Psoriasis: Lim HW

Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, Gottlieb A, Koo JY, Lebwohl M, Lim HW, Van Voorhees AS, Beutner KR, Bhushan R, Anonymous00035. · Baylor University Medical Center, Dallas, Texas, USA. · J Am Acad Dermatol. · Pubmed #19217694 No free full text.

Abstract: Psoriasis is a common, chronic, inflammatory, multi-system disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In this third of 6 sections of the guidelines of care for psoriasis, we discuss the use of topical medications for the treatment of psoriasis. The majority of patients with psoriasis have limited disease (<5% body surface area involvement) and can be treated with topical agents, which generally provide a high efficacy-to-safety ratio. Topical agents may also be used adjunctively for patients with more extensive psoriasis undergoing therapy with either ultraviolet light, systemic or biologic medications. However, the use of topical agents as monotherapy in the setting of extensive disease or in the setting of limited, but recalcitrant, disease is not routinely recommended. Treatment should be tailored to meet individual patients' needs. We will discuss the efficacy and safety of as well as offer recommendations for the use of topical corticosteroids, vitamin D analogues, tazarotene, tacrolimus, pimecrolimus, emollients, salicylic acid, anthralin, coal tar, as well as combination therapy.

Lee CS, Lim HW. · Department of Dermatology, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI 48202, USA. · Dermatol Clin. · Pubmed #14717407 No free full text.

Abstract: Atopic dermatitis, nummular dermatitis, dyshidrosis, and melasma seem to be more common in Asians, whereas psoriasis and skin cancer are less common. In addition, there are less common skin conditions that are usually seen in Asians, including Mongolian spot, nevus of Ota, nevus of Ito, Kawasaki disease, primary cutaneous amyloidosis, Kikuchi-Fujimoto disease, and LCAI. Awareness of these less common cutaneous disorders can be helpful, especially for clinicians who work in areas with a large Asian population.

Kerr HA, Lim HW. · Department of Dermatology, Henry Ford Medical Group, Detroit, Michigan, USA. · Adv Dermatol. · Pubmed #14626816 No free full text.

This publication has no abstract.

Akaraphanth R, Lim HW. · Institute of Dermatology, Bangkok, Thailand. · Photodermatol Photoimmunol Photomed. · Pubmed #9990666 No free full text.

Abstract: Cutaneous diseases are common manifestations of infection with human immunodeficiency virus (HIV). Phototherapy with ultraviolet B (UVB) and photochemotherapy with 8-methoxypsoralen plus UVA (PUVA) have been used successfully to treat several of these skin conditions, including psoriasis, folliculitis, pruritus, and eczema. However, in view of the known immunosuppressive effects of UV radiation, concerns have been raised about potential adverse effects of UV on persons infected with HIV. In the following report, we review the effects of UV in HIV-infected cell lines in vitro, in animal models, as well as in human studies. Based on currently available data, UV radiation, as used in phototherapy and photochemotherapy, appears to have no adverse effects in HIV-infected individuals.

Rivard J, Janiga J, Lim HW. · Department of Dermatology, Henry Ford Hospital, Detroit, MI 48202, USA. · J Drugs Dermatol. · Pubmed #16774101 No free full text.

Abstract: Psoriasis is a common skin condition affecting approximately 2.6% of the population in the US. The most effective current therapies for psoriasis have suppressive activity against T lymphocytes directly or by modulating the biologic effects of inflammatory cytokines. Tacrolimus has been used successfully to treat a number of T cell-mediated diseases. UVA1 has been shown to induce T lymphocyte apoptosis. Combination treatment is commonly used in the management of psoriasis. Therefore, this pilot study was performed to evaluate if the combination of medium-dose UVA1 (50 J/cm2) and tacrolimus ointment is effective for the treatment of palmar plantar psoriasis. A total of 5 patients completed the study of 30 UVA1 treatments, and another patient completed half of the treatments. No dramatic changes in plaque thickness or scaling were seen with either tacrolimus alone or with the combination of tacrolimus and medium dose UVA1 on palmar or plantar psoriasis.

Huggins RH, Leithauser LA, Eide MJ, Hexsel CL, Jacobsen G, Lim HW. · Department of Dermatology, Henry Ford Hospital, Detroit, MI 48202, USA. · Photodermatol Photoimmunol Photomed. · Pubmed #19614900 No free full text.

