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Background Little is known about the effectiveness and drug survival associated with apremilast under real-world conditions. Objective To investigate the influence of patient and disease characteristics on drug survival associated with apremilast and to elucidate clinical effectiveness with regard to the psoriasis area and severity index (PASI) reduction. Methods This was an observational, retrospective, multicenter analysis from the Austrian Psoriasis Registry. Results Data from 367 patients were eligible for analysis. The 12-month drug survival rate associated with apremilast (ie, the proportion of patients on the drug) was 57.3% and decreased significantly in patients younger than 40 years (relative hazard ratio = 1.49, P = .007918). Sex; concomitant arthritis; previous biologic therapy; obesity; and palmoplantar, scalp, nail, and intertriginous involvement did not significantly affect drug survival. At 12 months, the response rates in patients receiving apremilast per protocol with a PASI of 50, 75, 90, and 100 were 80.0%, 56.4%, 38.2%, and 22.7%, respectively. Limitations Inclusion of a substantial number of patients with no record of absolute PASI at study entry and lack of PASI reduction follow-up data of 103 patients (28.1%) after starting apremilast treatment. Conclusion Apremilast is a robust antipsoriatic drug for which the drug survival is not strongly influenced by most patient- or disease-related factors except age. Drug survival is significantly shorter in patients younger than 40 years.

Pityriasis rosea (PR), eine häufige Hauterkrankung bei jungen Erwachsenen, kann den Verlauf der Schwangerschaft und das ungeborene Kind nachteilig beeinträchtigen.Sechsundvierzig schwangere Frauen mit PR, die zwischen 2003 und 2018 an der dermatologischen Universität vorstellig waren, wurden analysiert und die Daten mit Patientendaten aus früher veröffentlichten Studien (n = 53) verglichen, um die Inzidenz und die Risikofaktoren für einen ungünstigen Schwangerschaftsausgang nach einer PR-Infektion zu bestimmen.Ungünstige Schwangerschaftsausgänge (definiert als Fehlgeburt, Frühgeburt vor der 37. Schwangerschaftswoche oder Geburtsgewicht 2500 g) waren in unserer Studienpopulation signifikant seltener als in der gepoolten Kohorte aus zuvor veröffentlichten Studien (10,9 % gegenüber 39,6 %; P = 0,0012). Die Analyse der gepoolten Daten aus unserer und früheren Studien ergab, dass die Schwangerschaftswoche bei Beginn der PR invers mit einem ungünstigen Ausgang assoziiert war (Odds Ratio [OR] = 0,937; 95 %-KI 0,883 bis 0,993). Darüber hinaus waren die Dauer der PR (OR = 1,432; 95 %-KI 1,129 bis 1,827), extrakutane Manifestationen (OR = 4,112; 95 %-KI 1,580 bis 10,23) und ein großflächiges Exanthem (OR = 5,203; 95 %-KI 1,702 bis 14,89) direkt mit einem ungünstigen Schwangerschaftsausgang assoziiert.In den meisten Fällen hatte die PR keinen Einfluss auf die Schwangerschaft oder die Geburt.

Pityriasis rosea (PR), a common skin disease in young adults, may adversely affects the course of pregnancy and the unborn child.Data from forty-six pregnant women with PR seen in the dermatological university clinic between 2003 and 2018 were analyzed and compared with patient data (n = 53) from previously published studies to determine the incidence and risk factors for an unfavorable pregnancy outcome after PR infection.Unfavorable pregnancy outcomes (defined as miscarriage, preterm delivery before week 37 of gestation, or birth weight 2,500 g) were significantly less frequent in our study population than in a pooled cohort obtained from previously published studies (10.9 % vs. 39.6 %; P = 0.0012). Analysis of pooled data from our study and from previous studies revealed that the week of pregnancy at onset of PR was inversely associated with an unfavorable outcome (odds ratio [OR] = 0.937; 95 % CI 0.883 to 0.993). In addition, duration of PR (OR = 1.432; 95 % CI 1.129 to 1.827), additional extracutaneous symptoms (OR = 4.112; 95 % CI 1.580 to 10.23), and widespread rash distribution (OR 5.203, 95 % CI 1.702 to 14.89) were directly associated with unfavorable outcome.In most cases, PR does not influence pregnancy or birth outcomes.

Summary Background Drug survival rates reflect efficacy and safety and may be influenced by the availability of alternative treatment options. Little is known about time‐dependent drug survival in psoriasis and the effect of increasing numbers of biologic treatment options. Objectives To determine whether drug survival is influenced by the availability of treatment options and by factors such as gender, psoriatic arthritis or previous biologic treatment. Methods This observational, retrospective, multicentre cohort study analysed data from patients registered in the Austrian Psoriasis Registry (PsoRA) who were treated with biologics between 1 January 2015 and 30 November 2019. Results A total of 1572 patients who received 1848 treatment cycles were included in this analysis. The highest long‐term Psoriasis Area and Severity Index improvement was observed after treatment with ixekizumab, followed by ustekinumab and secukinumab, adalimumab and etanercept. Overall, ustekinumab surpassed all other biologics in drug survival up to 48 months. However, when adjusted for biologic naïvety, its superiority vanished and drug survival rates were similar for ixekizumab (91·6%), secukinumab (90·2%) and ustekinumab (92·8%), all of them superior to adalimumab (76·5%) and etanercept (71·9%) at 12 months and beyond. Besides biologic non‐naïvety (2·10, P, What is already known about this topic? Female gender and previous biologic exposure have been discussed as predictors for decreased drug survival in patients with psoriasis, but it remains unknown whether a time‐dependent increased availability of treatment options alters biologic drug survival. What does this study add? The increased availability of alternative biologic treatments over time leads to an elevated risk for treatment discontinuation overall; therefore, drug survival analysis has to be time adjusted.Moreover, the study reveals that the impact of previous biologic treatment on drug survival is tremendous and confirms worse drug survival in female patients. Linked Comment: Gniadecki. Br J Dermatol 2021; 184:996–997.

