The association between psoriasis and obesity: a systematic review and meta-analysis of observational studies

The association between obesity and efficacy of psoriasis therapies: An expert consensus panel

BACKGROUND

Psoriasis is a chronic inflammatory skin disease often associated with obesity. Psoriasis therapies may be less effective in patients with obese. The purpose of this expert consensus panel is to evaluate the relationship between obesity and efficacy of psoriasis therapies, thereby optimizing patient care.

METHODS

A comprehensive literature search was completed on July 19, 2024, using the keywords "psoriasis," "obesity," "efficacy," "treatments," and "therapies." A panel of 11 dermatologists with significant expertise in treatment of psoriasis gathered to review the articles and create consensus statements. A modified Delphi process was used to approve each statement and a strength of recommendation was assigned.

RESULTS

The literature search produced 500 articles. A screening of the studies resulted in 22 articles that met criteria. The panel unanimously voted to adopt 10 consensus statements and recommendations, 6 were given a strength of "A," 2 were given a strength of "B," and 2 were given a strength of "C."

CONCLUSION

Psoriasis and obesity have a strong association. Obesity decreases efficacy of biologics and may decrease efficacy and potentiate side effects of conventional therapies. It also impacts drug survival. Weight control is a vital component of caring for patients with psoriasis and the number of therapeutic options available is rising.

BMI matters: understanding the link between weight and severe psoriasis

This study aims to investigate the causal relationship between Body Mass Index (BMI) and the severity of Psoriasis (PsO) using bidirectional Mendelian Randomization (MR) and regression analyses. We conducted a multicenter study which combined bidirectional MR analyses with regression analyses. The MR analyses included 366,776 individuals from the largest up-to-date published BMI Genome-Wide Association Study (GWAS) data. Regression analyses were performed on 1,979 patients with psoriasis from 12 participating centers (from October 31, 2019, to May 31, 2022). We assessed the impact of BMI on PsO severity using odds ratios (ORs) and regression coefficients for three key measures: the Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA), and Dermatology Life Quality Index (DLQI). Two independent MR analyses revealed a significant causal association between BMI and PsO development. The first MR1 analysis showed that an increased BMI is significantly associated with a higher risk of psoriasis, with odds ratios of 2.28 (95% CI 1.33-3.92; p = 0.003). A subsequent MR2 analysis yielded consistent results, presenting an odds ratio of 2.37 (95% CI 1.16-4.85; p = 0.018) using the inverse-variance weighted method. Logistic regression showed that for every 1-unit increase in BMI (unadjusted covariates), the risk of severe psoriasis (PASI ≥ 10, BSA ≥ 10%, DLQI ≥ 10) increased by 6%, 6%, and 3%, respectively. Linear regression analysis revealed that each unit increase in BMI (not standardised) was associated with an increase of 0.25 units in the mean PASI score (p < 0.001), 0.34 units in the BSA score (p = 0.001), and 0.14 units in the DLQI score (95% CI 0.05-0.23; p = 0.001). From both the genetic and clinical severity assessment perspectives, it has been verified that abnormal weight gain is correlated with the severity of the condition in psoriasis patients. Clinicians should prioritize weight management and nutritional balance in the management of psoriatic disease. Clinicaltrials.gov: ChiCTR1900024852, date of registration: 2019-07-31.

Cutaneous Changes Beyond Psoriasis: The Impact of Biologic Therapies on Angiomas and Solar Lentigines

Background and Objectives: Psoriasis is a chronic inflammatory skin disease, and biologic therapies have revolutionized treatment by targeting key cytokine pathways. While these therapies effectively control psoriatic lesions, their impact on other cutaneous structures, such as cherry angiomas and solar lentigines, remains unclear. Angiomas are benign vascular proliferations influenced by systemic inflammation and hormonal factors, whereas solar lentigines are UV-induced pigmentary lesions associated with aging and sun exposure. This study aimed to assess the impact of biologic therapies on the development of these lesions in psoriasis patients. Materials and Methods: This retrospective observational study was conducted over a five-year period (2019-2024) at a tertiary dermatological center in Southeastern Europe. Clinical and demographic data, including treatment history, were extracted from medical records, while digital dermoscopy was used to assess lesion progression. Statistical analyses evaluated associations among biologic therapy classes, systemic inflammation, and cutaneous lesion development. Results: Angioma prevalence was significantly higher among postmenopausal women and those with osteoporosis, suggesting a hormonal influence on vascular proliferation. Patients with psoriatic arthritis had a greater angioma burden, reinforcing the role of chronic inflammation in angiogenesis. IL-23 inhibitors were linked to increased angioma formation compared to TNF-α inhibitors, while methotrexate and UVB therapy appeared to have a protective effect. Solar lentigines were more frequent in postmenopausal women and in patients with systemic inflammatory conditions. In contrast, smoking and moderate alcohol consumption were associated with lower lesion counts. Conclusions: Our findings suggest that biologic therapies, particularly IL-23 inhibitors, may contribute to angiogenesis and pigmentary changes in psoriasis patients, highlighting the influence of systemic inflammation on vascular and melanocytic activity. Additionally, TNF-α inhibitors and NSAIDs were associated with an increased prevalence of solar lentigines, while methotrexate and UVB therapy appeared to have a protective effect. Given these associations, further research is needed to elucidate the underlying mechanisms and refine treatment strategies to optimize dermatologic care for psoriasis patients.

Association Between a Body Shape Index and Body Roundness Index with Prevalence of Psoriasis: A Cross-Sectional Population-Based Study

Background

Previous studies have suggested an intimate association between obesity and psoriasis. This study aimed to evaluate and compare the association between traditional and novel obesity biomarkers - waist circumference (WC), body mass index (BMI), a body shape index (ABSI), and body roundness index (BRI) - and the risk of psoriasis.

Methods

This cross-sectional study utilized data from the 2003-2006 and 2011-2014 National Health and Nutrition Examination Survey. The association between obesity biomarkers and psoriasis risk was evaluated using multivariate logistic regression and smoothed curve fitting. The diagnostic performance of various biomarkers for identifying psoriasis were calculated and compared using receiver-operating characteristic curves.

Results

Overall, 12,406 participants without psoriasis, 287 with mild psoriasis, and 68 with moderate-severe psoriasis, were included. Compared to the lowest quartile of WC, BMI, and BRI, higher quartiles were associated with significantly higher risks of psoriasis (all P for trend < 0.05). The area under the curve for identifying psoriasis was highest for BRI, which was comparable to WC (0.581 vs 0.575, P=0.34) but significantly higher than that of ABSI (0.581 vs 0.546, P=0.04) and BMI (0.581 vs 0.569, P=0.007). The association between BRI and psoriasis risk was not influenced by participant's age, sex, smoking status, physical activity, hypertension and diabetes status.

Conclusion

BRI is positively associated with risk of psoriasis and outperforms BMI and ABSI in identifying psoriasis. Given the cross-sectional design of this study, future research employing prospectively designed longitudinal studies is necessary to validate our findings.

Plant-Based Foods for Chronic Skin Diseases: A Focus on the Mediterranean Diet

PURPOSE OF REVIEW

In this narrative review, we provide an overview of how adherence to a Mediterranean dietary pattern can complement traditional treatment strategies for psoriasis, acne, and hidradenitis suppurativa. We emphasize the importance of an integrated approach, with dietary interventions as a key component of holistic patient care.

RECENT FINDINGS

Psoriasis, acne, and hidradenitis suppurativa are immune-mediated chronic diseases marked by systemic inflammation, with genetic and environmental factors influencing their onset. The Mediterranean diet, rich in plant-based foods with antioxidant and anti-inflammatory properties-such as whole-grain cereals, extra-virgin olive oil, vegetables, legumes, fruits, and nuts-has been shown to reduce the clinical severity of these conditions. It also supports weight control and positively impacts metabolic and cardiovascular risk factors, which are closely linked to these diseases. Dietary education, particularly about the Mediterranean diet, plays a crucial role in the management of these skin diseases and serves as an important non-pharmacological treatment option that can influence patient prognosis. This review offers specific nutrition recommendations for prescribing the Mediterranean diet to patients with chronic inflammatory skin diseases.

Exploring the Efficacy, Safety, and Clinical Implications of Deucravacitinib in East Asians with Psoriasis: A Narrative Review

Deucravacitinib, a selective oral tyrosine kinase 2 (TYK2) inhibitor, has demonstrated strong efficacy in the treatment of moderate-to-severe psoriasis. It works through an allosteric mechanism to selectively inhibit TYK2, leading to the suppression of the IL-23/Th17/IL-17 axis and a reduction in key pro-inflammatory cytokines such as IL-17A, IL-17F, IL-22, and IL-23. This review focuses on the clinical implications of deucravacitinib in East Asian patients, highlighting its efficacy, safety, and differences in treatment outcomes compared to other populations. Data from pivotal trials such as POETYK PSO-3 and PSO-4, which included East Asian populations, demonstrated robust efficacy and safety profiles, often surpassing results observed in global trials like POETYK PSO-1 and PSO-2. Subgroup analyses and network meta-analyses further corroborate these findings, providing a comprehensive understanding of its therapeutic potential in this demographic. Factors such as lower body mass index, genetic predispositions, and environmental influences may contribute to these differences in response. The safety profile of deucravacitinib is favorable, with low rates of serious adverse events and stable laboratory parameters. This review underscores the need for further research to investigate the genetic, metabolic, and environmental factors that may influence treatment outcomes, aiming to optimize personalized treatment strategies for East Asian patients with psoriasis.

