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Mann C, Dreher M, Rothschmidt JN, Staubach P. Burden of impaired sleep and its improvement through topical treatment in psoriasis and atopic dermatitis. J Dtsch Dermatol Ges 2024; 22:655-663. [PMID: 38634699 DOI: 10.1111/ddg.15373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/11/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Patients with chronic inflammatory skin diseases often suffer from sleep disturbances. However, objective data on sleep architecture, especially to evaluate potential overall influences under therapy, are lacking. PATIENTS AND METHODS Pilot study on sleep quality changes including psoriasis and atopic dermatitis patients before and 2 weeks after intensive topical treatment. In addition to disease activity rating, patient-rated outcomes for itch severity and sleep quality and polygraphy was performed before and after topical therapy. RESULTS 14 psoriasis, eleven atopic dermatitis patients (10 female, 15 male) with a mean age of 49 years were included. Disease activity scores (EASI and PASI) were significantly reduced with topical therapy after 2 weeks (p < 0.001). Pruritus intensity (NRS) showed a significant influence on deep sleep, which resolved after therapy. Insomnia severity significantly decreased (r > 0.50, p < 0.05) and daytime sleepiness showed a significant reduction in 40% of patients. N3 (deep sleep) and REM sleep significantly improved, showing a strong effect (r > 0.50). The apnea-hypopnea index decreased in one of four patients independent of the individual BMI. CONCLUSIONS Through polygraphy, we demonstrated impaired sleep patterns in psoriasis and atopic dermatitis patients with itch as a relevant factor and beyond that, rapid sleep improvement under 2 weeks of topical treatment.
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Affiliation(s)
- Caroline Mann
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Matthias Dreher
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- University Center for Autoimmunity, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Jan-Niklas Rothschmidt
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- University Center for Autoimmunity, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Mann C, Dreher M, Rothschmidt JN, Staubach P. Belastung durch gestörten Schlaf und dessen Verbesserung durch topische Behandlung bei Psoriasis und atopischer Dermatitis. J Dtsch Dermatol Ges 2024; 22:655-664. [PMID: 38730524 DOI: 10.1111/ddg.15373_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/11/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Patients with chronic inflammatory skin diseases often suffer from sleep disturbances. However, objective data on sleep architecture, especially to evaluate potential overall influences under therapy, are lacking. PATIENTS AND METHODS Pilot study on sleep quality changes including psoriasis and atopic dermatitis patients before and 2 weeks after intensive topical treatment. In addition to disease activity rating, patient-rated outcomes for itch severity and sleep quality and polygraphy was performed before and after topical therapy. RESULTS 14 psoriasis, eleven atopic dermatitis patients (10 female, 15 male) with a mean age of 49 years were included. Disease activity scores (EASI and PASI) were significantly reduced with topical therapy after 2 weeks (p < 0.001). Pruritus intensity (NRS) showed a significant influence on deep sleep, which resolved after therapy. Insomnia severity significantly decreased (r > 0.50, p < 0.05) and daytime sleepiness showed a significant reduction in 40% of patients. N3 (deep sleep) and REM sleep significantly improved, showing a strong effect (r > 0.50). The apnea-hypopnea index decreased in one of four patients independent of the individual BMI. CONCLUSIONS Through polygraphy, we demonstrated impaired sleep patterns in psoriasis and atopic dermatitis patients with itch as a relevant factor and beyond that, rapid sleep improvement under 2 weeks of topical treatment.
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Affiliation(s)
- Caroline Mann
- Klinik für Dermatologie, Universitätsklinikum der Johannes Gutenberg-Universität Mainz
| | - Matthias Dreher
- Abteilung für Rheumatologie und Klinische Immunologie, Klinik für Innere Medizin I, Universitätsklinikum der Johannes Gutenberg-Universität Mainz
- Universitätszentrum für Autoimmunität, Universitätsklinikum der Johannes Gutenberg-Universität Mainz
| | | | - Petra Staubach
- Klinik für Dermatologie, Universitätsklinikum der Johannes Gutenberg-Universität Mainz
- Universitätszentrum für Autoimmunität, Universitätsklinikum der Johannes Gutenberg-Universität Mainz
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Ou M, Xue Y, Qin Y, Zhang X. Experience and caring needs of patients with psoriasis: A qualitative meta-synthesis. J Clin Nurs 2024. [PMID: 38616578 DOI: 10.1111/jocn.17146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/26/2024] [Accepted: 02/05/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND As a chronic skin disease, psoriasis often affects the physical, psychological and social status of the patient, which in turn impacts on their experience of illness and needs. However, there is no review of qualitative research that integrates and analyses the experiences and needs of these three influences from a holistic perspective. METHODS This review follows the ENTREQ guidelines. Six English databases (JBI, Cochrane Library, PubMed, PsyINFO, CINAHL and Embase) and three Chinese databases (CNKI, VIP and Wanfang) were searched from January 2012 to October 2022. Literature was included if it was relevant to the experience of illness and caring needs of patients with psoriasis. The JBI-QARI was used to rate the quality of included studies. RESULTS Eleven studies were included in the meta-synthesis. Four analytical themes were identified for analysis: physical challenges, psychological discomfort, social phenomena and caring needs. CONCLUSIONS The combined physical, psychological and social effects of psoriasis and the consequent caring needs should be emphasised. Health professionals, including doctors and nurses, should be aware of the multiple changes in patients and their coping strategies, provide information about psoriasis, monitor and follow-up regularly over time and obtain feedback to inform further treatment and care so as to develop high-quality therapeutic interventions to help and guide patients with their coping strategies. RELEVANCE TO CLINICAL PRACTICE These findings describe the physical, psychological and social experiences of illness and caring needs of patients with psoriasis. Healthcare professionals should be more aware of patients' easily overlooked psychological and social distress, providing prompt attention and recognition of patients' experiences and needs, offering relevant assistance and support and enhancing daily, regular follow-up to help them improve their understanding of and ability to manage their illness. NO PATIENT OR PUBLIC CONTRIBUTION This is a meta-synthesis without direct patient involvement.
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Affiliation(s)
- Minxing Ou
- Department of Dermatology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yanan Xue
- Department of Dermatology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yiyi Qin
- Department of Psychology, Harbin Medical University, Harbin, China
| | - Xiujie Zhang
- Department of Dermatology, First Affiliated Hospital of Dalian Medical University, Dalian, China
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Tokuyama M, Fan P, Wang G, Choe YB, Song HJ, Tsai D, Sindhvananda J, Mabuchi T, Ozawa A. Epidemiological analysis of the patients with psoriasis in Asian countries and region using the same clinical case cards between 2020 and 2022. J Dermatol 2024; 51:567-583. [PMID: 38345285 DOI: 10.1111/1346-8138.17132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/21/2023] [Accepted: 01/11/2024] [Indexed: 02/28/2024]
Abstract
Although many epidemiological surveys for patients with psoriasis have been reported based on individual countries or facilities, there has been no study encompassing the major countries or the region in Asia. The Asian Society for Psoriasis (ASP) has been conducting an epidemiological study across various Asian countries and regions to elucidate the and compare the epidemiology of psoriasis. A total of 1948 cases were analyzed, with 938 cases from Japan, 530 cases from China, 325 cases from Korea, 141 cases from Chinese Taipei, and 14 cases from Thailand, all of which were enrolled between 2020 and 2022. In the Asian region total, the male-female ratio was 1.87:1 and the peak age at disease onset was 20-29 years. The proportion of psoriasis vulgaris (PsV), psoriatic arthritis (PsA), and pustular psoriasis (PP) was 80.1%, 17.7%, and 2.2%, respectively, and PsA was more commonly associated with nail symptoms than psoriasis vulgaris (PsV). Of the patients, 13% had a familial history of psoriasis and the most frequently affected family member was the father. Regarding treatment, 78.3% of the patients received topical medications, 9.0% underwent phototherapy, 34.0% received oral medications, and 36.1% were treated with biological agents. This study provided valuable information on the epidemiology and treatment of psoriasis using the registry data collected with the common reporting form in the same period in major Asian countries and regions. Male predominance is a distinctive feature of psoriasis in Asia. This epidemiological data registry in the ASP will continue afterwards.
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Affiliation(s)
- Michio Tokuyama
- Department of Dermatology, Tokai University School of Medicine, Kanagawa, Japan
| | - Pingshen Fan
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yong Beom Choe
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - Hae Jun Song
- Department of Dermatology, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Dino Tsai
- Taiwan Adventist Hospital, Taipei, Taiwan
| | | | - Tomotaka Mabuchi
- Department of Dermatology, Tokai University School of Medicine, Kanagawa, Japan
| | - Akira Ozawa
- Department of Dermatology, Tokai University School of Medicine, Kanagawa, Japan
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Kircik L, Zirwas M, Kwatra SG, Lewitt GM, Glover H, Chao T, Brown PM, Rubenstein DS, Tallman AM. Rapid Improvements in Itch with Tapinarof Cream 1% Once Daily in Two Phase 3 Trials in Adults with Mild to Severe Plaque Psoriasis. Dermatol Ther (Heidelb) 2024; 14:201-211. [PMID: 38123875 PMCID: PMC10828461 DOI: 10.1007/s13555-023-01068-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/02/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Patients with psoriasis report pruritus as their most bothersome symptom. Tapinarof cream 1% once daily demonstrated significant efficacy versus vehicle and was well tolerated in adults with mild to severe plaque psoriasis in two 12-week trials: PSOARING 1 (NCT03956355) and PSOARING 2 (NCT03983980). Here, we present patient-reported pruritus outcomes from these trials. METHODS Outcomes included a Peak Pruritus Numerical Rating Scale (PP-NRS) score of 0 or 1 (itch-free state); Dermatology Life Quality Index (DLQI) itch item scores; and Psoriasis Symptom Diary (PSD) itch item scores. RESULTS Analyses included 683 tapinarof- and 342 vehicle-treated patients. At baseline, mean pruritus scores were similar across trials with only 7-11% of patients reporting an itch-free state. At week 12, the proportion of tapinarof-treated patients achieving an itch-free state was 50% in both trials compared with 32% (P = 0.0007) and 27% (P < 0.0001) in the vehicle groups. Improvements were apparent at the earliest assessments with continued improvement over the course of the trials. There were rapid and statistically significant improvements in the proportion of patients with a ≥ 4-point improvement in PP-NRS for tapinarof-treated patients versus vehicle from week 2 with 68% vs 46% (P = 0.0004) and 60% vs 31% (P = 0.0001) at week 12 achieving a response in each trial. Significantly greater reductions in itch with tapinarof versus vehicle were also demonstrated at week 12 for DLQI itch item 1 (P = 0.0026 and P < 0.0001), PSD item 1 (both P < 0.0001), and PSD item 2 (both P < 0.0001). CONCLUSION Tapinarof was highly efficacious in reducing pruritus across multiple patient-reported outcome measures, with rapid, statistically significant, and clinically meaningful improvements. The high proportion of patients achieving the treatment target of an itch-free state at week 12 (50%) is a noteworthy clinical outcome for a non-steroidal topical cream in the treatment of mild to severe plaque psoriasis. TRIAL REGISTRATION Clinical trial registration information: NCT03956355, NCT03983980.
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Affiliation(s)
- Leon Kircik
- Icahn School of Medicine at Mount Sinai, 5 E. 98th St., 5th Fl., New York, NY, 10029, USA.
| | - Matthew Zirwas
- DOCS Dermatology, 2359 E Main St, Bexley, OH, 43209, USA
| | - Shawn G Kwatra
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Tomas Chao
- Atlanta North Dermatology, Woodstock, GA, USA
| | - Philip M Brown
- Dermavant Sciences, Inc., 3300 Paramount Parkway, Suite 150, Morrisville, NC, 27560, USA
| | - David S Rubenstein
- Dermavant Sciences, Inc., 3300 Paramount Parkway, Suite 150, Morrisville, NC, 27560, USA
| | - Anna M Tallman
- Dermavant Sciences, Inc., 3300 Paramount Parkway, Suite 150, Morrisville, NC, 27560, USA
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Xu Z, Wang Y, Jiang C, Wang Z, Cheng Y, Fan M. The regulation of the PD-1/PD-L1 pathway in imiquimod-induced chronic psoriasis itch and itch sensitization in mouse. Mol Pain 2024; 20:17448069241252384. [PMID: 38631843 PMCID: PMC11069332 DOI: 10.1177/17448069241252384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 04/19/2024] Open
Abstract
PD-1/PD-L1 inhibitors have been demonstrated to induce itch in both humans and experimental animals. However, whether the PD-1/PD-L1 pathway is involved in the regulation of chronic psoriatic itch remains unclear. This study aimed to investigate the role of the PD-1/PD-L1 pathway in imiquimod-induced chronic psoriatic itch. The intradermal injection of PD-L1 in the nape of neck significantly alleviated chronic psoriatic itch in imiquimod-treated skin. Additionally, we observed that spontaneous scratching behavior induced by imiquimod disappeared on day 21. Still, intradermal injection of PD-1/PD-L1 inhibitors could induce more spontaneous scratching for over a month, indicating that imiquimod-treated skin remained in an itch sensitization state after the spontaneous scratching behavior disappeared. During this period, there was a significant increase in PD-1 receptor expression in both the imiquimod-treated skin and the spinal dorsal horn in mice, accompanied by significant activation of microglia in the spinal dorsal horn. These findings suggest the potential involvement of the peripheral and central PD-1/PD-L1 pathways in regulating chronic itch and itch sensitization induced by imiquimod.