Background Medical phototherapy can lead to the manifestation of polymorphic light eruption (PLE), though little is known about the frequency of such events. Aims The aim of this Austrian single center study was to retrospectively investigate over a 4‐year time period the frequency of PLE in patients prone to the condition and patients with other diseases under phototherapy (mainly narrow‐band and broad‐band UVB). Materials and Methods The data for analysis were obtained from the electronic health and patient record database and patient files of the Photodermatology Unit, Department of Dermatology, Medical University of Graz, Austria. Results PLE occurred in 24.3% (18/74) of PLE patients but only 0.7% (3/421) of psoriasis patients under phototherapy (chi‐square; P

A total of 85 PM2.5 samples were collected at a site located in a large industrial zone (Porto Marghera, Venice, Italy) during a 1-year-long sampling campaign. Samples were analyzed to determine water-soluble inorganic ions, elemental and organic carbon, and levoglucosan, and results were processed to investigate the seasonal patterns, the relationship between the analyzed species, and the most probable sources by using a set of tools, including (i) conditional probability function (CPF), (ii) conditional bivariate probability function (CBPF), (iii) concentration weighted trajectory (CWT), and (iv) potential source contribution function (PSCF) analyses. Furthermore, the importance of biomass combustions to PM2.5 was also estimated. Average PM2.5 concentrations ranged between 54 and 16 μg m−3 in the cold and warm period, respectively. The mean value of total ions was 11 μg m−3 (range 1–46 μg m−3): The most abundant ion was nitrate with a share of 44 % followed by sulfate (29 %), ammonium (14 %), potassium (4 %), and chloride (4 %). Levoglucosan accounted for 1.2 % of the PM2.5 mass, and its concentration ranged from few ng m−3 in warm periods to 2.66 μg m−3 during winter. Average concentrations of levoglucosan during the cold period were higher than those found in other European urban sites. This result may indicate a great influence of biomass combustions on particulate matter pollution. Elemental and organic carbon (EC, OC) showed similar behavior, with the highest contributions during cold periods and lower during summer. The ratios between biomass burning indicators (K+, Cl−, NO3 −, SO4 2−, levoglucosan, EC, and OC) were used as proxy for the biomass burning estimation, and the contribution to the OC and PM2.5 was also calculated by using the levoglucosan (LG)/OC and LG/PM2.5 ratios and was estimated to be 29 and 18 %, respectively.

This retrospective multicentre analysis from the Psoriasis Registry Austria (PsoRA) was conducted to determine drug effectiveness and survival of anti-tumour necrosis factor alpha (anti-TNF-α) agents in patients with moderate-to-severe chronic plaque psoriasis over a 9-year period. Data on 1,019 treatment cycles with adalimumab (n = 460), etanercept (n = 501), and/or infliximab (n = 58) administered to 827 patients (272 women, 555 men) were available for analysis. Compared with etanercept, adalimumab and infliximab showed superior short-term effectiveness. Intention-to-treat-calculated median drug survivals for adalimumab (1,264 days) and etanercept (1,438 days) were similar to each other (p = 0.74), but significantly superior to that of infliximab (477 days) (p = 7.0e-07 vs. adalimumab and p=2.2e-07 vs. etanercept, respectively). Their drug survival rates at 36 months were 51.6%, 56.0%, and 22.6%, respectively. Survival rates correlated significantly with effectiveness for adalimumab and etanercept, but not for infliximab.

Importance Psoralen-UV-A (PUVA) photochemotherapy is standard first-line treatment for skin-limited, early-stage mycosis fungoides capable of producing high initial complete response (CR) rates. However, much remains unknown about PUVA's therapeutic mechanisms, optimal duration and frequency of treatment, dose escalation, or use as maintenance therapy. Objectives To evaluate low-dose, low-frequency PUVA, and whether maintenance treatment extends disease-free remission in patients with mycosis fungoides. Design, setting, and participants This prospective randomized clinical trial with defined PUVA dosing regimen was carried out in 5 centers (Graz, Vienna, Hietzing, Innsbruck, and Salzburg) across Austria. Patients with stage IA to IIA mycosis fungoides (n = 27) were enrolled in the study beginning March 13, 2013, with the last patient enrolled March 21, 2016. These patients were treated with oral 8-methoxypsoralen followed by UV-A exposure 2 times per week for 12 to 24 weeks until CR. Patients with CR were randomized to PUVA maintenance for 9 months (14 total exposures) or no maintenance. The study was conducted from April 27, 2012, to July 27, 2018. Data analysis of the primary end point was of the intention-to-treat population, and the secondary end point analysis was of the evaluable population. Main outcomes and measures Efficacy of the PUVA regimen was determined by the rate of CR as defined by a modified severity-weighted assessment tool (mSWAT) score reduction to 0. Levels of proinflammatory molecules in serum and histologic features and percentage of clonal T cells in skin were assessed to search for biomarkers of clinical response. Results In 27 patients with mycosis fungoides, 19 (70%) were male with mean (range) age 61 (30-80) years. At baseline, patients with CR had a mean (range) mSWAT score of 18.6 (1-66) compared with 16.8 (3-46) in patients with partial response. The 12- to 24-week PUVA induction regimen reduced the mSWAT score in all patients and led to CR in 19 (70%) of 27 patients and a low mean cumulative UV-A dose of 78.5 J/cm2. The subsequent standardized 9-month PUVA maintenance phase prolonged median (range) disease-free remission from 4 (1-20) months to 15 (1-54) months (P = .02). High density of histologic infiltrate and high percentage of clonal TCR sequences in skin biopsy specimens at baseline were inversely associated with therapeutic response. No severe adverse effects were seen during the PUVA induction or maintenance phase. Conclusions and relevance This proof-of-concept study identifies potential biomarkers for therapeutic response to PUVA in mycosis fungoides; it also demonstrates that low-dose, low-frequency PUVA appears to be highly effective, and maintenance treatment may extend disease-free remission. Trial registration ClinicalTrials.gov identifier: NCT01686594.

