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Evyana D, Novianto E, Budianti WK, Krisanti RIA, Wisnu W, Wibawanti R, Nilasari H, Legiawati L, Hapsari SAR, Mutmainnah E. Association between the severity of hard-to-treat psoriasis and the prevalence of metabolic syndrome: A hospital-based cross-sectional study in Jakarta, Indonesia. PLoS One 2024; 19:e0302391. [PMID: 38683749 PMCID: PMC11057762 DOI: 10.1371/journal.pone.0302391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 04/02/2024] [Indexed: 05/02/2024] Open
Abstract
Psoriatic lesions on the scalp, face, intertriginous, genitals, palms/soles, and nails are often delay diagnosed, hard-to-treat, and cause disability. Metabolic syndrome (MetS) is one of the most frequent and significant comorbidities in psoriasis. Many studies have discovered a link between psoriasis and MetS, but none have specifically assessed the hard-to-treat psoriasis in Indonesian population. This is a multicenter study involving four dermatology referral hospitals to investigate the association between psoriasis severity that has hard-to-treat lesions with the prevalence of MetS in Jakarta, Indonesia. Data was collected from April to October 2022. The severity of 84 hard-to-treat psoriasis patients was measured by Psoriasis Area Severity Index (PASI) scores. The participants divided into PASI score >10 (severe) and ≤ 10 (mild-moderate) groups. MetS was identified based on the modified National Cholesterol Education Program Adult Treatment Panel III. MetS was found in 64.3% of patients. Patients with a PASI score>10 had a significantly higher risk of metabolic syndrome compared to those with a score ≤ 10 (78.6% vs 50%, OR 3.667; 95% CI 1.413-9.514; p = 0.006). The prevalence of hypertension (p = 0.028), low levels of high-density lipoprotein (HDL) cholesterol (p = 0.01), mean fasting blood sugar (p = 0.018), and triglyceride levels (p = 0.044) between the two groups differed significantly. This study found most frequent components of MetS were abdominal obesity, decreased levels of HDL cholesterol, hypertension, hyperglycemia, and hypertriglyceridemia respectively. Individuals with severe hard-to-treat psoriasis had a 3.67 times more likely to have MetS rather than the mild-moderate group.
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Affiliation(s)
- Dina Evyana
- Faculty of Medicine Universitas Indonesia, Department of Dermatology and Venereology, Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Endi Novianto
- Faculty of Medicine Universitas Indonesia, Department of Dermatology and Venereology, Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Windy K. Budianti
- Faculty of Medicine Universitas Indonesia, Department of Dermatology and Venereology, Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Roro I. A. Krisanti
- Faculty of Medicine Universitas Indonesia, Department of Dermatology and Venereology, Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Wismandari Wisnu
- Faculty of Medicine Universitas Indonesia, Department of Internal Medicine, Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Retno Wibawanti
- Faculty of Medicine Universitas Indonesia, Department of Community medicine, Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Hanny Nilasari
- Faculty of Medicine Universitas Indonesia, Department of Dermatology and Venereology, Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Lili Legiawati
- Faculty of Medicine Universitas Indonesia, Department of Dermatology and Venereology, Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Saskia A. R. Hapsari
- Department of Dermatology and Venereology, Tarakan General Hospital, Jakarta, Indonesia
| | - Euis Mutmainnah
- Department of Dermatology and Venereology, Persahabatan Central General Hospital, Jakarta, Indonesia
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Gebauer K, Spelman L, Yamauchi PS, Bagel J, Nishandar T, Crane M, Kopeloff I, Kothekar M, Yao SL, Sofen HL. Efficacy and safety of tildrakizumab for the treatment of moderate-to-severe plaque psoriasis of the scalp: A multicenter, randomized, double-blind, placebo-controlled, Phase 3b study. J Am Acad Dermatol 2024:S0190-9622(24)00536-X. [PMID: 38554938 DOI: 10.1016/j.jaad.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/27/2024] [Accepted: 03/10/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Scalp psoriasis is common and difficult to treat. OBJECTIVE To evaluate efficacy and safety of tildrakizumab for the treatment of scalp psoriasis. METHODS In this Phase 3b, randomized, double-blind, placebo (PBO)-controlled study (NCT03897088), patients with moderate-to-severe plaque psoriasis affecting the scalp (Investigator Global Assessment modified [IGA mod] 2011 [scalp] ≥3, Psoriasis Scalp Severity Index [PSSI] ≥12, ≥30% scalp surface area affected) received tildrakizumab 100 mg or PBO at W0 and W4. The primary endpoint was IGA mod 2011 (scalp) score of "clear" or "almost clear" with ≥2-point reduction from baseline at W16 (IGA mod 2011 [scalp] response). Key secondary endpoints were PSSI 90 response at W12 and W16 and IGA mod 2011 (scalp) response at W12. Safety was assessed from adverse events. RESULTS Of patients treated with tildrakizumab (n = 89) vs PBO (n = 82), 49.4% vs 7.3% achieved IGA mod 2011 (scalp) response at W16 (primary endpoint) and 46.1% vs 4.9% at W12; 60.7% vs 4.9% achieved PSSI 90 response at W16 and 48.3% vs 2.4% at W12 (all P < .00001). No serious treatment-related adverse events occurred. LIMITATIONS Only short-term data are presented. CONCLUSION Tildrakizumab was efficacious for the treatment of scalp psoriasis with no new safety signals.
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Affiliation(s)
- Kurt Gebauer
- Fremantle Dermatology, Fremantle, WA, Australia; Probity Medical Research, Waterloo, Ontario, Canada.
| | - Lynda Spelman
- Veracity Clinical Research, Brisbane, QLD, Australia; Probity Medical Research, Woolloongabba, QLD, Australia
| | - Paul S Yamauchi
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jerry Bagel
- Psoriasis Treatment Center of Central New Jersey, East Windsor, New Jersey
| | | | - Michael Crane
- Sun Pharmaceutical Industries, Inc., Princeton, New Jersey
| | - Iris Kopeloff
- Sun Pharmaceutical Industries, Inc., Princeton, New Jersey
| | | | - Siu-Long Yao
- Sun Pharmaceutical Industries, Inc., Princeton, New Jersey
| | - Howard L Sofen
- David Geffen School of Medicine at UCLA, Los Angeles, California
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Pinter A, Tsianakas A, Eichner A. Efficacy and Safety of Topical Tacrolimus Microemulsion Applied Twice Daily in Patients with Mild to Moderate Scalp Psoriasis. Dermatol Ther (Heidelb) 2024; 14:521-532. [PMID: 38345680 PMCID: PMC10891015 DOI: 10.1007/s13555-024-01102-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/15/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Involvement of the scalp is common in psoriasis and severely affects the quality of life of those affected. It is difficult to treat and places special demands on the galenics of a drug formulation. Tacrolimus is a calcineurin inhibitor and is approved as an ointment formulation for the treatment of atopic dermatitis. The efficacy and safety of topically applied tacrolimus have also been studied and proven for psoriasis. However, no proprietary pharmaceutical product is currently approved for this indication. METHODS A multicenter, double-blind, vehicle-controlled phase 3 study was conducted to evaluate the efficacy and safety of 0.1% tacrolimus microemulsion when applied topically twice daily in 128 patients independently of sex with scalp psoriasis. RESULTS The primary efficacy analysis showed a scalp Investigator Global Assessment (s-IGA) of 0 (absence of disease) or 1 (very mild disease) at 8 weeks in 28.6% of subjects in the tacrolimus group, indicating a significantly better response (p = 0.0476, chi-square test) versus 12.7% of subjects in the placebo group (difference of 15.9%-points). The Dermatology Life Quality Index (DLQI) improved over time and was more pronounced in the group treated with tacrolimus-containing microemulsion than in the placebo group, but showed no statistically significant difference after 8 weeks of use (p = 0.193, ANCOVA). The safety analysis revealed no evidence of cutaneous side effects other than those known. Toxicologically relevant serum levels of tacrolimus could be excluded. CONCLUSION The study data show that 0.1% tacrolimus microemulsion has good efficacy and safety in the treatment of scalp psoriasis.
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Affiliation(s)
- Andreas Pinter
- Clinic for Dermatology, Venereology and Allergy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Adina Eichner
- Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06097, Halle (Saale), Germany.
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Horner ME, Orroth KK, Ma J, Duan Y, Cordey M. Redefining Disease Severity with Special Area Involvement and Reflecting on Treatment Patterns in a Real-World Psoriasis Population. Dermatol Ther (Heidelb) 2024; 14:187-199. [PMID: 38216820 PMCID: PMC10828323 DOI: 10.1007/s13555-023-01065-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/31/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND The International Psoriasis Council (IPC) recommends an approach that considers body surface area (BSA), involvement in special areas, and treatment history for classifying patients as candidates for topical or systemic treatment. This study aimed to quantify the burden of psoriasis by describing BSA distribution, special area involvement, and treatments in a real-world population. METHODS This retrospective cohort study included patients with psoriasis from the Optum® deidentified Electronic Health Records database with a BSA value (< 3%, 3-10%, and > 10%) recorded between 1 March 2014 and 1 September 2020. Treatments and special area involvement (face, scalp, palms/soles, nails, genitals) were identified within 90 days of the BSA value and stratified by BSA category. RESULTS Among eligible patients (N = 5120), mean age was 51.4 years and 49.3% were women. The majority of patients (78.9%) were treated with any topical. Proportions of patients with BSA < 3%, 3-10%, and > 10% were 23.4%, 41.9%, and 34.6%, respectively; proportions with 0, 1, and 2+ special areas were 21.6%, 31.6%, and 45.7%, respectively; and 44.4%, 45.7%, and 45.9% of patients with BSA < 3%, 3-10%, and > 10%, respectively, had 2+ special areas. CONCLUSION The IPC classification can likely identify many more patients who may benefit from systemic therapy than BSA alone.
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Affiliation(s)
- Mary E Horner
- Dermatology Consultants of Sacramento, 5340 Elvas Ave, Ste 600, Sacramento, CA, 95819, USA.