Exploring Interaction between Genetically Predicted Body Mass Index and Serum 25-Hydroxyvitamin D Levels on the Odds for Psoriasis in UK Biobank and the HUNT Study: A Factorial Mendelian Randomization Study

Mendelian randomization (MR) studies show that higher body mass index (BMI) and lower 25-hydroxyvitamin D (25[OH]D) increase psoriasis risk. The combined effect of these factors has not been explored using factorial MR. Using cross-sectional data from UK Biobank (n = 398,404) and The Trøndelag Health Study (n = 86,648), we calculated polygenic risk scores for BMI and 25(OH)D to estimate ORs for psoriasis using 2 × 2 and continuous factorial MR. We quantified additive interaction by estimating relative excess risk due to interaction. We also performed traditional observational analyses in UK Biobank. There were 12,207 (3.1%) participants with psoriasis in UK Biobank and 7794 (9.0%) in The Trøndelag Health Study. In 2 × 2 factorial MR, we found no evidence of relative excess risk for psoriasis due to interaction between genetically predicted higher BMI and lower 25(OH)D, neither in UK Biobank (relative excess risk due to interaction = -0.01, 95% confidence interval = -0.08 to 0.07) nor in The Trøndelag Health Study (relative excess risk due to interaction = -0.04, 95% confidence interval = -0.14 to 0.06). The same was observed in the continuous factorial MR and observational analyses. In conclusion, this study did not find evidence of interaction between BMI and 25(OH)D on the risk of psoriasis. Given minor differences in measured BMI and 25(OH)D between the factorial groups, small effects may have been undetected.

Associations between diet quality indices and psoriasis severity: results from the Asking People with Psoriasis about Lifestyle and Eating (APPLE) cross-sectional study

Psoriasis is a chronic immune-inflammatory skin disease. Cross-sectional research examining diet quality indices in psoriasis has focused on the Mediterranean diet and is confined to Mediterranean populations, thereby lacking generalisability to other populations. We explored associations between diet quality indices and the likelihood of reporting a higher psoriasis severity. This was an online cross-sectional study recruiting adult volunteers with psoriasis (n 257). A 147-item FFQ evaluated adherence to the Mediterranean diet score, the Dietary Approaches to Stop Hypertension score and the Plant-based Diet Index (PDI), including its original (oPDI), healthy (hPDI) and unhealthy (uPDI) subtypes. Psoriasis severity was determined with the self-assessed Simplified Psoriasis Index. When adjusted for age, sex, smoking, alcohol overconsumption, energy intake and psychological morbidity, multinomial logistic regression analyses revealed an increased likelihood of reporting a higher psoriasis severity in participants with a very low adherence to Dietary Approaches to Stop Hypertension (OR = 3·75; 95 % CI 1·313, 10·700; P = 0·01) and hPDI (OR = 4·04; 95 % CI 1·251, 13·064; P = 0·02) patterns. A reduced likelihood of reporting a higher psoriasis severity was shown in participants with low adherence to the uPDI (OR = 0·25; 95 % CI 0·085, 0·716; P = 0·01). With further adjustment for BMI, a very low adherence to the oPDI was significantly associated with an increased likelihood of reporting a higher psoriasis severity (OR = 3·46; 95 % CI 1·029, 11·656; P = 0·05). Dietary interventions and assessment should be introduced in the care pathway for psoriasis management.

Association between psoriasis and Life's Essential 8 among adults in the United States

This study aimed to investigate the association between psoriasis and Life's Essential 8 (LE8), which has demonstrated an inverse relationship with various chronic diseases, though its link to psoriasis remains unexplored. In this cross-sectional study, we analyzed data from the National Health and Nutrition Examination Survey (NHANES) conducted during 2005 to 2006 and 2009 to 2014 that included participants who were 20 years or older. The LE8 score was calculated based on the American Heart Association's recommendations and categorized into three levels: low (0-49), moderate (50-79), and high (80-100). Psoriasis was identified using self-reported questionnaires. Weighted multivariable logistic regression and restricted cubic splines were applied to evaluate the relationship between LE8 scores and psoriasis. The study included 12,744 participants with an average age of 46.2 years (95% CI: 45.53-46.87 years); 6,289 (50.96%) were female, and 374 (2.9%) reported having psoriasis. The weighted mean LE8 score was 68.50 (95% CI: 67.94-69.07). After complete adjustment, a linear negative association was observed between psoriasis and the LE8 score (OR per 1 SD increase: 0.86, 95% CI: 0.75-0.99). Among the subscales, the health factors score showed a linear relationship with psoriasis, while a nonlinear relationship was found between psoriasis and the health behaviors score. Additionally, BMI, an LE8 component, demonstrated a significant association with psoriasis (OR per 1 SD increase: 0.84, 95% CI: 0.72-0.98) in multivariable logistic regression models. Subgroup and sensitivity analyses confirmed the robustness of these findings. We identified a linear negative relationship between psoriasis and LE8, demonstrating that improving LE8 management could serve as a potential strategy for preventing and managing psoriasis.

Impact of a dermatological rehabilitation program on cardiovascular risks of psoriasis patients

BACKGROUND AND OBJECTIVES

Psoriasis vulgaris is a common chronic inflammatory skin disease, associated with multiple cardiovascular comorbidities, which can ultimately lead to increased mortality. Dermatological rehabilitation programs represent an additional therapeutic option in patients with psoriasis besides the classical outpatient or inpatient management. This study aimed to investigate the impact of dermatological rehabilitation on cardiovascular risk factors, cardiorespiratory fitness and quality of life at the Clinic of Dermatology, Bad Bentheim, Germany.

PATIENTS AND METHODS

This prospective study included 105 patients (age > 18 years) with known psoriasis and/or psoriasis (pustulosa) palmoplantaris committing to a 3-week long rehabilitation program. Various patient reported outcomes including dermatological life and quality index, patient global assessment, physical activity, pruritus and smoking and alcohol consumption history were captured. Body mass index (BMI) and physical fitness were also assessed. Study parameters were collected by telephone at baseline, at discharge, and at 3 and 6 months.

RESULTS

Significant improvements in cardiorespiratory fitness (p < 0.001), BMI (p < 0.001), quality of life (p < 0.001), patients subjective estimation of disease severity (p < 0.001) and psoriasis area and severity index (p < 0.001) were shown.

CONCLUSIONS

The findings emphasize the importance of a rehabilitation program for patients with psoriasis due to its positive and sustained effects on cardiovascular risk factors.

Psoriasis management tree based on comorbidity

Psoriasis, a common chronic inflammatory skin disorder, encompasses various subtypes, including guttate, pustular, erythrodermic, and the most common type, plaque psoriasis. Irrespective of the subtype, psoriasis can manifest with multisystemic presentations, including psoriatic arthritis, metabolic disorders, cardiovascular disease, malignancies, chronic kidney disease (CKD), psychiatric illness, and inflammatory bowel disease (IBD). Many comorbidities and concomitant conditions must be considered when selecting the most appropriate therapy for a patient (Kaushik et al., 2019 and Monks et al., 2021) . Ongoing clinical trials and the development of new therapeutic targets contribute to the continuous improvement of available treatment options. Given the dynamic landscape of therapies, particularly when managing complex patients with multiple comorbidities, dermatologists are constantly challenged with the task of adeptly tailoring treatments to each psoriasis patient. This article systematically reviews the current evidence, presenting it as an updated Psoriasis Decision Tree to assist physicians in selecting tailored treatment options.