A1 Meet the needs: Important questions for ICU relatives Magdalena M. Hoffmann1,2, Anna K. Holl3, Harald Burgsteiner4, Thomas Pieber1,5, Philipp Eller6, Karin Amrein1 A2 Daily use of the Surgical Safety Checklist: results of a real-time audit Gerald Sendlhofer1,2,3, Karina Leitgeb1, Veronika Gombotz1, Peter Tiefenbacher1, Lars-Peter Kamolz2,3 A3 Best-practice projects concerning patient safety in Austria Gerald Sendlhofer1,2,3,4, , Karina Leitgeb1,4, Magdalena Hoffmann1,4, Sabine Papst1,4, Susanne Gasteiner1,4, Lars Peter Kamolz2,3,4 A4 Comprehensive Cancer Center Graz: evaluation of availability of mandatory healthcare professionals in tumorboards Peter Tiefenbacher1,2, Yvonne Muller1,2, Gerald Sendlhofer1,2,3,4 A5 Comprehensive Cancer Center Graz: protocol to evaluate communication and recommendation finding in tumorboards Marlies Hart1, Peter Tiefenbacher1,2, Yvonne Muller1,2, Gerald Sendlhofer1,2,3,4 A6 Generating a new insulin prescription chart at a university hospital Julia Kopanz1, Katharina M. Neubauer1, Gerald Sendlhofer2,3,4, Barbara Semlitsch1, Andres Pak5, Gerald Cuder1, Thomas R. Pieber1, Johannes Plank6 A7 The Speech and Language Therapy teaching practice at the Institute for Speech and Language Therapy at FH JOANNEUM in Graz Annemarie Schinko1, Angelika Rother1 A8 Development and implementation of a progress test in undergraduate dental education: a prospective Austrian pilot project Barbara Kirnbauer1, Petra Rugani1, Norbert Jakse1, Johannes Bernhardt-Melischnig2, Rudolf Egger3 A9 What they need and what they get: protocol to identify the needs of information of patients and what they receive so far Magdalena M. Hoffmann1,2, Karina Leitgeb1,3, Esther Trampusch4,5, Angelika Hofer4, Regina Riedl6, Karin Amrein2, Christa Tax7, Gernot Brunner7, Gerald Sendlhofer,1,3,8 A 10 Medication-related problems resolved and money saved: results of a clinical pharmacy service evaluation in the surgical setting Emilie Tudela-Lopez1, Petra Polzleitner1, Klara Jadrna1, Christina Labut1, Maria Kundracikova1, Helga Fend1, Gunar Stemer1 A 11 Intercultural communication management in radiology Jutta Maria Lorenz1 A 12 Spotlight on data quality: comparison of data input by physicians vs. non-physicians in the German Resuscitation Registry Gerhard Prause1, Paul Zajic1, Philipp Zoidl1, Geza Gemes1 A 13 MRSA prevalence and eradication with octenidine Gerald Pichler1, Christian Pux1, Rita Babeluk2, Brigitte Hermann3, Eric Stoiser3, Antonella De Campo4, Andrea Grisold5, Ines Zollner-Schwetz6, Robert Krause6, Walter Schippinger4 A 14 QUIPS: a pain registry with impact in science and daily routine work Alexander Avian1,2, Brigitte Messerer3, Claudia Weinmann2, Winfried Meisner2 A 15 Patient empowerment for the youngest Karina Leitgeb1, Magdalena Hoffmann1, Gerald Sendlhofer1,2,3 A 16 Development of a pocket guide for parenteral nutrition in hospitalized adults Anna Maria Eisenberger1, Siegrid Fuchs2 A 17 Safety and efficacy of a clinical decision support system for blood glucose management in patients with diabetes mellitus type 2 at a plastic-surgical ward Alexandru-C. Tuca1, Katharina M. Neubauer2, Julia K. Mader2, Felix Aberer2 , David B. Lumenta1, Birgit Bauer1 ,Klaus Donsa3 , Thomas Augustin3 , Bernhard Holl3 , Lukas Schaupp2, Peter Beck4, Johannes Plank2 , Thomas R. Pieber2,3, Lars-P. Kamolz1,5 A 18 Urban dwellers show higher readiness in participating actively in the shaping of the healthcare system in Austria Christian Smolle1, Frederike Reischies2, Gudrun Pregartner3, Daryousch Parvizi2, Gerald Sendlhofer1,4, Lars-Peter Kamolz1,4

Psoriasis is a chronic skin disease associated with high levels of psychological distress and considerable life impact. Feelings of shame and stigmatization can lead to avoidance of social activity and intimacy. In this study, the questionnaire TSD-Q was used to evaluate pleasure in touching oneself and in a partnership, parental touching during childhood and (skin-related) shame and disgust. Skin-related disgust and shame were significantly higher in psoriatic patients than in healthy controls. Moreover, psoriasis-patients scored significantly lower than skin-healthy controls concerning appraisal of self-touching and parental touching. In contrast, psoriasis-patients scored higher concerning appraisal of touching in a partnership. Due to the fact that low self-esteem might enhance the negative evaluation of touch and the feelings of shame and disgust, psychological interventions should be integrated in the treatment of psoriasis.

Summary Background Treatment with the interleukin-12/23 antibody ustekinumab produces a satisfactory response [i.e. 75% reduction in Psoriasis Area and Severity Index (PASI) compared with baseline (PASI 75)] in the majority of patients with moderate to severe chronic plaque-type psoriasis. Objectives To determine whether concomitant 311-nm ultraviolet (UV) B therapy can further enhance the response in patients with psoriasis treated with ustekinumab. Methods Ten patients (five women and five men; mean age 58 years, range 48–66) with moderate to severe plaque-type psoriasis were treated with ustekinumab at a standard dosage of 45 or 90 mg subcutaneously depending on body weight (below or above 100 kg) at weeks 0 and 4. Within 2 days after ustekinumab initiation, the minimal erythemal dose (MED) was determined and suberythemal MED 311-nm UVB-based phototherapy was thereafter administered to one randomly selected body half (left or right, excluding the head) three times weekly for 6 weeks. Treatment response was monitored weekly in terms of half-body PASI. Results Nine patients completed the study. Analysis of their data showed that 311-nm UVB significantly accelerated the therapeutic response. At baseline (i.e. start of 311-nm UVB therapy), the mean PASI was similar in both irradiated and unirradiated body halves (13·6 vs. 13·3). At week 6, however, it was lower on irradiated body halves (2·5 vs. 6·1). This difference of 3·6 (95% confidence interval 1·3–5) was statistically significant and corresponded to an overall mean PASI reduction from baseline of 82% vs. 54%, respectively. At week 6, PASI 75 was achieved significantly more often on UV-irradiated body halves than on unirradiated body halves [7/9 patients (78%) vs. 1/9 (11%)] (McNemar test, P = 0·007). At week 12, this synergistic effect of 311-nm UVB was still apparent although not significantly so. Conclusions Treatment with 311-nm UVB accelerates the clearance of psoriatic lesions in ustekinumab-treated patients.