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Potestio L, Camela E, Cacciapuoti S, Fornaro L, Ruggiero A, Martora F, Battista T, Megna M. Biologics for the Management of Erythrodermic Psoriasis: An Updated Review. Clin Cosmet Investig Dermatol 2023; 16:2045-2059. [PMID: 37560255 PMCID: PMC10408653 DOI: 10.2147/ccid.s407813] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
Erythrodermic psoriasis (EP) is a severe and rare variant of psoriasis (less than 3% of cases), characterized by generalized scaling and erythema affecting more than 90% of body surface area. Several systemic symptoms can be present in patients with EP such as lymphadenopathy, arthralgia, fever, fatigue, dehydration, serum electrolyte disturbances, and tachycardia making this condition a possible life-threatening disease, particularly if appropriate treatments are not performed. In this scenario, effective and safe therapies are required. Unfortunately, the rarity of EP makes head-to-head Phase III trials challenging, leading to the lack of established guidelines for its management. Globally, conventional systemic drugs such as cyclosporine, methotrexate, and retinoids often have contraindications linked to patients' comorbidities and have not shown a high profile of efficacy and safety. Recently, the development of biologic drugs including anti-tumor necrosis factor-α and anti-interleukin 12-23, 23, and 17 has revealed favorable results for the management of plaque psoriasis, making them also a possible therapeutic option for EP disease. However, their use in EP is still off-label. The aim of our study was to review current literature on the use of biologic drugs for the treatment of EPs in order to offer a wide perspective on their possible application in EP management.
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Affiliation(s)
- Luca Potestio
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Elisa Camela
- Dermatology Unit, Istituto Dermopatico dell’Immacolata - IRCCS, Rome, Italy
| | - Sara Cacciapuoti
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luigi Fornaro
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Angelo Ruggiero
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabrizio Martora
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Teresa Battista
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Cetkovská P, Dediol I, Šola M, Kojanová M, Trčko K, Čarija A, Čeović R, Ledić-Drvar D, Kaštelan M, Hrabar A, Missoup MC, Mamun K. Apremilast Use in Severe Psoriasis: Real-World Data from Central and Eastern Europe. Adv Ther 2023; 40:1787-1802. [PMID: 36862361 PMCID: PMC9979124 DOI: 10.1007/s12325-023-02468-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/15/2023] [Indexed: 03/03/2023]
Abstract
INTRODUCTION The broad and sustained efficacy of apremilast for psoriasis has been demonstrated in randomized and real-world observational studies. Data from Central and Eastern Europe (CEE) are lacking. Moreover, apremilast use in this region is limited by country-specific reimbursement criteria. This is the first study to report data on the real-world use of apremilast in the region. METHODS APPRECIATE (NCT02740218) was an observational, retrospective, cross-sectional study assessing psoriasis patients 6 (± 1) months after apremilast treatment initiation. The study aimed to describe the characteristics of patients with psoriasis receiving apremilast, estimate treatment outcomes, including Psoriasis Area Severity Index (PASI), Body Surface Area (BSA), and Dermatology Life Quality Index (DLQI), and assess dermatologists' and patients' perspectives on treatment using questionnaires including the Patient Benefit Index (PBI). Adverse event reports were taken from the medical records. RESULTS Fifty patients (Croatia: 25; Czech Republic: 20; Slovenia: 5) were enrolled. In patients continuing apremilast at 6 (± 1) months, mean (± SD) PASI score was reduced from 16.2 ± 8.7 points at treatment initiation to 3.1 ± 5.2 at 6 (± 1) months; BSA from 11.9% ± 10.3% to 0.8% ± 0.9%; DLQI from 13.7 ± 7.4 points to 1.6 ± 3.2. PASI 75 was reached by 81% of patients. Physicians reported that the overall treatment success fulfilled their expectations in more than two thirds of patients (68%). At least three-quarters of patients reported apremilast had a quite or very high benefit on the needs they identified as being most important. Apremilast was well tolerated; no serious or fatal adverse events were identified. CONCLUSION Apremilast was effective in reducing skin involvement and improving quality of life in CEE patients having severe disease. Treatment satisfaction among physicians and patients was very high. These data add to the growing body of evidence showing consistent effectiveness of apremilast across the continuum of psoriasis disease severity and manifestations. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT02740218.
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Affiliation(s)
- Petra Cetkovská
- Department of Dermatology and Venereology, Faculty of Medicine, University Hospital in Pilsen, Charles University, Edvarda Beneše 1128/13, 301 00, Pilsen, Czech Republic.
| | - Iva Dediol
- Department of Dermatology and Venereology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Marija Šola
- Department of Dermatology and Venereology, University Hospital Center Osijek, Osijek, Croatia
| | - Martina Kojanová
- Department of Dermatology and Venereology, First Faculty of Medicine, General University Hospital, Charles University, Prague, Czech Republic
| | - Katarina Trčko
- Department of Dermatology and Venereology, University Clinical Center Maribor, Maribor, Slovenia
| | - Antoanela Čarija
- Department of Dermatology and Venereology, School of Medicine Split, University of Split, Split, Croatia
| | - Romana Čeović
- Department of Dermatology and Venereology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Daniela Ledić-Drvar
- Department of Dermatology and Venereology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Marija Kaštelan
- Department of Dermatology and Venereology, Medical Faculty, Clinical Hospital Center Rijeka, University of Rijeka, Rijeka, Croatia
| | - Andina Hrabar
- Department of Medicine, Amgen Croatia, Zagreb, Croatia
| | | | - Khalid Mamun
- Department of Medicine, Amgen Inc., Thousand Oaks, CA, USA
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Kimwell MJM, de Guzman DC, Onda AJM, Dofitas BL, Frez MLF, Mendoza CG, Rivera FD, Almirol BJQ, Malaluan MJQ, Guce K. Economic Evaluation of Selected Interleukin Inhibitors Versus Methotrexate for Moderate-to-Severe Plaque Psoriasis From the Philippine Payer Perspective. Value Health Reg Issues 2023; 34:100-107. [PMID: 36638606 DOI: 10.1016/j.vhri.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 10/31/2022] [Accepted: 12/02/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES We conducted an economic evaluation of interleukin inhibitors (ILIs) guselkumab, ixekizumab (IXE), secukinumab (SEC), and ustekinumab to a methotrexate (MTX) comparator for biologic-naive adult Filipino patients with moderate-to-severe chronic plaque psoriasis. METHODS A 1-year decision tree and 5-year Markov model were used to estimate incremental cost-effectiveness ratios (ICERs) in Philippine pesos (PHP) per Psoriasis Area Severity Index improvement of at least 75%. For health technology assessment purposes, we also estimated the budget impact of subsidies for SEC to a Government of the Philippines (GoP) payer. Deterministic and probabilistic sensitivity analyses were performed. Data sources included global literature and local intervention prices. RESULTS All ILIs were more effective but also more expensive than MTX. In the base case, only IXE and SEC were cost-effective treatments at a gross domestic product-benchmarked threshold, yielding ICERs of PHP468 098.01 and PHP483 525.32 per PASI responder, respectively. GUS and UST were less likely to be cost-effective throughout a range of simulated thresholds. ICERs were most responsive to discontinuation rates and drug prices. Full subsidy of SEC for 5 years would cost the GoP PHP1.83 billion more than a similar subsidy for MTX. CONCLUSIONS ILIs were clearly more effective than MTX, but only IXE and SEC were potentially cost-effective for a GoP payer. Any case in which SEC is fully subsidized is more expensive to the GoP than the base case. This study was limited by a lack of country-specific effectiveness data, underestimation of comparator costs, exclusion of noncutaneous and quality-of-life effects, and indirect costs.
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Affiliation(s)
- Miharu Jay M Kimwell
- School of Economics, University of the Philippines, Diliman, Quezon City, Philippines.
| | - Denese C de Guzman
- Technical and Policy Committee, Philippine Society of Public Health Physicians, Parañaque, Philippines
| | | | - Belen L Dofitas
- Department of Dermatology, University of the Philippines Manila - Philippine General Hospital, Manila, Philippines
| | - Ma Lorna F Frez
- Department of Dermatology, University of the Philippines Manila - Philippine General Hospital, Manila, Philippines
| | - Clarisse G Mendoza
- Immunodermatology Unit, Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Francisco D Rivera
- Department of Medical Dermatology, Rizal Medical Center, Pasig, Philippines
| | | | - Mark Jayson Q Malaluan
- Clinical Development and Medical Affairs, Novartis Healthcare Philippines, Inc, Makati City, Philippines
| | - Kristel Guce
- Value and Access, Novartis Healthcare Philippines, Inc, Makati City, Philippines
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Nery FVR, Souza DAS, Dantas JBDL, Martins GB, Reis SRDA, Medrado ARAP. Oral manifestations in patients diagnosed with psoriasis: A systematic review. SPECIAL CARE IN DENTISTRY 2023; 43:29-39. [PMID: 35714330 DOI: 10.1111/scd.12733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 01/21/2023]
Abstract
AIMS To identify the main types of oral lesions associated with psoriasis. METHODS AND RESULTS It was a systematic review, based on a search performed in the PubMed/Medline, and Scielo databases, and an associated manual search. Descriptors were selected from DeCs/MeSH and the PICOS strategy (population, intervention, comparison, outcomes, and study design) was applied. Randomized clinical trials and retrospective and prospective studies published from 2000 to 2022 were included, according to the PRISMA parameters (Preferred Reporting Items for Systematic Reviews and Meta-Analysis), registered in the PROSPERO platform. The STROBE quality scale (Strengthening the Reporting of Observational studies in Epidemiology) was also used. One hundred fourteen articles were identified using the search strategy, and nine articles were found in the manual search. Of the sixty-six preselected articles, seven were included in the study. Although it was not possible to identify a specific oral lesion associated with psoriasis, there was a greater occurrence of geographic tongue, fissured tongue, and Candida sp. infection CONCLUSION: Evidence shows that although patients with psoriasis may exhibit lesions in the oral mucosa, they are not specific to this condition. Further epidemiological studies are needed to address the association of psoriasis with possible changes in the oral mucosa.