Abstract: BACKGROUND/PURPOSE: Hydroa vacciniforme (HV) is a rare photodermatosis that primarily affects children. It is characterized by photodistributed vesicles that heal with scarring. The purposes of this study are to perform the initial investigation into the effect of HV on quality of life (QoL) and gain insight into disease diagnosis and management. METHODS: Using the listserv from a web-based, international HV support group, either the Dermatology Life Quality Index (DLQI) or the Children's DLQI (CDLQI), and an HV-specific questionnaire were administered. RESULTS: Fifteen HV patients participated, nine (60%) males and six (40%) females. Median age at onset was 7 years, and 11/15 (73%) were younger than 18 years. The majority of patients were Caucasian (73%). Children cited life quality as being negatively impacted by an inability to play outdoors while adults noted QoL influences due to limitations on clothing choices. The mean CLDLQI and DLQI scores, 12.1 and 8.5, respectively, suggest a higher negative QoL impact than previously reported indices for generalized eczema, atopic dermatitis, and psoriasis. CONCLUSION: When compared with other dermatoses, HV appears to have an equal or greater impact on patients' QoL. Dermatologists should be aware of the psychosociologic impact of this disease, especially on young HV patients.

Nair RP, Ruether A, Stuart PE, Jenisch S, Tejasvi T, Hiremagalore R, Schreiber S, Kabelitz D, Lim HW, Voorhees JJ, Christophers E, Elder JT, Weichenthal M. · Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan 48109-0932, USA. · J Invest Dermatol. · Pubmed #18219280 links to  free full text

Abstract: Psoriasis is a common inflammatory and hyperproliferative skin disease with a multifactorial genetic basis. A recent study reported that psoriasis was associated with the IL12B haplotype rs3212227 (3'-untranslated region)-rs6887695 (60 kb, 5') and the IL23R haplotype rs7530511 (L310P)-rs11209026 (Q381R). We examined these four single-nucleotide polymorphisms (SNPs) for association with psoriasis in two groups of North American and German Caucasians: (1) 1,810 cases and 2,522 controls; and (2) 509 pedigrees. Both IL12B markers showed highly significant association with psoriasis in the case-control (rs3212227, odds ratio (OR)=1.62, P=1.7 x 10(-15); rs6887695, OR=1.49, P=2.7 x 10(-15)) and in the family-based analysis (rs3212227, P=2.2 x 10(-3); rs6887695, P=1.7 x 10(-3)). The IL23R SNPs also showed significant association in the cases and controls (rs7530511, OR=1.22, P=3.9 x 10(-3); rs11209026, OR=1.40, P=3.8 x 10(-4)). For both genes, common risk haplotypes were identified whose statistical significance approached (IL23R) or exceeded (IL12B) genome-wide criteria. We found no statistical evidence for interactions of these haplotypes with HLA-Cw6. Our results confirm associations between IL12B and IL23R and psoriasis in Caucasians, and provide a genetic basis for the clinical association between psoriasis and Crohn's disease.

Rivard J, Lim HW. · Department of Dermatology, Henry Ford Hospital, Detroit, MI 48202, USA. · J Drugs Dermatol. · Pubmed #16774109 No free full text.

Abstract: Targeted phototherapy has been utilized in the past few years for the treatment of various dermatoses. In this article, we summarize the experience of using 308-nm excimer laser at Henry Ford Hospital, Detroit, MI, for the treatment of psoriasis, vitiligo, palmoplantar psoriasis, and hand dermatitis. A total of 34 patients were treated between January 2003 and February 2005. Of the 28 patients with psoriasis, over 80% had greater than 75% improvement after an average of 12 treatments. While the number of patients was small, excimer laser showed promising results for palmoplantar psoriasis. Possibly due to patient selection bias, we have not had the same success as other studies for the treatment of vitiligo with this modality.

Lewis TG, Tuchinda C, Lim HW, Wong HK. · Department of Dermatology, Henry Ford Hospital, Detroit, MI 48202, USA. · J Drugs Dermatol. · Pubmed #16774108 No free full text.

Abstract: Pustular and erythrodermic psoriasis can be a debilitating and recalcitrant disease which may result in secondary complications such as sepsis, electrolyte imbalance, renal failure, and heart failure. We report a case of a 46-year-old patient with life-threatening erythrodermic psoriasis who responded rapidly to intravenous infliximab.

