Ādas psoriāzes izplatība Eiropā un pasaulē, Ādas psoriāzes izplatība Eiropā un pasaulē, diagnostiskās un ārstēšanas problēmas.diagnostiskās un ārstēšanas problēmas.

Psoriāzes klīniskās vadlīnijas. Psoriāzes klīniskās vadlīnijas.

Jānis ĶīsisJānis ĶīsisRSU Infektoloģijas un dermatoloģijas katedraRSU Infektoloģijas un dermatoloģijas katedra

Asociētais profesors Asociētais profesors

''Vienotā pieeja psoriāzes izaicinājumu risināšanā''

Psoriāze .Psoriāze .Jau 200 gadus .Jau 200 gadus .

Willan R. Cutaneous Diseases. London: J. Johnson; Willan R. Cutaneous Diseases. London: J. Johnson; 1808.1808.

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Saturs .Saturs .

► 1. Epidemioloģija1. Epidemioloģija..

►2. Diagnostika .2. Diagnostika .►3.Terapija .3.Terapija .►4 .4 .PsoriāzesPsoriāzes terapija. terapija.

Epidemioloģija.Epidemioloģija.

► Telefonaptaujā Kanādā tika indicēti 500 psoriāzes Telefonaptaujā Kanādā tika indicēti 500 psoriāzes pacienti ar ādas bojājumu >3 plaukstas un viņu pacienti ar ādas bojājumu >3 plaukstas un viņu vidū 18 % tika konstatēts PsA ,vidū 18 % tika konstatēts PsA ,bet 51%bet 51% (256 of 500 (256 of 500 ) bija sāpes ,stīvums locītavās ) bija sāpes ,stīvums locītavās

► J Cutan Med Surg. J Cutan Med Surg. 2009 Sep-Oct;13(52009 Sep-Oct;13(5):235-52.):235-52.The burden of The burden of psoriasis in Canada: insights from the pSoriasis psoriasis in Canada: insights from the pSoriasis Knowledge IN Canada (SKIN) survey.Knowledge IN Canada (SKIN) survey.LyndeLynde CW CW, , PoulinPoulin Y Y, , GuentherGuenther L L, , JacksonJackson C C..

Epidemioloģija .Epidemioloģija .

►ASV diagnosticētas psoriāzes ASV diagnosticētas psoriāzes prevalence ir 3.15%.ar pieaugumu prevalence ir 3.15%.ar pieaugumu pēdējās 2 dekādēs .pēdējās 2 dekādēs .

► J Autoimmun. J Autoimmun. 2010 May;34(32010 May;34(3):J314-21. Epub 2009 Dec ):J314-21. Epub 2009 Dec 24.24.Geoepidemiology and environmental factors of psoriasis Geoepidemiology and environmental factors of psoriasis and psoriatic arthritis.and psoriatic arthritis.ChandranChandran V V, , RaychaudhuriRaychaudhuri SP SP..

The Nobel Prize in Physiology or Medicine 1950 was awarded jointly to Edward Calvin Kendall, Tadeus Reichstein and Philip Showalter Hench

"for their discoveries relating to the hormones of the adrenal cortex, their structure and biological effects".

www.nobelprize.org

Philip Showalter HenchEdward Calvin Kendall Tadeus Reichstein

Vēsture

Vēsture .Vēsture .

►HidrokortizonsHidrokortizons –pirmais lokāli –pirmais lokāli efektīvais efektīvais KSKS tika ieviests tika ieviests 1952.1952. gadā gadā . To veica Sulzberger un Witten .. To veica Sulzberger un Witten .

►6060.jubileja. .jubileja.

1. Sulzberger MB, Witten VH. Effect of topically applied compound F in selected dermatoses. J Invest Dermatol 1952; 19: 101–2.

Epidemioloģija . Bērniem. Epidemioloģija . Bērniem. ►Saslimstība ar psoriāzi bērniem ir Saslimstība ar psoriāzi bērniem ir

palielinājusies zīmīgi no palielinājusies zīmīgi no 29.629.6 uz uz 100,000 1970 100,000 1970 līdz līdz 1974 1974 uz uz 62.762.7 no no 100,000 100,000 jau jau 1995 1995 līdz līdz 1999 (P < 1999 (P < .001). .001).

J Am Acad Dermatol. 2009 Dec 3. [Epub ahead of print]Incidence of psoriasis in children: A population-based study.Tollefson MM, Crowson CS, McEvoy MT, Kremers HM.Department of Dermatology, College of Medicine, Mayo Clinic, Rochester, Minnesota.

Epidemiology of Psoriasis in Germany - Epidemiology of Psoriasis in Germany - Analysis of Secondary Health Insurance Analysis of Secondary Health Insurance

Data.Data.

► 33 981 33 981 nno 1 344 071 o 1 344 071 apdrošinātām apdrošinātām personām 2005 gadā un psoriāzes personām 2005 gadā un psoriāzes diagnozi diagnozi ,,tādejādi viena gada prevalence šai tādejādi viena gada prevalence šai kohortā bija kohortā bija 2.53%.2.53%. Līdz 80 gvLīdz 80 gv prevalence prevalence palielinājās un bija augstākā vecuma grupā palielinājās un bija augstākā vecuma grupā 50 to 79 50 to 79 g.v g.v ( 3.99-4.18%). ( 3.99-4.18%). Apdrošinātās personasApdrošinātās personas līdz 20 gv.bija līdz 20 gv.bija ar prevalenci ar prevalenci 0.73%0.73%.. Zemākie rādītātāji Zemākie rādītātāji bija dienvidos bija dienvidos (2.17%) (2.17%) un augstākie un augstākie (2.78%) (2.78%) Vācijas ziemeļos .Vācijas ziemeļos .Gesundheitswesen. 2010 Jun 11. [Epub ahead of print]Schäfer I, Rustenbach SJ, Radtke M, Augustin J, Glaeske G,

Pētnieki uzskata ,ka psoriāze Pētnieki uzskata ,ka psoriāze var samazināt iespējamo dzīves var samazināt iespējamo dzīves

ilgumu ilgumu ► MedPageMedPage Today Today (10/14, Bankhead) (10/14, Bankhead) ir citējis,ka ir citējis,ka

""psoripsoriāzes āzes pa paccientientiem ir koincidentas saslimšanas iem ir koincidentas saslimšanas ,kas ,kas ssaīsina iespējamo dzīvildzi par 10 un vairāk aīsina iespējamo dzīvildzi par 10 un vairāk gadiemgadiem" " Kanādas pētnieku komanda no Kanādas pētnieku komanda no NewLab NewLab ir ir atraduši ,,,ka pacienti ,kuriem atraduši ,,,ka pacienti ,kuriem psoripsoriāze ir diagnosticēta āze ir diagnosticēta pirms 25 gv.,nedzīvo līdz 60 gv.pirms 25 gv.,nedzīvo līdz 60 gv.““, , kamēr psoriāze kamēr psoriāze diagnosticēta 25 un vēlākā laika periodā ir asociēta ar diagnosticēta 25 un vēlākā laika periodā ir asociēta ar vidējo dzīvildzi virs 70 gv.vidējo dzīvildzi virs 70 gv. Dat Datu analīze parādīja ,ka,, u analīze parādīja ,ka,, psoriāzes pacientiem risks nomirt psoriāzes pacientiem risks nomirt pašnāvībā ,ievainojumu ,saindēšanās dēl ir pašnāvībā ,ievainojumu ,saindēšanās dēl ir 1 1 gadījumā gadījumā no no 600600 ,,bet kardiovaskulārās nāves risks ir bet kardiovaskulārās nāves risks ir aptuveni 1 no 75 aptuveni 1 no 75 ""