Residual Traditional Risk in Non-Traditional Atherosclerotic Diseases

Individuals with chronic inflammatory and immune disorders are at an increased risk of atherosclerotic events and premature cardiovascular (CV) disease. Despite extensive literature exploring the relationship between "non-traditional" atherosclerotic conditions and CV risk, many aspects remain unresolved, including the underlying mechanisms promoting the "non-traditional CV risk", the development of an innovative and comprehensive CV risk assessment tool, and recommendations for tailored interventions. This review aims to evaluate the available evidence on key "non-traditional" CV risk-enhancer conditions, with a focus on assessing and managing CV risk factors. We conducted a comprehensive review of 412 original articles, narrative and systematic reviews, and meta-analyses addressing the CV risk associated with "non-traditional" atherosclerotic conditions. The analysis examined the underlying mechanisms of these relationships and identified strategies for assessing and mitigating elevated risk. A major challenge highlighted is the difficulty in quantifying the contribution of individual risk factors and disease-specific elements to CV risk. While evidence supports the cardiovascular benefits of statins beyond lipid lowering, such as pleiotropic and endothelial effects, current guidelines lack specific recommendations for the use of statins or other therapies targeting non-traditional CV risk factors. Additionally, the absence of validated cardiovascular risk scores that incorporate non-traditional risk factors hinders accurate CV risk evaluation and management. The growing prevalence of "non-traditional CV risk-enhancer conditions" underscores the need for improved awareness of CV risk assessment and management. A thorough understanding of all contributing factors, including disease-specific elements, is crucial for accurate prediction of cardiovascular disease (CVD) risk. This represents an essential foundation for informed decision-making in primary and secondary prevention. We advocate for future research to focus on developing innovative, disease-specific CV risk assessment tools that incorporate non-traditional risk factors, recognizing this as a promising avenue for translational and clinical outcome research.

Low apolipoprotein A1 and high apolipoprotein B levels indicate specific lipid changes in treatment naïve early psoriatic arthritis

OBJECTIVES

To investigate serum lipid profile in early, treatment-naïve psoriatic arthritis (PsA) and to determine whether changes in classical lipids or apolipoproteins are specific to PsA.

METHODS

Total cholesterol, non-high-density lipoprotein cholesterol (non-HDL-c), low-density lipoprotein cholesterol (LDL-c), HDL-c, triglycerides, apolipoprotein B (ApoB) and apolipoprotein A1 (ApoA1) were compared in newly diagnosed untreated PsA patients (n=75) to sex- and age-matched controls (healthy control (HC)) (n=61) and early untreated rheumatoid arthritis (RA) patients (n=50).

RESULTS

Among classical lipid measurements, HDL-c levels were lower in PsA than in HC and RA (df 2, χ210, p=0.006, PsA vs HC p=0.013). Significant differences in ApoA1 and ApoB levels were observed between PsA, RA and controls. ApoB was higher in PsA than in RA patients but lower than in controls (df2, χ243.8; p<0.001). ApoA1 was markedly lower in PsA patients compared with both RA and controls (df2, χ2118.9; p<0.001). In regression models, the levels of ApoA1, adjusted for additional factors, were predictive of PsA diagnosis with 90.6% accuracy. In receiver operating characteristic analysis, ApoA1 was predictive of the diagnosis of PsA with a specificity of 82.4% and a sensitivity of 83.8% at an optimal cut-off value of 1403 µg/mL (area under the curve (95% CI), 0.886 (0.83 to 0.941)).

CONCLUSION

Early, treatment-naïve PsA patients exhibit a distinct pro-atherogenic lipid profile, characterised by decreased ApoA1 and increased ApoB levels, distinguishing them from early RA patients and healthy controls. These findings highlight the potential of apolipoprotein measurements to serve as more accurate indicators of lipid disturbances in PsA than traditional serum lipids and as aid to diagnosis of patients presenting with early arthritis.

Weight-Adjusted Waist Index, Psoriasis, and All-Cause Mortality: Findings from the NHANES 2003-2006 and 2009-2014

Purpose

Psoriasis is associated with obesity, which in turn is linked to increased mortality risk. Therefore, we undertook a cohort study utilizing data from the National Health and Nutrition Examination Survey (NHANES) to examine the impact of weight-adjusted waist index (WWI) on the likelihood of all-cause mortality in psoriasis individuals.

Patients and Methods

This study utilized data from the National Health and Nutrition Examination Survey (NHANES) to investigate the influence of WWI on the probability of all-cause mortality in psoriasis individuals. A retrospective cohort analysis included 19,919 participants aged 18 to 80 years, with or without psoriasis. The primary endpoint studied was all-encompassing mortality up to December 2019. The interplay between WWI and psoriasis was analyzed through multivariable logistic regression techniques. Survival probabilities were assessed employing Kaplan-Meier curves and Cox regression analyses.

Results

Out of the 19,919 subjects that we eventually included, 522 had psoriasis. Psoriasis and WWI were found to be significantly positively correlated. A significant correlation was found between an incremental unit increase in WWI and a 63% increased risk of all-cause mortality risk in psoriasis patients (HR = 1.63, 95% CI 1.02-2.61). Subgroup analyses demonstrated consistent findings within the psoriasis population. These findings suggest an independent impact of WWI on psoriasis risk and mortality.

Conclusion

Our investigation revealed that there is a strong positive correlation between WWI and all-cause mortality in US psoriasis adults. For those with psoriasis, managing WWI, or obesity, is crucial.

The role of diet in the management of psoriasis: a scoping review

Psoriasis is a chronic, systemic, immune-mediated, inflammatory skin disease associated with significant comorbidities. Globally, there are an estimated 60 million people living with psoriasis (PLwP). There is a growing body of evidence on the role of diet in psoriasis management, and demand for dietary advice is high. However, there are no specific, evidence-based dietary guidelines. This scoping review summarises the literature on use and effectiveness of diet in the management of psoriasis to improve understanding of the evidence and assist PLwP and healthcare professionals (HCPs) to discuss diet. The findings were categorised into three themes: (1) dietary intakes of PLwP, (2) the perceived role of diet in psoriasis management and (3) dietary approaches to manage psoriasis symptoms. In cross-sectional studies PLwP were reported to have higher fat and lower fibre intakes compared with controls, and lower psoriasis severity was associated with higher fibre intake. However, research is limited. PLwP perceive diet to have an impact on symptoms and make dietary modifications which are often restrictive. Systematic reviews and RCTs found certain dietary approaches improved symptoms, but only in specific populations (e.g. PLwP with obesity and PLwP with coeliac disease), and evidence for supplement use is inconclusive. The grey literature provides limited guidance to PLwP; focusing on weight loss and associated comorbidities. Larger, controlled trials are required to determine dietary approaches for psoriasis management, especially in PLwP without obesity and non-coeliac PLwP. Further understanding of diet modification, information acquisition and experiences among PLwP will enhance holistic care for psoriasis management.

Prevalence of cardiovascular and other selected diseases among Greenlanders with and without type 2 diabetes

This study aims to estimate the prevalence of cardiovascular disease, kidney disease, and other selected diseases including hypertension, atrial fibrillation, asthma, chronic obstructive lung disease, osteoarthritis, osteoporosis, psoriasis and depression among Greenlanders living in Nuuk with and without type 2 diabetes (T2D). The study was designed as a cross-sectional case-control study based on data from the electronic medical record (EMR) in Greenland. Persons with a registered T2D diagnosis in EMR and residence in Nuuk (N = 435) were included. The prevalence of cardiovascular disease was 17.9% among persons with T2D and significantly higher compared to the control group (10.1%). In addition, our results showed a significantly higher prevalence of ischaemic heart disease, hypertension, heart failure, atrial fibrillation, osteoarthritis and psoriasis among persons with T2D compared to the control group.Our study found a higher prevalence in five out of 10 selected diseases in regularly followed persons with T2D in Nuuk compared to unselected controls. This enlightens the importance of a broad multifaceted approach in combination of changing primary health care to focus on early detection of controllable risk factors and chronic conditions care in Artic Greenland.

Systematic analysis of serum peptidase inhibitor 3 in psoriasis diagnosis and treatment

BACKGROUND

Psoriasis is a chronic inflammatory skin disease. To date, there are no serum biomarkers for psoriasis that have been validated to diagnose or treat psoriasis.

METHODS

Peptidase inhibitor 3 (PI3) levels in serum were measured using chemiluminescence immunoassay (CLIA) in two independent cohorts including healthy controls (HC) and patients diagnosed with chronic urticaria (CU), chronic eczema (CE), systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), psoriatic arthritis (PsA), or psoriasis vulgaris (PV). Receiver operating characteristic (ROC) curve analysis determined the diagnostic performance of PI3 in patients with psoriasis. The correlation between PI3 levels and the Psoriasis Area Severity Index (PASI) score was analyzed using the Spearman correlation method. Additionally, the study evaluated PI3 expression and treatment response of PV patients 12 weeks before and after topical treatment with calcipotriol betamethasone and calcipotriol ointment (T#1) or topical therapy plus PSORI-CM01 granules (T#2).

RESULTS

In cohort #1, PI3 levels effectively discriminate PV patients from HC and CU patients, with AUCs of 0.909 and 0.840, respectively. In cohort #2, AUCs for detecting PV patients among HC, CU, CE, SLE, and RA patients were 0.940, 0.926, 0.802, 0.989, and 0.951, respectively. For PsA patients, AUCs were 0.989, 0.986, 0.910, 1.000, and 0.984 compared to HC, CU, CE, SLE, and RA patients, respectively. In both cohorts, PI3 levels correlated significantly with PASI scores in PV patients (cohort #1, r = 0.433; cohort #2, r = 0.634) and PsA patients (cohort #2, r = 0.718). Moreover, univariate logistic regression analyses revealed that PV patients with higher PI3 expression had a significantly higher risk of treatment resistance, with an odds ratio of 3.45 [95% confidence interval (CI) 1.54, 7.74, p = 0.003]. Finally, PI3 levels decreased nearly 35-fold more in the responder than in the non-responder group before and after treatment.

