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Background. Antinuclear antibody (ANA) is often used as a screening test for autoimmune comorbidities in patients with chronic spontaneous urticaria (CSU). However, the relationship of ANA status and the clinical course of the disease have not been fully described. Objectives. To compare clinical features of CSU patients who are positive and negative for ANA. Methods. This was a retrospective cohort study that enrolled CSU patients attending the Urticaria Clinic at Siriraj Hospital from 2013 to 2019. Demographics, clinical characteristics, laboratory investigations, and treatments were collected until July 2021. All patients were investigated for ANA. Clinical feature data was compared between CSU patients with positive ANA and negative ANA groups using the 2-sample t -test and the Mann–Whitney U test for quantitative variables. The chi-squared test or Fisher’s exact test was conducted to explore the association of qualitative variables. Disease relapse and remission were analysed via Kaplan-Meier survival analysis. Results. Of 323 CSU patients, 31% had positive ANA. There were no significant differences in disease severity or impairment in quality of life. Patients with a positive ANA test had significantly lower prevalence of allergic rhinitis ( p = .048 ) and significantly higher level of erythrocyte sedimentation rate ( p = 0.007 ). Kaplan-Meier survival analysis showed that 2% of ANA positive CSU patients achieved remission status after one year and 28% did so after five years. There was no statistically significant difference in time to remission and time to relapse between ANA-positive and negative groups. Conclusion. Positive ANA in CSU patients could not indicate the differences in main disease characteristics from the ANA-negative CSU patients. Investigation for ANA may be useful in CSU patients who are suspected of having autoimmune diseases.

Psoriasis hospitalisation is not frequently reported. The objective of this study was to determine (1) the clinical, laboratory and treatment features of patients with psoriasis hospitalised due to flare-up and (2) other causes of admission of patients with psoriasis. We retrospectively reviewed data on 48 patients admitted due to psoriasis flare-up and 1908 patients with psoriasis admitted due to concomitant illnesses or comorbidities. The study period was 2005-2021. The latter group was compared with 821,804 patients without psoriasis admitted during the period. Of the 48 cases, 37.5% had erythroderma, and 62.5% had generalised pustular psoriasis (GPP). Women (68.8%) predominated, especially in the GPP group (76.7%). The mean age of admission with erythroderma (44.8 years) was higher than for GPP (32.1 years). Infection was the main trigger for psoriasis flare-up (46%). Abnormalities in liver function tests were found in 33.3% of the cases. These abnormalities usually subsided 1-2 months after skin improvement (83.4%). Acitretin was the most prescribed drug for GPP (81.4%), whereas topical treatment alone (50%) was the most frequent erythroderma therapy. Intensive care was needed by 9.3% of patients with GPP. In the psoriasis group admitted due to concomitant illnesses or comorbidities, admission due to digestive and infectious causes was significantly higher for psoriasis patients. Our study showed that trend of psoriasis admission due to disease flare-up was not significantly changed even in the era of biologics. We believed that patient education on avoiding the common precipitating factors of psoriasis flare-up and good self-care is mandatory to reduce the risk of hospitalisation.

The Angioedema Control Test (AECT) is a questionnaire that monitors disease control in patients with angioedema, with a recall period of 4 weeks (AECT-4wk) or 3 months (AECT-3mo).This study investigated the psychometric properties of a Thai version of the AECT.Of 54 patients, 46, 5, 2, and 1 had recurrent angioedema with chronic spontaneous urticaria, hereditary angioedema, idiopathic histaminergic angioedema, and acquired angioedema due to C1 esterase inhibitor deficiency, respectively. The AECT, Angioedema Activity Score (AAS), Dermatology Life Quality Index (DLQI), Angioedema Quality of Life Questionnaire (AE-QoL), and anchors for disease control (numeric rating scale [NRS] and patient global assessment-Likert scale [PatGA-LS]) were used. The patients rated the efficacy of their treatment.Fifty-four and 47 patients completed the AECT-4wk and AECT-3mo, respectively. Both AECT versions showed significant correlations with disease activity (AAS, r = 0.6-0.8), disease control (NRS and PatGA-LS, r = 0.7-0.9), and quality of life impairment (DLQI and AE-QoL, r = 0.6-0.8). Higher correlations were found for the AECT-4wk than for the AECT-3mo. Excellent internal consistency (alpha = 0.98 and 0.97, respectively) and intraclass correlation (0.96 and 0.94, respectively) were found. A cutoff ≥ 10 was confirmed to identify patients with well-controlled disease for both AECT versions (AUCs = 0.89 and 0.97).The Thai version of the AECT is a valid and reliable tool for clinical practice. Due to the shorter recall period, the AECT-4wk may be more accurate than, and preferable to, the AECT-3mo. A cutoff ≥ 10 should be used to identify patients with well-controlled disease.