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Affiliation(s)
| | | | - Juliana Borges de Lima Dantas
- PhD student of the Pos-graduate Program in Interactive Processes of Organs and Systems in the Institute of Health Sciences of the Federal University of Bahia, Professor at Bahiana - School of Medicine and Public Health, Professor of Adventist College of Bahia, Cachoeira, Bahia, Brazil
| | - Gabriela Botelho Martins
- PhD in Clinical Stomatology from PUC-RS, Associate Professor of Health Sciences Institute of the Federal University of Bahia, Salvador, Bahia, Brazil
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Scala E, Kaczmarczyk R, Zink A, Balato A, Amerio P, Argenziano G, Babino G, Bardazzi F, Bianchi L, Caldarola G, Campanati A, Chiricozzi A, Conti A, Damiani G, Dapavo P, De Simone C, Esposito M, Fabbrocini G, Fargnoli MC, Ferrara F, Fidanza R, Gualdi G, Guarneri C, Hansel K, Malagoli P, Malara G, Megna M, Micali G, Mugheddu C, Musumeci ML, Odorici G, Offidani A, Papaianni V, Pescitelli L, Prignano F, Raimondo A, Ribero S, Rongioletti F, Stingeni L, Trifirò C, Zanframundo S. Sociodemographic, clinical and therapeutic factors as predictors of life quality impairment in psoriasis: a cross‐sectional study in Italy. Dermatol Ther 2022; 35:e15622. [DOI: 10.1111/dth.15622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/25/2022] [Accepted: 06/03/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Emanuele Scala
- Division of Dermatology and Venereology, Department of Medicine Solna, and Center for Molecular Medicine Karolinska Institutet Stockholm Sweden
| | - Robert Kaczmarczyk
- Technical University of Munich, School of Medicine, Department of Dermatology and Allergy Munich Germany
| | - Alexander Zink
- Technical University of Munich, School of Medicine, Department of Dermatology and Allergy Munich Germany
- Dermatology and Venerology Unit, Department of Medicine Solna Karolinska University Hospital Stockholm Sweden
| | - Anna Balato
- Dermatology Unit University of Campania “Luigi Vanvitelli” Naples Italy
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Galluzzo M, Talamonti M, Cioni A, Maffei V, Shumak RG, Tofani L, Bianchi L, Campione E. Efficacy of Tildrakizumab for the Treatment of Difficult-to-Treat Areas: Scalp, Nail, Palmoplantar and Genital Psoriasis. J Clin Med 2022; 11:jcm11092631. [PMID: 35566756 PMCID: PMC9100809 DOI: 10.3390/jcm11092631] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 12/14/2022] Open
Abstract
Tildrakizumab, an IL-23 inhibitor, is effective and safe for the improvement of moderate-to-severe chronic plaque psoriasis. However, little evidence is available on the use of this biologic in psoriasis in difficult-to-treat locations. In this retrospective analysis, we treated patients with 100 mg tildrakizumab at Day 0, after 4 weeks and every 12 weeks thereafter. Disease severity and treatment response was assessed by the Psoriasis Area and Severity Index (PASI), the static Physician’s Global Assessment of Genitalia (sPGA-G), the Psoriasis Scalp Severity Index (PSSI), Nail Psoriasis Severity Index (NAPSI) and the Palmoplantar Psoriasis Area and Severity Index (ppPASI) at baseline and after 4, 12 and 28 weeks. We followed 18 patients (mean age 49.1 ± 12.7 years, 61.1% male) with psoriasis localized to the genital region (N = 7), scalp (N = 6), nails (N = 5) and palmar/plantar areas (N = 7). PASI score decreased from 11.5 at baseline to 3.1 and 2.4 at 12 and 28 weeks. Tildrakizumab treatment decreased sPGA-G (3.3 to 0.2), PSSI (36.2 to 2.7), NAPSI (48.4 to 15.7) and ppPASI (5.3 to 0) from baseline to 28 weeks, respectively. Data from this real-life retrospective analysis shows that tildrakizumab is an effective option for the management of psoriasis in difficult-to-treat areas.
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Affiliation(s)
- Marco Galluzzo
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (A.C.); (V.M.); (R.G.S.); (L.T.); (L.B.); (E.C.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
- Correspondence: ; Tel.: +39-06-2090-2743
| | - Marina Talamonti
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (A.C.); (V.M.); (R.G.S.); (L.T.); (L.B.); (E.C.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Arnaldo Cioni
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (A.C.); (V.M.); (R.G.S.); (L.T.); (L.B.); (E.C.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Virginia Maffei
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (A.C.); (V.M.); (R.G.S.); (L.T.); (L.B.); (E.C.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Ruslana Gaeta Shumak
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (A.C.); (V.M.); (R.G.S.); (L.T.); (L.B.); (E.C.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Lorenzo Tofani
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (A.C.); (V.M.); (R.G.S.); (L.T.); (L.B.); (E.C.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Luca Bianchi
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (A.C.); (V.M.); (R.G.S.); (L.T.); (L.B.); (E.C.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Elena Campione
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (A.C.); (V.M.); (R.G.S.); (L.T.); (L.B.); (E.C.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
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11
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Chen WY, Chen SC, Hsu SY, Lin YA, Shih CM, Huang CY, Wang KH, Lee AW. Annoying Psoriasis and Atopic Dermatitis: A Narrative Review. Int J Mol Sci 2022; 23:ijms23094898. [PMID: 35563285 PMCID: PMC9104570 DOI: 10.3390/ijms23094898] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 12/12/2022] Open
Abstract
Skin is an important organ that mainly functions as a barrier. Skin diseases can damage a person's self-confidence and reduce their willingness to socialize, as well as their social behavior and willingness. When the skin appearance is abnormal, in addition to affecting the quality of life, it often leads to personal, social, and psychological dysfunction and even induces depression. Psoriasis and atopic dermatitis are common chronic skin diseases. Their prevalence in the world is 3-10%, and there is an increasing trend year by year. These congenital or acquired factors cause the dysfunction of the immune system and then destroy the barrier function of the skin. Because these patients are flooded with a variety of inflammatory mediators, this causes skin cells to be in chronic inflammation. Therefore, psoriasis and atopic dermatitis are also considered systemic chronic inflammatory diseases. In the healthcare systems of developed countries, it is unavoidable to spend high costs to relieve symptoms of psoriasis and atopic dermatitis patients, because psoriasis and atopic dermatitis have a great influence on individuals and society. Giving a lot of attention and developing effective treatment methods are the topics that the medical community must work on together. Therefore, we used a narrative review manuscript to discuss pathogenesis, clinical classification, incidence, and treatment options, including topical medication, systemic therapeutics, immunosuppressive medication for psoriasis, and atopic dermatitis, as well as also comparing the differences between these two diseases. We look forward to providing readers with comprehensive information on psoriasis and atopic dermatitis through this review article.
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Affiliation(s)
- Wei-Yu Chen
- Department of Anatomy and Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (W.-Y.C.); (S.-C.C.); (S.-Y.H.); (Y.-A.L.)
- Department of Family Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei 11031, Taiwan
| | - Shao-Chuan Chen
- Department of Anatomy and Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (W.-Y.C.); (S.-C.C.); (S.-Y.H.); (Y.-A.L.)
| | - Shou-Yi Hsu
- Department of Anatomy and Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (W.-Y.C.); (S.-C.C.); (S.-Y.H.); (Y.-A.L.)
| | - Yu-An Lin
- Department of Anatomy and Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (W.-Y.C.); (S.-C.C.); (S.-Y.H.); (Y.-A.L.)
| | - Chun-Ming Shih
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (C.-M.S.); (C.-Y.H.)
- Cardiovascular Research Center, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei 11031, Taiwan
| | - Chun-Yao Huang
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (C.-M.S.); (C.-Y.H.)
- Cardiovascular Research Center, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei 11031, Taiwan
| | - Kuo-Hsien Wang
- Department of Dermatology, Taipei Medical University Hospital, Taipei 11031, Taiwan;
| | - Ai-Wei Lee
- Department of Anatomy and Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (W.-Y.C.); (S.-C.C.); (S.-Y.H.); (Y.-A.L.)
- Correspondence: ; Tel.: +886-2-2736-1661 (ext. 3255)
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12
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Elewski BE, Blauvelt A, Gallo G, Wolf E, McKean-Matthews M, Burge R, Merola JF, Gottlieb AB, Guenther LC. Simultaneous Nail and Skin Clearance in Ixekizumab Head-to-Head Trials for Moderate-to-Severe Psoriasis and Psoriatic Arthritis. Dermatol Ther (Heidelb) 2022; 12:911-920. [PMID: 35279805 PMCID: PMC9021345 DOI: 10.1007/s13555-022-00704-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction The lifetime incidence of nail psoriasis in patients with psoriasis is 80–90%, with 23–27% of patients having nail psoriasis at any given time. Nail psoriasis is even more prevalent in patients with comorbid psoriatic arthritis. Complete psoriasis clearance, an achievable therapeutic goal, should ideally include the resolution of nail psoriasis. Here, we assessed simultaneous skin and nail clearance in patients with psoriasis across five head-to-head trials comparing ixekizumab with other biologics. Methods Data were assessed in patients with moderate-to-severe psoriasis (with or without psoriatic arthritis) with nail psoriasis at baseline from the IXORA-R, IXORA-S, UNCOVER-2, UNCOVER-3, and SPIRIT-H2H trials. Ixekizumab patients received IXEQ2W to week 12 and IXEQ4W beyond week 12. PASI 100 depicted complete skin clearance, and PGA-F 0 (IXORA-R) or NAPSI 0 (all other trials) depicted complete nail clearance. Treatment comparisons were evaluated using the Cochran-Mantel-Haenszel test. Non-responder imputation was used for missing data. Results Ixekizumab achieved significantly greater simultaneous skin and nail complete clearance than etanercept (UNCOVER-2: p < 0.001 and UNCOVER-3: p < 0.001) at week 12, demonstrating an efficacious and rapid response. Across all five head-to-head trials, ixekizumab achieved a high rate of simultaneous skin and nail clearance (range: 28.6–45.9% of patients) by week 24 that was maintained up to week 52 (range: 40.5–51.4% of patients). Ixekizumab achieved numerically greater simultaneous complete clearance than guselkumab at week 24 (p = 0.079), but statistically significant greater simultaneous clearance compared to ustekinumab (p < 0.001) and adalimumab (p = 0.006) at week 24 and week 52 (p < 0.001 and p = 0.007, respectively). Conclusion In five head-to-head trials, ixekizumab-treated patients had higher rates of simultaneous complete skin and nail clearance compared to etanercept, guselkumab, ustekinumab, and adalimumab, thereby reinforcing ixekizumab’s ability to achieve high levels of efficacy in multiple domains of psoriatic disease. Trial registration NCT01474512, NCT01597245, NCT01646177, NCT03573323, NCT02561806, and NCT03151551.