CONCLUSIONS

Serological PI3 is a reliable biomarker for PV diagnosis and may have the potential to predict and monitor the progression of PV before and after treatment. Key Points • This study validated PI3's diagnostic performance in two independent psoriasis cohorts using CLIA. • PI3 expression is significantly correlated with the psoriasis severity and with patients who benefited from the treatments. • Serological PI3 is a reliable biomarker for psoriasis diagnosis and may have the potential to monitor the psoriasis progression with and without treatments.

Metabolic Syndrome in Psoriasis and Psoriatic Arthritis in a Mixed Race Population: Comparison of Their Prevalences

Background

There is a growing body of evidence suggesting the association between psoriasis (PsO) and psoriatic arthritis (PsA) separately with metabolic syndrome (MS) in different populations. The literature is relatively scarce in terms of comparing the prevalence of MS in PsO and PsA with controls without systemic inflammatory diseases.

Objective

We aimed to assess the prevalence of MS among patients with PsO, PsA, and a control group without systemic inflammatory disease, in addition to investigating the risks of MS occurrence and its different components in each group.

Methods

This is a cross-sectional case-control study with three groups of patients: PsO, PsA, and control. The diagnosis of MS was defined according to the modified 2009 NCTEP ATP III criteria. Patients underwent thorough physical examination and fasting blood samples.

Results

A total of 195 patients were included in this analysis (PsO = 50; PsA = 64, and controls = 81). The prevalence of MS in the control, PsO, and PsA groups was 37%, 56%, and 57.8%, respectively (p < 0.001). Waist circumference (p = 0.013) and arterial hypertension (p < 0.001) were the most significant components of MS in patients with PsO and PsA. Multivariate analysis confirmed an independent risk of MS in women, elderly patients, obese patients, patients with hyperglycemia, and patients with psoriasis, especially PsA (OR = 6.2 [CI 95% 2.4-16.2], p < 0.001).

Conclusion

MS is more prevalent in patients with PsA, which can be determined by the increase in inflammatory pathways.

Demographics, Disease Characteristics, and Time to Effective Treatment of Patients with Psoriasis in the Ghent PsoPlus Cohort of 2021

INTRODUCTION

Psoriasis is a chronic immune-mediated skin disease with several comorbidities and a considerable influence on quality of life. Many patients with moderate-to-severe psoriasis are undertreated and have a substantial disease duration before effective treatment is started. This study analyzed patient and disease characteristics and time to effective treatment of patients with psoriasis who consulted PsoPlus. It also examined whether a treat-to-target (T2T) approach, which is implemented in PsoPlus, has an impact on treatment choice and disease progression.

METHODS

Through a single center, retrospective study, 170 patients in the PsoPlus dedicated clinic were compared at moment of enrollment in PsoPlus and at the last recorded consultation in 2021.

RESULTS

Median disease duration at the first PsoPlus consultation was 16.0 (interquartile range (IQR) 19.0) years. There was a significant difference in Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) between the first and the last recorded PsoPlus consultation (PASI 6.0 (IQR 6.4) vs. 0.6 (IQR 2.6); DLQI 11 (IQR 11) vs. 2 (IQR 6); p < 0.001). A weak positive Spearman correlation (rs) was found between disease duration and PASI at the first PsoPlus consultation (rs = 0.175; p = 0.034), while a weak negative correlation (rs = - 0.2; p = 0.013) was found at the last registered PsoPlus consultation. Patients with a disease duration of more than 20 years had significantly more switches of treatment than those with a shorter disease duration (p < 0.001). Median time from psoriasis onset until PASI ≤ 2 was 16.0 years. Median time from the first PsoPlus consultation until PASI ≤ 2 was 7.0 months.

CONCLUSION

The PsoPlus program with its T2T approach effectively improves clinical outcomes and quality of life for patients with psoriasis in a relatively short period, emphasizing the value of a structured, personalized treatment plan for long-term management.

Metabolic syndrome and psoriatic arthritis: the role of weight loss as a disease-modifying therapy

Psoriatic arthritis (PsA) is an inflammatory joint and entheseal disease associated with significant personal and public health burden. PsA has a prevalence of up to 1%, affecting ~20% of people suffering with psoriasis. PsA is frequently accompanied by metabolic syndrome (MetS), and both conditions are characterised by a chronic pro-inflammatory state, with several key cytokines in PsA (interleukin (IL)-17 and IL-23) also elevated in those with MetS. This narrative review aims to provide an update on MetS in PsA, focusing on its prevalence, pathogenesis, prognosis, treatment interactions and future therapeutic options. MetS is particularly prevalent in PsA compared to other inflammatory arthritides. Cohort studies indicate a higher risk of PsA in individuals with obesity, while Mendelian randomization studies link childhood obesity, insulin resistance, and dyslipidaemia to PsA. Weight loss interventions have been shown to reduce disease activity in PsA. Additionally, MetS negatively impacts the efficacy of tumour necrosis factor inhibitor (TNFi) drugs in treating PsA. Drugs given for PsA may also affect the conditions constituting MetS. Leflunomide has been shown to reduce body weight but also increase blood pressure. TNFi drugs lead to weight gain but reduce cardiovascular risk. Janus kinase inhibitors increase lipid levels and cardiovascular risk among high-risk groups. Anti-IL-17 and anti-IL-12/IL-23 drugs may cause a short-term increase in cardiovascular risk, although the long-term effects have yet to be established. Weight loss represents an unexplored avenue for disease modification in PsA, alongside a plethora of general health benefits. Dietary and exercise modifications are the cornerstone of weight management but vary substantially across individuals. Novel therapies to treat weight loss, such as glucagon-like peptide 1 agonists and sodium-glucose cotransporter 2 inhibitors, may prove useful alongside disease-modifying therapies for those with PsA and MetS and should be investigated as potential therapeutic adjuncts.

Clinical Implications of Metabolic Syndrome in Psoriasis Management

Psoriasis is an increasingly common chronic immune-mediated skin disease recognized for its systemic effects that extend beyond the skin and include various cardiovascular diseases, neurological diseases, type 2 diabetes, and metabolic syndrome. This study aimed to explore the complex relationship between psoriasis and metabolic syndrome by analyzing clinical, biochemical, and immunological parameters in patients with psoriasis alone and in patients combining psoriasis and metabolic syndrome. A total of 150 patients were enrolled, 76 with psoriasis only (PSO) and 74 with psoriasis and metabolic syndrome (PSO-MS). Data collected included anthropometric measurements, blood tests, and inflammatory markers. Statistical analysis was performed using the independent t-test, Mann-Whitney U test, Kruskal-Wallis test, and chi-square test to compare the two groups. Patients in the PSO-MS group had a significantly higher body weight, abdominal circumference, BMI, and inflammatory markers compared to patients with PSO. In addition, increased levels of IL-17A, cholesterol, triglycerides, and glucose were observed in the PSO-MS group. This study highlights the increased metabolic risk and exacerbated systemic inflammation associated with the coexistence of psoriasis and metabolic syndrome. These findings demonstrate the need for a comprehensive therapeutic approach and early intervention to manage metabolic complications in patients with psoriasis and metabolic syndrome.

The Link Between Weight-Adjusted-Waist Index and Psoriasis in Adults: A Cross-Sectional Study Based on 2009-2014 and 2003-2006 Data

Purpose

The weight-adjusted-waist index (WWI) is a new indicator that may be used to assess obesity. However, there has never been any prior research indicating a link between psoriasis and WWI. Hence, the aim of this investigation is to search for the correlation between the two.

Patients and Methods

Cross-sectional analyses used National Health and Nutrition Examination Survey (NHANES) data from 2003 to 2006 and 2019 to 2014. Through multivariate logistic regression, the connection between Psoriasis and WWI was explored, while subgroup analyses aimed to identify possible causes. Furthermore, Smoothed curve fitting was also performed to further understand the association. The non-linear connection was examined through the use of threshold effects.

Results

There were 21,916 participants over the age of 20 in the research. Psoriasis and WWI were revealed to be positively correlated [1.25 (1.14, 1.38)] using multivariate logistic regression analysis. This association was observed in both men [1.50(1.29,1.78)] and hypertensive patients [1.37(1.16,1.62)] in subgroup analysis. Furthermore, we noticed a curvilinear association between WWI and psoriasis, wherein the inflection point was identified as 10.15. To the left of the inflection point, there existed a negative correlation [0.12(0.02,0.91)] while to the right, a positive one [1.68(1.03,2.72)].

Conclusion

According to our findings, psoriasis and WWI are related, although more extensive prospective research is still required to support this conclusion.

