Moyamoya syndrome may result from psoriasis: Four case reports

BACKGROUND Moyamoya syndrome(MMS)is a group of diseases that involves more than one underlying disease and is accompanied by moyamoya vascular phenomena.Psoriasis is a chronic immune skin disease closely linked to high blood pressure and heart disease.However,psoriasis-related MMS has not been reported.CASE SUMMARY We collected data on patients with stroke due to MMS between January 2017 and December 2019 and identified four cases of psoriasis.Case histories,imaging,and hematological data were collected.The average age of the initial stroke onset was 58.25±11.52 years;three cases of hemorrhagic and one case of ischemic stroke were included.The average duration from psoriasis confirmation to the initial MMS-mediated stroke onset was 17±3.56 years.All MMS-related stenoses involved the bilateral cerebral arteries:Suzuki grade III in one case,grade IV in two cases,and grade V in one case.Abnormally elevated plasma interleukin-6 levels were observed in four patients.Two patients had abnormally elevated immunoglobulin E levels,and two had thrombocytosis.All four patients received medication instead of surgery.With an average follow-up time of 2 years,two causing transient ischemic attacks occurred in two patients,and no hemorrhagic events occurred.CONCLUSION Psoriasis may be a potential risk factor for MMS.Patients with psoriasis should be screened for MMS when they present with neurological symptoms.

Cytokine release syndrome triggered by programmed death 1 blockade(sintilimab)therapy in a psoriasis patient:A case report

BACKGROUND In recent years,immune checkpoint inhibitors(ICIs)have demonstrated remarkable efficacy across diverse malignancies.Notably,in patients with advanced gastric cancer,the use of programmed death 1(PD-1)blockade has significantly prolonged overall survival,marking a pivotal advancement comparable to the impact of Herceptin over the past two decades.While the therapeutic benefits of ICIs are evident,the increasing use of immunotherapy has led to an increase in immune-related adverse events.CASE SUMMARY This article presents the case of a patient with advanced gastric cancer and chronic plaque psoriasis.Following sintilimab therapy,the patient developed severe rashes accompanied by cytokine release syndrome(CRS).Fortunately,effective management was achieved through the administration of glucocorticoid,tocilizumab,and acitretin,which resulted in favorable outcomes.CONCLUSION Glucocorticoid and tocilizumab therapy was effective in managing CRS after PD-1 blockade therapy for gastric cancer in a patient with chronic plaque psoriasis.

Systemic Amyloidosis Secondary to Psoriasis: A Rare, Autoimmune and Genetically-Determined Disorder That Is Amenable to Treatment with Cyclosporin A—Cyclosporin A for Psoriasis-Induced Amyloidosis

Background: Systemic secondary amyloidosis (SSA) is associated with chronic inflammatory disorders and/or chronic infections. Patients and Methods: Over the past 10 years;a total of 21 patients, with long-term (17 months) and extensive psoriasis (P) with psoriasis area severity index (PASI) >29, were evaluated. Results: Two patients had nephrotic syndrome (proteinuria 3.9 and 3.6 g/day) and decrease creatinine clearance (46 and 62 ml/minute). Their renal biopsy revealed Congo-red (+) nodular glomerulosclerosis that lacked immune-deposits and resisted wash with K-permanganate wash indicating SSA. Three months subsequent to Cyclosporin A (CyA) therapy with 100 mg twice daily;psoriasis improved in all patients with decrease in (PASI) from 29.5 to 3.5 1. In the 2 patients with SSA;proteinuria decreased to 2.1 and 1.8 g/day and creatinine clearance improved to 51 and 69 ml/minute. Such improvement persisted up to 2 years of follow up and up to 78 months in patients with SSA. Conclusion: psoriasis-induced SSA is an autoimmune disease, with genetic predisposition that is amenable to CyA therapy.

