Journal of the Portuguese Society of Dermatology and Venereology, 2011
Descrevemos um caso de herpes zoster observado num doente de sexo masculino com apenas 10 meses d... more Descrevemos um caso de herpes zoster observado num doente de sexo masculino com apenas 10 meses de idade. Apresentava manifestações clínicas típicas e o diagnóstico foi corroborado pelo estudo serológico. Foi tratado com aciclovir por via oral. Neste caso, realçamos a ausência de história prévia de varicela, tendo-se registado presumível primeiro contacto com o vírus VZV ao 1º mês de vida quando a irmã mais velha teve varicela. Neste contexto, revemos as características e a abordagem clínica desta entidade neste grupo etário.
Elastosis perfurans serpiginosa is a rare perforating dermatosis found primarily in adolescents a... more Elastosis perfurans serpiginosa is a rare perforating dermatosis found primarily in adolescents and young adults, characterized by transepidermal elimination of abnormal elastic fibers. The only drug known capable of inducing elastosis perfurans serpiginosa is D-penicillamine. We report the case of a 52 year-old woman with keratotic papules arranged in an annular pattern with central clearing and centrifugal growth, located in the anterior cervical region. The patient was chronically treated with D-penicillamine for Wilson disease. Lesion biopsy showed transepidermal elimination of thickened, eosinophilic, branched, sawtooth-like elastic fibers. The clinical and pathological findings were consistent with elastosis perfurans serpiginosa secondary to D-penicillamine. It is estimated that elastosis perfurans serpiginosa occurs in 1% of patients treated with D-penicillamine. By blocking directly or indirectly the desmosine cross-links between elastin molecules, D-penicillamine leads to ...
A leishmaniose é uma doença infecciosa causada por espécies de Leishmania. A leishmaniose cutânea... more A leishmaniose é uma doença infecciosa causada por espécies de Leishmania. A leishmaniose cutânea manifesta-se por pápulas que evoluem para nódulos/placas com ulceração. O diagnóstico é essencialmente clínico, podendo ser confirmado através de biópsia cutânea. Nos doentes HIV positivos há uma maior propensão ao desenvolvimento de leishmaniose visceral, bem como ao aparecimento de lesões cutâneas atípicas. Descrevemos o caso clínico de um doente com leishmaniose cutânea e pancitopenia cuja investigação conduziu ao diagnóstico de uma infecção pelo HIV previamente desconhecida. Um doente do sexo masculino é observado com 2 lesões nodulares ulceradas na face com 6 meses de evolução. Suspeitou-se clinicamente de leishmaniose cutânea, confirmado por biópsia cutânea. Introduziu-se itraconazol, com regressão completa das lesões. O doente referia também astenia, anorexia e perda de peso, pelo que se efectuou estudo complementar, que revelou pancitopenia e infiltração esplénica. Foram realiza...
Journal of the Portuguese Society of Dermatology and Venereology, 1970
Um doente seropositivo para o VIH1 é observado com lesões múltiplas eritemato-violáceas com bordo... more Um doente seropositivo para o VIH1 é observado com lesões múltiplas eritemato-violáceas com bordo elevado, confluentes, localizadas ao escroto. No corpo do pénis estavam presentes placas eritematosas ovaladas isoladas, com superfície não descamativa. As lesões evoluíam desde há 2 semanas e eram assintomáticas, sendo sugestivas de granuloma annulare. Concomitantemente haviam surgido lesões eritematosas maculosas ovaladas discretas, dispersas pelo tronco e membros superiores. Foi realizada biopsia cutânea de uma lesão escrotal que revelou infiltrado liquenóide de células mononucleadas, rico em plasmócitos. O sífilis screening foi positivo e RPR reactivo com título 1:256. Foi estabelecido o diagnóstico de sífilis secundária e o doente foi medicado com 3 injecções intramusculares de penicilina benzatínica (2.4 MU 1x/semana).Nos doentes com co-infecção pelo VIH, a clínica da sífilis poderá ser mais exuberante e com apresentações clínicas atípicas. A sífilis, sendo “a grande imitadora”, d...
