spectroscopy experts towards simplifying the technology and creating robust, rapid, easy-to-use and less expensive CRS applications.
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Hendriks AGM, Steenbergen W, Zeeuwen PLJM, Schalkwijk J, Hondebrink E, Klitsie MAJ, Schreurs R, van de Kerkhof PCM, Seyger MMB. Perfusion Intensity Correlates with Expression Levels of Psoriasis-Related Genes and Proteins. Skin Pharmacol Physiol 2015; 28:296-306. [PMID: 26361329 DOI: 10.1159/000381628] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 03/11/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Previous research revealed heterogeneity in the perfusion intensity within clinically homogenous-appearing plaques, without differences in erythema. In addition, an increased perfusion was found within the perilesional skin. This raises the question whether the heterogeneity in perfusion found both inside and outside a lesion influences the expression levels of genes and proteins involved in the pathogenesis of psoriasis. OBJECTIVES To correlate the perfusion intensity to mRNA and protein expression of genes associated with the pathogenesis of psoriasis and to visualize the dynamics of the perfusion intensity over time using laser Doppler perfusion imaging. METHODS Fourteen patients with plaque psoriasis were included. The superficial microcirculation and clinical local scores (single usability metric, SUM, scores) were analysed in one representative lesion every 2 weeks. After 8 weeks 4 biopsies were taken, one from a highly perfused area (hotspot) and one from a low perfusion area (coldspot) of the lesional skin, one biopsy from the highly perfused perilesional skin and one from the distant uninvolved skin. RESULTS Statistically significant differences in mRNA and protein expression, including IL-17 and TBX21/T-Bet, were found between hotspots and coldspots, and between the highly perfused perilesional and the uninvolved skin. Hotspots tend to remain on the same location during 8 weeks of follow-up. CONCLUSIONS Within homogenous-appearing psoriatic plaques, there are remarkable differences in mRNA and protein levels, which are correlated with the perfusion intensity and can be detected by using laser Doppler perfusion imaging. In addition, differences in mRNA and protein expression between the highly perfused perilesional skin and the uninvolved skin were found, indicating that several biological changes occur well before clinical changes become manifest.
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Bachelez H, van de Kerkhof PCM, Strohal R, Kubanov A, Valenzuela F, Lee JH, Yakusevich V, Chimenti S, Papacharalambous J, Proulx J, Gupta P, Tan H, Tawadrous M, Valdez H, Wolk R. Tofacitinib versus etanercept or placebo in moderate-to-severe chronic plaque psoriasis: a phase 3 randomised non-inferiority trial. Lancet 2015; 386:552-61. [PMID: 26051365 DOI: 10.1016/s0140-6736(14)62113-9] [Citation(s) in RCA: 305] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND New therapeutic options are needed for patients with psoriasis. Tofacitinib, an oral Janus kinase inhibitor, is being investigated as a treatment for moderate-to-severe chronic plaque psoriasis. In this study, we aimed to compare two tofacitinib doses with high-dose etanercept or placebo in this patient population. METHODS In this phase 3, randomised, multicentre, double-dummy, placebo-controlled, 12-week, non-inferiority trial, adult patients with chronic stable plaque psoriasis (for ≥12 months) who were candidates for systemic or phototherapy and had a Psoriasis Area and Severity Index (PASI) score of 12 or higher and a Physician's Global Assessment (PGA) of moderate or severe, and had failed to respond to, had a contraindication to, or were intolerant to at least one conventional systemic therapy, were enrolled from 122 investigational dermatology centres worldwide. Eligible patients were randomly assigned in a 3:3:3:1 ratio to receive tofacitinib 5 mg or 10 mg twice daily at about 12 h intervals, etanercept 50 mg subcutaneously twice weekly at about 3-4 day intervals, or placebo. Randomisation was done by a computer-generated randomisation schedule, and all patients and study personnel were masked to treatment assignment. The co-primary endpoints were the proportion of patients at week 12 with at least a 