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Jānis Ķīsis RSU Infektoloģijas un dermatoloģijas katedra Asociētais profesors

''Vienotā pieeja psoriāzes izaicinājumu risināšanā''. Ādas psoriāzes izplatība Eiropā un pasaulē, diagnostiskās un ārstēšanas problēmas. Psoriāzes klīniskās vadlīnijas. Jānis Ķīsis RSU Infektoloģijas un dermatoloģijas katedra Asociētais profesors. Psoriāze . Jau 200 gadus.

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Jānis Ķīsis RSU Infektoloģijas un dermatoloģijas katedra Asociētais profesors

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  1. ''Vienotā pieeja psoriāzes izaicinājumu risināšanā'' Ādas psoriāzes izplatība Eiropā un pasaulē, diagnostiskās un ārstēšanas problēmas.Psoriāzes klīniskās vadlīnijas. Jānis Ķīsis RSU Infektoloģijas un dermatoloģijas katedra Asociētais profesors

  2. Psoriāze .Jau 200 gadus . Willan R. Cutaneous Diseases. London: J. Johnson; 1808. First< PrevPage of 1669 Next >Last >> Results: 1 to 20 of 33372

  3. Saturs . 1. Epidemioloģija. 2. Diagnostika . 3.Terapija . 4 .Psoriāzes terapija.

  4. Epidemioloģija. • Telefonaptaujā Kanādā tika indicēti 500 psoriāzes pacienti ar ādas bojājumu >3 plaukstas un viņu vidū 18 % tika konstatēts PsA ,bet 51% (256 of 500 ) bija sāpes ,stīvums locītavās • J Cutan Med Surg. 2009 Sep-Oct;13(5):235-52.The burden of psoriasis in Canada: insights from the pSoriasis Knowledge IN Canada (SKIN) survey.Lynde CW, Poulin Y, Guenther L, Jackson C.

  5. Epidemioloģija . • ASV diagnosticētas psoriāzes prevalence ir 3.15%.ar pieaugumu pēdējās 2 dekādēs . • J Autoimmun. 2010 May;34(3):J314-21. Epub 2009 Dec 24.Geoepidemiology and environmental factors of psoriasis and psoriatic arthritis.Chandran V, Raychaudhuri SP.

  6. Vēsture Edward Calvin Kendall Tadeus Reichstein Philip Showalter Hench The Nobel Prize in Physiology or Medicine 1950 was awarded jointly to Edward Calvin Kendall, Tadeus Reichstein and Philip Showalter Hench "for their discoveries relating to the hormones of the adrenal cortex, their structure and biological effects". www.nobelprize.org

  7. Vēsture . 1. Sulzberger MB, Witten VH. Effect of topically applied compound F in selected dermatoses. J Invest Dermatol 1952; 19: 101–2. Hidrokortizons –pirmais lokāli efektīvais KS tika ieviests 1952. gadā . To veica Sulzberger un Witten . 60.jubileja.

  8. Epidemioloģija . Bērniem. J Am Acad Dermatol.2009 Dec 3. [Epub ahead of print]Incidence of psoriasis in children: A population-based study.Tollefson MM, Crowson CS, McEvoy MT, Kremers HM.Department of Dermatology, College of Medicine, Mayo Clinic, Rochester, Minnesota. Saslimstība ar psoriāzi bērniem ir palielinājusies zīmīgi no 29.6 uz 100,000 1970 līdz 1974 uz 62.7 no 100,000 jau 1995 līdz 1999 (P < .001).

  9. Epidemiology of Psoriasis in Germany - Analysis of Secondary Health Insurance Data. Gesundheitswesen. 2010 Jun 11. [Epub ahead of print] Schäfer I, Rustenbach SJ, Radtke M, Augustin J, Glaeske G, 33 981 no 1 344 071 apdrošinātām personām 2005 gadā un psoriāzes diagnozi ,tādejādi viena gada prevalence šai kohortā bija 2.53%.Līdz 80 gvprevalence palielinājās un bija augstākā vecuma grupā 50 to 79 g.v ( 3.99-4.18%).Apdrošinātās personas līdz 20 gv.bija ar prevalenci 0.73%.Zemākie rādītātāji bija dienvidos (2.17%) un augstākie (2.78%) Vācijas ziemeļos .