Objective: Evaluate the importance of topical lesional provocation in the study of fixed drug eru... more Objective: Evaluate the importance of topical lesional provocation in the study of fixed drug eruption (FDE) from nonsteroidal anti-inflammatory drugs (NSAID). Patients and Results: We studied 14 patients with FDE imputed with high probability to piroxicam (8 patients), nimesulide (5) and feprazone (1). One patient with FDE from piroxicam suffered lesion reactivation after intravenous tenoxicam. The suspected drug and related compounds were patch tested on residual lesional skin and on the normal back skin. Positive results were obtained, only in affected areas, in 13 out of 14 patients (92.9%): in all cases due to feprazone and nimesulide and in 7/8 cases of FDE due to piroxicam. The 7 patients reactive to piroxicam also had positive tests to tenoxicam, and 1 out of 5 reacted to meloxicam. None reacted to thiosalicylic acid. Comments and Conclusions: Topical lesional provocation is a safe, sensible and specific complementary method for drug imputation in FDE from these NSAID, namel...
A few studies in psoriasis vulgaris patients have reported changes suggesting red blood cell (RBC... more A few studies in psoriasis vulgaris patients have reported changes suggesting red blood cell (RBC) damage is linked to neutrophil activation, oxidative stress, and psoriasis worsening. The aim of this study was to evaluate erythroid disturbances in Portuguese psoriasis vulgaris patients, before, during, and after treatment. A cross-sectional study (n = 73 patients vs 40 healthy control subjects) followed by a longitudinal study (n = 47 patients) was performed, with assessments before, and at 3, 6, and 12 weeks of therapy (10 patients started topical treatment, 17 narrow-band UVB, and 20 photochemotherapy [psoralen plus UVA; PUVA]). Evaluations included hematologic data, total bilirubin levels, membrane-bound hemoglobin (MBH), membrane protein band 3 profile, total plasma antioxidant status (TAS), lipid peroxidation (thiobarbituric acid [TBA] assay), elastase, lactoferrin, and C-reactive protein (CRP). Before treatment, patients presented with higher leukocyte/neutrophil and reticulocyte counts, elastase, lactoferrin, TBA, TBA/TAS, reticulocyte production index, total bilirubin and MBH values, lower RBC and hematocrit, higher percentages of high-molecular-weight aggregates, and lower percentages of band 3 monomer. After treatment, we observed a reversal in most of the parameters. However, patients still presented with values suggestive of accelerated RBC damage, removal, and production, as most of the parameters were still higher than those in the control group; the same occurred with CRP. Our data suggest that psoriasis vulgaris triggers an inflammatory response, with release of acute-phase reactants, reactive oxygen species, cationic proteins, and proteases, leading to enhanced RBC damage/aging and, ultimately, to enhanced RBC removal. These assumptions were strengthened by the observation that, with treatment, all of these changes were reversed, the inflammation was reduced, the production of reticulocytes was increased, and the RBCs presented changes usually observed in younger/less damaged RBCs. These erythroid changes were enhanced with PUVA therapy, probably due to the more pronounced clearing of the lesions, as suggested by Psoriasis Area and Severity Index (PASI) scores. Finally, after treatment, a residual inflammation still persisted that might contribute to the observed erythroid disturbances.
Journal of the Portuguese Society of Dermatology and Venereology, 2020
As reações de fotossensibilidade caracterizam-se por uma resposta alterada à radiação não-ionizan... more As reações de fotossensibilidade caracterizam-se por uma resposta alterada à radiação não-ionizante, apresentando diversos padrões morfológicos, que refletem as suas diferentes etiologias. Relatamos o caso de um doente observado por dermatose fotossensível refratária a múltiplos tratamentos. Excluídas possíveis causas exógenas e após demonstração de uma dose de eritema mínimo diminuída para UVB, o estudo analítico com vista a iniciar azatioprina revelou serologia positiva para VIH, revelando elevada carga viral e contagens TCD4+ reduzidas. Neste seguimento, iniciou de imediato terapêutica anti-retroviral, com resolução rápida e completa do quadro. Estima-se que 5% dos doentes VIH-positivos apresentem fotossensibilidade em algum momento da sua evolução. Mais frequentemente associada a fármacos utilizados no tratamento, a sensibilidade à luz solar tem também sido ocasionalmente descrita como manifestação inicial da infeção, como no presente caso. Os autores pretendem alertar para a as...
Psoriasis, a recurrent inflammatory skin condition, has been associated with metabolic syndrome (... more Psoriasis, a recurrent inflammatory skin condition, has been associated with metabolic syndrome (MS) and obesity. In psoriasis, obesity is closely related with hypoadiponectinemia and hyperleptinemia (1) . Body mass index (BMI) adversely influences psoriasis therapy (2) . C-reactive protein (CRP), a marker of psoriasis severity (3) , and PASI (psoriasis area and severity index) are determinants of the length of psoriasis remission (4) . This article is protected by copyright. All rights reserved.