Cutaneous adverse events after receiving a COVID-19 vaccine were identified. The disease activity of urticaria after a COVID-19 vaccine has never been explored in chronic urticaria patients.To evaluate disease activity of chronic urticaria after receiving a COVID-19 vaccine.A prospective cross-sectional study was conducted in chronic urticaria patients aged 18 or above who visited Siriraj Hospital between July and September 2021, and received the first and second dose of COVID-19 vaccine. The status prior to vaccination, including disease activity, disease control and disease severity was assessed by a urticaria activity score over seven days, urticaria control test, and modified medication score. The disease activity after vaccination was recorded.A total of 130 patients with a mean age of 45.9 ± 14.7 were enrolled in this study. Adenoviral and inactivated vaccines were administered to 85 (65.4%) and 45 patients (34.6%), respectively. Exacerbation was reported in 20 cases (15.4%) after the first dose and 17 cases (13.1%) after the second dose. Nine patients (45%) reported exacerbation after both the first and second dose. The majority of patients only had wheal, while three patients reported wheal with angioedema. No anaphylaxis was reported. Factor predicting exacerbation was concurrent thyroid disease (aRR 2.78, p0.01).Approximately 15% of chronic urticaria patients reported exacerbation after receiving a COVID-19 vaccination. No serious events were observed. Chronic urticaria patients should be vaccinated against COVID-19 after a discussion of the risk of disease flare-up.

Secukinumab demonstrated high efficacy and favorable safety profile in patients with moderate-to-severe plaque psoriasis (PsO) in clinical trials. However, understanding of patient characteristics and clinical outcomes in real world in Thailand is still limited. To describe patient characteristics, effectiveness and safety of secukinumab in Thai PsO patients. This retrospective study analyzed data from medical records of adult PsO patients who initiated secukinumab at 7 dermatology centers from September 2017 to April 2021. Study outcomes included patient characteristics and changes in Psoriasis Area and Severity Index (PASI) score from baseline at weeks 4 and 16 after secukinumab initiation. Adverse events were recorded. Subgroup analyses by adherence rate and completeness of loading dose were performed. Of 163 patients, the mean (SD) age was 44.0 (14.0) years. Most patients (84.7%) were previously treated with topical therapy while 62.0% and 21.5% of patients had received systemic and biologic therapy, respectively. The mean baseline PASI score was 15.4 (9.3). Overall, the mean PASI score improved by 58.0% at week 4 and 78.4% at week 16. Statistically significant differences in PASI approvement were revealed among subgroups of patients with different loading dose and adherence rate. Adverse effects were reported in 8.0% of patients. The characteristics of patients in this study were slightly different from clinical trials in terms of demographic and clinical characteristics, as well as PsO treatment. Secukinumab was effective and safe in Thai patients with PsO, especially among those with complete loading dose and a higher adherence rate.