75% reduction in the PASI score from baseline (PASI75 response) and the proportion of patients achieving a PGA score of "clear" or "almost clear" (PGA response), analysed in the full analysis set (all patients who were randomised and received at least one dose of study drug). This study is registered with ClinicalTrials.gov, number NCT01241591. FINDINGS Between Nov 29, 2010, and Sept 13, 2012, we enrolled 1106 eligible adult patients with chronic plaque psoriasis and randomly assigned them to the four treatment groups (330 to tofacitinib 5 mg twice daily, 332 to tofacitinib 10 mg twice daily, 336 to etanercept 50 mg twice weekly, and 108 to placebo). Of these patients, 1101 actually received their assigned study medication (329 in the tofactinib 5 mg group, 330 in the tofacitinib 10 mg group, 335 in the etanercept group, and 107 in the placebo group). At week 12, PASI75 responses were recorded in 130 (39·5%) of 329 patients in the tofacitinib 5 mg group, 210 (63·6%) of 330 in the tofacitinib 10 mg group, 197 (58·8%) of 335 in the etanercept group, and six (5·6%) of 107 in the placebo group. A PGA response was achieved by 155 (47·1%) of 329 patients in the tofacitinib 5 mg group, 225 (68·2%) of 330 in the tofacitinib 10 mg group, 222 (66·3%) of 335 in the etanercept group, and 16 (15·0%) of 107 in the placebo group. The rate of adverse events was similar across the four groups, with serious adverse events occurring in seven (2%) of 329 patients in the tofacitinib 5 mg group, five (2%) of 330 in the tofacitinib 10 mg group, seven (2%) of 335 in the etanercept group, and two (2%) of 107 in the placebo group. Three (1%) of 329 patients in the tofacitinib 5 mg group, ten (3%) of 330 in the tofacitinib 10 mg group, 11 (3%) of 335 in the etanercept group, and four (4%) of 107 patients in the placebo group discontinued their assigned treatment because of adverse events. INTERPRETATION In patients with moderate-to-severe plaque psoriasis, the 10 mg twice daily dose of tofacitinib was non-inferior to etanercept 50 mg twice weekly and was superior to placebo, but the 5 mg twice daily dose did not show non-inferiority to etanercept 50 mg twice weekly. The adverse event rates over 12 weeks were similar for tofacitinib and etanercept. This study indicates that in the future tofacitinib could provide a convenient and well-tolerated therapeutic option for patients with moderate-to-severe plaque psoriasis. FUNDING Pfizer Inc.
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Lubeek SFK, van der Geer ER, van Gelder MMHJ, Koopmans RTCM, van de Kerkhof PCM, Gerritsen MJP. Current Dermatologic Care in Dutch Nursing Homes and Possible Improvements: A Nationwide Survey. J Am Med Dir Assoc 2015; 16:714.e1-6. [PMID: 26059629 DOI: 10.1016/j.jamda.2015.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 04/24/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To assess the provision and need of dermatologic care among Dutch nursing home patients and to obtain recommendations for improvement. DESIGN Cross-sectional nationwide survey. SETTING All 173 nursing home organizations in the Netherlands. PARTICIPANTS Physicians working in nursing homes. MEASUREMENTS Web-based questionnaire concerning the burden of skin diseases in nursing home patients, diagnostic procedures and therapy, collaboration with dermatologists, physicians' level of education, and suggestions for improvement. RESULTS A total of 126 (72.8%) nursing home organizations, with 1133 associated physicians participated in our study and received the questionnaire. A total of 347 physicians (30.6%) completed the questionnaire. Almost all respondents (99.4%) were recently confronted with skin diseases, mostly (pressure) ulcers, eczema, and fungal infections. Diagnostic and treatment options were limited because of a lack of availability and experience of the physicians. More live consultation of dermatologists was suggested as being important to improve dermatologic care. Other suggestions were better education, more usage of telemedicine applications, and better availability of diagnostic and/or treatment procedures like cryotherapy. CONCLUSION Physicians in nursing homes are frequently confronted with skin diseases. Several changes in organization of care and education are expected to improve dermatologic care in nursing home patients.
