Abstract
A 59-year-old African American male presented to clinic for evaluation of plaque-type psoriasis. The clinical diagnosis was confirmed by biopsy of the right forearm plaque, which revealed prominent parakeratosis with an absent granular cell layer, epidermal acanthosis with suprapapillary plate thinning, and superficial dermal mononuclear perivascular cell infiltrate consistent with psoriasiform dermatitis. The patient was placed on 20 mg acitretin daily, calcipotriol cream daily on weekdays, and clobetasol ointment daily during weekends and experienced symptomatic improvement. At that time, all thick leg plaques were cleared. However, the patient’s triglycerides were found to be elevated at 569 mg/dL in non-fasting conditions and 528 mg/dL in fasting conditions (normal range, 35–160 mg/dL). Acitretin was decreased to 10 mg daily, and the patient was started on gemfibrozil. Triglyceride levels stabilized at 252 mg/dL within the same month, and the patient was advised to maintain 10 mg daily acitretin dose as long as CBC, CMP, and lipid panels remained within normal limits. The patient subsequently reported psoriasis flares while on 10 mg acitretin daily, and the dosage was increased back to 20 mg daily.
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References
Soleymani T, Hung T, Soung J. The role of vitamin D in psoriasis: a review. Int J Dermatol. 2015;54(4):383–92.
Weiss G, Shemer A, Trau H. The Koebner phenomenon: review of the literature. J Eur Acad Dermatol Venereol. 2002;16(3):241–8.
Bernhard JD. Auspitz sign is not sensitive or specific for psoriasis. J Am Acad Dermatol. 1990;22(6 Pt 1):1079–81.
Raychaudhuri SK, Maverakis E, Raychaudhuri SP. Diagnosis and classification of psoriasis. Autoimmun Rev. 2014;13(4–5):490–5.
Grover C, Reddy BS, Uma Chaturvedi K. Diagnosis of nail psoriasis: importance of biopsy and histopathology. Br J Dermatol. 2005;153(6):1153–8.
Schön MP, Boehncke W-H. Psoriasis. N Engl J Med. 2005;352(18):1899–912.
Weinstein GD, McCullough JL, Ross PA. Cell kinetic basis for pathophysiology of psoriasis. J Invest Dermatol. 1985;85(6):579–83.
Henseler T, Schmitt-Rau K. A comparison between BSA, PASI, PLASI and SAPASI as measures of disease severity and improvement by therapy in patients with psoriasis. Int J Dermatol. 2008;47(10):1019–23.
Langley RG, Ellis CN. Evaluating psoriasis with psoriasis area and severity index, psoriasis global assessment, and lattice system physician’s global assessment. J Am Acad Dermatol. 2004;51(4):563–9.
Thomas CL, Finlay AY. The ‘handprint’ approximates to 1% of the total body surface area whereas the ‘palm minus the fingers’ does not. Br J Dermatol. 2007;157(5):1080–1.
Lewis VJ, Finlay AY. Two decades experience of the psoriasis disability index. Dermatology. 2005;210(4):261–8.
Murphy G, Reich K. In touch with psoriasis: topical treatments and current guidelines. J Eur Acad Dermatol Venereol. 2011;25(s4):3–8.
American Academy of Dermatology Work Group, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions. J Am Acad Dermatol. 2011;65(1):137–74.
Kalb RE, et al. Treatment of intertriginous psoriasis: from the medical board of the national psoriasis foundation. J Am Acad Dermatol. 2009;60(1):120–4.
Koo J, Blum RR, Lebwohl M. A randomized, multicenter study of calcipotriene ointment and clobetasol propionate foam in the sequential treatment of localized plaque-type psoriasis: short- and long-term outcomes. J Am Acad Dermatol. 2006;55(4):637–41.
Samarasekera EJ, et al. Topical therapies for the treatment of plaque psoriasis: systematic review and network meta-analyses. Br J Dermatol. 2013;168(5):954–67.
