P5912Potential complications of psoriasis therapy: A case report and review ofcatastrophic antiphospholipid syndrome

Nicholas Rudloff, DO, Ohio University College of Osteopathic Medicine, SummaWestern Reserve Hospital, Cuyahoga Falls, OH, United States; Schield Wikas, DO,Ohio University College of Osteopathic Medicine, Summa Western ReserveHospital, Cuyahoga Falls, OH, United States

Background: Catastrophic antiphospholipid syndrome (CAPS) is a rare conditionthat makes up a small subset of patients with antiphospholipid syndrome (APS). Itentails a dramatic, accelerated form of APS which results in multiorgan failure and ahigh mortality rate. To our knowledge, no cases of CAPS have been reported inpatients while on etanercept for treatment of psoriasis.

Case report: A 51-year-old man presented to our dermatology clinic for follow-up forplaque psoriasis. The patient described ‘‘flu-like’’ symptoms for 3 months. Hereported generalized weakness, fatigue, fever, chills, night sweats, and weight loss.Therapeutic regimen consisted of topical therapy and systemic biologic therapy,etanercept 25mg subcutaneously for the past 3 years. Hewas evaluated by oncologyfor possible underlying malignancy. Over 3 days, the patient developed severe backand leg pain. He presented to an emergency department with absent lowerextremity pulses. Computerized tomography angiogram showed arterial thrombiin the aorta, a saddle embolism at the aortoiliac bifurcation extending into the leftcommon iliac artery and infarctions of the spleen and kidneys. The patientunderwent a thromboembolectomy and was treated for a myocardial infarction,renal failure, respiratory failure with mechanical ventilation and arterial thrombi.Laboratory studies showed an elevated antiphospholipid antibody titer. He wasdiagnosed with CAPS. After a 20-day hospitalization he was discharged home instable condition.

Discussion: Rapid onset of multivessel thromboemboli and an elevated antiphos-pholipid antibody titer in the setting of multiorgan failure was consistent with adiagnosis of CAPS. The role of etanercept in contributing to our patients compli-cations is unclear. The majority of CAPS cases are associated with a precipitatingevent such as infection, neoplasms and surgery. Biologics have been associated withboth infections and neoplasms. Although the initial triggering event was unknown,it is possible that etanercept may have contributed to our patients morbidity.

Conclusion: CAPS is a rare condition, accounting for 1% of all patients with APS. Wedemonstrated a case study involving a 51-year-old man with psoriasis with ‘‘flu-like’’symptoms while on etanercept. He developed rapid onset of multiple thromboem-boli and a sequence of life-threatening events; he was diagnosed with CAPS. Thiscase report exhibits potential rare complications in the management of psoriasis.

AB208

cial support: None identified.

Commer

P7028Prevalence of psoriasis and rosacea comorbidities in the outpatient setting

Shar Alamdari, Wake Forest School of Medicine, Winston-Salem, NC, UnitedStates; Cheryl Gustafson, MD, Wake Forest School of Medicine, Winston-Salem,NC, United States; Hsien-Chang Lin, PhD, Indiana University, Bloomington, IN,United States; Karen Huang, MS, Wake Forest School of Medicine, Winston-Salem, NC, United States; Rajesh Balkrishnan, PhD, University of Michigan, AnnArbor, MI, United States; Scott Davis, Wake Forest School of Medicine, Winston-Salem, NC, United States; Steven Feldman, MD, Wake Forest School of Medicine,Winston-Salem, NC, United States

Background: Psoriasis and rosacea are chronic inflammatory skin conditions thatmay affect a patient’s overall health. While there is a large body of literature onassociations between psoriasis and comorbid conditions, there is limited informa-tion as to the associations between rosacea and comorbidities.

Purpose: To assess the frequency of the most common comorbid conditions inpatients with rosacea, and to compare these frequencies to those amongst patientswith psoriasis and patients without psoriasis.

Methods: Medicaid data covering the years 2003-2007 were accessed throughMarketsScan. Patients 18 years or older with at least 1 outpatient visit during thestudy period were included and divided as follows: those (1) without psoriasis; (2)with psoriasis; (3) with rosacea. Diagnosis of psoriasis or rosacea and comorbiditieswere identified using ICD-9 codes. Comorbidity frequencies and their 95% confi-dence intervals were calculated using STATA 12 software.

Results: Approximately 4.5 million patients without psoriasis, 26,211 patients withpsoriasis, and 13,026 patients with rosaceawere included. The 3 patient groups hadmany of the same top 10 comorbidities, with the top 3 in all groups being abdominalpain, unspecified hypertension and lumbago. All of the shared comorbid conditionswere twice as frequent in rosacea patients compared to patients without psoriasis.Having pain in a limb was unique to psoriasis and rosacea patients, affecting 30.4%(95% CI, 29.9-31.0) and 40.6% (95% CI, 39.8-41.4) respectively.

