Bibliographic record
Abstract
BACKGROUND: Psoriasis of the skin is in itself a disturbing disorder both physically and psychologically. However, most often the scaly plaques can be hidden by clothing. When psoriasis involves the face it can be more disabling and can decrease the patient's quality of life. Facial psoriasis is difficult to treat and is associated with severe cutaneous disease. Patients who have a long duration of psoriasis or early age of onset are more likely to suffer from facial involvement. Facial psoriasis may also be associated with pruritus, psoriatic arthritis, and with a family history of psoriasis. OBJECTIVE: The authors report a case of a female patient with psoriasis with severe cutaneous disease and extensive facial involvement successfully treated with adalimumab. This 50-year-old Caucasian female had a history of cutaneous psoriasis since 1990 and psoriatic arthritis since 2005. The patient had associated pruritus and a family history (maternal). Systematic treatment with mycophenolate mofetil and acitretin proved unsuccessful. The patient also lost efficacy after months of ultraviolet light B and topical psoralen plus ultraviolet light A phototherapy. RESULTS: In 2007, the patient was screened and initiated therapy with a monoclonal humanized tumor necrosis factor alpha inhibitor, adalimumab. She had severe facial and body involvement with a body surface area of 25%, a Psoriasis Area and Severity Index of 20.4 (PASI), and a head and neck psoriasis area and severity index (HNPASI) of 3.6. Photographic documentation was carried out with improvement noted as soon as 4 weeks with continuing significant response thereafter. No adverse effects were noted. The patient's quality of life also improved. LIMITATIONS: Although severe facial psoriasis is rare and associated with only the most extensive and severe psoriatic cases, it is likely the most psychologically disturbing and cosmetically disrupting to the patient because it cannot easily be covered or concealed. The authors hope this case can illustrate an excellent therapeutic option for these patients. CONCLUSION: Although facial psoriasis is difficult to treat, with newer systemic therapy now available in the form of biologics, patients now have a hope for this disease, especially devastating when associated with severe and extensive cutaneous involvement. The case gives promise in a serial photo-documented fashion of the success that can be achieved.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".