Epidemiology of Psoriasis and Comorbid Diseases: A Narrative Review

Real-world psoriasis treatment patterns and disease burden in Germany, with a focus on biologics and apremilast: data from a German statutory health insurance database

BACKGROUND

Psoriasis is a chronic, systemic, inflammatory skin disease, with increasing prevalence; however, few studies have reported real-world prescription patterns and healthcare burden.

OBJECTIVES

This retrospective, observational cohort study used statutory health insurance claims data (January 2014-December 2019) to estimate prevalence/incidence of moderate-to-severe psoriasis in Germany. Patient characteristics, treatment patterns/compliance, and healthcare resource utilization (HCRU)/costs were evaluated, focusing on apremilast and anti-interleukin (IL), and anti-tumor necrosis factor (TNF) biologics.

METHODS

The epidemiology population included adults with psoriasis; 1-year prevalence/incidence rates were extrapolated to the statutory health insurance population. The HCRU/costs population included adults with psoriasis and a first prescription for a drug of interest (index date). Baseline periods were 12 or 48 months before the index date, with 12‑month follow-up.

RESULTS

In 2019, the estimated psoriasis prevalence/incidence was 2,672.9 per 100,000 individuals/508.7 per 100,000 person-years. Of 2,809 patients in the HCRU/costs population, 3.6% (n = 101) received index drug apremilast, 10.2% (n = 287) anti-IL, 6.8% (n = 191) anti-TNF, and 79.4% (n = 2,230) traditional/other systemic therapy. Patients initiating apremilast were older and were more often biologic-naïve than those initiating anti-IL/TNF biologics. Twelve months after treatment initiation, drug adherence (medication possession rate >80%) and persistence (<60 days between prescriptions/no switch) were lower for apremilast vs. anti-IL and anti-TNF groups (24.8% vs. 59.6% and 53.9%; 36.6% vs. 66.9% and 57.6%, respectively). During a 12-month baseline period, psoriasis-related hospitalization was lower for apremilast vs. anti-IL and anti-TNF groups (4.95% vs. 15.68% and 14.14%) and higher during 12 months' follow-up (5.94% vs. 2.44% and 3.14%). Adjusted index drug costs during follow-up were €4,105, €3,498, and €13,777 higher for adalimumab, other anti-TNF and anti-IL biologics vs. apremilast, respectively, and the main driver for lower overall apremilast costs.

CONCLUSION

Given variation in treatment adherence/persistence, HCRU, and costs between apremilast and biologics, these findings could be key considerations during treatment selection.

Limonin alleviates imiquimod-induced psoriasis-like skin inflammation in mice model by downregulating inflammatory responses

Psoriasis is a chronic inflammatory condition affecting 1-2% of the global population. Phytomedicine, which uses plant-based compounds, is emerging as a promising approach to managing such inflammatory diseases. Limonin, a phytochemical found in citrus fruits and known for its bitter taste, possesses significant pharmacological properties. In this study, we evaluated the anti-psoriatic effects of limonin using a psoriasis-induced mice model. BALB/c mice were treated with imiquimod to induce psoriasis and then administered limonin at doses of 20 and 40 mg/kg/day for 6 days. Tacrolimus ointment served as a positive control. We assessed the hematological profile to determine limonin's impact on leukocytes in the psoriasis model. Additionally, histomorphometric analysis of ear and skin tissues was conducted to evaluate the therapeutic effects of limonin. We further investigated the antioxidant properties of limonin by measuring levels of antioxidants and oxidative stress markers. The anti-inflammatory effects were evaluated by quantifying inflammatory cytokines and signaling proteins. In vitro, the cytotoxicity and anti-inflammatory potential of limonin were assessed using murine macrophage RAW264.7 cells. Our findings showed that limonin significantly reduced leukocyte counts, decreased inflammatory cell infiltration, and improved skin histoarchitecture in psoriasis-induced mice. Limonin also effectively scavenged free radicals and reduced levels of inflammatory cytokines and proteins without causing cytotoxicity in RAW264.7 cells. Overall, our in vivo and in vitro results confirm that limonin is a potent anti-inflammatory agent that effectively ameliorates imiquimod-induced psoriasis.

Hsa-miR-31-3p targets CLDN8 to compromise skin barrier integrity in psoriasis

Skin barrier dysfunction in psoriasis has emerged as a significant concern, yet the underlying molecular mechanisms remain incompletely understood. This study investigates the role of hsa-miR-31-3p in regulating skin barrier function through its interaction with claudin-8 (CLDN8) in psoriasis. Through analysis of clinical samples and public datasets, we observed significantly impaired skin barrier function in psoriasis patients, characterized by increased transepidermal water loss and decreased stratum corneum hydration. Notably, CLDN8 expression was markedly downregulated in psoriatic lesions, while hsa-miR-31-3p levels were elevated. Bioinformatics analysis and molecular studies revealed that hsa-miR-31-3p directly targets the 3'UTR of CLDN8, leading to its downregulation. In vitro experiments demonstrated that both CLDN8 knockdown and hsa-miR-31-3p overexpression compromised the permeability barrier in keratinocytes. Furthermore, in an imiquimod-induced psoriasis mouse model, administration of mmu-miR-31-3p antagomir effectively ameliorated skin barrier damage, reduced inflammatory manifestations, and restored CLDN8 expression. These findings unveil a novel mechanism whereby hsa-miR-31-3p regulates skin barrier function through CLDN8 in psoriasis, suggesting potential therapeutic strategies targeting this pathway for psoriasis treatment.

Saturated fatty acid-induced neutrophil extracellular traps contribute to exacerbation and biologic therapy resistance in obesity-related psoriasis

Psoriasis patients who are obese tend to have serious clinical manifestations and poor responses to various biological agents in most cases. However, the mechanisms by which obesity exacerbates psoriasis remain enigmatic. In this study, we found that the abundance of systemic and localized cutaneous neutrophil extracellular traps (NETs) associated with the obesity-induced aggravation of psoriasis was positively correlated with disease severity and that the inhibition of NETs alleviated psoriatic dermatitis in obese mice. Mechanistically, we found that changes in fatty acid composition in obese subjects resulted in the deposition of saturated fatty acids (SFAs), which promoted the release of NETs via the TLR4-MD2/ROS signaling pathway. We further revealed that NETs potentiate IL-17 inflammation, especially γδT17-mediated immune responses, in obesity-exacerbated psoriasis patients. Moreover, SFAs induced a decreased response to anti-IL17A treatment in psoriasis-like mice, whereas the inhibition of NETs improved the beneficial effects of anti-IL17A in psoriasis-like mice with lipid metabolism disorders. Our findings collectively suggest that SFA-induced NETs play a critical role in the exacerbation of obesity-related psoriasis and provide potential new strategies for the clinical treatment of refractory psoriasis patients with lipid metabolism disorders.

Bidirectional association between uveitis and psoriasis: a systematic review and meta-analysis

BACKGROUND

In recent years, the prevalence of uveitis among patients with psoriasis has shown a noticeable upward trend. Previous studies have investigated the immunological mechanisms underlying the potential connection between psoriasis and uveitis, but systematic studies exploring their bidirectional relationship is absent. This study aims to systematically evaluate the bidirectional association between psoriasis and uveitis to provide evidence.

METHODS

We thoroughly searched PubMed, Embase, and the Cochrane Library for relevant observational studies published from the inception of these databases up to Mar 11th, 2024. Our systematic review was based on priori protocol pre-registered in PROSPERO (No. CRD42024522464). Risk and bias assessments were analyzed using STATA 16.0.

RESULTS

We analyzed the results from 7 studies involving 81,775,820 subjects. The results showed that the incidence of uveitis was higher in patients with psoriasis compared to patients without psoriasis (OR = 1.16, 95% CI: 1.11-1.21). At the same time, patients with uveitis showed heightened susceptibility to psoriasis (OR = 1.52, 95% CI: 1.34-1.70, I2: 90.6%, P < 0.01). The subgroup analysis found that uveitis affects the severity and type of psoriasis.

CONCLUSIONS

The current systematic review and meta-analysis found a bidirectional association between psoriasis and uveitis. Notably, patients with severe psoriasis and psoriasis with joint symptoms should be informed about their increased risk to developing uveitis.