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Affiliation(s)
- Zhehao Xu
- Department of Pharmacology, Clinic Medical College, Anhui Medical University, Hefei, China
| | - Yue Wang
- Department of Pharmacology, Clinic Medical College, Anhui Medical University, Hefei, China
- Department of Science and Education, Hefei BOE Hospital, Hefei, China
| | - Changcheng Jiang
- Department of Pharmacology, Clinic Medical College, Anhui Medical University, Hefei, China
| | - Zhengwei Wang
- Department of Pharmacology, Clinic Medical College, Anhui Medical University, Hefei, China
| | - YongFeng Cheng
- Department of Pharmacology, Clinic Medical College, Anhui Medical University, Hefei, China
| | - Manli Fan
- Department of Pharmacy, Fuyang Hospital, Anhui Medical University, Fuyang, China
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Xu ZH, Zhang JC, Chen K, Liu X, Li XZ, Yuan M, Wang Y, Tian JY. Mechanisms of the PD-1/PD-L1 pathway in itch: From acute itch model establishment to the role in chronic itch in mouse. Eur J Pharmacol 2023; 960:176128. [PMID: 37866747 DOI: 10.1016/j.ejphar.2023.176128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 09/22/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023]
Abstract
Programmed cell death receptor/ligand 1 (PD-1/PD-L1) blockade therapy for various cancers induces itch. However, few studies have evaluated the mechanism underlying PD-1/PD-L1 inhibitor-induced itch. This study aimed to establish and evaluate a mouse model of acute itch induced by PD-1/PD-L1 inhibitors and to explore the role of the PD-1/PD-L1 pathway in chronic itch. The intradermal injection of the PD-1/PD-L1 small molecule inhibitors, or anti-PD-1/PD-L1 antibodies in the nape of the neck in the mice elicited intense spontaneous scratches. The model was evaluated using pharmacological methods. The number of scratches was reduced by naloxone but not by antihistamines or the transient receptor potential (TRP) channel inhibitor. Moreover, the PD-1 receptor was detected in the spinal cord of the mouse models of chronic itch that exhibited acetone, diethyl ether, and water (AEW)-induced dry skin, imiquimod-induced psoriasis, and 1-fluoro-2,4-dinitrobenzene (DNFB)-induced allergic contact dermatitis. Intrathecal PD-L1 (1 μg, 4 times a week for 1 week) suppressed the activation of the microglia in the spinal dorsal horn to relieve the chronic itch that was elicited by imiquimod-induced psoriasis and DNFB-induced allergic contact dermatitis. Although the activation of the microglia in the spinal dorsal horn was not detected in the AEW-treated mice, intrathecal PD-L1 still reduced the number of scratches that were elicited by AEW. Our findings suggest that histamine receptor inhibitors or TRP channel inhibitors have limited effects on PD-1/PD-L1 inhibitor-induced itch and that spinal PD-1 is important for the spinal activation of the microglia, which may underlie chronic itch.
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Affiliation(s)
- Zhe-Hao Xu
- Department of Pharmacology, Clinical College of Anhui Medical University, Hefei, China.
| | - Jing-Cheng Zhang
- Department of Biliary and Pancreatic Surgery, Anhui Provincial Hospital Affiliated with Anhui Medical University, China
| | - Ke Chen
- Department of General Surgery, The Frist Affiliated of Anhui Medical University, China
| | - Xuan Liu
- Department of Pharmacology, Clinical College of Anhui Medical University, Hefei, China
| | - Xian-Zhi Li
- Department of Pharmacology, Clinical College of Anhui Medical University, Hefei, China
| | - Ming Yuan
- Department of Pharmacology, Clinical College of Anhui Medical University, Hefei, China
| | - Yue Wang
- Department of Pharmacology, Clinical College of Anhui Medical University, Hefei, China
| | - Jing-Yu Tian
- Department of Pharmacology, Clinical College of Anhui Medical University, Hefei, China
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Thouvenin MD, Bacquey A, Babin M, Lestienne F, Lauze C, Gravier E, Placintescu D, Ortiz-Brugués A, Ständer S. Efficacy of Avène Hydrotherapy on Chronic Pruritus in Patients with Plaque Psoriasis. Dermatol Ther (Heidelb) 2023; 13:3137-3151. [PMID: 37837493 PMCID: PMC10689587 DOI: 10.1007/s13555-023-01047-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/22/2023] [Indexed: 10/16/2023] Open
Abstract
INTRODUCTION Pruritus is a prevalent symptom, described as one of the most bothersome of psoriasis. Specific itch management remains a challenge, for which hydrotherapy could be used as adjunct care to medical treatment. Therefore, we assessed the immediate and longer-term benefit of 3 weeks of Avène thermal spring water hydrotherapy on chronic pruritus in patients in addition to their usual psoriasis and/or pruritus management. METHODS Twenty-six patients suffering from chronic pruritus due to psoriasis were evaluated before and after 3 weeks of hydrotherapy with a 3 and 6 month follow-up. A control group (18 patients) did not undergo hydrotherapy and continued to follow their usual skin management. Pruritus was assessed according to the numeric rating scale (NRS, pruritus intensity), the visual dynamic pruritus score (vDPS, change in pruritus intensity), and the 5-D itch scale (pruritus characteristics). Psoriasis severity was measured using the psoriasis area and severity index (PASI) score. The "itchy quality of life" (ItchQoL) scale was used to assess quality-of-life (QoL) impact related to itch. Pruritus and psoriasis gene and protein biomarkers were measured in lesional and nonlesional skin. RESULTS Pruritus measurements (NRS, vDPS, and 5-D itch scale) indicated an immediate and long-lasting positive effect of hydrotherapy compared with control patients. The psoriasis area and severity index (PASI) was decreased by 40.0% by hydrotherapy, which was sustained over 6 months. The ItchQoL also improved directly after hydrotherapy, which was still much improved even 6 months later. Analysis of gene and/or protein biomarkers revealed a significant decrease of inflammation biomarkers (IL-8, IL-1α, IL-1RA, and RANTES), of psoriasis biomarkers (PI3, S100A7, and IL-17), and of pruritus biomarkers (IL-31, TRPV1, and CGRP1). CONCLUSIONS These findings demonstrated an immediate and long-lasting improvement of pruritus in patients with psoriasis who underwent Avène thermal spring water hydrotherapy, indicating that this would be a good complementary therapy in the management of this disease. TRIAL REGISTRATION NCT03023254.
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Affiliation(s)
| | - Adeline Bacquey
- Clinical Skin Research and Development Center, Pierre Fabre Dermo-Cosmétique, Toulouse, France
| | - Marine Babin
- Clinical Skin Research and Development Center, Pierre Fabre Dermo-Cosmétique, Toulouse, France
| | - Fabrice Lestienne
- Pharmaco-Clinical Research Group, Pierre Fabre Dermo-Cosmétique, Toulouse, France
| | - Christophe Lauze
- Pharmaco-Clinical Research Group, Pierre Fabre Dermo-Cosmétique, Toulouse, France
| | - Eléonore Gravier
- Pharmaco-Clinical Research Group, Pierre Fabre Dermo-Cosmétique, Toulouse, France
| | | | - Ariadna Ortiz-Brugués
- Medical Direction, Laboratoires Dermatologiques Avène, Lavaur, France
- Department of Oncodermatology, Claudius Regaud Institute and University Cancer Institute Toulouse Oncopole, Toulouse, France
| | - Sonja Ständer
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Münster, Münster, Germany
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Bibi I, Schaffert D, Blauth M, Lull C, von Ahnen JA, Gross G, Weigandt WA, Knitza J, Kuhn S, Benecke J, Leipe J, Schmieder A, Olsavszky V. Automated Machine Learning Analysis of Patients With Chronic Skin Disease Using a Medical Smartphone App: Retrospective Study. J Med Internet Res 2023; 25:e50886. [PMID: 38015608 PMCID: PMC10716771 DOI: 10.2196/50886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Rapid digitalization in health care has led to the adoption of digital technologies; however, limited trust in internet-based health decisions and the need for technical personnel hinder the use of smartphones and machine learning applications. To address this, automated machine learning (AutoML) is a promising tool that can empower health care professionals to enhance the effectiveness of mobile health apps. OBJECTIVE We used AutoML to analyze data from clinical studies involving patients with chronic hand and/or foot eczema or psoriasis vulgaris who used a smartphone monitoring app. The analysis focused on itching, pain, Dermatology Life Quality Index (DLQI) development, and app use. METHODS After extensive data set preparation, which consisted of combining 3 primary data sets by extracting common features and by computing new features, a new pseudonymized secondary data set with a total of 368 patients was created. Next, multiple machine learning classification models were built during AutoML processing, with the most accurate models ultimately selected for further data set analysis. RESULTS Itching development for 6 months was accurately modeled using the light gradient boosted trees classifier model (log loss: 0.9302 for validation, 1.0193 for cross-validation, and 0.9167 for holdout). Pain development for 6 months was assessed using the random forest classifier model (log loss: 1.1799 for validation, 1.1561 for cross-validation, and 1.0976 for holdout). Then, the random forest classifier model (log loss: 1.3670 for validation, 1.4354 for cross-validation, and 1.3974 for holdout) was used again to estimate the DLQI development for 6 months. Finally, app use was analyzed using an elastic net blender model (area under the curve: 0.6567 for validation, 0.6207 for cross-validation, and 0.7232 for holdout). Influential feature correlations were identified, including BMI, age, disease activity, DLQI, and Hospital Anxiety and Depression Scale-Anxiety scores at follow-up. App use increased with BMI >35, was less common in patients aged >47 years and those aged 23 to 31 years, and was more common in those with higher disease activity. A Hospital Anxiety and Depression Scale-Anxiety score >8 had a slightly positive effect on app use. CONCLUSIONS This study provides valuable insights into the relationship between data characteristics and targeted outcomes in patients with chronic eczema or psoriasis, highlighting the potential of smartphone and AutoML techniques in improving chronic disease management and patient care.
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Affiliation(s)
- Igor Bibi
- Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, Center of Excellence in Dermatology, Heidelberg University, Mannheim, Germany
| | - Daniel Schaffert
- Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, Center of Excellence in Dermatology, Heidelberg University, Mannheim, Germany
| | - Mara Blauth
- Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, Center of Excellence in Dermatology, Heidelberg University, Mannheim, Germany
| | - Christian Lull
- Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, Center of Excellence in Dermatology, Heidelberg University, Mannheim, Germany
| | - Jan Alwin von Ahnen
- Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, Center of Excellence in Dermatology, Heidelberg University, Mannheim, Germany
| | - Georg Gross
- Department of Medicine V, Division of Rheumatology, University Medical Centre and Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Wanja Alexander Weigandt
- Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, Center of Excellence in Dermatology, Heidelberg University, Mannheim, Germany
| | - Johannes Knitza
- Institute of Digital Medicine, Philipps-University Marburg and University Hospital of Giessen and Marburg, Marburg, Germany
| | - Sebastian Kuhn
- Institute of Digital Medicine, Philipps-University Marburg and University Hospital of Giessen and Marburg, Marburg, Germany
| | - Johannes Benecke
- Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, Center of Excellence in Dermatology, Heidelberg University, Mannheim, Germany
| | - Jan Leipe
- Department of Medicine V, Division of Rheumatology, University Medical Centre and Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Astrid Schmieder
- Department of Dermatology, Venereology, and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Victor Olsavszky
- Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, Center of Excellence in Dermatology, Heidelberg University, Mannheim, Germany
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Deng L, Costa F, Blake KJ, Choi S, Chandrabalan A, Yousuf MS, Shiers S, Dubreuil D, Vega-Mendoza D, Rolland C, Deraison C, Voisin T, Bagood MD, Wesemann L, Frey AM, Palumbo JS, Wainger BJ, Gallo RL, Leyva-Castillo JM, Vergnolle N, Price TJ, Ramachandran R, Horswill AR, Chiu IM. S. aureus drives itch and scratch-induced skin damage through a V8 protease-PAR1 axis. Cell 2023; 186:5375-5393.e25. [PMID: 37995657 PMCID: PMC10669764 DOI: 10.1016/j.cell.2023.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 08/20/2023] [Accepted: 10/18/2023] [Indexed: 11/25/2023]
Abstract
Itch is an unpleasant sensation that evokes a desire to scratch. The skin barrier is constantly exposed to microbes and their products. However, the role of microbes in itch generation is unknown. Here, we show that Staphylococcus aureus, a bacterial pathogen associated with itchy skin diseases, directly activates pruriceptor sensory neurons to drive itch. Epicutaneous S. aureus exposure causes robust itch and scratch-induced damage. By testing multiple isogenic bacterial mutants for virulence factors, we identify the S. aureus serine protease V8 as a critical mediator in evoking spontaneous itch and alloknesis. V8 cleaves proteinase-activated receptor 1 (PAR1) on mouse and human sensory neurons. Targeting PAR1 through genetic deficiency, small interfering RNA (siRNA) knockdown, or pharmacological blockade decreases itch and skin damage caused by V8 and S. aureus exposure. Thus, we identify a mechanism of action for a pruritogenic bacterial factor and demonstrate the potential of inhibiting V8-PAR1 signaling to treat itch.
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Affiliation(s)
- Liwen Deng
- Department of Immunology, Harvard Medical School, Boston, MA 02215, USA
| | - Flavia Costa
- Department of Immunology and Microbiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Kimbria J Blake
- Department of Immunology, Harvard Medical School, Boston, MA 02215, USA
| | - Samantha Choi
- Department of Immunology, Harvard Medical School, Boston, MA 02215, USA
| | - Arundhasa Chandrabalan
- Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario N6A 5C1, Canada
| | - Muhammad Saad Yousuf
- Department of Neuroscience and Center for Advanced Pain Studies, University of Texas at Dallas, Richardson, TX 75080, USA
| | - Stephanie Shiers
- Department of Neuroscience and Center for Advanced Pain Studies, University of Texas at Dallas, Richardson, TX 75080, USA
| | - Daniel Dubreuil
- Departments of Neurology and Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Daniela Vega-Mendoza
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Corinne Rolland
- IRSD, Université de Toulouse, INSERM, INRAe, ENVT, Université Toulouse III-Paul Sabatier (UPS), Toulouse, France
| | - Celine Deraison
- IRSD, Université de Toulouse, INSERM, INRAe, ENVT, Université Toulouse III-Paul Sabatier (UPS), Toulouse, France
| | - Tiphaine Voisin
- Department of Immunology, Harvard Medical School, Boston, MA 02215, USA
| | - Michelle D Bagood
- Department of Dermatology, University of California, San Diego, La Jolla, CA 92093, USA
| | - Lucia Wesemann
- Department of Immunology, Harvard Medical School, Boston, MA 02215, USA
| | - Abigail M Frey
- Department of Immunology, Harvard Medical School, Boston, MA 02215, USA
| | - Joseph S Palumbo
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brian J Wainger
- Departments of Neurology and Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Richard L Gallo
- Department of Dermatology, University of California, San Diego, La Jolla, CA 92093, USA
| | | | - Nathalie Vergnolle
- IRSD, Université de Toulouse, INSERM, INRAe, ENVT, Université Toulouse III-Paul Sabatier (UPS), Toulouse, France
| | - Theodore J Price
- Department of Neuroscience and Center for Advanced Pain Studies, University of Texas at Dallas, Richardson, TX 75080, USA
| | - Rithwik Ramachandran
- Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario N6A 5C1, Canada
| | - Alexander R Horswill
- Department of Immunology and Microbiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Isaac M Chiu
- Department of Immunology, Harvard Medical School, Boston, MA 02215, USA.