Genital Psoriasis: A Systematic Genital Psoriasis: A Systematic Literature Review on this Literature Review on this Hidden Skin Hidden Skin

DiseaseDisease..► Ģenitāliju āda bojājums sastopams Ģenitāliju āda bojājums sastopams 29–40% 29–40%

pacientiem ar pacientiem ar psori psoriāzi ;āzi ;► No No 48 pa48 pacientiem cientiem ar ar inversinversuu psori psoriāziāzi ,,

ārējās ģenitālijas bija iesaistītas 38 ārējās ģenitālijas bija iesaistītas 38 (79.2%).(79.2%).

► VulvVulvāro psoriāziāro psoriāziar psoriasis ar psoriasis bieži novēro bieži novēro bērnu vecumā .Izvērtējot bērnu vecumā .Izvērtējot 130 prepuber 130 prepuberātes ātes vecuma meitenes ar vulvārām sūdzībām –vecuma meitenes ar vulvārām sūdzībām – psoripsoriāze āze (17%) (17%) bija 3. biežākais ādas bija 3. biežākais ādas stāvoklis pēc AD un iritanta D(33%) un stāvoklis pēc AD un iritanta D(33%) un lichen sclerosus (18%)lichen sclerosus (18%)Acta Derm Venereol. 2010 Oct 7. doi: 10.2340/00015555-0988. [Epub ahead

of print] .Meeuwis KA, de Hullu JA, Massuger LF, van de Kerkhof PC,.

Globālā epidemioloģija .Globālā epidemioloģija .

► 53 pētījumi no 385 bija globāli pētījumi , caurskatīti 53 pētījumi no 385 bija globāli pētījumi , caurskatīti laika posmā lidz 2011 gada jūlijam.laika posmā lidz 2011 gada jūlijam.

► Bērnu prevalence 0% (Taivānā ) līdz 2.1% (Itālija) Bērnu prevalence 0% (Taivānā ) līdz 2.1% (Itālija) pieaugušie no 0.91% (Amerika ) līdz 8.5% pieaugušie no 0.91% (Amerika ) līdz 8.5% (Norvēģija(Norvēģija

► Bērnu psoriāzes incidence (Amerika) bija Bērnu psoriāzes incidence (Amerika) bija 40.8/100,000 person-gadi ,pieaugušajiem variācijas 40.8/100,000 person-gadi ,pieaugušajiem variācijas no 78.9/100,000 person-gadiem (Amerika )līdz no 78.9/100,000 person-gadiem (Amerika )līdz 230/100,000 person-gadiem (Itālijā ). 230/100,000 person-gadiem (Itālijā ).

► Tas nozīmē ,ka psoriāzes sastopamība un Tas nozīmē ,ka psoriāzes sastopamība un saslimstība variē atbilstoši vecumam un saslimstība variē atbilstoši vecumam un ģeogrāfiskajam reģionam. ģeogrāfiskajam reģionam.

► Psoriāze biežāka ir rajonos attālinātos no ekvatora . Psoriāze biežāka ir rajonos attālinātos no ekvatora . J Invest Dermatol. 2012 Sep 27. doi: 10.1038/jid.2012.339. [Epub ahead of print] Global Epidemiology of Psoriasis: A Systematic Review of Incidence and Prevalence.Parisi R, Symmons DP, Griffiths CE, Ashcroft DM;

► Heterosexual women with psoriasis 0.03) compared Heterosexual women with psoriasis 0.03) compared with those without = with those without = had 1.13 times more had 1.13 times more unprotected sexunprotected sex (RR 1.13, 95% CI 1.02-1.24, P (RR 1.13, 95% CI 1.02-1.24, P psoriasis . Conclusion. psoriasis . Conclusion. Psoriasis is associated Psoriasis is associated with a significantly reduced number of sexual with a significantly reduced number of sexual partners in nonheterosexual womenpartners in nonheterosexual women..

► Psoriasis may differentially impact sexual behavior Psoriasis may differentially impact sexual behavior based on sexual orientation in women. based on sexual orientation in women.

► J J SexSex Med. Med. 2012 Nov 21. 2012 Nov 21. Psoriasis and Sexual Behavior in Psoriasis and Sexual Behavior in U.S. Women: An Epidemiologic Analysis Using the U.S. Women: An Epidemiologic Analysis Using the National Health and Nutrition Examination Survey National Health and Nutrition Examination Survey (NHANES).(NHANES).

► ArmstrongArmstrong AW AW, , FollansbeeFollansbee MR MR, , HarskampHarskamp CT CT, , SchuppSchupp CW CW..

Neatpazīta psoriāze.Neatpazīta psoriāze.

Neatpazīta psoriāze.Neatpazīta psoriāze.

►Agrīns sākumsAgrīns sākums ,neregulāra ,neregulāra gaita ,tendence smagai gaitai .gaita ,tendence smagai gaitai .

► J Dermatolog J Dermatolog TreatTreat.. 2012 Dec 5. [Epub 2012 Dec 5. [Epub ahead of print]ahead of print]

►Current therapeutic approaches of Current therapeutic approaches of psoriasis are affected by age at psoriasis are affected by age at disease onset.disease onset.

►DiDi LerniaLernia V V, , FicarelliFicarelli E E..

ArchArch DermatolDermatol.. 2012 Aug;148(8):918-24. 2012 Aug;148(8):918-24. The association The association between physical activity and the risk of incident between physical activity and the risk of incident

psoriasis.psoriasis.FrankelFrankel HC HC, , HanHan J J, , LiLi T T, , QureshiQureshi AA AA..

► a cohort of 116,430 women aged 27 to 44 years in 1991.a cohort of 116,430 women aged 27 to 44 years in 1991.► The study population included 86,655 US female nurses who The study population included 86,655 US female nurses who

reported reported ► After adjusting for age, smoking, and alcohol use, increasing After adjusting for age, smoking, and alcohol use, increasing

physical activity was inversely associated with the risk of physical activity was inversely associated with the risk of psoriasis. The most physically active quintile of women had a psoriasis. The most physically active quintile of women had a lower multivariate relative risk (RR) of psoriasis (0.72 [95% CI, lower multivariate relative risk (RR) of psoriasis (0.72 [95% CI, 0.59-0.89; P < .001 for trend]) compared with the least active 0.59-0.89; P < .001 for trend]) compared with the least active quintile. quintile.