Analysis of herbs-combination of Professor Yang Su-qing in the treatment of psoriasis vulgaris with blood stasis syndrome

Objective:To explore Professor Yang Suqing’s experience in treating blood stasis syndrome of psoriasis vulgaris and analyze the characteristics of its prescription;Methods:Outpatient prescriptions for the treatment of psoriasis vulgaris with blood stasis syndrome were selected and extracted traditional Chinese medicine for standardized processing.Then analyze the data by using set visualization analysis and Apriori algorithm.Results:A total of 149 traditional Chinese herbs were extracted.Among them,and the top 12 commonly used herbs with frequency>30 were Licorice,Saposhnikovia,Schizonepeta tenuifolia,Angelica sinensis,Paeonia lactiflora,Ligusticum chuanxiong,Rehmannia glutinosa,Cicada slough,Oyster and Keel through the set visualization analysis,herbs association rules analysis,and herbs combination analysis.Saposhnikovia,Liquorice,Schizonepeta tenuifolia,Angelica sinensis and Paeonia Alba are the most commonly used combination of herbs by Professor Yang Suqing in the treatment of blood stasis syndrome of psoriasis vulgaris.Conclusion:In addition to invigorating blood circulation and removing blood stasis herbs,which are preferred for the treatment of blood stasis syndromes,Saposhnikovia and Schizonepeta tenuifolia,etc.,are used to synergistically exert the functions of invigorating blood circulation and removing blood stasis and eliminating wind expression,with remarkable efficacy.

Preventive and therapeutic effect of long snake moxibustion on psoriasis with yang deficiency and external cold syndrome based on the theory of "treatment of winter disease in summer"

Psoriasis is a chronic inflammatory skin disease with multiple layers of silvery white scales on the surface of erythema papule as the main clinical characteristics,of which yang-deficiency external cold psoriasis is refractory,recurrent and severe in winter and mild in summer,which has a great impact on patients'physical and mental health and quality of life.Traditional Chinese medicine has unique insights in the treatment of psoriasis,both curative effect and safety,have obvious advantages.Based on the concept of"winter disease and summer treatment",long-snake moxibustion gives full play to its functions of warming the kidney,invigorating the marrow,warming the meridians,activating blood circulation and removing blood stasis,so as to restore the deficiency of Yang in patients with psoriasis with external cold syndrome,enhance disease resistance,and prevent psoriasis recurrence or aggravation in winter.Therefore,based on the theory of"winter disease and summer treatment",this paper preliminarily discusses the mechanism of long-snake moxibustion in the prevention and treatment of psoriasis with external cold syndrome of Yang deficiency,and provides new ideas and directions for the prevention and treatment of psoriasis with traditional Chinese medicine.

Effect of Yinxieling decoction on PASI,TNF-α and IL-8 in patients with psoriasis vulgaris

Objective:To study the effect of Yinxieling decoction on PASI,TNF-α and IL-8 in patients with psoriasis vulgaris.Methods:A total of 120 cases of psoriasis vulgaris were divided into 4 groups according to syndrome differentiation of TCM and randomized controlled method:wind heat syndrome group(group A).blood stasis syndrome group(group B) blood dryness syndrome group(group C)nd control group(group D)(n=30 per group).Patients in observation groups were treated with Yinxieling decoction,while patients in control group were treated by placebo for 8 weeks.Levels of TNT-α and IL-8 were determined before treatment.4 and 8 weeks after treatment.psoriasis area and severity index score was also performed before and after treatment.Results:psoriasis area and severity index score and serum level of TNF-α,IL-8 were significantly decreased in all groups.The decrease in three observation groups was more significant(P<0.05 or P<0.01),and the decrease in wind heat syndrome group was the most significant(P<0.01).psoriasis area and severity index was positively correlated with TNF-α and IT.-8,respectively(P<0.05).Conclusions:Yinxieling decoction has therapeutical effect on psoriasis vulgaris via regulating TNF-α and IL-8.

