The relationship between clinical characteristics including presence of exposed lesions and health-related quality of life (HRQoL) in patients with psoriasis: analysis from the nationwide epidemiologic study for psoriasis in Korea (EPI-PSODE study)

BACKGROUND

Psychological aspect and quality of life should be considered in treating patients with psoriasis.

OBJECTIVE

We sought to ascertain which clinical characteristics including presence of exposed lesions are associated with impairment of health-related quality of life (HRQoL) in patients with psoriasis.

METHODS

The EPI-PSODE study was a nationwide, multicenter, cross-sectional study conducted in Korea that included 1260 adult patients with psoriasis. In addition to clinical characteristics including presence of exposed lesions, data were collected using the Psoriatic Arthritis (PsA) Screening and Evaluation (PASE), Dermatology Life Quality Index (DLQI), MOS 36-Item Short-Form Health Survey (SF-36), Work Productivity and Activity Impairment Questionnaire Psoriasis (WPAI: PSO) and Medication Satisfaction Questionnaire (MSQ).

RESULTS

Patients with a DLQI score > 5 (n = 990) were younger, had an earlier onset of psoriasis, scored higher on the Psoriasis Area and Severity Index (PASI), had higher body surface area (BSA) and had higher PASE scores than patients with DLQI ≤ 5 (n = 266). The group of patients with exposed lesions (n = 871) were younger and male predominance, earlier onset of psoriasis, longer disease duration, higher PASI/BSA score and a higher proportion with drinking and smoking history each than the group of patients without exposed lesions (n = 389). Presence of exposed lesions negatively influenced DLQI, 36-Item Short-Form Health Survey (SF-36) (mental component), presenteeism, total work productivity impairment and total activity impairment in the WPAI: PSO. In multiple regression model, PASI score was the only variable which was significantly associated with all HRQoL measures. Presence of exposed lesions was a significant factor affecting DLQI and SF-36 (mental).

CONCLUSION

The presence of exposed lesions has a negative impact on quality of life, mental health and work productivity. Therefore, effective treatments are particularly needed for psoriasis patients with exposed lesions.

The effect of low-volatile organic compounds, water-based paint on aggravation of allergic disease in schoolchildren

Whether indoor painting aggravates preexisting allergic diseases remains unclear. We aimed to evaluate the impact of new classroom painting on aggravation of asthma, allergic rhinitis (AR), and atopic dermatitis (AD) in children. Studied school was previously painted with conventional water-based paint 20 years ago and had natural ventilation system. We identified a total of 172 children aged 10-12 years with allergic diseases in 17 classrooms, which were allocated to newly painted rooms with low-volatile organic compounds (VOC), water-based paint, or existing rooms. After painting, there was no intervention or internal airflow to influence indoor air environment in both classrooms. We prospectively assessed the symptom severity and serious events of allergic diseases between both classrooms at baseline and after one and eight weeks after painting. At one and eight weeks, there were no significant changes in the Childhood Asthma Control Test scores, the fractional nitric oxide levels, lung function in asthmatic children in either classroom. There were also no significant changes in the severity score of AR or AD, or serious events in all allergic diseases. These findings suggest classroom painting with this new paint at the levels encountered in this study might not be a major aggravating factor for school-aged children with allergic diseases.

A case of lichen striatus following Blaschko lines

We present a case of lichen striatus (LS) in a 36-year-old woman with skin lesions on the right side of the chest distributed along Blaschko lines that showed a swirling s-shaped pattern. The differential diagnosis of LS includes a variety of nevoid and acquired conditions following Blaschko lines, particularly acquired relapsing self-healing Blaschko dermatitis. The extent to which these 2 conditions overlap remains contentious.