Nair RP, Stuart PE, Nistor I, Hiremagalore R, Chia NV, Jenisch S, Weichenthal M, Abecasis GR, Lim HW, Christophers E, Voorhees JJ, Elder JT. · Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI 48109-0932, USA. · Am J Hum Genet. · Pubmed #16642438 links to  free full text

Abstract: Previous studies have narrowed the interval containing PSORS1, the psoriasis-susceptibility locus in the major histocompatibility complex (MHC), to an approximately 300-kb region containing HLA-C and at least 10 other genes. In an effort to identify the PSORS1 gene, we cloned and completely sequenced this region from both chromosomes of five individuals. Two of the sequenced haplotypes were associated with psoriasis (risk), and the other eight were clearly unassociated (nonrisk). Comparison of sequence of the two risk haplotypes identified a 298-kb region of homology, extending from just telomeric of HLA-B to the HCG22 gene, which was flanked by clearly nonhomologous regions. Similar haplotypes cloned from unrelated individuals had nearly identical sequence. Combinatorial analysis of exonic variations in the known genes of the candidate interval revealed that HCG27, PSORS1C3, OTF3, TCF19, HCR, STG, and HCG22 bore no alleles unique to risk haplotypes among the 10 sequenced haplotypes. SPR1 and SEEK1 both had messenger RNA alleles specific to risk haplotypes, but only HLA-C and CDSN yielded protein alleles unique to risk. The risk alleles of HLA-C and CDSN (HLA-Cw6 and CDSN*TTC) were genotyped in 678 families with early-onset psoriasis; 620 of these families were also typed for 34 microsatellite markers spanning the PSORS1 interval. Recombinant haplotypes retaining HLA-Cw6 but lacking CDSN*TTC were significantly associated with psoriasis, whereas recombinants retaining CDSN*TTC but lacking HLA-Cw6 were not associated, despite good statistical power. By grouping recombinants with similar breakpoints, the most telomeric quarter of the 298-kb candidate interval could be excluded with high confidence. These results strongly suggest that HLA-Cw6 is the PSORS1 risk allele that confers susceptibility to early-onset psoriasis.

Stuart P, Nair RP, Abecasis GR, Nistor I, Hiremagalore R, Chia NV, Qin ZS, Thompson RA, Jenisch S, Weichenthal M, Janiga J, Lim HW, Christophers E, Voorhees JJ, Elder JT. · Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA. · J Med Genet. · Pubmed #15923274 links to  free full text

Abstract: BACKGROUND: A previous study identified two peaks of allelic association between psoriasis and single nucleotide polymorphisms (SNPs) mapping to distal chromosome 17q, including a disease associated SNP that leads to loss of a RUNX1 transcription factor binding site, and additional SNPs in the third intron of the RAPTOR gene. Another study found an association with SNPs in the RAPTOR gene, but not with the RUNX1 binding site polymorphism. METHODS: In an effort to confirm these observations, we genotyped 579 pedigrees containing 1285 affected individuals for three SNPs immediately flanking and including the RUNX1 binding site, and for three SNPs in the RAPTOR gene. RESULTS: Here we report further evidence for linkage to distal chromosome 17q, with a linkage peak mapping 1.7 cM distal to the RUNX1 binding site (logarithm of the odds 2.26 to 2.73, depending upon statistic used). However, we found no evidence for association to individual SNPs or haplotypes in either of the previously identified peaks of association. Power analysis demonstrated 80% power to detect significant association at genotype relative risks of 1.2 (additive and multiplicative models) to 1.5 (dominant and recessive models) for the RUNX1 binding site, and 1.3 to 1.4 for the RAPTOR locus under all models except dominant. CONCLUSIONS: Our data provide no support for the previously identified RUNX1 binding site or for the RAPTOR locus as genetic determinants of psoriasis, despite evidence for linkage of psoriasis to distal chromosome 17q.

Samson Yashar S, Gielczyk R, Scherschun L, Lim HW. · Department of Dermatology, Henry Ford Health System, Detroit, MI 48202, USA. · Photodermatol Photoimmunol Photomed. · Pubmed #12925186 No free full text.

Abstract: BACKGROUND: Narrow-band ultraviolet B (NB-UVB) therapy has been used successfully for the treatment of inflammatory and pigmentary skin disorders including atopic dermatitis, psoriasis, mycosis fungoides, polymorphous light eruption, and vitiligo. METHODS: This is a retrospective review of the treatment outcomes of 117 consecutive patients with vitiligo, pruritus, and other inflammatory dermatoses, excluding those with psoriasis and CTCL, who were treated with NB-UVB between 1998 and 2001 at our institution. RESULTS: Approximately 80% of all patients showed improvement in their condition. NB-UVB phototherapy was well tolerated, with no serious adverse effects. In patients with vitiligo, 6.4% had an abnormal thyroid-stimulating hormone level and 6.5% had anemia. CONCLUSION: NB-UVB may be considered as a viable therapeutic option in the treatment of vitiligo, pruritus, and other inflammatory dermatoses. Long-term adverse effects and cost-benefit analysis of NB-UVB therapy compared to other treatment modalities remain to be determined.

