Letters to the Editor
A total of 10 age-matched male psoriasis patients (six cases of psoriasis vulgaris and four cases of psoriatic arthritis [PsA]) (aged 34–49 years; mean, 41.9) and six healthy male individuals (aged 34–43 years; mean, 39.0) participated in this study (P = 0.159, unpaired Student’s t-test). Topical treatment only, oral cyclosporin and biologics were applied for one, three and six cases of psoriasis, respectively: secukinumab for four cases, ustekinumab for one case and adalimumab for one case. NES was examined in the right middle finger nails by regularly measuring the shifting length of a scraped line at the edge of a nail cuticle. To eliminate seasonal variation, NES was analyzed during the snowy winter season in Hokkaido, Japan (from November 2014 to March 2015). Nail Psoriasis Severity Index (NAPSI) of the target nail and Psoriasis Area and Severity Index (PASI) were also evaluated. NES was 0.120 mm/day (range, 0.112–0.129) and 0.143 mm/day (range, 0.114–0.172)in healthy controls and psoriasis patients, respectively (P = 0.0032, unpaired Student’s t-test) (Fig. 1a). Clinical subtypes of psoriasis, treatments or PASI did not affect NES. There was no significant correlation between NES and NAPSI score (Fig. 1b) (R = 0.422). In this study, accelerated nail elongation in psoriasis patients is clearly shown when compared with that in healthy individuals. This finding can be essential for the evaluation of the therapeutic effect of nail psoriasis treatment. Arthritis resulting in joint destruction is an important symptom of psoriasis. Recent progress of psoriasis treatment using biologics, such as anti-tumor necrosis factor (TNF), p40 subunit of interleukin (IL)-12/23 and IL-17 antibody, has made it possible to keep the arthritis under control or even improve.2 The involvement of scalp, nails and intergluteal skin is a significant risk factor for PsA.3 Increased serum TNF-a concentrations in nail psoriasis patients when compared with that in patients without nail involvement may be an indicator of the close correlation between PsA and nail psoriasis.4 While accelerated nail elongation has been suggested in psoriasis,5 to date, there has never been a detailed examination of NES in psoriasis. The present study revealed approximately 19% of NES acceleration in psoriasis as compared with age-matched healthy individuals.
This result suggests that NES is potentially accelerated after psoriasis treatment. Therefore, we should not attribute the lack of clinical improvement of nail lesions to slow growth of nails, but rather to insufficient therapeutic effect. Further analysis is required to determine specific details of NES in psoriasis. Nail lesions, which can be related to a systemic inflammatory condition, should be considered very seriously as a useful clinical marker to evaluate any ongoing treatment.
CONFLICT OF INTEREST:
None declared.
Masaru HONMA, Shin IINUMA, Hidetoshi TAKAHASHI, Hajime IIZUKA, Akemi ISHIDA-YAMAMOTO Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan doi: 10.1111/1346-8138.12990
REFERENCES nchez-Regan ~a M, Sola-Ortigosa J, Alsina-Gibert M, Vidal-Ferna n1 Sa dez M, Umbert-Millet P. Nail psoriasis: a retrospective study on the effectiveness of systemic treatments (classical and biological therapy). J Eur Acad Dermatol Venereol 2011; 25: 579–586. 2 Crowley JJ, Weinberg JM, Wu JJ, Robertson AD, Van Voorhees AS, National Psoriasis Foundation. Treatment of nail psoriasis: best practice recommendations from the Medical Board of the National Psoriasis Foundation. JAMA Dermatol 2015; 151: 87–94. 3 Wilson FC, Icen M, Crowson CS, McEvoy MT, Gabriel SE, Kremers HM. Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population-based study. Arthritis Rheum 2009; 61: 233–239. 4 Kyriakou A, Patsatsi A, Vyzantiadis TA, Sotiriadis D. Serum levels of TNF-a, IL-12/23 p40, and IL-17 in psoriatic patients with and without nail psoriasis: a cross-sectional study. Sci World J 2014; 2014: 508178. 5 Baran R, Dawber R, Haneke E, Tosti A, Bristow I. A Text Atlas of Nail Disorders, 3rd edn. Martin Dunitz, London 2003.