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Affiliation(s)
| | | | - Gaia Gallo
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Eric Wolf
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Russel Burge
- Eli Lilly and Company, Indianapolis, IN, USA
- University of Cincinnati, Cincinnati, OH, USA
| | - Joseph F Merola
- Department of Medicine, Division of Rheumatology, and Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine, New York, NY, USA
| | - Lyn C Guenther
- Guenther Research Inc., London, ON, Canada
- Western University, London, ON, Canada
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13
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Galluzzo M, Talamonti M, Atzori L, Bardazzi F, Campanati A, Di Cesare A, Diotallevi F, Flori ML, Mugheddu C, Offidani A, Piaserico S, Russo F, Sacchelli L, Bianchi L, Prignano F. Secukinumab for the treatment of palmoplantar psoriasis: a 2-year, multicenter, real-life observational study. Expert Opin Biol Ther 2022; 22:547-554. [DOI: 10.1080/14712598.2022.2029841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Marco Galluzzo
- Dermatology Unit, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Marina Talamonti
- Dermatology Unit, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Laura Atzori
- Section of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Federico Bardazzi
- Dermatology Division, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Anna Campanati
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, Italy
| | - Antonella Di Cesare
- Dermatology Clinic, Department of Health Sciences, University of Florence, Florence, Italy
| | - Federico Diotallevi
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, Italy
| | - Maria Laura Flori
- Dermatology Section, Department of Medical, Surgical and Neurological Science, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - Cristina Mugheddu
- Section of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Annamaria Offidani
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, Italy
| | - Stefano Piaserico
- Dermatology Unit - Department of Medicine, University of Padova, Padova, Italy
| | - Filomena Russo
- Dermatology Section, Department of Medical, Surgical and Neurological Science, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - Lidia Sacchelli
- Dermatology Division, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Luca Bianchi
- Dermatology Unit, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Francesca Prignano
- Dermatology Clinic, Department of Health Sciences, University of Florence, Florence, Italy
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14
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Reich K, Korge B, Magnolo N, Manasterski M, Schwichtenberg U, Staubach-Renz P, Kaiser S, Roemmler-Zehrer J, Gómez NN, Lorenz-Baath K. Quality-of-Life Outcomes, Effectiveness and Tolerability of Apremilast in Patients with Plaque Psoriasis and Routine German Dermatology Care: Results from LAPIS-PSO. Dermatol Ther (Heidelb) 2021; 12:203-221. [PMID: 34913153 PMCID: PMC8776950 DOI: 10.1007/s13555-021-00658-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/27/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Psoriasis is a systemic inflammatory disease characterised by pruritic skin lesions that impair quality of life (QOL). Long-Term Documentation of the Utilization of Apremilast in Patients with Plaque Psoriasis under Routine Conditions (LAPIS-PSO; ClinicalTrials.gov: NCT02626793) was a 52-week, prospective, multicentre, observational cohort study conducted in real-world dermatology clinical settings in Germany. We evaluated physician- and patient-reported outcomes for QOL, effectiveness and tolerability in patients with moderate to severe psoriasis vulgaris in LAPIS-PSO. METHODS The primary endpoint was the percentage of patients achieving Dermatology Life Quality Index (DLQI) score ≤ 5 or ≥ 5-point improvement from baseline in DLQI score at visit 2 (~ 4 months after baseline). Secondary endpoints included assessments of symptoms and disease severity. Tolerability was evaluated based on adverse events (AEs). A pre-defined subgroup analysis based on baseline Physician's Global Assessment (PGA) score (2 or 3 versus 4) was performed. Data were examined descriptively through visit 5 (~ 13 months) using the last-observation-carried-forward (LOCF) approach and data as observed. RESULTS In total, 257 patients were included for efficacy assessment. On LOCF analysis, most patients achieved the primary endpoint at visit 2 (66.5%); DLQI response was maintained at visit 5 (72.4%). Earlier treatment response was observed in patients with a PGA score of 2 or 3 versus 4 (visit 1 PASI ≤ 3: 20.5% versus 10.8%). Adverse events were consistent with the known safety profile of apremilast. CONCLUSIONS In routine clinical care in Germany, patients with moderate to severe plaque psoriasis benefited from apremilast treatment up to ~ 13 months, consistent with findings from clinical trials, with a good safety profile.
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Affiliation(s)
- Kristian Reich
- Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Building West 38/Room 514, 20246, Hamburg, Germany.
| | - Bernhard Korge
- Hautarztpraxis Priv. Doz. Dr. med. Bernhard Korge, Düren, Germany
| | - Nina Magnolo
- Department of Dermatology, University Hospital Muenster, Münster, Germany
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15
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Feng B, Li JH. Erythematous plaques on the skin folds. Assoc Med J 2021. [DOI: 10.1136/bmj-2021-068621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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16
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Zahran E, Youssof A, Shehata W, Bahgat A, Elshebiny E. Predictive role of serum rheumatoid factor in different disease pattern of psoriasis and psoriatic arthritis. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.1186/s43162-021-00082-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Psoriasis is a multisystem inflammatory disorder with variable morphology, clinical pattern and multiple comorbidities. Interplay between genetic and environmental factors leading to an aberrant immune response in the skin may contribute to disease development. The assessment for risk factors, signs, and symptoms of potential comorbid diseases is an important component of patient management. The aim of this study is to determine rheumatoid factors (RF) positivity and its levels in psoriasis patients, and describe its relationship with the demographic and clinical characteristics, comorbidities, and disease patterns of psoriasis.
Results
Rheumatoid factor was positive in psoriatic patients more than control,30% of patients had positive rheumatoid factor while only 10% of control had positive results. Rheumatoid factor level was 63.8 ± 186.7 IU/ml in psoriasis vs. 9.3 ± 12.3 in control. Thirty percent of psoriasis patients have positive rheumatoid factor vs. 10% of control. There was no significant statistical difference between psoriasis patients with or without arthritis as regard rheumatoid factor positivity and titer; rheumatoid factor was positive in 20% in psoriatic patients with arthritis vs. 26% in psoriatic patients without arthritis. In psoriatic patients, the status of rheumatoid factor did not relate to disease severity, onset, course, site of affection, presence of scalp, nail affection, and presence of dactylitis (p value>0.5).
Conclusion
Psoriasis was associated with higher seropositivity of RF compared to age-matched non-psoriatic healthy controls. Occurrence and level of rheumatoid factor were not associated with severity or clinical pattern of psoriasis.
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Abstract
Dermatitis is a common condition frequently encountered by dermatologists. The diagnosis of dermatitis can be challenging because this condition is often multifactorial, and many skin diseases that can mimic dermatitis should be considered in the differential diagnosis. It is important to recognize and be familiar with these conditions because some of them can represent signs of systemic disease or malignancies and misdiagnosis can lead to mismanagement and adverse outcomes for the patient.
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Affiliation(s)
- Oksana A Bailiff
- Geisinger Dermatology, 16 Woodbine Lane, Danville, PA 17822, USA
| | - Christen M Mowad
- Geisinger Dermatology, 16 Woodbine Lane, Danville, PA 17822, USA.
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18
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Tajalli M, Li T, Drucker AM, Qureshi AA, Cho E. A description of treatment patterns of psoriasis by medical providers and disease severity in US women. ACTA ACUST UNITED AC 2021; 6:45-51. [PMID: 33738385 DOI: 10.1177/2475530320970531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Studies on treatment patterns of psoriasis are valuable to evaluate how efficiently individuals with psoriasis are treated and may facilitate improved outcomes for these patients. Objective To describe treatment patterns of psoriasis among US women. Methods In the Nurses' Health Study II (NHS II), a prospective study of female nurses, 2107 women reported to have a diagnosis of psoriasis made by a clinician. We sent them the Psoriasis Screening Tool-2, a validated diagnostic tool for psoriasis, which queries age at diagnosis, treatments, type of psoriasis lesions, body surface area involved, and the provider who made the diagnosis. Results A total of 1382 women completed and returned the survey, with 1243 of them validated for having psoriasis. 30% of the patients were diagnosed by non-dermatologists. 79% of the patients reported mild, 17% moderate and 4% severe disease. Psoriasis phenotypes were as follows: plaque 41%, scalp 49%, inverse 27%, nail 22% and palmoplantar 15%. Treatment patterns for mild psoriasis were as follows: only topical treatment 58%, systemic therapy and/or phototherapy 16% and no treatment 26%. Treatment patterns for moderate-to-severe disease were as follows: only topical treatment 42%, systemic therapy and/or phototherapy 47% and no treatment 11%. Conclusion The majority of women in NHS II with psoriasis have mild disease. A large proportion of psoriasis patients were diagnosed by non-dermatologists. More than half of people with moderate-to-severe disease received no treatment or only topical medications. A considerable percentage of people with psoriasis reported phenotypes other than chronic plaque psoriasis.
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Affiliation(s)
- Mahroo Tajalli
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Tricia Li
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Aaron M Drucker
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of Dermatology, Department of Medicine and Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Abrar A Qureshi
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Epidemiology, Brown School of Public Health, Providence, Rhode Island, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eunyoung Cho
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Epidemiology, Brown School of Public Health, Providence, Rhode Island, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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19
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Borsky P, Chmelarova M, Fiala Z, Hamakova K, Palicka V, Krejsek J, Andrys C, Kremlacek J, Rehacek V, Beranek M, Malkova A, Svadlakova T, Holmannova D, Borska L. Aging in psoriasis vulgaris: female patients are epigenetically older than healthy controls. Immun Ageing 2021; 18:10. [PMID: 33658053 PMCID: PMC7927262 DOI: 10.1186/s12979-021-00220-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/10/2021] [Indexed: 12/26/2022]
Abstract
Background Psoriasis vulgaris is a skin autoimmune disease. Psoriatic patients have significantly lowered life expectancy and suffer from various comorbidities. The main goal of the study was to determine whether psoriatic patients experience accelerated aging. As accelerated aging might be the reason for the higher prevalence of comorbidities at lower chronological ages, we also wanted to investigate the relationship between aging and selected parameters of frequent psoriatic comorbidities - endocan, vascular endothelial growth factor and interleukin-17. Samples were obtained from 28 patients and 42 healthy controls. Epigenetic age measurement was based on the Horvath clock. The levels of endocan, vascular endothelial growth factor and interleukin-17 were analyzed using standardized ELISA methods. Results The difference between the epigenetic age and the chronological age of each individual subject did not increase with the increasing chronological age of patients. We cannot conclude that psoriasis causes accelerated aging. However, the epigenetic and chronological age difference was significantly higher in female patients than in female controls, and the difference was correlated with endocan (r = 0.867, p = 0.0012) and vascular endothelial growth factor (r = 0.633, p = 0.0365) only in female patients. Conclusions The findings suggest a possible presence of pathophysiological processes that occur only in female psoriatic patients. These processes make psoriatic females biologically older and might lead to an increased risk of comorbidity occurrence. This study also supports the idea that autoimmune diseases cause accelerated aging, which should be further explored in the future. Supplementary Information The online version contains supplementary material available at 10.1186/s12979-021-00220-5.