Diagnosis of trichomoniasis by polymerase chain reaction

The clinical usefulness of polymerase chain reaction (PCR) for the diagnosis of trichomoniasis was evaluated in comparison with other conventional tests. PCR was used for specific detection of Trichomonas vaginalis by primers based on the repetitive sequence cloned from T. vaginalis (TV-E650). Between June 1996 and August 1997, 426 patients visited the department of obstetrics and gynecology, Hanyang University Kuri Hospital and were examined for trichomoniasis using wet mount examination, Papanicolaou (Pap) smear, culture and PCR. One hundred and seventy-seven patients (group A) visited with the symptoms of vaginal discharge and 249 patients (group B) visited for regular cervical Pap smear with no vaginal symptoms. From group A (n = 177), 3 infections (2.0%) were detected by wet mount, 6 infections (3.3%) by Pap smear and culture, and 17 infections (10.4%) by PCR. From group B (n = 249), 4 patients (1.6%) were found to have T. vaginalis by culture and 6 infections (2.4%) were detected by PCR. Therefore, in both groups, PCR for T. vaginalis showed a higher detection rate compared with conventional wet mount, Pap smear or culture. The detection by PCR was specific for T. vaginalis since no amplification was detected with DNAs from other protozoa and Candida albicans. The sensitivity and specificity of PCR were 100%. This method could detect T. vaginalis in vaginal discharge at a concentration as low as 1 cell per PCR mixture. These results indicate that PCR could be used as a specific and sensitive diagnostic tool for human trichomoniasis.

Q-switched ruby laser in the treatment of nevus of Ota

The purpose of this study is to evaluate the efficacy of Q-switched ruby laser in the treatment of nevus of Ota, a pigmented lesion on the face. The Q-switched ruby laser has been shown to remove tattoos without scarring. With this in mind, the nevus of Ota with pigmented cells in the dermis could be effectively treated with Q-switched ruby laser. Eighty patients (19 men, and 61 women) with nevus of Ota on the face were enlisted to be tested in evaluating the efficiency of Q-switched ruby laser therapy. The age of patients ranged from 1 to 62 years. The energy fluence used varied from 6 to 8.5 J/cm2. Treatment intervals ranged from 4 to 16 weeks, and the number of treatment sessions varied between 1 to 9 visits. During a 2-year follow-up period, more than fifty percent removal of nevus-pigment was noted in 64 of the 80 patients. Transient hyperpigmentation was noted in 32 patients lasting for 2 to 6 months after treatment; transient hypopigmentation was seen in 3 cases which recovered within one year. No patients had permanent textural or pigmentary changes or scarring. Q-switched ruby laser therapy appears to be an effective and safe modality for the treatment of nevus of Ota.

Oncogene interaction in basal cell carcinomas of human skin

The expression of the p53 protein (p53) was compared with those of several oncogenes including c-fos (Fos), c-jun (Jun), and epidermal growth factor receptor (EGFR1) using immunohistochemistry in frozen and paraffin-embedded sections of 25 basal cell carcinomas (BCCs) to find out any correlation between p53 and oncogenes in the pathogenesis of human BCC. In normal skin, positive reactions were obtained for EGFR1 and Fos, while p53 and Jun were negative in all cases. In the lesions, EGFR1 was observed in all cases and p53 was positive in 9 of 25 (36%). Fos was expressed in 21 of 25 (84%) and four negative cases were all p53-positive; this negative correlation between p53 and Fos staining was statistically significant (P < 0.01). Jun was detected in 14 of 20 (70%) and no significant relationship was observed between the expression of Jun and Fos or p53. These data suggest the possibility of down regulation of Fos expression by high levels of p53 protein. Further work is necessary to determine the mechanism of this interaction.

Expression of the nucleoside diphosphate kinase in human skin cancers: an immunohistochemical study

Expression of nucleoside diphosphate(NDP) kinase, which is homologous to the nm23 gene product in a variety of species, has been found to be inversely associated with metastatic potential. However, the relationship remains controversial according to the tumor cell types and experimental system, with conflicting results from different research groups. In order to determine whether NDP kinase expression serves as a marker for metastatic potential in human skin cancer, we assessed the levels of NDP kinase expression in 9 keratoacanthomas (KAs), 26 squamous cell carcinomas (SCCs), and 25 basal cell carcinomas (BCCs) using immunohistochemistry. The expression of NDP kinase was intense in KA and SCC compared with BCC. However, the difference of NDP kinase expression between KA and SCC was not statistically significant. And there was no statistically significant difference in NDP kinase expression between SCC with metastasis and SCC without metastasis. Our results contradict the hypothesis concerning the possible role of nm23 gene as a metastatic suppressor gene in human skin cancer. The mechanism of overexpression in various tumor cell types and its biological significance in cutaneous carcinogenesis remain to be determined.

Pemphigus developed on preexisting dermatoses

A case of pemphigus foliaceus which initially developed at sites of preexisting psoriasis and a case of pemphigus erythematosus that developed on the lesions of photosensitive erythemas are described. Inflammatory dermatoses can be considered to be local factors which facilitate the autoimmune response of pemphigus, which in turn may induce blistering cutaneous lesions in subclinical patients with autoantibodies.