Katz HI, et al. Preatrophy: covert sign of thinned skin. J Am Acad Dermatol. 1989;20(5 Pt 1):731–5.
Pang ML, Murase JE, Koo J. An updated review of acitretin—a systemic retinoid for the treatment of psoriasis. Expert Opin Drug Metab Toxicol. 2008;4(7):953–64.
Ormerod AD, et al. British association of dermatologists guidelines on the efficacy and use of acitretin in dermatology. Br J Dermatol. 2010;162(5):952–63.
Vissers W, et al. The effect of the combination of calcipotriol and betamethasone dipropionate versus both monotherapies on epidermal proliferation, keratinization and T‐cell subsets in chronic plaque psoriasis. Exp Dermatol. 2004;13(2):106–12.
Bourke JF, Berth-Jones J, Hutchinson PE. Hypercalcaemia with topical calcipotriol. BMJ. 1993;306(6888):1344–5.
Patel B, et al. Compatibility of calcipotriene with other topical medications. J Am Acad Dermatol. 1998;38(6 Pt 1):1010–1.
Fluhr JW, Cavallotti C, Berardesca E. Emollients, moisturizers, and keratolytic agents in psoriasis. Clin Dermatol. 2008;26(4):380–6.
Parisi R, et al. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol. 2013;133(2):377–85.
Tollefson MM, et al. Incidence of psoriasis in children: a population-based study. J Am Acad Dermatol. 2010;62(6):979–87.
Brandrup F, et al. Psoriasis in monozygotic twins: variations in expression in individuals with identical genetic constitution. Acta Derm Venereol. 1982;62(3):229–36.
Mahil SK, Capon F, Barker JN. Genetics of psoriasis. Dermatol Clin. 2015;33(1):1–11.
Sagoo GS, et al. Meta-analysis of genome-wide studies of psoriasis susceptibility reveals linkage to chromosomes 6p21 and 4q28-q31 in Caucasian and Chinese Hans population. J Invest Dermatol. 2004;122(6):1401–5.
Raychaudhuri SP, Gross J. Psoriasis risk factors: role of lifestyle practices. Cutis. 2000;66(5):348–52.
Ahronowitz I, Fox L. Severe drug-induced dermatoses. Semin Cutan Med Surg. 2014;33(1):49–58.
Cullen G, et al. Psoriasis associated with anti-tumour necrosis factor therapy in inflammatory bowel disease: a new series and a review of 120 cases from the literature. Aliment Pharmacol Ther. 2011;34(11–12):1318–27.
Orgaz-Molina J, et al. Deficiency of serum concentration of 25-hydroxyvitamin D in psoriatic patients: a case-control study. J Am Acad Dermatol. 2012;67(5):931–8.
Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266–81.
Lehmann B, Querings K, Reichrath J. Vitamin D and skin: new aspects for dermatology. Exp Dermatol. 2004;13(s4):11–5.
Bikle DD. Vitamin D regulated keratinocyte differentiation. J Cell Biochem. 2004;92(3):436–44.
Bikle DD. Vitamin D metabolism and function in the skin. Mol Cell Endocrinol. 2011;347(1):80–9.
Holick M, Pochi P, Bhawan J. Topically applied and orally-administered 1, 25-dihydroxyvitamin-D3 is a novel, safe, and effective therapy for the treatment of psoriasis-a 3-year experience with histologic analysis. J Invest Dermatol. 1989;92(3):446–446
Savoia P, et al. Effects of topical calcipotriol on the expression of adhesion molecules in psoriasis. J Cutan Pathol. 1998;25(2):89–94.
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Luk, K.M.H., Tangpricha, V., Chen, S.C. (2016). Vitamin D in Psoriasis. In: Tangpricha, V. (eds) Vitamin D. Springer, Cham. https://doi.org/10.1007/978-3-319-26176-8_11
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DOI: https://doi.org/10.1007/978-3-319-26176-8_11
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