Immunomodulatory interactions between mesenchymal stromal/stem cells and immune cells in psoriasis: therapeutic potential and challenges

Psoriasis is defined as a persistent autoimmune disease characterized by the appearance of psoriatic lesions on the surface of the skin. Currently, various approaches including chemicals, corticosteroids, phototherapy, and biological agents are being proposed and implemented to improve psoriatic lesions by modulating immune system activity or metabolic processes, often with unintended consequences and side effects. Currently, mesenchymal stromal/stem cells (MSCs) have attracted considerable interest among researchers due to their ability to modulate immune responses and their ease of application, representing a promising strategy for alleviating clinical symptoms in the treatment of allergic reactions, autoimmune diseases, cancer, and more. This study will investigate how MSCs interact with immune system cells involved in psoriasis development, such as neutrophils, keratinocytes, dendritic cells (DC), and T cell subtypes, for potential therapeutic use in psoriasis management. In this case, several immunomodulatory mechanisms are involved, including expression of chemokines, pro-inflammatory cytokines, matrix metalloproteinase and other factors involved in cell proliferation and neutrophil extracellular trap (NET) formation are among the effects of MSCs on keratinocytes and neutrophils. keratinocytes and neutrophils as pro-inflammatory cells involved in psoriasis pathogenesis and pathogenesis and progression of psoriasis. On the other hand, MSCs interact with DCs and various subsets of T cells, including Th1, Th2, Th17 and Tregs, to generate tolerogenic DCs and increase the differentiation of Tregs and modulate the Th17/Treg towards a regulatory state through overexpression of anti-inflammatory and immunomodulatory and immunomodulatory cytokines, including IL-10 and transforming growth Factor beta (TGF-β). Finally, we will focus on the challenges and obstacles in psoriasis treatment using MSCs, including limitations in the case of using MSCs from different sources and side effects that may be encountered by whole cell therapy strategies, which are attracting attention towards the implication of cell-free regimens such as using MSC-derived secretome or extracellular vesicles and exosomes to provide similar therapeutic outcomes without presumed side effects.

Therapeutic effects and mechanisms of Fufang Longdan mixture on metabolic syndrome with psoriasis via miR-29a-5p/IGF-1R axis

Background

The occurrence of comorbid metabolic syndrome and psoriasis (MS-P) is owing to the complex interplay between metabolic dysregulation and inflammatory responses. However, current treatments have shown limited efficacy in improving the symptoms of both conditions simultaneously.

Objective

This study aimed to investigate the therapeutic efficacy of Fufang Longdan Mixture (FLM) in treating MS-P comorbidity, elucidate its mechanism through the miR-29a-5p/IGF-1R axis and evaluate treatment responses between APOE-/- and C57BL/6 mice.

Methods

UPLC-Q-exactive-MS/MS analysis was used to characterise FLM's chemical composition. Metabolic syndrome was induced in APOE-/- and C57BL/6 mice using a high-fat, high-sugar diet, while psoriasis-like lesions were induced in the mice via the administration of imiquimod. The mice were randomised into control, model, Yinxieling (8 g/kg/d) and FLM (0.5 mL/d) groups. We assessed the treatment efficacy through metabolic parameters, hematoxylin and eosin (H&E) staining and inflammatory cytokine profiling. The direct targeting of IGF-1R by miR-29a-5p was verified via dual-luciferase reporter assays. We analysed the expression patterns and interactions of miR-29a-5p/IGF-1R using RT-qPCR, Western blotting and fluorescence in situ hybridisation.

Results

Chemical analysis identified 2,665 compounds in FLM, which were predominantly shikimates and phenylpropanoids (32%), alkaloids (20%) and terpenoids (13%). FLM significantly improved metabolic parameters in MS-P mice, including fasting glucose levels, insulin resistance indices and lipid profiles (p < 0.05), with more pronounced effects observed in the C57BL/6 mice (p < 0.05). FLM demonstrated superior metabolic regulatory effects compared with Yinxieling (p < 0.05). The treatment significantly reduced Psoriasis Area and Severity Index (PASI) scores and inhibited epidermal hyperplasia (p < 0.05). Furthermore, FLM suppressed the pro-inflammatory cytokines, such as GM-CSF, IFN-γ, IL-9 and IL-17, while elevating the anti-inflammatory IL-10 levels (p < 0.05). Dual-luciferase assays confirmed that IGF-1R is a direct target of miR-29a-5p. Mechanistic studies revealed that FLM upregulated miR-29a-5p expression while downregulating IGF-1R (p < 0.05), with evident co-localisation in lesional tissues.

Conclusion

Our findings demonstrate that FLM effectively ameliorates MS-P comorbidity through modulation of the miR-29a-5p/IGF-1R axis, showing significant therapeutic efficacy across different genetic backgrounds.

IL17RA genetic variants are associated with susceptibility and severity of psoriasis

BACKGROUND

Genetic variants that can play an important role in psoriasis (PsO) ethiology and pathophysiology.

OBJECTIVE

To evaluate the association between the IL17RA genetic variants with the susceptibility and severity of PsO.

METHODS

This study included 154 patients with PsO and 154 healthy controls. The severity of PsO was determined using Psoriatic Activity and Severity Index (PASI). The IL17RA single nucleotide variants T > C rs2241043, A > G rs2241049, and G > A rs6518661 were genotyped.

RESULTS

The IL17RA A > G (rs2241049) GG genotype was associated with protection against PsO [odds ratio (OR): 0.391, 95 % confidence interval (CI):0.199-0.768, p = 0.006)] while the IL17RA T > C (rs2241043) CC genotype and the IL17RA G > A (rs6518661) AA genotype were associated with the PsO severity (OR = 0.30, 95 % CI 0.10-0.093, p = 0.020 and OR = 0.22, 95 % CI 0.05-0.99, p = 0.020, respectively).

CONCLUSION

The results demonstrated that the IL17RA A > G (rs2241049) GG genotype may be a protective factor against the development of PsO and the CC genotype of the IL17RA T > C (rs2241043) and the AA genotype of the IL17RA G > A (rs6518661) variants were associated with protection against the severity of PsO. Considering that these variants are located in intronic regions of the IL17RA, other genetic and epigenetic mechanisms involved in these associations should be investigated.

Patient-centred Preferences for Biologic Therapies in Moderate to Severe Psoriasis in Vietnam: A Discrete Choice Experiment

Psoriasis is a chronic autoimmune disease that significantly impairs patients' quality of life. With the growing availability of biologic drugs - each varying in efficacy, safety, dosing, and cost - treatment decisions have become increasingly complex. A study conducted from March to July 2024 surveyed 302 Vietnamese patients with moderate to severe psoriasis to assess preferences for biologic therapies. Using a discrete choice experiment (DCE), participants evaluated 6 treatment attributes: short-term efficacy, long-term efficacy, sustained efficacy after drug withdrawal, frequency of administration, copayment, and risk of serious infection. Preference data were analysed using conditional logit models. Analysis revealed that treatment cost (relative importance [RI]: 31.4%) and long-term efficacy (RI: 25.3%) were the most critical factors influencing patient decisions, while sustained efficacy after withdrawal and early onset of efficacy were less impactful. Long-term efficacy and cost consistently ranked highest across all patient subgroups, with variations depending on demographic and clinical characteristics. These findings provide practical guidance for clinicians to incorporate patient preferences into the selection of biologic therapies, with particular emphasis on treatment cost and long-term efficacy. The significant influence of treatment cost also highlights the need for healthcare policymakers in Vietnam to enhance reimbursement policies and financial support programmes, improving access and equity in psoriasis care.