The association between weight-adjusted-waist index and psoriasis: A cross-sectional study

INTRODUCTION

This study explored the association between psoriasis and the weight-adjusted waist index (WWI), a newly developed measure of adiposity. The research was conducted among adults in the United States.

METHODS

Utilizing survey data from the National Health and Nutrition Examination Survey (NHANES) spanning the years 2009 to 2014, the present study aimed to investigate the potential correlation between psoriasis and WWI within a sample of 15,920 adult participants. Employing multivariable logistic regression and nonlinear curve fitting techniques, we analyzed this plausible association. Additionally, a subgroup analysis was conducted to ascertain the consistency across diverse populations.

RESULTS

A significant positive association was discovered between psoriasis and WWI in the investigated sample of 15,920 adults. After conducting a comprehensive adjustment of the model, it was observed that each incremental unit of WWI was significantly associated with an 14% elevated likelihood of developing psoriasis (OR = 1.16, 95% CI 1.01-1.36). Moreover, individuals belonging to the highest quartile of WWI exhibited a 47% higher risk of psoriasis compared to those in the lowest quartile (OR = 1.44, 95% CI 1.01-2.06). This positive correlation remained consistent across various subgroups. The study also compared WWI with BMI and waist circumference, finding that WWI is a more stable metric of obesity.

CONCLUSIONS

Our study suggested that in US adults, there is a positive association between WWI and psoriasis. It also indicated that WWI showed potential as a valuable index of psoriasis among the general population.

Assessing the genetic associations between plasma lipidomic profiles and psoriasis vulgaris

Several studies have indicated a potential causal relationship between plasma standard lipids, such as high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), triglycerides (TG), and total cholesterol (TC), and psoriasis. However, few studies have offered causal evidence of lipid species beyond these standard lipids. We conducted an analysis using a genome-wide association study (GWAS) dataset comprising 179 lipid species, including 13 types across four major categories, to identify instrumental variables (IVs) associated with plasma lipids. We utilized two GWAS datasets from the IEU and Finngen for psoriasis vulgaris as the outcome. A two-sample Mendelian randomization (MR) analysis was used to explore the causal relationship between 179 lipid species and psoriasis vulgaris in two datasets. Lipid species showing causal association in both psoriasis datasets were compared for overlap. Our study identified potential causal relationships between six lipid species and psoriasis vulgaris: phosphatidylcholine (16:1_18:2), phosphatidylcholine (18:0_18:2), phosphatidylcholine (18:1_20:4), phosphatidylethanolamine (16:0_18:2), phosphatidylinositol (18:0_20:3), and triacylglycerol (50:1). In summary, elevated plasma levels of phosphatidylcholine (16:1_18:2), phosphatidylcholine (18:0_18:2), phosphatidylethanolamine (16:0_18:2), phosphatidylinositol (18:0_20:3), and triacylglycerol (50:1) may increase the risk of psoriasis vulgaris. Conversely, plasma phosphatidylcholine (18:1_20:4) may play a protective role against psoriasis vulgaris.

Early Cerebral Microvasculature Impairment and Increased Body Mass Index in Patients with Psoriasis

Psoriasis induces systemic atherosclerosis, but its impact on cerebrovascular function remains unclear. However, stroke prevention must be considered in psoriasis, as it is commonly comorbid with classic cardiovascular risk factors. Thus, the aim of the study is to assess cerebral microvasculature function and its confounders in patients with psoriasis. The study protocol included cerebral autoregulation assessment with measurements of vasomotor reactivity reserve (VMRr) on the middle cerebral arteries with the use of a Transcranial Doppler (TCD) in 50 patients with psoriasis without cerebrovascular events (46; 21-74 years) and 26 healthy controls (41; 29-58 years). Analyses of VMRr relationships with the psoriasis course, comorbidities, inflammatory markers and intima-media thickness (IMT) were performed. The study showed that VMRr was lower (64% vs. 76%, p = 0.001), and the IMT was higher (0.65 vs. 0.52 mm, p = 0.001) in patients compared to controls. The patients were also characterized by a higher body mass index (BMI) and a higher level of Il-6 than the controls (29.14 vs. 25.76 kg/m2, p = 0.004 and 585 vs. 204 pg/mL, p < 0.001, respectively), but only BMI was independently impacting VMRr reduction (p = 0.02). In conclusion, early cerebral microvasculature dysfunction may occur in patients with psoriasis, and its extent is associated with an increase in BMI. Thus, body mass reduction should be strongly recommended for stroke prophylaxis in patients with psoriasis.

Role of Claudin- 3 as a biomarker of gut-skin axis integrity in patients with psoriasis

Increased intestinal permeability and gut dysbiosis are important factors in the pathophysiology of psoriasis and its associated conditions. Claudin-3 is a protein that is found in tight junctions and may be used to assess the integrity of the gut barrier. The aim of this study was to investigate serum concentration of Claudin- 3 (CLDN3) in patients with psoriasis. Exploring its possible relations with patients' demographic, clinical and laboratory findings was another objective. Fifty psoriatic patients and thirty-five age- and sex-matched healthy volunteers served as the study's control group in this case-control, hospital-based research. The amount of serum CLDN3 was determined by means of an enzyme-linked immunosorbent test (ELISA). Concentration of serum CLDN3 was found to be significantly higher in patients with psoriasis. (p = 0.002). There was no statistically significant correlation between CLDN3 and patient's clinical & laboratory variables. We demonstrated that gut permeability is dysfunctional in patients with psoriasis as indicated by reduction of serum CLDN3. Further investigations are needed to determine whether modulation of gut barrier may represent a new therapeutic approach for psoriasis.

The Intersection of the Pathogenic Processes Underlying Psoriasis and the Comorbid Condition of Obesity

In the past decade, our understanding of psoriasis pathogenesis has made significant steps forward, leading to the development of multiple game-changing therapies. While psoriasis primarily affects the skin, it is increasingly recognized as a systemic disease that can have effects beyond the skin. Obesity is associated with more severe forms of psoriasis and can potentially worsen the systemic inflammation and metabolic dysfunction seen in psoriatic patients. The exact mechanisms underlying the link between these two conditions are not fully understood, but it is believed that chronic inflammation and immune dysregulation play a role. In this review, we examine the existing body of knowledge regarding the intersection of pathogenic processes responsible for psoriasis and obesity. The ability of biological therapies to reduce systemic and obesity-related inflammation in patients with psoriasis will be also discussed.

Fatty Acid Profile of Erythrocyte Membranes in Patients with Psoriasis

Psoriasis is a chronic systemic disease with a multifaceted pathomechanism and immunological basis, with the presence of inflammatory skin lesions and joint ailments. Diseases accompanying psoriasis include metabolic and cardiovascular disorders. It has been suggested that inflammation is involved in the development of each of these conditions. The main objective of this study was to analyse the fatty acid profile, including polyunsaturated fatty acids, in the erythrocyte membranes of patients suffering from psoriasis. A total of 58 adult patients of the Department of Skin and Venereal Diseases of the Pomeranian Medical University in Szczecin, suffering from psoriasis, were qualified for this study. The patients had undergone an interview and physical examination, during which the severity of psoriasis was assessed. All patients had their weight and height measured to assess their body mass index (BMI). After 3 months of treatment, biochemical parameters (ALT, AST, total cholesterol) and inflammatory markers (CRP) in the blood were assessed. In addition, the isolation of fatty acids (PUFAs, SFAs, MUFAs) from erythrocyte membranes and the qualitative and quantitative analysis of their profile using a gas chromatograph were carried out. In patients with severe psoriasis requiring systemic treatment, an altered profile of fatty acids in erythrocyte membranes was found, including a significantly lower concentration of polyunsaturated fatty acids (omega-3), which have an anti-inflammatory effect; a significantly higher concentration of saturated fatty acids; and a decreased concentration of oleic acid (omega-9), compared to the results obtained in patients with less severe psoriasis receiving topical treatment. In patients with psoriasis and BMI ≥ 25, significantly higher concentrations of AST and ALT in the blood and significantly higher concentrations of pro-inflammatory arachidonic acid in erythrocyte membranes were found. Elevated concentrations of saturated (R = 0.31) and monounsaturated fatty acids (R = 0.29) may correlate with a greater severity of psoriasis.

Association between psoriasis and atrial fibrillation: A Systematic review and meta-analysis

INTRODUCTION

Psoriasis is a prevalent inflammatory skin condition characterized by erythematous plaques with scaling. Recent research has demonstrated an increased risk of cardiovascular diseases in patients with psoriasis; however, current evidence on atrial fibrillation (AF) risk in psoriasis is limited.

MATERIALS AND METHODS

A systematic literature search was performed on major bibliographic databases to retrieve studies that evaluated AF risk in patients with psoriasis. The DerSimonian and Laird random effects model was used to pool the hazard ratios (HR) with 95 % confidence intervals (CI). Subgroup analysis was conducted by dividing the patients into mild and severe psoriasis groups. Publication bias was assessed by visual inspection and Egger's regression test. Statistical significance was set at p < 0.05.