Summary Background Few studies have directly compared the clinical efficacy of psoralen plus ultraviolet A (PUVA) vs. biologics in the treatment of psoriasis. Objectives To compare the clinical efficacy of PUVA and biologic therapies for psoriasis under daily life conditions. Methods Data from a psoriasis registry (http://www.psoriasis-therapieregister.at) of 172 adult patients with moderate to severe chronic plaque psoriasis treated between 2003 and 2010 were analysed retrospectively. These patients had received oral PUVA [118 treatment courses including 5-methoxypsoralen (5-MOP; n = 32) and 8-methoxypsoralen (8-MOP; n = 86)] and/or biologic agents [130 treatment courses including adalimumab (n = 18), alefacept (n = 32), efalizumab (n = 17), etanercept (n = 38), infliximab (n = 7) and ustekinumab (n = 18)]. Treatment responses were analysed in terms of Psoriasis Area and Severity Index (PASI) improvement, including complete remission (CR) and reduction of PASI by at least 90% (PASI 90) or 75% (PASI 75), at treatment completion for PUVA (median time 10·3 and 9·2 weeks, for 8-MOP and 5-MOP, respectively) and at week 12 for biologics. Results Intention-to-treat–as observed CR, PASI 90 and PASI 75 rate was 22%, 69% and 86% for PUVA compared with 6%, 22% and 56% for adalimumab (P = 0·0034 by adapted Wilcoxon test), 3%, 3% and 25% for alefacept (P = 0·000000002), 6%, 6% and 59% for efalizumab (P = 0·000053), 6%, 29% and 39% for etanercept (P = 0·0000086), 29%, 71% and 100% for infliximab (P = 0·36) and 6%, 39% and 67% for ustekinumab (P = 0·028). When applying a more conservative post-hoc modified worst-case scenario analysis, with CR of 15%, PASI 90 of 58% and PASI 75 of 69%, PUVA was superior only to alefacept (P = 0·000013), efalizumab (P = 0·015) and etanercept (P = 0·0037). There were no statistically significant differences in PASI reduction rates between PUVA and infliximab. Conclusions Retrospective analysis of registry data revealed that the primary efficacy of PUVA was superior to that of certain biologics. Prospective head-to-head studies of PUVA and biologics are warranted to confirm these observations.

Background: Treatment with the tumor necrosis factor-alpha antibody adalimumab for 12–16 weeks produces a satisfactory response [i.e., 75% reduction in psoriasis area and severity index (PASI)] in a majority (70–80%) of patients with psoriasis. We asked whether 311 nm ultraviolet B (UVB) can improve therapeutic response of psoriatic lesions to adalimumab. Methods: Four patients (age range, 49–67 years) with moderate to severe plaque-type psoriasis were treated with standard dosage of adalimumab. During adalimumab therapy, a randomly selected body half (left or right, excluding the head) was irradiated with 311 nm UVB three times weekly for 6 weeks. Treatment response was monitored weekly in terms of half-body PASI. Results: 311 nm UVB significantly accelerated the therapeutic response during adalimumab treatment. At the start of 311 nm UVB therapy, the mean PASI was 14.8. After 6 weeks of 311 nm UVB therapy, the mean PASI was 2.0 on UV-irradiated body halves and 6.9 on non-irradiated body halves (difference, 4.9; 95% confidence interval, 0.4–9.4; P=0.041; 2-tailed paired t-test). This corresponded to an overall mean PASI reduction from baseline (i.e., adalimumab start) of 86% on UV-irradiated body halves vs. 53% on non-irradiated body halves. Conclusion: 311 nm UVB may accelerate and improve the clearance of psoriatic lesions in adalimumab-treated patients.

Polymorphic light eruption (PLE) is a very frequent photodermatosis in Europe whose pathogenesis may involve resistance to UV-induced immune suppression and simultaneous immune reactions against skin photoneoantigens. We performed a randomized, double-blind, placebo-controlled intra-individual half-body trial to investigate the protective effect of an after-sun (AS) lotion containing DNA-repair enzymes (photolyase from Anacystis nidulans and Micrococcus luteus extract with endonuclease activity). Fourteen PLE patients were exposed to suberythemal doses of solar-simulated UV radiation on 4 consecutive days at 4 symmetrically located PLE-prone test fields per patient. The test fields were treated with (i) active AS lotion or (ii) a placebo lotion immediately after each UV exposure, or (iii) an SPF30 sunscreen before UV exposure or left untreated. All test fields were exposed to photoactivating blue light 1 h after each UV exposure. As shown by a newly established specific PLE test score (AA + SI + 0.4P [range, 0-12], where AA is affected area score [range, 0-4], SI is skin infiltration score [range, 0-4], and P is pruritus score on a visual analogue scale [range, 0-10]), PLE symptoms were significantly fewer on test sites treated with active AS lotion than on untreated (P = 0.00049) or placebo-treated test sites (P = 0.024). At 144 h after first UV exposure (the time point of maximal PLE symptoms), the mean test scores for untreated, active AS lotion-treated, and placebo-treated test fields were 4.39, 1.73 (61% reduction; 95% confidence interval (CI), 36% to 85%), and 3.20 (27% reduction; 95% CI, 3% to 51%), respectively. Pretreatment with SPF30 sunscreen completely prevented PLE symptoms in all patients. The present results indicate that DNA damage may trigger PLE and that the application of topical liposomes containing DNA repair enzymes to increase DNA repair may effectively prevent PLE.

Summary Background Polymorphic light eruption (PLE) is a very frequent photodermatosis whose pathogenesis may involve resistance to ultraviolet (UV)-induced immune suppression. Similar to UV radiation, calcitriol (1,25-dihydroxyvitamin D3) and its analogues such as calcipotriol have been shown to exhibit immunosuppressive properties. Objectives We performed a randomized double-blinded placebo-controlled intraindividual half-body trial (NCT00871052) to investigate the preventive effect of a calcipotriol-containing cream in PLE. Methods Thirteen patients with PLE (10 women, three men; mean age 37 years) pretreated their skin on two symmetrically located test fields with calcipotriol or placebo cream twice daily for 7 days before the start of photoprovocation testing with solar-simulated UV radiation. We established a specific PLE test score [AA + SI + 0·4 P (range 0–12), where AA is affected area score (range 0–4), SI is skin infiltration score (range 0–4) and P is pruritus score on a visual analogue scale (range 0–10)] to quantify PLE severity. Results Photoprovocation led to PLE lesions in 12/13 (92%) patients. As shown by the PLE test score, compared with placebo calcipotrial pretreatment significantly reduced PLE symptoms in average by 32% (95% confidence interval 21–44%; P = 0·0022, exact Wilcoxon signed-rank test) throughout the observation period starting at 48 h until 144 h after the first photoprovocation exposure. At 48, 72 and 144 h calcipotriol pretreatment resulted in a lower PLE test score in 7 (58%), 9 (75%) and 10 (83%) of the 12 cases, respectively. Considering all time points together, calcipotriol diminished the PLE test score in all 12 photoprovocable patients (P = 0·0005; Wilcoxon signed-rank test). Conclusions These results suggest a potential therapeutic benefit of topical 1,25-dihydroxyvitamin D3 analogues as prophylactic treatment in patients with PLE.