Safety and effectiveness of ixekizumab in Japanese patients with psoriasis vulgaris, psoriatic arthritis, generalized pustular psoriasis, and erythrodermic psoriasis: Post-marketing surveillance

We report findings from a post-marketing study conducted from November 2016 to September 2022, which evaluated the safety and effectiveness of ixekizumab in Japanese patients with psoriasis under routine clinical practice for up to 52 weeks, and the incidence of serious infections and malignancies for up to 3 years. Of 804 patients in this analysis (67.9% male; median age, 54 years; mean disease duration, 11.8 years), 72.9%, 37.7%, 7.8%, and 3.7% had psoriasis vulgaris, psoriatic arthritis, pustular psoriasis, and erythrodermic psoriasis, respectively (subtypes not mutually exclusive). At 52 weeks, adverse events were reported in 203 patients (25.3%). Serious adverse events were reported in 36 patients (4.5%), including serious infections and infestations (n = 13, 1.6%). The incidence of serious infections and benign, malignant, and unspecified neoplasms was 0.8% (n = 5) and 0.6% (n = 4) respectively, at 3 years. Overall, 137 patients (17.0%) received Q2/Q2 treatment (160 mg starting dose, followed by 80 mg every 2 weeks from week 12); 550 patients (68.4%) received Q2/Q4 treatment (160 mg starting dose, followed by 80 mg every 2 weeks from weeks 2 to 12 and 80 mg every 4 weeks thereafter); and 117 patients (14.6%) discontinued before week 12 or received only one dose after week 12. A higher proportion of patients in the Q2/Q2 group had psoriatic arthritis (56.9% [n = 78]) compared with the Q2/Q4 group (32.9% [n = 181]). Among patients in the Q2/Q2 versus the Q2/Q4 dose groups, 21 (15.3%) and 141 (25.6%) respectively had adverse events and 2 (1.5%) and 32 (5.8%) respectively had serious adverse events. The mean Psoriasis Area and Severity Index score and body surface area percentage significantly decreased from baseline to week 52 for all psoriasis subtypes and by Q2/Q2 and Q2/Q4 ixekizumab doses (p < 0.01 or p < 0.001). Overall, the safety and effectiveness of ixekizumab in real-world settings in Japan were similar to those reported in clinical trials.

Cardiovascular safety of systemic psoriasis treatments: A prospective cohort study in the BIOBADADERM registry

BACKGROUND

Psoriasis is a chronic inflammatory disease with multiple comorbidities, including an increased risk of major adverse cardiovascular events (MACE). There is limited and contradictory evidence comparing the impact of systemic treatments for psoriasis on MACE.

OBJECTIVES

To evaluate the incidence of MACE associated with each systemic treatment used for patients with psoriasis and compare these rates to those observed with methotrexate (MTX).

METHODS

We conducted a prospective cohort study using data from the BIOBADADERM registry. Propensity score matching was used to adjust for baseline differences between treatment groups. We calculated the incidence rate (IR) of MACE for each systemic treatment class, including biologics (anti-TNF, IL-12/23, IL-17 and IL-23 inhibitors), conventional systemic therapies (MTX, cyclosporine, dimethyl fumarate and acitretin) and apremilast (APR). The IR for each group was compared to those observed in patients treated with MTX using Poisson regression models adjusted for potential confounders, with 95% confidence intervals (95% CI). The primary outcome was the adjusted incidence rate ratios (IRR) for MACE between patients receiving MTX and those receiving another systemic treatment.

RESULTS

We analysed data from 5622 patients, 11,368 treatment cycles and 21,762 person-years (PYs). APR (IRR = 0.17; 95% CI, 0.04-0.70) and IL-17 (IRR = 0.43; 95% CI, 0.20-0.91) were associated with a significant reduction in the risk of MACE compared to MTX. Cyclosporine was associated with an increased risk of MACE (IRR = 3.59; 95% CI, 1.17-10.99) compared to MTX. The remaining systemic psoriasis treatments were not significantly associated with an increased or decreased risk of MACE.

CONCLUSIONS

This real-world evidence study indicates a potential association between APR and IL-17 with a lower incidence of MACE, while CYC showed a higher incidence compared to MTX. These findings underscore the importance of considering cardiovascular outcomes when selecting systemic therapies for patients with psoriasis.

C, Pasha S, Kollur SP, S. N, Shivamallu C, Allur Mallanna S. Advancements in understanding and treating psoriasis: a comprehensive review of pathophysiology, diagnosis, and therapeutic approaches

Psoriasis is a chronic autoimmune disease affecting millions worldwide. This condition is characterized by scaly, red patches of skin that can be painful, itchy, and disfiguring. This non-contagious illness forms plaques and accelerates the dermal cell's life cycle. This review provides a comprehensive overview of the current knowledge on psoriasis, covering its definition, prevalence, causes, pathogenesis, clinical features, diagnosis, and treatment options. The psychosocial impact of psoriasis on patients and their coping mechanisms is also explored. Biologic agents, which target specific cytokines involved in psoriasis pathogenesis, have revolutionized psoriasis treatment and have significantly improved patient outcomes. However, effective and safe treatments for moderate to severe psoriasis are still needed. Future research directions include the development of biomarkers for predicting disease severity and treatment response, investigating new therapeutic targets like the microbiome and epigenetics, and leveraging advancements in technology and genomics for deeper insights into psoriasis pathogenesis and treatment. This study summarizes the key aspects of psoriasis, including its epidemiology, pathophysiology, clinical traits, disease burden, and management. However, further research is needed to improve treatment outcomes and enhance the quality of life for patients affected by this complex condition.

Effectiveness and Safety of Guselkumab in Patients With Moderate-to-Severe Plaque Psoriasis in Real-World Practice in Korea: A Prospective, Multicenter, Observational, Postmarketing Surveillance Study

Clinical trials have demonstrated the efficacy and safety of guselkumab in patients with moderate-to-severe plaque psoriasis. Real-world evidence for guselkumab in Korea is needed to establish drug safety and effectiveness under real-world practice in this population. This study assessed the effectiveness, safety, and drug survival of guselkumab in Korean patients with moderate-to-severe plaque psoriasis in a real-world clinical setting. In this prospective, non-interventional observational study conducted at 44 clinical centers in South Korea, adult patients with moderate-to-severe plaque psoriasis who would receive guselkumab per the product label were enrolled. Disease assessment was performed at visits 1 (baseline, week 0), 2 (approximately week 4), and 3-7 (approximately every 8 weeks after week 4, weeks 12-44). Between February 25, 2019 and March 25, 2022, 707 patients were enrolled and 562 (79.5%) had completed the 56-week observation period. The proportions of patients with an absolute Psoriasis Area and Severity Index (PASI) score of ≤ 3, ≤ 2, or ≤ 1 reached maximums of 96.0%, 86.7%, and 59.0%, respectively, at visit 7. A significantly greater proportion of biologic-naïve (vs. biologic-experienced) patients achieved absolute PASI ≤ 3 by visits 5-7 (p = 0.001 at visit 7) and absolute PASI ≤ 2 by visits 6-7 (p = 0.0014 at visit 7). Dermatology Life Quality Index (DLQI) scores decreased over time, with 64.1% of patients achieving DLQI 0/1 by visit 7; results were similar regardless of prior biologic therapy. The estimated drug-survival rate at 1 year was 92.7%. Adverse events (AEs) occurred in 22.5% of patients, with an incidence rate of 42.1 per 100 patient years (PY); 14 serious AEs occurred in 13 (1.8%) patients, with an incidence rate (95% confidence interval) of 2.4 (1.2-3.7) per 100 PY. Guselkumab administered under approved label conditions was effective and well-tolerated in Korean patients with moderate-to-severe plaque psoriasis in a real-world clinical setting.

Severe psoriasis vulgaris complicating pemphigus vulgaris: A case report

RATIONALE

Currently, the main comorbidities of psoriasis are cardiovascular, metabolic, liver and kidney, autoimmune, and psychological disorders. Psoriasis associated with pemphigus is relatively rare. This rare disease presents with significant clinical, diagnostic, and therapeutic challenges.

PATIENT CONCERNS

The patient was a 71-year-old man with recurrent erythema, papules, and scales with itching all over the body for 11 years, accompanied by blisters and erosions for more than 1 month, and aggravated by generalized eruption for 1 week. The patient was diagnosed with pemphigus vulgaris and admitted to our hospital with intravenous methylprednisolone combined with a conventional oral antihistamine and topical hormonal ointment. The patient's symptoms significantly disappeared. The patient complained that his condition recurred easily after discontinuing medication, which seriously affected his daily life and sleep. The patient also had essential hypertension, nail psoriasis, tinea pedis, and onychomycosis.

DIAGNOSES

The patient was diagnosed with psoriasis vulgaris with coexisting pemphigus vulgaris.

INTERVENTIONS

The patient was treated with modest doses of glucocorticoids combined with secukinumab and methotrexate.

OUTCOMES

The patient's generalized skin lesions and fingernails and toenails of the hands and feet healed virtually. There was no recurrence at 8 months follow-up, and no adverse effects were noted.

LESSONS

Moderate-dose glucocorticoids combined with secukinumab and methotrexate may be an option for treating psoriasis and pemphigus vulgaris. This case allows us to consider whether we can treat psoriasis vulgaris combined with pemphigus vulgaris based on a common pathogenesis, and to guide us in clinical dosing.

