Evaluation of hematological inflammatory parameters in patients with palmoplantar pustulosis
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Abstract Background Palmoplantar pustulosis (PPP) is a chronic inflammatory disease of ill‐defined etiopathology. Recent studies have proposed complete blood count‐based hematological parameters, such as neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR), as biomarkers to monitor disease status in many inflammatory diseases. This study aimed to analyze for the first time the clinical significance of hematological parameters, including NLR, monocyte/lymphocyte ratio (MLR), PLR, mean platelet volume (MPV), plateletcrit (PCT), and pan‐immune‐inflammation value (PIV) in PPP patients. Methods We retrospectively investigated the clinical and laboratory data of 237 patients with PPP and 250 sex‐age‐matched healthy controls (HCs). Hematological parameters were compared between patients with PPP and HCs. The correlations between these parameters and disease severity, as well as treatment response, were analyzed. Results NLR, MLR, MPV, PCT, and PIV values were significantly higher in PPP patients than in HCs. But in receiver‐operating characteristic analyses, only monocyte count (Youden Index = 0.53), PCT (Youden Index = 0.65), and PIV (Youden Index = 0.52) performed relatively accurate distinguishment between moderate‐to‐severe cases and mild cases. PCT and PIV values were significantly correlated with disease severity. After treatment, both PIV and PCT values decreased significantly in the responder group but not in the non‐responder group. Conclusions Hematological parameters altered significantly in PPP patients. PCT and PIV can be used as simple and inexpensive biomarkers for systemic inflammation in PPP patients.Keywords:
Mean platelet volume
Youden's J statistic
Palmoplantar pustulosis
In 18 ambulant patients with palmoplantar pustulosis low plasma zinc concentrations were observed. During treatment with an all-trans aromatic retinoid (RO-10-9359) the values increased while at the same time the skin condition improved in particular with regard to the pustule formation. The observed low plasma zinc values may in some way be related to pustulosis but not as causal factor.
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Journal Article Acute palmoplantar pustulosis Get access S.M. BURGE, S.M. BURGE Department of Dermatology, The Slade Hospital, Oxford, U.K. Dr S.M.Burge, Department of Dermatology, The Slade Hospital, Headington, Oxford, U.K. Search for other works by this author on: Oxford Academic Google Scholar T.J. RYAN T.J. RYAN Department of Dermatology, The Slade Hospital, Oxford, U.K. Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 113, Issue 1, 1 July 1985, Pages 77–83, https://doi.org/10.1111/j.1365-2133.1985.tb02046.x Published: 01 July 1985 Article history Accepted: 15 December 1984 Published: 01 July 1985
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Background: Coronavirus disease 2019 (COVID-19) is a coronavirus outbreak caused by severe acute respiratory syndrome coronavirus 2 infection. Objectives: This study aimed to investigate the relationship between laboratory variables and COVID-19 severity. Methods: A total of 731 confirmed cases were included in this study. Based on the clinical course of the disease, the patients were divided into non-severe (n = 599) and severe (n = 132) groups. The area under the curve was estimated for each of the significant predictive factors by the receiver operating characteristic curve. Youden’s index was used to determine the optimal cut-off points to predict the severity of COVID-19. Results: Out of 731 patients, 407 (55.56%) cases were male. The mean age value and age range of the patients were 58.37 and 1 - 98 years, respectively. The age (OR = 1.03, 95% CI: 1.02 - 1.05), international normalized ratio (INR) (OR = 2.09, 95% CI: 1.11 - 3.96), lactate dehydrogenase (LDH) (OR = 1.003, 95% CI: 1.001 - 1.1.003), and neutrophil/lymphocyte ratio (NLR) (OR = 1.08, 95% CI: 1.02 - 1.14) were associated with the severity of COVID-19 in the multivariate analyses. The areas under the curve of LDH, NLR, and INR for the diagnosis of disease severity were 0.76, 0.69, and 0.62, respectively. Conclusions: The results of this study revealed that LDH, NLR, and INR could help to discriminate between non-severe and severe COVID-19 cases. Therefore, clinicians can use these variables to improve therapeutic effects and reduce disease severity.
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A 59-year-old female with palmoplantar pustulosis (PPP) of 20 years' duration was referred to our hospital.Although she had been treated with topical corticosteroid ointment, skin lesions had waxed and waned during this time period.She was a past smoker (three cigarettes a day for 1 year), but quit smoking soon after she was diagnosed as PPP.She occasionally had a sore throat when she was a child.Her mother also had PPP.The patient further developed arthralgia involving the left clavicle two years previously.Physical examination showed palmoplantar erythema with scales and a small number of pustules and vesiculopustules (Fig. 1).Skin atrophy due to long-term topical corticosteroid therapy was also observed.She did not have acne.Laboratory examination showed slight increases in inflammatory markers (C-reactive protein; 2.0 mg/dl, erythrocyte sedimentation rate; 34 mm/h); however, anti-thyroid, microsome, and nuclear antibodies were all within normal limits.Examination using technetium-99m bone scintigraphy revealed increased uptake in the left clavicle (Fig. 2).Otolaryngological examination revealed tonsillar hypertrophy.For joint pain, non-steroidal anti-inflammatory drugs (NSAIDs), methotrexate (6 mg/week) for 10 months, and cyclosporine (100-200 mg/day) for 8 months were administered, all of which resulted in little effect.The patient refused tonsillectomy, and guselkumab was initiated for severe joint pain.A few days after the first subcutaneous injection of guselkumab (100 mg), the patient's joint pain was dramatically improved, and NSAIDs were not needed.Her visual analogue scale score for joint pain was decreased to 0.
