754 Correspondence
would prevent the occurrence of these SCCs. Oropharyngeal SCCs that are associated with HPV infection carry a more favourable prognosis than those that are HPV-negative and patients exhibiting high HPV16 viral load have been considered to yield a better prognosis compared with those with a low viral load.5 In contrast, our two cases exhibited aggressive clinical behaviour with rapid growth and regional lymph node metastases. In fact, the more aggressive tumour (case 1) exhibited a lower number of HPV DNA viral copies per cell in tumoral tissue. Additional cases are needed to validate a potential increased incidence of extragenital HPV16-induced skin SCC and confirm whether HPV16 viral load could have a prognostic value in these cancers. 1
Department of Dermatology, CHU N^ımes, Place du Pr R Debre, 30029 N^ımes cedex 9, France 2 Department of Virology, APHM Marseille, Marseille, France 3 Department of Virology, CHU Montpellier, Montpellier, France Correspondence: Pierre-Emmanuel Stoebner. E-mail: [email protected]
A. CROCI-TORTI1 C. TAMALET2 M. SEGONDY3 M. DANDURAND1 L. MEUNIER1 P.-E. STOEBNER1
References 1 Attner P, Du J, Nasman A et al. The role of human papillomavirus in the increased incidence of base of tongue cancer. Int J Cancer 2010; 126:2879–84. 2 Riddel C, Rashid R, Thomas V. Ungual and periungual human papillomavirus-associated squamous cell carcinoma: a review. J Am Acad Dermatol 2011; 64:1147–53. 3 Tamalet C, Richet H, Carcopino X et al. Testing for human papillomavirus and measurement of viral load of HPV 16 and 18 in selfcollected vaginal swabs of women who do not undergo cervical cytological screening in Southern France. J Med Virol 2010; 82:1431–7. 4 Carcopino X, Henry M, Benmoura D et al. Determination of HPV type 16 and 18 viral load in cervical smears of women referred to colposcopy. J Med Virol 2006; 78:1131–40. 5 Holzinger D, Schmitt M, Dyckhoff G et al. Viral RNA patterns and high viral load reliably define oropharynx carcinomas with active HPV16 involvement. Cancer Res 2012; 72:4993–5003.
Supporting Information Additional Supporting Information may be found in the online version of this article at the publisher’s website: Figure S1. Supplementary files for review. Histopathological findings. Histopathological examination of skin biopsy obtained from the tumour (a, patient 1; b, patient 2) revealed findings typical of squamous cell carcinoma (haematoxylin and eosin stain, original magnification 940. Funding sources: no external funding. Conflicts of interest: none declared.
British Journal of Dermatology (2014) 170, pp735–758
Noninvasive, in vivo assessment of oral squamous cell carcinoma DOI: 10.1111/bjd.12728 DEAR EDITOR, Oral squamous cell carcinoma (OSCC) arises from precursor lesions (leucoplakia) or on pre-existing inflammatory conditions (such as lichen planus). Precursors are often indistinguishable from early OSCC because both may present clinically as whitish, hypertrophic plaques. Early diagnosis and adequate management decreases recurrences and improves patient prognosis.1,2 An increased incidence of oral cancers among younger people has been reported in recent years.3,4 Surgical biopsy and histological examination remain the gold standard for diagnosis, but it is mandatory to select the correct sampling site in order to avoid multiple biopsies and minimize inconclusive histological reports. For this purpose, noninvasive techniques like tissue autofluorescence, toluidine blue, and Lugol’s iodine vital staining are still being used, but lack specificity.5–7 Recently, in vivo reflectance confocal microscopy (RCM), a noninvasive technique for real-time imaging, has been used to describe the microscopic features of oral normal mucosa8,9 and carcinoma, the last using an experimental confocal microscope.10 We evaluated a patient presenting an oral lesion suspected for OSCC in whom the site of biopsy was selected using RCM in order to provide to the pathologist the sample with the most significant microscopic changes for a definitive diagnosis. The patient was a 39-year-old man, seen at outpatient services, with complaints of asymptomatic white lesions on the left side of the tongue that had progressively enlarged over a period of 5 years. He was a nonsmoker, nonalcoholic with no known risk factors for human papillomavirus or history of any chronic local trauma. Clinical examination revealed white hyperkeratotic plaques on the dorsolateral aspect of the tongue (Fig. 1). Regional lymph nodes were not palpable. We employed a commercially available, hand-held reflectance confocal microscope (Vivascope 3000â; Lucid, Rochester, NY, U.S.A.) to aid clinical investigation of OSCC and select the site for the proper biopsy. The confocal examination disclosed the presence of hyperkeratosis, seen as hyper-retractile areas with single corneocyte detachment located at the level of an abnormal keratinized epithelium. At the epithelial level, clearly visible atypia and polymorphism of keratinocytes were also evident. Presence of targetoid-like structures located at different epithelial layers, previously described in the literature as characteristically visible on confocal microscopy of squamous neoplasia involving the skin,11 was also evident (Fig. 2). Histopathology of the biopsy performed on the selected area confirmed the clinical suspicion of OSCC showing overlying epithelium with dysplastic changes and abnormal keratinization. Presence of irregular masses of squamous atypical cells, which invaded the submucosa and underlying striated muscle with perineural invasion associated with the presence © 2013 British Association of Dermatologists
Correspondence 755
(a)
(b)
Fig 1. (a) Clinical image of hyperkeratotic white plaque on the left side of the tongue; (b) histology (haematoxylin and eosin, original magnification 9 50) showing superficial epithelium with dysplastic changes and abnormal keratinization (red square).The tumour infiltrates the submucosa (yellow rectangle).