Traditional Chinese Medicine nursing protocols for psoriasis vulgaris（英文）

Psoriasis is a common chronic inflammatory skin disease with a spectrum of clinical phenotypes including psoriasis vulgaris, pustular psoriasis, guttate psoriasis and erythrodermic psoriasis, in which psoriasis vulgaris is most common. In recent years, Traditional Chinese Medicine(TCM) has attracted widespread attention in the treatment of psoriasis because of better efficacy and a lower incidence of adverse reactions. In TCM, psoriasis is considered to be caused by blood heat and the stagnation of Qi and blood. This article primarily investigated the key points of common syndromes, TCM nursing methods and healthy guidance of psoriasis vulgaris, aiming at maintaining and developing the strengths of TCM, improving its efficacy and standardizing its behavior.

Metabolic co-morbidities and psoriasis: The chicken or the egg?

Accumulating evidence supports that psoriasis may be a potential multisystem inflammatory disease associated with a range of co-morbidities showing an overlapping pathology and an important health impact such as metabolic diseases.Psoriasis is associated with an increased risk of obesity,metabolic syndrome(Mets)and diabetes mellitus type 2,following a"dose-response"relationship from mild to severe psoriasis.Conversely,recent evidence from large prospective studies suggests that obesity constitutes a risk factor for psoriasis and psoriatic arthritis.Also,a dyslipidemic profile may precede psoriasis onset.Both obesity,Mets and psoriasis,characterized as chronic inflammatory states,stem from a shared underlying pathophysiology exhibiting common genetic predisposition and risk factors such as high caloric intake,physical inactivity and psychological stress.Excess weight may potentiate the inflammation of psoriasis through the deregulation of adipocytokines while,at the same time,it may help the development of Mets.Interestingly,recent translational data has shown that psoriasis,through increased T-helper inflammatory cytokines in skin and sera,may exert a plethora of effects on insulin regulation and lipid metabolism.Largerpopulation-based prospective cohort and longitudinal studies are needed to unravel the association between psoriasis and metabolic co-morbidities.The recognition of the intricate complex interplay between psoriasis and metabolic co-morbidities may help dermatologists to be aware of associated metabolic co-morbidities in order to screen for metabolic diseases and manage holistically and effectively the psoriatic patient.

Progressive Symmetrical Erythrokeratoderma-Like Psoriasis: A New Case Report

Background: Psoriasis, a chronic, systemic, inflammatory disease with prominent skin involvement, affects approximately 2% - 4% of the world population. Common variants of psoriasis are plaque psoriasis, inverse psoriasis, guttate psoriasis, erythrodermic psoriasis, pustular form either palmoplantar pustular psoriasis or generalized pustular psoriasis, nail psoriasis, and psoriatic arthritis. Progressive Symmetrical Erythrokeratoderma (PSEK) is a rare genetic disorder, characterized by fixed, well-defined erythematous and hyperkeratotic plaques distributed predominantly on the elbows, knees, trunk, and dorsal surfaces of hands and feet. Clinically has the same presentation to psoriasis especially at early onset and could be confused with psoriasis but histopathological findings and progression of the psoriatic disease can differentiate between both conditions. Aim: To document a new variant of a severe, recalcitrant type of psoriasis with a history of recurrent attacks of exacerbations and partial remissions especially in lesions involving lower extremities that are clinically PSEK-like in presentation, but histopathologically consistent with psoriasis. Case report: A 12-year-old childhood male, known case of Down’s syndrome, presented to our clinic with a history of severely pruritic skin rashes involving the perioral area, corners of the mouth, bilateral elbows, dorsal hands, scrotum, and both lower extremities for 6 years duration. The rashes gradually progressed with time to form fixed lesions in the last 2 years. He was received multiple treatment modalities, including topical steroids, topical vitamin D derivatives, and narrowband UVB phototherapy without significant improvement and the lesions became more worsened over time. Conclusion: psoriasis can be presenting with a new variant of a severe, recalcitrant, and difficult to treat type in Down syndrome cases with a history of recurrent attacks of exacerbations and partial remissions especially in lesions involving lower extremities which are clinically PSEK-like in presentation, but histopathologically consistent with psoriasis. However, early diagnosis and strict management are important in controlling the severity of the condition.