► VigorousVigorous physical activity (≥6 metabolic equivalents) was physical activity (≥6 metabolic equivalents) was associated with a associated with a reducedreduced risk of psoriasis (multivariate RR risk of psoriasis (multivariate RR for the highest quintile, 0.66 [95% CI, 0.54-0.81; P < .001 for for the highest quintile, 0.66 [95% CI, 0.54-0.81; P < .001 for trend]); this association remained significant after adjusting trend]); this association remained significant after adjusting for body mass index (RR, 0.73 [95% CI, 0.60-0.90; P = .009 for for body mass index (RR, 0.73 [95% CI, 0.60-0.90; P = .009 for trend]). trend]).

J J DrugsDrugs DermatolDermatol.. 2012 Apr;11(4):466-73. 2012 Apr;11(4):466-73.Top dermatologic conditions in patients of color: an Top dermatologic conditions in patients of color: an analysis of nationally representative data.analysis of nationally representative data.DavisDavis SA SA, ,

NarahariNarahari S S, , FeldmanFeldman SR SR, ,

► in patient visits to U.S. dermatologists from 1993 to 2009. The in patient visits to U.S. dermatologists from 1993 to 2009. The leading diagnoses were tabulated for each racial and ethnic leading diagnoses were tabulated for each racial and ethnic group, and the top conditions were compared between groups. group, and the top conditions were compared between groups.

► The top five diagnoses for African-American patients in The top five diagnoses for African-American patients in dermatology clinics were acne, unspecified dermatitis or dermatology clinics were acne, unspecified dermatitis or eczema, seborrheic dermatitis, atopic dermatitis, and eczema, seborrheic dermatitis, atopic dermatitis, and dyschromia.dyschromia.

► For Asian or Pacific Islander patients, the top five were acne, For Asian or Pacific Islander patients, the top five were acne, unspecified dermatitis or eczema, benign neoplasm of skin, unspecified dermatitis or eczema, benign neoplasm of skin, psoriasis,psoriasis, and seborrheic keratosis. and seborrheic keratosis.

► Caucasian patients, the top five were actinic keratosis, acne, Caucasian patients, the top five were actinic keratosis, acne, benign neoplasm of skin, unspecified dermatitis or eczema, and benign neoplasm of skin, unspecified dermatitis or eczema, and nonmelanoma skin cancer.nonmelanoma skin cancer.

► In Hispanic patients of any race, the leading diagnoses were In Hispanic patients of any race, the leading diagnoses were acne, unspecified dermatitis or eczema, acne, unspecified dermatitis or eczema, psoriasispsoriasis, benign , benign neoplasm of skin, and viral warts. neoplasm of skin, and viral warts.

Saturs .Saturs .

►1.Epidemioloģija.1.Epidemioloģija.►2. Diagnostika .2. Diagnostika .►3.Psoriāzes terapija.3.Psoriāzes terapija.►4. Vadlīnijas 4. Vadlīnijas

EurEur J J PharmPharm SciSci.. 2012 Nov 15. S0928-0987(12)00408- 2012 Nov 15. S0928-0987(12)00408-3. 3. Diagnostic opportunities based on skin Diagnostic opportunities based on skin

biomarkers.biomarkers.

PaliwalPaliwal S S, , HwangHwang BH BH, , TsaiTsai KY KY,, ► Source Source Santa Barbara, CA 93106, United States.Santa Barbara, CA 93106, United States.► AbstractAbstract► Systemic as well as localized skin diseases modify Systemic as well as localized skin diseases modify

the molecular composition of human skin. Changes the molecular composition of human skin. Changes in skin chemistry have been observed in diseases in skin chemistry have been observed in diseases such as cancer, psoriasis, eczema, diabetes, and such as cancer, psoriasis, eczema, diabetes, and atherosclerosis. Skin chemistry, represented by an atherosclerosis. Skin chemistry, represented by an enormous wealth of disease biomarkers including enormous wealth of disease biomarkers including lipids, structural proteins, inflammatory mediators, lipids, structural proteins, inflammatory mediators, nucleic acids and small molecules, therefore, can nucleic acids and small molecules, therefore, can serve as a "window to body's health". Various serve as a "window to body's health". Various methods including tape-stripping, iontophoresis, methods including tape-stripping, iontophoresis, microneedles and ultrasound, among others, are microneedles and ultrasound, among others, are being developed to access skin biomarkers and being developed to access skin biomarkers and understand skin's detailed molecular composition. understand skin's detailed molecular composition.

ClinClin ChemChem LabLab Med. Med. 2012 Aug 22.. 2012 Aug 22.. Serum kallikrein-8 correlates with skin activity, Serum kallikrein-8 correlates with skin activity,

but not psoriatic arthritis, in patients with but not psoriatic arthritis, in patients with psoriatic disease.psoriatic disease.

EissaEissa A A, , CretuCretu D D, , SoosaipillaiSoosaipillai A A,, ►Kallikreins Kallikreins (KLKs) are secreted serine (KLKs) are secreted serine

proteases implicated in skin proteases implicated in skin desquamation and inflammation. joint desquamation and inflammation. joint counts.counts.

► Increased KLK8 serum level in PsA Increased KLK8 serum level in PsA patients reflects disease activity in the patients reflects disease activity in the skin but not in the joints. Serum KLK skin but not in the joints. Serum KLK levels are not useful for screening levels are not useful for screening psoriasis patients for Pspsoriasis patients for Ps

Diagnostika .Diagnostika .

►Cathepsin SCathepsin S (CATS) (CATS) ir ir cisteīna cisteīna proteāze,kasproteāze,kas parasti konstatējama parasti konstatējama dermā makrofāgos,bet dermā makrofāgos,bet tikai pie tikai pie psoriāzespsoriāzes atrodama ir nosakāma atrodama ir nosakāma keratinocītos . keratinocītos .

► Exp Dermatol. Exp Dermatol. 2009 Oct 222009 Oct 22. . Upregulation of Upregulation of cathepsin S in psoriatic keratinocytes.cathepsin S in psoriatic keratinocytes.SchönefußSchönefuß A A, , Wendt WWendt W, , SchattlingSchattling B B, , at al .at al .

Diagnostika .Diagnostika .

►Cilvēku Cilvēku antimikrobais peptīds antimikrobais peptīds beta-beta-defensin-2defensin-2 (hBD-2) (hBD-2) ir stingri saistīts ar ir stingri saistīts ar psoriāzes izsitumu epidermu .psoriāzes izsitumu epidermu . Augsts beta defensīnu kopiju skaits ir Augsts beta defensīnu kopiju skaits ir saistīts ar uzņēmību pret psoriāzi .saistīts ar uzņēmību pret psoriāzi .