Immunohistochemical analysis of p53 protein expression in benign and malignant skin tumors using a panel of anti-p53 antibodies

The expression of p53 in a variety of benign and malignant skin lesions has been first assessed in frozen sections and then compared with the results obtained in corresponding paraffin-embedded sections using various immunohistochemical staining methods with a panel of anti-p53 antibodies. Of the 48 benign and malignant skin lesions studied, 46(96%) had corresponding paraffin sections and immunohistochemical results obtained with DO7 on frozen and paraffin sections were concordant in 97%, qualitatively. Using streptavidin-biotin complex method, p53 was identified in 33% of dysplastic squamous lesions, 50% of squamous cell carcinomas (SCCs) and 36% of basal cell carcinomas (BCCs) on frozen section, whereas 25% of dysplastic squamous lesions, 40% of SCCs, and 32% of BCCs showed p53 positivity on paraffin-embedded sections. In frozen sections, the same regions of each specimen exhibited similar topographic patterns of positive immunoreactivity with both monoclonal antibodies, PAb 1801 and DO7. In contrast, immunohistochemical staining with polyclonal antibody, CM-1, gave poor morphologic resolution, although effective in paraffin-embedded sections.

p53 mutations are common and early events that precede tumor invasion in squamous cell neoplasia of the skin

Mutations of the p53 gene are the most common genetic abnormality described in human cancer; p53 mutations have recently been reported in more than half of the cases of squamous cell carcinomas of the skin. We have previously reported positive p53 immunostaining in Bowen's disease and actinic keratosis. To determine if this abnormal immunostaining reflects p53 mutation or alternative pathways of p53 protein inactivation we have performed direct sequencing of p53 in 20 further cases of Bowen's disease. We found eight mutations in 20 cases, seven of which would produce alterations in the p53 protein product. Our results suggest that p53 mutation is an early event in malignant conversion, frequently preceding invasion in squamous cell neoplasia of the skin. The type and site of the observed mutations reflect known mutational hotspots and support the role of ultraviolet radiation in the pathogenesis of these tumors.

p53 protein expression in benign and malignant skin tumours

The skin affords an excellent model of human carcinogenesis because a variety of lesions from benign tumours to invasive malignancy, with or without metastatic potential, are commonly found, and are accessible to biopsy. To date, few genetic alterations have been observed in skin neoplasia. In this study we have used a recently developed monoclonal antibody (DO7) to examine p53 protein expression in a wide variety of benign and malignant skin lesions. Benign skin lesions were negative, but a significant number of malignant epithelial lesions showed detectable p53; 56% of squamous carcinomas and 42% of basal cell carcinomas were positive. A smaller proportion of dysplastic epithelial lesions were positive (27%), and only 3.6% of malignant melanomas were positive. Thus, although detectable p53 protein is a common occurrence in malignant epithelial lesions, it does not correlate with the malignant phenotype or with metastatic potential. The finding of a lower proportion of positivity in dysplastic lesions, and absence of staining in benign tumours, suggests that p53 mutation may be involved in the progression towards invasive malignancy in human squamous skin lesions.

Granulomatous tissue reaction following cosmetic eyebrow tattooing

We report a case of epithelioid granuloma which occurred at the site of a previous cosmetic eyebrow tattooing. A biopsy specimen showed the organized appearance of epithelioid cell granulomas containing little pigment as well as occasional giant cells, mainly of Langhans' type, thus showing the characteristic features of granulomatous hypersensitivity. With the use of energy dispersive X-ray microanalysis and inductively coupled plasma spectrometry, the presence of copper, iron, cobalt, and chromium was demonstrated.

Cefoperazone (Cefobid) for treating men with gonorrhoea caused by penicillinase producing Neisseria gonorrhoeae

The recent emergence of spectinomycin resistant penicillinase producing Neisseria gonorrhoeae (PPNG) and the high prevalence of PPNG strains among the gonococcal isolates in Seoul represent a grave challenge to the programme for controlling sexually transmitted disease (STD). Fifty men with uncomplicated gonococcal urethritis caused by PPNG strains were treated with a single intramuscular injection of 1 g cefoperazone. Forty two patients were followed up. All patients recovered including three who became reinfected and required further treatment. Two patients (4.8%) developed postgonococcal urethritis (PGU). The MIC90 of cefoperazone measured by an agar dilution susceptibility test was 0.12 mg/l.