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11
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Costanzo A, Llamas-Velasco M, Fabbrocini G, Cuccia A, Rivera-Diaz R, Gaarn Du Jardin K, Kasujee I, Puig L, Carrascosa JM. Tildrakizumab improves high burden skin symptoms, impaired sleep and quality of life of moderate-to-severe plaque psoriasis patients in conditions close to clinical practice. J Eur Acad Dermatol Venereol 2023; 37:2004-2015. [PMID: 37246505 DOI: 10.1111/jdv.19229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/20/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Tildrakizumab (TIL) is an interleukin (IL)-23p19 inhibitor for the treatment of moderate-to-severe plaque psoriasis with long-term efficacy and safety demonstrated in Phase III trials. Studies conducted in conditions closer to clinical practice are needed. OBJECTIVES The TRIBUTE study (open-label, Phase IV) assessed the efficacy and impact on health-related quality of life (HRQoL) of TIL 100 mg in adult moderate-to-severe psoriasis patients (naïve to IL-23/Th17 pathway inhibitors) in conditions similar to clinical practice. METHODS Key efficacy measure was Psoriasis Area Severity Index (PASI). HRQoL was evaluated using the Dermatology Life Quality Index (DLQI) and Skindex-16. Additional patient-reported outcomes included Pain-, Pruritus- and Scaling-Numerical Rating Scale (NRS), Medical Outcome Study (MOS)-Sleep, Work Productivity and Activity Impairment (WPAI), Patient Benefit Index (PBI) and Treatment Satisfaction Questionnaire for Medication (TSQM). RESULTS One hundred and seventy-seven patients were enrolled (six patients did not complete the study). After 24 weeks, the proportion of patients achieving PASI scores ≤ 3, PASI 75, PASI 90 and DLQI 0/1 was 88.4%, 92.5%, 74.0% and 70.4%, respectively. Skindex-16 overall score improved (mean absolute change from baseline, MACB [95%CI]: -53.3 [-58.1, -48.5]). Significant benefits (MACB [95%CI]) were found on pruritus-, pain- and scaling-NRS scores (-5.7 [-6.1, -5.2], -3.5 [-4.1, -3.0] and -5.7 [-6.2, -5.2], respectively), MOS-Sleep (-10.4 [-13.3, -7.4] Sleep problems Index II) and WPAI (-36.4 [-42.6, -30.2] activity impairment, -28.2 [-34.7, -21.7] productivity loss, -27.0 [-32.9, -21.1] presenteeism and -6.8 [-12.1, -1.5] absenteeism). 82.7% of patients reported PBI ≥ 3 and the mean (SD) global TSQM score was high (80.5 [18.5]). Only one serious treatment-emergent adverse event was reported (not-related to TIL). CONCLUSIONS TIL 100 mg treatment after 24 weeks in conditions close to real clinical practice showed a quick and high improvement in psoriasis signs and HRQoL. Patient reported improvements in sleep outcomes and work productivity, relevant benefits and high treatment satisfaction. The safety profile was favourable and consistent with Phase III trials.
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Affiliation(s)
- Antonio Costanzo
- Section of Dermatology, Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Mar Llamas-Velasco
- Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Aldo Cuccia
- Unit of Dermatology, San Donato Hospital, Arezzo, Italy
| | - Raquel Rivera-Diaz
- Department of Dermatology, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | | | | | - Lluís Puig
- Department of Dermatology, IIB SANTPAU, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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12
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Kaczmarska A, Kwiatkowska D, Skrzypek KK, Kowalewski ZT, Jaworecka K, Reich A. Pathomechanism of Pruritus in Psoriasis and Atopic Dermatitis: Novel Approaches, Similarities and Differences. Int J Mol Sci 2023; 24:14734. [PMID: 37834183 PMCID: PMC10573181 DOI: 10.3390/ijms241914734] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Pruritus is defined as an unpleasant sensation that elicits a desire to scratch. Nearly a third of the world's population may suffer from pruritus during their lifetime. This symptom is widely observed in numerous inflammatory skin diseases-e.g., approximately 70-90% of patients with psoriasis and almost every patient with atopic dermatitis suffer from pruritus. Although the pathogenesis of atopic dermatitis and psoriasis is different, the complex intricacies between several biochemical mediators, enzymes, and pathways seem to play a crucial role in both conditions. Despite the high prevalence of pruritus in the general population, the pathogenesis of this symptom in various conditions remains elusive. This review aims to summarize current knowledge about the pathogenesis of pruritus in psoriasis and atopic dermatitis. Each molecule involved in the pruritic pathway would merit a separate chapter or even an entire book, however, in the current review we have concentrated on some reports which we found crucial in the understanding of pruritus. However, the pathomechanism of pruritus is an extremely complex and intricate process. Moreover, many of these signaling pathways are currently undergoing detailed analysis or are still unexplained. As a result, it is currently difficult to take an objective view of how far we have come in elucidating the pathogenesis of pruritus in the described diseases. Nevertheless, considerable progress has been made in recent years.
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Affiliation(s)
- Agnieszka Kaczmarska
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland; (A.K.); (D.K.); (K.J.)
| | - Dominika Kwiatkowska
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland; (A.K.); (D.K.); (K.J.)
| | | | | | - Kamila Jaworecka
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland; (A.K.); (D.K.); (K.J.)
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland; (A.K.); (D.K.); (K.J.)
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13
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Tsuji G, Yamamura K, Kawamura K, Kido-Nakahara M, Ito T, Nakahara T. Regulatory Mechanism of the IL-33-IL-37 Axis via Aryl Hydrocarbon Receptor in Atopic Dermatitis and Psoriasis. Int J Mol Sci 2023; 24:14633. [PMID: 37834081 PMCID: PMC10572928 DOI: 10.3390/ijms241914633] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/20/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
Interleukin (IL)-33 and IL-37 have been identified as novel cytokines involved in various inflammatory diseases. However, their specific roles remain largely unknown. Recent studies have shown that IL-33, which triggers inflammation, and IL-37, which suppresses it, cooperatively regulate the balance between inflammation and anti-inflammation. IL-33 and IL-37 are also deeply involved in the pathogenesis of inflammatory skin diseases such as atopic dermatitis (AD) and psoriasis. Furthermore, a signaling pathway by which aryl hydrocarbon receptor (AHR), a receptor for dioxins, regulates the expression of IL-33 and IL-37 has been revealed. Here, we outline recent findings on the mechanisms regulating IL-33 and IL-37 expression in AD and psoriasis. IL-33 expression is partially dependent on mitogen-activated protein kinase (MAPK) activation, and IL-37 has a role in suppressing MAPK in human keratinocytes. Furthermore, IL-33 downregulates skin barrier function proteins including filaggrin and loricrin, thereby downregulating the expression of IL-37, which colocalizes with these proteins. This leads to an imbalance of the IL-33-IL-37 axis, involving increased IL-33 and decreased IL-37, which may be associated with the pathogenesis of AD and psoriasis. Therefore, AHR-mediated regulation of the IL-33-IL-37 axis may lead to new therapeutic strategies for the treatment of AD and psoriasis.
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Affiliation(s)
- Gaku Tsuji
- Research and Clinical Center for Yusho and Dioxin, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (K.Y.); (T.N.)
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (K.K.); (M.K.-N.); (T.I.)
| | - Kazuhiko Yamamura
- Research and Clinical Center for Yusho and Dioxin, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (K.Y.); (T.N.)
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (K.K.); (M.K.-N.); (T.I.)
| | - Koji Kawamura
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (K.K.); (M.K.-N.); (T.I.)
| | - Makiko Kido-Nakahara
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (K.K.); (M.K.-N.); (T.I.)
| | - Takamichi Ito
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (K.K.); (M.K.-N.); (T.I.)
| | - Takeshi Nakahara
- Research and Clinical Center for Yusho and Dioxin, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (K.Y.); (T.N.)
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (K.K.); (M.K.-N.); (T.I.)
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14
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Kircik LH, Alonso-Llamazares J, Bhatia N, Bukhalo M, Devani AR, Draelos ZD, DuBois J, Gooderham MJ, Kempers SE, Lain E, Lee M, Moore A, Murrell DF, Papp KA, Pariser DM, Sinclair R, Zirwas M, Burnett P, Higham RC, Krupa D, Berk DR. Once-daily roflumilast foam 0.3% for scalp and body psoriasis: a randomized, double-blind, vehicle-controlled phase IIb study. Br J Dermatol 2023; 189:392-399. [PMID: 37279795 DOI: 10.1093/bjd/ljad182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/10/2023] [Accepted: 05/23/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Scalp psoriasis affects most patients with psoriasis, but it can be difficult to treat. OBJECTIVES To evaluate the efficacy and safety of once-daily roflumilast foam 0.3% on scalp and body psoriasis. METHODS In a phase IIb randomized controlled trial, adults and adolescents aged ≥ 12 years with scalp and body psoriasis were randomized (2 : 1) to roflumilast foam 0.3% or vehicle for 8 weeks. The primary efficacy endpoint was scalp Investigator Global Assessment (S-IGA) success (score of 'clear' or 'almost clear' plus ≥ 2-grade improvement from baseline) at week 8. Safety and tolerability were also evaluated. RESULTS Significantly more roflumilast-treated patients (59.1%) than vehicle-treated patients (11.4%) achieved S-IGA success at week 8 (P < 0.001); differences favoured roflumilast as early as the first postbaseline visit at week 2 (P < 0.001). Significant improvements were also seen for secondary endpoints, including body IGA success, Scalp Itch Numeric Rating Scale and the Psoriasis Scalp Severity Index. The safety of roflumilast was generally similar to vehicle. Patients treated with roflumilast experienced low rates of treatment-emergent adverse events (AEs), with few discontinuations due to an AE. Few patients with skin of colour (11%) and few adolescents (0.7%) were included. CONCLUSIONS The results support the further development of roflumilast foam for treating scalp and body psoriasis.
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Affiliation(s)
- Leon H Kircik
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Indiana Medical Center, Indianapolis, IN, USA
- Physicians Skin Care PLLC, Louisville, KY, USA
- Skin Sciences PLLC, Louisville, KY, USA
| | | | - Neal Bhatia
- Therapeutics Clinical Research, San Diego, CA, USA
| | | | - Alim R Devani
- Dermatology Research Institute, Calgary, AB, Canada
- Skin Health and Wellness Centre, Calgary, AB, Canada
- Probity Medical Research, Calgary, AB, Canada
| | - Zoe D Draelos
- Dermatology Consulting Services, High Point, NC, USA
| | | | - Melinda J Gooderham
- SkiN Centre for Dermatology, Peterborough, ON, Canada
- Probity Medical Research, Peterborough, ON, Canada
- Queen's University, Peterborough, ON, Canada
| | | | | | - Mark Lee
- Progressive Clinical Research, San Antonio, TX, USA
| | - Angela Moore
- Arlington Research Center, Arlington, TX, USA
- Baylor University Medical Center, Dallas, TX, USA
| | | | - Kim A Papp
- Probity Medical Research, Waterloo, ON, Canada
- K. Papp Clinical Research, Waterloo, ON, Canada
| | - David M Pariser
- Eastern Virginia Medical School, Norfolk, VA, USA
- Virginia Clinical Research Inc., Norfolk, VA, USA
| | | | - Matthew Zirwas
- Dermatologists of the Central States, Probity Medical Research, Bexley, OH, USA
- Ohio University, Bexley, OH, USA
| | | | | | - David Krupa
- Arcutis Biotherapeutics Inc., Westlake Village, CA, USA
| | - David R Berk
- Arcutis Biotherapeutics Inc., Westlake Village, CA, USA
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15
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Nadinda PG, van Laarhoven AIM, Evers AWM, Maas J, van Beugen S. Itch-Related Avoidance and Attentional Biases in Patients with Psoriasis? J Invest Dermatol 2023; 143:1848-1850.e8. [PMID: 36963611 DOI: 10.1016/j.jid.2023.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 02/23/2023] [Accepted: 02/25/2023] [Indexed: 03/26/2023]
Affiliation(s)
- Putu Gita Nadinda
- Department of Health, Medical and Neuropsychology Unit, Leiden University, The Netherlands.
| | | | - Andrea W M Evers
- Department of Health, Medical and Neuropsychology Unit, Leiden University, The Netherlands; Medical Delta, Leiden University, Technical University Delft, and Erasmus University, The Netherlands
| | - Joyce Maas
- GGZ Oost Brabant, Centre for Eating Disorders, Helmond, The Netherlands; Department of Medical and Clinical Psychology, Tilburg University, The Netherlands
| | - Sylvia van Beugen
- Department of Health, Medical and Neuropsychology Unit, Leiden University, The Netherlands
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16
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Drakos A, Vender R, Torres T. Topical roflumilast for the treatment of psoriasis. Expert Rev Clin Immunol 2023; 19:1053-1062. [PMID: 37243575 DOI: 10.1080/1744666x.2023.2219897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/13/2023] [Accepted: 05/26/2023] [Indexed: 05/29/2023]
Abstract
INTRODUCTION New non-steroidal topical agents are needed for the treatment of psoriasis. Roflumilast cream 0.3% is a once daily phosphodiesterase-4 inhibitor that was recently approved by the FDA for the treatment of plaque psoriasis in adolescents and adults. It is indicated for use on all body surfaces including intertriginous areas. AREAS COVERED In this review, we summarize the current knowledge about roflumilast cream for the treatment of psoriasis, highlighting its efficacy and safety profile from published clinical trials. Roflumilast's mechanism of action and pharmacokinetic profile are also discussed. EXPERT OPINION Positive results were reported across trials with 48% of patients treated with roflumilast achieving an Investigator Global Assessment score of clear or almost clear at 8 weeks in phase III studies. Most adverse events were mild or moderate in severity and few application-site reactions were reported among participants. Unique advantages of the cream are its success in treating intertriginous areas and its ability to reduce symptoms of itch, results of which may significantly improve quality of life for patients. In the future, real-world data and active comparator trials with existing non-steroidal agents are needed to better understand roflumilast's place in the current treatment landscape.