RESULTS

Seven studies were included, with 10,974,668 participants (1,94,230 in the psoriasis group and 10,780,439 in the control group). Patients with psoriasis had a significantly higher risk of AF [Pooled HR: 1.28; 95 % CI: 1.20, 1.36; p < 0.00001]. In subgroup analysis, patients with severe psoriasis [HR: 1.32; 95 % CI: 1.23, 1.42; p < 0.00001] demonstrated a slightly higher risk of AF, although statistically insignificant (p = 0.17), than the mild psoriasis group [HR: 1.21; 95 % CI: 1.10, 1.33; p < 0.0001]. Egger's regression test showed no statistically significant publication bias (p = 0.24).

CONCLUSION

Our analysis demonstrated that patients with psoriasis are at a significantly higher risk of AF and hence should be closely monitored for AF. Further large-scale and multicenter randomized trials are warranted to validate the robustness of our findings.

Role of Platelets in Rheumatic Chronic Autoimmune Inflammatory Diseases

Platelets are essential in maintaining blood homeostasis and regulating several inflammatory processes. They constantly interact with immune cells, have immunoregulatory functions, and can affect, through immunologically active substances, endothelium, leukocytes, and other immune response components. In reverse, inflammatory and immune processes can activate platelets, which might be significant in autoimmune disease progression and arising complications. Thus, considering this interplay, targeting platelet activity may represent a new approach to treatment of autoimmune diseases. This review aims to highlight the role of platelets in the pathogenic mechanisms of the most frequent chronic autoimmune inflammatory diseases to identify gaps in current knowledge and to provide potential new targets for medical interventions.

Global prevalence of obesity in patients with psoriasis: An analysis in the past two decades

BACKGROUND

Obesity is the risk factor for psoriasis. Therefore, we conducted a comprehensive review and meta-analysis to determine the prevalence of obesity in patients with psoriasis.

METHODS

We examined four databases from their inception to October 2023 and used the Agency for Healthcare Research and Quality and the Newcastle-Ottawa Scale to assess the quality of observational studies. Data analysis was conducted by R language. Meta-regression, sensitivity and subgroup analyses were used to evaluate inter-study heterogeneity. Egger's test and funnel plots were used to evaluate publication bias.

RESULTS

The global prevalence of psoriasis and obesity comorbidity was 25% (95% confidence interval [CI]: 0.21-0.30). Furthermore, the co-morbidity rate was 18% (95% CI: 0.11-0.24) in children and adolescents, and 35% (95% CI: 0.30-0.39) in adults. The gender-specific prevalence rates were 23% (95% CI: 0.16-0.32) in men and 38% (95% CI: 0.20-0.61) in women. Africa had the highest prevalence (60%, 95% CI: 0.21-0.99), followed by Asia (40%, 95% CI: 0.28-0.51), while Europe and North America had similar prevalence rates at 34% (95% CI: 0.27-0.41) and 31% (95% CI: 0.27-0.38), respectively. Regarding psoriasis severity, obesity prevalence was higher in moderate psoriasis (36%, 95% CI: 0.20-0.64) and lower in mild psoriasis (27%, 95% CI: 0.16-0.46). The prevalence of obesity in the patients with severe psoriasis was 30% (95% CI: 0.20-0.45).

CONCLUSION

This study underscores the importance of identifying and treating obesity in patients with psoriasis to mitigate disease progression. However, more high-quality observational studies are required to elucidate their global prevalence and comorbid associations.

SCORE2 Screening Tool for Cardiovascular Risk Assessment in Psoriasis-A Case-Control Study

Background: Psoriasis is a common, T-cell-mediated inflammatory and immune-mediated skin disease. Numerous studies confirmed that patients with psoriasis have a significant frequency of cardiovascular (CV) risk factors and CV diseases (CVDs). Risk stratification is helpful in light of the elevated risk of CVD in psoriasis patients. SCORE2 and SCORE2-OP, a new algorithm derived, calibrated and validated to predict the 10-year risk of first-onset CVD in European populations, enhances the identification of individuals at higher risk of developing CVD across Europe. Objective: Using the SCORE2 and SCORE2-OP scoring systems, the current study objective was to evaluate CV risk in Slovak psoriasis patients and the relationship between CV risk and psoriasis features in a real-world setting. Results: A case-control study was conducted involving 115 outpatients with plaque psoriasis and 66 age- and gender-matched controls with skin conditions other than psoriasis. Patients with psoriasis had significantly higher mean SCORE2 values. In the age group up to 50 years, more psoriasis patients were classified as moderate risk than controls (33.8% vs. 13.6%, p = 0.010); the high-risk category was dominated by psoriasis patients. Analysing the relationship between CV risk and selected variables, we determined, using linear regression, the dependence of the SCORE2 risk score on gender in the age group up to 50 years, on age in both age groups, on waist circumference (WC) in the category up to 50 years and on the duration and severity of psoriasis in both age groups using linear regression. For individuals older than 70, we estimated the SCORE2-OP risk score, with the average risk score being 19.5 ± 4.95. We did not observe controls with a high risk score. Psoriasis patients were more likely to be smokers and had significantly higher mean values for body mass index (BMI), WC, total cholesterol (TC), low-density lipoprotein (LDL) and systolic blood pressure (BP). Conclusions: Because CV risk factors and psoriasis are strongly related, the importance of CV risk stratification is growing, and initiating preventive lifestyle changes or therapeutic interventions in patients with psoriasis is warranted.

Impact of Biologic Therapy on Key Cardiovascular Risk Parameters in a Psoriatic Cohort-a Retrospective Review

BACKGROUND

Psoriasis is a risk factor for cardiovascular disease. Biologic agents have revolutionised psoriatic skin control. This study aims to assess the change in cardiovascular risk factors in a cohort of patients treated with 1 year of continuous biologic treatment.

METHODS

A retrospective medical record review was conducted of consecutive patients receiving biologic therapy for chronic plaque psoriasis in a single dermatology centre at a major tertiary hospital in Australia. The effect of biologic therapy on psoriasis was assessed using a psoriasis area severity index (PASI). Cardiovascular risk factors included systolic blood pressure (SBP), diastolic BP (DBP), heart rate (HR) and body mass index (BMI). Measurements at baseline and 1-year follow-up were compared using paired t-tests.

RESULTS

A total of 106 patients were reviewed with a median age of 44 years, and 63% of the patients were male. At baseline, mean BMI was 30 (SD 7), mean SBP was 129 (SD 17), mean DBP was 81 (SD 9) and mean HR was 82 (SD 14). Over 12 months, the PASI was reduced from 17.4 (SD 8.5) to 1.4 (SD 1.7, p < 0.001) indicating skin improvement. There was no significant difference from baseline in SBP (difference 2.3 mmHg, 95% CI - 1.4-5.9), DBP (0.6 mmHg, 95% CI - 1.2-2.5), BMI (difference - 0.1 kg/m2, 95% CI - 0.9-0.7) or HR (difference 1.3, 95% CI - 3.9-6.4).

CONCLUSION

In patients with psoriasis, markers of cardiovascular disease risk did not improve after 1 year of biologic therapy despite significant improvements in psoriasis skin severity.

Development and trends in metabolomics studies in psoriasis: A bibliometric analysis of related research from 2011 to 2024

Background

Psoriasis is a chronic, inflammatory skin disease with autoimmune characteristics. Recent research has made significant progress in the field of psoriasis metabolomics. However, there is a lack of bibliometric analysis on metabolomics of psoriasis. The objective of this study is to utilize bibliometrics to present a comprehensive understanding of the knowledge structure and research hotspots in psoriasis within the field of metabolomics.

Methods

We conducted a bibliometric analysis by searching the Web of Science Core Collection database for publications on metabolomics in psoriasis from 2011 to 2024. To perform this analysis, we utilized tools such as VOSviewers, CiteSpace, and the R package "bibliometrix".

Results

A total of 307 articles from 47 countries, with the United States and China leading the way, were included in the analysis. The publications focusing on metabolomics in psoriasis have shown a steady year-on-year growth. The Medical University of Bialystok is the main research institution. The International Journal of Molecular Sciences emerges as the prominent journal in the field, while the Journal of Investigative Dermatology stands out as the highly co-cited publication. A total of 2029 authors contributed to these publications, with Skrzydlewska Elzbieta, Baran Anna, Flisiak Iwona, Murakami Makoto being the most prolific contributors. Notably, Armstrong April W. received the highest co-citation. Investigating the mechanisms of metabolomics in the onset and progression of psoriasis, as well as exploring therapeutic strategies, represents the primary focus of this research area. Emerging research hotspots encompass inflammation, lipid metabolism, biomarker, metabolic syndrome, obesity, and arthritis.