► PLoS One.PLoS One. 2009 2009;4(3):e4725.Beta-defensin-2 protein ;4(3):e4725.Beta-defensin-2 protein is a serum biomarker for disease activity in psoriasis is a serum biomarker for disease activity in psoriasis and reaches biologically relevant concentrations in and reaches biologically relevant concentrations in lesional skin.lesional skin. Jansen PA Jansen PA, , Rodijk-OlthuisRodijk-Olthuis D D, , HolloxHollox EJ EJ, , KamsteegKamsteeg M M The NetherlandsThe Netherlands

Identification of 15 new psoriasis susceptibility Identification of 15 new psoriasis susceptibility loci highlights the role of innate immunity.loci highlights the role of innate immunity.

TsoiTsoi LC LC, , SpainSpain SL SL, , KnightKnight J J,,

NatNat GenetGenet.. 2012 Nov 11;44(12):1341-8 2012 Nov 11;44(12):1341-8. .

► To gain further insight into the genetic To gain further insight into the genetic architecture of psoriasis, we conducted a architecture of psoriasis, we conducted a meta-analysis of 3 genome-wide association meta-analysis of 3 genome-wide association studies (GWAS) and 2 independent data sets studies (GWAS) and 2 independent data sets genotyped on the Immunochip, including genotyped on the Immunochip, including 10,588 cases and 22,806 controls. 10,588 cases and 22,806 controls. We We identified 15 new susceptibility loci, identified 15 new susceptibility loci, increasing to 36increasing to 36 the number associated the number associated with psoriasis in European individuals. We with psoriasis in European individuals. We also identified, using conditional analyses, also identified, using conditional analyses, five independent signals within previously five independent signals within previously known loci. known loci.

ClinClin ExpExp DermatolDermatol.. 2012. Feb 2. 2012. Feb 2.Serum lipocalin-2 levels are increased in Serum lipocalin-2 levels are increased in

patients with psoriasis.patients with psoriasis.KamataKamata M M, , TadaTada Y Y, , TatsutaTatsuta A A

► The protein lipocalin (LCN)-2 is known to be related to The protein lipocalin (LCN)-2 is known to be related to insulin resistance, obesity and atherosclerotic insulin resistance, obesity and atherosclerotic diseasesdiseases. Psoriasis is an inflammatory skin disease related to . Psoriasis is an inflammatory skin disease related to metabolic syndrome. The aim of this study was to examine metabolic syndrome. The aim of this study was to examine the relationship between serum LCN2 levels and indicators for the relationship between serum LCN2 levels and indicators for metabolic syndrome and inflammatory cytokine levels in metabolic syndrome and inflammatory cytokine levels in patients with psoriasis. Serum LCN2 levels were also patients with psoriasis. Serum LCN2 levels were also compared with several indicators for metabolic syndrome, and compared with several indicators for metabolic syndrome, and with serum levels of interleukin (IL)-6 and tumour necrosis with serum levels of interleukin (IL)-6 and tumour necrosis factor (TNF)-α, two markers of inflammation. Serum LCN2 factor (TNF)-α, two markers of inflammation. Serum LCN2 levels in patients with psoriasis were significantly higher than levels in patients with psoriasis were significantly higher than those of healthy controls, but there was no significant those of healthy controls, but there was no significant correlation between serum LCN2 and body mass index. Serum correlation between serum LCN2 and body mass index. Serum LCN2 levels also correlated with serum IL-6 and TNF-α levels LCN2 levels also correlated with serum IL-6 and TNF-α levels in patients with psoriasis. in patients with psoriasis. Serum LCN2 levels are a general Serum LCN2 levels are a general indicator for increased inflammation in the patients indicator for increased inflammation in the patients with psoriasis.with psoriasis.

►DisDis MarkersMarkers.. 2012 Nov 14. 2012 Nov 14. Psoriasin: Psoriasin: A novel marker linked obesity A novel marker linked obesity with psoriasis.with psoriasis.

►SalamaSalama RH RH, , Al-ShobailiAl-Shobaili HA HA, , AlAl RobaeeRobaee AA AA, , AlzolibaniAlzolibani AA AA

Tohoku J Exp Med. 2012;228(4):325-32.Tohoku J Exp Med. 2012;228(4):325-32.Psoriasis Is Associated with Low Serum Levels Psoriasis Is Associated with Low Serum Levels

of Hydrogen Sulfide, a Potential Anti-of Hydrogen Sulfide, a Potential Anti-inflammatory Molecule.inflammatory Molecule.

K H Alshorafa A, Guo Q, Zeng FK H Alshorafa A, Guo Q, Zeng F

► Although hydrogen sulfide (H(2)S) has been shown Although hydrogen sulfide (H(2)S) has been shown to be a signaling molecule with both pro- or anti-to be a signaling molecule with both pro- or anti-inflammatory effects, its relationship with psoriasis inflammatory effects, its relationship with psoriasis has not been elucidated.has not been elucidated.

► In the present study, 15 patients with chronic In the present study, 15 patients with chronic progressive psoriasis and 15 healthy volunteers progressive psoriasis and 15 healthy volunteers were investigated. Serum H(2)S levels in psoriasis were investigated. Serum H(2)S levels in psoriasis patients were significantly lower than those of patients were significantly lower than those of healthy controls (16.69 ± 5.47 μM vs. 34.5 ± 6.39 healthy controls (16.69 ± 5.47 μM vs. 34.5 ± 6.39 μM)..μM)..

► In conclusion, H(2)S may play a protective role in In conclusion, H(2)S may play a protective role in the pathogenesis of psoriasis. H(2)S-releasing the pathogenesis of psoriasis. H(2)S-releasing agents may be promising therapeutics for psoriasis.agents may be promising therapeutics for psoriasis.

EurEur J J DermatolDermatol.. 2012 May-Jun;22(3):337-44. 2012 May-Jun;22(3):337-44.Atheroma plaque, metabolic syndrome and inflammation Atheroma plaque, metabolic syndrome and inflammation

in patients with psoriasis.in patients with psoriasis.

Arias-SantiagoArias-Santiago S S, , Orgaz-MolinaOrgaz-Molina J J, , Castellote-CaballeroCastellote-Caballero L L,, ►The chronic inflammation and The chronic inflammation and

hyperhomocysteinemiahyperhomocysteinemia found in found in psoriatic patients may explain the psoriatic patients may explain the association with atheroma plaque and association with atheroma plaque and metabolic syndrome. Cardiovascular metabolic syndrome. Cardiovascular screening by metabolic syndrome criteria screening by metabolic syndrome criteria assessment and carotid ultrasound in assessment and carotid ultrasound in psoriasis may be useful to detect psoriasis may be useful to detect individuals at risk and start preventive individuals at risk and start preventive treatment against the development of treatment against the development of cardiovascular disease cardiovascular disease

Homocysteine, vitamin B12 and folic acid Homocysteine, vitamin B12 and folic acid levels in psoriatic patients and levels in psoriatic patients and

correlation with disease severity.correlation with disease severity. I I

HyperhomocysteinHyperhomocysteinēmijaēmija ir neatkarīgs ir neatkarīgs riska faktors aterosklerotiskai riska faktors aterosklerotiskai kardiovaskulārāi slimībai, insultam, kardiovaskulārāi slimībai, insultam, perifēro artēriju oklūzijai un venozai perifēro artēriju oklūzijai un venozai trombozei ,paaugstinātai atertrombozei trombozei ,paaugstinātai atertrombozei un kardio vaskulārā riska profilam. un kardio vaskulārā riska profilam.

