Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

Fitzpatrickʼs Dermatology in General Medicine

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.

https://www.huidziekten.nl/richtlijnen/european-guideline-psoriasis-2009.pdf

European S3-guidelines on the systemic treatment of psoriasis vulgaris

Psoriasis vulgaris is a common and often chronic inflammatory skin disease. The incidence of psoriasis in Western industrialized countries ranges from 1.5% to 2%. Patients afflicted with severe psoriasis vulgaris may experience a significant reduction in quality of life. Despite the large variety of treatment options available, surveys have shown that patients still do not received optimal treatments. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologi sche Gesellschaft (DDG) and the Berufsverband Deutscher Dermatologen (BVDD) have initiated a project to develop evidence-based guidelines for the management of psoriasis. They were first published in 2006 and updated in 2011. The Guidelines focus on induction therapy in cases of mild, moderate and severe plaque-type psoriasis in adults including systemic therapy, UV therapy and topical therapies. The therapeutic recommendations were developed based on the results of a systematic literature search and were finalized during a consensus meeting using structured consensus methods (nominal group process).

S3 – Guidelines on the treatment of psoriasis vulgaris (English version). Update

Fitzpatrick's Dermatology in General Medicine.

Background The difficulty with erythroderma lies in finding the underlying cause. Almost all the published original clinical series of erythroderma originate from western countries. Our aim was to evaluate various causes of exfoliative dermatitis in our community and compare the findings with previous studies.



Methods Ninety patients with erythroderma of either sex and any age, were studied at the Dermatology Department, Mayo Hospital, Lahore, Pakistan, between April 1992 and May 1995. A thorough clinical examination and relevant laboratory investigations, including skin biopsies, were performed.



Results The mean age of onset was 41.6 years with a male : female ratio of 2.8 : 1. The onset was acute in 69% of patients. The salient features included nail changes (80%), mucosal involvement (36.6%), alopecia (30%), islands of normal skin (14.4%), and the “deck chair sign” (5.5%). The most frequent cause of erythroderma was pre-existing dermatoses (74.4%), including psoriasis (37.8%), dermatitis (12.2%), ichthyoses (7.8%), and pemphigus foliaceus (5.6%). Drugs and malignancy each induced erythroderma in 5.5% of cases. No cause could be found in 14.6% of cases.



Conclusions Etiologically, pre-existing dermatoses showed the highest incidence and drugs the lowest compared with previous studies. Dermatitis was less common. There was a greater variety of causes of erythroderma in our series. Hair and nails were more frequently involved. Mucosal involvement, not mentioned in other studies, was present in 36.6% of our cases. The “deck chair sign” and islands of normal skin were seen in dermatoses not reported previously.

Erythroderma: a clinico‐etiologic study of 90 cases

Background Oral psoralen, when combined with UVB, shows an increased response in psoriasis. In this study, conventional psoralen–UVA (PUVA) therapy was compared with psoralen–UVB (PUVB) therapy in plaque-type psoriasis in patients with Fitzpatrick skin type IV.



Patients and methods  Equal numbers of patients with stable, plaque-type psoriasis were treated with either PUVA (n = 22) or PUVB (n = 22), three times weekly until 90% clearance was achieved. A final evaluation was made 3 months later.



Results  The two groups showed no significant differences in terms of clearance of disease, mean number of exposures, or the average duration of therapy; however, the cumulative dose of UVB required for clearance was significantly lower than that of UVA. Both groups had a similar acute side-effects' profile.



Conclusions  PUVB therapy is as effective as conventional PUVA in the treatment of stable, plaque-type psoriasis in patients with Fitzpatrick skin type IV. A significantly lower dose of UVB is required for clearance as compared with UVA.

Psoralen-ultraviolet A therapy vs. psoralen-ultraviolet B therapy in the treatment of plaque-type psoriasis: our experience with fitzpatrick skin type IV.