PROPOSE The purpose of this study was to investigate panels of enzyme-linked immunospot assays (ELISpot) to detect drug-specific mediator releasing cells for confirming culprit drugs in severe cutaneous adverse reactions (SCARs). METHODS Frequencies of drug-induced interleukin-22 (IL-22)-, interferon-gamma (IFN-γ)-, and granzyme-B (GrB)-releasing cells were measured by incubating peripheral blood mononuclear cells (PBMCs) from SCAR patients with the culprit drugs. Potential immunoadjuvants were supplemented to enhance drug-induced mediator responses. RESULTS Twenty-seven patients, including 9 acute generalized exanthematous pustulosis (AGEP), 10 drug reactions with eosinophilia and systemic symptoms, and 8 Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) were recruited. The average frequencies of drug-induced IL-22-, IFN-γ-, and GrB-releasing cells were 35.5±16.3, 33.0±7.1, and 164.8±43.1 cells/million PBMCs, respectively. The sensitivity of combined IFN-γ/IL-22/GrB ELISpot was higher than that of IFN-γ ELISpot alone for culprit drug detection in all SCAR subjects (77.8% vs 51.9%, P < 0.01). The measurement of drug-induced IL-22- and IFN-γ releasing cells confirmed the culprit drugs in 77.8% of AGEP. The measurement of drug-induced IFN-γ- and GrB-releasing cells confirmed the culprit drugs in 62.5% of SJS/TEN. Alpha-galactosylceramide supplementation significantly increased the frequencies of drug-induced IFN-γ releasing cells. CONCLUSION The measurement of drug-induced IFN-γ-releasing cells is the key for identifying culprit drugs. The additional measurement of drug-induced IL-22-releasing cells enhances ELISpot sensitivity to identify drug-induced AGEP, while the measurement of drug-induced GrB-releasing cells could have a role in SJS/TEN. ELISpot sensitivity might be improved by supplementary alpha-galactosylceramide. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02574988.

BACKGROUND Mediterranean diets have been reported to improve psoriasis. Asian food has a unique character and differs from Mediterranean diets. METHODS This study compared the dietary intake of psoriatic patients and individuals without psoriasis, and investigated the association between diet and psoriasis severity. Data were collected on the frequency of consumption of Mediterranean and Asian diets. RESULTS One-hundred psoriatic patients and 100 individuals (age- and sex-matched controls) was conducted. In the case of the anti-inflammatory diets, the psoriatic patients consumed significantly less olive oil, berry fruits, fish, seafood, tree nuts, and eggs than the controls. As to the pro-inflammatory diets, greater quantities of dairy products and soft drinks were consumed by the psoriatic patients than the controls. Regarding Asian food, the patients consumed significantly less pickled foods and brown rice/Riceberry (a rice variety), but more coconut milk, than the controls. In terms of psoriasis severity, the patients with lower severities consumed significantly more vegetables; in contrast, a higher consumption of red meat, belly meat, and instant noodles was associated with greater psoriasis severities. CONCLUSIONS Our study adds further information on the role of diets-especially Asian diets-and psoriasis. These data should help patients and clinicians to focus more clearly on diet management.

Aromatic antiepileptic drugs (AEDs)-induced cutaneous adverse drug reactions (cADRs) add up to the limited use of the AEDs in the treatment and prevention of seizures. Human leukocyte antigen-B (HLA-B) alleles have been linked to AEDs-induced cADRs. We investigated the association between cADRs (including Stevens–Johnson syndrome; SJS/toxic epidermal necrolysis; TEN, drug reaction with eosinophilia and systemic symptoms; DRESS, and Maculopapular eruption; MPE) caused by AEDs (phenytoin, carbamazepine, lamotrigine, phenobarbital and oxcarbazepine) and HLA-B alleles in Thai population. Through the case-control study, 166 patients with AEDs-induced cADRs, 426 AEDs-tolerant patients (AEDs-tolerant controls), and 470 healthy subjects (Thai population) were collected. The HLA genotypes were detected using the polymerase chain reaction-sequence specific oligonucleotide probe (PCR-SSOP) method. We also performed a meta-analysis with these data and other populations. The carrier rate of HLA-B*15:02 was significantly different between AEDs-induced cADRs group and AEDs-tolerant group (Odds ratio; OR 4.28, 95% Confidence interval; CI 2.64–6.95, p p HLA-B*15:02 with AEDs-induced cADRs (OR 4.77, 95%CI 1.79–12.73, p HLA-B*15:02 was associated with SJS/TEN induced by AEDs (OR 10.28, 95%CI 6.50–16.28, p p = 0.001) and carbamazepine (OR 137.69, 95%CI 50.97–371.98, p HLA-B*15:02 and AEDs-induced SJS/TEN was demonstrated with an OR of 10.79 (95%CI 5.50–21.16, p HLA-B*08:01, HLA-B*13:01, and HLA-B*56:02 were significantly higher in the DRESS group compared with the AEDs-tolerant group (p = 0.029, 0.007, and 0.017, respectively). The HLA-B*15:02 allele may represent a risk factor for AEDs-induced cADRs.