Infant with generalized pustular psoriasis who responded to cyclosporin A therapy Dear Editor, Generalized pustular psoriasis (GPP) is a rare type of psoriasis, characterized by a fever of several days’ duration, together with the sudden appearance of sterile pustules over the trunk and extremities.1 We herein describe an infant case of GPP. A healthy 3-month-old female developed multiple erythematous lesions
with pustules that were arranged in a circular pattern on her abdomen. In the absence of fever, the eruptions had spread to the head, trunk and four extremities 3 weeks later (Fig. 1a). None of her family members had a history of similar eruptions. A blood examination revealed normal white and red blood cell counts, normal C-reactive protein, no anti-streptolysin O antibodies, no anti-streptokinase antibodies and normal albumin
Correspondence: Masayuki Takahashi, M.D., Department of Dermatology, Tsushima City Hospital, 3-73 Tachibana-cho, Tsushima, Aichi 496-8537, Japan. Email: [email protected]
© 2015 Japanese Dermatological Association
911
Letters to the Editor
(a)
(b)
(c)
(d)
(e)
(f)
level, but a high platelet count (82.0 9 104/lL; normal,
A total of 10 age-matched male psoriasis patients (six cases of psoriasis vulgaris and four cases of psoriatic arthritis [PsA]) (aged 34–49 years; mean, 41.9) and six healthy male individuals (aged 34–43 years; mean, 39.0) participated in this study (P = 0.159, unpaired Student’s t-test). Topical treatment only, oral cyclosporin and biologics were applied for one, three and six cases of psoriasis, respectively: secukinumab for four cases, ustekinumab for one case and adalimumab for one case. NES was examined in the right middle finger nails by regularly measuring the shifting length of a scraped line at the edge of a nail cuticle. To eliminate seasonal variation, NES was analyzed during the snowy winter season in Hokkaido, Japan (from November 2014 to March 2015). Nail Psoriasis Severity Index (NAPSI) of the target nail and Psoriasis Area and Severity Index (PASI) were also evaluated. NES was 0.120 mm/day (range, 0.112–0.129) and 0.143 mm/day (range, 0.114–0.172)in healthy controls and psoriasis patients, respectively (P = 0.0032, unpaired Student’s t-test) (Fig. 1a). Clinical subtypes of psoriasis, treatments or PASI did not affect NES. There was no significant correlation between NES and NAPSI score (Fig. 1b) (R = 0.422). In this study, accelerated nail elongation in psoriasis patients is clearly shown when compared with that in healthy individuals. This finding can be essential for the evaluation of the therapeutic effect of nail psoriasis treatment. Arthritis resulting in joint destruction is an important symptom of psoriasis. Recent progress of psoriasis treatment using biologics, such as anti-tumor necrosis factor (TNF), p40 subunit of interleukin (IL)-12/23 and IL-17 antibody, has made it possible to keep the arthritis under control or even improve.2 The involvement of scalp, nails and intergluteal skin is a significant risk factor for PsA.3 Increased serum TNF-a concentrations in nail psoriasis patients when compared with that in patients without nail involvement may be an indicator of the close correlation between PsA and nail psoriasis.4 While accelerated nail elongation has been suggested in psoriasis,5 to date, there has never been a detailed examination of NES in psoriasis. The present study revealed approximately 19% of NES acceleration in psoriasis as compared with age-matched healthy individuals.
This result suggests that NES is potentially accelerated after psoriasis treatment. Therefore, we should not attribute the lack of clinical improvement of nail lesions to slow growth of nails, but rather to insufficient therapeutic effect. Further analysis is required to determine specific details of NES in psoriasis. Nail lesions, which can be related to a systemic inflammatory condition, should be considered very seriously as a useful clinical marker to evaluate any ongoing treatment.
CONFLICT OF INTEREST:
None declared.
Masaru HONMA, Shin IINUMA, Hidetoshi TAKAHASHI, Hajime IIZUKA, Akemi ISHIDA-YAMAMOTO Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan doi: 10.1111/1346-8138.12990
REFERENCES nchez-Regan ~a M, Sola-Ortigosa J, Alsina-Gibert M, Vidal-Ferna n1 Sa dez M, Umbert-Millet P. Nail psoriasis: a retrospective study on the effectiveness of systemic treatments (classical and biological therapy). J Eur Acad Dermatol Venereol 2011; 25: 579–586. 2 Crowley JJ, Weinberg JM, Wu JJ, Robertson AD, Van Voorhees AS, National Psoriasis Foundation. Treatment of nail psoriasis: best practice recommendations from the Medical Board of the National Psoriasis Foundation. JAMA Dermatol 2015; 151: 87–94. 3 Wilson FC, Icen M, Crowson CS, McEvoy MT, Gabriel SE, Kremers HM. Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population-based study. Arthritis Rheum 2009; 61: 233–239. 4 Kyriakou A, Patsatsi A, Vyzantiadis TA, Sotiriadis D. Serum levels of TNF-a, IL-12/23 p40, and IL-17 in psoriatic patients with and without nail psoriasis: a cross-sectional study. Sci World J 2014; 2014: 508178. 5 Baran R, Dawber R, Haneke E, Tosti A, Bristow I. A Text Atlas of Nail Disorders, 3rd edn. Martin Dunitz, London 2003.
Infant with generalized pustular psoriasis who responded to cyclosporin A therapy Dear Editor, Generalized pustular psoriasis (GPP) is a rare type of psoriasis, characterized by a fever of several days’ duration, together with the sudden appearance of sterile pustules over the trunk and extremities.1 We herein describe an infant case of GPP. A healthy 3-month-old female developed multiple erythematous lesions
with pustules that were arranged in a circular pattern on her abdomen. In the absence of fever, the eruptions had spread to the head, trunk and four extremities 3 weeks later (Fig. 1a). None of her family members had a history of similar eruptions. A blood examination revealed normal white and red blood cell counts, normal C-reactive protein, no anti-streptolysin O antibodies, no anti-streptokinase antibodies and normal albumin
Correspondence: Masayuki Takahashi, M.D., Department of Dermatology, Tsushima City Hospital, 3-73 Tachibana-cho, Tsushima, Aichi 496-8537, Japan. Email: [email protected]
© 2015 Japanese Dermatological Association
911
Letters to the Editor
(a)
(b)
(c)
(d)
(e)
(f)
level, but a high platelet count (82.0 9 104/lL; normal,