Efficacy, Safety, and Drug Survival During the First Year of Biologic Therapy for Psoriasis in Elderly Versus Younger Patients

BACKGROUND

Older people represent an increasing proportion of patients treated with biologics for psoriasis. However, data availability is limited due to the underrepresentation of older patients in clinical trials.

MATERIALS AND METHODS

This is a multicentric real-world observational study conducted in dermatology centers in the Czech Republic. It aims to compare the efficacy, safety, and drug survival of biologics in psoriasis patients aged ≥ 65 years with matched controls aged 18-64 years (1:2 ratio) during the first year of treatment. Data were extracted from the prospective BIOREP registry and patient medical records for adverse events (AEs).

RESULTS

A total of 265 elderly patients and 530 matched controls were included. In both groups, a similar proportion of patients achieved a Psoriasis Area and Severity Index (PASI) ≤ 2 after 14 weeks (67% older vs. 63% younger adults), 26 weeks (71% vs. 76%), and 52 weeks (72% vs. 76%). During the first year of biologic therapy, at least one AE was reported in 108 (41%) older and 214 (40%) younger patients. Serious adverse events (SAEs) were reported in 13 (5%) older and 16 (3%) younger patients. Drug survival during the first year of therapy was lower in older (88%) compared to younger patients (96%), especially in those treated with adalimumab (81% vs. 99%).

CONCLUSION

The efficacy of biological treatment was comparable between older and younger patients. Despite older people having more comorbidities, SAEs did not increase in this age group. Nonetheless, the survival rate of older patients was notably lower during the treatment period, especially when adalimumab was administered.

Foam-Based Drug Delivery Systems for Skin Disorders: A Comprehensive Review

Foam-based drug delivery systems signify a significant innovation in dermatology, facilitating improved drug penetration and administration via a gas-liquid dispersion matrix. These formulations have shown considerable promise in the medical, cosmetic, and pharmaceutical fields. Recent improvements in topical foams have resulted in their extensive utilization in dermatological therapies, with a growing emphasis on categorization techniques grounded in formulation composition and the creation of novel methodologies for assessing essential physicochemical factors. Foam formulations comprising calcipotriol and betamethasone demonstrate 30% enhanced therapeutic effectiveness in the treatment of psoriasis compared to traditional topical therapies. The low-density, aerated structure of foams promotes improved skin covering and hydration, which is especially advantageous for disorders like eczema. Moreover, novel advances such as propellant-free foams and the incorporation of nanotechnology have broadened the use of foam-based delivery methods in targeted drug administration and customized medicine. Ongoing research into new biomaterials and refined formulation procedures seeks to overcome these constraints, ensuring that foam-based systems emerge as a breakthrough method in dermatological care. These systems promise to enhance clinical results and overall patient quality of life by increasing medication bioavailability, patient adherence, and therapeutic effectiveness.

Andrographolide represses HIF-1α and VEGFA expression, thus inhibiting hypoxia-induced proliferation, oxidative stress, and inflammatory cytokine secretion in human keratinocytes

Epidermal hypoxia, hyperproliferation of keratinocytes, and inflammation in skin lesions are relevant to the pathogenesis of inflammatory skin diseases, including psoriasis. Andrographolide (Andro) is a natural labdane diterpene with diverse biofunctions. Andro has been reported to alleviate psoriasis in mice. However, the exact mechanisms need further study. Our results demonstrated that Andro inhibited hypoxia-induced proliferation of human keratinocytes. Andro also protected the keratinocytes from hypoxia-induced oxidative stress and inflammatory response. Furthermore, we found that Andro suppressed the expression of HIF-1α and VEGFA expression in hypoxia-exposed keratinocytes. Overexpression of either HIF-1α or VEGFA attenuated the inhibitory effects of Andro on hypoxia-induced proliferation, oxidative stress, and inflammatory cytokine secretion. In summary, our results demonstrated that Andro protected keratinocytes from hypoxia-induced proliferation, oxidative stress, and inflammatory cytokine secretion by suppressing HIF-1α and VEGFA expression. Our findings provide an unreported insight into the potential use of Andro as an effective agent for the treatment of inflammatory skin diseases such as psoriasis in the future.

Early diagnosis of type 2 diabetes mellitus in patients with psoriasis: Construction of a multifactorial diagnostic model

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a significant comorbidity of psoriasis that exerts a long-term detrimental effect on patients. Early T2DM detection in psoriasis patients is essential for timely medical intervention and the prevention of further complications.

OBJECTIVE

To develop a diagnostic model and introduce a web-based calculator for assessing the risk of T2DM in patients with psoriasis.

METHODS

A diagnostic model was constructed using the least absolute shrinkage and selection operator and logistic regression on data from 17,124 patients with psoriasis from 49 hospitals. The model's performance was evaluated using receiver operating characteristic curve, decision curve analysis, and clinical impact curve.

RESULTS

Eleven significant independent predictors were identified in our model. The area under the receiver operating characteristic curve of this model was 0.875 (95% confidence interval: 0.862-0.889), and the result of Hosmer-Lemeshow goodness of fit test showed a P-value of 0.06. Within the threshold probability of 0-0.2, the diagnostic model showed a significant net benefit.

LIMITATIONS

The limitations of retrospective studies, including a potential data bias to arise during pandemics, must be considered.

CONCLUSION

A multifactorial diagnostic model for diagnosing T2DM in patients with psoriasis was constructed to help clinicians make better decisions.

Pharmacotherapy of arterial hypertension in patients with psoriasis

Psoriasis is a chronic systemic autoimmune disease associated with an elevated risk of developing cardiovascular disease. In patients with psoriasis, arterial hypertension treatment requires careful selection of antihypertensive drugs, as some drugs may worsen the skin manifestations of psoriasis. In this review, we summarize the available evidence regarding the risks and benefits of each group of antihypertensive drugs. We also suggest a scheme for optimizing antihypertensive treatment in patients with psoriasis, with emphasis on achieving effective control of blood pressure and cardiovascular disease, while minimizing the worsening of cutaneous manifestations. Angiotensin receptor blockers appear to be the most appropriate treatment for hypertensive patients with psoriasis, with the potential addition of calcium channel blockers if blood pressure is not adequately controlled. Alternatives are angiotensin-converting enzyme inhibitors and/or mineralocorticoid receptor antagonists. Diuretics and beta blockers are associated with greater risk of worsening of psoriatic lesions.

Evaluating the Efficacy of Bimekizumab across the Different Sensitive Areas in Moderate-to-Severe Psoriasis: A 52-week Italian Multicenter Real-Life Lazio Experience

INTRODUCTION

Psoriasis significantly impacts a patient's quality of life (QoL). Bimekizumab targets IL-17A and IL-17F, offering a broader blockade of the IL-17 pathway compared to other IL-17 inhibitors.

OBJECTIVES

This study evaluated the clinical efficacy of bimekizumab in bio-naive and bio-experienced patients with moderate-to-severe psoriasis over a 52-week period, with a focus on improvements across different body areas and QoL.

METHODS

A retrospective analysis of real-world data was conducted on 132 patients from eight medical centers. Efficacy was assessed using PASI scores, at baseline and at weeks 4, 16, 24, and 52, and DLQI scores. Patients were categorized based on prior biologic treatment experience.

RESULTS

The mean PASI score decreased for all patients, from 14.41 at baseline to 0.18 at week 52, indicating substantial improvement. Area-specific PASI subscores showed significant reductions: head (3.24 to 0.13), upper limb (8.49 to 0), trunk (8.35 to 0.03), and lower limb (8.61 to 0.12). Complete skin clearance was achieved by week 16 in the majority of patients: 85% achieved complete skin clearance on the head, 90% on upper limbs, and 94% on both trunk and lower limbs. DLQI scores significantly improved, from 13.57 at baseline to 0.86 at week 16, highlighting the early positive impact of bimekizumab in improving QoL. When comparing PASI scores between bio-naive and bio-experienced patients, no significant difference was found.

CONCLUSIONS

Bimekizumab demonstrates significant efficacy in reducing psoriasis severity across different body areas and improving QoL over a 52-week period. These findings support this robust treatment option for moderate-to-severe psoriasis.