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Affiliation(s)
- Pavel Borsky
- Institute of Preventive Medicine, Faculty of Medicine in Hradec Kralove, Charles University, Simkova 870, 50038, Hradec Kralove, Czech Republic.
| | - Marcela Chmelarova
- Institute of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove and Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Zdenek Fiala
- Institute of Preventive Medicine, Faculty of Medicine in Hradec Kralove, Charles University, Simkova 870, 50038, Hradec Kralove, Czech Republic
| | - Kvetoslava Hamakova
- Clinic of Dermatology and Venereology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Vladimir Palicka
- Institute of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove and Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Jan Krejsek
- Institute of Clinical Immunology and Allergology, University Hospital and Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Ctirad Andrys
- Institute of Clinical Immunology and Allergology, University Hospital and Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Jan Kremlacek
- Institute of Pathological Physiology, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Vit Rehacek
- Transfusion Center, University Hospital, 500 03, Hradec Kralove, Czech Republic
| | - Martin Beranek
- Institute of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove and Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Andrea Malkova
- Institute of Preventive Medicine, Faculty of Medicine in Hradec Kralove, Charles University, Simkova 870, 50038, Hradec Kralove, Czech Republic
| | - Tereza Svadlakova
- Institute of Preventive Medicine, Faculty of Medicine in Hradec Kralove, Charles University, Simkova 870, 50038, Hradec Kralove, Czech Republic.,Institute of Clinical Immunology and Allergology, University Hospital and Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Drahomira Holmannova
- Institute of Preventive Medicine, Faculty of Medicine in Hradec Kralove, Charles University, Simkova 870, 50038, Hradec Kralove, Czech Republic
| | - Lenka Borska
- Institute of Pathological Physiology, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
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20
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Miguens Blanco J, Borghese F, McHugh N, Kelleher P, Sengupta R, Marchesi JR, Abraham S. Longitudinal profiling of the gut microbiome in patients with psoriatic arthritis and ankylosing spondylitis: a multicentre, prospective, observational study. BMC Rheumatol 2020; 4:60. [PMID: 33292821 PMCID: PMC7653819 DOI: 10.1186/s41927-020-00155-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/09/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Psoriasis is a chronic inflammatory disease of the skin affecting 2-3% of UK population. 30% of people affected by psoriasis will develop a distinct form of arthritis within 10 years of the skin condition onset. Although the pathogenesis of psoriatic arthritis is still unknown, there is a genetic predisposition triggered by environmental factors. Limited but convincing evidence link the gut microbiome to psoriatic arthritis. The Microbiome in Psoriatic ARThritis (Mi-PART) study propose is to characterise the microbiome-metabolic interface in patients affected by psoriatic arthritis to deepen our understanding of the pathogenesis of the disease. METHODS This is a multicentre, prospective, observational study. Psoriatic arthritis (n = 65) and ankylosing spondylitis (n = 30) patients will be recruited in addition to a control group of healthy volunteers (n = 30). Patients eligibility will be evaluated against the Criteria for Psoriatic Arthritis (CASPAR), the Bath Ankylosing Spondylitis Activity Index (BASDAI) and the healthy volunteers who fulfil study inclusion and exclusion criteria. Information regarding their medical and medication history, demographics, diet and lifestyle will be collected. All the participants in the study will be asked to complete a 7-day food diary, to provide stool samples and to complete quality of life questionnaires. Routine clinical laboratory tests will be performed on blood and urine samples. Patients and healthy volunteers with gastrointestinal symptoms, previous history of cancer, gastrointestinal surgery in the previous 6 months or alcohol abuse will be excluded from the study. DISCUSSION The aim of this trial is to characterise the microbiome of psoriatic arthritis patients and to compare it with microbiome of healthy volunteers and of patient with ankylosing spondylitis in order to define if different rheumatologic conditions are associated with characteristic microbiome profiles. Investigating the role of the microbiome in the development of psoriatic arthritis could deepen our understanding of the pathogenesis of the disease and potentially open the way to new therapies.
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Affiliation(s)
- Jesus Miguens Blanco
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, W2 1NY UK
| | - Federica Borghese
- NIHR/Wellcome Trust Imperial CRF, Imperial Centre for Translational and Experimental Medicine, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS UK
| | - Neil McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY UK
| | - Peter Kelleher
- Chelsea and Westminster Hospital, Department of Medicine, Imperial College London, London, W2 1NY UK
| | - Raj Sengupta
- Royal National Hospital for Rheumatic diseases, Bath, BA1 1RL UK
| | - Julian R. Marchesi
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, W2 1NY UK
| | - Sonya Abraham
- NIHR/Wellcome Trust Imperial CRF, Imperial Centre for Translational and Experimental Medicine, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS UK
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21
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Yamaguchi Y, Kanai Y, Kitabayashi H, Okada H, Nakagawa H. Relationship between serum trough levels and efficacy of brodalumab from a post hoc exploratory analysis of a Japanese study in patients with plaque psoriasis. J Dermatol 2020; 48:324-333. [PMID: 33161605 PMCID: PMC7984373 DOI: 10.1111/1346-8138.15690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/18/2020] [Indexed: 11/29/2022]
Abstract
Previous clinical studies have shown that efficacy and serum brodalumab levels are dose dependent in patients with psoriasis receiving the same dose of brodalumab during the study. This study aimed to investigate the association between dosage, serum levels, and efficacy of brodalumab in Japanese patients with plaque psoriasis with dosage variations during the study. This was a post hoc exploratory analysis of a 108‐week, multicenter, open‐label extension study, which changed into a post‐marketing surveillance study following brodalumab approval in Japan. Eligible patients with plaque psoriasis (n = 129) received brodalumab 140 mg every 4 weeks on Day 1; dosage change at physician’s discretion from 140 mg every 8 weeks to 210 mg every 2 weeks was permitted; patients switched to 210 mg every 2 weeks during the post‐marketing surveillance study. Exploratory endpoints included serum brodalumab levels at Weeks 28 and 108, its association with Psoriasis Area and Severity Index score, and Psoriasis Area and Severity Index score in patients receiving brodalumab 210 mg every 2 weeks at end of study. Median brodalumab trough levels were significantly higher (P < 0.05) at higher vs. lower dosages at Weeks 28 (n = 126) and 108 (n = 111) except for 140 mg every 2 weeks vs. 210 mg every 2 weeks at Week 108 and higher in patients with lower Psoriasis Area and Severity Index scores—significantly different only for Psoriasis Area and Severity Index score 0 vs. >2 at Week 28 (P = 0.0153). Of 100 patients receiving 210 mg every 2 weeks at end of study, 89% had a Psoriasis Area and Severity Index score ≤2. In patients with plaque psoriasis, brodalumab efficacy may depend upon sustained serum trough levels and can be restored by using the approved dose.
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Affiliation(s)
- Yukie Yamaguchi
- Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | | | | | - Hiroki Okada
- Clinical Sciences Research Laboratories, Translational Research Unit, R&D Division, Kyowa Kirin Co., Ltd., Tokyo, Japan
| | - Hidemi Nakagawa
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
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22
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Axial psoriatic arthritis: An update for dermatologists. J Am Acad Dermatol 2020; 84:92-101. [PMID: 32747079 DOI: 10.1016/j.jaad.2020.05.089] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/30/2020] [Accepted: 05/11/2020] [Indexed: 12/17/2022]
Abstract
Psoriasis is a chronic, immune-mediated, systemic, inflammatory disorder characterized by skin plaques and, often, nail disease and arthritis that contribute to reduced quality of life. Psoriatic arthritis-a heterogeneous, inflammatory, musculoskeletal disease that can cause permanent damage to both peripheral and axial joints-is the most common comorbidity of psoriasis. Axial disease occurs in 25% to 70% of patients with PsA, with some patients exclusively experiencing axial joint involvement. Early therapeutic intervention is important for preventing permanent joint and spine damage and loss of functionality in these patients. Because skin symptoms associated with psoriasis often precede psoriatic arthritis, dermatologists are uniquely positioned to play an important role in identifying and treating patients with psoriatic arthritis. Proactive screening of patients with all severities of psoriasis for the signs and symptoms of psoriatic arthritis is key to early diagnosis and intervention. In this review, we discuss the clinical presentation, risk factors, and treatment options for psoriatic arthritis with axial involvement, with the aim of helping dermatologists understand the disease and identify patients who might benefit from further assessment, treatment, and/or referral to a rheumatology practice.
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23
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Thomas C, Matthies M, Homey B, Meller S. [Intertriginous psoriasis]. Hautarzt 2020; 71:263-268. [PMID: 32144441 DOI: 10.1007/s00105-020-04558-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Intertriginous psoriasis is a variant of psoriasis that is associated with inflammatory lesions in skin folds. Patients often feel ashamed, are subjected to stigmatization, social isolation, or experience mental health issues. There is no general consensus on the definition of intertriginous psoriasis. Depending on the definition used, the prevalence varies substantially. Due to the particular location of skin lesions, therapeutic management is very challenging. Mild symptoms can be treated with topical corticosteroids or topical immunomodulators. There are encouraging data demonstrating the efficacy of ixekizumab, possibly charting the way for it to become a systemic treatment option.