The main aim of this study was to evaluate the clinical outcome of patients submitted to sentinel... more The main aim of this study was to evaluate the clinical outcome of patients submitted to sentinel lymph node biopsy for melanoma. Another objective was to examine the procedure itself concerning morbidity and percentage of sentinel lymph nodes removed. One hundred patients underwent pre-operative lymphoscintigraphy to determine sentinel lymph nodes. During surgery, intra-operative gamma probe evaluation, along with isosulfan blue dye injection around the tumour, allowed their identification and removal. Sentinel lymph node biopsy is a safe, low morbidity technique that could probably play a role in the early detection of sub clinical metastases, although the argument about its influence in what concerns the patients' overall survival persists.
Mutation Research/Genetic Toxicology and Environmental Mutagenesis, 2013
Acitretin is currently used alone or combined with PUVA (psoralen + UVA) or with narrow-band ultr... more Acitretin is currently used alone or combined with PUVA (psoralen + UVA) or with narrow-band ultraviolet B (NBUVB), to treat moderate and severe psoriasis. However, little is known about the potential genotoxic/carcinogenic risk and the cytostatic/cytotoxic effects of these treatments. Our aim was to study the cytotoxic and genotoxic effects of acitretin - alone or in combination with PUVA or NBUVB - by performing studies with blood from patients with psoriasis vulgaris who were treated with acitretin, acitretin+PUVA or acitretin+NBUVB for 12 weeks, and in vitro studies with blood from healthy volunteers, which was incubated with acitretin at different concentrations. The cytotoxic and genotoxic effects were evaluated by the cytokinesis-blocked micronucleus test and the comet assay. Our results show that psoriatic patients treated with acitretin alone or with acitretin+NBUVB, did not show genotoxic effects. In addition, these therapies reduced the rate of proliferation and induced apoptosis and necrosis of lymphocytes; the same occurred with lymphocyte cultures incubated with acitretin (1.2-20μM). The acitretin+PUVA reduced also the proliferation rate, and increased the necrotic lymphocytes. Our studies suggest that therapy with acitretin alone or combined with NBUVB, as used in psoriatic patients, does not show genotoxic effects, reduces the rate of proliferation and induces apoptosis and necrosis of lymphocytes. The combination of acitretin with PUVA also reduces the proliferation rate and increases the number of necrotic lymphocytes. However, as it induced slight genotoxic effects, further studies are needed to clarify its genotoxic potential.
Several cross-sectional studies have shown that different cytokines and growth factors are enhanc... more Several cross-sectional studies have shown that different cytokines and growth factors are enhanced in psoriasis. We aimed to understand the role/relation of interleukin (IL)-22, IL-17, IL-23, IL-8, vascular endothelial growth factor (VEGF) and tumour necrosis factor (TNF)-α in psoriasis vulgaris, addressing their levels and changes before, during and after psoralen-ultraviolet A (PUVA) and narrowband ultraviolet B (NB-UVB) treatment. A cross-sectional and a longitudinal study (n = 34) - before (T0) and at 3 (T3), 6 (T6) and 12 (T12) weeks of NB-UVB and PUVA therapy - were performed; 17 patients started NB-UVB and 17 PUVA, and IL-22, IL-17, IL-23, IL-8, TNF-α and VEGF levels were evaluated. At T0, compared with controls (n = 20), all the parameters were significantly higher in patients, except for TNF-α. Both NB-UVB and PUVA treatment gave, at T3, a significant decrease in TNF-α and IL-23; IL-22 and IL-17 decreased significantly at T6; all parameters and Psoriasis Area and Severity Index decreased significantly at T12. However, in both groups, at T12, VEGF was still significantly higher than control. Psoriasis seems to be a complex disease in which the cytokine network is disturbed, namely in levels of IL-22, IL-17, IL-23, IL-8, TNF-α and VEGF. NB-UVB and PUVA follow-up studies suggested that the reduction in the IL-23/Th17 axis might be important in the pathogenic mechanisms of psoriasis. Further follow-up studies of patients with psoriasis treated with these and other therapies could be very helpful for the understanding of the disturbance in the cytokine network in psoriasis and indirectly in its pathogenesis.