Discordance between patient and physician global assessments of psoriatic arthritis activity: an observational study in 13 Arab countries

Discordance between physicians and patients in assessing psoriatic arthritis (PsA) activity is common and might impact treatment adherence and decision-making. Cultural and belief systems may influence this discordance. This study aimed to assess the extent of patient-physician discordance in PsA in Arab countries and its association with demographic and disease characteristics.The TACTIC study was a cross-sectional observational study across 13 Arab countries in 2022. Patient and physician global assessments (PGA, PhGA) of disease activity (0-10 scale) were collected, along with demographic and disease data, Disease Activity in Psoriatic Arthritis (DAPSA), and Psoriatic Arthritis Impact of Disease (PsAID). Discordance was defined as an absolute difference of |PGA-PhGA|> 2. Its association with patient characteristics was analyzed through multivariable multinomial logistic regression. In 538 patients (317 females, 58.9%), with a mean age of 45.5 ± 13.2 years and PsA duration of 8.8 ± 7.3 years, the disease was moderately active (mean DAPSA 19.3 ± 16.1; mean PsAID 3.86 ± 2.33). Mean PGA was higher than mean PhGA (4.7 ± 2.5 versus 4.0 ± 2.4, p < 0.001) with an absolute difference of 1.30 ± 1.41 and a high correlation between global assessments (r = 0.74). Discordance was infrequent, occurring in 84 patients (15.6%), and was mostly due to higher PGA (70/84, 83.3%). Discordance (one-point increase) was associated with a lower PhGA (Odds ratio (OR) 3.03 [95%CI 2.18-4.22]), positive fibromyalgia screening (OR 1.28 [95%CI 1.03-1.58]), higher DAPSA (OR 1.16 [95%CI 1.03-1.09]), and higher PsAID scores (OR 2.63 [95%CI 1.96-3.54]). Discordance was primarily identified in patients with moderate disease activity. Discordance between PGA and PhGA was infrequent in Arab countries, suggesting strong patient-physician alignment. Expectations and disease perceptions may play a role in this discordance.

MRI-based neuroimaging alterations in immune-related skin diseases: a comprehensive review

The skin, as the largest organ in the human body, serves as the primary physical barrier and plays a crucial role in the immune defense process. Immune-related skin diseases encompass a spectrum of complex dermatological conditions characterized by aberrant immune responses, including the production of autoantibodies and dysregulation of inflammatory mediators. Growing evidence suggest a heightened prevalence of comorbid neuropsychiatric disorders among patients with immune-related skin diseases, indicative of potential shared pathogenesis. In recent years, the brain connectome, delineating the intricate network of neural connections, has gained prominence in elucidating various neurological and psychiatric conditions. Researchers have begun to investigate whether alterations in brain connectivity occur in patients with immune-related skin diseases, thereby exploring the connectome perspective in understanding the pathogenesis of these diseases. This review aims to synthesize and analyze recent neuroimaging studies about immune-related skin diseases, including systemic lupus erythematosus, psoriasis, chronic spontaneous urticaria, and atopic dermatitis. We mainly discussed the connectome studies related to these diseases and summarized the underlying mechanisms associated with their clinical manifestations, progression, and treatment. Then from our perspectives, we believe that interdisciplinary collaborations encompassing fields such as neurology, psychiatry, dermatology, and neuroimaging will be instrumental in advancing our understanding of immune-related skin diseases. Furthermore, multi-omics approaches will enable a comprehensive exploration of the molecular mechanisms underlying these neural changes, facilitating the identification of novel diagnostic biomarkers and therapeutic targets.

Single-cell RNA sequencing in autoimmune diseases: New insights and challenges

Autoimmune diseases involve a variety of cell types, yet the intricacies of their individual roles within molecular mechanisms and therapeutic strategies remain poorly understood. Single-cell RNA sequencing (scRNA-seq) offers detailed insights into transcriptional diversity at the single-cell level, significantly advancing research in autoimmune diseases. This article explores how scRNA-seq enhances the understanding of cellular heterogeneity and its potential applications in the etiology, diagnosis, treatment, and prognosis of autoimmune diseases. By revealing a comprehensive cellular landscape, scRNA-seq illuminates the functional regulation of different cell subtypes during disease progression. It aids in identifying diagnostic and prognostic markers, and analyzing cell communication networks to uncover potential therapeutic targets. Despite its valuable contributions, addressing the limitations of scRNA-seq is essential for making further advancements.

The Risk of Metabolic Dysfunction-Associated Steatotic Liver Disease in Moderate-to-Severe Psoriasis: A Systematic Review and Meta-Analysis

Background/Objectives: Psoriasis is a chronic immune-mediated skin disease associated with several metabolic comorbidities. Metabolic dysfunction-associated steatotic liver disease (MASLD) is also linked to psoriasis, but evidence regarding the severity of this association remains inconclusive. This meta-analysis aimed to investigate the relationship between MASLD and varying severities of psoriasis. Methods: We conducted an extensive search of four databases, MEDLINE, EMBASE, OSF, and ClinicalTrials.gov to identify relevant published articles assessing the risk of prevalent MASLD in patients with moderate-to-severe psoriasis up to April 2024. Effect estimates from each included study were combined together to calculate a pooled effect estimate for the meta-analysis using the generic inverse variance method of DerSimonian and Laird. Results: This meta-analysis included eight studies with a total of 109,806 participants. A 4.01-fold increased risk of prevalent MASLD was observed in patients with moderate-to-severe psoriasis compared to those without psoriasis (95% CI: 2.17, 7.77; I2 = 67%, p < 0.0001). The evidence supporting this outcome had low certainty. Conclusions: An incremental trend of MASLD was observed in patients with moderate-to-severe psoriasis. Routine screening for MASLD should be emphasized in this population.

Single-cell RNA sequencing of circulating immune cells supports inhibition of TNFAIP3 and NFKBIA translation as psoriatic arthritis biomarkers

Objective

To identify biomarkers that distinguish psoriatic arthritis (PsA) from cutaneous psoriasis without arthritis (PsC) and healthy controls (HC) using single cell RNA sequencing (scRNA-seq).

Method

Peripheral blood mononuclear cell samples from three patients with PsA fulfilling CASPAR criteria, three patients with PsC and two HC were profiled using scRNA-seq. Differentially expressed genes (DEGs) identified through scRNA-seq were validated on classical monocytes, and CD4+ and CD8+ T cell subsets derived from an independent cohort of patients using the NanoString nCounter® platform. Protein expression was measured in CD4+ and CD8+ T cells by immunoblotting.

Results

A total of 18 immune cell population clusters were identified. Across 18 cell clusters, we identified 234 DEGs. NFKBIA and TNFAIP3 were overexpressed in PsA vs HC and PsC patients. Immunoblotting of the proteins encoded in these genes (IκBα and A20, respectively) showed higher levels in PsA CD4+ T cells compared to HC. Conversely, lower levels were observed in PsA CD8+ T cell lysates compared to HC for both proteins.

Conclusion

These results suggest that translation of TNFAIP3 and NFKBIA may be inhibited in PsA CD8+ T cells. This study provides insight into the cellular heterogeneity of PsA, showing that non-cell type specific expression of genes associated with the disease can be dysregulated through different mechanisms in distinct cell types.

Evaluation of nasal mucociliary clearance in patients with psoriasis

PURPOSE

Psoriasis is an autoimmune pathology characterized by chronic inflammation with known multiorgan involvement. In the literature, there are few studies investigating the effects of psoriasis on upper respiratory tract mucosa. Our aim in our study was to investigate the possible effect of psoriasis disease severity and duration on nasal mucosa.

METHODS

A study group was formed from patients with psoriasis and disease duration, Psoriasis Area Severity Index (PASI) and Nasal Obstruction Symptom Evaluation (NOSE) scores of these patients were recorded. Demographic data were noted in all participants with the participation of control group patients, saccharin test was performed to evaluate the nasal mucosa and nasal mucociliary clearance (NMC) times were measured. Psoriasis patients with pathology that may cause nasal obstruction were excluded from the study.

RESULTS

A total of 59 people (30 patients and 29 controls) aged 20-65 years were included in the study. There was no difference in age and gender distribution between the two groups. No statistically significant difference in the NMC time between two groups. In the patients group, a correlation was observed between the NMC time to the NOSE test, but no correlation was observed between the NMC time to the duration of the disease and the PASI score.

CONCLUSION

In our study, no difference was observed in NMC time between the two groups and according to the duration or severity of the disease. In addition, NOSE score of patients was also relatively low. No significant impact of psoriasis on nasal functions was found.