Pacientiem ar psoriāzi plazmas Pacientiem ar psoriāzi plazmas homocisteīna homocisteīna līmenis ir augstāks 57% līmenis ir augstāks 57% nekā kontrolē 27%nekā kontrolē 27% ((p<p< 0.0001 0.0001))

Homocysteine, vitamin B12 and folic acid Homocysteine, vitamin B12 and folic acid levels in psoriatic patients and levels in psoriatic patients and

correlation with disease severity.correlation with disease severity. II II

► FolFolskābe un skābe un vitam vitamīns īns B12 pla B12 plazmā bija zemāks zmā bija zemāks psoriāzespsoriāzes pacientiem nekā pacientiem nekā kontrolē ,viszemākie B12 līmeņi bija kontrolē ,viszemākie B12 līmeņi bija pacientiem ar pacientiem ar h hiiperhomocperhomocisteisteinemiinemiju ju salīdzinot pacientiem ar normālu salīdzinot pacientiem ar normālu homoc homocisteīna isteīna līmeni līmeni (p = 0.0009). (p = 0.0009).

► PASI tieši nekorelēja ar augstāku homocisteīna līmeni PASI tieši nekorelēja ar augstāku homocisteīna līmeni ,vai B12 vai folskābes līmeni .,vai B12 vai folskābes līmeni .

► Int J Immunopathol Pharmacol. Int J Immunopathol Pharmacol. 2010 Jul-Sep;23(32010 Jul-Sep;23(3):911-6.):911-6. Homocysteine, vitamin B12 and folic acid levels in Homocysteine, vitamin B12 and folic acid levels in psoriatic patients and correlation with disease severity.psoriatic patients and correlation with disease severity.BrazzelliBrazzelli V V, , Grasso VGrasso V, , FornaraFornara L L, , MoggioMoggio E E, , GambaGamba G G, , VillaniVillani S S, , BorroniBorroni G G..

Diagnostika . Diagnostika .

► 3 jautājumu kopa dod sensitivitāti 3 jautājumu kopa dod sensitivitāti 96.4% 96.4% un un specifitātespecifitāte 97.3% 97.3% psoriāzei.psoriāzei.

► Pievienojot jautājumu ar bildi sensitivitāte Pievienojot jautājumu ar bildi sensitivitāte palielinājās līdz palielinājās līdz 98.2% 98.2% Šī studija palielina Šī studija palielina iespēju atšķirt psoriāzi indivīdiem ar psoriāzi iespēju atšķirt psoriāzi indivīdiem ar psoriāzi no indivīdiem bez psoriāzes .no indivīdiem bez psoriāzes .

► Br J Dermatol Br J Dermatol 2009 Oct:161(42009 Oct:161(4):778-84 Development ):778-84 Development and pilot testing of psoriasis screening and pilot testing of psoriasis screening tool .Domininguez ar al.Boston,USA,tool .Domininguez ar al.Boston,USA,

1. Man ir diagnosticējuši psoriāzi nedermatologi – reimatologs, 1. Man ir diagnosticējuši psoriāzi nedermatologi – reimatologs, gimenes ārsts, citi ārsti.gimenes ārsts, citi ārsti. Jā.Jā. Nē.Nē.

2. Man ir diagnosticējuši psoriāzi māsiņa, ārsta asistents. 2. Man ir diagnosticējuši psoriāzi māsiņa, ārsta asistents. Jā.Jā. Nē.Nē.

3. Man ir diagnosticējis psoriāzi dermatologs. 3. Man ir diagnosticējis psoriāzi dermatologs. Jā.Jā. Nē.Nē.

4. Man ir līdzīgi izsitumi uz manas ādas. 4. Man ir līdzīgi izsitumi uz manas ādas.

Jā.Jā. Nē.Nē.

5. Man ir līdzīgas nagu izmaiņas.5. Man ir līdzīgas nagu izmaiņas.

Jā.Jā. Nē.Nē.

6. Man ir bijuši līdzīgi izsitumi galvā. 6. Man ir bijuši līdzīgi izsitumi galvā.

Jā.Jā. Nē.Nē.

7. Man ir bijuši izsitumi vai apsārtums/kairinājumu manā cirkšņu 7. Man ir bijuši izsitumi vai apsārtums/kairinājumu manā cirkšņu rajonā, starp gurniem vai padusēs, kas ilgst vairāk kā 2 nedēļas .rajonā, starp gurniem vai padusēs, kas ilgst vairāk kā 2 nedēļas . Jā.Jā. Nē.Nē.

8. 8. Man ir diagnosticēti citas ādas saslimšanas kā ekzēma vai Man ir diagnosticēti citas ādas saslimšanas kā ekzēma vai nātrene.nātrene. Jā.Jā. Nē.Nē.

IndianIndian J J DermatolDermatol VenereolVenereol LeprolLeprol.. 2012 May- 2012 May-Jun;78(3):290-8.Jun;78(3):290-8.

Role of nail biopsy as a diagnostic tool.Role of nail biopsy as a diagnostic tool.GroverGrover C C, , ChaturvediChaturvedi UK UK, , ReddyReddy BS BS

► Nail biopsy (NB) is an investigation that is not Nail biopsy (NB) is an investigation that is not routinely resorted to by most of the dermatologists. routinely resorted to by most of the dermatologists. The commonly cited reasons are the complexity of The commonly cited reasons are the complexity of the procedure, risk of scarring and the reluctance of the procedure, risk of scarring and the reluctance of the patient. However, in cases with isolated nail the patient. However, in cases with isolated nail psoriasis, isolated nail lichen planus, onychomycosis psoriasis, isolated nail lichen planus, onychomycosis not confirmed on direct microscopy and culture, or not confirmed on direct microscopy and culture, or longitudinal melanonychia, the treating longitudinal melanonychia, the treating dermatologist is left with no choice but to resort to dermatologist is left with no choice but to resort to this procedure. Nail as a unit, is capable of projecting this procedure. Nail as a unit, is capable of projecting only a limited number of clinical manifestations. This only a limited number of clinical manifestations. This is responsible for the more or less similar clinical is responsible for the more or less similar clinical presentation of many different nail disorders. presentation of many different nail disorders.

AnAn BrasBras DermatolDermatol.. 2012 Dec;87(6):910-3. 2012 Dec;87(6):910-3.Norwegian scabies mimicking rupioid psoriasis.Norwegian scabies mimicking rupioid psoriasis.

CostaCosta JB JB, , SousaSousa VL VL, , TrindadeTrindade Neto PB Neto PB, , ..