Conclusion

The results of this study indicate that metabolism-related research is thriving in psoriasis, with a focus on the investigation of metabolic targets and interventions within the metabolic processes. Metabolism is expected to be a hot topic in future psoriasis research.

Childhood Obesity, Weight Change, and Pediatric Immune-Mediated Skin Diseases

Whether childhood obesity or weight gain leads to the development of pediatric immune-mediated skin diseases remains unclear. We aimed to determine the associations between body mass index or body mass index changes and the development of 3 main immune-mediated skin diseases-alopecia areata, atopic dermatitis (AD), and psoriasis-by analyzing a longitudinal cohort of 2,161,900 Korean children from 2009 to 2020. The findings indicated that children who were obese had a higher risk of pediatric immune-mediated skin diseases than those with normal weight (P for trend < .01). An increase in body mass index was associated with a higher risk of AD, whereas a decrease in body mass index was correlated with a reduced risk of AD. Children who gained weight, transitioning from normal to overweight, exhibited a higher AD risk than those who maintained a normal weight (adjusted hazard ratio = 1.15, 95% confidence interval = 1.11-1.20). However, those who shifted from being overweight to achieving a normal weight (adjusted hazard ratio = 0.87, 95% confidence interval = 0.81-0.94) had a lower AD risk than children who were overweight who maintained their weight. In summary, early childhood obesity may increase the risk of pediatric immune-mediated skin diseases. Weight gain may increase AD risk, whereas weight loss may lower the risk.

Non-alcoholic Fatty Liver Disease Among Iraqi Patients With Psoriasis: A Case-Control Study

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide. Several studies have shown that patients with psoriasis have a higher risk of developing NAFLD. Obesity, metabolic syndrome, and cytokine-mediated inflammation might be the link between psoriasis and NAFLD.

AIMS

This study aims to investigate the prevalence of NAFLD among psoriatic Iraqi patients and examine the relationship with disease severity using the Psoriasis Area and Severity Index (PASI) score and the correlation with different clinical and laboratory parameters.

SUBJECTS AND METHODS

A case-control study on 130 psoriatic patients and 130 age-, sex-, and BMI-matched healthy controls was conducted at the Department of Dermatology in Basra Teaching Hospital from November 2022 to October 2023. All demographic and clinical data were collected using a pre-designed questionnaire, and NAFLD was diagnosed through a FibroScan examination performed on each participant. The severity of psoriasis was determined using the PASI score. Fasting glucose, liver enzymes, and lipid profile levels were investigated, and metabolic syndrome was identified.

RESULTS

The prevalence of NAFLD was significantly higher in our psoriatic patients than in the control group (66.2% vs. 42.3%, OR=2.6, P<0.01). Psoriatic patients were found to have more severe NAFLD than the controls, as evidenced by their steatosis and fibrosis staging (P<0.01). In patients with psoriasis, NAFLD was associated with a higher prevalence of diabetes (17.4%) and metabolic syndrome (55.8%). Furthermore, psoriatic patients with NAFLD had significantly higher values of BMI, waist circumference, PASI score, as well as serum alanine transaminase (ALT), triglyceride, cholesterol, low-density lipoprotein (LDL), and fasting glucose levels. The study also found a significant positive correlation between the psoriasis severity based on PASI and the steatosis score. Metabolic syndrome, PASI, BMI, serum triglycerides, LDL, and age are the independent predictors of NAFLD.

CONCLUSIONS

NAFLD is highly prevalent among psoriatic patients affecting more than half of them and closely associated with metabolic syndrome and severity of psoriasis. Routine screening for NAFLD may be necessary in psoriatic patients particularly when considering the use of hepatotoxic drug therapy.

The management of cardiovascular risk in psoriatic disease: A bridge over troubled water

Evidence that psoriatic disease is burdened by an excess cardiovascular (CV) risk has accrued, however many questions remain unanswered. Although an interplay between traditional risk factors inflammation, disease activity and pharmacological therapies, as observed in rheumatoid arthritis (RA), may account for this increased risk, metabolic comorbidities rather than inflammation seem to have a leading role in psoriatic disease. Therefore, specific approaches, risk factors targeting and the importance of traditional risk factors and inflammation management need to be considered. The purpose of this review article is to discuss current data on CV risk in psoriatic disease, and to outline similarities and differences with RA in the light of international recommendations. Arguments in favour of developing specific guidance for CV prevention in psoriatic disease are discussed.

Phenotypes and Serum Biomarkers in Sarcoidosis

Sarcoidosis is a multisystem disease, which is diagnosed on a compatible clinical presentation, non-necrotizing granulomatous inflammation in one or more tissue samples, and exclusion of alternative causes of granulomatous disease. Considering its heterogeneity, numerous aspects of the disease remain to be elucidated. In this context, the identification and integration of biomarkers may hold significance in clinical practice, aiding in appropriate selection of patients for targeted clinical trials. This work aims to discuss and analyze how validated biomarkers are currently integrated in disease category definitions. Future studies are mandatory to unravel the diverse contributions of genetics, socioeconomic status, environmental exposures, and other sociodemographic variables to disease severity and phenotypic presentation. Furthermore, the implementation of transcriptomics, multidisciplinary approaches, and consideration of patients' perspectives, reporting innovative insights, could be pivotal for a better understanding of disease pathogenesis and the optimization of clinical assistance.

The Effect of a Ketogenic Diet versus Mediterranean Diet on Clinical and Biochemical Markers of Inflammation in Patients with Obesity and Psoriatic Arthritis: A Randomized Crossover Trial

The effect of different diet patterns on psoriasis (PSO) and psoriatic arthritis (PSA) is unknown. Τhe aim of our study was to evaluate the effectiveness of a Mediterranean diet (MD) and Ketogenic diet (KD), in patients with PSO and PSA. Twenty-six patients were randomly assigned to start either with MD or KD for a period of 8 weeks. After a 6-week washout interval, the two groups were crossed over to the other type of diet for 8 weeks. At the end of this study, MD and KD resulted in significant reduction in weight (p = 0.002, p < 0.001, respectively), in BMI (p = 0.006, p < 0.001, respectively), in waist circumference (WC) (p = 0.001, p < 0.001, respectively), in total fat mass (p = 0.007, p < 0.001, respectively), and in visceral fat (p = 0.01, p < 0.001, respectively), in comparison with baseline. After KD, patients displayed a significant reduction in the Psoriasis Area and Severity Index (PASI) (p = 0.04), Disease Activity Index of Psoriatic Arthritis (DAPSA) (p = 0.004), interleukin (IL)-6 (p = 0.047), IL-17 (p = 0.042), and IL-23 (p = 0.037), whereas no significant differences were observed in these markers after MD (p > 0.05), compared to baseline. The 22-week MD-KD diet program in patients with PSO and PSA led to beneficial results in markers of inflammation and disease activity, which were mainly attributed to KD.

Triggers for the onset and recurrence of psoriasis: a review and update

Psoriasis is an immune-mediated inflammatory skin disease, involving a complex interplay between genetic and environmental factors. Previous studies have demonstrated that genetic factors play a major role in the pathogenesis of psoriasis. However, non-genetic factors are also necessary to trigger the onset and recurrence of psoriasis in genetically predisposed individuals, which include infections, microbiota dysbiosis of the skin and gut, dysregulated lipid metabolism, dysregulated sex hormones, and mental illness. Psoriasis can also be induced by other environmental triggers, such as skin trauma, unhealthy lifestyles, and medications. Understanding how these triggers play a role in the onset and recurrence of psoriasis provides insights into psoriasis pathogenesis, as well as better clinical administration. In this review, we summarize the triggers for the onset and recurrence of psoriasis and update the current evidence on the underlying mechanism of how these factors elicit the disease. Video Abstract.

A Bibliometric Analysis of Global Research Trends in Psoriasis and Metabolic Syndrome

Background

Psoriasis is a frequent form of chronic inflammation in dermatology that is unmistakably linked to the metabolic syndrome (MetS) and its elements. This study was to explore the current status and new developments in the global research, and the holistic landscape of this field more intuitively through bibliometric analysis of scientific output and activity.

Methods

Publications regarding psoriasis and MetS were searched and chosen from the database of the Web of Science Core Collection. Excel 2019, VOSviewer, and CiteSpace software were utilized to conduct bibliometric analysis.

Results

There were 1096 publications included. The scientific outputs in this field had increased from 2004 to 2022, and the expansion could continue in the following years. The United States contributed the most publications (241, 21.99%) and had the most citation frequency (13,489 times). The University of California System was the most productive affiliation. Girolomoni G., Armstrong A.W., Gisondi P. and Gelfand J.M. were key and influential researchers. Journal of the European Academy of Dermatology and Venereology published the greatest number of articles (65 articles). By analyzing keyword frequency and clustering, we have identified the following areas of research interest and frontiers: prevalence, risk, association, gene expression, waist circumference, adipose tissue inflammation, vascular inflammation, cardiovascular disease, psoriatic arthritis, and fibrosis.