Effects of topical isoxsuprine ointment on imiquimod-induced psoriasiform skin inflammation in mice

This study assesses the potential positive impact of a 0.05% isoxsuprine ointment on psoriasiform skin inflammation generated by imiquimod in mouse models. Thirty-two male albino mice were allocated into four groups: the control group (which received topical emollients twice daily for 16 days), the induction group (which received imiquimod cream (5%) for 8 days, twice daily followed by petrolatum gel (15%) for another 8 days), and the other two groups, which received imiquimod cream (5%) for 8 days followed by either clobetasol ointment (0.05%) or isoxsuprine ointment (0.05%) twice daily for an additional 8 days. At the end of the experiment, mice were sacrificed by ethical standards, and levels of TNF-α, IL-6, IL-17A, IL-23, and VEGF were measured; PASI and Backer's score were examined, in addition to the histopathology of skin tissue. Each clobetasol and isoxsuprine group displayed a significant reduction in tissue homogenate levels of TNF-α, IL-6, IL-17A, IL-23, and VEGF, besides increments in IL-10 compared to the induction group. Some markers (IL-17A, IL23, and VEGF) showed no significant difference between clobetasol and the isoxsuprine group. In contrast, the other markers (TNF-α, IL6, and IL10) showed significant differences between clobetasol and isoxsuprine groups. Isoxsuprine ointment showed comparable efficacy to clobetasol ointment in treating imiquimod-induced psoriasiform skin inflammation in mice models, probably due to its possible effect of anti-inflammatory and immunomodulatory activities.

The Role of Fibroblasts in Chronic Inflammatory and Proliferative Skin Diseases

Fibroblasts (FBs) are crucial mesenchymal cells that preserve the skin's natural structure and physiological processes. They can build dense connective tissue by remodelling the extracellular matrix (ECM) and control immunological activity by secreting cytokines. This indicates that the development of chronic inflammatory and proliferative skin disorders is significantly influenced by fibroblasts. In order to provide new ideas for clinical research and treatment with a clearer perspective, this study thoroughly compiles the involvement of fibroblasts in various chronic inflammatory and proliferative skin diseases such as psoriasis, hypertrophic scar (HS), keloid, atopic dermatitis (AD), oral lichen planus (OLP), chronic eczema, and rosacea.

Outline of Therapeutic Potential of Different Plants Reported Against Psoriasis via In Vitro, Pre-Clinical or Clinical Studies

Psoriasis is a noncontagious, autoimmune chronic inflammatory disease with an unknown root cause. It is classified as a multifactorial and chronic skin disorder that also affects the immune system and is genetic. Environmental factors such as stress, infections, and injuries all play an important role in the disease's development. Although there is no cure for this disease, topical, oral, and systemic whole-body treatments are available to relieve symptoms. Several plants and phytochemicals which have been found effective in the management of the psoriasis experimentally (preclinical and clinical). These plants/phytochemicals have applications in topical, oral, and systemic treatments. Traditionally, some of the plants have been utilized as the primary treatment, including their extracts and/or phytochemicals, for individuals with moderate to severe psoriasis (due to fewer side effects), while phototherapy is generally reserved for more advanced cases. This report describes various plants and phytochemicals that have been found to be effective against psoriasis in in vitro, preclinical, and clinical studies. This review summarizes the key findings from experimental studies on various pathological aspects of psoriasis and may be useful, effective, and informative for future research.

Association Between Systemic Inflammation, Metabolic Syndrome and Quality of Life in Psoriasis Patients

BACKGROUND/OBJECTIVES

Psoriasis is a chronic inflammatory autoimmune disease with important systemic and psychosocial impacts. The association with metabolic syndrome (MS) impairs disease severity and negatively influences patient-reported outcomes, particularly their quality of life as measured by the Dermatology Life Quality Index (DLQI). This study aims to investigate the relationship between systemic inflammation, DLQI scores and disease severity, focusing on the persistent impact of MS on patient outcomes after one year of treatment.

METHODS

This retrospective cross-sectional study included 150 psoriasis patients, with 74 also meeting the diagnostic criteria for MS. Clinical and inflammatory markers such as systemic immune-inflammatory index (SII), cytokines (IL-17A, IL-23), leptin, BMI and triglycerides were analyzed alongside PASI and DLQI scores.

RESULTS

Patients with MS had significantly higher PASI and DLQI scores compared to those without MS, reflecting worse disease severity and quality of life (p < 0.01). Elevated SII levels were strongly associated with higher DLQI scores (p < 0.01). Despite considerable reductions in PASI scores over one year of treatment, DLQI scores indicated a persistent negative impact of MS on quality of life. Notably, markers of systemic inflammation, such as SII, leptin and cytokines, correlated positively with both PASI and DLQI scores, highlighting the role of systemic inflammation in disease burden.

CONCLUSIONS

This study underlines the significant role of systemic inflammation and metabolic comorbidities in amplifying the burden of psoriasis. The persistent impact of MS on quality of life despite clinical improvement underscores the need for comprehensive treatment approaches targeting systemic inflammation, metabolic health and psychosocial factors to improve long-term outcomes.

Geriatric Psoriasis: Evaluation of Clinical Features, Disease Course, and Treatment Modalities of Patients from a Tertiary Care Hospital

INTRODUCTION

Psoriasis is an inflammatory skin disease characterized by erythematous, scaly, pruritic plaques on the extensor areas of the extremities. It is one of the most common dermatological diseases in the geriatric population.

OBJECTIVE

The aim of this investigation was to evaluate the demographic data, clinical characteristics, and treatment responses of the geriatric population (≥65 years) with psoriasis at our hospital.

METHODS

In this study, we examined 160 geriatric patients diagnosed with psoriasis. We evaluated patients in two groups: early onset (EaO) (<60 years) and elderly onset (EO) (≥60 years).

RESULTS

In our study, 53.8% of the patients were male, the average age was 68.7 years, and 65% of the patients were considered EaO. Knee and elbow lesions were detected more frequently at the beginning and during the disease in the EaO group; 44.4% of patients had nail psoriasis, while 20.6% had psoriatic arthritis. Nail involvement (P = 0.17) and the presence of psoriatic arthritis (P = 0.035) were more common in the EaO group. Erythrodermic psoriasis was more common in the EaO group, but it was not statistically significant (P = 0.097). It was observed that the disease course of psoriasis was slower in the EaO group compared to the EO group (P = 0.001). Systemic treatment was predominantly initiated as the first treatment agent in the EO group (P = 0.006). Patients in the EaO group received more cyclosporine treatment than the others (P = 0.004).

CONCLUSIONS

The geriatric population is associated with multiple comorbidities and polypharmacy, highlighting the importance of evaluating patients' medications and comorbidities when selecting a treatment agent for psoriasis.

The Role of Long Non-Coding RNA in the Pathogenesis of Psoriasis

Psoriasis is a chronic immune-mediated disease with complex pathogenesis. The altered proliferation and differentiation of keratinocytes, together with the activity of dendritic cells and T cells, are crucial drivers of psoriasis progression. Long non-coding RNAs (lncRNAs) are composed of over 200 nucleotides and exert a large variety of functions, including the regulation of gene expression. Under pathological conditions, the expression of lncRNAs is frequently dysregulated. Recent studies demonstrated that lncRNAs significantly affect major cellular processes, and their aberrant expression is likely involved in the pathogenesis of various disorders. In this review, we will discuss the role of lncRNAs in the pathophysiology of psoriasis. We will summarize recent studies that investigated the relationships between lncRNAs and keratinocyte proliferation and pro-inflammatory responses.

Biologic therapy for psoriasis is associated with the development of metabolic dysfunction-associated steatotic liver disease (MASLD). A study on the association of cardiometabolic conditions with psoriasis treatment

BACKGROUND

Psoriasis requires a comprehensive assessment of concomitant diseases to make better therapeutic decisions. This study examined the differences in the onset and progression of associated cardiometabolic comorbidities in psoriasis patients based on their treatments.

METHODS

A retrospective longitudinal study was conducted on patients aged over 13 years with psoriasis seen at a Northern Mexican Hospital between 2012 and 2023. Patients were categorized into three groups according on the type of treatment received: topical, systemic, and biologic. A logistic regression analysis was performed to identify predictors of comorbidity development.

RESULTS

197 patients were included; 52.8% were women, with a mean (SD) age of 54.45 (16.91) years, divided into topical [n = 90 (45.7%)], systemic [n = 57 (29.1%)], and biologic [n = 50 (25.5%)] groups, metabolic dysfunction-associated steatotic liver disease (MASLD) was significantly more prevalent in the biologic group [22 (44%)], p < 0.001. The logistic regression showed that type 2 diabetes mellitus, biological treatments (OR = 5.798, p = 0.001), and body mass index (OR = 1.144, p = 0.002), predicted the development of MASLD with a Nagelkerke's R2 of 0.400.