  10. Pētnieki uzskata ,ka psoriāze var samazināt iespējamo dzīves ilgumu • MedPage Today (10/14, Bankhead) ir citējis,ka "psoriāzes pacientiem ir koincidentas saslimšanas ,kas saīsina iespējamo dzīvildzi par 10 un vairāk gadiem" Kanādas pētnieku komanda no NewLab ir atraduši ,,,ka pacienti ,kuriem psoriāze ir diagnosticēta pirms 25 gv.,nedzīvo līdz 60 gv.“, kamēr psoriāze diagnosticēta 25 un vēlākā laika periodā ir asociēta ar vidējo dzīvildzi virs 70 gv. Datu analīze parādīja ,ka,, psoriāzes pacientiem risks nomirt pašnāvībā ,ievainojumu ,saindēšanās dēl ir 1 gadījumā no 600,bet kardiovaskulārās nāves risks ir aptuveni 1 no 75 "

  11. Genital Psoriasis: A Systematic Literature Review on this Hidden Skin Disease. Acta Derm Venereol. 2010 Oct 7. doi: 10.2340/00015555-0988. [Epub ahead of print].Meeuwis KA, de Hullu JA, Massuger LF, van de Kerkhof PC,. Ģenitāliju āda bojājums sastopams 29–40% pacientiem ar psoriāzi ; No 48 pacientiem ar inversu psoriāzi, ārējās ģenitālijas bija iesaistītas 38 (79.2%). Vulvāro psoriāziar psoriasis bieži novēro bērnu vecumā .Izvērtējot 130 prepuberātes vecuma meitenes ar vulvārām sūdzībām – psoriāze (17%) bija 3. biežākais ādas stāvoklis pēc AD un iritanta D(33%) un lichen sclerosus (18%)

  12. Globālā epidemioloģija . • 53 pētījumi no 385 bija globāli pētījumi , caurskatīti laika posmā lidz 2011 gada jūlijam. • Bērnu prevalence 0% (Taivānā ) līdz 2.1% (Itālija) pieaugušie no 0.91% (Amerika ) līdz 8.5% (Norvēģija • Bērnu psoriāzes incidence (Amerika) bija 40.8/100,000 person-gadi ,pieaugušajiem variācijas no 78.9/100,000 person-gadiem (Amerika )līdz 230/100,000 person-gadiem (Itālijā ). • Tas nozīmē ,ka psoriāzes sastopamība un saslimstība variē atbilstoši vecumam un ģeogrāfiskajam reģionam. • Psoriāze biežāka ir rajonos attālinātos no ekvatora . J Invest Dermatol. 2012 Sep 27. doi: 10.1038/jid.2012.339. [Epub ahead of print] Global Epidemiology of Psoriasis: A Systematic Review of Incidence and Prevalence.Parisi R, Symmons DP, Griffiths CE, Ashcroft DM;

  13. Heterosexual women with psoriasis 0.03) compared with those without = had 1.13 times more unprotected sex (RR 1.13, 95% CI 1.02-1.24, P psoriasis . Conclusion. Psoriasis is associated with a significantly reduced number of sexual partners in nonheterosexual women. • Psoriasis may differentially impact sexual behavior based on sexual orientation in women. • J Sex Med. 2012 Nov 21. Psoriasis and Sexual Behavior in U.S. Women: An Epidemiologic Analysis Using the National Health and Nutrition Examination Survey (NHANES). • Armstrong AW, Follansbee MR, Harskamp CT, Schupp CW.

  14. Neatpazīta psoriāze.

  15. Neatpazīta psoriāze.

  16. Agrīns sākums ,neregulāra gaita ,tendence smagai gaitai . • J Dermatolog Treat. 2012 Dec 5. [Epub ahead of print] • Current therapeutic approaches of psoriasis are affected by age at disease onset. • Di Lernia V, Ficarelli E.