Analysis of Clinical Features of Patients With Psoriasis and Metabolic Syndrome in Xinjiang,China:A Cross-Sectional Study

Objective:Psoriasis is often closely related to metabolic syndrome (MS),herein we conducted this study to investigate the clinical characteristics of a large sample of psoriasis patients with MS in Xinjiang,China.Methods:The prevalence of MS,age,height,weight,body mass index (BMI),red blood cell count,white blood cell count,platelet count,aspartate aminotransferase level,alanine aminotransferase level,and other clinical data were analyzed in 2,492 patients with psoriasis.The patients were divided into 2 groups based on the presence of MS and their clinical features were compared.Studentt test was used for independent samples,and the chi-square test was used for count data.Results:Among the 2,492 patients,349 had MS and 1,269 were considered overweight/obese.There were significant differences in sex,age,disease course,age at onset,BMI,systolic blood pressure (SBP),and diastolic blood pressure (DBP) between the patients with MS and those without (allP < 0.05).The red blood cell count (P < 0.001),white blood cell count (P = 0.013),erythrocyte sedimentation rate (P < 0.001),blood urea nitrogen level (P < 0.001),triglyceride level (P < 0.001),total cholesterol level (P < 0.001),and low-density lipoprotein cholesterol level (P = 0.002) were significantly higher in the MS group than in the psoriasis-only group.The high-density lipoprotein cholesterol level was significantly lower in the MS group than in the psoriasis-only group (P < 0.001).The alanine aminotransferase (P = 0.145) and albumin levels (P = 0.192) were not significantly different between the 2 groups (P > 0.05).Binary logistic regression analysis showed that sex,age,BMI,SBP,DBP,and fasting plasma glucose were independent risk factors for MS in patients with psoriasis,and high-density lipoprotein cholesterol was considered a protective factor for these patients.Conclusion:The prevalence of MS in patients with psoriasis is high.Female sex,age,BMI,SBP,DBP,and fasting plasma glucose may be risk factors for psoriasis complicated by MS.

Upregulation of REL and WSB1 in Patients With Psoriasis and Metabolic Syndrome

Objective:A strong association exists between metabolic syndrome and psoriasis.The current study was performed to explore the gene regulation of metabolic syndrome in patients with psoriasis.Methods:Patients were assessed for psoriasis and metabolic syndrome clinically (Psoriasis Area and Severity Index,height,weight,waist circumference,and blood pressure) and biochemically (lipid profile and fasting blood sugar concentration).Systemic gene regulation was first explored by microarray and analyzed using Transcriptome Analysis Console Software,after which two selected upregulated genes were further validated using polymerase chain reaction and enzyme-linked immunosorbent assay and analyzed using independent samplet test.Results:The analysis showed 7,269 upregulated and 3 downregulated genes at a fold change of 2 andP value of < 0.05;only 17 genes were upregulated and none were downregulated at a fold change of 8 andP value of < 0.005.Comparison with 22 previously reported potential biomarkers of metabolic syndrome in patients with psoriasis showed that the levels of 16 biomarkers aligned with the gene regulation observed in the current study.In particular,theREL transcript was upregulated 12-fold (P = 8.16 × 10-17),while theWSB1 transcript was upregulated 9-fold (P = 9.87 × 10-13).Validation showed thatREL was also upregulated 2-fold in the polymerase chain reaction,and its protein was expressed at 7.140 ng/mLvs.undetectable levels in the cases (P = 0.048).However,WSB1 was upregulated 2-fold in the polymerase chain reaction compared with controls,and unexpectedly,its protein was undetectable in cases but detectable in controls (P = 0.018).Conclusion:The upregulation ofREL andWSB1 was observed in patients with psoriasis and metabolic syndrome,the clinical application ofREL andWSB1 as biomarkers needs further validation for potential future implications in clinical practice.