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Affiliation(s)
| | - Ron Vender
- Dermatrials Research Inc. & Venderm Innovations in Psoriasis, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Tiago Torres
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
- Department of Dermatology, Centro Hospitalar de Santo António, Porto, Portugal
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17
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Shang L, Zhao S, Shi H, Xing X, Zhang J, He Y. Nerve growth factor mediates activation of transient receptor potential vanilloid 1 in neurogenic pruritus of psoriasis. Int Immunopharmacol 2023; 118:110063. [PMID: 37004343 DOI: 10.1016/j.intimp.2023.110063] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/04/2023] [Accepted: 03/19/2023] [Indexed: 04/03/2023]
Abstract
Pruritus is a common and painful symptom in psoriasis with profoundly negative impacts on quality of life. The underlying mechanisms of pruritus are complex and multifactorial, and accumulating evidence suggests that pruritus induced by neurogenic inflammation predominates in psoriasis. Nerve growth factor (NGF) -mediated transient receptor potential vanilloid receptor 1(TRPV1) pathway has emerged as a crucial node in the regulation of neurogenic pruritus. TRPV1 appears coupled to most pruritus-specific molecules via the neuro-immune axis. While the modes of regulation differ for each axis, TRPV1 is involved in substantial biochemical crosstalk-causing feedback loops with significant effects on neurogenic pruritus. Therefore, TRPV1 has emerged as a target molecular in drug development for pruritus in psoriasis. However, no significant clinical progress occurred in the development of systemic TRPV1 antagonists due to elevated core temperature. Thus, topical application of TRPV1 antagonists and interference with mediators linked to the TRPV1 activation pathway may be promising therapeutic options to ameliorate pruritus. This Review focuses on recent advances in complicated regulation of NGF-mediated TRPV1 pathway in psoriatic neurogenic pruritus, as well as the therapeutic options that arise from the dissection of the pathway.
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18
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Liu X, Li L, Jiang J, Ge W, Huang Y, Jin Z, Liu X, Kong Y, Zhanmu O, Zeng X, Li F, Li M, Chen H. Role of Type I Cannabinoid Receptor in Sensory Neurons in Psoriasiform Skin Inflammation and Pruritus. J Invest Dermatol 2023; 143:812-821.e3. [PMID: 36410425 DOI: 10.1016/j.jid.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 11/23/2022]
Abstract
Type I cannabinoid receptor (CB1R) has been reported to exhibit favorable anti-inflammation and antipruritus effects against inflammation-based skin diseases, but the specific mechanism remains to be explored. In this study, we found that the activation of CB1R significantly relieved the scratching behavior and skin inflammation in a psoriatic mouse model, whereas CB1R antagonist aggravated these symptoms. Because the expression of CB1R was abundant in dorsal root ganglia, we constructed mice with conditional CB1R knockout in primary sensory neurons and found that imiquimod-induced psoriasiform inflammation and itch were both worsened in CB1R-conditional knockout mice. Next, we observed that the CB1R was mostly located in peptidergic neurons, and deletion of CB1R in primary sensory neurons promoted the production and release of substance P to the skin tissue. Furthermore, the elevated substance P in the skin affected the activation of extracellular signal‒regulated kinase in keratinocytes and induced the accumulation of mast cells in the dermis. Finally, we showed that blocking the substance P signal significantly alleviated the exacerbation of psoriasiform inflammation and itch caused by imiquimod in CB1R-conditional knockout mice. Together, our work reveals that CB1R in sensory neurons plays a key role in psoriasiform skin inflammation and pruritus by regulating substance P expression.
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Affiliation(s)
- Xin Liu
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Li
- Department of Dermatology, School of Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jian Jiang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenqiang Ge
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuqiong Huang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zilin Jin
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - XinXin Liu
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Kong
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ouyang Zhanmu
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Zeng
- Department of Dermatology, Union Shenzhen Hospital, Huazhong University of Science and Technology, Shenzhen, China
| | - Fei Li
- Department of Dermatology, Union Shenzhen Hospital, Huazhong University of Science and Technology, Shenzhen, China
| | - Man Li
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongxiang Chen
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Dermatology, Union Shenzhen Hospital, Huazhong University of Science and Technology, Shenzhen, China.
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19
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Lee LL, Huo AP, Chen SL. Experiences and coping behaviours of patients with psoriasis: a qualitative study. J DERMATOL TREAT 2023; 34:2193661. [PMID: 36942918 DOI: 10.1080/09546634.2023.2193661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Psoriasis is a complex, chronic, lifelong inflammatory skin disease characterized by the development of erythematous, indurated, scaly, pruritic and often painful skin plaques, and it is currently incurable. It profoundly affects psychological wellbeing and social functioning and has significant associated co-morbidities. To improve clinical approaches, understanding of the experiences of patients with psoriasis is needed. OBJECTIVE To explore the experiences and coping behaviours of patients with psoriasis. METHODS A qualitative study approach was conducted. Through semi-structured interviews, 20 patients with psoriasis were recruited from general practices and specialist dermatology practices in a regional teaching hospital in Taiwan. Recorded interviews were transcribed and analysed by content analysis. RESULTS Three themes and nine subthemes were identified: 1. Symptoms distress: (a) trouble with scaling, (b) bothersome itching, and (c) complex pain experiences; 2. Psychological distress: (a) encountering discrimination and (b) feeling stigmatised; 3. Managing psoriasis: (a) coping with symptoms, (b) seeking alternative methods, (c) using biologic agents, and (d) changing thinking and coexisting with the disease. CONCLUSION The experience of patients with psoriasis has significant negative impacts on their lives. The findings of this study can provide healthcare professionals with a reference for the care of patients with psoriasis.
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Affiliation(s)
- Lin-Lin Lee
- Department of Nursing, Hungkuang University, Taichung 433304, Taiwan
| | - An-Ping Huo
- Department of Internal Medicine, Jen-Ai Hospital, Dali, Taichung 412224, Taiwan
| | - Shu-Ling Chen
- Department of Nursing, Hungkuang University, Taichung 433304, Taiwan
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Stein Gold L, Alonso-Llamazares J, Draelos ZD, Gooderham MJ, Kempers SE, Kircik LH, Lebwohl MG, Papp KA, Pariser DM, Toth DP, Yosipovitch G, Higham RC, Feng A, Berk DR. Effect of Roflumilast Cream (ARQ-151) on Itch and Itch-Related Sleep Loss in Adults with Chronic Plaque Psoriasis: Patient-Reported Itch Outcomes of a Phase 2b Trial. Am J Clin Dermatol 2023; 24:305-13. [PMID: 36370336 DOI: 10.1007/s40257-022-00739-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Itch is the most bothersome symptom reported by patients with psoriasis. Safe and effective treatments for psoriasis that also address itch are needed. OBJECTIVES To report effects of roflumilast cream on itch-related outcomes from a Phase 2b trial. METHODS Adults with chronic plaque psoriasis were randomized to roflumilast 0.3%, roflumilast 0.15%, or vehicle once-daily for 12 weeks. Psoriasis severity was assessed via the Investigator Global Assessment (IGA; a 5-point scale assessing plaque thickening, scaling, and erythema ranging from 0 [clear] to 4 [severe]) and ≥ 2 on a modified Psoriasis Area and Severity Index (PASI-HD, which combines severity of lesions and area affected, ranging from 0 [no disease] to 72 [maximal disease], with the actual percentage of the anatomical area involved in those patients with < 10% of anatomical area involved [e.g., 0.1 for 1% to 0.9 for 9%]). Itch was evaluated via Worst Itch Numeric Rating Scale (WI-NRS), Psoriasis Symptom Diary (PSD) Items 1 (severity of itch) and 2 (bother of itch), and itch-related sleep loss NRS scores. Post hoc correlation analyses between WI-NRS and PASI, WI-NRS and itch-related sleep loss, and WI-NRS and DLQI were also performed. RESULTS Roflumilast-treated patients had significantly greater improvements than vehicle-treated patients in WI-NRS and PSD Items 1 and 2 beginning at Week 2 and in itch-related sleep loss Weeks 6 through 12. Among patients with baseline WI-NRS ≥ 6, significantly more patients achieved ≥ 4-point improvement with roflumilast than with vehicle as early as Week 2. Itch severity had low correlation with PASI while WI-NRS and IGA were not always aligned. LIMITATIONS The first assessment was at 2 weeks, limiting the ability to assess early onset of itch response. CONCLUSION Roflumilast cream improved itch and itch-related sleep loss associated with chronic plaque psoriasis. CLINICALTRIALS GOV IDENTIFIER NCT03638258.
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Honma M, Kanai Y, Murotani K, Ito K, Ohata C, Yamazaki F, Saeki H, Seishima M, Mizutani Y, Kitabayashi H, Imafuku S. Effectiveness of brodalumab in improving itching and skin pain in Japanese patients with psoriasis: The
ProLOGUE
study. J Dermatol 2022; 50:453-461. [PMID: 36540010 DOI: 10.1111/1346-8138.16682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/31/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
Itching and skin pain are bothersome symptoms of psoriasis, but evidence is limited regarding the treatment effectiveness on these symptoms in daily clinical settings. We assessed the changes in the levels of itching and skin pain after brodalumab treatment in Japanese patients with psoriasis using patient-reported outcomes (PROs). Patients with psoriasis who have inadequate response to existing treatments were enrolled in the single-arm, open-label, multicenter, prospective ProLOGUE study and received brodalumab 210 mg subcutaneously in daily clinical practice. Psoriasis Area and Severity Index (PASI) and PRO assessments were performed at baseline and weeks 12 and 48. Seventy-three patients (men, 82.2%; median age, 54.0 years) were enrolled. The Itch Numeric Rating Scale (NRS; p < 0.0001 at weeks 12 and 48) and Skin Pain NRS (week 12, p = 0.0004; week 48, p < 0.0001) scores significantly decreased from baseline. The Itch NRS score was significantly higher in patients with a Dermatology Life Quality Index (DLQI) score of ≥2 (vs. 0/1; p < 0.0001 at weeks 12 and 48) and in patients with a Treatment Satisfaction Questionnaire for Medication-9 (TSQM-9) global satisfaction domain score of ≤70% (vs. >70%; week 12, p = 0.0120; week 48, p = 0.0348). The Itch NRS score cutoff value for achieving a PASI score of ≤2, DLQI score of 0/1, and TSQM-9 global satisfaction domain score of >70% was 1 at week 12 and 0 at week 48. Brodalumab treatment was associated with improvement in itching and skin pain in Japanese patients with psoriasis. An Itch NRS score of 0 can be a long-term treatment goal for psoriasis (Japan Registry of Clinical Trials identifier: jRCTs031180037).
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Affiliation(s)
- Masaru Honma
- Department of Dermatology Asahikawa Medical University Asahikawa Japan
| | | | | | - Kei Ito
- Department of Dermatology JR Sapporo Hospital Sapporo Japan
| | - Chika Ohata
- Department of Dermatology Osaka General Medical Center Osaka Japan
| | | | - Hidehisa Saeki
- Department of Dermatology Nippon Medical School Tokyo Japan
| | - Mariko Seishima
- Department of Dermatology Gifu University Graduate School of Medicine Gifu Japan
| | - Yoko Mizutani
- Department of Dermatology Gifu University Graduate School of Medicine Gifu Japan
| | | | - Shinichi Imafuku
- Department of Dermatology Fukuoka University Faculty of Medicine Fukuoka Japan
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22
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Xue K, Wu H, Jia L, Yang S. Effectiveness and safety of auricular acupuncture for psoriasis: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e32020. [PMID: 36401494 PMCID: PMC9678494 DOI: 10.1097/md.0000000000032020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Psoriasis is a chronic, immune-mediated, polygenic skin disease that is common in clinical practice and often develops on the extremities, back, and scalp of patients. In that psoriasis lesions are stubborn and prone to recurrence, it has a serious impact on patients' quality of life and is detrimental to their physical and psychological health. Auricular acupuncture is one of the traditional Chinese medical treatments, which has the advantages of low adverse effects and simple operation and has been widely used in clinical practice with good efficacy. However, there has been no systematic evaluation of auricular acupuncture in the treatment of psoriasis. This protocol aims to evaluate the effectiveness and safety of auricular acupuncture in patients with psoriasis. METHODS We will search the following 8 databases including PubMed, MEDLINE, EMBASE, Cochrane Library, CNKI, Wan Fang, VIP, and CBM databases for randomized controlled trials of auricular acupuncture treated psoriasis from their inception to 10 October 2022. We will analyze the data meeting the inclusion criteria with the RevMan V.5.4 software. Two authors will assess the quality of the study with the Cochrane systematic evaluation tool. Treatment effectiveness and the psoriasis area and severity index are defined as the main outcomes, and the additional outcomes include itchy, dermatology life quality index, relapse rate, and adverse events. RESULTS This study will review and evaluate the available evidence on the effectiveness and safety of auricular acupuncture for psoriasis. CONCLUSIONS The results of this study will provide evidence for the effectiveness and safety of treating psoriasis, providing clinicians and patients with appropriate treatment options for this disease.
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Affiliation(s)
- Kaiyuan Xue
- School of Graduate, Heilongjiang University of Traditional Chinese Medicine, Harbin, Heilongjiang Province, China
| | - Haiyuan Wu
- School of Graduate, Heilongjiang University of Traditional Chinese Medicine, Harbin, Heilongjiang Province, China
| | - Lidan Jia
- First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province, China
| | - Suqing Yang
- First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province, China
- * Correspondence: Suqing Yang, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150040, China (e-mail: )
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23
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Mießner H, Seidel J, Smith ESJ. In vitro models for investigating itch. Front Mol Neurosci 2022; 15:984126. [PMID: 36385768 PMCID: PMC9644192 DOI: 10.3389/fnmol.2022.984126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/10/2022] [Indexed: 12/04/2022] Open
Abstract
Itch (pruritus) is a sensation that drives a desire to scratch, a behavior observed in many animals. Although generally short-lasting and not causing harm, there are several pathological conditions where chronic itch is a hallmark symptom and in which prolonged scratching can induce damage. Finding medications to counteract the sensation of chronic itch has proven difficult due to the molecular complexity that involves a multitude of triggers, receptors and signaling pathways between skin, immune and nerve cells. While much has been learned about pruritus from in vivo animal models, they have limitations that corroborate the necessity for a transition to more human disease-like models. Also, reducing animal use should be encouraged in research. However, conducting human in vivo experiments can also be ethically challenging. Thus, there is a clear need for surrogate models to be used in pre-clinical investigation of the mechanisms of itch. Most in vitro models used for itch research focus on the use of known pruritogens. For this, sensory neurons and different types of skin and/or immune cells are stimulated in 2D or 3D co-culture, and factors such as neurotransmitter or cytokine release can be measured. There are however limitations of such simplistic in vitro models. For example, not all naturally occurring cell types are present and there is also no connection to the itch-sensing organ, the central nervous system (CNS). Nevertheless, in vitro models offer a chance to investigate otherwise inaccessible specific cell–cell interactions and molecular pathways. In recent years, stem cell-based approaches and human primary cells have emerged as viable alternatives to standard cell lines or animal tissue. As in vitro models have increased in their complexity, further opportunities for more elaborated means of investigating itch have been developed. In this review, we introduce the latest concepts of itch and discuss the advantages and limitations of current in vitro models, which provide valuable contributions to pruritus research and might help to meet the unmet clinical need for more refined anti-pruritic substances.