A failure to induce immune suppression after UV exposure has been implicated in the pathogenesis of polymorphic light eruption (PLE). This immunological resistance has been linked to an impaired neutrophil infiltration into the skin following UV exposure. Therapeutic photohardening can restore this abnormal neutrophil infiltration in PLE skin and is thought to be responsible for the prophylactic efficacy. The aim of this study was to elucidate the pathogenic mechanism of the described neutrophil deficiency in PLE. Peripheral blood neutrophil responses to the chemoattractants leukotriene B4 (LTB(4)) and formyl-methionyl-leucyl-phenylalanin (fMLP) were investigated in vitro. Samples from 10 patients with PLE before and after 6 weeks of photohardening therapy were assessed. Flow cytometry was used to measure the changes associated with neutrophil activation. We found a significantly reduced neutrophil responsiveness to LTB(4) and fMLP in PLE patients, which was restored to normal levels after phototherapy. Indeed, PLE neutrophil responsiveness to these two chemoattractants after (but not before) phototherapy was similar to that of age- and sex-matched healthy control subjects. This indicates that an abnormal chemotactic potential to neutrophils is a crucial factor in the pathogenesis of PLE. Normalization following photohardening may therefore account for the therapeutic efficacy by restoring UV-induced neutrophil skin infiltration. Our results reveal a completely novel pathogenic mechanism involved in PLE and offer unique targets for therapy.

Background: The purpose of this study was to evaluate and compare the short- and long-term therapeutic efficacy of psoralen plus UVA (PUVA) vs. UVB-311 nm in the treatment of patients with disseminated lichen planus. Methods: A computerized data bank search and chart review revealed that data from a total of 28 patients, including 15 patients [11 women, four men; mean age 47 years (range, 16–65 years)] treated between 1998 and 2004 with PUVA and 13 patients [10 women, three men; mean age 51 years (range, 19–69 years)] treated with UVB-311 nm, were available at our institution for retrospective analysis. Results: All 15 patients (100%) treated with oral PUVA had a complete [n=10 (67%)] or partial [n=5 (33%)] clinical response, whereas 10 of 13 patients (77%) treated with UVB-311 nm showed complete [n=4 (31%)] or partial [n=6 (46%)] clinical response. Statistical analysis revealed that the initial response to PUVA was superior to that of UVB-311 nm (P=0.0426; Wilcoxon's exact test). There were no statistically significant differences between the PUVA- and UVB-311 nm-treated patient groups with regard to mean therapy duration (10.5 vs. 8.2 weeks; P=0.1107; unpaired, two-tailed Student's t test) or mean number of treatment exposures (25.9 vs. 22.5; P=0.1775). After a mean follow-up period of 20.5 months (range, 2–49 months) and 35.7 months (range, 3–60 months), respectively, disease recurrence or deterioration was observed in seven of 15 PUVA-treated patients (47%) and three of 10 UVB-311 nm-treated patients (30%). Kaplan–Meier lifetime table analysis revealed no statistically significant difference between the 2 treatment groups in terms of sustained overall (i.e., partial and complete) clinical response rate (P=0.8593; log-rank test). Conclusions: Even though oral PUVA produces a better initial clinical response rate, both oral PUVA and UVB-311 nm are effective treatments for lichen planus that produce similar long-term outcomes.

Background The treatment with XeCl-excimer laser generated 308-nm UVB radiation has shown promising results in patients with vitiligo. Objective In this controlled, prospective trial we studied the primary efficacy (start and grade of repigmentation) and patient's satisfaction of XeCl-excimer laser for treatment of vitiligo patches at different body sites and re-evaluated the achieved repigmentation 12 months after the end of therapy. Methods Twenty-five patients with generalized or localized vitiligo with a total of 85 lesions at different body sites were enrolled in this study. Vitiligo patches were treated with 308-nm XeCl-excimer laser 3 times a week for 6 to 10 weeks. The overall repigmentation grade of each treated lesion was evaluated once a week on a 5 point scale rating from 0 (no repigmentation), 1 (1–5%), 2 (6–25%), 3 (26–50%), 4 (51–75%), to 5 (76–100%). Results Twenty-four patients completed the study. Within 6 to 10 weeks of treatment 67% of the patients (16/24) developed follicular repigmentation of at least one of their vitiligo lesions. Lesion repigmentation started after a mean of 13 treatments in lesions located on the face, trunk, arm, and/or leg (high-responder location), and after a mean of 22 treatments in lesions located on the elbow, wrist, dorsum of the hand, knee, and/or dorsum of the foot (low-responder location). Untreated control lesions and lesions located on the fingers did not achieve any repigmentation. After 10 weeks of treatment repigmentation of more than 75% was found in 25% (7/28) of lesions of the high-responder location group versus 2% (1/43) of lesions of the low-responder location group. In most cases, laser-induced repigmentation was persistent, as determined 12 months after the end of treatment. Conclusions 308-nm excimer laser is an effective modality for the treatment of vitiligo. However, similar to other non-surgical treatment modalities, the therapeutic effect is mainly dependent on the location of vitiligo lesions.