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Affiliation(s)
- C Thomas
- Klinik für Dermatologie, Medizinische Fakultät, Heinrich-Heine-Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - M Matthies
- Klinik für Dermatologie, Medizinische Fakultät, Heinrich-Heine-Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - B Homey
- Klinik für Dermatologie, Medizinische Fakultät, Heinrich-Heine-Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - S Meller
- Klinik für Dermatologie, Medizinische Fakultät, Heinrich-Heine-Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
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24
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Callis Duffin K, Mason MA, Gordon K, Harrison RW, Crabtree MM, Guana A, Germino R, Lebwohl M. Characterization of Patients with Psoriasis in Challenging-to-Treat Body Areas in the Corrona Psoriasis Registry. Dermatology 2020; 237:46-55. [PMID: 31962340 DOI: 10.1159/000504841] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/18/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Real-world studies evaluating patients with challenging-to-treat localizations of psoriasis (scalp, nail, and palmoplantar) are limited. OBJECTIVE To characterize patients with versus without psoriasis in challenging-to-treat areas seen in routine US clinical practice. METHODS This retrospective observational study included all adult patients with psoriasis enrolled in the Corrona Psoriasis Registry between April 2015 and May 2018 who initiated a biologic therapy at registry enrollment. Patients were stratified by the presence of scalp, nail, or palmoplantar psoriasis (nonmutually exclusive groups). Patient demographics, clinical char-acteristics, disease activity, and patient-reported outcome measures (pain, fatigue, itch, EuroQol visual analog scale [EQ VAS], Dermatology Life Quality Index [DLQI], and Work Productivity and Activity Impairment questionnaire [WPAI]) were assessed at registry enrollment and compared between patients with versus without each challenging-to-treat area using nonparametric Kruskal-Wallis tests for continuous variables and χ2 or Fisher exact tests for categorical variables. Generalized linear regression models were used to estimate differences in disease activity and patient-reported outcomes between patients with versus without each challenging-to-treat area. RESULTS Among 2,042 patients with psoriasis (mean age [±SD], 49.6 ± 14.7 years; 51.5% male), 38.4% had psoriatic arthritis (PsA), 38.1% had scalp psoriasis, 16.0% had nail psoriasis, 10.9% had palmoplantar psoriasis, and 26.2% had a combination of ≥2 challenging-to-treat areas and PsA; only 34.2% had body plaque psoriasis without PsA or challenging-to-treat areas. Patients in all challenging-to-treat groups reported higher (mean [95% CI]) itch (scalp, 58.01 [57.62-58.40] vs. 54.35 [53.99-54.72]; nail, 56.42 [56.02-56.81] vs. 55.59 [55.20-55.97]; palmoplantar, 60.22 [59.86-60.59] vs. 55.15 [54.79-55.54]) and lower EQ VAS (scalp, 68.12 [67.78-68.48] vs. 69.46 [69.12-69.81]; nail, 66.21 [65.89-66.55] vs. 69.48 [69.14-69.83]; palmoplantar, 66.21 [66.07-66.75] vs. 69.29 [68.94-69.94]) scores than those without the respective challenging-to-treat localization. Patients with nail or palmoplantar psoriasis reported higher pain, fatigue, and DLQI scores than those without. Higher proportions of patients with scalp or palmoplantar psoriasis reported work impairment compared with those without. CONCLUSION Two-thirds of patients with psoriasis who initiated biologic therapy had PsA and/or ≥1 challenging-to-treat area. Patients with challenging-to-treat areas had worse patient-reported outcome scores than those without, indicating a significant burden of challenging-to-treat areas on patients' quality of life.
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Affiliation(s)
| | | | | | | | | | - Adriana Guana
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Rebecca Germino
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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25
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Hashim PW, Chima M, Kim HJ, Bares J, Yao CJ, Singer G, Chen T, Genece J, Baum D, Kimmel GW, Nia JK, Gagliotti M, Lebwohl MG. Crisaborole 2% ointment for the treatment of intertriginous, anogenital, and facial psoriasis: A double-blind, randomized, vehicle-controlled trial. J Am Acad Dermatol 2019; 82:360-365. [PMID: 31279028 DOI: 10.1016/j.jaad.2019.06.1288] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/24/2019] [Accepted: 06/28/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Psoriasis of the intertriginous, anogenital, and facial regions remains a therapeutic challenge, with current algorithms lacking a topical agent that exhibits both high efficacy and minimal side effects. OBJECTIVE To assess the safety and efficacy of crisaborole 2% ointment-a nonsteroidal phosphodiesterase 4 inhibitor-in the treatment of intertriginous, anogenital, and facial psoriasis. METHODS A double-blind, randomized, vehicle-controlled trial was conducted in 21 participants. Participants were randomized 2:1 to receive 4 weeks of twice-daily treatment with either crisaborole 2% ointment (n = 14) or vehicle ointment (n = 7), followed by 4 weeks of open-label treatment with crisaborole 2% ointment. Disease severity was measured by using the Target Lesion Severity Scale (TLSS). RESULTS After 4 weeks, participants in the crisaborole group demonstrated 66% improvement compared with 9% in the vehicle group (P = .0011). Participants in the crisaborole group continued to experience improvement through the open-label phase, demonstrating 81% lesional improvement by week 8, with 71% of these participants achieving clinical clearance. There were no adverse events. LIMITATIONS The study was limited to a single tertiary care center and small sample size. CONCLUSION Treatment with crisaborole 2% ointment was well-tolerated and led to clinical improvement in participants with intertriginous, anogenital, or facial psoriasis.
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Affiliation(s)
- Peter W Hashim
- Department of Dermatology, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Margot Chima
- Department of Dermatology, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hee J Kim
- Department of Dermatology, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jennifer Bares
- Department of Dermatology, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Christopher J Yao
- Department of Dermatology, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Giselle Singer
- Department of Dermatology, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tinley Chen
- Department of Dermatology, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jordan Genece
- Department of Dermatology, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Danielle Baum
- Department of Dermatology, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Grace W Kimmel
- Department of Dermatology, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - John K Nia
- Department of Dermatology, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Matthew Gagliotti
- Department of Dermatology, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mark G Lebwohl
- Department of Dermatology, The Icahn School of Medicine at Mount Sinai, New York, New York.
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26
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Abstract
GENERAL PURPOSE To provide information about the diagnosis and management of cutaneous psoriasis. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After completing this continuing education activity, the provider should be better able to: ABSTRACT: Psoriasis is a chronic inflammatory disease that is characterized by plaque, inverse, guttate, pustular, and erythrodermic variants. This review focuses on the epidemiology, diagnosis, and treatment of cutaneous psoriasis. Other related topics discussed include peristomal psoriasis, the Koebner phenomenon, and the relationship between biologic therapy and wound complications.
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27
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Abstract
Psoriatic arthritis (PsA) affects up to one-third of patients with psoriasis. It is the major comorbidity of psoriasis because of the likelihood that loss of function and permanent disability will develop if initiation of treatment is delayed. Dermatologists are uniquely positioned to recognize early signs of PsA and be the first-line healthcare practitioners to detect PsA in patients with psoriasis. PsA can affect six clinical domains: peripheral arthritis, dactylitis, enthesitis, psoriasis, psoriatic nail disease, and axial disease. However, not every patient will have involvement of all domains and the domains affected can change over time. Complicating the diagnosis is the condition's similarity with other arthritic diseases and potential heterogeneity. In this article, we provide practical guidance for dermatologists for detecting PsA in patients with psoriasis. We also review the available treatment options by each clinical domain of PsA and give advice on how to interpret the results of PsA clinical trials. Through early recognition of PsA in patients with psoriasis and initiation of proper treatment, dermatologists can help to prevent PsA disease progression, irreversible joint damage, and resultant permanent disability, and improve quality of life.
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Affiliation(s)
- Alice Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt Sinai, New York, NY, USA
| | - Joseph F Merola
- Department of Medicine, Division of Rheumatology and Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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28
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Odorici G, Paganelli A, Peccerillo F, Serra J, Chester J, Kaleci S, Pellacani G, Conti A. Moderate to severe psoriasis: a single-center analysis of gender prevalence. Ital J Dermatol Venerol 2019; 156:226-230. [PMID: 30648835 DOI: 10.23736/s2784-8671.18.06200-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Psoriasis is a chronic, relapsing disease and most epidemiological studies include selected patients undergoing systemic therapies only. Epidemiological data suggest that psoriasis affects 2-3% of the general population, and that men and women are equally affected. The objective was to identify differences in gender for disease severity, patient characteristics and comorbidities in patients with moderate to severe psoriasis, independent of therapy. METHODS A retrospective medical chart review of consecutive patients diagnosed with moderate-severe psoriasis at a single center between 2004 and 2017, with a complete set of medical records, was undertaken. Both univariate and multivariate regression analyses were performed. Statistical significance was defined as P<0.05. RESULTS The male-to-female ratio revealed a higher prevalence for male gender (2:1, P<0.05). Whilst no significant differences were found for most factors according to gender, age at first evaluation was significantly higher for women. Logistic regression analysis indicated that autoimmune/autoinflammatory diseases were more frequently observed in women, as well as phenotypes other than plaque psoriasis and hypertension. Inversely, dyslipidemia was more frequently associated with male gender. CONCLUSIONS Our results show that moderate-severe psoriasis is more common in men and suggests a differential gender distribution of some specific comorbidities in the setting of this disease.
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Affiliation(s)
- Giulia Odorici
- Unit of Dermatology, Department of Surgical, Medical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy -
| | - Alessia Paganelli
- Unit of Dermatology, Department of Surgical, Medical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Peccerillo
- Unit of Dermatology, Department of Surgical, Medical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Jole Serra
- Unit of Dermatology, Department of Surgical, Medical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Johanna Chester
- Unit of Dermatology, Department of Surgical, Medical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Shaniko Kaleci
- Unit of Dermatology, Department of Surgical, Medical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Pellacani
- Unit of Dermatology, Department of Surgical, Medical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Conti
- Unit of Dermatology, Department of Surgical, Medical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
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29
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Abstract
Psoriasis is a chronic inflammatory dermatosis affecting 1–3% of the general population. Patients with psoriasis represent a heterogeneous population with individual disease expression – different degrees and severity of skin involvement. Psoriatic lesions in particular localizations such as the face, scalp, intertriginous or palmoplantar areas significantly reduce quality of life. Patients often feel ashamed, embarrassed, or self-conscious about their symptoms. Furthermore, genital psoriasis significantly affects sexual health. Among patients with psoriasis, the prevalence of special localizations is estimated to be 23–27% on the nails, 49% on the face, 12–16% on the palms and soles, and up to 36% in intertriginous regions. Due to peculiar features of skin in these areas, adequate and specific management is required, which is discussed in this review.