Conclusion

This bibliometric analysis elucidates research domain of psoriasis and MetS, portraying present hotspots and future emerging trends. This field has generated significant interest and displays potential for further growth. The United States has made distinguished contributions, and currently dominates this field.

Self-assembled hyaluronic acid nanoparticles for the topical treatment of inflammatory skin diseases: Beyond drug carriers

Inflammatory skin diseases represent a significant health concern, affecting approximately 20-25% of the global population. These conditions not only reduce an individual's quality of life but also impose a huge burden on both humanity and society. However, addressing these challenges is hindered by their chronic nature, insufficient therapeutic effectiveness, and the propensity for recurrence and adverse side effects. Hyaluronic acid (HA) has emerged as a potential solution to these barriers, owing to its excellent attributes such as biocompatibility, non-toxicity, and targeted drug delivery. However, its practical application has been limited because endogenous hyaluronidase (HYAL) rapidly degrades HA in inflamed skin thus reducing its ability to penetrate deep into the skin. Interestingly, recent research has expanded the role of self-assembled HA-nanoparticles (HA-NPs) beyond drug carriers; they are resistant to HYAL, thereby enabling deep skin penetration, and possess inherent anti-inflammatory properties. Moreover, these abilities can be fine-tuned depending on the conditions during particle synthesis. Additionally, their role as a drug delivery system holds potential for use as a multi-target drug or hybrid drug. In conclusion, this review aims to specifically introduce and highlight the emerging potential of HA-NPs as a topical treatment for inflammatory skin conditions.

PRDM16 regulates γδT17 cell differentiation via controlling type 17 program and lipid-dependent cell fitness

γδT17 cells are a subset of γδT cells producing IL-17, which is crucial for protection against bacterial and fungal infections. It has recently been shown that γδT17 cells have enriched lipid storage and lipid metabolism. However, the regulation of γδT17 cell function and differentiation with respect to lipids remains unknown. Here, we report that PRDM16 is a critical regulator of γδT17 cell differentiation, controlling type 17 immunity gene expression program and lipid-dependent cell fitness. We demonstrated that γδT17 cells have higher lipid-dependent cell fitness, which is negatively correlated with the expression of Prdm16. Loss of Prdm16 enhances the function and differentiation of γδT17 cells, and increases their fitness in lipid-rich environments. Specifically, loss of Prdm16 exacerbates development of psoriasis in the skin, a lipid-rich organ, and Prdm16 controls lipid-mediated differentiation of Vγ4+ γδT17 cells, which are the major source of IL-17 during the onset of psoriasis. Our study highlights the potential impact of PRDM16 on lipid-dependent fitness and protective immune function of γδT cells and also on the immunotherapy of psoriasis and inflammatory diseases.

Improvement in Cutaneous Conditions Can Benefit Some Health Conditions in the Elderly

As we are aging, a number of cutaneous and extracutaneous disorders will be developed. Although the pathogenesis of these aging-associated disorders is not clear yet, abnormalities in the skin are linked to some aging-associated disorders at least to some extent. Inflammatory dermatoses such as psoriasis and atopic dermatitis predispose to the development of cardiovascular diseases, obesity and type 2 diabetes. In addition, both chronologically aged skin and individuals with some aging-associated systemic conditions display altered epidermal function, such as reduced stratum corneum hydration levels, which can provoke cutaneous inflammation. Because aged skin exhibits higher expression levels of inflammatory cytokines, which play a pathogenic role in a variety of aging-associated health condition, the association of the skin with some aging-associated disorders is likely mediated by inflammation. This postulation is supported by the evidence that improvement in either epidermal function or inflammatory dermatoses can mitigate some aging-associated disorders such as mild cognitive impairment and insulin sensitivity. This perspective discusses the association of the skin with aging-associated disorders and highlights the potential of improvement in cutaneous conditions in the management of some health conditions in the elderly.

No causal effect of genetically determined circulating homocysteine levels on psoriasis in the European population: evidence from a Mendelian randomization study

Background

Although numerous studies demonstrated a link between plasma homocysteine (Hcy) levels and psoriasis, there still exists a certain level of controversy. Therefore, we conducted a Mendelian randomization study to investigate whether homocysteine plays a causative role in the development or exacerbation of psoriasis.

Methods

A two-sample Mendelian randomization (MR) analysis was conducted. Summary-level data for psoriasis were acquired from the latest R9 release results from the FinnGen consortium (9,267 cases and 364,071 controls). Single nucleotide polymorphisms (SNPs) robustly linked with plasma Hcy levels at the genome-wide significance threshold (p < 5 × 10-8) (18 SNPs) were recognized from the genome-wide meta-analysis on total Hcy concentrations (n = 44,147 participants) in individuals of European ancestry. MR analyses were performed utilizing the random-effect inverse variance-weighted (IVW), weighted median, and MR-Egger regression methods to estimate the associations between the ultimately filtrated SNPs and psoriasis. Sensitivity analyses were conducted to evaluate heterogeneity and pleiotropy.

Results

MR analyses revealed no causal effects of plasma Hcy levels on psoriasis [IVW: odds ratio (OR) = 0.995 (0.863-1.146), p = 0.941; weighed median method: OR = 0.985 (0.834-1.164), p = 0.862; MR-Egger regression method: OR = 0.959 (0.704-1.305), p = 0.795]. The sensitivity analyses displayed no evidence of heterogeneity and directional pleiotropy, and the causal estimates of Hcy levels were not influenced by any individual SNP.

Conclusion

Our study findings did not demonstrate a causal effect of genetically determined circulating Hcy levels on psoriasis.

Baseline Characteristics of Canadian Patients in the Psoriasis Longitudinal Assessment and Registry (PSOLAR)

BACKGROUND

The Psoriasis Longitudinal Assessment and Registry (PSOLAR) is a global, prospective, longitudinal, disease-based registry. It serves as a post-marketing safety commitment with a focus on patients with moderate to severe plaque psoriasis who are candidates for systemic therapy.

OBJECTIVES

To describe the baseline disease demographics and clinical characteristics of a Canadian subgroup of participants enrolled in PSOLAR.

METHODS

Baseline demographic/disease characteristics, medical histories, and previous psoriasis treatments for Canadian patients in PSOLAR were summarized using descriptive statistics.

RESULTS

There were 1896 patients analyzed in the Canadian subgroup at 37 clinical sites, accounting for 15.7% of the global PSOLAR population. Baseline disease and clinical characteristics were as expected for a moderate to severe psoriasis population and were generally similar to the global PSOLAR population. Two distinctions were noted in the Canadian subgroup versus those enrolled globally: a higher proportion of patients were overweight/obese (84.7% vs. 80.4%) and male (61.4% vs. 54.7%). In addition, the Canadian subgroup had numerically higher historical peak disease activity (PGA score 3.35 vs. 3.1) and longer disease duration (22.3 years vs. 17.5 years). Canadian PSOLAR patients reported a variety of comorbidities, including psoriatic arthritis (31.5%), hypertension (34.6%), hyperlipidemia (24.3%), mental illness (24.1%), and inflammatory bowel disease (1.6%).

CONCLUSION

The Canadian subgroup of PSOLAR patients was generally similar to those enrolled globally with respect to baseline disease demographics and clinical characteristics. Multiple comorbidities are noted in the Canadian subgroup, underscoring the need for a holistic approach to the treatment of psoriatic patients.

Effects of liraglutide among patients living with psoriasis and obesity

BACKGROUND AND AIMS

There is a bidirectional relationship between obesity and psoriasis. Liraglutide has been shown to improve the severity of psoriatic lesions in patients with type 2 diabetes. We aimed to study the effects of liraglutide 3mg in patients with obesity and psoriasis.

METHODS

Twenty patients started treatment with liraglutide 3mg for 3 months. Severity of the lesions was evaluated using the Psoriasis Area Severity Index (PASI) and the visual analogue scale of pain (VAS), and quality of life with the Dermatology Quality Index (DLQI).

RESULTS

There was a significant reduction in BMI (38.9±5.8 vs. 36.4±5.6; p<0.001), CRP (4.5±2.4 vs. 3±2mg/L; p<0.01), homocysteine (13.3±3.6 vs. 11.9±3μmol/L; p<0.01), ferritin (185.4±142.2 vs. 97.43±114.4ng/mL; p=0.04) and plasma cortisol (12±3.1 vs. 11.6±2.2μg/dL, p=0.04). PASI (10±8.4 vs. 5.1±6; p<0.0001), VAS (4.1±2 vs. 2.3±0.92; p=0.009) and DLQI (12.7±7 vs. 6.4±5.6, p<0.0001) improved significantly. In multiple regression analysis, weight loss did not correlate with any inflammatory parameter or PASI.

CONCLUSIONS

Liraglutide 3mg for three months is effective and safe in reducing weight and improving psoriatic lesions among patients with psoriasis and obesity. Besides, there is an improvement in psoriatic lesions regardless of weight loss that deserves further studies.