Expression of T-Helper 17 Cells and Signal Transducers in Patients with Psoriasis Vulgaris of Blood-Heat Syndrome and Blood-Stasis Syndrome

Objective： To investigate the levels of cytokines related to T-helper （Th） 17 cells in serum and signal transducers in the psoriatic lesions of patients with psoriasis vulgaris of blood-heat syndrome （BHS） and blood-stasis syndrome （BSS）. Methods： Sixty patients with psoriasis vulgaris were divided into the BHS and BSS groups according to the syndrome differentiation of Chinese medicine （CM）. Ten healthy subjects were considered as the control group. Cytokine levels of interleukin （IL）-17, IL-23 and IL-6 in serum were determined by enzyme-linked immunosorbent assay. Expression levels of signal transducer and activator of transcription 3 （STAT3）, p38-mitogen-activated protein kinase （MAPK） and STAT6 in the psoriatic lesions were determined using immunohistochemistry （IHC）, Western blot, and real-time quantitative reverse transcription polymerase chain reaction, respectively. Results： Production of IL-17, IL-23 and IL-6 in the BHS group and BSS group were significantly increased compared with those in the control group （P〈0.05）. Levels of IL-17 and IL-23 in the BHS group were higher than those in the BSS group （P〈0.05）. Compared with the control group, IHC positive expressions and protein expressions of STAT3 and p38-MAPK, and the STAT3 mRNA expressions in the BHS and BSS groups were significantly higher （P〈0.05 or P〈0.01）. The protein expression of STAT3 in the BHS group was significantly higher than that in the BSS group （P〈0.05）. Conclusions： Cytokines in serum and signal transducers in the psoriatic lesions alter with various CM syndromes of psoriasis. The results provide scientific basis for the treatment based on syndrome differentiation of CM in treating psoriasis vulgaris.

Literature Research of Chinese Medicine Recipes for the Treatment of Psoriasis Vulgaris with Blood-heat Syndrome Type

Objective：To analyze and investigate the rules for drug utilization of Chinese medicine for the treatment of psoriasis vulgaris with blood-heat syndrome.Methods：The literatures that met the following inclusion criteria were screened out from China National Knowledge Infrastructure（CNKI） from January 1998 to December 2008,including the compositions and dosages of the recipes reported completely and accurately, the sample size being30 cases and the total effective rate being70%.Results：In total,289 papers meeting the inclusion criteria were retrieved,involving 301 recipes;in which 111 recipes consisting of 145 individual drugs were the function for clearing the heat,accounting for 52.84%.The three drugs with the highest utilized frequency were Radix Rehmanniae,Radix Arnebiae seu Lithospermi and Cortex Moutan.Meridian adscription of the drugs was mainly the Gan（肝）-meridian.Conclusion：There were rules for the treatment of psoriasis vulgaris of blood-heat syndrome with Chinese medicine prescriptions.

Effect of New Pulian Ointment (新普连膏) in Treating Psoriasis of Blood-Heat Syndrome:A Randomized Controlled Trial

Objective:To objectively assess the clinical efficacy and safety of a new Pulian Ointment(新普连膏,NPLO) in treating psoriasis of blood-heat syndrome of Chinese medicine.Methods:A total of 108 patients with psoriasis of blood-heat syndrome were equally assigned,using a randomizing digital table,to the test group treated externally with NPLO and the control group treated with placebo;the medication was done using a single-blinded method twice a day.Meanwhile,all patients received by oral intake a conventional Ch...

司库奇尤单抗治疗银屑病伴代谢综合征患者的临床疗效

目的观察司库奇尤单抗治疗银屑病伴代谢综合征的疗效。方法纳入2022年6月至2023年10月期间在我院就诊治疗的斑块型银屑病伴代谢综合征患者。将所有患者随机分为观察组和对照组,每组各40例。观察组给予司库奇尤单抗皮下注射,对照组给予氨甲蝶呤口服治疗,均持续治疗52周。观察两组的临床总有效率、治疗前后PASI评分(评估疾病严重程度,分值越高,病情越重)变化及不良反应率。结果治疗52周后,观察组总有效率97.5%,高于对照组的62.5%(P<0.05);对照组对血脂血压血糖代谢无影响,观察组对血压血糖无影响,但可调节血脂代谢;观察组PASI评分低于对照组(P<0.05);观察组未出现不良反应,对照组共出现7例(17.5%)不良反应(P<0.05)。结论在对重度斑块型银屑病伴代谢综合征患者,采用司库奇尤单抗注射液相比传统氨甲蝶呤治疗效果更优,改善疾病严重程度的同时,还可调节血脂代谢,且不良反应低。

