Method of assessing involved facial areas: rule of fours

Relation between the Peripherofacial Psoriasis and Scalp Psoriasis

BACKGROUND

Facial involvement of psoriasis is known to be one of the clinical manifestations that indicate the severity of the psoriasis and thought to be more closely associated with certain distribution. Centrofacial (CF) psoriasis has been suggested to be related with severity of systemic disease while peripherofacial (PF) psoriasis has been thought to have connection with scalp psoriasis.

OBJECTIVE

To analyze the epidemiologic characteristics, clinical features and subjective feelings of patients with facial psoriasis and to find out relationship between scalp psoriasis and facial involvement according to the facial types.

METHODS

One hundred nineteen facial psoriasis patients were categorized into 3 types according to the distribution: PF type, CF type and mixed facial (MF) type. Onset and duration of facial and scalp psoriasis, and their relationship were questioned. Severity and extent of psoriasis on whole body, face, and scalp were rated by clinicians.

RESULTS

There was no significant difference of whole body psoriasis area and severity index (PASI) and body surface area (BSA) score but scalp PASI and BSA was much higher in PF psoriasis compared to CF psoriasis (scalp PASI, 17.9 vs. 10.1; p=0.005) (scalp BSA, 40.9 vs. 22.2; p=0.002). According to the questionnaire, patient's objective feeling about the spreading of scalp lesion to facial area was markedly more prominent in the patients with peripheral involvement (PF+MF, 90.1%; CF, 54.2%; p<0.0001).

CONCLUSION

Among subtypes of facial psoriasis, PF psoriasis is closely associated with spreading of scalp lesion into the face rather than reflecting the disease severity.

Relation between pH in the Trunk and Face: Truncal pH Can Be Easily Predicted from Facial pH

BACKGROUND

The clinical symptoms of facial and truncal acne differ. Skin surface acidity (pH), which is affected by sebum secretions, reflects the different clinical characteristics of the face and trunk. However, no studies have been conducted on truncal sebum production and skin pH.

OBJECTIVE

We evaluated the differences and relationship between pH values of the face and trunk. We also evaluated the relationship between pH and the quantity of sebum produced in the trunk.

METHODS

A total of 35 female patients clinically diagnosed with truncal acne were included. We measured pH on the face and truncal area using the Skin-pH-Meter PH 905®. We measured truncal sebum secretions using the Sebumeter SM 815®. Statistical analysis was performed to evaluate the correlations and differences between pH and sebum.

RESULTS

Facial pH was significantly higher than chest and back pH values. The correlation between pH on the trunk and the face was significant. We used linear regression equations to estimate truncal pH using only measured pH from the chin. There was no significant relationship between truncal sebum secretion and pH.

CONCLUSION

This was the first study that evaluated the differences and correlations between facial and truncal pH. We found that facial pH can predict truncal pH. In addition, we conclude that differences in pH and sebum secretion between the face and trunk are one of the reasons for differences in acne symptom at those sites.

Facial Psoriasis Log-based Area and Severity Index: A valid and reliable severity measurement method detecting improvement of facial psoriasis in clinical practice settings

Facial psoriasis is often observed in moderate to severe degrees of psoriasis. While we previously demonstrated construct validity of the facial Psoriasis Log-based Area and Severity Index (fPLASI) system for the cross-sectional evaluation of facial psoriasis, its reliability and accuracy to detect clinical improvement has not been confirmed yet. The aim of this study is to analyze whether the fPLASI properly represents the range of improvement for facial psoriasis compared with the existing facial Psoriasis Area and Severity Index (fPASI) after receiving systemic treatments in clinical practice settings. The changing severity of facial psoriasis for 118 patients was calculated by the scales of fPASI and fPLASI between two time points after systemic treatments. Then, percentage changes (ΔfPASI and ΔfPLASI) were analyzed from the perspective of both the Physician's Global Assessment of effectiveness (PGA) and patients' Subjective Global Assessment (SGA). As a result, the distribution of the fPASI was more heavily clustered around the low score range compared with the fPLASI at both first and second visits. Linear regression analysis between ΔfPASI and ΔfPLASI shows that the correlation coefficient was 0.94, and ΔfPLASI represented greater percentage changes than ΔfPASI. Remarkably, degrees of clinical improvement measured by the PGA matched better with ΔfPLASI, while ΔfPASI underestimated clinical improvements compared with ΔfPLASI from treatment-responding groups by the PGA and SGA. In conclusion, the fPLASI represented clinical improvement of facial psoriasis with more sensitivity and reliability compared with the fPASI. Therefore, the PLASI system would be a viable severity measurement method for facial psoriasis in clinical practice.