CONCLUSIONS

Psoriasis patients using biological therapies have a greater predisposition to MASLD. These patients should receive a comprehensive approach to identify metabolic conditions, and screening tests for MASLD are recommended.

Knowledge and awareness in psychodermatology: Findings from a survey among Ibero-Latin American dermatologists

Background

Psychodermatology is an interdisciplinary field that bridges psychiatry and dermatology, addressing the psychosocial and psychiatric aspects of skin diseases. Managing such cases presents a challenge for both dermatologists and psychiatrists as patients often resist psychiatric consultations, complicating diagnosis and treatment.

Aim

This study aimed to assess the level of knowledge and awareness of psychodermatology among dermatologists in Ibero-Latin America, explore their experiences with psychodermatological conditions, and identify the educational needs and challenges in this interdisciplinary field.

Materials and Methods

An observational, descriptive, cross-sectional study was conducted through an online survey from December 2023 to March 2024. The survey was distributed through messaging apps and emails and targeted a sample of dermatologists from Ibero-Latin America to explore their experience, training, and perceived challenges in psychodermatology. The participants were selected through non-probabilistic sampling from the staffing records of the Ibero-Latin American College of Dermatology.

Results

Of 301 dermatologists, the vast majority (99%) reported a good level of knowledge in the field of psychodermatology; however, only 36.5% had substantial clinical experience with these conditions. Approximately 70.1% did not prescribe psychotropic medications, reflecting hesitancy or lack of confidence in managing the psychiatric issues of dermatological conditions. The study also highlighted a strong preference (86.7%) for a multidisciplinary approach for managing psychodermatological disorders. Significant perceived challenges included limited access to professional training and patients' reluctance to accept psychological contributions to their dermatological conditions.

Conclusion

The level of knowledge in psychodermatology is widespread among Ibero-Latin American dermatologists, even though a significant gap in practical experience and confidence in integrating psychological management into their dermatological practice was found. These findings emphasize the need for enhanced professional training programs and an interdisciplinary approach to effectively address psychodermatological conditions.

Effects of Semaglutide Treatment on Psoriatic Lesions in Obese Patients with Type 2 Diabetes Mellitus: An Open-Label, Randomized Clinical Trial

Psoriasis is a chronic inflammatory skin disease with relapsing nature. Estimates are that approximately 2-3% of the world's population suffers from this disease. More severe forms of psoriasis are conditions of high inflammation, which is confirmed by the clinical picture and numerous inflammatory parameters such as C-reactive protein (CRP), cytokines and homocysteine, which vary with disease activity. The objective of this clinical study was to investigate the effect of GLP-1 receptor agonist semaglutide therapy on pro-inflammatory factors in the serum and the severity of the clinical picture of psoriasis in obese patients with type 2 diabetes mellitus (T2DM) on chronic metformin therapy. This randomized clinical study was conducted on 31 psoriatic patients with T2DM that were randomized into two groups: one that received semaglutide during the 12-week trial (n = 15), while the second was control (n = 16). The results demonstrated that the severity of the clinical picture of psoriasis, determined by the Psoriasis Area and Severity Index (PASI) score, was significantly better after the administration of semaglutide (the median baseline PASI score in patients treated with semaglutide was 21 (IQR = 19.8), while after 12 weeks of therapy the score was 10 (IQR = 6; p = 0.002). Also, the quality of life in the group of patients who received the drug, measured by the Dermatology Life Quality Index (DLQI), improved significantly after 3 months (a median baseline DLQI score in the semaglutide group was 14 (IQR = 5) at the beginning of the study, and after 12 weeks of treatment the median DLQI score was 4 (IQR = 4; p = 0.002)). The use of semaglutide led to a significant decrease in pro-inflammatory cytokines in the serum (IL6), as well as a significant decrease in CRP values (p < 0.05). A significant decrease in the body mass index (BMI) value in the semaglutide-treated group was also identified, as well as a significant decrease in the level of low-density cholesterol (LDL) (p < 0.05). In conclusion, semaglutide, based on its systemic anti-inflammatory characteristics, could contribute to the treatment of psoriatic obese patients with T2DM.

Stigma and psychological health in psoriasis patients based on the dual-factor model of mental health: the chain mediating roles of social appearance anxiety and alexithymia

Background

Patients with psoriasis also often experience stigma due to skin lesions, and this stigma further leads to severe psychological problems such as anxiety and depression. However, it is unclear how, and under what conditions, stigma relates to mental health. This study aimed to investigate the current status and interrelationships between stigma, social appearance anxiety, alexithymia, and mental health in patients with psoriasis. It also sought to identify the factors that influenced their mental health and to examine the mediating roles of social appearance anxiety and alexithymia in the relationship between stigma and psychological health.

Method

From June to December 2023, patients with psoriasis were recruited from the outpatient department or ward of the dermatology department of a tertiary hospital in Guangzhou. Patients were assessed using the General Information Questionnaire, the Psoriasis Stigma Scale, the Social Appearance Anxiety Scale, the Toronto Alexithymia Scale, and the Satisfaction with Life Scale. Structural equation modeling (SEM) was conducted using Amos 24.0 to explore the relationships among the variables, and mediation effects were tested using SPSS 26.0.

Results

A total of 317 psoriasis patients were recruited to participate in the survey. The total score of stigma of patients was (82.03 ± 1.52), which was at a moderate level. The total score of social appearance anxiety scale was (49.38 ± 1.00), which was at a high level. The total score of negative mental health of patients was (2.77 ± 0.14), which was at a low level. The total score of positive mental health of patients was (20.14 ± 0.36), which was at a medium level. The findings revealed that social appearance anxiety and alexithymia play significant chain mediating roles between stigma and negative mental health in patients with psoriasis, with an effect size of -0.031. Similarly, these factors also mediate the relationship between stigma and positive mental health, with an effect size of 0.056.

Conclusion

Stigma in patients with psoriasis can directly impact their mental health and can also influence it indirectly through social appearance anxiety and alexithymia. Both social appearance anxiety and alexithymia serve as mediators in the relationship between stigma and mental health in these patients.

Demographics, Disease Characteristics, and Treatment Patterns of Patients with Plaque Psoriasis Treated with Biological Drugs: The Experience of a Single-Centre Study in Poland

Objectives: This study is a retrospective analysis of patients with plaque psoriasis treated with biological drugs at a single center in Poland. We sought to evaluate patient demographics, disease characteristics, comorbidity burden, and treatment patterns in this cohort. Methods: Data were collected from the medical records of patients with plaque psoriasis who received biological treatments. In total, data from 1 January 2013 to 2 August 2024 were analyzed, encompassing 159 patients. The variables analyzed included age, disease duration, affected areas, prior treatments, and treatment outcomes. Results: The mean age at the start of biological treatment was 48 years (range: 10-73 years), with an average psoriasis duration of 18.2 years (range: 1-51 years). Obesity was noted in 39% of patients. Psoriasis lesions commonly affected the scalp (74.66%) and nails (64.38%). Methotrexate was the most commonly used systemic therapy prior to biologics (86.30%). Risankizumab and adalimumab were the most frequently prescribed biologics. Secondary treatment failure led to the highest discontinuation rates with tildrakizumab, whereas bimekizumab, guselkumab, risankizumab, and secukinumab showed the lowest rates. Conclusions: Biological drugs play a pivotal role in managing plaque psoriasis, particularly for patients with comorbidities and in treating challenging areas such as the scalp and nails. Risankizumab and adalimumab were prominent in prescription patterns. Future research involving larger cohorts and prospective designs is needed to deepen understanding and optimize treatment strategies for plaque psoriasis in Poland.

Topical Application of Dipyridamole and Roflumilast Combination Nanoparticles Loaded Nanoemulgel for the Treatment of Psoriasis in Rats

Background

Phosphodiesterase-4 is an enzyme that regulates immune responses and contributes to the development of psoriasis. Dipyridamole and roflumilast function as phosphodiesterase-4 inhibitors, reducing pro-inflammatory cytokine expression. The aim was to evaluate the anti-psoriatic effect of the topical administration of dipyridamole and roflumilast nanoemulgel combination on imiquimod-induced psoriasiform skin inflammation in rats.