► Source Source , Brazil., Brazil.► Norwegian scabies is a highly contagious skin Norwegian scabies is a highly contagious skin

infestation caused by an ectoparasite, Scarcoptes infestation caused by an ectoparasite, Scarcoptes scabiei var. Hominis, which mainly affects scabiei var. Hominis, which mainly affects immunosuppressed individuals. Clinically, it may immunosuppressed individuals. Clinically, it may simulate various dermatoses such as psoriasis, Darier's simulate various dermatoses such as psoriasis, Darier's disease, seborrheic dermatitis, among others. This is a disease, seborrheic dermatitis, among others. This is a case report of a 33-year-old woman, immunocompetent, case report of a 33-year-old woman, immunocompetent, diagnosed with generalized anxiety disorder (cancer diagnosed with generalized anxiety disorder (cancer phobia), who had erythematous, well-defined plaques, phobia), who had erythematous, well-defined plaques, covered with rupioid crusts, on her neck, axillary folds, covered with rupioid crusts, on her neck, axillary folds, breast, periumbilical region, groin area, besides upper breast, periumbilical region, groin area, besides upper back and elbows, mimicking an extremely rare variant back and elbows, mimicking an extremely rare variant of psoriasis, denominated rupioid of psoriasis, denominated rupioid

Prevalence and relevance of secondary contact Prevalence and relevance of secondary contact sensitizers in subjects with psoriasis.sensitizers in subjects with psoriasis.

KrupashankarKrupashankar DS DS, , ManivasagamManivasagam SR SR. . IndianIndian

DermatolDermatol OnlineOnline J. J. 2012 Sep;3(3):177-81 2012 Sep;3(3):177-81 ► .Psoriasis may be complicated by contact dermatitis due to .Psoriasis may be complicated by contact dermatitis due to

an impaired cutaneous barrier. Patch testing helps an impaired cutaneous barrier. Patch testing helps elucidate sensitizers if any.elucidate sensitizers if any.

► AIMS: AIMS: ► To determine the prevalence and relevance of secondary To determine the prevalence and relevance of secondary

contact dermatitis in subjects with psoriasis.contact dermatitis in subjects with psoriasis.► MATERIALS AND METHODS: MATERIALS AND METHODS: ► Patch testing with Indian Standard Series was done and Patch testing with Indian Standard Series was done and

readings interpreted after 48 and 96 hours.readings interpreted after 48 and 96 hours.► RESULTS: RESULTS: ► Among 110 subjects Among 110 subjects 47 (42.7%)47 (42.7%) showed reactions to at showed reactions to at

least one antigen. Fifteen (13.6%) reacted to fragrance mix, least one antigen. Fifteen (13.6%) reacted to fragrance mix, 10 (9.1%) to nickel sulfate, seven (6.4%) to parthenium, 10 (9.1%) to nickel sulfate, seven (6.4%) to parthenium, and six (5.5%) to balsam of Peru. Palmoplantar psoriasis and six (5.5%) to balsam of Peru. Palmoplantar psoriasis was the commonest type of psoriasis patch tested. was the commonest type of psoriasis patch tested. Fragrance mix was the commonest antigen showing 100% Fragrance mix was the commonest antigen showing 100% current relevance as an aggravating factor of psoriasis. current relevance as an aggravating factor of psoriasis.

AutoimmunAutoimmun RevRev.. 2012 Nov 24. 2012 Nov 24. Immunomodulation Immunomodulation in psoriatic arthritis: Focus on cellular and in psoriatic arthritis: Focus on cellular and

molecular pathways.molecular pathways.

►Complement system can be Complement system can be considered part of the acute phase considered part of the acute phase response as demonstrated by response as demonstrated by higher higher plasma levels of C3 and C4 plasma levels of C3 and C4 complement componentscomplement components in in PsA PsA patientspatients compared with healthy compared with healthy subjects. These abnormal levels are subjects. These abnormal levels are then reverted by anti-TNF drugs. then reverted by anti-TNF drugs.

DermatolDermatol OnlineOnline J. J. 2012 Jan 15;18(1):11. 2012 Jan 15;18(1):11.Psoriasis and oral lesions: multicentric study of Oral Psoriasis and oral lesions: multicentric study of Oral

Mucosa Diseases Italian Group (GIPMO).Mucosa Diseases Italian Group (GIPMO).

Germi LGermi L, , DeDe GiorgiGiorgi V V, , BergamoBergamo F F,,, , ► Out of a total of 535 psoriatic patients and Out of a total of 535 psoriatic patients and

436 control group patients, oral mucosal 436 control group patients, oral mucosal lesions were detected in 188 (lesions were detected in 188 (35.1%)35.1%) and 86 and 86 (19.7%) cases, respectively, and the (19.7%) cases, respectively, and the difference is statistically significant. difference is statistically significant. Fissured Fissured tongue (FT) and geographic tongue (GT), tongue (FT) and geographic tongue (GT), which were most frequently detected,which were most frequently detected, were seen more frequently in psoriatic were seen more frequently in psoriatic patients (FT: 22.6%; GT: 9.1%) than the patients (FT: 22.6%; GT: 9.1%) than the control group (FT: 10.3%; GT: 5.2%) (p<0.05).control group (FT: 10.3%; GT: 5.2%) (p<0.05).

Saturs .Saturs .

► 1. 1. Epidemioloģija.Epidemioloģija.

►2. Diagnostika .2. Diagnostika .►3.Terapija .3.Terapija .►4.Vadlīnijas .4.Vadlīnijas .

DDermatolermatol TherTher ( (HeidelbHeidelb).). 2012 Dec;2(1):15. 2012 Dec;2(1):15. Inverse Inverse Psoriasis Involving Genital Skin Folds: Psoriasis Involving Genital Skin Folds:

Successful Therapy with Dapsone.Successful Therapy with Dapsone.GuglielmettiGuglielmetti A A, Conlledo R, Bedoya J, Conlledo R, Bedoya J

► , , The authors present a 42-year-old female The authors present a 42-year-old female patient with erythematous plaques in the patient with erythematous plaques in the vulva, groin, and perianal region. The patient vulva, groin, and perianal region. The patient had previously received a broad range of had previously received a broad range of topical and systemic therapies that had to be topical and systemic therapies that had to be discontinued due to ineffectiveness or side discontinued due to ineffectiveness or side effects. She was treated with 100 mg dapsone effects. She was treated with 100 mg dapsone daily for 10 months, showing a significant daily for 10 months, showing a significant improvement of her cutaneous and mucous improvement of her cutaneous and mucous lesions. Complete clearance of psoriatic lesions. Complete clearance of psoriatic lesions was observed after 4 weeks of lesions was observed after 4 weeks of treatment. She has remained in remission for treatment. She has remained in remission for up to 2 years, using only topical therapy with up to 2 years, using only topical therapy with tacrolimus 0.1% and calcipotriol.tacrolimus 0.1% and calcipotriol.