Background Warts are a common skin disorder. They are caused by human papillomavirus (HPV). The currently available therapies are based on local destruction of the lesion. Other treatment options include immunotherapy. Candida antigen acts as an immune modulator. It causes resolution of warts in the vicinity of the injection and also at distant sites, when given intralesional and intradermal simultaneously. Objectives To determine the efficacy and safety of intradermal and intralesional Candida antigen in comparison with the placebo in the treatment of viral warts. Patients and methods It was an interventional (qausi experimental) study, carried out in out-patient, Department of Dermatology, Unit II, Mayo Hospital, Lahore. Patients were divided into two groups of 30 each. Group A was given 0.1 ml of Candida antigen and group B was given 0.1 ml of normal saline intradermally and intralesionally. Maximum of 1 ml was given per visit. Total of three doses were given each one month apart. Patients were followed up for three months after the last dose. Results The treatment was effective in about 67% of patients receiving Candida antigen therapy, whereas, in the control group only 20% patients showed improvement ( p <0.05). The results were statistically significant. The antigen was well tolerated and the side effects produced were mainly local and only transient.

http://www.jpad.com.pk/index.php/jpad/article/view/531/504

Role of Candida antigen in treatment of viral warts: a placebo-controlled study

Background Scabies is an ectoparasitic, highly contagious skin disease caused by a mite called Sarcoptes scabiei. Topical permethrin and oral ivermectin are currently being used and considered to be safe and effective than the previously used agents. Objective To compare the efficacy and safety of oral ivermectin with topical permethrin in treating scabies. Patients and methods It was an interventional (quasi-experimental) study, conducted in out-patient clinic of Dermatology Department, Unit II, Mayo Hospital, Lahore. Hundred patients belonging to either sex and from 2 to 60 years of age were divided into two groups. Oral ivermectin was given to group A in a single dose of 200 µg/kg body weight. Group B was given single application of topical permethrin 5% cream at night on whole body for 12 hours. When there was no cure in two weeks, a 2 nd treatment was given with either drug in their respective group. Investigations were carried out at presentation and at 2 nd week while patients were followed up at 2 nd and 4 th weeks. Results Permethrin showed marginal better efficacy (88.1%) in completely clearing scabietic lesions at fourth week of therapy as compared to ivermectin (79.5%), the difference was insignificant ( p =0.15). Seven patients in ivermectin group had side effects as headache, increase in itching and secondary bacterial infections as compared to permethrin group in which one patient had erythema ( p <0.05).  Conclusion Ivermectin is as effective as permethrin in the treatment of scabies when used in two doses over a period of 4 weeks.

http://www.jpad.com.pk/index.php/jpad/article/download/382/357

Comparison of efficacy and safety of oral ivermectin with topical permethrin in treatment of scabies

Background:  Narrow band UVB (TL-01 lamp) has been proved more successful than broad band UVB in the treatment of chronic plaque psoriasis. It is equally effective but more safe than that of psoralen ultraviolet A (PUVA). Study Design:  Interventional study. Aims and Objectives:  To evaluate the success rate and safety of narrowband UVB in chronic plaque psoriasis in type IV skin. Material and methods:  It is an ongoing study of 60 patients. Till date, twenty patients aged between 8-70 years have completed the study. According to the skin type IV, the starting dose was 330 mJ/ cm 2 . All patients were exposed to whole body narrowband UVB chamber thrice a week until clearance or upto maximum of 24 sessions. Patients were assessed according to the PASI (Psoriatic Area and Severity Index) score at the baseline and then at 4 th and 8 th week of therapy. Results:  Out of a 20 patients, those who have completed the study till date, 18 have been cleared while two cases showed a poor response. None of our patients developed any adverse effect. Conclusion:  Narrowband UVB is a safe and effective therapy for chronic plaque psoriasis but long term follow up is needed to determine its carcinogenic effects. Key words:  Psoriasis, narrowband UVB, PASI.

Sabrina Suhail Pal

Papers

Erythroderma: a clinico‐etiologic study of 90 cases

Psoralen-ultraviolet A therapy vs. psoralen-ultraviolet B therapy in the treatment of plaque-type psoriasis: our experience with fitzpatrick skin type IV.

Role of Candida antigen in treatment of viral warts: a placebo-controlled study

Comparison of efficacy and safety of oral ivermectin with topical permethrin in treatment of scabies

Efficacy and Safety of Narrow Band UVB in the Treatment of Chronic Plaque Psoriasis