Journal of the Portuguese Society of Dermatology and Venereology, 2011
Descrevemos um caso de herpes zoster observado num doente de sexo masculino com apenas 10 meses d... more Descrevemos um caso de herpes zoster observado num doente de sexo masculino com apenas 10 meses de idade. Apresentava manifestações clínicas típicas e o diagnóstico foi corroborado pelo estudo serológico. Foi tratado com aciclovir por via oral. Neste caso, realçamos a ausência de história prévia de varicela, tendo-se registado presumível primeiro contacto com o vírus VZV ao 1º mês de vida quando a irmã mais velha teve varicela. Neste contexto, revemos as características e a abordagem clínica desta entidade neste grupo etário.
Elastosis perfurans serpiginosa is a rare perforating dermatosis found primarily in adolescents a... more Elastosis perfurans serpiginosa is a rare perforating dermatosis found primarily in adolescents and young adults, characterized by transepidermal elimination of abnormal elastic fibers. The only drug known capable of inducing elastosis perfurans serpiginosa is D-penicillamine. We report the case of a 52 year-old woman with keratotic papules arranged in an annular pattern with central clearing and centrifugal growth, located in the anterior cervical region. The patient was chronically treated with D-penicillamine for Wilson disease. Lesion biopsy showed transepidermal elimination of thickened, eosinophilic, branched, sawtooth-like elastic fibers. The clinical and pathological findings were consistent with elastosis perfurans serpiginosa secondary to D-penicillamine. It is estimated that elastosis perfurans serpiginosa occurs in 1% of patients treated with D-penicillamine. By blocking directly or indirectly the desmosine cross-links between elastin molecules, D-penicillamine leads to ...
A leishmaniose é uma doença infecciosa causada por espécies de Leishmania. A leishmaniose cutânea... more A leishmaniose é uma doença infecciosa causada por espécies de Leishmania. A leishmaniose cutânea manifesta-se por pápulas que evoluem para nódulos/placas com ulceração. O diagnóstico é essencialmente clínico, podendo ser confirmado através de biópsia cutânea. Nos doentes HIV positivos há uma maior propensão ao desenvolvimento de leishmaniose visceral, bem como ao aparecimento de lesões cutâneas atípicas. Descrevemos o caso clínico de um doente com leishmaniose cutânea e pancitopenia cuja investigação conduziu ao diagnóstico de uma infecção pelo HIV previamente desconhecida. Um doente do sexo masculino é observado com 2 lesões nodulares ulceradas na face com 6 meses de evolução. Suspeitou-se clinicamente de leishmaniose cutânea, confirmado por biópsia cutânea. Introduziu-se itraconazol, com regressão completa das lesões. O doente referia também astenia, anorexia e perda de peso, pelo que se efectuou estudo complementar, que revelou pancitopenia e infiltração esplénica. Foram realiza...
Journal of the Portuguese Society of Dermatology and Venereology, 1970
Um doente seropositivo para o VIH1 é observado com lesões múltiplas eritemato-violáceas com bordo... more Um doente seropositivo para o VIH1 é observado com lesões múltiplas eritemato-violáceas com bordo elevado, confluentes, localizadas ao escroto. No corpo do pénis estavam presentes placas eritematosas ovaladas isoladas, com superfície não descamativa. As lesões evoluíam desde há 2 semanas e eram assintomáticas, sendo sugestivas de granuloma annulare. Concomitantemente haviam surgido lesões eritematosas maculosas ovaladas discretas, dispersas pelo tronco e membros superiores. Foi realizada biopsia cutânea de uma lesão escrotal que revelou infiltrado liquenóide de células mononucleadas, rico em plasmócitos. O sífilis screening foi positivo e RPR reactivo com título 1:256. Foi estabelecido o diagnóstico de sífilis secundária e o doente foi medicado com 3 injecções intramusculares de penicilina benzatínica (2.4 MU 1x/semana).Nos doentes com co-infecção pelo VIH, a clínica da sífilis poderá ser mais exuberante e com apresentações clínicas atípicas. A sífilis, sendo “a grande imitadora”, d...
