Search

The aim of this multi-centre French retrospective study was to identify severe, i.e. crusted and profuse, scabies patients. Records were retrieved from 22 Dermatology or Infectious Diseases departments in the Ile-de-France from January 2009 to January 2015 to characterize epidemiology, demography, diagnosis, contributing factors, treatment features, and outcomes in severe scabies. A total of 95 inpatients (57 crusted and 38 profuse) were included. A higher number of cases was observed among elderly patients (>75 years), mostly living in institutions. Thirteen patients (13.6%) reported a history of previously treated scabies. Sixty-three patients (66.3%) had been seen by a previous practitioner for the current episode (up to 8 previous visits). Initial misdiagnosis (e.g. eczema, prurigo, drug-related eruptions, psoriasis) was documented in 41 patients (43.1%). Fifty-eight patients (61%) had already received 1 or more previous treatments for their current episode. Forty percent received corticosteroids or acitretin for an initial diagnosis of eczema or psoriasis. Median time from the onset of symptoms to the diagnosis of severe scabies was 3 months (range 0.3-22). Itch was present in all patients at diagnosis. Most patients (n=84, 88.4%) had comorbidities. Diagnostic and therapeutic approaches varied. Complications occurred in 11.5% of cases. To date, there is no consensus for diagnosis and treatment, and future standardization of is required for optimal management.

Background: The development of evidence based guidelines is a demanding and time consuming process. Therefore it is important to share the knowledge and discuss the structure of these guidelines in detail., Objectives: To present a method report on the development process of the European evidence based guidelines on the systemic treatment of psoriasis vulgaris with the aim to offer guidance to other guidelines groups with lesser experience and to critically appraise the methodology of the guidelines development process., Methods: The guidelines are based on the previously evaluated literature from three European national evidence based guidelines and an additional systematic search and evaluation of new literature. Further steps included a structured consensus conference and a DELPHI procedure to develop the recommendations, as well as several internal and external reviews. All steps were coordinated by the Division of evidence based medicine in cooperation with a group of methodologists., Results: A total of 114 studies were included, serving as base for the efficacy chapters of the intervention. The recommendations, based on the efficacy and the level of evidence of the included studies were discussed and finally consented by the guidelines group. After subsequent reviews the guidelines were presented to the European Dermatology Forum, European Academy of Dermatology and Venereology and Union Européenne des Médicins Spécialistes for approval and published in October 2009., Conclusion: The development of European evidence based guidelines requires a coordinated structure which can be achieved by the integration of an experienced group of methodologists. Nevertheless further improvements are imaginable and might be considered for an update or other European evidence based guidelines., (© 2010 The Authors. Journal compilation © 2010 European Academy of Dermatology and Venereology.)

Of the 131 studies on monotherapy or combination therapy assessed, 56 studies on the different forms of phototherapy fulfilled the criteria for inclusion in the guidelines. Approximately three-quarters of all patients treated with phototherapy attained at least a PASI 75 response after 4 to 6 weeks, and clearance was frequently achieved (levels of evidence 2 and 3). Phototherapy represents a safe and very effective treatment option for moderate to severe forms of psoriasis vulgaris. The onset of clinical effects occurs within 2 weeks. Of the unwanted side effects, UV erythema from overexposure is by far the most common and is observed frequently. With repeated or long-term use, the consequences of high, cumulative UV doses (such as premature aging of the skin) must be taken into consideration. In addition, carcinogenic risk is associated with oral PUVA and is probable for local PUVA and UVB. The practicability of the therapy is limited by spatial, financial, human, and time constraints on the part of the physician, as well as by the amount of time required by the patient. From the perspective of the cost-bearing institution, phototherapy has a good cost-benefit ratio. However, the potentially significant costs for, and time required of, the patient must be considered.

Background: Numerous consumer products, including medicines, can be bought over the Internet. Previous reports indicate that patients are able to purchase the current available treatments, including expensive systemic and biological agents with side-effects, available for use on an outpatient basis. In France, as in most industrialized countries, these drug treatments are available only by prescription. Objective To evaluate whether psoriatic outpatients can buy the full range of psoriasis medications, including biological therapies, without a prescription, via the Internet., Methods: One investigator acted as a consumer to purchase psoriasis treatments and complementary medicines over the Internet. The website search was limited to a 4-h period. All products had to be available for delivery in France, without a prescription, and be suitable for outpatient use. Key words for the Internet search were combinations of medicinal product names, 'psoriasis', 'shopping', 'pharmacy', 'parapharmacy', entered into two major search engines, Google and Yahoo., Results: The investigator identified 47 websites offering a total of 340 products. All treatments, including biological therapies (etanercept, adalumimab and efaluzimab), were available for purchase with the exception of calcitriol and alefacept, with median prices being higher than the French price., Conclusion: This study shows that it is possible for consumers to purchase the majority of treatments for psoriasis via the Internet, including systemic therapies and even the most recent and expensive products such as biological agents, without a prescription.