J Dermatolog J Dermatolog TreatTreat.. 2012 Dec 5. 2012 Dec 5. Evaluation of the effect of Evaluation of the effect of tacrolimus-loaded liquid crystalline nanoparticles on tacrolimus-loaded liquid crystalline nanoparticles on

psoriasis-like skin inflammation.psoriasis-like skin inflammation.

ThapaThapa RK RK, , YooYoo BK BK..► Liquid crystalline nanoparticle (LCN) is one Liquid crystalline nanoparticle (LCN) is one

of the potential drug delivery systems for of the potential drug delivery systems for topical drug delivery. topical drug delivery.

► Tacrolimus-loaded LCNs were more effective Tacrolimus-loaded LCNs were more effective in the treatment of psoriasis-like skin in the treatment of psoriasis-like skin inflammation as compared to tacrolimus inflammation as compared to tacrolimus dissolved in propylene glycol. Hence, this dissolved in propylene glycol. Hence, this study provides a basis for possible study provides a basis for possible applicability of tacrolimus-loaded LCNs in applicability of tacrolimus-loaded LCNs in the treatment of psoriasis.the treatment of psoriasis.

Dermatol Ther (Heidelb). 2012 Dec;2(1):1. Dermatol Ther (Heidelb). 2012 Dec;2(1):1. A Delphi A Delphi Consensus Approach to Challenging Case Scenarios in Consensus Approach to Challenging Case Scenarios in

Moderate-to-Severe Psoriasis: Part 1.Moderate-to-Severe Psoriasis: Part 1.Strober BE, Clay Cather J, Cohen D, Strober BE, Clay Cather J, Cohen D,

► Six of the 24 discussed case scenarios are presented Six of the 24 discussed case scenarios are presented in this article (another five are presented in Part 2): in this article (another five are presented in Part 2): (1) psoriasis with human papilloma virus-induced (1) psoriasis with human papilloma virus-induced cervical or anogenital dysplasia; (2) concomitant cervical or anogenital dysplasia; (2) concomitant psoriasis and systemic lupus erythematosus; (3) psoriasis and systemic lupus erythematosus; (3) severe psoriatic nail disease causing functional or severe psoriatic nail disease causing functional or emotional impairment; (4) psoriasis therapies that emotional impairment; (4) psoriasis therapies that potentially reduce cardiovascular morbidity and potentially reduce cardiovascular morbidity and mortality; (5) older patients (≥65 years of age) with mortality; (5) older patients (≥65 years of age) with psoriasis; and (6) severe scalp psoriasis that is psoriasis; and (6) severe scalp psoriasis that is unresponsive to topical therapy.unresponsive to topical therapy.

A Delphi Consensus Approach to Challenging A Delphi Consensus Approach to Challenging Case Scenarios in Moderate-to-Severe Psoriasis: Case Scenarios in Moderate-to-Severe Psoriasis:

Part 2.Part 2.

Strober BE, Clay Cather J, Cohen DStrober BE, Clay Cather J, Cohen D, , ► Five of the 24 discussed case scenarios are Five of the 24 discussed case scenarios are

presented in this article: (1) moderate-to-presented in this article: (1) moderate-to-severe psoriasis that has failed to respond to severe psoriasis that has failed to respond to all currently approved therapies for psoriasis; all currently approved therapies for psoriasis; (2) palmoplantar psoriasis that is unresponsive (2) palmoplantar psoriasis that is unresponsive to topical therapy and phototherapy; (3) to topical therapy and phototherapy; (3) erythrodermic psoriasis; (4) pustular psoriasis; erythrodermic psoriasis; (4) pustular psoriasis; and (5) the preferred therapeutic choice to and (5) the preferred therapeutic choice to combine with low-dose methotrexate. combine with low-dose methotrexate.

► The Delphi exercise resulted in guidelines for The Delphi exercise resulted in guidelines for practicing physicians to utilize when practicing physicians to utilize when confronted with patients with challenging confronted with patients with challenging cases of psoriasis.cases of psoriasis.

Acta Derm Venereol. 2012 Nov 9. Acta Derm Venereol. 2012 Nov 9. Treatment Patterns, Treatment Satisfaction, Severity of Treatment Patterns, Treatment Satisfaction, Severity of Disease Problems, and Quality of Life in Patients with Disease Problems, and Quality of Life in Patients with

Psoriasis in Three Nordic Countries.Psoriasis in Three Nordic Countries.Ragnarson Tennvall G, Hjortsberg C,Ragnarson Tennvall G, Hjortsberg C,

► Biological drugs are expensive, but can reduce symptoms and Biological drugs are expensive, but can reduce symptoms and increase quality of life for patients with psoriasis. The aim of increase quality of life for patients with psoriasis. The aim of this study was to examine quality of life, disease severity and this study was to examine quality of life, disease severity and treatment satisfaction in Danish, Finnish and Swedish patients treatment satisfaction in Danish, Finnish and Swedish patients with psoriasis. with psoriasis.

► Based on 12 months' data from patient surveys and chart Based on 12 months' data from patient surveys and chart reviews, 3 treatment groups were identified: topical, systemic reviews, 3 treatment groups were identified: topical, systemic and/or biological <12 months, and biological for 12 months. and/or biological <12 months, and biological for 12 months.

► Patients treated with biological drugs for 12 months showed Patients treated with biological drugs for 12 months showed the highest treatment satisfaction and the lowest the highest treatment satisfaction and the lowest Dermatology Life Quality Index score.Dermatology Life Quality Index score.

► A number of patients with topical treatment reported low A number of patients with topical treatment reported low quality of life, severe or very severe disease problems, and quality of life, severe or very severe disease problems, and low treatment satisfaction. low treatment satisfaction.

Single administration of lesion-limited high-dose (TURBO) Single administration of lesion-limited high-dose (TURBO) ultraviolet B using the excimer laser: clinical clearing in ultraviolet B using the excimer laser: clinical clearing in

association with apoptosis of epidermal and dermal T cell association with apoptosis of epidermal and dermal T cell subsets in psoriasis.subsets in psoriasis.

Kagen M, Cao LY, Oyetakin-White P,Kagen M, Cao LY, Oyetakin-White P, ► ,.,. ► Development of effective therapy for psoriasis is confounded by numerous factors Development of effective therapy for psoriasis is confounded by numerous factors

contributing to disease pathogenesis, including pathogenic immunocytes which appear contributing to disease pathogenesis, including pathogenic immunocytes which appear to drive epidermal keratinocyte hyperproliferation. Our objective was to study clinical to drive epidermal keratinocyte hyperproliferation. Our objective was to study clinical and biomarker effects of a single dose of TURBO laser UVB (308 nm) applied directly to and biomarker effects of a single dose of TURBO laser UVB (308 nm) applied directly to psoriatic plaques.psoriatic plaques.