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van Beugen S, Ograczyk A, Ferwerda M, Smit JV, Zeeuwen-Franssen MEJ, Kroft EBM, de Jong EMGJ, Zalewska-Janowska A, Donders AR, van de Kerkhof PCM, van Middendorp H, Evers AWM. Body attention, ignorance and awareness scale: assessing relevant concepts for physical and psychological functioning in psoriasis. Acta Derm Venereol 2015; 95:444-50. [PMID: 25270666 DOI: 10.2340/00015555-1977] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A certain level of attention to bodily signals may be adaptive in the management of chronic skin conditions, as a lack of attention may lead to inadequate self-care behaviour and, consequently, may affect functioning and treatment outcomes. The purpose of this study was to develop a body awareness questionnaire and to investigate its psychometric properties and physical and psychological correlates in a cross-sectional study in patients with psoriasis (n = 475). The 16-item Body Attention, Ignorance and Awareness Scale demonstrated a 3-factor structure that could be interpreted as body ignorance, body attention, and body awareness (Cronbach's α of 0.73, 0.74, and 0.68, respectively). Higher body ignorance was significantly related to more physical symptoms and worse psychological functioning. Body attention and body awareness showed small significant correlations with coping and personality. Given the negative influence of impaired psychological functioning on treatment outcomes, it may be clinically important to screen for theses constructs of body awareness in chronic skin conditions.
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van de Kerkhof PCM. How to personalize the treatment of psoriasis with biologics? J DERMATOL TREAT 2015; 26:101-2. [DOI: 10.3109/09546634.2014.880397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Koetsier MIA, van de Kerkhof PCM. “Patient-centered treatment” for mild-to-moderate psoriasis. J DERMATOL TREAT 2015; 26:1-6. [DOI: 10.3109/09546634.2015.1011301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Meeuwis KAP, de Hullu JA, IntHout J, Hendriks IMP, Sparreboom EE, Massuger LFAG, van de Kerkhof PCM, van Rossum MM. Genital psoriasis awareness program: physical and psychological care for patients with genital psoriasis. Acta Derm Venereol 2015; 95:211-6. [PMID: 24806592 DOI: 10.2340/00015555-1885] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Genital psoriasis is a neglected manifestation of psoriasis, although it affects numerous patients and has major effects on sexual quality of life (SQoL). We aimed to assess the value of specialised care for patients with genital psoriasis. Patients were treated for at least one year at a specialised research outpatient clinic with extensive attention for genital lesions and SQoL. The genital lesions were treated according to a stepwise algorithm. First follow-up was planned after 6 weeks; subsequent follow-up visits were scheduled every 3 months. At every visit, psoriasis severity and SQoL were measured with validated tools. Differences in scores between visits were analysed by a mixed model for repeated measures. Forty-two patients were included (M:F = 25:17). All objective and subjective genital psoriasis severity and QoL parameters improved significantly within the first follow-up period of approximately 6 weeks. In female patients, SQoL also significantly improved. In conclusion, genital psoriasis can relatively easy be treated within limited time exposure, resulting in significant improvement of QoL. Prompt and simple adjustments in the provided care are enough to accomplish this.
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van de Kerkhof PCM. Dermatology: Where are We Coming from and Where are We Going to? Front Med (Lausanne) 2015; 1:40. [PMID: 25593913 PMCID: PMC4292053 DOI: 10.3389/fmed.2014.00040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 10/07/2014] [Indexed: 11/13/2022] Open
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Keijsers RRMC, Joosten I, Hendriks AGM, Koenen HJPM, van Erp PEJ, van de Kerkhof PCM. Balance of Treg versus T-effector cells during systemic treatment with adalimumab and topical treatment with calcipotriol-betamethasone dipropionate ointment. Exp Dermatol 2014; 24:65-7. [PMID: 25355140 DOI: 10.1111/exd.12575] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2014] [Indexed: 11/28/2022]
Abstract
Diminished suppressive capacity of regulatory T cells (Treg) has been demonstrated in blood and in lesional skin of psoriatic patients. Treatment with anti-TNFα restored the number and function of circulating Treg in psoriasis. We aimed to study Treg in the skin of psoriatic patients undergoing topical treatment with calcipotriol-betamethasone dipropionate (CBD) ointment (n = 12) or systemic treatment with anti-TNFα agent adalimumab (n = 10). Skin biopsies were collected from patients with chronic plaque psoriasis who responded to the above-mentioned treatments with a SUM-score improvement of at least 50% (at the end of treatment). Biopsies were processed for immunohistochemistry. As Treg function is associated with a numerical balance between Treg and effector T cells, Foxp3/CD4 ratios were calculated. It appeared that both treatments cause a significant decrease in the presence of Foxp3+ cells. However, in patients that were treated with CBD ointment, we observed lower Foxp3/CD4 ratios after 8 weeks of treatment compared to baseline (t = 0: 0.41 ± 0.08; t = 8: 0.22 ± 0.04, P = 0.033), whereas in patients who were treated with adalimumab we observed an increase of the Foxp3/CD4 ratios after 1.5 and 16 weeks of treatment compared to baseline (t = 0: 0.25 ± 0.04; t = 1.5: 0.32 ± 0.06; t = 16: 0.49 ± 0.10, P = 0.15). Based on Foxp3/CD4 ratios, we can conclude that adalimumab treated skin differs from CBD treated skin with regard to the anti-inflammatory/inflammatory balance. We suggest that, in contrast to CBD ointment, adalimumab favours local Treg function in the skin.
