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ePaper created 2014-09-15, 12:31:02 | version 1.32.01
Genetic studies by Marieke Seijger and her colleagues have shown that onset of psoriasis during childhood is associated with ERAP1 and IL23R loci, LCE3C_LCE3B deletion and HLA-C*06.[7] Extensive studies on the quality of life in children with psoriasis revealed that various issues have to be assessed before and during treatment. In particular, there exists in children a large discrepancy between objective assessment and quality-of-life assessment. The Nijmegen group established the world’s first patient registry on juvenile psoriasis. Through long-term follow-up of patients in this registry, adequate long-term efficacy and safety data are provided on various treatments. The association between psoriasis and metabolic syndrome in children was investigated in a multi-center study. The study indicated an association in the population of this international grouping. Further studies are needed in order to scrutinise the association. The Nijmegen group has designed an evidence- based treatment, which has become the leading international paradigm.[8] Studies by Marcel Pasch and his colleagues established the substantial impact of nail psoriasis on quality of life. The clinical manifestations of nail psoriasis were revisited: onycholysis and splinter hemorrhages were most frequently observed (both 93.9%). Leukonychia was seen more often in controls. Longitudinal ridges and Beau’s lines were seen significantly more in nail psoriasis patients than in controls. Furthermore, the efficacy of the first biologic on nail psoriasis was shown in our center. The Nijmegen center has investigated the transition between symptomless and lesional skin in order to find out sequential changes in the pathogenesis of psoriasis. Studies in the margin of spreading psoriatic lesions and studies on the relapse following successful treatment have been performed during the years and have provided some insights into the dynamics of the pathogenesis of psoriasis. Studies on enzymes involved in the pathogenesis in the 80s revealed that the marker enzyme for endothelium (alkaline phosphatase) extended in the symptomless skin of the expanding psoriatic lesions for up to 2 cm . These observations are in line with studies on the response to surface trauma. In psoriatic patients the unaffected skin showed a marked response as compared to the skin of healthy volunteers . Involvement of the endothelium early in the pathogenesis was confirmed by laser doppler follow measurements. Studies on epidermal keratinization and proliferation of the epidermis revealed that changes in the suprabasal compartment anticipated on increased epidermal proliferation.[9] The appearance of T cells are observed after changes in the endothelium but well before epidermal proliferation. In particular, the (CD45RO+) and cytotoxic (CD8+) T cells appear in the symptomless skin before overt epidermal changes.[10] The appearance of regulatory T cells appeared to be relatively late in the pathogenesis. 108 BWEADVSMGFINCORR:Opmaak 1 21-07-2014 17:40 Pagina 108