Objective: Evaluate the importance of topical lesional provocation in the study of fixed drug eru... more Objective: Evaluate the importance of topical lesional provocation in the study of fixed drug eruption (FDE) from nonsteroidal anti-inflammatory drugs (NSAID). Patients and Results: We studied 14 patients with FDE imputed with high probability to piroxicam (8 patients), nimesulide (5) and feprazone (1). One patient with FDE from piroxicam suffered lesion reactivation after intravenous tenoxicam. The suspected drug and related compounds were patch tested on residual lesional skin and on the normal back skin. Positive results were obtained, only in affected areas, in 13 out of 14 patients (92.9%): in all cases due to feprazone and nimesulide and in 7/8 cases of FDE due to piroxicam. The 7 patients reactive to piroxicam also had positive tests to tenoxicam, and 1 out of 5 reacted to meloxicam. None reacted to thiosalicylic acid. Comments and Conclusions: Topical lesional provocation is a safe, sensible and specific complementary method for drug imputation in FDE from these NSAID, namel...
A few studies in psoriasis vulgaris patients have reported changes suggesting red blood cell (RBC... more A few studies in psoriasis vulgaris patients have reported changes suggesting red blood cell (RBC) damage is linked to neutrophil activation, oxidative stress, and psoriasis worsening. The aim of this study was to evaluate erythroid disturbances in Portuguese psoriasis vulgaris patients, before, during, and after treatment. A cross-sectional study (n = 73 patients vs 40 healthy control subjects) followed by a longitudinal study (n = 47 patients) was performed, with assessments before, and at 3, 6, and 12 weeks of therapy (10 patients started topical treatment, 17 narrow-band UVB, and 20 photochemotherapy [psoralen plus UVA; PUVA]). Evaluations included hematologic data, total bilirubin levels, membrane-bound hemoglobin (MBH), membrane protein band 3 profile, total plasma antioxidant status (TAS), lipid peroxidation (thiobarbituric acid [TBA] assay), elastase, lactoferrin, and C-reactive protein (CRP). Before treatment, patients presented with higher leukocyte/neutrophil and reticulocyte counts, elastase, lactoferrin, TBA, TBA/TAS, reticulocyte production index, total bilirubin and MBH values, lower RBC and hematocrit, higher percentages of high-molecular-weight aggregates, and lower percentages of band 3 monomer. After treatment, we observed a reversal in most of the parameters. However, patients still presented with values suggestive of accelerated RBC damage, removal, and production, as most of the parameters were still higher than those in the control group; the same occurred with CRP. Our data suggest that psoriasis vulgaris triggers an inflammatory response, with release of acute-phase reactants, reactive oxygen species, cationic proteins, and proteases, leading to enhanced RBC damage/aging and, ultimately, to enhanced RBC removal. These assumptions were strengthened by the observation that, with treatment, all of these changes were reversed, the inflammation was reduced, the production of reticulocytes was increased, and the RBCs presented changes usually observed in younger/less damaged RBCs. These erythroid changes were enhanced with PUVA therapy, probably due to the more pronounced clearing of the lesions, as suggested by Psoriasis Area and Severity Index (PASI) scores. Finally, after treatment, a residual inflammation still persisted that might contribute to the observed erythroid disturbances.
Journal of the Portuguese Society of Dermatology and Venereology, 2020
As reações de fotossensibilidade caracterizam-se por uma resposta alterada à radiação não-ionizan... more As reações de fotossensibilidade caracterizam-se por uma resposta alterada à radiação não-ionizante, apresentando diversos padrões morfológicos, que refletem as suas diferentes etiologias. Relatamos o caso de um doente observado por dermatose fotossensível refratária a múltiplos tratamentos. Excluídas possíveis causas exógenas e após demonstração de uma dose de eritema mínimo diminuída para UVB, o estudo analítico com vista a iniciar azatioprina revelou serologia positiva para VIH, revelando elevada carga viral e contagens TCD4+ reduzidas. Neste seguimento, iniciou de imediato terapêutica anti-retroviral, com resolução rápida e completa do quadro. Estima-se que 5% dos doentes VIH-positivos apresentem fotossensibilidade em algum momento da sua evolução. Mais frequentemente associada a fármacos utilizados no tratamento, a sensibilidade à luz solar tem também sido ocasionalmente descrita como manifestação inicial da infeção, como no presente caso. Os autores pretendem alertar para a as...
Psoriasis, a recurrent inflammatory skin condition, has been associated with metabolic syndrome (... more Psoriasis, a recurrent inflammatory skin condition, has been associated with metabolic syndrome (MS) and obesity. In psoriasis, obesity is closely related with hypoadiponectinemia and hyperleptinemia (1) . Body mass index (BMI) adversely influences psoriasis therapy (2) . C-reactive protein (CRP), a marker of psoriasis severity (3) , and PASI (psoriasis area and severity index) are determinants of the length of psoriasis remission (4) . This article is protected by copyright. All rights reserved.
