Infant with generalized pustular psoriasis who responded to cyclosporin A therapy
Infant with generalized pustular psoriasis who responded to cyclosporin A therapy
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对环孢素 A 治疗有反应的全身性脓疱型银屑病婴儿
DOI：
10.1111/1346-8138.12960
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发表时间：
2015
期刊：
影响因子：
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通讯作者：
K. Matsunaga
中科院分区：
文献类型：
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作者：
Masayuki Takahashi;M. Takeuchi;K. Matsunaga
1 例寻常型银屑病和 4 例银屑病关节炎 [PsA]）（年龄 34-49 岁；平均 41.9）和 6 名健康男性个体（年龄 34-43 岁；平均 39.0）参与了这项研究（P = 0.159，未配对的学生 t 检验）。仅局部治疗，口服环孢素和生物制剂分别治疗1例、3例和6例银屑病：苏金单抗4例，乌特克单抗1例，阿达木单抗1例。通过定期测量指甲角质层边缘刮线的移动长度来检查右手中指指甲的 NES。为了消除季节性变化，NES 在日本北海道冬季多雪季节（2014 年 11 月至 2015 年 3 月）进行了分析。还评估了目标指甲的指甲银屑病严重程度指数（NAPSI）以及银屑病面积和严重程度指数（PASI）。健康对照和银屑病患者的 NES 分别为 0.120 毫米/天（范围，0.112-0.129）和 0.143 毫米/天（范围，0.114-0.172）（P = 0.0032，未配对的学生 t 检验）（图 1a）。银屑病的临床亚型、治疗或 PASI 不影响 NES。 NES 和 NAPSI 评分之间没有显着相关性（图 1b）（R = 0.422）。在这项研究中，与健康个体相比，银屑病患者的指甲伸长速度明显加快。这一发现对于评估指甲银屑病治疗的疗效至关重要。导致关节破坏的关节炎是牛皮癣的重要症状。使用抗肿瘤坏死因子（TNF）、白细胞介素（IL）-12/23的p40亚基和IL-17抗体等生物制剂治疗银屑病的最新进展使得控制甚至改善关节炎成为可能。头皮、指甲和臀间皮肤的受累是银屑病关节炎的重要危险因素。与没有指甲受累的患者相比，指甲银屑病患者血清 TNF-a 浓度升高可能是银屑病关节炎和指甲银屑病之间密切相关的一个指标。虽然银屑病中指甲加速伸长已被提出，但迄今为止，从未对银屑病中的 NES 进行过详细检查。本研究显示，与年龄匹配的健康个体相比，银屑病患者的 NES 加速大约为 19%。这一结果表明，银屑病治疗后 NES 可能会加速。因此，我们不应将指甲病变临床改善的缺乏归因于指甲生长缓慢，而应归咎于治疗效果不足。需要进一步分析以确定银屑病 NES 的具体细节。指甲病变可能与全身炎症有关，应认真对待，将其作为评估任何正在进行的治疗的有用临床标志物。
of psoriasis vulgaris and four cases of psoriatic arthritis [PsA]) (aged 34–49 years; mean, 41.9) and six healthy male individuals (aged 34–43 years; mean, 39.0) participated in this study (P = 0.159, unpaired Student’s t-test). Topical treatment only, oral cyclosporin and biologics were applied for one, three and six cases of psoriasis, respectively: secukinumab for four cases, ustekinumab for one case and adalimumab for one case. NES was examined in the right middle finger nails by regularly measuring the shifting length of a scraped line at the edge of a nail cuticle. To eliminate seasonal variation, NES was analyzed during the snowy winter season in Hokkaido, Japan (from November 2014 to March 2015). Nail Psoriasis Severity Index (NAPSI) of the target nail and Psoriasis Area and Severity Index (PASI) were also evaluated. NES was 0.120 mm/day (range, 0.112–0.129) and 0.143 mm/day (range, 0.114–0.172)in healthy controls and psoriasis patients, respectively (P = 0.0032, unpaired Student’s t-test) (Fig. 1a). Clinical subtypes of psoriasis, treatments or PASI did not affect NES. There was no significant correlation between NES and NAPSI score (Fig. 1b) (R = 0.422). In this study, accelerated nail elongation in psoriasis patients is clearly shown when compared with that in healthy individuals. This finding can be essential for the evaluation of the therapeutic effect of nail psoriasis treatment. Arthritis resulting in joint destruction is an important symptom of psoriasis. Recent progress of psoriasis treatment using biologics, such as anti-tumor necrosis factor (TNF), p40 subunit of interleukin (IL)-12/23 and IL-17 antibody, has made it possible to keep the arthritis under control or even improve. The involvement of scalp, nails and intergluteal skin is a significant risk factor for PsA. Increased serum TNF-a concentrations in nail psoriasis patients when compared with that in patients without nail involvement may be an indicator of the close correlation between PsA and nail psoriasis. While accelerated nail elongation has been suggested in psoriasis, to date, there has never been a detailed examination of NES in psoriasis. The present study revealed approximately 19% of NES acceleration in psoriasis as compared with age-matched healthy individuals. This result suggests that NES is potentially accelerated after psoriasis treatment. Therefore, we should not attribute the lack of clinical improvement of nail lesions to slow growth of nails, but rather to insufficient therapeutic effect. Further analysis is required to determine specific details of NES in psoriasis. Nail lesions, which can be related to a systemic inflammatory condition, should be considered very seriously as a useful clinical marker to evaluate any ongoing treatment.
影响因子：
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作者：
Wilson, Floranne C.;Icen, Murat;Crowson, Cynthia S.;Mcevoy, Marian T.;Gabriel, Sherine E.;Kremers, Hilal Maradit
通讯作者：
Kremers, Hilal Maradit