(a)
(d)
(b)
(e)
(c)
(f)
Fig 2. (a) Histology (haematoxylin and eosin, original magnification 9 200) showing overlying epithelium with dysplastic changes at different levels (red and black lines) and abnormal keratinization of the superficial layer (yellow line). (b) RCM single frame (05 9 05 mm) at the level of the surface of the epithelium disclosing hyperkeratosis with numerous polygonal bright cells corresponding to detached corneocytes visible as bright structures with dark nuclei and bright contours (yellow arrows). RCM images taken at the level of superficial epithelium (c), deeper into the spinous layer (d) and at the level of the suprapapillary plate, closer to the epithelial junction (e), showing the presence of cellular disarray with pleomorphic and dyskeratotic corneocytes (red arrows) in association with target-like structures (black arrows). (f) RCM close-up showing dilated blood vessels inside connective tissue papillae (white arrows). RCM, reflectance confocal microscopy.
of several horn pearls, keratinization of individual cells and atypical mitotic figures were seen (Fig. 1). A conclusive diagnosis of moderately differentiated squamous cell carcinoma was made. This is the first case report describing in vivo RCM features of OSCC performed with a commercially available device. The confocal microscope we have used, in comparison with the © 2013 British Association of Dermatologists
device employed by Mainland et al.,10 provides a better lateral resolution (05 lm instead of 2 lm), and a bigger field of view for single image (500 9 500 lm instead of 230 9 230 lm), with more detailed cytological features and easier scanning of the tissue. Moreover, our device uses a smaller laser wavelength (830 nm instead of 1064 nm) with significant reduction of the risk of tissue damage.10 British Journal of Dermatology (2014) 170, pp735–758
756 Correspondence
Our experience, performed on an exemplary case, underlines the promising usefulness of RCM for a noninvasive, real-time, biopsy site selection for a fast and conclusive histopathological diagnosis of OSCC. In order to better define the effective usefulness of RCM for in vivo diagnosis of oral squamous tumours and patient management, a larger number of cases performed with advanced-generation RCM are needed. 1
Department of Dermatology, San Gallicano Dermatological Institute, Via Chianesi, 53, Rome 00144, Italy 2 Employees’ State Insurance Hospital & Post Graduate Institute of Medical Sciences and Research, New Delhi, India 3 UOC of Dermatology, University of Rome Tor Vergata, Rome, Italy 4 Department of Mental Health, Section of Pathology, Second University of Naples, Naples, Italy Correspondence: Marco Ardigo. E-mail: [email protected]
1
M. AGOZZINO P. BHASNE2 C. FRANCESCHINI3 G. VINCENZA4 C . C A T R I C A L A1 M . A R D I G O 1
References 1 Zwetyenga N, Majoufre-Lefebvre C, Siberchicot F et al. Squamouscell carcinoma of the tongue: treatment results and prognosis. Rev Stomatol Chir Maxillofac 2003; 104:10–17. 2 Kourelis K, Tsue T, Girod D et al. Negative prognostic factors for head and neck cancer in the young. J Buon 2013; 18:459–64. 3 Warnakulasuriya S, Mak V, Moller H. Oral cancer survival in young people in South East England. Oral Oncol 2007; 43:982–6. 4 Annertz K, Anderson H, Biorklund A et al. Incidence and survival of squamous cell carcinoma of the tongue in Scandinavia, with special reference to young adults. Int J Cancer 2002; 101:95–9. 5 Scheer M, Neugebauer J, Derman A et al. Autofluorescence imaging of potentially malignant mucosa lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 111:568–77. 6 Cancela-Rodrıguez P, Cerero-Lapiedra R, Esparza-G omez G et al. The use of toluidine blue in the detection of premalignant and malignant oral lesions. J Oral Pathol Med 2011; 40:300–4. 7 Petruzzi M, Lucchese A, Baldoni E et al. Use of Lugol’s iodine in oral cancer diagnosis: an overview. Oral Oncol 2010; 46:811–13. 8 Contaldo M, Agozzino M, Moscarella E et al. In vivo characterization of healthy oral mucosa by reflectance confocal microscopy: a translational research for optical biopsy. Ultrastruct Pathol 2013; 37:151–8. 9 White WM, Rajadhyaksha M, Gonzalez S et al. Noninvasive imaging of human oral mucosa in vivo by confocal reflectance microscopy. Laryngoscope 1999; 109:1709–17. 10 Mainland KC, Gillenwater AM, Williams MD et al. In vivo imaging of oral neoplasia using a miniaturized fiber optic confocal reflectance microscope. Oral Oncol 2008; 44:1059–66. 11 Ulrich M, Kanitakis J, Gonzalez S et al. Evaluation of Bowen disease by in vivo reflectance confocal microscopy. Br J Dermatol 2012; 166:451–3. Funding sources: none. Conflicts of interest: none declared.