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Affiliation(s)
- Hendrik Mießner
- Department of Pharmacology, University of Cambridge, Cambridge, United Kingdom
- Dermatological Skin Care, Beiersdorf AG, Hamburg, Germany
| | - Judith Seidel
- Dermatological Skin Care, Beiersdorf AG, Hamburg, Germany
| | - Ewan St. John Smith
- Department of Pharmacology, University of Cambridge, Cambridge, United Kingdom
- *Correspondence: Ewan St. John Smith,
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24
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Shi L, Liu C, Xiong H, Shi D. Elevation of IgE in patients with psoriasis: Is it a paradoxical phenomenon? Front Med (Lausanne) 2022; 9:1007892. [PMID: 36314037 PMCID: PMC9606585 DOI: 10.3389/fmed.2022.1007892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/26/2022] [Indexed: 11/25/2022] Open
Abstract
Immunoglobulin E (IgE) elevation is a hallmark of allergic conditions such as atopic dermatitis (AD). The pathogenesis of AD is typically associated with high levels of IL-4 and IL-13 produced by activated T helper 2 (Th2) cells. Psoriasis, on the other hand, is an inflammatory skin disease mainly driven by Th17 cells and their related cytokines. Although the immunopathologic reactions and clinical manifestations are often easily distinguished in the two skin conditions, patients with psoriasis may sometimes exhibit AD-like manifestations, such as elevated IgE and persistent pruritic lesions. Given the fact that the effective T cells have great plasticity to re-differentiate in response to innate and environmental factors, this unusual skin condition could be a consequence of a cross-reaction between distinct arms of T-cell and humoral immunity. Here we review the literature concerning the roles of IgE in the development of AD and psoriasis, showing that elevated IgE seems to be an important indicator for this non-typical psoriasis.
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Affiliation(s)
- Leyao Shi
- The Second Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China,The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, China
| | - Chen Liu
- The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, China
| | - Huabao Xiong
- Basic Medical School, Institute of Immunology and Molecular Medicine, Jining Medical University, Jining, China,Huabao Xiong
| | - Dongmei Shi
- The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, China,Department of Dermatology, Jining No.1 People's Hospital, Jining, China,*Correspondence: Dongmei Shi
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25
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Miyagi T, Kanai Y, Murotani K, Okubo Y, Honma M, Kobayashi S, Seishima M, Mizutani Y, Kitabayashi H, Imafuku S. Itch as a critical factor in impaired health-related quality of life in patients with plaque psoriasis achieving clear or almost-clear skin: Analysis of the single-arm, open-label, multicenter, prospective ProLOGUE study. JAAD Int 2022; 8:146-153. [PMID: 35942062 PMCID: PMC9356143 DOI: 10.1016/j.jdin.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 11/22/2022] Open
Abstract
Background Patients with psoriasis report impaired health-related quality of life (HRQoL; Dermatology Life Quality Index score ≥ 2) even after achieving clear or almost-clear skin with biologic treatment. Objective To assess the effectiveness of brodalumab in HRQoL improvement and the factors associated with incomplete HRQoL improvement in Japanese patients with psoriasis. Methods As a part of the single-arm, open-label, multicenter, prospective ProLOGUE study (Japan Registry of Clinical Trials identifier: jRCTs031180037), patients were treated with 210 mg of subcutaneous brodalumab in daily clinical practice until week 48. The absolute Psoriasis Area and Severity Index scores and patient-reported outcomes were assessed at baseline and weeks 12 and 48. Results Seventy-three patients (male, 82.2%; median age, 54.0 years) were enrolled. The Dermatology Life Quality Index and European Quality of Life 5-Dimension 5-Level Utility Index scores significantly improved from baseline to weeks 12 and 48. At week 48, all 13 patients with a Dermatology Life Quality Index score of ≥2 and an absolute Psoriasis Area and Severity Index score of 0 to ≤2 reported itching. Limitations Unclear generalizability of the results to other biologics. Conclusion Treatment with brodalumab improved HRQoL in patients with psoriasis. Itching may contribute to incomplete HRQoL improvement in patients who have achieved clear or almost-clear skin.
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26
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Hawro M, Sahin E, Steć M, Różewicka-Czabańska M, Raducha E, Garanyan L, Philipp S, Kokolakis G, Christou D, Kolkhir P, Pogorelov D, Weller K, Metz M, Sabat R, Maleszka R, Olisova O, Maurer M, Hawro T. A comprehensive, tri-national, cross-sectional analysis of characteristics and impact of pruritus in psoriasis. J Eur Acad Dermatol Venereol 2022; 36:2064-2075. [PMID: 35699348 DOI: 10.1111/jdv.18330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 05/05/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Pruritus is prevalent in psoriasis but still many features of pruritus, its response to therapy and its burden in psoriasis remain to be better characterized. OBJECTIVE To investigate characteristics and burden of pruritus in an international cohort of patients with psoriasis. METHODS This cross-sectional study included a total of 634 patients and 246 controls from Germany, Poland and Russia. Physicians examined and interviewed participants, recording clinical characteristics, such as severity, therapy and localization of psoriatic lesions. Participants filled out self-reported questionnaires including questions on pruritus severity and impact, characteristics, and response to therapy, and quality of life (QoL). Localization patterns of pruritus and skin lesions were visualized using body heat maps. RESULTS Most patients (82%) experienced pruritus throughout their disease, and 75% had current pruritus. The majority of patients (64%) perceived pure pruritus, and those who reported additional painful and/or burning sensations (36%) reported overall stronger pruritus. The scalp was the most frequently reported localization of pruritus, even in the absence of skin lesions. Body surface area (BSA) of pruritus was not linked to pruritus intensity, but to BSA of psoriatic lesions (rho = 0.278; P < 0.001). One third of patients (31%) reported impaired sex-life, and 4% had suicidal ideations due to pruritus. In up to one third of patients, psoriasis therapies had little or no effect on pruritus. The only therapeutic option offered to some of these patients were antihistamines, which appeared to be effective in most cases. CONCLUSION Pruritus is highly prevalent in psoriasis and is linked to a significant burden. Current psoriasis therapies are frequently insufficient to control pruritus. Managing psoriasis should include the assessment and control of itch. Efficient antipruritic therapies should be developed and be made available for patients with psoriasis.
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Affiliation(s)
- M Hawro
- Department of Dermatology, Allergology and Venereology, Institute and Comprehensive Center for Inflammation Medicine, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - E Sahin
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - M Steć
- Department of Computer Science, Chair of Embedded Systems Architectures for Signal Processing, University of Potsdam, Potsdam, Germany
| | - M Różewicka-Czabańska
- Department of Skin and Venereal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - E Raducha
- Department of Skin and Venereal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - L Garanyan
- V.A. Rakhmanov Department of Skin and Venereal Diseases, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russian Federation
| | - S Philipp
- Department of Dermatology and Allergy, Institute of Medical Immunology, Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - G Kokolakis
- Department of Dermatology and Allergy, Institute of Medical Immunology, Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - D Christou
- Department of Dermatology and Allergy, Institute of Medical Immunology, Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - P Kolkhir
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.,Division of Immune-Mediated Skin Diseases, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - D Pogorelov
- Division of Immune-Mediated Skin Diseases, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.,Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - K Weller
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - M Metz
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - R Sabat
- Department of Dermatology and Allergy, Institute of Medical Immunology, Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - R Maleszka
- Department of Skin and Venereal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - O Olisova
- V.A. Rakhmanov Department of Skin and Venereal Diseases, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russian Federation
| | - M Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - T Hawro
- Department of Dermatology, Allergology and Venereology, Institute and Comprehensive Center for Inflammation Medicine, University Medical Center Schleswig-Holstein, Lübeck, Germany
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von Spreckelsen R, Gerdes S, Mrowietz U, Emmert H. Zugang und Inanspruchnahme psychosomatischer Versorgung aus ärztlicher Sicht: Eine qualitative Interviewstudie. Aktuelle Dermatologie 2022. [DOI: 10.1055/a-1754-4332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Zusammenfassung
Hintergrund Chronisch entzündliche Hauterkrankungen sind häufig mit psychosozialen Beeinträchtigungen und einer reduzierten Lebensqualität vergesellschaftet. Ziel dieser Studie war es zu erfassen, wie spezialisiertes medizinisches Personal eines universitären Haut-Entzündungszentrums die Zugangswege und die Inanspruchnahme psychosomatischer Sondierungsgespräche oder Kurzzeitinterventionen bei PatientInnen mit chronisch entzündlichen Hauterkrankungen wahrnimmt.
Methoden Es wurden qualitative Erhebungen in Form von 10 Einzelinterviews mit medizinischem Personal durchgeführt, das zum Zeitpunkt der Befragung im Zentrum für entzündliche Hauterkrankungen der Uni-Hautklinik tätig war. Die Daten wurden inhaltsanalytisch mithilfe einer qualitativen Analysesoftware ausgewertet.
Ergebnisse Die Ergebnisse aus den geführten Einzelinterviews ergaben, dass die Einbindung einer psychosomatischen Versorgung innerhalb eines dermatologischen Entzündungszentrums vom ärztlichen Personal als durchweg positiv bewertet wurde. Die Option auf ein zeit- und zentrumsnahes Gesprächsangebot nimmt dabei eine besondere Rolle ein. Experten fühlen sich mit der ortsnahen Einbindung psychosomatischer Expertise sicherer im Umgang mit belasteten Patient*innen. Der holistische Ansatz scheint einen positiven Einfluss auf die individuelle Behandlung und die Beziehungsgestaltung mit den Patient*innen zu nehmen. Dabei zeigten sich keine wesentlichen Unterschiede im Geschlecht und über verschiedene Altersgruppen hinweg.
Diskussion Die Möglichkeit zur zentrumsnahen Anbindung von belasteten Patient*innen in Form von zusätzlichen psychosomatischen Sondierungsgesprächen wie auch dem Einsatz von adaptierten Kurzzeitinterventionen trägt zur holistischen Behandlung bei, scheint einen günstigen Einfluss auf den somatischen Behandlungsverlauf zu nehmen und unterstützt Ärzt*innen in ihrer Behandlung.
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Affiliation(s)
- Regina von Spreckelsen
- Zentrum für entzündliche Hauterkrankungen, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Kiel
- Klinik für Psychotherapie und Psychosomatik, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Kiel
| | - Sascha Gerdes
- Zentrum für entzündliche Hauterkrankungen, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Kiel
| | - Ulrich Mrowietz
- Zentrum für entzündliche Hauterkrankungen, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Kiel
| | - Hila Emmert
- Zentrum für entzündliche Hauterkrankungen, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Kiel
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Purzycka-Bohdan D, Kisielnicka A, Zabłotna M, Nedoszytko B, Nowicki RJ, Reich A, Samotij D, Szczęch J, Krasowska D, Bartosińska J, Narbutt J, Lesiak A, Barasińska P, Owczarczyk-Saczonek A, Czerwińska J, Szepietowski JC, Batycka-Baran A, Czajkowski R, Górecka-Sokołowska M, Rudnicka L, Czuwara J, Sobalska-Kwapis M, Strapagiel D, Szczerkowska-Dobosz A. Chronic Plaque Psoriasis in Poland: Disease Severity, Prevalence of Comorbidities, and Quality of Life. J Clin Med 2022; 11:jcm11051254. [PMID: 35268344 PMCID: PMC8911198 DOI: 10.3390/jcm11051254] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 02/04/2023] Open
Abstract
The epidemiology of psoriasis has not been widely assessed in Polish population so far. This study aimed to investigate psoriasis epidemiological situation by evaluating disease course and severity, management, comorbidities, environmental factors, and knowledge about this disorder among psoriatic patients in Poland. A cross-sectional cohort population-based study enrolled 1080 psoriatic patients and 1200 controls. The mean age of psoriasis onset was 27.6 years; 78.24% had type I psoriasis. Positive family history of psoriasis was reported in 44.81% of patients, whereas itch was reported in vast majority of patients (83.33%). Based on PASI score moderate psoriasis was the most common in studied group (mean 12.63 ± 9.33, range 0−67.2). The DLQI score (12.01 ± 7.41, range 0−30.0) indicated a very large effect of psoriasis on the quality of life. Hypertension was the most prevalent comorbidity (33.80%), followed by obesity (16.85%) and dyslipidemia (11.85%). Stress was the foremost cause of disease exacerbation (66.20%); however, infections (44.07%) and seasonal changes (45.09%) had also an impact on the course of psoriasis. Psoriatic patients were more often smokers (37.59%) vs. general population (27.50%; p < 0.0001). In conclusion, epidemiological studies help clinicians in better disease and patient understanding, which may translate into better management and patient compliance.
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Affiliation(s)
- Dorota Purzycka-Bohdan
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.K.); (M.Z.); (B.N.); (R.J.N.); (A.S.-D.)
- Correspondence:
| | - Anna Kisielnicka
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.K.); (M.Z.); (B.N.); (R.J.N.); (A.S.-D.)
| | - Monika Zabłotna
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.K.); (M.Z.); (B.N.); (R.J.N.); (A.S.-D.)
| | - Bogusław Nedoszytko
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.K.); (M.Z.); (B.N.); (R.J.N.); (A.S.-D.)
- Invicta Fertility and Reproductive Centre, Molecular Laboratory, 80-850 Gdansk, Poland
| | - Roman J. Nowicki
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.K.); (M.Z.); (B.N.); (R.J.N.); (A.S.-D.)