  17. Arch Dermatol. 2012 Aug;148(8):918-24. The association between physical activity and the risk of incident psoriasis.Frankel HC, Han J, Li T, Qureshi AA. • a cohort of 116,430 women aged 27 to 44 years in 1991. • The study population included 86,655 US female nurses who reported • After adjusting for age, smoking, and alcohol use, increasing physical activity was inversely associated with the risk of psoriasis. The most physically active quintile of women had a lower multivariate relative risk (RR) of psoriasis (0.72 [95% CI, 0.59-0.89; P < .001 for trend]) compared with the least active quintile. • Vigorous physical activity (≥6 metabolic equivalents) was associated with a reduced risk of psoriasis (multivariate RR for the highest quintile, 0.66 [95% CI, 0.54-0.81; P < .001 for trend]); this association remained significant after adjusting for body mass index (RR, 0.73 [95% CI, 0.60-0.90; P = .009 for trend]).

  18. J Drugs Dermatol. 2012 Apr;11(4):466-73.Top dermatologic conditions in patients of color: an analysis of nationally representative data.Davis SA, Narahari S, Feldman SR, • in patient visits to U.S. dermatologists from 1993 to 2009. The leading diagnoses were tabulated for each racial and ethnic group, and the top conditions were compared between groups. • The top five diagnoses for African-American patients in dermatology clinics were acne, unspecified dermatitis or eczema, seborrheic dermatitis, atopic dermatitis, and dyschromia. • For Asian or Pacific Islander patients, the top five were acne, unspecified dermatitis or eczema, benign neoplasm of skin, psoriasis, and seborrheic keratosis. • Caucasian patients, the top five were actinic keratosis, acne, benign neoplasm of skin, unspecified dermatitis or eczema, and nonmelanoma skin cancer. • In Hispanic patients of any race, the leading diagnoses were acne, unspecified dermatitis or eczema, psoriasis, benign neoplasm of skin, and viral warts.

  19. Saturs . 1.Epidemioloģija. 2. Diagnostika . 3.Psoriāzes terapija. 4. Vadlīnijas

  20. Eur J Pharm Sci. 2012 Nov 15. S0928-0987(12)00408-3. Diagnostic opportunities based on skin biomarkers.Paliwal S, Hwang BH, Tsai KY, • Source Santa Barbara, CA 93106, United States. • Abstract • Systemic as well as localized skin diseases modify the molecular composition of human skin. Changes in skin chemistry have been observed in diseases such as cancer, psoriasis, eczema, diabetes, and atherosclerosis. Skin chemistry, represented by an enormous wealth of disease biomarkers including lipids, structural proteins, inflammatory mediators, nucleic acids and small molecules, therefore, can serve as a "window to body's health". Various methods including tape-stripping, iontophoresis, microneedles and ultrasound, among others, are being developed to access skin biomarkers and understand skin's detailed molecular composition.

  21. Clin Chem Lab Med. 2012 Aug 22.. Serum kallikrein-8 correlates with skin activity, but not psoriatic arthritis, in patients with psoriatic disease.Eissa A, Cretu D, Soosaipillai A, • Kallikreins (KLKs) are secreted serine proteases implicated in skin desquamation and inflammation. joint counts. • Increased KLK8 serum level in PsA patients reflects disease activity in the skin but not in the joints. Serum KLK levels are not useful for screening psoriasis patients for Ps

  22. Diagnostika . Cathepsin S (CATS) ir cisteīna proteāze,kas parasti konstatējama dermā makrofāgos,bet tikai pie psoriāzes atrodama ir nosakāma keratinocītos . Exp Dermatol. 2009 Oct 22. Upregulation of cathepsin S in psoriatic keratinocytes.Schönefuß A, Wendt W, Schattling B, at al .