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Oostveen AM, Bergboer JGM, van de Kerkhof PCM, Zeeuwen PLJM, de Jong EMGJ, Schalkwijk J, Seyger MMB. Genotype-phenotype correlations in a prospective cohort study of paediatric plaque psoriasis: lack of correlation between HLA-C*06 and family history of psoriasis. Acta Derm Venereol 2014; 94:667-71. [PMID: 24791935 DOI: 10.2340/00015555-1810] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aims to investigate associations between observed clinical parameters and known genetic risk factors of psoriasis in a well-defined prospective cohort of paediatric patients with plaque psoriasis (n = 151). Significant associations were found for paediatric-onset psoriasis with ERAP1 (p = 0.002), IL23R (p = 0.01), LCE3C_LCE3B-del (p = 0.00049) and HLA-C*06 (p = 3.15 × 10(-30)). Psoriasis severity was associated with the single nucleotide polymorphisms tagging IFIH1 and ERAP1 (p < 0.05). An onset before 10 years of age was associated with IL12B (p = 0.02). Nail psoriasis was more often seen in HLA-C*06-negative patients (p = 0.008). Remarkably, family history is clearly not associated with HLA-C*06 in this specific group. The large proportion of patients with a positive family history in HLA-C*06 negative patients (and the lack of correlation between the two) indicates that other genes, either alone or interaction between two or more genes, may have significant effects on heritability.
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de Brouwer SJM, van Middendorp H, Stormink C, Kraaimaat FW, Joosten I, Radstake TRDJ, de Jong EMGJ, Schalkwijk J, Donders ART, Eijsbouts A, van de Kerkhof PCM, van Riel PLCM, Evers AWM. Immune responses to stress in rheumatoid arthritis and psoriasis. Rheumatology (Oxford) 2014; 53:1844-8. [PMID: 24850878 DOI: 10.1093/rheumatology/keu221] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Stress is one of the factors that may exacerbate the progression of chronic inflammatory diseases such as RA and psoriasis. We exploratively compared the effects of acute stress on levels of circulating cytokines involved in disease progression and/or the stress response in patients with RA, patients with psoriasis and healthy subjects. METHODS Patients with RA, patients with psoriasis and healthy controls underwent a standardized psychosocial stress test (Trier Social Stress Test). Levels of circulating cytokines (IL-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IFN-γ and TNF-α) were measured before and after the stress test. RESULTS The baseline levels of all cytokines, except IL-8, were significantly higher in patients with RA. After correction for baseline levels, patients with RA showed higher stress-induced levels of IL-1β and IL-2 than patients with psoriasis and healthy controls. CONCLUSION The results suggest that patients with RA have a different immune response to stress than patients with psoriasis or healthy controls. More needs to be learned about the complex interaction between stress, immune parameters and chronic inflammation.