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland; (A.R.); (D.S.); (J.S.)
| | - Dominik Samotij
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland; (A.R.); (D.S.); (J.S.)
| | - Justyna Szczęch
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland; (A.R.); (D.S.); (J.S.)
| | - Dorota Krasowska
- Department of Dermatology, Venerology and Paediatric Dermatology, Medical University of Lublin, 20-081 Lublin, Poland; (D.K.); (J.B.)
| | - Joanna Bartosińska
- Department of Dermatology, Venerology and Paediatric Dermatology, Medical University of Lublin, 20-081 Lublin, Poland; (D.K.); (J.B.)
| | - Joanna Narbutt
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Lodz, 90-419 Lodz, Poland; (J.N.); (A.L.); (P.B.)
| | - Aleksandra Lesiak
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Lodz, 90-419 Lodz, Poland; (J.N.); (A.L.); (P.B.)
| | - Paulina Barasińska
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Lodz, 90-419 Lodz, Poland; (J.N.); (A.L.); (P.B.)
| | - Agnieszka Owczarczyk-Saczonek
- Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, Collegium Medicum, University of Warmia and Mazury, 10-229 Olsztyn, Poland; (A.O.-S.); (J.C.)
| | - Joanna Czerwińska
- Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, Collegium Medicum, University of Warmia and Mazury, 10-229 Olsztyn, Poland; (A.O.-S.); (J.C.)
| | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-367 Wroclaw, Poland; (J.C.S.); (A.B.-B.)
| | - Aleksandra Batycka-Baran
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-367 Wroclaw, Poland; (J.C.S.); (A.B.-B.)
| | - Rafał Czajkowski
- Department of Dermatology and Venerology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland; (R.C.); (M.G.-S.)
| | - Magdalena Górecka-Sokołowska
- Department of Dermatology and Venerology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland; (R.C.); (M.G.-S.)
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland; (L.R.); (J.C.)
| | - Joanna Czuwara
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland; (L.R.); (J.C.)
| | - Marta Sobalska-Kwapis
- Biobank Laboratory, Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, 90-237 Lodz, Poland; (M.S.-K.); (D.S.)
| | - Dominik Strapagiel
- Biobank Laboratory, Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, 90-237 Lodz, Poland; (M.S.-K.); (D.S.)
| | - Aneta Szczerkowska-Dobosz
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-210 Gdansk, Poland; (A.K.); (M.Z.); (B.N.); (R.J.N.); (A.S.-D.)
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Honma M, Kanai Y, Murotani K, Nomura T, Ito K, Imafuku S. Itching and skin pain in real-life patients with plaque psoriasis: baseline analysis of the ProLOGUE study. J Dermatol Sci 2022. [DOI: 10.1016/j.jdermsci.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/11/2022] [Accepted: 02/06/2022] [Indexed: 01/10/2023]
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Li F, Han D, Wang B, Zhang W, Zhao Y, Xu J, Meng L, Mou K, Lu S, Zhu W, Zhou Y, Yan S. Topical Treatment of Colquhounia Root Relieves Skin Inflammation and Itch in Imiquimod-Induced Psoriasiform Dermatitis in Mice. Mediators Inflamm 2022; 2022:1-15. [PMID: 35069008 PMCID: PMC8767412 DOI: 10.1155/2022/5782922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 12/15/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2022] Open
Abstract
Itch is one of the major clinical manifestations of psoriasis, which is closely related with neurogenic inflammation and difficult to control. Colquhounia Root (CR) is a Chinese herb exhibiting broad bioactivities on anti-inflammation. This study was designed to explore the antipsoriatic and anti-itch potential of CR and its underlying mechanisms. Mice in a model of imiquimod-induced psoriasiform dermatitis were treated topically with CR for 7 days, and the severity of skin lesions and itch was significantly ameliorated. CR reduced the inflammatory cell infiltration, as well as mast cells in skins. Particularly, the expression of inflammatory cytokines and chemokine including Il17a, Il22, and Ccl20 and itch-related molecules such as SP, CGRP, and NGF in lesions were decreased in diseased mice upon application with CR. The normal human epidermal keratinocytes were stimulated with the M5 cytokine cocktail, the mixture of IL-17A, IL-22, Oncostatin M, IL-1α, and TNF-α, and cell viability and mRNA expression levels of inflammatory factors and itch-related molecules were measured after being treated with CR. We found that CR inhibited both cell hyperproliferation and overexpression of inflammatory cytokines and itch-related molecules in vitro. Altogether, we conclude that CR relieves psoriatic lesions and itch via controlling immunological and neurogenic inflammation.
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Zhang X, Cao J, Zhao S, Yang X, Dong J, Tan Y, Yu T, He Y. Nociceptive Sensory Fibers Drive Interleukin-23 Production in a Murine Model of Psoriasis via Calcitonin Gene-Related Peptide. Front Immunol 2021; 12:743675. [PMID: 34745116 PMCID: PMC8569654 DOI: 10.3389/fimmu.2021.743675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022] Open
Abstract
Neuroimmunity is involved in the pathogenesis of psoriasis, but the mechanism underlying the interaction between the nervous system and the interleukin (IL)-23/IL-17 immune axis is yet unclear. This study reveals the essential role of the sensory neuron-derived calcitonin gene-related peptide (CGRP) in imiquimod (IMQ)-induced expression of IL-23. First, we show that the increased nociceptive behavior was consistent with the development of psoriasiform dermatitis, which requires intact sensory innervation. Systemic ultrapotent Transient receptor potential vanilloid 1 (TRPV1) agonist (resiniferatoxin, RTX) treatment-induced sensory denervation resulted in a significant decrease in IL-23 expression in this model, while the recombinant IL-23 treatment induced IL-17A expression was intact after RTX treatment. In addition, IMQ exposure induced a transient increase in CGRP expression in the dorsal root ganglion. The neuron-derived CGRP expression was completely abolished by sensory denervation, thereby downregulating IL-23 expression, which could be reversed through the introduction of CGRP into the denervated dorsal skin. Our results suggest that nociceptive sensory neurons may drive the production of IL-23, resulting in IL-17A production from γδ T cells via the neuropeptide CGRP in the pathology of psoriasis.
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Affiliation(s)
- Xuan Zhang
- Department of Dermatology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jiali Cao
- Department of Dermatology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Siqi Zhao
- Department of Dermatology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xutong Yang
- Department of Dermatology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jie Dong
- Department of Dermatology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yaqi Tan
- Department of Dermatology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Teng Yu
- Department of Dermatology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yanling He
- Department of Dermatology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Branch in Beijing Chaoyang Hospital, Beijing, China
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Cervantes-Durán C, Avalos-Viveros M, Torner L, Sánchez-Ceja SG, Rodríguez-Orozco AR, Martínez-Flores HE, García-Pérez ME. The 5-HT 1A receptor agonist, 8-OH-DPAT, attenuates long-lasting pain in imiquimod-induced psoriasis in mice. Exp Dermatol 2021; 31:600-607. [PMID: 34726306 DOI: 10.1111/exd.14492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/11/2021] [Accepted: 10/30/2021] [Indexed: 11/30/2022]
Abstract
Psoriasis pain is a common symptom underestimated and rarely evaluated in psoriasis clinical trials. This work aimed to investigate whether the development of secondary chronic allodynia and hyperalgesia in the imiquimod (IMQ)-induced psoriasis mice model could be modulated by anti-inflammatory agents and compound 48/80 (C48/80) and to determine whether the activation of 5-HT1A receptor modulates these nociceptive behaviours. C57BL/6 male mice were treated with 5% IMQ for 7 days. The paw withdrawal responses to von Frey filaments (10 and 250 mN) were used to assess the allodynia and hyperalgesia. Nociceptive behaviours were also evaluated using ketorolac 15 mg/kg s.c., adalimumab 10 mg/kg s.c. and C48/80 10 mg/kg i.p. Then, the serum serotonin and the impact of 8-OH-DPAT (1 mg/kg s.c), a 5-HT1A receptor agonist, on long-lasting pain were examined. Mice receiving IMQ showed enhanced nociception, which decreased with all tested compounds. The serum serotonin in the IMQ group showed a significant decrease (947.042 ng/ml) regarding the control group (1143.68 ng/ml). The pretreatment with 8-OH-DPAT alleviated pain-related behaviours. These results suggest that the long-lasting pain resulting from psoriasis inflammation is also associated with the serotonergic system. The 5-HT1A receptor should be further explored as a potential therapeutic target for psoriasis pain modulation.
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Affiliation(s)
- Claudia Cervantes-Durán
- Escuela Nacional de Estudios Superiores, Unidad Morelia, Universidad Nacional Autónoma de México, Morelia, Michoacán, México
| | - Miguel Avalos-Viveros
- Instituto de Investigaciones Químico-Biológicas, Universidad Michoacana de San Nicolás de Hidalgo, Morelia, Michoacán, México
| | - Luz Torner
- Centro de Investigación Biomédica de Michoacán, Instituto Mexicano del Seguro Social, Morelia, Michoacán, México
| | | | - Alain-Raimundo Rodríguez-Orozco
- Facultad de Ciencias Médicas y Biológicas "Dr. Ignacio Chávez", Universidad Michoacana de San Nicolás de Hidalgo, Morelia, Michoacán, México
| | | | - Martha-Estrella García-Pérez
- Instituto de Investigaciones Químico-Biológicas, Universidad Michoacana de San Nicolás de Hidalgo, Morelia, Michoacán, México
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Orsmond A, Bereza-Malcolm L, Lynch T, March L, Xue M. Skin Barrier Dysregulation in Psoriasis. Int J Mol Sci 2021; 22:10841. [PMID: 34639182 PMCID: PMC8509518 DOI: 10.3390/ijms221910841] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 02/07/2023] Open
Abstract
The skin barrier is broadly composed of two elements-a physical barrier mostly localised in the epidermis, and an immune barrier localised in both the dermis and epidermis. These two systems interact cooperatively to maintain skin homeostasis and overall human health. However, if dysregulated, several skin diseases may arise. Psoriasis is one of the most prevalent skin diseases associated with disrupted barrier function. It is characterised by the formation of psoriatic lesions, the aberrant differentiation and proliferation of keratinocytes, and excessive inflammation. In this review, we summarize recent discoveries in disease pathogenesis, including the contribution of keratinocytes, immune cells, genetic and environmental factors, and how they advance current and future treatments.
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Affiliation(s)
- Andreas Orsmond
- Sutton Arthritis Research Laboratory, Faculty of Medicine and Health, Institute of Bone and Joint Research, Kolling Institute, University of Sydney at Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (A.O.); (L.B.-M.)
- The Australian Arthritis and Autoimmune Biobank Collaborative (A3BC), Faculty of Medicine and Health, Institute of Bone and Joint Research, Kolling Institute, University of Sydney at Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (T.L.); (L.M.)
| | - Lara Bereza-Malcolm
- Sutton Arthritis Research Laboratory, Faculty of Medicine and Health, Institute of Bone and Joint Research, Kolling Institute, University of Sydney at Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (A.O.); (L.B.-M.)
- The Australian Arthritis and Autoimmune Biobank Collaborative (A3BC), Faculty of Medicine and Health, Institute of Bone and Joint Research, Kolling Institute, University of Sydney at Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (T.L.); (L.M.)
| | - Tom Lynch
- The Australian Arthritis and Autoimmune Biobank Collaborative (A3BC), Faculty of Medicine and Health, Institute of Bone and Joint Research, Kolling Institute, University of Sydney at Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (T.L.); (L.M.)
| | - Lyn March
- The Australian Arthritis and Autoimmune Biobank Collaborative (A3BC), Faculty of Medicine and Health, Institute of Bone and Joint Research, Kolling Institute, University of Sydney at Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (T.L.); (L.M.)
| | - Meilang Xue
- Sutton Arthritis Research Laboratory, Faculty of Medicine and Health, Institute of Bone and Joint Research, Kolling Institute, University of Sydney at Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (A.O.); (L.B.-M.)
- The Australian Arthritis and Autoimmune Biobank Collaborative (A3BC), Faculty of Medicine and Health, Institute of Bone and Joint Research, Kolling Institute, University of Sydney at Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (T.L.); (L.M.)
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Mohd Nordin UU, Ahmad N, Salim N, Mohd Yusof NS. Lipid-based nanoparticles for psoriasis treatment: a review on conventional treatments, recent works, and future prospects. RSC Adv 2021; 11:29080-29101. [PMID: 35478537 PMCID: PMC9038133 DOI: 10.1039/d1ra06087b] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/19/2021] [Indexed: 12/19/2022] Open
Abstract
Psoriasis is a lingering inflammatory skin disease that attacks the immune system. The abnormal interactions between T cells, immune cells, and inflammatory cytokines causing the epidermal thickening. International guidelines have recommended topical treatments for mild to moderate psoriasis whilst systemic and phototherapy treatments for moderate to severe psoriasis. However, current therapeutic approaches have a wider extent to treat moderate to severe type of psoriasis especially since the emergence of diverse biologic agents. In the meantime, topical delivery of conventional treatments has prompted many unsatisfactory effects to penetrate through the skin (stratum corneum). By understanding the physiology of stratum corneum barrier functions, scientists have developed different types of lipid-based nanoparticles like solid lipid nanoparticles, nanostructured lipid carriers, nanovesicles, and nanoemulsions. These novel drug delivery systems help the poorly solubilised active pharmaceutical ingredient reaches the targeted site seamlessly because of the bioavailability feature of the nanosized molecules. Lipid-based nanoparticles for psoriasis treatments create a paradigm for topical drug delivery due to their lipids' amphiphilic feature to efficiently encapsulate both lipophilic and hydrophilic drugs. This review highlights different types of lipid-based nanoparticles and their recent works of nano formulated psoriasis treatments. The encapsulation of psoriasis drugs through lipid nanocarriers unfold numerous research opportunities in pharmaceutical applications but also draw challenges for the future development of nano drugs.