  23. Diagnostika . Cilvēku antimikrobais peptīds beta-defensin-2 (hBD-2) ir stingri saistīts ar psoriāzes izsitumu epidermu . Augsts beta defensīnu kopiju skaits ir saistīts ar uzņēmību pret psoriāzi . PLoS One. 2009;4(3):e4725.Beta-defensin-2 protein is a serum biomarker for disease activity in psoriasis and reaches biologically relevant concentrations in lesional skin. Jansen PA, Rodijk-Olthuis D, Hollox EJ, Kamsteeg MThe Netherlands

  24. Identification of 15 new psoriasis susceptibility loci highlights the role of innate immunity.Tsoi LC, Spain SL, Knight J,Nat Genet. 2012 Nov 11;44(12):1341-8. • To gain further insight into the genetic architecture of psoriasis, we conducted a meta-analysis of 3 genome-wide association studies (GWAS) and 2 independent data sets genotyped on the Immunochip, including 10,588 cases and 22,806 controls. We identified 15 new susceptibility loci, increasing to 36 the number associated with psoriasis in European individuals. We also identified, using conditional analyses, five independent signals within previously known loci.

  25. Clin Exp Dermatol. 2012. Feb 2.Serum lipocalin-2 levels are increased in patients with psoriasis.Kamata M, Tada Y, Tatsuta A • The protein lipocalin (LCN)-2 is known to be related to insulin resistance, obesity and atherosclerotic diseases. Psoriasis is an inflammatory skin disease related to metabolic syndrome. The aim of this study was to examine the relationship between serum LCN2 levels and indicators for metabolic syndrome and inflammatory cytokine levels in patients with psoriasis. Serum LCN2 levels were also compared with several indicators for metabolic syndrome, and with serum levels of interleukin (IL)-6 and tumour necrosis factor (TNF)-α, two markers of inflammation. Serum LCN2 levels in patients with psoriasis were significantly higher than those of healthy controls, but there was no significant correlation between serum LCN2 and body mass index. Serum LCN2 levels also correlated with serum IL-6 and TNF-α levels in patients with psoriasis. Serum LCN2 levels are a general indicator for increased inflammation in the patients with psoriasis.

  26. Dis Markers. 2012 Nov 14. Psoriasin: A novel marker linked obesity with psoriasis. • Salama RH, Al-Shobaili HA, Al Robaee AA, Alzolibani AA

  27. Tohoku J Exp Med. 2012;228(4):325-32.Psoriasis Is Associated with Low Serum Levels of Hydrogen Sulfide, a Potential Anti-inflammatory Molecule.K H Alshorafa A, Guo Q, Zeng F • Although hydrogen sulfide (H(2)S) has been shown to be a signaling molecule with both pro- or anti-inflammatory effects, its relationship with psoriasis has not been elucidated. • In the present study, 15 patients with chronic progressive psoriasis and 15 healthy volunteers were investigated. Serum H(2)S levels in psoriasis patients were significantly lower than those of healthy controls (16.69 ± 5.47 μM vs. 34.5 ± 6.39 μM).. • In conclusion, H(2)S may play a protective role in the pathogenesis of psoriasis. H(2)S-releasing agents may be promising therapeutics for psoriasis.

  28. Eur J Dermatol. 2012 May-Jun;22(3):337-44.Atheroma plaque, metabolic syndrome and inflammation in patients with psoriasis.Arias-Santiago S, Orgaz-Molina J, Castellote-Caballero L, • The chronic inflammation and hyperhomocysteinemia found in psoriatic patients may explain the association with atheroma plaque and metabolic syndrome. Cardiovascular screening by metabolic syndrome criteria assessment and carotid ultrasound in psoriasis may be useful to detect individuals at risk and start preventive treatment against the development of cardiovascular disease

  29. Homocysteine, vitamin B12 and folic acid levels in psoriatic patients and correlation with disease severity. I Hyperhomocysteinēmija ir neatkarīgs riska faktors aterosklerotiskai kardiovaskulārāi slimībai, insultam, perifēro artēriju oklūzijai un venozai trombozei ,paaugstinātai atertrombozei un kardio vaskulārā riska profilam. Pacientiem ar psoriāzi plazmas homocisteīna līmenis ir augstāks 57% nekā kontrolē 27%(p< 0.0001)

  30. Homocysteine, vitamin B12 and folic acid levels in psoriatic patients and correlation with disease severity. II Folskābe un vitamīns B12 plazmā bija zemāks psoriāzes pacientiem nekā kontrolē ,viszemākie B12 līmeņi bija pacientiem ar hiperhomocisteinemiju salīdzinot pacientiem ar normālu homocisteīna līmeni (p = 0.0009). PASI tieši nekorelēja ar augstāku homocisteīna līmeni ,vai B12 vai folskābes līmeni . Int J Immunopathol Pharmacol. 2010 Jul-Sep;23(3):911-6.Homocysteine, vitamin B12 and folic acid levels in psoriatic patients and correlation with disease severity.Brazzelli V, Grasso V, Fornara L, Moggio E, Gamba G, Villani S, Borroni G.