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30
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Claßen A, Buhl T, Schubert S, Worm M, Bauer A, Geier J, Molin S. The frequency of specific contact allergies is reduced in patients with psoriasis. Br J Dermatol 2018; 180:315-320. [DOI: 10.1111/bjd.17080] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2018] [Indexed: 12/17/2022]
Affiliation(s)
- A. Claßen
- Department of Dermatology and Allergology University Medical Center Göttingen Göttingen Germany
| | - T. Buhl
- Department of Dermatology and Allergology University Medical Center Göttingen Göttingen Germany
| | - S. Schubert
- Information Network of Departments of Dermatology (IVDK) University of Göttingen Göttingen Germany
| | - M. Worm
- Department of Dermatology and Allergology Allergy‐Center‐Charité, Charité – Universitätsmedizin Berlin Berlin Germany
| | - A. Bauer
- Department of Dermatology University Hospital Carl Gustav Carus Technical University Dresden Dresden Germany
| | - J. Geier
- Information Network of Departments of Dermatology (IVDK) University of Göttingen Göttingen Germany
| | - S. Molin
- Department of Dermatology and Allergy Ludwig Maximilian University Munich Germany
- Division of Dermatology Queen's University 166 Brock Street C3‐027 Kingston ON K7L 5G2 Canada
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31
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Merola JF, Espinoza LR, Fleischmann R. Distinguishing rheumatoid arthritis from psoriatic arthritis. RMD Open 2018; 4:e000656. [PMID: 30167326 PMCID: PMC6109814 DOI: 10.1136/rmdopen-2018-000656] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/25/2018] [Accepted: 05/25/2018] [Indexed: 12/19/2022] Open
Abstract
Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) have key differences in clinical presentation, radiographic findings, comorbidities and pathogenesis to distinguish between these common forms of chronic inflammatory arthritis. Joint involvement is typically, but not always, asymmetric in PsA, while it is predominantly symmetric in RA. Bone erosions, without new bone growth, and cervical spine involvement are distinctive of RA, while axial spine involvement, psoriasis and nail dystrophy are distinctive of PsA. Patients with PsA typically have seronegative test findings for rheumatoid factor (RF) and cyclic citrullinated peptide (CCP) antibodies, while approximately 80% of patients with RA have positive findings for RF and CCP antibodies. Although there is overlap in the pathogenesis of PsA and RA, differences are also present that affect the efficacy of treatment. In PsA, levels of interleukin (IL)-1β, IL-6, IL-17, IL-22, IL-23, interferon-γ and tumour necrosis factor-α (TNF-α) are elevated, and in RA, levels of IL-1, IL-6, IL-22, IL-33, TNF-α, chemokine ligand 11 and chemokine C-X-C motif ligand 13 are elevated. Differences in the pathogenesis of RA and PsA translate into some variances in the specificity and efficacy of therapies.
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Affiliation(s)
- Joseph F Merola
- Department of Dermatology, Medicine and Rheumatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Luis R Espinoza
- Section of Rheumatology, LSU Health Sciences Center at New Orleans, New Orleans, Louisiana, USA
| | - Roy Fleischmann
- Department of Medicine, University of Texas Southwestern Medical Center, Metroplex Clinical Research Center, Dallas, Texas, USA
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32
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Sanchez IM, Shankle L, Wan MT, Afifi L, Wu JJ, Doris F, Bridges A, Boas M, Lafoy B, Truman S, Orbai AM, Takeshita J, Gelfand JM, Armstrong AW, Siegel MP, Liao W. Building a Citizen Pscientist: Advancing Patient-Centered Psoriasis Research by Empowering Patients as Contributors and Analysts. Dermatol Ther (Heidelb) 2018; 8:405-423. [PMID: 29876724 PMCID: PMC6109031 DOI: 10.1007/s13555-018-0242-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Indexed: 01/16/2023] Open
Abstract
Introduction To design and implement a novel cloud-based digital platform that allows psoriatic patients and researchers to engage in the research process. Methods Citizen Pscientist (CP) was created by the National Psoriasis Foundation (NPF) to support and educate the global psoriatic disease community, where patients and researchers have the ability to analyze data. Psoriatic patients were invited to enroll in CP and contribute health data to a cloud database by responding to a 59-question online survey. They were then invited to perform their own analyses of the data using built-in visualization tools allowing for the creation of “discovery charts.” These charts were posted on the CP website allowing for further discussion. Results As of May 2017, 3534 patients have enrolled in CP and have collectively contributed over 200,000 data points on their health status. Patients posted 70 discovery charts, generating 209 discussion comments. Conclusion With the growing influence of the internet and technology in society, medical research can be enhanced by crowdsourcing and online patient portals. Patient discovery charts focused on the topics of psoriatic disease demographics, clinical features, environmental triggers, and quality of life. Patients noted that the CP platform adds to their well-being and allows them to express what research questions matter most to them in a direct and quantifiable way. The implementation of CP is a successful and novel method of allowing patients to engage in research. Thus, CP is an important tool to promote patient-centered psoriatic disease research.
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Affiliation(s)
- Isabelle M Sanchez
- Department of Dermatology, University of California San Francisco, San Francisco, USA
| | - Lindsey Shankle
- National Psoriasis Foundation, Portland, USA.,Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Marilyn T Wan
- Department of Dermatology, University of Pennsylvania, Philadelphia, USA.,Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Ladan Afifi
- Department of Dermatology, University of California San Francisco, San Francisco, USA.,Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Jashin J Wu
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, USA.,Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Frank Doris
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Alisha Bridges
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Marc Boas
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Brian Lafoy
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Sarah Truman
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Ana-Maria Orbai
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA.,Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Junko Takeshita
- Department of Dermatology, University of Pennsylvania, Philadelphia, USA.,Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania, Philadelphia, USA.,Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - April W Armstrong
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Michael P Siegel
- National Psoriasis Foundation, Portland, USA.,Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, San Francisco, USA. .,Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA.
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33
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Chen K, Wang G, Jin H, Xu J, Zhu X, Zheng M, Gu H. Clinic characteristics of psoriasis in China: a nationwide survey in over 12000 patients. Oncotarget 2018. [PMID: 28637026 PMCID: PMC5542274 DOI: 10.18632/oncotarget.18453] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Psoriasis is a worldwide chronic inflammatory disease, involving both skin and joints. In order to characterize psoriasis in Han Chinese population, we conducted this nationwide prospective and hospital based survey, in which 56 hospitals with departments of dermatology participated, located in 33 cities across China. A total of 12,031 outpatients with psoriasis were registered during 2009 to 2010, which the data was collected by standard questionnaires. The main data acquisition included demographics, family history, disease status and other comorbidities. Physical and dermatological examination, including body surface area (BSA) and psoriasis area severity index (PASI) were applied to evaluate the disease severity. Descriptive statistics, 2 tailed t-test and chi-square test were used appropriately for the statistical analysis. From the study, we found that the male and female ratio of the patients was 1.49:1. Mean age of onset was 30.2 ± 14.5 years for males and 27.1 ± 15.6 years for females (P < 0.05). Scalp was the most common onset site (52.8%), The mean PASI was 18.70 ± 10.01, indicating that most patients presenting at the hospitals had moderate-to-severe psoriasis and the majority was psoriasis vulgaris (96.5%). Among 12,031 patients, 23.1% had a family history of psoriasis,16.1% had comorbidities, and 29.9% had nail changes. The most important aggravation factor was season change (60.2%), followed by psychological stress (34.5%), and there significant differences between genders on trigger factors. In conclusion, this study characterizing psoriasis in Han Chinese population, could be used as basic data for future study.
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Affiliation(s)
- Kun Chen
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College,Nanjing, Jiangsu, China
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - Hongzhong Jin
- Peking Union Medical Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking, China
| | - Jinhua Xu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xuejun Zhu
- Department of Dermatology, Peking University First Hospital, Peking, China
| | - Min Zheng
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Heng Gu
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College,Nanjing, Jiangsu, China
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Kivelevitch D, Frieder J, Watson I, Paek SY, Menter MA. Pharmacotherapeutic approaches for treating psoriasis in difficult-to-treat areas. Expert Opin Pharmacother 2018; 19:561-575. [PMID: 29565192 DOI: 10.1080/14656566.2018.1448788] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Despite great therapeutic advancements in psoriasis, four notable difficult-to-treat areas including the scalp, nails, intertriginous (including genitals), and palmoplantar regions, pose a challenge to both physicians and patients. Localized disease of these specific body regions inflicts a significant burden on patients' quality of life and requires an adequate selection of treatments. AREAS COVERED This manuscript discusses appropriate therapies and important treatment considerations for these difficult-to-treat areas based on the available clinical data from the literature. EXPERT OPINION Clinical trials assessing therapies for the difficult-to-treat areas have been inadequate. With the first biological clinical trial for genital psoriasis pending publication, it is with hope that other biological agents will be evaluated for region-specific psoriasis. A greater understanding of the genetic and immunologic aspects of regional psoriasis, as well as identification of unique biomarkers, will further guide management decisions. For example, the recent discovery of the IL-36 receptor gene for generalized pustular psoriasis may prove valuable for other forms of psoriasis. Ultimately, identification of the most beneficial treatments for each psoriasis subtype and difficult-to-treat area will provide patients with maximal quality of life.
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Affiliation(s)
- Dario Kivelevitch
- a Division of Dermatology , Baylor Scott and White , Dallas , TX , USA
| | - Jillian Frieder
- a Division of Dermatology , Baylor Scott and White , Dallas , TX , USA
| | - Ian Watson
- b Texas A&M Health Sciences Center College of Medicine , Bryan , TX , USA
| | - So Yeon Paek
- a Division of Dermatology , Baylor Scott and White , Dallas , TX , USA.,b Texas A&M Health Sciences Center College of Medicine , Bryan , TX , USA
| | - M Alan Menter
- a Division of Dermatology , Baylor Scott and White , Dallas , TX , USA
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Merola JF, Qureshi A, Husni ME. Underdiagnosed and undertreated psoriasis: Nuances of treating psoriasis affecting the scalp, face, intertriginous areas, genitals, hands, feet, and nails. Dermatol Ther 2018; 31:e12589. [PMID: 29512290 PMCID: PMC6901032 DOI: 10.1111/dth.12589] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 12/01/2017] [Accepted: 12/14/2017] [Indexed: 12/11/2022]
Abstract
Psoriasis of the scalp, face, intertriginous areas, genitals, hands, feet, and nails is often underdiagnosed, and disease management can be challenging. Despite the small surface area commonly affected by psoriasis in these locations, patients have disproportionate levels of physical impairment and emotional distress. Limitations in current disease severity indices do not fully capture the impact of disease on a patient's quality of life, and, combined with limitations in current therapies, many patients do not receive proper or adequate care. In this review, we discuss the clinical manifestations of psoriasis in these less commonly diagnosed areas and its impact on patient quality of life. We also examine clinical studies evaluating the effectiveness of therapies on psoriasis in these regions. This article highlights the need to individualize treatment strategies for psoriasis based on the area of the body that is affected and the emerging role of biologic therapy in this regard.