Objective: To systemically summarize and meta-analyze the risk of dementia in psoriasis patients. Methods: A systematic review was performed in two databases (EMBASE and MEDLINE). The eligible studies had to be a cohort study or a cross-sectional study that compared either the prevalence or incidence of dementia in patients with psoriasis, versus individuals without psoriasis. Results: Of 791 retrieved articles, seven studies met the inclusion criteria and were included into the meta-analysis. The risk of incident and prevalent dementia were significantly higher in patients with psoriasis, with a pooled risk ratio of 1.16 (95% CI: 1.02-1.33; I2 96%) and 1.36 (95% CI: 1.07-1.72; I2 10%), respectively. Conclusions: This study revealed a slight increase in both the incidence and prevalence of dementia in psoriasis patients. However, dermatologists should carefully observe and periodically screen psoriasis patients for this comorbidity, especially among those who have symptoms and signs of cognitive impairment.

Methotrexate (MTX) has long been considered the first-line oral systemic pharmacotherapy for psoriasis. The drug has several well-known systemic side effects, such as bone marrow suppression and hepatotoxicity. To avoid them, the use of topical or intralesional administrations of MTX has become an interesting option. With the advent of novel drug delivery systems, especially nanocarriers, the usage of a high-efficacy and safe topical MTX for psoriasis has nearly been attained. This review examined the development, anti-psoriatic efficacy and adverse effects of topical forms of MTX (plain MTX; MTX with chemical enhancer; MTX using nanotechnology; MTX with protein transduction domains; MTX with liquid crystalline systems; and MTX with physical enhancer/laser) and intralesional MTX in psoriasis patients and psoriasis-induced animals. The efficacy of topical MTX varied with the drug delivery technology employed. Nevertheless, the overall safety profile of the topical forms was favourable. A 25 mg/mL MTX solution injected intralesionally at the nail matrix worked well for nail psoriasis recalcitrant to topical treatment. To improve the standard of care for patients with psoriasis, randomized controlled trials that establish the most effective MTX-delivery system are needed.

Moisturizers play an important role in restoring the skin barrier. They should be used to treat and prevent eczema, especially in atopic dermatitis (AD).To evaluate the factors that influence selection of moisturizers in adult patients with AD and without it. Usage behavior between the two groups was also determined.A cross-sectional web-based survey was performed.A total of 1,195 participants with mean age of 46.5 ± 14.5 were enrolled. Fifty participants (4.2%) met the William's criteria for AD diagnosis. Most participants reported using moisturizer every day or two times per day. A non-sticky moisturizer, followed by pleasant odor were considered important properties. For choosing a moisturizer, personal satisfaction was the most common answer given by participants. The most common locations that participants applied moisturizer were the extremities (85.1%) and face (84.9%). Physicians' suggestion was also a significant factor that led to moisturizer use by AD patients but it was not significant in the non-AD group (29.2% vs 14.7%, p = 0.007, OR 2.4). A pH of 5.5 and the anti-inflammatory property were important factors in choosing a moisturizer in the AD group. Both AD and non-AD participants preferred liquid soap over bar soap in daily life.Our results showed that most participants have basic knowledge of how to use a moisturizer. Physicians' suggestion influenced the selection of moisturizer in AD patients. Thus, physicians should continue to educate in order to achieve good clinical outcomes.