Limitations: There may be misspecification of comorbidities or diseases since ICD-9codes were used rather than clinical records.

Conclusion: While the profiles of the top 10 comorbidities were similar amongst the3 patient groups, rosacea patients consistently had greater proportions of thesecomorbid conditions compared to patients with or without psoriasis. These findingsmay highlight the importance of providing raised attention to potential comorbid-ities of patients with rosacea compared to other patients.

r for Dermatology Research is supported by an unrestricted edum Galderma Laboratories, L.P.

The Cente cationalgrant fro

J AM ACAD DERMATOL

P6454PSOLAR: Global update of a multicenter, open registry of psoriasis patients

Kim Papp, MD, Probity Research, Waterloo, Ontario, Canada; Bruce Strober, MD,University of Connecticut, Farmington, CT, United States; Marc Chevrier, MD,Janssen Services, LLC, Horsham, PA, United States; Vincent Ho, MD, University ofBritish Columbia, Vancouver, British Columbia, Canada

Objective: To determine the baseline characteristics of participants in the PSOLARregistry for patients with psoriasis who are candidates for systemic treatment.Baseline demographics of the enrolled cohort are presented here.

Methods: PSOLAR (PSOriasis Longitudinal Assessment Registry) is a multicenter,prospective, longitudinal, 8+ years, observational study in academic and commu-nity-based settings. Eligible patients are aged $ 18 years, have a diagnosis ofpsoriasis and are currently receiving or are candidates to receive systemic therapiesfor psoriasis. Demographics and medical/family history are collected at enrollment.Collections at 6-month intervals include: adverse events, disease activity, quality oflife, economic status, health care usation and interval therapies. International sites inNorth America and Europe recruited 9495 patients as of 23 August 2011.

Results: The baseline characteristics were as follows: median age: 49.0 (range 18-100yrs), 61.8% of patients $ 45 yrs, 54.5.0%male, 82.4%white, mean BMI 31.1 (SD7.3),disease duration of 17.4yrs (SD 13.6 yrs) since diagnosis. Medical history includes:38.8% cardiovascular disorders, 14.9% pulmonary disorders, 21.0% psychiatricdisorders, 19.0% endocrine disorders, and 6.4% skin cancer. Infections requiringtreatment in the last 3yrs occurred in 26.0% of which 23.1% were bacterialinfections. Mean BSA coverage at enrollment was 12.5% (SD18.0%), mean PGA 2(SD1.2); 96.8% of patients presented with plaque type psoriasis. Medication(current and historical) included topicals (97.3%), phototherapy (54.8%), systemicsteroids (24.6%), immunomodulators (46.2%), and biologics (78.7%).

Conclusion: As a disease directed registry, PSOLAR offers the ability to collectdisease activity/outcomes associated with many therapies in actual clinical practice.

d by Janssen Services, LLC.

Supporte

P7097Psoriasiform and pustular eruption induced by tumor necrosis factorantagonists

Susana Vilaca, MD, Centro Hospitalar do Porto, Porto, Portugal; Isabel Amorim,MD, Centro Hospitalar do Porto, Porto, Portugal; Manuela Selores, MD, CentroHospitalar do Porto, Porto, Portugal; Rosario ALves, MD, Centro Hospitalar doPorto, Porto, Portugal

Background: Tumor necrosis factor (TNF) antagonists, including monoclonalantibody (infliximab) are used in the treatment of a wide range of chronicautoimmune and inflammatory diseases, such as Crohn’s disease and psoriasis.Paradoxically there have been also several reports of adverse skin reaction inducedby these agents.

Case reports: A 27-year-old woman with no previous personal or family history ofpsoriasis, was treated for her Crohn’s disease with infliximab (5 mg/kg intrave-nously) every 8 weeks. Five months after initiating treatment, she developednumerous, 1- to 2-mm symmetrical pustules, underlying erythema and desquama-tion on his palms and soles. The skin biopsy confirmed the diagnosis ofpalmoplantar pustulosis. Treatment was started with topical corticosteroids withno improvement of the skin lesions. Consequently the patient discontinuedinfliximab treatment and the skin lesion improved remarkably. A 28-year-old womanwith no previous personal or family history of psoriasis suffered from Crohn’sdisease and was receiving infliximab (5 mg/kg intravenously) every 8 weeks for 4years. Physical examination showed pruritic, scaly, erythematous plaques localizedaround her belly. Skin biopsy confirmed the diagnosis of psoriasis. The patient didnot need to discontinue infliximab infusions because of successful control of theskin lesions with topical corticosteroids.

Conclusion: The use of TNF antagonists have increased worldwide and theparadoxically inductions of psoriasiform skin lesions have been associated to thisagents. The complete mechanism of the immunoregulatory system still remainsunclear and switching to another agent might not resolve the problem. Thereforethe clinician should be aware and report these cases for a better understanding inthe future.

cial support: None identified.

Commer

APRIL 2013