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Affiliation(s)
- Joseph F Merola
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Abrar Qureshi
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - M Elaine Husni
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio
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Kaskas N, Merola JF, Qureshi AA, Paek SY. Polyphenotypic Psoriasis: A Report from the GRAPPA 2016 Annual Meeting. J Rheumatol 2018; 44:695-696. [PMID: 28461530 DOI: 10.3899/jrheum.170149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Recent groundbreaking therapies for psoriasis target specific pathways that drive this systemic inflammatory disease. However, patients with nonplaque psoriasis phenotypes often do not qualify for these therapies and are currently undertreated because of the criteria used during the development of novel agents. We propose use of the phrase "polyphenotypic psoriasis" to describe both plaque and nonplaque subtypes, as well as single and multiple phenotype involvement in individual patients. The goal of using the phrase "polyphenotypic psoriasis" is to remind clinicians about the heterogeneous manifestations of psoriasis in addition to chronic plaque psoriasis.
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Affiliation(s)
- Nadine Kaskas
- From the Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,N. Kaskas, MD, Department of Dermatology, Warren Alpert Medical School, Brown University; J.F. Merola, MD, MMSc, Brigham and Women's Hospital, Harvard Medical School; A.A. Qureshi, MD, MPH, Department of Dermatology, Warren Alpert Medical School, Brown University; S.Y. Paek, MD, FAAD, Warren Alpert Medical School, Brown University
| | - Joseph F Merola
- From the Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,N. Kaskas, MD, Department of Dermatology, Warren Alpert Medical School, Brown University; J.F. Merola, MD, MMSc, Brigham and Women's Hospital, Harvard Medical School; A.A. Qureshi, MD, MPH, Department of Dermatology, Warren Alpert Medical School, Brown University; S.Y. Paek, MD, FAAD, Warren Alpert Medical School, Brown University
| | - Abrar A Qureshi
- From the Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,N. Kaskas, MD, Department of Dermatology, Warren Alpert Medical School, Brown University; J.F. Merola, MD, MMSc, Brigham and Women's Hospital, Harvard Medical School; A.A. Qureshi, MD, MPH, Department of Dermatology, Warren Alpert Medical School, Brown University; S.Y. Paek, MD, FAAD, Warren Alpert Medical School, Brown University
| | - So Yeon Paek
- From the Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. .,N. Kaskas, MD, Department of Dermatology, Warren Alpert Medical School, Brown University; J.F. Merola, MD, MMSc, Brigham and Women's Hospital, Harvard Medical School; A.A. Qureshi, MD, MPH, Department of Dermatology, Warren Alpert Medical School, Brown University; S.Y. Paek, MD, FAAD, Warren Alpert Medical School, Brown University.
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Rentz AM, Skalicky AM, Burslem K, Becker K, Kaschinski D, Esser D, Revicki DA. The content validity of the PSS in patients with plaque psoriasis. J Patient Rep Outcomes 2017; 1:4. [PMID: 29757301 PMCID: PMC5934906 DOI: 10.1186/s41687-017-0004-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 07/27/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The primary objective of this study was to evaluate the content validity of the Psoriasis Symptom Scale (PSS), with a specific focus on understanding of the content of the PRO measure by conducting one-on-one interviews with patients with moderate to severe plaque psoriasis. This was a cross-sectional, qualitative study conducted with 20 patients with plaque psoriasis who participated in in-person, one-on-one interviews. Participants were asked to describe their psoriasis symptoms, completed the PSS, and were cognitively debriefed on its content. Interviews were conducted in two separate rounds. Following Round 1, the study data were examined to determine if modifications to the PSS were required. All interviews were audio-recorded and transcribed. Sociodemographic and clinical data were collected for sample descriptive purposes. RESULTS The 20 study participants had a mean age of 50.2 ± 12.0 years (range: 25.0-73.0), and 55% were female. Thirty-five percent of the sample reported their psoriasis severity as moderate or severe. The average time since diagnosis of plaque psoriasis was almost 18 years, ranging from less than one to over 38 years. The most frequently reported symptoms and signs during the concept elicitation portion of the interviews included redness (N = 20, 100%), itching (n = 20, 100%), pain (n = 15, 75%), burning (n = 13, 65%), and flaking (n = 11, 55%). Overall, participants provided positive feedback on the PSS and felt that it was comprehensive and relevant to their experience with psoriasis. The item meaning and response options were well-understood for the majority of the items. Findings indicate that for the patient-reported symptom of redness, which is also a sign that can be reported by clinicians, redness or the perception of redness is most accurately captured by patient report. Study results did not support modifications to the instrument and no changes to the PSS were recommended. CONCLUSION The evidence gained in this study provided support for the content validity of the PSS for use as clinical trial endpoint among patients with plaque psoriasis. This study found that the symptoms included in the PSS are important to and well-understood by patients with plaque psoriasis. The PSS is appropriate for inclusion in future studies designed to measure the effect of treatment on psoriasis-related symptoms.
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Affiliation(s)
- A. M. Rentz
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD 20814 USA
| | | | - K. Burslem
- Boehringer Ingelheim GmbH, Ingelheim am Rhein, Germany
| | - K. Becker
- Boehringer Ingelheim GmbH, Ingelheim am Rhein, Germany
| | - D. Kaschinski
- Boehringer Ingelheim GmbH, Ingelheim am Rhein, Germany
| | - D. Esser
- Boehringer Ingelheim GmbH, Ingelheim am Rhein, Germany
| | - D. A. Revicki
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD 20814 USA
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Cunha JS, Amorese-O’Connell L, Gutierrez M, Qureshi AA, Reginato AM. Ultrasound Imaging of Nails in Psoriasis and Psoriatic Arthritis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2017. [DOI: 10.1007/s40674-017-0067-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Menter A, Warren RB, Langley RG, Merola JF, Kerr LN, Dennehy EB, Shrom D, Amato D, Okubo Y, Reich K. Efficacy of ixekizumab compared to etanercept and placebo in patients with moderate-to-severe plaque psoriasis and non-pustular palmoplantar involvement: results from three phase 3 trials (UNCOVER-1, UNCOVER-2 and UNCOVER-3). J Eur Acad Dermatol Venereol 2017; 31:1686-1692. [PMID: 28322474 DOI: 10.1111/jdv.14237] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 02/27/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Palmoplantar psoriasis has significant physical and emotional impact on patients and can be difficult to treat. OBJECTIVE To evaluate the efficacy of ixekizumab in the treatment of patients with moderate-to-severe plaque psoriasis and moderate-to-severe non-pustular palmoplantar involvement. METHODS In three phase 3, double-blind, placebo-controlled trials, patients with moderate-to-severe non-pustular plaque psoriasis [UNCOVER-1 (N = 1296), UNCOVER-2 (N = 1224), UNCOVER-3 (N = 1346)] were randomized to subcutaneous 80 mg ixekizumab every 2 or 4 weeks (Q2W, Q4W), after a 160-mg starting dose, or placebo through week 12. Additional UNCOVER-2 and UNCOVER-3 cohorts were randomized to 50 mg etanercept biweekly. Patients entering the open-label long-term extension (UNCOVER-3) received ixekizumab Q4W weeks 12-60. Moderate-to-severe palmoplantar involvement was defined as Palmoplantar Psoriasis Area and Severity Index (PPASI) ≥8. RESULTS Twenty-eight percent of UNCOVER-1, UNCOVER-2 and UNCOVER-3 patients had baseline palmoplantar involvement (PPASI ≥0, n = 1092) and 9.1% (n = 350) had moderate-to-severe involvement, with mean baseline PPASI ~20, PASI ~24, and most (>60%) had static Physician's Global Assessment ≥4. Higher percentages of patients treated with ixekizumab vs. placebo or etanercept achieved PPASI 50 (approximately 80% vs. 32.9%, 67.8%; ixekizumab, placebo, etanercept, respectively) and PPASI 75 (approximately 70% vs. 18.8%, 44.1%; ixekizumab, placebo, etanercept, respectively) at week 12 (all P < 0.05). PPASI 100 was achieved by higher percentages of ixekizumab-treated patients vs. placebo (approximately 50% vs. 8.2%, P < 0.001) and ixekizumab Q2W-treated patients vs. etanercept (51.8% vs. 32.2%, P < 0.05). Outcomes were maintained or improved in patients continuing on ixekizumab Q4W through week 60. Differences between ixekizumab and placebo or etanercept were statistically significant as early as week 1. CONCLUSION In a subpopulation analysis of patients from phase 3 trials with moderate-to-severe non-pustular palmoplantar involvement and moderate-to-severe plaque psoriasis, ixekizumab treatment resulted in greater and more rapid improvements than placebo and etanercept at week 12; improvements were sustained with continued treatment.
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Affiliation(s)
- A Menter
- Baylor University Medical Center, Dallas, TX, USA
| | - R B Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health, Science Centre, University of Manchester, Manchester, UK
| | | | - J F Merola
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - L N Kerr
- Eli Lilly and Company, Indianapolis, IN, USA
| | - E B Dennehy
- Eli Lilly and Company, Indianapolis, IN, USA
| | - D Shrom
- Eli Lilly and Company, Indianapolis, IN, USA
| | - D Amato
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Y Okubo
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - K Reich
- Dermatologikum Hamburg and SCIderm GmbH, Hamburg, Germany
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Palmer BC, DeLouise LA. Nanoparticle-Enabled Transdermal Drug Delivery Systems for Enhanced Dose Control and Tissue Targeting. Molecules 2016; 21:molecules21121719. [PMID: 27983701 PMCID: PMC5639878 DOI: 10.3390/molecules21121719] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 11/28/2016] [Accepted: 12/09/2016] [Indexed: 01/10/2023] Open
Abstract
Transdermal drug delivery systems have been around for decades, and current technologies (e.g., patches, ointments, and creams) enhance the skin permeation of low molecular weight, lipophilic drugs that are efficacious at low doses. The objective of current transdermal drug delivery research is to discover ways to enhance skin penetration of larger, hydrophilic drugs and macromolecules for disease treatment and vaccination. Nanocarriers made of lipids, metals, or polymers have been successfully used to increase penetration of drugs or vaccines, control drug release, and target drugs to specific areas of skin in vivo. While more research is needed to identify the safety of nanocarriers, this technology has the potential to expand the use of transdermal routes of administration to a wide array of therapeutics. Here, we review the current state of nanoparticle skin delivery systems with special emphasis on targeting skin diseases.
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Affiliation(s)
- Brian C Palmer
- Department of Environmental Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA.
| | - Lisa A DeLouise
- Department of Environmental Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA.
- Department of Biomedical Engineering, School of Engineering and Applied Sciences, University of Rochester, Rochester, NY 14627, USA.
- Department of Dermatology, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA.
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