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Pityriasis lichenoides is a benign disease that includes a continuous spectrum with two polar ends: pityriasis lichenoides et varioliformis acuta (PLEVA) and pityriasis lichenoides chronica (PLC). Although its benign and self-limited character, treatment is required, both for itch relief and for cosmetic issues. The present study is a retrospective analysis of 13 patients (11 PLC and 2 PLEVA) treated in our institution with psoralen plus ultraviolet A (PUVA) or ultraviolet A combined with ultraviolet B (UVA/UVB) during the period 1998-2011. In the PUVA group, complete response was achieved in five patients and partial response in two. Total cumulative UVA dose was 84.4 J/cm2. One patient quit therapy without therapeutic response. In the UVA/UVB group, complete response was achieved in two patients and partial response in an equal number of patients. One patient did not reach a significant improvement. Total cumulative doses were: 26.1 J/cm2 for UVA and 3.62 J/cm2 for UVB. There were no acute side effects in either therapeutic group. In the present study, PUVA phototherapy was preferred for patients with more widespread or long-evolving disease, while UVA/UVB was selected for patients who presented more recent disease or contraindications for PUVA therapy. Regardless of the absence of clinical guidelines, both therapeutic options proved to be successful, ascertaining phototherapy as an effective and safe option for pityriasis lichenoides patients. [ABSTRACT FROM AUTHOR]

Introduction: During the last half of the 20th century, the use of UVB therapy and photochemotherapy (PUVA), were one of the mainstays of treatment for psoriasis. However, accompanying to the advent of the most recent era of psoriasis, with targeted biologic therapy has been a decline in the frequency of phototherapy. This does not diminish its known clinical effects. Objective: To perform a retrospective analysis of demographic, clinical and therapeutic variables of psoriatic patients treated with phototherapy in the last 10 years, when biological therapies become available. Also, review some of the published phototherapy and biological therapy data in psoriasis. Methods: Psoriatic patients were treated between 1st January 2000 and 31st December 2010 in a Lisbon Phototherapeutic unit. Psoriatic arthritis patients were excluded. Regimes used included PUVA (systemic or topical), Re PUVA, UVAB (broad band) or combined options. Results: During this period, 211 patients were treated with phototherapy; 40% (85/211) UVAB, 31% (64/211) topical PUVA, 23% (49/211) systemic PUVA and 6% (13/211) Re PUVA. Mean follow-up period was 18 months (Min 1; Max 120). The average age was 45 years old (mean 44.80; Min 10; Max 80; SD 16.31), 54% (114/211) of patients were female and 46% (97/211) were male. Of all 211 psoriasis patients, 54% (144/211) had plaque psoriasis diagnosis, 31% (66/211) palmoplantar psoriasis and 15% (41/211) guttate psoriasis. Regardless the phototherapy modality used, substantial BSA improvements were achieved in all psoriasis groups. Discussion: Current advancements in therapeutics enjoyed today include the advent of the biologics and other immunomodulating systemic agents. However, attending to the responses achieved, and considering other variables like well-known side effects and cost, photo(chemo)therapy will remain an essential method of treatment for psoriasis vulgaris in the 21st century. [ABSTRACT FROM AUTHOR]

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Objectives: Generalized pustular psoriasis (GPP) is a rare, life-threatening skin inflammatory disorder. This study aimed to describe the disease course, treatment strategies, and healthcare utilization among patients with GPP in Portugal., Methods: This multicentric, observational, retrospective study included consecutive adult patients with GPP undergoing a dermatology evaluation in different reporting institutions by experienced dermatologists between 2002 and 2023., Results: A total of 59 patients were assessed. Most of the cohort had a previous history of plaque psoriasis (71%) and 83% presented at least one comorbidity. At the initial encounter, 64% of the cohort needed hospitalization. Systemic involvement was common, including fever (37%), and elevated white blood cell count and erythrocyte sedimentation rate/C-reactive protein (49%). Nearly, 73% of patients initiated systemic drugs, and 70% had to discontinue the first treatment. During the study, 98% of patients experienced at least one flare. At the last visit, 3.4% of patients had died, and 71.2% exhibited signs of active disease despite undergoing treatment., Conclusions: Our study demonstrates that GPP is a chronic, debilitating condition associated with systemic involvement, frequent flares, and hospitalizations, despite receiving multiple systemic treatments. Improved disease awareness and new treatments are needed to improve patient care and decrease the burden of the disease.

Introduction: Several skin disorders, immunosuppression-induced, have been described in transplant recipients. The aim of our study is to characterize the clinical spectrum of skin disorders and to compare the findings in liver and kidney transplant recipients., Material and Methods: A retrospective descriptive study was conducted. Data were collected from the medical records of all liver and kidney transplant recipients from 2000 - 2010 who had been referred to our Dermato-Venereology Department., Results: Three hundred nineteen transplant recipients (23.5%) have been seen, resulting in 410 diagnoses (230 in the subpopulation of liver transplant recipients and 180 in the subpopulation of kidney transplant recipients) grouped into 4 categories: 1) cutaneous infections; 2) skin cancer or premalignant skin lesions; 3) cutaneous side-effects; 4) non-iatrogenic skin disorders. Cutaneous infections were the most common presentations (42.2%), on average 32.7 months after transplantation. The latter group included 20.5% of fungal, 12.7% viral and 8.5% bacterial infections. Skin cancer and premalignant skin lesions made up 11.7% of all diagnoses, over a mean of 44.8 months post transplant and occurring primarily in kidney transplant recipients (20.6% vs 4.8% in liver transplantation patients; P < 0.001). The kidney transplant population had a squamous cell carcinoma (SCC) to basal cell carcinoma (BCC) ratio of 1.3:1 with SCC predominance, and the liver transplant population had a BCC:SCC ratio of 3.5:1. We also identified 10.5% of cutaneous side-effects and 35.6% of non-iatrogenic skin disorders., Discussion: Although neoplastic pathology is more frequently mentioned in the literature, cutaneous infections were the most common diagnoses in our study. The significant differences between the two subpopulations studied may be related to higher immunosuppression after kidney transplantation., Conclusion: The high number of skin disorders reported in these patients makes it essential for Dermato-Venereology to be included within the multidisciplinary post-transplant care provided.

Psoriasis is an inflammatory dermatosis, affecting approximately 2% of the population, with predominantly skin and joint involvement but also associated with considerable comorbidities. Approximately 20% to 30% of patients have moderate to severe disease uncontrollable with topical therapy. Traditional systemic therapy – oral PUVA, retinoids, cyclosporin and methotrexate – may induce organ specific toxicity and a significant number of patients are unresponsive, intolerant or have specific contraindications to its use. With the increased understanding of the pathogenesis of psoriasis, multiple biologic agents have been introduced. In the last years there has been an increased utilization of these agents and several studies were designed to evaluate their efficacy and safety. Currently, four biologics have been already approved by EMEA (European Medicines Agency) for the treatment of plaque psoriasis, 3 anti-TNFα (adalimumab, etanercept and infliximab) and one anti-IL12/23p40 (ustecinumab). In the present article we update the prior published guidelines (Trabalhos da SPDV 2010;68(1):47-68 and 2011;69(4):531-553) due to the recent progress in the knowledge and therapeutic options in these area. These recommendations should be used with caution and treatment should be tailored to meet individual patient's needs and each specific clinical situation.