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Affiliation(s)
- Ummu Umaimah Mohd Nordin
- Department of Chemistry, Faculty of Science, University of Malaya 50603 Kuala Lumpur Malaysia +603-79674193 +603-79674008
| | - Noraini Ahmad
- Department of Chemistry, Faculty of Science, University of Malaya 50603 Kuala Lumpur Malaysia +603-79674193 +603-79674008
| | - Norazlinaliza Salim
- Integrated Chemical Biophysics Research, Faculty of Science, Universiti Putra Malaysia 43400 UPM Serdang Selangor Malaysia
| | - Nor Saadah Mohd Yusof
- Department of Chemistry, Faculty of Science, University of Malaya 50603 Kuala Lumpur Malaysia +603-79674193 +603-79674008
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Jaworecka K, Kwiatkowska D, Marek L, Tamer F, Stefaniak A, Szczegielniak M, Chojnacka-Purpurowicz J, Matławska M, Gulekon A, Szepietowski JC, Narbutt J, Owczarczyk-Saczonek A, Reich A. Characteristics of Pruritus in Various Clinical Variants of Psoriasis: Results of the Multinational, Multicenter, Cross-Sectional Study. Life (Basel) 2021; 11:life11070623. [PMID: 34199131 PMCID: PMC8304988 DOI: 10.3390/life11070623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/20/2021] [Accepted: 06/24/2021] [Indexed: 12/16/2022] Open
Abstract
Psoriasis is a chronic, inflammatory skin disease present in about 3% of the world’s population. The clinical symptoms manifest diversely, therefore one can distinguish several subtypes of psoriasis. The majority of patients with psoriasis experience pruritus, which is an unpleasant sensation that decreases patients’ quality of life. The knowledge on pruritus in different subtypes of psoriasis is limited. We have performed a cross-sectional, prospective, and multicenter study to evaluate the relationship between clinical subtypes of psoriasis (large-plaque, nummular, guttate, palmoplantar, inverse, erythrodermic, palmoplantar pustular, generalized pustular psoriasis, and psoriasis of the scalp) and the prevalence, intensity, and clinical manifestation of itch. We introduced a questionnaire assessing various aspects of pruritus to a total of 254 patients. Out of these, 42 were excluded. Pruritus was present in 92.9% of the remaining patients and its prevalence did not depend on the clinical subtype. A correlation between the severity of psoriasis and the intensity of itch was explicitly noticeable in palmoplantar pustular psoriasis and scalp psoriasis (p < 0.05). The itch sensation was individual and differed among subtypes of psoriasis. In conclusion, pruritus is a frequent phenomenon, and its presentation is different in various subtypes of psoriasis.
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Affiliation(s)
- Kamila Jaworecka
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland; (K.J.); (D.K.)
| | - Dominika Kwiatkowska
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland; (K.J.); (D.K.)
| | - Luiza Marek
- Department of Dermatology and Venerology, Faculty of Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland;
| | - Funda Tamer
- Department of Dermatology, Gazi University School of Medicine, 06560 Ankara, Turkey; (F.T.); (A.G.)
| | - Aleksandra Stefaniak
- Department of Dermatology, Venerology and Allergology, Wroclaw Medical University, 50-368 Wrocław, Poland; (A.S.); (J.C.S.)
| | - Magdalena Szczegielniak
- Department of Dermatology, Pediatric Dermatology and Oncology, Lodz Medical University, 91-347 Łódź, Poland; (M.S.); (J.N.)
| | - Joanna Chojnacka-Purpurowicz
- Department and Clinic of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-959 Olsztyn, Poland; (J.C.-P.); (M.M.); (A.O.-S.)
| | - Monika Matławska
- Department and Clinic of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-959 Olsztyn, Poland; (J.C.-P.); (M.M.); (A.O.-S.)
| | - Ayla Gulekon
- Department of Dermatology, Gazi University School of Medicine, 06560 Ankara, Turkey; (F.T.); (A.G.)
| | - Jacek C. Szepietowski
- Department of Dermatology, Venerology and Allergology, Wroclaw Medical University, 50-368 Wrocław, Poland; (A.S.); (J.C.S.)
| | - Joanna Narbutt
- Department of Dermatology, Pediatric Dermatology and Oncology, Lodz Medical University, 91-347 Łódź, Poland; (M.S.); (J.N.)
| | - Agnieszka Owczarczyk-Saczonek
- Department and Clinic of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-959 Olsztyn, Poland; (J.C.-P.); (M.M.); (A.O.-S.)
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland; (K.J.); (D.K.)
- Correspondence:
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Nicolescu AC, Bucur Ș, Giurcăneanu C, Gheucă-Solovăstru L, Constantin T, Furtunescu F, Ancuța I, Constantin MM. Prevalence and Characteristics of Psoriasis in Romania-First Study in Overall Population. J Pers Med 2021; 11:523. [PMID: 34200208 DOI: 10.3390/jpm11060523] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/31/2021] [Accepted: 06/05/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Psoriasis is a chronic inflammatory disease characterized by an excessive hyperproliferation of keratinocytes and a combination of genetic, epigenetic, and environmental influences. The pathogenesis of psoriasis is complex and the exact mechanism remains elusive. Objectives: The study of the prevalence of psoriasis will allow the estimation of the number of people suffering from this condition at the national level, as well as the development and validation of a questionnaire to estimate the prevalence and the risk factors associated with the disease. Methods: A quantitative research was conducted at a national level among the target population in order to validate the questionnaire and estimate the national prevalence. Results: Declaratively, the prevalence of psoriasis in the studied group (N = 1500) is 4%, the first symptoms appearing around the age of 50, with a certified diagnosis being made on average at 55 years. The prevalence of psoriasis vulgaris was 4.99%. Conclusions: The results obtained will be useful in guiding future initiatives and communication campaigns related to this condition, and the methodological approach used will provide the opportunity to make recommendations for improving similar initiatives in the future.
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Yan J, Ye F, Ju Y, Wang D, Chen J, Zhang X, Yin Z, Wang C, Yang Y, Zhu C, Zhou Y, Cao P, Xu Y, Yu G, Tang Z. Cimifugin relieves pruritus in psoriasis by inhibiting TRPV4. Cell Calcium 2021; 97:102429. [PMID: 34087722 DOI: 10.1016/j.ceca.2021.102429] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 02/02/2023]
Abstract
Psoriasis is an immune-mediated chronic inflammatory skin disease characterized by erythema, scales, and infiltration of the skin, which causes deleterious effects on patient quality of life. TRP channel played important roles in the generation and conductance of itch signal . According to our results, psoriasis induced itch was TRPV4 dependent, and TRPV4 expression in both epidermis and DRG were up-regulated in psoriasis. Thus, TRPV4 is an attractive candidate for treating psoriasis induced itch. Cimifugin is a common compound in antipruritic Chinese medicine. In our study, GSK1016790A, a TRPV4 channel specific agonist, induced acute itch was inhibited by cimifugin in a dose-dependent manner. Furthermore, cimifugin treatment reduced the scratching behavior and reversed the TRPV4 up-regulation induced by psoriasis. In particular, cimifugin decreased GSK1016790A induced calcium response both in HaCaT cells and DRG neurons. Importantly, in TRPV4 transfected HEK293 cells, GSK101 induced calcium response was also significantly inhibited by cimifugin pretreatment. Consistent with our calcium imaging result, cimifugin pretreatment also inhibited GSK101 induced inward currents. Our study delineated a new role of TRPV4 in psoriasis and emphasized the antipruritic effect of cimifugin, which opened a new avenue to itch management in psoriasis.
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Affiliation(s)
- Jinjin Yan
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023 China
| | - Fan Ye
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023 China
| | - Ying Ju
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023 China
| | - Dijun Wang
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023 China
| | - Jiao Chen
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Xinyu Zhang
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023 China
| | - Zhi Yin
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Changming Wang
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023 China
| | - Yan Yang
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023 China
| | - Chan Zhu
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023 China
| | - Yuan Zhou
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023 China
| | - Peng Cao
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Yang Xu
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guang Yu
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023 China.
| | - Zongxiang Tang
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023 China.
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Jalili A, Yosipovitch G. Fixed-dose combination calcipotriol/betamethasone dipropionate foam provides a rapid onset of action, effective itch relief and improves patient quality of life. J Eur Acad Dermatol Venereol 2021; 35 Suppl 1:20-27. [PMID: 33619778 PMCID: PMC7986201 DOI: 10.1111/jdv.17085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/01/2020] [Indexed: 12/21/2022]
Abstract
The physical symptoms of psoriasis vulgaris (chronic plaque psoriasis), such as itch and itch‐related sleep loss, and the psychological impact of visible plaques on the body, all contribute to significantly reduced health‐related quality of life (HRQoL) in patients with psoriasis. In fact, the deterioration of HRQoL in patients with psoriasis is similar to patients with other chronic conditions, such as cancer and cardiovascular diseases. Rapid and effective improvements in HRQoL and itch‐related outcomes would therefore be highly valued by patients and may even improve adherence to treatment. In this article, we summarise previously published data assessing the impact of fixed‐dose combination calcipotriol 50 µg/g plus betamethasone dipropionate 0.5 mg/g cutaneous foam (Cal/BD foam) on itch relief, quality of sleep, onset of action and HRQoL. Findings across multiple analyses indicate that Cal/BD foam provides significant improvements in itch, itch‐related sleep loss and HRQoL compared with vehicle foam or Cal/BD gel comparators. Additionally, the benefits of Cal/BD foam were recorded earlier than these comparators, often within 1 week of treatment, indicating a rapid onset of action. With the published data to hand, it is clear that Cal/BD foam provides significant improvements in the outcomes that matter most to patients and should be considered an effective topical treatment for psoriasis. Video abstract
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Affiliation(s)
- A Jalili
- Dermatology & Skin Care, Bürgenstock Medical Center, Obbürgen, Switzerland
| | - G Yosipovitch
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery & Miami Itch Center, Miller School of Medicine, Miami, FL, USA
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Kahremany S, Hofmann L, Harari M, Gruzman A, Cohen G. Pruritus in psoriasis and atopic dermatitis: current treatments and new perspectives. Pharmacol Rep 2021; 73:443-453. [PMID: 33460006 DOI: 10.1007/s43440-020-00206-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/11/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023]
Abstract
Psoriasis and atopic dermatitis (AD) are two common chronic inflammatory skin diseases. Although showing different etiology and clinical manifestations, patients with either disease suffer from low health-related quality of life due to pruritus (dermal itch). Recent studies have revealed that more than 85% of psoriasis patients suffer from pruritus, and it is also the dominating symptom of AD. However, as this is a non-life treating symptom, it was partly neglected for years. In this review, we focus on current findings as well as the impact and potential treatments of pruritus in these two skin diseases. We first distinguish the type of itch based on involved mediators and modulators. This clear delineation between the types of pruritus based on involved receptors and pathways allows for precise treatment. In addition, insights into recent clinical trials aimed to alleviate pruritus by targeting these receptors are presented. We also report about novel advances in combinatorial treatments, dedicated to the type of pruritus linked to a causal disease. Altogether, we suggest that only a focused treatment tailored to the primary disease and the underlying molecular signals will provide fast and sustained relief of pruritus associated with psoriasis or AD.
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Affiliation(s)
- Shirin Kahremany
- Department of Chemistry, Faculty of Exact Sciences, Bar-Ilan University, 5290002, Ramat Gan, Israel. .,The Skin Research Institute, The Dead Sea and Arava Science Center, 86910, Masada, Israel.
| | - Lukas Hofmann
- Department of Chemistry, Faculty of Exact Sciences, Bar-Ilan University, 5290002, Ramat Gan, Israel
| | - Marco Harari
- Medical Climatotherapy Unit, The Dead Sea and Arava Science Center, 86910, Masada, Israel
| | - Arie Gruzman
- Department of Chemistry, Faculty of Exact Sciences, Bar-Ilan University, 5290002, Ramat Gan, Israel
| | - Guy Cohen
- The Skin Research Institute, The Dead Sea and Arava Science Center, 86910, Masada, Israel.,Ben Gurion University of the Negev, Eilat Campus, 8855630, Eilat, Israel
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Yang Y, Guo L, Chen Z, Jiang X, Liu Y. Benefits and harms of NK 1 R antagonists in pruritus: A systematic review and meta-analysis. Dermatol Ther 2021; 34:e14698. [PMID: 33368902 DOI: 10.1111/dth.14698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/21/2020] [Indexed: 02/05/2023]
Abstract
Accumulating evidence has showed the possibility of using NK1R antagonists for the treatment of chronic pruritus. However, the benefit and risk profile of NK1R antagonists-serlopitant and aprepitant for the treatment of pruritus remains unclear. To assess the efficacy and safety of NK1R antagonists-serlopitant and aprepitant in patients with pruritus based on analysis of clinical trials. The current systematic review and meta-analysis was performed according to PRISMA guidelines. A total of 10 randomized clinical trials including 631 patients were enrolled. Four randomized controlled trials investigated the comparative treatment effect of serlopitant on pruritus. Our results showed that serlopitant had reasonable anti-pruritic effectiveness in patients, with mild toxicities. The overall proportion of 4-point improvement of NRS and VAS in serlopitant-treatment group were both significantly higher relative to placebo group (OR 2.345, 95%CI 1.557 to 3.531, P < .001; OR 3.308, 95% CI 1.949 to 5.616, P < .001). Serlopitant treatment was also found to be associated with a significant reduction in NRS score as compared with placebo (SMD -0.381, 95%CI -0.599 to -0.164, P = .001). Six clinical trials reported the treatment effect of aprepitant on pruritus. The meta-analysis result of fixed-effect model showed that there was no significant difference between aprepitant and controlled treatment in terms of improved pruritus VAS score (SMD -0.088, 95%CI -0.384 to 0.207, P = .558). There is promising high-quality evidence regarding the efficacy of serlopitant on pruritus. More large-sample randomized controlled trials with appropriate treatment regimen are urgently needed to further evaluate the effectiveness of aprepitant in pruritus.
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Affiliation(s)
- Yong Yang
- Department of Basic Medical Sciences, Sichuan Vocational College of Health and Rehabilitation, Zigong, Sichuan, China
| | - Linghong Guo
- Department of Basic Medical Sciences, Sichuan Vocational College of Health and Rehabilitation, Zigong, Sichuan, China.,Department of Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhiyan Chen
- Department of Basic Medical Sciences, Sichuan Vocational College of Health and Rehabilitation, Zigong, Sichuan, China
| | - Xian Jiang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yin Liu
- Department of Basic Medical Sciences, Sichuan Vocational College of Health and Rehabilitation, Zigong, Sichuan, China.,Department of Pharmacology, West China School of Basic Sciences and Forensic Medicine, Animal Research Institute, Sichuan University, Chengdu, Sichuan, China.,Department of Anesthesiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
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41
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Chen X, Cao D, Luo Y, Kuang Y. Relationship among itching and clinical and psychological characteristics among patients with psoriasis in China. Dermatol Ther 2020; 34:e14626. [PMID: 33277769 DOI: 10.1111/dth.14626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Xiang Chen
- Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
| | - Duling Cao
- Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
| | - Yan Luo
- Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
| | - Yehong Kuang
- Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
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42
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Komiya E, Tominaga M, Kamata Y, Suga Y, Takamori K. Molecular and Cellular Mechanisms of Itch in Psoriasis. Int J Mol Sci 2020; 21:E8406. [PMID: 33182442 DOI: 10.3390/ijms21218406] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 02/06/2023] Open
Abstract
Itch (or pruritus) was not previously recognized as a serious symptom of psoriasis. However, approximately 60-90% of psoriatic patients with pruritus have stated that it deteriorates their quality of life. Since conventional antipruritic therapies, such as antihistamines, only exert limited effects, the establishment of a treatment option for itch in psoriasis is urgently needed. Although a definitive drug is not currently available, various itch mediators are known to be involved in pruritus in psoriasis. In this review, we describe the clinical features of pruritus in psoriasis, classify a wide range of itch mediators into categories, such as the nervous, immune, endocrine, and vascular systems, and discuss the mechanisms by which these mediators induce or aggravate itch in the pathophysiology of psoriasis.