Background Symptomatic dermographism (SD), the most common form of chronic inducible urticaria, presents with transient wheals accompanied by itching in response to scratching. Little is known about available treatment options and their efficacy in SD. Objective To systematically review the efficacy of treatment options for patients with SD. Methods Using predefined search terms, we searched for relevant literature published until September 2019. The systematic review process was consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations. Results The 23 studies identified included 15 randomized controlled trials; 22 and 17 assessed treatment responses in patients with SD by provocation/threshold testing and patient/physician clinical assessment, respectively. Thirteen different treatments were investigated in a total of 430 adult patients. The most frequently studied therapy, first-generation H1-antihistamines, showed variable efficacy and significant side effects. In contrast, second-generation H1-antihistamines (2ndAH1), in all studies, were effective and well tolerated. Monotherapy with an H2-antihistamine (AH2) was not effective, whereas adding an AH2 increased the efficacy of treatment with an H1-antihistamine (AH1). SD improved with omalizumab. All other treatments were only investigated in small, unrepeated, and/or uncontrolled studies. There are no studies on updosing of 2ndAH1. Conclusions The available SD studies are heterogeneous, mostly monocentric, old, small, and unrepeated, pointing to a high need for more and better studies. We suggest that 2ndAH1 should be the first-line treatment. In uncontrolled cases, the combination of AH1 and AH2 may be tried. Even though there is no evidence of its efficacy over standard dosage, updosing of 2ndAH1 may be considered based on the extrapolation of evidence from chronic spontaneous urticaria; omalizumab should be added in recalcitrant patients.

Methotrexate (MTX) is a mainstay drug in the treatment of psoriatic and rheumatologic conditions. Subcutaneous MTX has become a feasible treatment alternative with the development of prefilled syringes or autoinjectors containing MTX solution that can be self-administered by the patient at home. However, MTX prefilled auto-injector pens are still not available in some countries.This study aimed to investigate the stability and sterility of 25 mg/mL MTX solution in a disposable plastic syringe over a 12-week period under light protection at temperatures of 4 °C, 25 °C, and 37 °C.This study was conducted during November 2019 to February 2020 at the Faculty of Medicine Siriraj Hospital, Mahidol University. Stability was evaluated using ultra-high-performance liquid chromatography technique, and sterility was assessed by cultures for bacterial and fungal contamination.Our results revealed that patient-ready syringes containing 25 mg/mL MTX solution can be prepared in advance and kept for up to 12 weeks under light protection, and they can be kept at temperatures ranging from 4 to 37 °C.This system for delivering MTX to patients that are refractory to or intolerant of oral MTX

Background. Uveitis is a known ophthalmologic manifestation of seronegative spondyloarthropathy, including psoriatic arthritis. However, the data is less clear among patients with psoriasis due to the limited number of published studies. Aims. To investigate whether the risk of incident and prevalent uveitis is elevated among patients with psoriasis using systematic review and meta-analysis technique. Methods. The MEDLINE and EMBASE databases were searched from their inception to May 2019. Eligible studies must have included a psoriasis group and a nonpsoriasis group. Eligible studies must also have investigated for prevalent or incident uveitis, and the magnitude of difference between the study groups must have been reported. Pooled risk ratio and 95% confidence interval (CI) were calculated using random-effect generic inverse variance methods. Results. Of 7,107 potentially eligible articles from the EMBASE and MEDLINE databases, 7 studies were included in the meta-analysis. Two of those studies compared the incidence, and 5 studies compared the prevalence of uveitis between the psoriasis and nonpsoriasis groups. For incident uveitis, a total of 5,865,801 patients (222,083 with psoriasis and 5,643,718 without psoriasis) were analyzed. For prevalent uveitis, a total of 1,343,436 patients (37,891 with psoriasis and 1,305,545 without psoriasis) were studied. The risk of incident uveitis was significantly higher among patients with psoriasis with a pooled risk ratio of 1.23 (95% CI: 1.05-1.45, I2=55%). The risk of prevalent uveitis was also significantly higher among patients with psoriasis with a pooled risk ratio of 1.97 (95% CI: 1.68-2.31, I2=0%). Conclusions. The results of this study revealed significantly increased risk of both prevalent and incident uveitis among patients with psoriasis.