血热型寻常性银屑病辨治思考

在审证求机的中医思维指导下,发现血热型寻常性银屑病的“血热”只是表象,其背后隐藏着不同的病因病机,风热蕴毒入血、肝经郁热入血是其主要的两种证候,故确立以解毒和疏肝解郁治本、以清热凉血治标的总原则,可选翘根犀角地黄汤解毒凉血、丹栀逍遥散疏肝解郁,随证治之。

新银灵颗粒对寻常型银屑病血热证患者外周血Th22细胞及其细胞因子的影响

目的观察新银灵颗粒对寻常型银屑病(PsV)血热证患者外周血辅助性T细胞22(Th22)及其细胞因子的影响。方法选取2019年12月—2020年12月在天津市中医药研究院附属医院皮肤科门诊就诊的30例PsV血热证患者为研究组,10例健康志愿者为对照组。研究组采用新银灵颗粒治疗8周,分别于治疗前后采取外周血,流式细胞术检测外周血Th22细胞比例,酶联免疫吸附测定(ELISA)法检测白细胞介素-22(IL-22)水平,实时荧光定量聚合酶链反应(RT-qPCR)检测IL-22 mRNA表达。结果经过新银灵颗粒治疗,研究组与治疗前比较,银屑病面积及严重程度指数(PASI)评分、中医证候评分和皮肤病生活质量指数评分(DLQI)均显著下降(均P<0.01);治疗后外周血中Th22细胞比例、IL-22及IL-22信使RNA(mRNA)表达水平均显著降低(P<0.01)。结论新银灵颗粒可能通过抑制Th22细胞活化、降低Th22细胞因子表达,从而治疗PsV血热证。

基于“高梁之变,足生大丁”探讨银屑病合并代谢综合征辨治思路

银屑病与代谢综合征关系密切,“高梁之变,足生大丁”可以用来描述这一现象。本文提出“高梁之变”之“浊邪”可能为银屑病与代谢综合征共同的病因,并阐述浊邪引发银屑病的病机及防治思路。浊邪化生痰湿、血瘀、郁热等病理产物,通过浊热入血、浊瘀互结、浊聚肤燥、郁热化毒、浊淫关节、浊热酿脓的病理过程,参与寻常型银屑病的各个病程阶段。重视化浊法在银屑病合并代谢综合征患者中的作用,在不同的病情阶段侧重分消化浊、通阳化浊、健脾化浊之法。倡导合理饮食,避免“高梁之变”在银屑病及共病的预防方面有积极意义。

刘红霞教授基于“阴证学说”治疗难治性银屑病的经验

银屑病为皮肤科常见慢性炎症性疾病,反复发作,难以治愈,极易进展为难治性银屑病。刘红霞教授基于王好古“阴证学说”的思想,并结合新疆的地域特点,指出新疆地区难治性银屑病患者“本虚”的体质特点,燥、湿、瘀邪气蕴积成毒,本虚伏毒是发病的核心病机,病位在肝脾肾。刘红霞教授将难治性银屑病分为脾虚湿蕴证、脾肾两虚证、上热下寒证,提出健脾解毒、脾肾双补、引火归原、养血润肤的治疗原则,以健脾解毒汤为基础方,并根据病证特点加减用药,强调配合走罐、火疗、中药药浴法等中医外治疗法,内外同治,协同增效,为临床辨治难治性银屑病提供新思路。

银屑病共病诊治进展

银屑病是一种伴有免疫系统异常的皮肤疾病。银屑病治疗进入生物制剂时代,对其认识也不仅停留于皮肤,更多脏器、系统、心理等相关疾病谱与银屑病之间的联系也被发现。随着研究深入,在银屑病共病的预防、筛查、治疗中也更具有指向性,对皮肤科医师来说,还应早期识别共病。因此,临床中对于涉及多系统疾病的银屑病患者,应进行全面的评估,以制定有效的治疗方案,达到除皮损外的全面综合治疗,以改善长期结局。