Stuart P, Malick F, Nair RP, Henseler T, Lim HW, Jenisch S, Voorhees J, Christophers E, Elder JT. · Department of Dermatology, University of Michigan, Ann Arbor, Michigan 48109, USA. · Arch Dermatol Res. · Pubmed #12115023 No free full text.

Abstract: To evaluate the relationship between psoriasis disease severity, age at onset, and family history, we analyzed 537 US psoriatics, most of whom were from Michigan. Total body surface area involvement (%TBSA), presence or absence of joint complaints, and nail involvement were measured. Analysis of familial psoriatics revealed that %TBSA was 15.1% when onset was early, but only 8.7% when onset was late ( P=0.00003). The opposite trend was seen when psoriasis was sporadic: %TBSA was 14.3% when onset was early (</=40 years of age) compared to 28.0% when onset was late ( P=0.0034). However, the sporadic group was small and ascertainment of the sporadic group was biased for severe involvement. As determined by log-linear analysis, joint complaints and age at onset were not significantly associated after controlling for age at examination, nor were joint complaints and familial status. Psoriatic nail changes were conditionally independent of familial status, given age at onset; nail changes were more frequently encountered in early-onset patients. There was no significant difference in the frequency of carriage of the MHC psoriasis risk determinant in the familial vs sporadic groups. Early-onset psoriatics did carry this determinant significantly more frequently, as expected. These results demonstrate increased severity of skin and nail disease in early-onset psoriasis, when psoriasis is familial. The lack of clinical differences between "familial" and "sporadic" psoriasis may reflect a similar genetic basis for both conditions, at least when onset is early.

Nair RP, Stuart P, Henseler T, Jenisch S, Chia NV, Westphal E, Schork NJ, Kim J, Lim HW, Christophers E, Voorhees JJ, Elder JT. · Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA. · Am J Hum Genet. · Pubmed #10801386 links to  free full text

Abstract: Recent genome scans have established the presence of a major psoriasis-susceptibility locus in the human leukocyte antigen (HLA) complex on chromosome 6p21.3. To narrow the interval for candidate gene testing, we performed a linkage-disequilibrium analysis of 339 families, with the use of 62 physically mapped microsatellite markers spanning the major histocompatibility complex (MHC). As detected by use of the transmission/disequilibrium test (TDT), individual markers yielded significant linkage disequilibrium across most of the MHC. However, the strongest evidence for marker-trait disequilibrium was found in an approximately 300-kb region extending from the MICA gene to the corneodesmosin gene. Maximum-likelihood haplotypes were constructed across the entire MHC in the original sample and across a 1.2-Mb region of the central MHC in an expanded sample containing 139 additional families. Short (two- to five-marker) haplotypes were subjected to the TDT using a "moving-window" strategy that reduced the variability of TDT P values relative to the single-locus results. Furthermore, the expanded sample yielded a sharp peak of evidence for linkage disequilibrium that spanned approximately 170 kb and that was centered 100 kb telomeric to HLA-C. The 1.2-Mb interval was further dissected by means of recombinant ancestral haplotype analysis. This analysis identified risk haplotype 1 (RH1), which is a 60-kb fragment of ancestral haplotype 57.1, on all identifiable HLA risk haplotypes. One of these haplotypes exhibits significant linkage disequilibrium with psoriasis but does not carry Cw6, which is the HLA allele most strongly associated with the disease. These results demonstrate that RH1 is highly likely to carry the disease allele at PSORS1, and they exclude HLA-C and corneodesmosin with a high degree of confidence.

Nistor I, Nair RP, Stuart P, Hiremagalore R, Thompson RA, Jenisch S, Weichenthal M, Abecasis GR, Qin ZS, Christophers E, Lim HW, Voorhees JJ, Elder JT. · No affiliation provided · J Invest Dermatol. · Pubmed #16098055 No free full text.

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Carretero-Mangolis C, Lim HW. · No affiliation provided · Photodermatol Photoimmunol Photomed. · Pubmed #11555336 No free full text.

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Chia NV, Stuart P, Nair RP, Henseler T, Jenisch S, Lim HW, Christophers E, Voorhees JJ, Elder JT. · No affiliation provided · J Invest Dermatol. · Pubmed #11348479 links to  free full text

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Lim HW, Anderson TF, Douglass M, Koo J, Lebwohl M, Morison W, Taylor C, Zanolli M. · No affiliation provided · Arch Dermatol. · Pubmed #10376708 No free full text.

This publication has no abstract.