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The coronavirus disease 2019 (COVID-19) pandemic has caused a global health crisis and is a source of increased morbidity and mortality in the world. COVID-19 caused by SARS-CoV-2 affects the proliferation of lymphocytes, but the clinical significance of lymphocytes remains unclear. Therefore, this study aims to analyze the relationship between lymphocytes with the clinical severity of COVID-19. The retrospective study design collected medical records of demographic data, chest X-rays, and laboratory tests at the time of hospital admission for confirmed patients. Furthermore, the severity of the disease was divided into moderate, severe, and very severe degrees. The severity of lung injury was assessed based on the Brixia Score, and the clinical outcome of patients had criteria of recovered and died. This study has collected 100 COVID-19 patients above 60 years (39%) with male gender (66%). The Majority of patients with low lymphocyte levels (51%), severe lung injury (45%), and one-third of the treated cases ended in death (33.0%), and most of them recovered (67%). Furthermore, low lymphocyte levels were associated with severe and critically ill severity and death (p<0.05). Almost all lung damage was detected in severe and critically ill severity, and Brixia scores were detected high in patients with low lymphocyte levels (51.0%)(p>0.05). lymphocyte can be an indicator of clinical severity and mortality for COVID-19 patients. This study shows that lymphocyte count may help identify patients with severe diseases. Therefore, observation of the lymphocyte count is necessary for the initial screening, diagnosis, and treatment of COVID-19 patients.
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Abstract Palmoplantar pustulosis is a chronic inflammatory disorder characterized by sterile pustules predominantly involving the palms and soles. Palmoplantar pustulosis has many similar aspects to psoriasis, either plaque and pustular type, namely familial occurrence between palmoplantar pustulosis and psoriasis, the appearance of the Köbner phenomenon, joint involvement, and nail involvement. Pustular psoriasis is classified into generalized and localized types, and there are a number of papers regarding palmoplantar pustulosis as an acral variant of localized pustular psoriasis. Many Japanese dermatologists consider palmoplantar pustulosis to be a distinct entity from pustular psoriasis, and the coexistence of palmoplantar pustulosis and psoriasis is rare. However, outside Japan, palmoplantar pustulosis is often considered to be palmoplantar psoriasis or palmoplantar pustular psoriasis, and extra‐palmoplantar lesions are also considered to be psoriasis. The purpose of the current review is to compare the similarities and differences between palmoplantar pustulosis and generalized/localized pustular psoriasis. Japanese patients with palmoplantar pustulosis have a close relationship with focal infection, and the associated bone–joint manifestation exclusively involves the anterior chest wall. Furthermore, pediatric occurrence of palmoplantar pustulosis is extremely rare, and difference of genetic background between palmoplantar pustulosis and psoriasis has also been reported. Treatment of focal infection often results in dramatic effects on both cutaneous lesions and joint pain of palmoplantar pustulosis. Those findings suggest that palmoplantar pustulosis should be separately considered from either palmoplantar psoriasis or palmoplantar pustular psoriasis. The clinicopathological features and therapeutic approach of both diseases are discussed.
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The chest computed tomography (CT) characteristics of coronavirus disease 2019 (COVID-19) are important for diagnostic and prognostic purposes. The aim of this study was to investigate chest CT findings in COVID-19 patients in order to determine the optimal cut-off value of a CT severity score that can be considered a potential prognostic indicator of a severe/critical outcome.The CT findings were evaluated by means of a severity score that included the extent (0-4 grading scale) and nature (0-4 grading scale) of CT abnormalities. The images were evaluated at 3 levels bilaterally. A receiver operating characteristics (ROC) curve was used to identify the optimal score (Youden's index) predicting severe/critical COVID-19.The study involved 165 COVID-19 patients (131 men [79.4%] and 34 women [20.6%] with a mean age of 61.5 ± 12.5 years), of whom 30 (18.2%) had severe/critical disease and 135 (81.8%) mild/typical disease. The most frequent CT finding was bilateral predominantly subpleural and basilar airspace changes, with more extensive ground-glass opacities than consolidation. CT findings of consolidation, a crazy-paving pattern, linear opacities, air bronchogram, and extrapulmonary lesions correlated with severe/critical COVID-19. The mean CT severity score was 63.95 in the severe/critical group, and 35.62 in the mild/typical group (P < .001). ROC curve analysis showed that a CT severity score of 38 predicted the development of severe/critical symptoms.A CT severity score can help the risk stratification of COVID-19 patients.
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