  31. Diagnostika . 3 jautājumu kopa dod sensitivitāti 96.4% un specifitāte 97.3% psoriāzei. Pievienojot jautājumu ar bildi sensitivitāte palielinājās līdz 98.2% Šī studija palielina iespēju atšķirt psoriāzi indivīdiem ar psoriāzi no indivīdiem bez psoriāzes . Br J Dermatol 2009 Oct:161(4):778-84 Development and pilot testing of psoriasis screening tool .Domininguez ar al.Boston,USA,

  32. Indian J Dermatol Venereol Leprol. 2012 May-Jun;78(3):290-8.Role of nail biopsy as a diagnostic tool.Grover C, Chaturvedi UK, Reddy BS • Nail biopsy (NB) is an investigation that is not routinely resorted to by most of the dermatologists. The commonly cited reasons are the complexity of the procedure, risk of scarring and the reluctance of the patient. However, in cases with isolated nail psoriasis, isolated nail lichen planus, onychomycosis not confirmed on direct microscopy and culture, or longitudinal melanonychia, the treating dermatologist is left with no choice but to resort to this procedure. Nail as a unit, is capable of projecting only a limited number of clinical manifestations. This is responsible for the more or less similar clinical presentation of many different nail disorders.

  33. An Bras Dermatol. 2012 Dec;87(6):910-3.Norwegian scabies mimicking rupioid psoriasis.Costa JB, Sousa VL, Trindade Neto PB, . • Source , Brazil. • Norwegian scabies is a highly contagious skin infestation caused by an ectoparasite, Scarcoptes scabiei var. Hominis, which mainly affects immunosuppressed individuals. Clinically, it may simulate various dermatoses such as psoriasis, Darier's disease, seborrheic dermatitis, among others. This is a case report of a 33-year-old woman, immunocompetent, diagnosed with generalized anxiety disorder (cancer phobia), who had erythematous, well-defined plaques, covered with rupioid crusts, on her neck, axillary folds, breast, periumbilical region, groin area, besides upper back and elbows, mimicking an extremely rare variant of psoriasis, denominated rupioid

  34. Prevalence and relevance of secondary contact sensitizers in subjects with psoriasis.Krupashankar DS, Manivasagam SR. Indian Dermatol Online J. 2012 Sep;3(3):177-81 • .Psoriasis may be complicated by contact dermatitis due to an impaired cutaneous barrier. Patch testing helps elucidate sensitizers if any. • AIMS: • To determine the prevalence and relevance of secondary contact dermatitis in subjects with psoriasis. • MATERIALS AND METHODS: • Patch testing with Indian Standard Series was done and readings interpreted after 48 and 96 hours. • RESULTS: • Among 110 subjects 47 (42.7%) showed reactions to at least one antigen. Fifteen (13.6%) reacted to fragrance mix, 10 (9.1%) to nickel sulfate, seven (6.4%) to parthenium, and six (5.5%) to balsam of Peru. Palmoplantar psoriasis was the commonest type of psoriasis patch tested. Fragrance mix was the commonest antigen showing 100% current relevance as an aggravating factor of psoriasis.

  35. Autoimmun Rev. 2012 Nov 24.Immunomodulation in psoriatic arthritis: Focus on cellular and molecular pathways. • Complement system can be considered part of the acute phase response as demonstrated by higher plasma levels of C3 and C4 complement components in PsA patients compared with healthy subjects. These abnormal levels are then reverted by anti-TNF drugs.