The term “cumulative life course impairment” (CLCI) has been proposed to capture the overall effects of psoriasis that result in altered or impaired life potential during the life course of a patient. Severity and comorbidities were the most frequently studied risk factors for CLCI in psoriasis. This study evaluated the health-utility values and risk factors for CLCI using Patient Acceptable Symptom State (PASS) and EQ-5D. This cross-sectional investigation enrolled patients with psoriasis attending the Psoriasis Clinic, Siriraj Hospital, Bangkok. Patients were asked PASS questions about their overall self-perceived health state, adaptation, and expectations for current, future, and lifelong conditions. The patients also completed EQ-5D. The mean age of 139 enrolled patients was 45.8 ± 14.4 years, and 57.6% were women. There were 121 (87.1%) cases of chronic plaque psoriasis, 9 (6.5%) of guttate psoriasis, 4 (2.9%) of erythrodermic psoriasis, 3 (2.2%) of pustular psoriasis, and 2 (1.4%) of acrodermatitis continua of Hallopeau. For current PASS, satisfaction was significantly associated with older age, being married, and lower disease severity. The mean health-utility value and EQ-VAS score of the 139 patients were 0.89 ± 0.12 and 77.0 ± 17.4, respectively. Patients would not accept their disease if they had moderate to extreme problems in usual activities and depression/anxiety for the future and lifelong. Univariate analysis revealed that depression and usual activities were significantly associated with satisfaction for current PASS, future PASS, and lifelong PASS. In conclusion, disease severity, age, marital status, problems with usual activities, and depression/anxiety were significantly related to CLCI. These findings may allow physicians to identify psychosocial and psychological aspects of psoriatic patients at high risk for developing CLCI. Early and adequate treatment, good coping strategies, and good social support can prevent a negative impact on CLCI and major life-changing decisions.

Psoriasis in people living with HIV (PLHIV) has been reported as having particular clinical characteristics. However, most of the source data was derived from descriptive studies in Europe and the USA. This study was conducted to compare the characteristics of psoriasis in PLHIV to general psoriasis patients. We retrospectively reviewed the records of 73 cases of psoriasis in PLHIV and of 232 general psoriasis patients who visited a psoriasis clinic in Bangkok, Thailand. Psoriasis in PLHIV predominated in males (78.1%), with an older age of onset, significantly lower rates of nail involvement and psoriatic arthritis, but higher rates of co-infectious diseases than for general psoriasis patients. A low nadir CD4 T-cell count (100 cells/μl) and CD4 T-cell count at psoriasis diagnosis were associated with a high body surface area (BSA) involvement. The mean BSA involvement in PLHIV was 24. Although 64.4% (47/73) of the PLHIV had moderate-to-high psoriasis severity, 29.8% of those (14/47) only received topical treatment. Acitretin was the most common drug used. Other therapies were rarely used, and no biologics were administered. In conclusion, psoriasis in PLHIV has several clinical features that differ from general psoriasis. PLHIV tend to receive substandard care for psoriasis, even in upper-middle-income countries.

BACKGROUND Pruritus is commonly associated with skin disorders. The 5-D itch scale was developed as a specific questionnaire for pruritus. OBJECTIVE This study aimed to evaluate the validity, reliability, and sensitivity to change of the Thai 5-D itch scale in Thai patients. METHODS The Thai Dermatology Life Quality Index (DLQI), patient's global assessment of disease severity (PatGA-VAS), Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL), and seven-day urticaria activity score (UAS7) were evaluated as correlation with Thai 5-D itch scale. Seventy-five stable patients (42 chronic urticaria patients and 33 eczema patients), who had no change in disease severity after 4-weeks were assessed for test-retest reliability. RESULTS Of 130 pruritus patients who were treated at Department of Dermatology, Siriraj Hospital, 65 patients were diagnosed with chronic urticaria. The others were diagnosed with eczema. The validity of Thai 5-D itch scale correlated strongly with Thai DLQI total score (r = 0.76, p < 0.0001) and PatGA-VAS (r = 0.79, p < 0.0001). The strong reliability of Thai 5-D itch scale was demonstrated as intraclass correlation coefficient of 0.90. The changes in Thai 5-D itch scale was correlated with the changes in PatGA-VAS and UAS7 which indicated that the Thai 5-D itch scale had good sensitivity to change (r = 0.66) and (r = 0.67), respectively. CONCLUSIONS The Thai 5-D itch scale is a questionnaire with good validity, reliability and sensitivity to change to evaluate pruritus in Thai patients. This will support the use of 5-D itch scale in practice, in other languages.