British Journal of Dermatology (2014) 170, pp735–758
Psoriasis and uveitis – should we be asking about eye symptoms? DOI: 10.1111/bjd.12731 DEAR EDITOR, The association between seronegative spondyloarthropathies, including psoriatic arthritis and uveitis has been well documented. Uveitis is the most common extraarticular feature, occurring preferentially in HLA-B27-positive patients.1 In patients with psoriatic arthritis the estimated frequency is between 15% and 25% of cases.2 Uveitis may be independently associated with psoriasis in the absence of psoriatic arthritis and HLA-B27. A 13-year-old girl with severe psoriasis, Psoriasis Area and Severity Index (PASI) 166 and Dermatology Life Quality Index (DLQI) 28, has been managed at our centre over the past 7 years. During this time she has received treatment with ciclosporin, methotrexate and etanercept. All systemic therapies ceased 3 years ago when her psoriasis went into remission. In 2013 she re-presented with severe scalp psoriasis and bilateral red eyes, diagnosed by ophthalmology as anterior uveitis. No active joint disease was found on assessment by paediatric rheumatology. We therefore wondered what the risk of anterior uveitis was in patients presenting with psoriasis in the absence of joint disease. To assess the current evidence for psoriasis and uveitis a search was performed in Pubmed and EMBASE using the terms ‘psoriasis’ AND ‘uveitis’. The literature was screened from 1975 to 2013. This search identified 858 papers, 847 of which were excluded as they were not specific to psoriasis, were review articles or duplicates. A further seven case reports and small case series were also excluded due to limited numbers. Consequently this review includes four studies (Table 1), which present 251 patients with psoriasis, selected from secondary or tertiary care. The four studies include a cross-sectional prevalence study, two case–control studies, and one case series of 10 patients. Chandran et al.3 reported a cross-sectional prevalence study on 105 Asian Singaporean patients with chronic plaque psoriasis. Their aim was to clarify the nature and prevalence of eye abnormalities in patients with psoriasis. Two patients had anterior uveitis, of which one patient was known to have psoriatic arthritis. No significant correlation was found between uveitis and family history of psoriasis or arthropathy (P = 1), but this may be due to the small number of patients with uveitis. The severity of psoriasis significantly correlated with the development of uveitis (P = 0092). In total 67 patients were diagnosed with eye disease, and the paper concludes that there is a higher prevalence of eye disease in the psoriatic population. The paper by Kilic et al.4 supports this view. They compared 100 consecutive patients with psoriasis with age- and sexmatched controls. A pre-existing diagnosis of psoriatic arthritis was noted in 12 patients. Ocular findings detected included blepharitis, conjunctivitis, episcleritis, corneal involvement, anterior uveitis, pigment dispersion, cataract and cystoid © 2013 British Association of Dermatologists
would prevent the occurrence of these SCCs. Oropharyngeal SCCs that are associated with HPV infection carry a more favourable prognosis than those that are HPV-negative and patients exhibiting high HPV16 viral load have been considered to yield a better prognosis compared with those with a low viral load.5 In contrast, our two cases exhibited aggressive clinical behaviour with rapid growth and regional lymph node metastases. In fact, the more aggressive tumour (case 1) exhibited a lower number of HPV DNA viral copies per cell in tumoral tissue. Additional cases are needed to validate a potential increased incidence of extragenital HPV16-induced skin SCC and confirm whether HPV16 viral load could have a prognostic value in these cancers. 1
Department of Dermatology, CHU N^ımes, Place du Pr R Debre, 30029 N^ımes cedex 9, France 2 Department of Virology, APHM Marseille, Marseille, France 3 Department of Virology, CHU Montpellier, Montpellier, France Correspondence: Pierre-Emmanuel Stoebner. E-mail: [email protected]
A. CROCI-TORTI1 C. TAMALET2 M. SEGONDY3 M. DANDURAND1 L. MEUNIER1 P.-E. STOEBNER1