  36. Dermatol Online J. 2012 Jan 15;18(1):11.Psoriasis and oral lesions: multicentric study of Oral Mucosa Diseases Italian Group (GIPMO).Germi L, De Giorgi V, Bergamo F,, • Out of a total of 535 psoriatic patients and 436 control group patients, oral mucosal lesions were detected in 188 (35.1%) and 86 (19.7%) cases, respectively, and the difference is statistically significant. Fissured tongue (FT) and geographic tongue (GT), which were most frequently detected, were seen more frequently in psoriatic patients (FT: 22.6%; GT: 9.1%) than the control group (FT: 10.3%; GT: 5.2%) (p<0.05).

  37. Saturs . 1. Epidemioloģija. 2. Diagnostika . 3.Terapija . 4.Vadlīnijas .

  38. Dermatol Ther (Heidelb). 2012 Dec;2(1):15. Inverse Psoriasis Involving Genital Skin Folds: Successful Therapy with Dapsone.Guglielmetti A, Conlledo R, Bedoya J • , The authors present a 42-year-old female patient with erythematous plaques in the vulva, groin, and perianal region. The patient had previously received a broad range of topical and systemic therapies that had to be discontinued due to ineffectiveness or side effects. She was treated with 100 mg dapsone daily for 10 months, showing a significant improvement of her cutaneous and mucous lesions. Complete clearance of psoriatic lesions was observed after 4 weeks of treatment. She has remained in remission for up to 2 years, using only topical therapy with tacrolimus 0.1% and calcipotriol.

  39. J Dermatolog Treat. 2012 Dec 5. Evaluation of the effect of tacrolimus-loaded liquid crystalline nanoparticles on psoriasis-like skin inflammation.Thapa RK, Yoo BK. • Liquid crystalline nanoparticle (LCN) is one of the potential drug delivery systems for topical drug delivery. • Tacrolimus-loaded LCNs were more effective in the treatment of psoriasis-like skin inflammation as compared to tacrolimus dissolved in propylene glycol. Hence, this study provides a basis for possible applicability of tacrolimus-loaded LCNs in the treatment of psoriasis.

  40. Dermatol Ther (Heidelb). 2012 Dec;2(1):1. A Delphi Consensus Approach to Challenging Case Scenarios in Moderate-to-Severe Psoriasis: Part 1.Strober BE, Clay Cather J, Cohen D, • Six of the 24 discussed case scenarios are presented in this article (another five are presented in Part 2): (1) psoriasis with human papilloma virus-induced cervical or anogenital dysplasia; (2) concomitant psoriasis and systemic lupus erythematosus; (3) severe psoriatic nail disease causing functional or emotional impairment; (4) psoriasis therapies that potentially reduce cardiovascular morbidity and mortality; (5) older patients (≥65 years of age) with psoriasis; and (6) severe scalp psoriasis that is unresponsive to topical therapy.

  41. A Delphi Consensus Approach to Challenging Case Scenarios in Moderate-to-Severe Psoriasis: Part 2.Strober BE, Clay Cather J, Cohen D, • Five of the 24 discussed case scenarios are presented in this article: (1) moderate-to-severe psoriasis that has failed to respond to all currently approved therapies for psoriasis; (2) palmoplantar psoriasis that is unresponsive to topical therapy and phototherapy; (3) erythrodermic psoriasis; (4) pustular psoriasis; and (5) the preferred therapeutic choice to combine with low-dose methotrexate. • The Delphi exercise resulted in guidelines for practicing physicians to utilize when confronted with patients with challenging cases of psoriasis.

  42. Acta Derm Venereol. 2012 Nov 9. Treatment Patterns, Treatment Satisfaction, Severity of Disease Problems, and Quality of Life in Patients with Psoriasis in Three Nordic Countries.Ragnarson Tennvall G, Hjortsberg C, • Biological drugs are expensive, but can reduce symptoms and increase quality of life for patients with psoriasis. The aim of this study was to examine quality of life, disease severity and treatment satisfaction in Danish, Finnish and Swedish patients with psoriasis. • Based on 12 months' data from patient surveys and chart reviews, 3 treatment groups were identified: topical, systemic and/or biological <12 months, and biological for 12 months. • Patients treated with biological drugs for 12 months showed the highest treatment satisfaction and the lowest Dermatology Life Quality Index score. • A number of patients with topical treatment reported low quality of life, severe or very severe disease problems, and low treatment satisfaction.