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van den Eijnde WAJ, Peppelman M, Lamers EAD, van de Kerkhof PCM, van Erp PEJ. Understanding the Acute Skin Injury Mechanism Caused by Player-Surface Contact During Soccer: A Survey and Systematic Review. Orthop J Sports Med 2014; 2:2325967114533482. [PMID: 26535330 PMCID: PMC4555542 DOI: 10.1177/2325967114533482] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Superficial skin injuries are considered minor, and their incidence is probably underestimated. Insight into the incidence and mechanism of acute skin injury can be helpful in developing suitable preventive measures and safer playing surfaces for soccer and other field sports. Purpose: To gain insight into the incidence and severity of skin injuries related to soccer and to describe the skin injury mechanism due to player-surface contact. Study Design: Systematic review; Level of evidence, 4. Methods: The prevention model by van Mechelen et al (1992) combined with the injury causation model of Bahr and Krosshaug (2005) were used as a framework for the survey to describe the skin injury incidence and mechanism caused by player-surface contact. Results: The reviewed literature showed that common injury reporting methods are mainly based on time lost from participation or the need for medical attention. Because skin abrasions seldom lead to absence or medical attention, they are often not reported. When reported, the incidence of abrasion/laceration injuries varies from 0.8 to 6.1 injuries per 1000 player-hours. Wound assessment techniques such as the Skin Damage Area and Severity Index can be a valuable tool to obtain a more accurate estimation of the incidence and severity of acute skin injuries. Conclusion: The use of protective equipment, a skin lubricant, or wet surface conditions has a positive effect on preventing abrasion-type injuries from artificial turf surfaces. The literature also shows that essential biomechanical information of the sliding event is lacking, such as how energy is transferred to the area of contact. From a clinical and histological perspective, there are strong indications that a sliding-induced skin lesion is caused by mechanical rather than thermal injury to the skin.
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Hendriks AGM, Keijsers RRMC, Seyger MMB, van Erp PEJ, van de Kerkhof PCM. Are newly discovered drivers of immune-mediated skin disorders expressed in normal skin regenerating from standardized surface injury? Dermatology 2014; 228:255-60. [PMID: 24603530 DOI: 10.1159/000358008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 12/15/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In healthy skin, tape stripping induces a transient wave of histological changes resembling immune-mediated skin diseases, such as psoriasis. The response to surface trauma may harbor mechanisms which are also relevant to the development of Koebner-positive skin disorders. However, studies on newly discovered drivers of inflammation in regenerative skin are lacking. METHODS The course of epidermal proliferation and keratinization as well as key representatives of innate and acquired immunity were studied during the first 72 h after tape stripping. RESULTS Epidermal rupture rapidly activates various epidermal processes, which remain upregulated for 72 h. Elastase+ and IL-17+ cells dominate the acute phase and their numbers decrease rapidly thereafter. The number of T-Bet+ cells increases more gradually, reaching maximum levels several hours later when the other cell types decrease. CONCLUSIONS This model permits investigations on the sequence of crucial inflammatory processes set off by cutaneous injury, which are presumed to play a role within the pathogenesis of immune-mediated skin diseases exhibiting the Koebner phenomenon.
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Oostveen AM, Jong EMGJ, Evers AWM, Donders AR, van de Kerkhof PCM, Seyger MMB. Reliability, responsiveness and validity of Scalpdex in children with scalp psoriasis: the Dutch study. Acta Derm Venereol 2014; 94:198-202. [PMID: 24002532 DOI: 10.2340/00015555-1622] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This aim of this study was to validate the Scalpdex, a quality of life questionnaire for adults with scalp dermatitis, in children with scalp psoriasis. The reliability, responsiveness and validity of the 3 scales (symptoms, functioning and emotions) of this 22-item questionnaire were analysed in a cohort of children with scalp psoriasis (age range 6-18 years). A total of 94 children completed the questionnaire once, and 53 children a second time, after treatment of their scalp psoriasis. The Children's Scalpdex in Psoriasis (CSP) demonstrated reliability with internal consistency (Cronbach's α, 0.69-0.91). The CSP scales proved sensitive to change in the expected direction for children whose scalp psoriasis improved. Moderate effect sizes were observed between both visits for all 3 scales of the CSP (Cohen's d, 0.44-0.58). In conclusion, the CSP is a reliable, responsive and valid questionnaire, which is the first to illustrate the specific influence of scalp psoriasis on quality of life in children.
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van der Velden HMJ, Klaassen KMG, van de Kerkhof PCM, Pasch MC. Invited reply to "Possible reconsideration of the Nail Psoriasis Severity Index (NAPSI) score". J Am Acad Dermatol 2013; 69:1054. [PMID: 24238164 DOI: 10.1016/j.jaad.2013.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 07/25/2013] [Indexed: 10/26/2022]
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