The main aim of this study was to evaluate the clinical outcome of patients submitted to sentinel... more The main aim of this study was to evaluate the clinical outcome of patients submitted to sentinel lymph node biopsy for melanoma. Another objective was to examine the procedure itself concerning morbidity and percentage of sentinel lymph nodes removed. One hundred patients underwent pre-operative lymphoscintigraphy to determine sentinel lymph nodes. During surgery, intra-operative gamma probe evaluation, along with isosulfan blue dye injection around the tumour, allowed their identification and removal. Sentinel lymph node biopsy is a safe, low morbidity technique that could probably play a role in the early detection of sub clinical metastases, although the argument about its influence in what concerns the patients' overall survival persists.
Mutation Research/Genetic Toxicology and Environmental Mutagenesis, 2013
Acitretin is currently used alone or combined with PUVA (psoralen + UVA) or with narrow-band ultr... more Acitretin is currently used alone or combined with PUVA (psoralen + UVA) or with narrow-band ultraviolet B (NBUVB), to treat moderate and severe psoriasis. However, little is known about the potential genotoxic/carcinogenic risk and the cytostatic/cytotoxic effects of these treatments. Our aim was to study the cytotoxic and genotoxic effects of acitretin - alone or in combination with PUVA or NBUVB - by performing studies with blood from patients with psoriasis vulgaris who were treated with acitretin, acitretin+PUVA or acitretin+NBUVB for 12 weeks, and in vitro studies with blood from healthy volunteers, which was incubated with acitretin at different concentrations. The cytotoxic and genotoxic effects were evaluated by the cytokinesis-blocked micronucleus test and the comet assay. Our results show that psoriatic patients treated with acitretin alone or with acitretin+NBUVB, did not show genotoxic effects. In addition, these therapies reduced the rate of proliferation and induced apoptosis and necrosis of lymphocytes; the same occurred with lymphocyte cultures incubated with acitretin (1.2-20μM). The acitretin+PUVA reduced also the proliferation rate, and increased the necrotic lymphocytes. Our studies suggest that therapy with acitretin alone or combined with NBUVB, as used in psoriatic patients, does not show genotoxic effects, reduces the rate of proliferation and induces apoptosis and necrosis of lymphocytes. The combination of acitretin with PUVA also reduces the proliferation rate and increases the number of necrotic lymphocytes. However, as it induced slight genotoxic effects, further studies are needed to clarify its genotoxic potential.
Several cross-sectional studies have shown that different cytokines and growth factors are enhanc... more Several cross-sectional studies have shown that different cytokines and growth factors are enhanced in psoriasis. We aimed to understand the role/relation of interleukin (IL)-22, IL-17, IL-23, IL-8, vascular endothelial growth factor (VEGF) and tumour necrosis factor (TNF)-α in psoriasis vulgaris, addressing their levels and changes before, during and after psoralen-ultraviolet A (PUVA) and narrowband ultraviolet B (NB-UVB) treatment. A cross-sectional and a longitudinal study (n = 34) - before (T0) and at 3 (T3), 6 (T6) and 12 (T12) weeks of NB-UVB and PUVA therapy - were performed; 17 patients started NB-UVB and 17 PUVA, and IL-22, IL-17, IL-23, IL-8, TNF-α and VEGF levels were evaluated. At T0, compared with controls (n = 20), all the parameters were significantly higher in patients, except for TNF-α. Both NB-UVB and PUVA treatment gave, at T3, a significant decrease in TNF-α and IL-23; IL-22 and IL-17 decreased significantly at T6; all parameters and Psoriasis Area and Severity Index decreased significantly at T12. However, in both groups, at T12, VEGF was still significantly higher than control. Psoriasis seems to be a complex disease in which the cytokine network is disturbed, namely in levels of IL-22, IL-17, IL-23, IL-8, TNF-α and VEGF. NB-UVB and PUVA follow-up studies suggested that the reduction in the IL-23/Th17 axis might be important in the pathogenic mechanisms of psoriasis. Further follow-up studies of patients with psoriasis treated with these and other therapies could be very helpful for the understanding of the disturbance in the cytokine network in psoriasis and indirectly in its pathogenesis.
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