  43. Single administration of lesion-limited high-dose (TURBO) ultraviolet B using the excimer laser: clinical clearing in association with apoptosis of epidermal and dermal T cell subsets in psoriasis.Kagen M, Cao LY, Oyetakin-White P, • ,. • Development of effective therapy for psoriasis is confounded by numerous factors contributing to disease pathogenesis, including pathogenic immunocytes which appear to drive epidermal keratinocyte hyperproliferation. Our objective was to study clinical and biomarker effects of a single dose of TURBO laser UVB (308 nm) applied directly to psoriatic plaques. • METHODS: • Eighteen patients with chronic plaque psoriasis received a single dose of 10 minimal erythema dose (MED) UVB and were followed for 8 weeks. Keratome and punch biopsies were assessed for T cell depletion and apoptosis following a single 308-nm dose of UVB. • RESULTS: • Patients demonstrated clinical improvement as indicated by decreased global Psoriasis Area and Severity Index scores and reduced numbers of pathogenic memory/effector T cells infiltrating lesional epidermis and dermis. Consistent with apoptosis induction, caspase activation increased in lesional T cells after treatment. • CONCLUSION: • We conclude that a single 10 MED dose of TURBO UVB is effective at reducing the severity and extent of psoriatic lesions. We hypothesize that the reason a single treatment is sufficient to clear a psoriatic plaque is that the 10 MED dose is able to deliver sufficient photons to a microanatomic area of the lesion where susceptible pathogenic T cell mechanisms are operative

  44. Saturs . 1. Epidemioloģija. 2. Diagnostika . 3.Terapija . 4.Vadlīnijas .

  45. Vadlīnijas • European Board of Dermato-Venereology • UNION EUROPÉENNE DES MÉDECINS SPÉCIALISTES • EUROPEAN UNION OF MEDICAL SPECIALISTS • Section de Dermato-Vénéréologie • Section of Dermato-Venereology • President: Prof. Dr. Magdalena Czarnecka-Operacz (PL) • Past President: Prof. Dr. Harald Gollnick (DE • Secretary: Prof . Dr. Peter Steijlen (NL) • Treasurer: Prof. Dr. Veli-Matti Kähäri (Fi) • www.uems-ebdv.org/ebdv

  46. Evidence-based (S3) guidelines for the treatment of psoriasis vulgaris 2007 • Alexander Nast1, Ina B. Kopp2,Matthias Augustin3, Kirstin-Benita Banditt4,Wolf-Henning Boehncke5, • Markus Follmann6,Markus Friedrich7,Matthias Huber8, Christina Kahl1, Joachim Klaus9, Joachim Koza9, • Inga Kreiselmaier10, Johannes Mohr11, Ulrich Mrowietz10, Hans-Michael Ockenfels12, • Hans-Dieter Orzechowski8, Jörg Prinz13, Kristian Reich14,Thomas Rosenbach15, Stefanie Rosumeck1, • Martin Schlaeger16, Gerhard Schmid-Ott17,Michael Sebastian18,Volker Streit19,Tobias Weberschock5,

  47. Systemic Treatment of Psoriasis vulgaris. • Developed by the Guideline Subcommittee of the European Dermatology Forum • Darba grupa no 2008 gada .

  48. Vadlīnijas veltītas papulozas psoriāzes ts. vulgārās formas aprūpei . • Vadlīnijas veltītas papulozas psoriāzes ts. vulgārās formas aprūpei . • Psoriāzes vadlīniju projekts satur 92 , kopā ar literatūru 105 lapaspuses .Saturā - ievads(1) ,informācija par psoriāzes nozoloģiju un tās pamatterapiju (2,3) .Terapijas izvēles algoritmi tiek izskatīti 4. nodaļā .ādas aprūpe un lokālā terapija izklāstīta 5, nodaļā . 6 nodaļa fototerapija bet 7. nodaļa klimatoterapija balstīta uz vispārējām atziņām un Latvijas kūrortu iespējām. 8. nodaļā izkatīta vispārējā terapijas , tai skaitā bioloģiskā terapija . Seko vēres (197 autori) un pielikumi.

  49. Secinājumi . Psoriāzes uzskaite- Individualizēta terapija .

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