Background: Both bath psoralen plus ultraviolet A (PUVA) and oral PUVA with 8-methoxypsoralen (8-MOP) have been successfully used for the treatment of recalcitrant palmoplantar psoriasis. This trial was designed to assess the efficacy and side effects of the different treatment modalities in a randomized half-side comparison. Methods: Eight patients with moderate-to-severe psoriasis on soles (n=6) and/or palms (n=8) were randomly assigned to receive bath PUVA treatment on one side and oral PUVA on the other. Initial treatment dose was 50% of the minimal phototoxic dose evaluated for bath PUVA and oral PUVA. Treatment was given three times a week for 4 weeks. Before treatment and every week a severity index (SI) was assessed by summing the scores of erythema, infiltration, scaling and vesicles evaluated on a scale from 0 to 4. After 4 weeks of treatment the half-side trial was finished and the treatment was continued on both sides with the more effective treatment regimen. Results: Both bath PUVA and oral PUVA achieved a reduction of the mean initial SI from 5.9 (95% confidence intervals (CI) 4.5–8.0) to 3.3 (1.8–6.0) (44% SI reduction, P

Summary Background Psoralen plus ultraviolet (UV) A (PUVA) is the standard treatment for early stage mycosis fungoides (MF). When 8-methoxypsoralen (8-MOP) is used in PUVA therapy, it often produces intolerance reactions such as nausea, vomiting and headache. Objectives To investigate whether 5-methoxypsoralen (5-MOP) is a safe and effective alternative to 8-MOP in PUVA therapy for MF. Methods A retrospective database search and chart review was done to identify patients with MF who received PUVA with either 5-MOP or 8-MOP as initial monotherapy at our institution. Between 1990 and 2004, 14 patients [seven men and seven women; mean age 70 years, range 51–82; National Cancer Institute disease stages IA (n = 6) and IB (n = 8)] received 5-MOP, and 24 patients [21 men and three women; mean age 58 years, range 28–89; disease stages IA (n = 11), IB (n = 12) and IIB (n = 1)] received 8-MOP. Results Twelve of 14 patients (86%) in the 5-MOP group and 22 of 24 (92%) in the 8-MOP group had a complete response to PUVA. These two subgroups of complete responders did not differ significantly in terms of PUVA therapy duration, number of treatments or cumulative UVA dose. They also did not differ significantly in terms of relapse-free rate [8% (one of 12) vs. 23% (five of 22)] or time to relapse [17 months (range 4–31) vs. 14 months (range 4–33)]. Moreover, PUVA maintenance therapy with either 5-MOP or 8-MOP in a subset of patients [26% (nine of 34)] did not affect long-term relapse-free status either. Conclusions 5-MOP and 8-MOP have comparable therapeutic efficacy when used in PUVA therapy for MF.

Soil horizons below 30 cm depth contain about 60% of the organic carbon stored in soils. Although insight into the physical and chemical stabilization of soil organic matter (SOM) and into microbial community composition in these horizons is being gained, information on microbial functions of subsoil microbial communities and on associated microbially-mediated processes remains sparse. To identify possible controls on enzyme patterns, we correlated enzyme patterns with biotic and abiotic soil parameters, as well as with microbial community composition, estimated using phospholipid fatty acid profiles. Enzyme patterns (i.e. distance-matrixes calculated from these enzyme activities) were calculated from the activities of six extracellular enzymes (cellobiohydrolase, leucine-amino-peptidase, N-acetylglucosaminidase, chitotriosidase, phosphatase and phenoloxidase), which had been measured in soil samples from organic topsoil horizons, mineral topsoil horizons, and mineral subsoil horizons from seven ecosystems along a 1500 km latitudinal transect in Western Siberia. We found that hydrolytic enzyme activities decreased rapidly with depth, whereas oxidative enzyme activities in mineral horizons were as high as, or higher than in organic topsoil horizons. Enzyme patterns varied more strongly between ecosystems in mineral subsoil horizons than in organic topsoils. The enzyme patterns in topsoil horizons were correlated with SOM content (i.e., C and N content) and microbial community composition. In contrast, the enzyme patterns in mineral subsoil horizons were related to water content, soil pH and microbial community composition. The lack of correlation between enzyme patterns and SOM quantity in the mineral subsoils suggests that SOM chemistry, spatial separation or physical stabilization of SOM rather than SOM content might determine substrate availability for enzymatic breakdown. The correlation of microbial community composition and enzyme patterns in all horizons, suggests that microbial community composition shapes enzyme patterns and might act as a modifier for the usual dependency of decomposition rates on SOM content or C/N ratios., Highlights • Enzyme patterns differed more strongly between horizons than between ecosystems. • Enzyme patterns in subsoils vary more strongly than enzyme patterns in topsoils. • Enzyme patterns in topsoil are related to SOM content and mic. community composition. • Enzyme patterns in mineral subsoil were not related to SOM content or SOM C/N.

In this cross-sectional, exploratory case-control study the vegetative arousal in vitiligo patients compared to an age and gender matched healthy control group was assessed. Forty-eight participants (24 outpatients with generalised vitiligo and 24 healthy controls) completed a test procedure consisting of an initial period of rest (R1), a defined mental stress task (the d2 test of attention), a second period of rest (R2) followed by an individually, age adapted physical stress task (bicycle ergometry) and a final period of rest (R3). Based on a continuously recorded electrocardiogram, heart rate variability, in particular high frequency (HF) and low frequency (LF) components were determined. Within the 3 periods of rest, vitiligo patients showed a higher vegetative arousal than controls, represented by the ratio of LF/HF which mirrors the sympatho-vagal balance (R1: p = 0.027; R2: p = 0.003; R3: p = 0.029). No differences between the 2 groups were found during the mental (p = 0.187) and the physical stress task (p = 0.773). The results suggest a higher vegetative arousal in vitiligo patients.

Estuaries and coastal zones are dynamic transitional systems which provide many economic and ecological benefits to humans, but also are an ideal habitat for other organisms as well. These areas are becoming contaminated by various anthropogenic activities due to a quick economic growth and urbanization. This chapter explores the sources, chemical speciation, sediment accumulation and removal mechanisms of the harmful elements in estuarine and coastal seawaters. It also describes the effects of toxic elements on aquatic flora and fauna. Finally, the toxic element pollution of the Venice Lagoon, a transitional water body located in the northeastern part of Italy, is discussed as a case study, by presenting the procedures adopted to measure the extent of the pollution, the impacts on organisms and the restoration activities.

Coexistence (collision) of two different neoplasms in the same lesion has previously been documented by several authors. In this report, we describe a 13-year-old boy with xeroderma pigmentosum presenting with squamous-cell carcinoma and melanoma arising at the same site on the nose. Histopathologically, the melanoma component of the lesion was located mainly eccentrically to the squamous-cell carcinoma component. Immunohistochemical stains confirmed the histopathologic findings. Mutations for p53 assessed using single-strand conformation polymorphism, and sequencing analysis revealed a CC-to-TT transition at codon 159 of the p53 gene in the squamous-cell component but not in the melanoma component. This finding suggests a possible role for UV in the pathogenesis of at least the squamous-cell component of the tumor. To the best of our knowledge, this is the first report of a collision tumor comprising squamous-cell carcinoma and melanoma arising in childhood.