► METHODS: METHODS: ► Eighteen patients with chronic plaque psoriasis received a single dose of 10 minimal Eighteen patients with chronic plaque psoriasis received a single dose of 10 minimal

erythema dose (MED) UVB and were followed for 8 weeks. Keratome and punch biopsies erythema dose (MED) UVB and were followed for 8 weeks. Keratome and punch biopsies were assessed for T cell depletion and apoptosis following a single 308-nm dose of UVB.were assessed for T cell depletion and apoptosis following a single 308-nm dose of UVB.

► RESULTS: RESULTS: ► Patients demonstrated clinical improvement as indicated by decreased global Psoriasis Patients demonstrated clinical improvement as indicated by decreased global Psoriasis

Area and Severity Index scores and reduced numbers of pathogenic memory/effector T Area and Severity Index scores and reduced numbers of pathogenic memory/effector T cells infiltrating lesional epidermis and dermis. Consistent with apoptosis induction, cells infiltrating lesional epidermis and dermis. Consistent with apoptosis induction, caspase activation increased in lesional T cells after treatment.caspase activation increased in lesional T cells after treatment.

► CONCLUSION: CONCLUSION: ► We conclude that a single 10 MED dose of TURBO UVB is effective at reducing the We conclude that a single 10 MED dose of TURBO UVB is effective at reducing the

severity and extent of psoriatic lesions. We hypothesize that the reason a single severity and extent of psoriatic lesions. We hypothesize that the reason a single treatment is sufficient to clear a psoriatic plaque is that the 10 MED dose is able to treatment is sufficient to clear a psoriatic plaque is that the 10 MED dose is able to deliver sufficient photons to a microanatomic area of the lesion where susceptible deliver sufficient photons to a microanatomic area of the lesion where susceptible pathogenic T cell mechanisms are operative pathogenic T cell mechanisms are operative

Saturs .Saturs .

► 1. 1. Epidemioloģija.Epidemioloģija.

►2. Diagnostika .2. Diagnostika .►3.Terapija .3.Terapija .►4.Vadlīnijas .4.Vadlīnijas .

Vadlīnijas Vadlīnijas ► European Board of Dermato-VenereologyEuropean Board of Dermato-Venereology► UNION EUROPÉENNE DES MÉDECINS UNION EUROPÉENNE DES MÉDECINS

SPÉCIALISTESSPÉCIALISTES► EUROPEAN UNION OF MEDICAL SPECIALISTSEUROPEAN UNION OF MEDICAL SPECIALISTS► Section de Dermato-VénéréologieSection de Dermato-Vénéréologie► Section of Dermato-VenereologySection of Dermato-Venereology► President: Prof. Dr. Magdalena Czarnecka-Operacz President: Prof. Dr. Magdalena Czarnecka-Operacz

(PL)(PL)► Past President: Prof. Dr. Harald Gollnick (DEPast President: Prof. Dr. Harald Gollnick (DE► Secretary: Prof . Dr. Peter Steijlen (NL)Secretary: Prof . Dr. Peter Steijlen (NL)► Treasurer: Prof. Dr. Veli-Matti Kähäri (Fi)Treasurer: Prof. Dr. Veli-Matti Kähäri (Fi)► www.uems-ebdv.org/ebdvwww.uems-ebdv.org/ebdv

► Evidence-based (S3) guidelines for the Evidence-based (S3) guidelines for the treatment of psoriasis vulgaris 2007treatment of psoriasis vulgaris 2007

► Alexander Nast1, Ina B. Kopp2,Matthias Augustin3, Alexander Nast1, Ina B. Kopp2,Matthias Augustin3, Kirstin-Benita Banditt4,Wolf-Henning Boehncke5,Kirstin-Benita Banditt4,Wolf-Henning Boehncke5,

► Markus Follmann6,Markus Friedrich7,Matthias Markus Follmann6,Markus Friedrich7,Matthias Huber8, Christina Kahl1, Joachim Klaus9, Joachim Huber8, Christina Kahl1, Joachim Klaus9, Joachim Koza9,Koza9,

► Inga Kreiselmaier10, Johannes Mohr11, Ulrich Inga Kreiselmaier10, Johannes Mohr11, Ulrich Mrowietz10, Hans-Michael Ockenfels12,Mrowietz10, Hans-Michael Ockenfels12,

► Hans-Dieter Orzechowski8, Jörg Prinz13, Kristian Hans-Dieter Orzechowski8, Jörg Prinz13, Kristian Reich14,Thomas Rosenbach15, Stefanie Rosumeck1,Reich14,Thomas Rosenbach15, Stefanie Rosumeck1,

► Martin Schlaeger16, Gerhard Schmid-Ott17,Michael Martin Schlaeger16, Gerhard Schmid-Ott17,Michael Sebastian18,Volker Streit19,Tobias Weberschock5,Sebastian18,Volker Streit19,Tobias Weberschock5,

►Systemic Treatment of Psoriasis Systemic Treatment of Psoriasis vulgaris.vulgaris.

►Developed by the Guideline Developed by the Guideline Subcommittee of the Subcommittee of the European European Dermatology ForumDermatology Forum

►Darba grupa no 2008 gada . Darba grupa no 2008 gada .

Vadlīnijas veltītas papulozas psoriāzes Vadlīnijas veltītas papulozas psoriāzes ts. vulgārās formas aprūpei .ts. vulgārās formas aprūpei .

► Vadlīnijas veltītas papulozas psoriāzes ts. vulgārās Vadlīnijas veltītas papulozas psoriāzes ts. vulgārās formas aprūpei . formas aprūpei .

► Psoriāzes vadlīniju projekts satur 92 , kopā ar Psoriāzes vadlīniju projekts satur 92 , kopā ar literatūru 105 lapaspuses .Saturā - literatūru 105 lapaspuses .Saturā - ievads(1) ,informācija par psoriāzes nozoloģiju un ievads(1) ,informācija par psoriāzes nozoloģiju un tās pamatterapiju (2,3) .Terapijas izvēles algoritmi tās pamatterapiju (2,3) .Terapijas izvēles algoritmi tiek izskatīti 4. nodaļā .ādas aprūpe un lokālā tiek izskatīti 4. nodaļā .ādas aprūpe un lokālā terapija izklāstīta 5, nodaļā . 6 nodaļa fototerapija terapija izklāstīta 5, nodaļā . 6 nodaļa fototerapija bet 7. nodaļa klimatoterapija balstīta uz vispārējām bet 7. nodaļa klimatoterapija balstīta uz vispārējām atziņām un Latvijas kūrortu iespējām. 8. nodaļā atziņām un Latvijas kūrortu iespējām. 8. nodaļā izkatīta vispārējā terapijas , tai skaitā bioloģiskā izkatīta vispārējā terapijas , tai skaitā bioloģiskā terapija . Seko vēres (197 autori) un pielikumi.terapija . Seko vēres (197 autori) un pielikumi.

Secinājumi .Secinājumi .

Psoriāzes uzskaite-Psoriāzes uzskaite-

Individualizēta terapija . Individualizēta terapija .

12 12 1212 12 12 21 21 21