References 1 Attner P, Du J, Nasman A et al. The role of human papillomavirus in the increased incidence of base of tongue cancer. Int J Cancer 2010; 126:2879–84. 2 Riddel C, Rashid R, Thomas V. Ungual and periungual human papillomavirus-associated squamous cell carcinoma: a review. J Am Acad Dermatol 2011; 64:1147–53. 3 Tamalet C, Richet H, Carcopino X et al. Testing for human papillomavirus and measurement of viral load of HPV 16 and 18 in selfcollected vaginal swabs of women who do not undergo cervical cytological screening in Southern France. J Med Virol 2010; 82:1431–7. 4 Carcopino X, Henry M, Benmoura D et al. Determination of HPV type 16 and 18 viral load in cervical smears of women referred to colposcopy. J Med Virol 2006; 78:1131–40. 5 Holzinger D, Schmitt M, Dyckhoff G et al. Viral RNA patterns and high viral load reliably define oropharynx carcinomas with active HPV16 involvement. Cancer Res 2012; 72:4993–5003.
Supporting Information Additional Supporting Information may be found in the online version of this article at the publisher’s website: Figure S1. Supplementary files for review. Histopathological findings. Histopathological examination of skin biopsy obtained from the tumour (a, patient 1; b, patient 2) revealed findings typical of squamous cell carcinoma (haematoxylin and eosin stain, original magnification 940. Funding sources: no external funding. Conflicts of interest: none declared.
British Journal of Dermatology (2014) 170, pp735–758
Noninvasive, in vivo assessment of oral squamous cell carcinoma DOI: 10.1111/bjd.12728 DEAR EDITOR, Oral squamous cell carcinoma (OSCC) arises from precursor lesions (leucoplakia) or on pre-existing inflammatory conditions (such as lichen planus). Precursors are often indistinguishable from early OSCC because both may present clinically as whitish, hypertrophic plaques. Early diagnosis and adequate management decreases recurrences and improves patient prognosis.1,2 An increased incidence of oral cancers among younger people has been reported in recent years.3,4 Surgical biopsy and histological examination remain the gold standard for diagnosis, but it is mandatory to select the correct sampling site in order to avoid multiple biopsies and minimize inconclusive histological reports. For this purpose, noninvasive techniques like tissue autofluorescence, toluidine blue, and Lugol’s iodine vital staining are still being used, but lack specificity.5–7 Recently, in vivo reflectance confocal microscopy (RCM), a noninvasive technique for real-time imaging, has been used to describe the microscopic features of oral normal mucosa8,9 and carcinoma, the last using an experimental confocal microscope.10 We evaluated a patient presenting an oral lesion suspected for OSCC in whom the site of biopsy was selected using RCM in order to provide to the pathologist the sample with the most significant microscopic changes for a definitive diagnosis. The patient was a 39-year-old man, seen at outpatient services, with complaints of asymptomatic white lesions on the left side of the tongue that had progressively enlarged over a period of 5 years. He was a nonsmoker, nonalcoholic with no known risk factors for human papillomavirus or history of any chronic local trauma. Clinical examination revealed white hyperkeratotic plaques on the dorsolateral aspect of the tongue (Fig. 1). Regional lymph nodes were not palpable. We employed a commercially available, hand-held reflectance confocal microscope (Vivascope 3000â; Lucid, Rochester, NY, U.S.A.) to aid clinical investigation of OSCC and select the site for the proper biopsy. The confocal examination disclosed the presence of hyperkeratosis, seen as hyper-retractile areas with single corneocyte detachment located at the level of an abnormal keratinized epithelium. At the epithelial level, clearly visible atypia and polymorphism of keratinocytes were also evident. Presence of targetoid-like structures located at different epithelial layers, previously described in the literature as characteristically visible on confocal microscopy of squamous neoplasia involving the skin,11 was also evident (Fig. 2). Histopathology of the biopsy performed on the selected area confirmed the clinical suspicion of OSCC showing overlying epithelium with dysplastic changes and abnormal keratinization. Presence of irregular masses of squamous atypical cells, which invaded the submucosa and underlying striated muscle with perineural invasion associated with the presence © 2013 British Association of Dermatologists
Correspondence 755
(a)
(b)
Fig 1. (a) Clinical image of hyperkeratotic white plaque on the left side of the tongue; (b) histology (haematoxylin and eosin, original magnification 9 50) showing superficial epithelium with dysplastic changes and abnormal keratinization (red square).The tumour infiltrates the submucosa (yellow rectangle).