Background: Extracorporeal photochemotherapy (EXP) is an immunomodulating therapy that has been used in a limited number of patients with systemic sclerosis (SSC) with controversial results. The present study was performed to evaluate the efficacy and safety of extended EXP with extracorporeal application of liquid 8-methoxypsoralen (8-MOP) in the treatment of SSC, Methods: Eleven women with progressive SSC of recent onset mere treated for a period of 16-57 months. Skin. changes, physical performance, extracutaneous manifestations, and quality of life mere evaluated before initiation of EXP and at regular intervals thereafter. Results: From the start to the last set of EXP, we observed an overall, improvement and/or stabilization of skin changes and physical performance in 5 of 11 patients (45%). Extracutaneous manifestations deteriorated in 10 of 11 patients (91%) (P

Background: Psoriasis is a chronic inflammatory skin disease. Among other cytokines, interleukin 22 (IL-22) has been implicated in the pathogenesis of chronic plaque psoriasis. The purpose of this study was to investigate a hypothesized association between common IL-22 gene polymorphisms and chronic plaque psoriasis. Methods: Genotypes of 10 common polymorphisms of the IL-22 gene were determined by fluorogenic 5′ exonuclease assays (TaqMan) in 475 patients with chronic plaque psoriasis and 252 controls. Results: Two blocks of high linkage disequilibrium, formed by eight polymorphisms upstream of exon 5 (rs2227485, rs2227491, rs2046068, rs1179251, rs1012356, rs2227501, rs2227503, rs976748) and two polymorphisms in the 3′ near gene region (rs1182844, rs1179246), were observed within the IL-22 gene. Neither single polymorphisms nor haplotypes were significantly associated with the presence or clinical features of chronic plaque psoriasis (P > 0.05). Conclusions: Our data suggest that the investigated IL-22 gene polymorphisms are unlikely major risk factors for chronic plaque psoriasis.

Photodynamic therapy with 5-aminolevulinic acid (ALA-PDT) is based on photosensitization by endogenous synthesis of protoporphyrin IX and its transient accumulation especially in malignant epithelially derived tissues. Recent studies have indicated that ALA-PDT is effective for the treatment of solar keratoses (SK), but there has been a lack of long-term clinical follow-up. The goal of the present study was to investigate the immediate and long-term effect of ALA-PDT on SK. Twenty-eight patients with a total of 251 SK were enrolled in the study. Standard treatment involved the topical application of 20% ALA, under occlusive and light-shielding dressing for 4 hours before exposure to UVA and/or different wave bands or wave band combinations of polychromatic visible light (full-spectrum visible light, and/or different wave bands of filtered visible light >515, >530, >570, or >610 nm) in one or two treatment sessions. The primary complete response rate of SK to ALA-PDT was 64% after one treatment, but 85% when the responses to a second treatment were included. Taken all treatments together, the complete response rate for lesions on face, scalp and neck was 93% for full-spectrum visible light, 96% for the combination of full-spectrum visible light and filtered light, 91% for different wave bands of filtered visible light, and 100% for the combination of long wave UVA and full-spectrum visible light, respectively. The complete response rate for lesions on forearms and hands was 51% for full-spectrum visible light and 33% for the combination of full-spectrum visible light and filtered light. The greater response rate for SK on the face, scalp, and neck was associated with a higher surface fluorescence and immediate response rate after ALA photosensitization at these sites ( X 2 : p = 0.0001). However, due to the treatment protocol the mean light dose applied to lesions on the face, scalp and neck (50 J cm −2 ) was substantially higher than that for lesions on forearms and hands (35 J cm −2 ). In the long term follow-up of SK on face scalp and neck, the projected disease-free rate at 36 months after therapy was 71% for lesions treated with full-spectrum visible light versus 23% for lesions treated with different wave bands of filtered light (Log rank - Mantel Cox; p = 0.0001). These results indicate that treatment with full-spectrum visible light at higher light doses may be the most effective and promising form of light exposure in ALA-PDT of SK.

Summary Background: Numerous studies have confirmed the short-term effectiveness of 8-methoxypsoralen bath PUVA therapy in patients with chronic palmoplantar dermatoses; however, little is known about long-term results. Patients and methods: In this retrospective study we examined the long-term results in 79 patients (mean age: 48 years) with chronic palmoplantar dermatoses who were treated with bath PUVA three times a week over an 8-year period. A good clinical response (a reduction of more than 50% of the skin lesions) occurred after a mean of 23 treatments and a mean cumulative UVA dose of 39 J/cm2 in 51 patients (65%). In 2007 a questionnaire was sent to these 51 patients to assess the long-term outcome. Results: With bath PUVA treatment, the best results were found in patients with hyperkeratotic eczema (17/22; 77% good clinical response) followed by patients with palmoplantar psoriasis (26/41; 63%) and patients with dyshidrotic eczema (8/16; 50%). Thirty-four patients (67%) answered the questionnaire after a mean follow-up interval of 4.3 years (10–87 months). Among these patients, 36% reported an improved course of disease after PUVA therapy with reduced frequency and/or intensity of the skin rash, and 29% of patients reported continued complete clearance. 79% of our patients reported a long-term reduction in the use of topical corticosteroids during the follow-up period (mean: 4.3 years). In addition, 67% of patients reported a lasting improvement in quality of life. Conclusions: These data show that bath PUVA may have a long-term, beneficial influence on the course of disease in a majority of patients with recalcitrant chronic palmoplantar dermatoses.

Conventional risk assessment studies provide no detailed information about the role of specific sources determining the total carcinogenic and mutagenic potencies of PAH mixtures on humans health. In this study, the main emission sources of 11 particle-phase PAHs listed as carcinogenic and mutagenic agents by the IARC were identified by a risk apportionment method. The contribution of sources to the total concentration of PAHs in the study area was also quantified. A receptor model based on factor and multiple linear regression analyses was applied to estimate the source-specific risk associated to PAH inhalation in an urban background area of a large city (Venice-Mestre, Northern Italy). The proposed approach has discriminated the sources of mutagenic and carcinogenic congeners and their role in determining a serious hazard for human health. Results, interpreted on the basis of seasonal variations and atmospheric conditions, have shown that even though domestic heating is the main source of total PAHs in winter, a background pollution including traffic mainly accounts for the carcinogenic and mutagenic risk during the whole year. The findings of this work and the approach used can be easily applied to other geographic areas and provide useful information for local and regional air pollution control strategies.