Taking the perspectives of patients into consideration is of the utmost importance when defining treatment goals for psoriasis. The patient-acceptable symptom state (PASS) is a dichotomised question that captures patients' perceptions of their overall health state.To evaluate PASS and determine the factors associated with a satisfactory PASS for psoriatic patients.Three questions were asked: (Q1) Considering the ways that your skin symptoms affect your functioning, is your current skin psoriasis satisfactory? (Current PASS), (Q2) Considering the ways that your psoriasis is affecting you, if you were to remain in this state for the next few months, would this be satisfactory? (Future PASS) and (Q3) If you were to remain for the rest of your life as you were during the last 48 hours, would this be satisfactory? (Lifelong PASS). Disease severity, symptoms and health-related quality of life (HRQoL) were collected.Of 140 patients, 74.3%, 70.0% and 85.7% expressed satisfaction with their current, future and lifelong skin psoriasis conditions respectively. A satisfactory PASS was significantly associated with older and married patients; lower disease severity; fewer skin symptoms; and a higher HRQoL. A multivariate analysis revealed that the independent factors associated with a satisfactory PASS were being older than 40 years, being married, practising meditation, not having extensive lesions at sensitive areas and having a high HRQoL.PASS is a simple and easily administered questionnaire that reflects both disease severity and HRQoL. Understanding patients' needs and satisfaction levels will result in better care for psoriatic patients than otherwise.

Aquagenic urticaria (AquaU) is a rare variant of chronic inducible urticaria where wheals occur after skin contact with water. Information on clinical manifestations and treatment outcomes is limited, which makes the management of AquaU challenging.To systematically review disease features and relevant triggers of AquaU and patients' response to treatment.Related articles were searched by use of the terms "aquagenic urticaria" and "aquagenic angioedema" until June 2021 and reviewed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations.A total of 77 patients with AquaU were investigated in 59 studies including 47 case reports and 12 case series. AquaU predominantly presented in women (47 patients, 61%), and the mean age of onset of the disease was 19.6 ± 10.8 years (range: 0-54 years). Wheals commonly occurred in localized areas and regardless of the water temperature. Based on the reviewed evidence, AquaU can be classified as familial AquaU (FAquaU, 18.2%) and acquired AquaU (AAquaU, 81.8%). Although many treatments were used in both subtypes of AquaU, the use of second-generation HAquaU is proposed to be classified into 2 subtypes, FAquaU and the more common AAquaU. Treatment with a 2

Dermographism is the most common form of chronic inducible urticaria. However, the natural history and clinical course of patients with dermographism in tropical countries has not fully been described.To examine clinical features, natural history and clinical course of dermographism in Thai patients according to their experiences.A cross-sectional, internet-based survey was conducted in 2021. All study respondents completed a 45-item questionnaire that was circulated on social media regarding dermographism.Among the 2,456 respondents who reported dermographism, 1,900 had symptomatic dermographism (SD), while 556 had simple dermographism (SimD). Of the respondents who reported SD and SimD, the female to male ratio was 2.2:1 and 2.4:1, respectively. The median age of the first episode of SD and SimD was 16 and 15 years, respectively. Older age, greater body weight, cardiovascular diseases, allergic conjunctivitis, atopic dermatitis, changes in temperature, and family history of dermographism were all factors linked to an increased probability of SD. Half of the respondents with SD reported moderate itch severity. Moreover, about half of SD and almost all of SimD respondents let the wheal resolve on its own. Second generation HThis survey highlights several aspects of dermographism in Thai patients which can be useful for healthcare providers. SD is troublesome and affects the quality of life of many patients, leading some to seek medication themselves.