(a)
(d)
(b)
(e)
(c)
(f)
Fig 2. (a) Histology (haematoxylin and eosin, original magnification 9 200) showing overlying epithelium with dysplastic changes at different levels (red and black lines) and abnormal keratinization of the superficial layer (yellow line). (b) RCM single frame (05 9 05 mm) at the level of the surface of the epithelium disclosing hyperkeratosis with numerous polygonal bright cells corresponding to detached corneocytes visible as bright structures with dark nuclei and bright contours (yellow arrows). RCM images taken at the level of superficial epithelium (c), deeper into the spinous layer (d) and at the level of the suprapapillary plate, closer to the epithelial junction (e), showing the presence of cellular disarray with pleomorphic and dyskeratotic corneocytes (red arrows) in association with target-like structures (black arrows). (f) RCM close-up showing dilated blood vessels inside connective tissue papillae (white arrows). RCM, reflectance confocal microscopy.
of several horn pearls, keratinization of individual cells and atypical mitotic figures were seen (Fig. 1). A conclusive diagnosis of moderately differentiated squamous cell carcinoma was made. This is the first case report describing in vivo RCM features of OSCC performed with a commercially available device. The confocal microscope we have used, in comparison with the © 2013 British Association of Dermatologists
device employed by Mainland et al.,10 provides a better lateral resolution (05 lm instead of 2 lm), and a bigger field of view for single image (500 9 500 lm instead of 230 9 230 lm), with more detailed cytological features and easier scanning of the tissue. Moreover, our device uses a smaller laser wavelength (830 nm instead of 1064 nm) with significant reduction of the risk of tissue damage.10 British Journal of Dermatology (2014) 170, pp735–758
756 Correspondence
Our experience, performed on an exemplary case, underlines the promising usefulness of RCM for a noninvasive, real-time, biopsy site selection for a fast and conclusive histopathological diagnosis of OSCC. In order to better define the effective usefulness of RCM for in vivo diagnosis of oral squamous tumours and patient management, a larger number of cases performed with advanced-generation RCM are needed. 1
Department of Dermatology, San Gallicano Dermatological Institute, Via Chianesi, 53, Rome 00144, Italy 2 Employees’ State Insurance Hospital & Post Graduate Institute of Medical Sciences and Research, New Delhi, India 3 UOC of Dermatology, University of Rome Tor Vergata, Rome, Italy 4 Department of Mental Health, Section of Pathology, Second University of Naples, Naples, Italy Correspondence: Marco Ardigo. E-mail: [email protected]
1
M. AGOZZINO P. BHASNE2 C. FRANCESCHINI3 G. VINCENZA4 C . C A T R I C A L A1 M . A R D I G O 1
References 1 Zwetyenga N, Majoufre-Lefebvre C, Siberchicot F et al. Squamouscell carcinoma of the tongue: treatment results and prognosis. Rev Stomatol Chir Maxillofac 2003; 104:10–17. 2 Kourelis K, Tsue T, Girod D et al. Negative prognostic factors for head and neck cancer in the young. J Buon 2013; 18:459–64. 3 Warnakulasuriya S, Mak V, Moller H. Oral cancer survival in young people in South East England. Oral Oncol 2007; 43:982–6. 4 Annertz K, Anderson H, Biorklund A et al. Incidence and survival of squamous cell carcinoma of the tongue in Scandinavia, with special reference to young adults. Int J Cancer 2002; 101:95–9. 5 Scheer M, Neugebauer J, Derman A et al. Autofluorescence imaging of potentially malignant mucosa lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 111:568–77. 6 Cancela-Rodrıguez P, Cerero-Lapiedra R, Esparza-G omez G et al. The use of toluidine blue in the detection of premalignant and malignant oral lesions. J Oral Pathol Med 2011; 40:300–4. 7 Petruzzi M, Lucchese A, Baldoni E et al. Use of Lugol’s iodine in oral cancer diagnosis: an overview. Oral Oncol 2010; 46:811–13. 