This study presents a procedure to differentiate the local and remote sources of particulate-bound polycyclic aromatic hydrocarbons (PAHs).Data were collected during an extended PM(2.5) sampling campaign (2009-2010) carried out for 1 year in Venice-Mestre, Italy, at three stations with different emissive scenarios: urban, industrial, and semirural background. Diagnostic ratios and factor analysis were initially applied to point out the most probable sources. In a second step, the areal distribution of the identified sources was studied by applying the discriminant analysis on factor scores. Third, samples collected in days with similar atmospheric circulation patterns were grouped using a cluster analysis on wind data. Local contributions to PM(2.5) and PAHs were then assessed by interpreting cluster results with chemical data.Results evidenced that significantly lower levels of PM(2.5) and PAHs were found when faster winds changed air masses, whereas in presence of scarce ventilation, locally emitted pollutants were trapped and concentrations increased. This way, an estimation of pollutant loads due to local sources can be derived from data collected in days with similar wind patterns. Long-range contributions were detected by a cluster analysis on the air mass back-trajectories. Results revealed that PM(2.5) concentrations were relatively high when air masses had passed over the Po Valley. However, external sources do not significantly contribute to the PAHs load.The proposed procedure can be applied to other environments with minor modifications, and the obtained information can be useful to design local and national air pollution control strategies.

Treatment with the tumor necrosis factor-alpha antibody adalimumab for 12-16 weeks produces a satisfactory response [i.e., 75% reduction in psoriasis area and severity index (PASI)] in a majority (70-80%) of patients with psoriasis. We asked whether 311 nm ultraviolet B (UVB) can improve therapeutic response of psoriatic lesions to adalimumab.Four patients (age range, 49-67 years) with moderate to severe plaque-type psoriasis were treated with standard dosage of adalimumab. During adalimumab therapy, a randomly selected body half (left or right, excluding the head) was irradiated with 311 nm UVB three times weekly for 6 weeks. Treatment response was monitored weekly in terms of half-body PASI.311 nm UVB significantly accelerated the therapeutic response during adalimumab treatment. At the start of 311 nm UVB therapy, the mean PASI was 14.8. After 6 weeks of 311 nm UVB therapy, the mean PASI was 2.0 on UV-irradiated body halves and 6.9 on non-irradiated body halves (difference, 4.9; 95% confidence interval, 0.4-9.4; P=0.041; 2-tailed paired t-test). This corresponded to an overall mean PASI reduction from baseline (i.e., adalimumab start) of 86% on UV-irradiated body halves vs. 53% on non-irradiated body halves.311 nm UVB may accelerate and improve the clearance of psoriatic lesions in adalimumab-treated patients.

The palatability of plants was studied in young, immature and adult geese of three species,Anser anser, Anser indicus andBranta canadensis, with respect to secondary plant metabolites. In their first 1–4 weeks of life, hand-reared goslings feed on a wide variety of plants, more or less irrespective of their allelochemical contents. Older birds become more selective, but still consume plants which are normally considered to be unpalatable or even toxic for other animals. Choice experiments were performed with pure secondary metabolites which were offered on otherwise highly palatable food items, such as leaves ofTaraxacum officinale. These experiments revealed a similar trend, in that very young goslings discriminate their food much less than older goslings or adult geese. In general, food contaminated with essential oils was rejected, whereas alkaloids, glycosides, amines and sulfur compounds were tolerated to a remarkable degree. In consequence, especially young, but also adult geese must have a high capacity to tolerate and/or to detoxify dietary allelochemicals. Another detoxification mechanism became evident during the experiments: geese ingest soil and mud quite regularly. It could be shown experimentally that the respective soil had a high capacity to bind alkaloids. We assume that geophagy is a means (besides a presumed active detoxification in the liver) to adsorb and thus reduce the contents of dietary allelochemicals.

Contains fulltext : 89179.pdf (Publisher’s version ) (Closed access) To identify new susceptibility loci for psoriasis, we undertook a genome-wide association study of 594,224 SNPs in 2,622 individuals with psoriasis and 5,667 controls. We identified associations at eight previously unreported genomic loci. Seven loci harbored genes with recognized immune functions (IL28RA, REL, IFIH1, ERAP1, TRAF3IP2, NFKBIA and TYK2). These associations were replicated in 9,079 European samples (six loci with a combined P < 5 x 10 and two loci with a combined P < 5 x 10). We also report compelling evidence for an interaction between the HLA-C and ERAP1 loci (combined P = 6.95 x 10). ERAP1 plays an important role in MHC class I peptide processing. ERAP1 variants only influenced psoriasis susceptibility in individuals carrying the HLA-C risk allele. Our findings implicate pathways that integrate epidermal barrier dysfunction with innate and adaptive immune dysregulation in psoriasis pathogenesis. 01 november 2010

Background: Methylenetetrahydrofolate reductase (MTHFR) is involved in the formation of methyl donors, which contribute to DNA methylation. DNA methylation is an essential epigenetic feature playing a critical role in gene regulation and cellular differentiation. In addition, MTHFR activity affects plasma homocysteine levels. A functional polymorphism in the MTHFR gene (677C>T, rs1801133) leading to reduced enzyme activity has been associated with chronic plaque psoriasis in a Chinese population. This finding, however, has not yet been either confirmed or refuted in other populations. The purpose of the present study was to investigate a hypothesized association between the MTHFR 677C>T polymorphism and the presence of chronic plaque psoriasis in a Caucasian population. Methods: Genotypes for the MTHFR 677C>T polymorphism were determined in 310 patients and 247 control subjects. In a subgroup of 33 patients and 33 sex- and age-matched control subjects, fasting plasma homocysteine concentrations were determined by high-performance liquid chromatography and immunological assays were used for the measurement of folate and vitamin B12. Results: Prevalence of the homozygous MTHFR 677TT genotype did not significantly differ between patients and controls (15.2% vs 11.7%, P = 0.24). Mean plasma homocysteine concentrations were significantly higher in psoriasis patients than among control subjects (13.5 ± 5.3 μmol/l vs 11.0 ± 2.2 μmol/l, P = 0.026). No significant differences between either mean plasma folate or vitamin B12 concentrations were observed between both groups. Conclusion: Our data suggest that the MTHFR 677C>T gene polymorphism is not associated with chronic plaque psoriasis among Caucasians.