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Patsinakidis N, Meyer NH, Raap U. [Psoriasis]. MMW Fortschr Med 2020; 162:43-50. [PMID: 33164190 DOI: 10.1007/s15006-020-1458-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Nikolaos Patsinakidis
- Universitätsklinik für Dermatologie und Allergologie, Klinikum Oldenurg AöR, Rahel-Straus-Str. 10, 26133, Oldenburg, Germany.
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Hawro T, Przybyłowicz K, Spindler M, Hawro M, Steć M, Altrichter S, Weller K, Magerl M, Reidel U, Alarbeed E, Alraboni O, Maurer M, Metz M. The characteristics and impact of pruritus in adult dermatology patients: A prospective, cross-sectional study. J Am Acad Dermatol 2021; 84:691-700. [PMID: 32798581 DOI: 10.1016/j.jaad.2020.08.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/23/2020] [Accepted: 08/10/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pruritus often accompanies chronic skin diseases, exerting considerable burden on many areas of patient functioning; this burden and the features of pruritus remain insufficiently characterized. OBJECTIVE To investigate characteristics, including localization patterns, and burden of pruritus in patients with chronic dermatoses. METHODS We recruited 800 patients with active chronic skin diseases. We assessed pruritus intensity, localization, and further characteristics. We used validated questionnaires to assess quality of life, work productivity and activity impairment, anxiety, depression, and sleep quality. RESULTS Nine out of every 10 patients had experienced pruritus throughout their disease and 73% in the last 7 days. Pruritus often affected the entire body and was not restricted to skin lesions. Patients with moderate to severe pruritus reported significantly more impairment to their sleep quality and work productivity, and they were more depressed and anxious than control individuals and patients with mild or no pruritus. Suicidal ideations were highly prevalent in patients with chronic pruritus (18.5%) and atopic dermatitis (11.8%). CONCLUSIONS Pruritus prevalence and intensity are very high across all dermatoses studied; intensity is linked to impairment in many areas of daily functioning. Effective treatment strategies are urgently required to treat pruritus and the underlying skin disease.
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Thouvenin MD, Dalmon S, Theunis J, Lauze C, Coubetergues H, Mengeaud V, Calvet B. Tolerance and efficacy of a new celastrol-containing balm as adjunct care in psoriasis. J Eur Acad Dermatol Venereol 2020; 34 Suppl 6:10-16. [PMID: 32783264 DOI: 10.1111/jdv.16691] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/11/2020] [Accepted: 05/20/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND In patients with psoriasis, the non-lesional skin also presents abnormalities, requiring emollient application on the whole body. OBJECTIVES To evaluate the tolerance of a new emollient balm containing celastrol, an active ingredient with anti-Th17 immunomodulatory properties used alone or in association with topical or systemic drug treatments or phototherapy, and its efficacy when used alone. METHODS Adults with body plaque psoriasis applied the product over the whole body once a day for 4 weeks (balm used alone in 41 patients and with ongoing treatment in 50 patients). At D1, D8 ('balm alone' study) or D15 ('balm in association' study) and D29, the dermatologist rated physical and functional signs and assessed pruritus and body global lesion score (evaluating erythema, induration/thickness, scaling and dryness) in the 'balm alone' study. RESULTS No reaction related to the product was reported, and the tolerance was deemed excellent. In the 'balm alone' study, mean pruritus intensity score significantly decreased at D8 (-39%, P < 0.001) and D29 (-60%, P < 0.001) compared with D1, together with the body global lesion score (-24% at D8 and -26% at D29, P < 0.001). In parallel, quality of life improved, as evidenced by a patient-reported outcome questionnaire. Cosmetic acceptability was good. CONCLUSION This new emollient balm was very well tolerated by patients with body plaque psoriasis either alone or in association with drug treatment or phototherapy, which is important to ensure long-term compliance. Daily application during one month improved pruritus, physical signs and quality of life.
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Affiliation(s)
- M D Thouvenin
- Clinical Skin Research and Development Center, Pierre Fabre Dermo-Cosmétique, Toulouse, France
| | - S Dalmon
- Clinical Skin Research and Development Center, Pierre Fabre Dermo-Cosmétique, Toulouse, France
| | - J Theunis
- Clinical Skin Research and Development Center, Pierre Fabre Dermo-Cosmétique, Toulouse, France
| | - C Lauze
- Clinical Skin Research and Development Center, Pierre Fabre Dermo-Cosmétique, Toulouse, France
| | - H Coubetergues
- Clinical Skin Research and Development Center, Pierre Fabre Dermo-Cosmétique, Toulouse, France
| | - V Mengeaud
- Medical Department, Laboratoires dermatologiques Ducray, Les Cauquillous, France
| | - B Calvet
- Clinical Skin Research and Development Center, Pierre Fabre Dermo-Cosmétique, Toulouse, France
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Abstract
INTRODUCTION Chronic pruritus is non-histaminergic and mediated through a complex interplay of peripheral and central immune and neural pathways. Significant developments in the understanding of chronic pruritus have emerged and paved the way for new, emerging therapies. AREAS COVERED This review details the emerging drug landscape for chronic pruritus treatment, focusing on monoclonal antibody agents that target key cytokines and their receptors as well as small molecule agents that inhibit mediators of the immune and neural pathways. The article provides background regarding the currently available therapies and the rationale for the development of new agents based on the current market and recent scientific developments. EXPERT OPINION Identification of new targets along neuroimmune itch pathways has allowed for the development of targeted drugs which can be utilized for effective therapy. As we enter a new era of chronic itch treatments, we face exciting prospects and challenges.
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Affiliation(s)
- Kayla Fourzali
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, Miami, FL, USA
| | - Rachel Shireen Golpanian
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, Miami, FL, USA
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, Miami, FL, USA
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Zhang D, Men H, Zhang L, Gao X, Wang J, Li L, Zhu Q, Zhang H, Jia Z. Inhibition of M/K v7 Currents Contributes to Chloroquine-Induced Itch in Mice. Front Mol Neurosci 2020; 13:105. [PMID: 32694980 PMCID: PMC7339983 DOI: 10.3389/fnmol.2020.00105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 05/20/2020] [Indexed: 01/31/2023] Open
Abstract
M/Kv7 potassium channels play a key role in regulation of neuronal excitability. Modulation of neuronal excitability of primary sensory neurons determines the itch sensation induced by a variety of itch-causing substances including chloroquine (CQ). In the present study, we demonstrate that suppression of M/Kv7 channel activity contributes to generation of itch in mice. CQ enhances excitability of the primary sensory neurons through inhibiting M/Kv7 potassium currents in a Ca2+ influx-dependent manner. Specific M/Kv7 channel opener retigabine (RTG) or tannic acid (TA) not only reverses the CQ-induced enhancement of neuronal excitability but also suppresses the CQ-induced itch behavior. Systemic application of RTG or TA also significantly inhibits the itch behavior induced by a variety of pruritogens. Taken together, our findings provide novel insight into the molecular basis of CQ-induced itch sensation in mammals that can be applied to the development of strategies to mitigate itch behavior.
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Affiliation(s)
- Dong Zhang
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, China.,Center for Innovative Drug Research and Evaluation, Institute of Medical Science and Health, Hebei Medical University, Shijiazhuang, China.,The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Shijiazhuang, China.,The Key Laboratory of New Drug Pharmacology and Toxicology, Shijiazhuang, China.,Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Hongchao Men
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, China.,Center for Innovative Drug Research and Evaluation, Institute of Medical Science and Health, Hebei Medical University, Shijiazhuang, China.,The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Shijiazhuang, China.,The Key Laboratory of New Drug Pharmacology and Toxicology, Shijiazhuang, China.,Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Ludi Zhang
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, China.,Center for Innovative Drug Research and Evaluation, Institute of Medical Science and Health, Hebei Medical University, Shijiazhuang, China.,The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Shijiazhuang, China.,The Key Laboratory of New Drug Pharmacology and Toxicology, Shijiazhuang, China
| | - Xiangxin Gao
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, China.,Center for Innovative Drug Research and Evaluation, Institute of Medical Science and Health, Hebei Medical University, Shijiazhuang, China.,The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Shijiazhuang, China.,The Key Laboratory of New Drug Pharmacology and Toxicology, Shijiazhuang, China
| | - Jingjing Wang
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, China.,Center for Innovative Drug Research and Evaluation, Institute of Medical Science and Health, Hebei Medical University, Shijiazhuang, China.,The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Shijiazhuang, China.,The Key Laboratory of New Drug Pharmacology and Toxicology, Shijiazhuang, China
| | - Leying Li
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, China.,Center for Innovative Drug Research and Evaluation, Institute of Medical Science and Health, Hebei Medical University, Shijiazhuang, China.,The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Shijiazhuang, China.,The Key Laboratory of New Drug Pharmacology and Toxicology, Shijiazhuang, China
| | - Qiaoying Zhu
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, China.,Center for Innovative Drug Research and Evaluation, Institute of Medical Science and Health, Hebei Medical University, Shijiazhuang, China.,The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Shijiazhuang, China.,The Key Laboratory of New Drug Pharmacology and Toxicology, Shijiazhuang, China
| | - Hailin Zhang
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, China.,Center for Innovative Drug Research and Evaluation, Institute of Medical Science and Health, Hebei Medical University, Shijiazhuang, China.,The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Shijiazhuang, China.,The Key Laboratory of New Drug Pharmacology and Toxicology, Shijiazhuang, China
| | - Zhanfeng Jia
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, China.,Center for Innovative Drug Research and Evaluation, Institute of Medical Science and Health, Hebei Medical University, Shijiazhuang, China.,The Key Laboratory of Neural and Vascular Biology, Ministry of Education, Shijiazhuang, China.,The Key Laboratory of New Drug Pharmacology and Toxicology, Shijiazhuang, China
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Murer C, Sgier D, Mettler SK, Guillet C, Maul JT, Djamei V, Navarini AA, Anzengruber F. Gender differences in psoriasis: a Swiss online psoriasis survey. Arch Dermatol Res 2020; 313:89-94. [PMID: 32281022 DOI: 10.1007/s00403-020-02066-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/19/2020] [Accepted: 03/28/2020] [Indexed: 10/24/2022]
Abstract
Physicians' and patients' perspectives can vary significantly. For a long time, physicians considered psoriasis a non-pruritic dermatosis until a survey found pruritus to be the most bothersome symptom among psoriasis patients. In our study, we wanted to get an insight into the factors that affect patients and evaluate whether gender differences exist. A link of an anonymous online survey ( www.fightpsoriasis.ch ) with 24 questions was placed on the website of the Swiss Psoriasis and Vitiligo Patient Association ( www.spvg.ch ) from May 2016 until June 2017. 3164 persons participated in this online survey, of which 1979 were diagnosed with psoriasis. Significantly more females than males were affected by psoriatic pruritus [713 (36%) vs. 500 (25.3%), p ≤ 0.001] and 756 (39.7%) of all patients identified pruritus as the most life quality-limiting factor. Fewer women reported high satisfaction with their therapy compared to men [96 (4.9%) vs. 110 (5.6%), p ≤ 0.015]. Pruritus remains the most bothersome symptom and women were more often affected by it, leading to a lower treatment satisfaction among female patients.
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Affiliation(s)
- Carla Murer
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - David Sgier
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Sofia Kyonhi Mettler
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Carole Guillet
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Vahid Djamei
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | | | - Florian Anzengruber
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland. .,Faculty of Medicine, University of Zurich, Zurich, Switzerland.
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Pariser DM, Bagel J, Lebwohl M, Yosipovitch G, Chien E, Spellman MC. Serlopitant for psoriatic pruritus: A phase 2 randomized, double-blind, placebo-controlled clinical trial. J Am Acad Dermatol 2020; 82:1314-1320. [PMID: 32007513 DOI: 10.1016/j.jaad.2020.01.056] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 01/17/2020] [Accepted: 01/21/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Pruritus, a common symptom of psoriasis, negatively affects quality of life; however, treatment of lesional skin does not consistently alleviate psoriatic itch. OBJECTIVE To examine the effects of serlopitant, an oral, once-daily neurokinin 1 receptor antagonist, for treatment of psoriatic pruritus in a phase 2, randomized clinical trial (NCT03343639). METHODS Patients (n = 204) were randomized to receive serlopitant, 5 mg, or placebo daily for 8 weeks. Eligible adult patients had plaque psoriasis for ≥6 months, plaques covering ≤10% of body surface area, pruritus for ≥4 weeks, and Worst Itch Numeric Rating Scale (WI-NRS) score ≥7 at the initial screening. RESULTS Participants (54.2% women) had a mean age of 47.5 years and 85.2% were white. Mean baseline WI-NRS scores were 8.3 for serlopitant and 8.1 for placebo. The WI-NRS 4-point response rate at 8 weeks (primary end point) was 33.3% for serlopitant vs 21.1% for placebo (P = .028); at 4 weeks the rates were 20.8% for serlopitant vs 11.5% for placebo (P = .039). Treatment-related adverse events were reported for 4.9% of serlopitant-treated and 4.0% of placebo-treated patients. LIMITATIONS This was a phase 2 study with a small study population. Patients with severe psoriasis were excluded. CONCLUSION Serlopitant significantly reduced pruritus associated with mild to moderate psoriasis, supporting continued development of serlopitant for this patient population.
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Affiliation(s)
- David M Pariser
- Department of Dermatology, Eastern Virginia Medical School and Virginia Clinical Research, Inc, Norfolk, Virginia
| | - Jerry Bagel
- Psoriasis Treatment Center of Central New Jersey, East Windsor, New Jersey
| | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gil Yosipovitch
- Miami Itch Center, Department of Dermatology, University of Miami, Miller School of Medicine, Miami, Florida
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