8 Contaldo M, Agozzino M, Moscarella E et al. In vivo characterization of healthy oral mucosa by reflectance confocal microscopy: a translational research for optical biopsy. Ultrastruct Pathol 2013; 37:151–8. 9 White WM, Rajadhyaksha M, Gonzalez S et al. Noninvasive imaging of human oral mucosa in vivo by confocal reflectance microscopy. Laryngoscope 1999; 109:1709–17. 10 Mainland KC, Gillenwater AM, Williams MD et al. In vivo imaging of oral neoplasia using a miniaturized fiber optic confocal reflectance microscope. Oral Oncol 2008; 44:1059–66. 11 Ulrich M, Kanitakis J, Gonzalez S et al. Evaluation of Bowen disease by in vivo reflectance confocal microscopy. Br J Dermatol 2012; 166:451–3. Funding sources: none. Conflicts of interest: none declared.
British Journal of Dermatology (2014) 170, pp735–758
Psoriasis and uveitis – should we be asking about eye symptoms? DOI: 10.1111/bjd.12731 DEAR EDITOR, The association between seronegative spondyloarthropathies, including psoriatic arthritis and uveitis has been well documented. Uveitis is the most common extraarticular feature, occurring preferentially in HLA-B27-positive patients.1 In patients with psoriatic arthritis the estimated frequency is between 15% and 25% of cases.2 Uveitis may be independently associated with psoriasis in the absence of psoriatic arthritis and HLA-B27. A 13-year-old girl with severe psoriasis, Psoriasis Area and Severity Index (PASI) 166 and Dermatology Life Quality Index (DLQI) 28, has been managed at our centre over the past 7 years. During this time she has received treatment with ciclosporin, methotrexate and etanercept. All systemic therapies ceased 3 years ago when her psoriasis went into remission. In 2013 she re-presented with severe scalp psoriasis and bilateral red eyes, diagnosed by ophthalmology as anterior uveitis. No active joint disease was found on assessment by paediatric rheumatology. We therefore wondered what the risk of anterior uveitis was in patients presenting with psoriasis in the absence of joint disease. To assess the current evidence for psoriasis and uveitis a search was performed in Pubmed and EMBASE using the terms ‘psoriasis’ AND ‘uveitis’. The literature was screened from 1975 to 2013. This search identified 858 papers, 847 of which were excluded as they were not specific to psoriasis, were review articles or duplicates. A further seven case reports and small case series were also excluded due to limited numbers. Consequently this review includes four studies (Table 1), which present 251 patients with psoriasis, selected from secondary or tertiary care. The four studies include a cross-sectional prevalence study, two case–control studies, and one case series of 10 patients. Chandran et al.3 reported a cross-sectional prevalence study on 105 Asian Singaporean patients with chronic plaque psoriasis. Their aim was to clarify the nature and prevalence of eye abnormalities in patients with psoriasis. Two patients had anterior uveitis, of which one patient was known to have psoriatic arthritis. No significant correlation was found between uveitis and family history of psoriasis or arthropathy (P = 1), but this may be due to the small number of patients with uveitis. The severity of psoriasis significantly correlated with the development of uveitis (P = 0092). In total 67 patients were diagnosed with eye disease, and the paper concludes that there is a higher prevalence of eye disease in the psoriatic population. The paper by Kilic et al.4 supports this view. They compared 100 consecutive patients with psoriasis with age- and sexmatched controls. A pre-existing diagnosis of psoriatic arthritis was noted in 12 patients. Ocular findings detected included blepharitis, conjunctivitis, episcleritis, corneal involvement, anterior uveitis, pigment dispersion, cataract and cystoid © 2013 British Association of Dermatologists