Background: To further improve the standard of care provided to psoriasis patients in Europe, the European Dermatology Forum and the European Academy of Dermatology and Venereology have initiated a project to develop common European psoriasis guidelines., Objective: This paper aims to assess the methodological quality and suitability of evidence-based psoriasis guidelines as a base of common European treatment guidelines., Methods: A systematic literature search of the National Guidelines Clearinghouse, MEDLINE, EMBASE and GIN database for evidence-based psoriasis treatment guidelines published between 2001 and 2007 was performed and the AGREE instrument was used to assess the methodological quality., Results: Out of 166 hits, we identified three evidence-based guidelines. A Dutch guideline that includes systemic treatments and photo(chemo)therapy, a British guideline that includes biologics only, and a German guideline that includes systemic therapy, photo(chemo)therapy and topical therapy. For the majority of the 23 AGREE items assessed, all three guidelines rated high (3-4/4). The highest score was obtained by the British guidelines with 75 points out of 92, followed by the German guidelines with 74 points and the Dutch guidelines with 73 points. All guidelines showed weaknesses in the field of 'applicability'., Conclusion: The three guidelines that could be included rated high enough to be considered 'strongly recommended' and were included to serve as a basis for the new common European guidelines. During the development of the European guidelines, special attention should be paid to meet the requirements of good 'applicability'.

Background: The link between guttate psoriasis and streptococcal infection is acknowledged. This form of psoriasis generally follows pharyngitis, but a small number of cases have been described as being triggered by a streptococcal infection other than in the throat. We report the case of a child with streptococcal anitis followed by guttate psoriasis., Case Report: A 4-year-old boy presented painful perianal erythema present for two weeks with diffuse lesions of guttate psoriasis present since the second week. Group A beta-haemolytic streptococcus was found during bacterial examination of the anal region. After one month of antibiotic treatment with josamycin combined with daily application of desonide 0.05% topical cream, all symptoms subsided without relapse in the ensuing 6 months., Discussion: This case demonstrates the need for careful clinical examination, both of the nose and throat but also of the perianal region, in children consulting for guttate psoriasis. It also demonstrates the strong link between guttate psoriasis and streptococcal infections in certain patients.

A skin equivalent model has been used to fabricate tissues with psoriatic and normal cells. Psoriatic fibroblasts can induce hyperproliferative activity in normal keratinocytes. The psoriatic epidermis from lesions continues to proliferate at high rates for at least 15 days in this model, and normal fibroblasts are unable to suppress this hyperproliferation. The primary defect in psoriatic skin may reside in the dermal fibroblast.

Background Numerous consumer products, including medicines, can be bought over the Internet. Previous reports indicate that patients are able to purchase the current available treatments, including expensive systemic and biological agents with side-effects, available for use on an outpatient basis. In France, as in most industrialized countries, these drug treatments are available only by prescription. Objective To evaluate whether psoriatic outpatients can buy the full range of psoriasis medications, including biological therapies, without a prescription, via the Internet. Methods One investigator acted as a consumer to purchase psoriasis treatments and complementary medicines over the Internet. The website search was limited to a 4-h period. All products had to be available for delivery in France, without a prescription, and be suitable for outpatient use. Key words for the Internet search were combinations of medicinal product names, ‘psoriasis’, ‘shopping’, ‘pharmacy’, ‘parapharmacy’, entered into two major search engines, Google and Yahoo. Results The investigator identified 47 websites offering a total of 340 products. All treatments, including biological therapies (etanercept, adalumimab and efaluzimab), were available for purchase with the exception of calcitriol and alefacept, with median prices being higher than the French price. Conclusion This study shows that it is possible for consumers to purchase the majority of treatments for psoriasis via the Internet, including systemic therapies and even the most recent and expensive products such as biological agents, without a prescription. Conflicts of interest None declared. [ABSTRACT FROM AUTHOR]

Presents letters to the editor regarding articles published in the previous issues of the "British Journal of Dermatology." "Lichen sclerosus et atrophicus in non-identical female twins," which discusses the development of perineal lichen sclerosus et atrophicus in female twins; "Influence of containers on the quantities of topical preparations used," which was about the dispensing of topical agents; "Laser, dermal fibroblasts and psoriasis," which was about psoriasis.