Methods

Dipyridamole and roflumilast were formulated into nanoemulgel to enhance skin penetration and retention. The production of nanoemulgels involves a two-part process. A nanoemulsion is created (the aqueous phase titration method was employed to create nanoemulsions‎), which is then incorporated into the gelling agent during the second phase. The new formula was then tested in rats. The rats were divided into seven groups; all animals were treated for 16 days. Induction was achieved by 120 mg of 5% imiquimod cream, which was applied daily for 8 days. After induction, groups received one of the following: 0.05% clobetasol ointment, 1% dipyridamole nanoemulgel (D-NEG), 0.3% roflumilast nanoemulgel (R-NEG), 1% dipyridamole and 0.3% roflumilast gel combination (DR-gel), and 1% dipyridamole and 0.3% roflumilast nanoemulgel combination (DR-NEG). At the end of the experiment, all animals were euthanized, and their blood and skin tissue samples were obtained. Inflammatory markers, immunohistochemistry, and histopathology were measured.

Results

The DR-NEG group showed significantly lower levels of IL17, IL23, and TNF-α, while TGF-β showed higher levels than the clobetasol group. The expression of CK16 was significantly lower compared to the clobetasol group. DR-NEG showed a significantly lower PASI and Baker score than the clobetasol group.

Conclusion

The new DR-NEG's topical combination administration showed better anti-inflammatory, tissue healing, and anti-psoriatic activity than each drug alone or topical clobetasol administration; this could be attributed to the possible synergic effects of both drugs and the enhanced skin penetration offered by the nanoemulgel formulation.

Evaluating prevalence and consequence of residual disease in individuals with psoriasis receiving apremilast treatment: results from a US patient survey

Purpose: This noninterventional, cross-sectional survey estimated the prevalence and consequences of residual disease in apremilast-treated US adults with moderate to severe psoriasis. Materials and Methods: Residual disease was defined as experiencing moderate, severe, or very severe psoriasis over the past week or having ≥3% body surface area affected, despite treatment. Factors associated with residual disease and its effects on flare-ups, humanistic burden, and health care resource utilization (HCRU) were evaluated. Results: Of the 344 apremilast users (mean age, 44.9 years; female, 65.4%), 174 (50.6%) had residual disease. It was more prevalent in Black versus White participants (OR, 4.5; 95% CI, 1.6-12.2), those receiving apremilast for ≥1 versus <1 year (OR, 16.5; 95% CI, 7.9-34.4), those reporting ≥2 versus 0 to 1 flare-ups during the past 3 months (OR, 10.0; 95% CI, 5.0-20.1), and those with ≥4 versus 1 to 3 body regions affected at time of survey (OR, 8.6; 95% CI, 3.8-19.8). Participants with versus without residual disease self-reported more psoriasis flare-ups over the past 3 months (mean, 4.7 vs 0.9; p < .001) and more anxiety (89.7% vs 50.0%; p < .001) and depression (69.0% vs 23.6%; p < .001) over the past 30 days. Conclusion: Generally, participants with versus without residual disease also had significantly more comorbidities and greater HCRU.

Association of enthesitis with severity of psoriasis in psoriatic arthritis: an observational study

The relationship between dermatological and articular manifestations of psoriatic disease remains incompletely elucidated. There is no strong correlation between the severity of cutaneous psoriasis and the clinical phenotypes of psoriatic arthritis (PsA). This study aims to examine the correlation between the severity of psoriasis and various clinical features, including measures of severity and activity of PsA, in a real-world clinical setting. Seventy-six consecutive adult patients of both genders with confirmed diagnoses of psoriatic arthritis (PsA) and psoriasis were included in the study. The Psoriasis Area and Severity Index (PASI) was assessed alongside various PsA variables: tender joint count (TJC), swollen joint count (SJC), duration of morning stiffness, presence of dactylitis and number of affected digits, presence of enthesitis and Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), patient's global assessment (PGA), and examiner's global assessment (EGA). Associations were analyzed using the Spearman correlation test and the Kruskal-Wallis test. Statistical significance was established at p = 0.05. Forty-two men and thirty-four women, median age of 56 (range 33-85) years, participated in the study. The median duration of psoriasis was 216 (range 0-600) months and median duration of PsA was 120 (range 7-456) months. There was no significant correlation between PASI and any PsA variables, except for the correlation between PASI and the presence of enthesitis (ρ = 0.285; p = 0.013). Moreover, older patients and patients with a long history of psoriasis manifested more often with enthesis as a sign of PsA. Our findings emphasize the correlation between the severity of psoriasis and presence of enthesitis in patients with PsA.

Tildrakizumab Treatment for Psoriasis in Real-world Practice: An Analysis from the Swiss Registry (SDNTT)

Real-world data on the effectiveness and safety of tildrakizumab, an interleukin 23p19 inhibitor, in Switzerland is limited. The objectives of this analysis were to assess the effectiveness and safety of tildrakizumab in patients with moderate-to-severe plaque psoriasis in Switzerland. Twenty-eight adults from the Swiss Dermatology Network for Targeted Therapies registry (SDNTT), who were on tildrakizumab treatment and had at least 3 months' follow-up, were enrolled in this prospective, multicentre study. No missing data imputation was performed. The median Psoriasis Area and Severity Index (PASI) decreased from 9.5 at baseline to 2.1 and 0.3 (both p < 0.001) after 3 and 18 months, respectively, of tildrakizumab treatment. After 3 months, 76.9%/30.8% patients reached an absolute PASI <  3/ < 1. These rates increased to 85.7%/57.1% after 18 months of treatment. The proportions of patients achieving PASI 90/100 responses were 47.8%/30.4% at month 6 and 42.9%/14.3% at month 18. A significant improvement in quality of life up to 18 months of follow-up was observed as measured by the Dermatology Life Quality Index. There were no treatment discontinuations due to adverse events. This real-world registry provides robust evidence supporting the long-term effectiveness and favourable safety profile of tildrakizumab in treating patients with moderate-to-severe psoriasis.

Efficacy and safety of secukinumab in psoriasis: five-year real life experience

BACKGROUND

The efficacy and safety of secukinumab in psoriasis patients has been demonstrated in randomized controlled clinical trials.

OBJECTIVES

The authors aimed to evaluate the efficacy and safety of secukinumab in plaque psoriasis patients followed in our clinic.

METHODS

Data from 101 plaque psoriasis patients who received at least 16 weeks of secukinumab treatment between June 2018 and June 2023 were retrospectively analyzed.

RESULTS

Fifty-three (53%) of the patients were bionaive. PASI-75, -90, -100 response rates were 72%, 50%, 30% respectively at week 16 in all patients. PASI-75 and -90 responses were higher in naive patients at weeks 16 and 28 (p < 0.001, p < 0.001, p < 0.01, p = 0.01, respectively). The percentage of patients with PASI ≤ 1, ≤ 3, ≤ 5 were 50%, 77%, and 92%, respectively at week 16. They were higher in the naive group than in nonnaive group at weeks 16 and 28 (p = 0.02, p < 0.01, p = 0.05, p = 0.07, p < 0.01, p = 0.03, respectively). At week 52, PASI-75, -90, -100 responses were significantly lower in smoking patients (p = 0.04, p = 0.03, p < 0.01, respectively). The mean duration of secukinumab treatment was 19.80 ± 12.76 months. Secukinumab was discontinued 14 (26.4%) naive patients and 28 (58.3%) nonnaive patients at one occasion during treatment (p < 0.001). The most common adverse event in patients was mucocutaneous candida infection (8%). No hepatitis B or C reactivation and no active or reactivation tuberculosis were observed in any of the patients during the follow-up period.

STUDY LIMITATIONS

This is a single-center retrospective study with relatively few patients including only the Turkish population.

CONCLUSION

Secukinumab seems to be effective in plaque psoriasis, particularly in bionaive and non-smokers. Moreover, it is safe in patients with inactive hepatitis or tuberculosis.

Screening of psoriatic arthritis by dermatologists - a German nationwide survey

BACKGROUND AND OBJECTIVES

Up to 30% of psoriasis (PsO) is clinically associated with psoriatic arthritis (PsA). A large proportion of new onset of PsA is diagnosed at a later stage, despite the necessity of early effective treatment to prevent structural damage. This study aimed to identify the routine screening practices used for PsA in patients with PsO.

PATIENTS AND METHODS

This non-interventional, prospective, epidemiological, cross-sectional study conducted in Germany focuses on screening activity and treatment selection of dermatological practices in suspected PsA. Descriptive statistics and patient characteristics were analyzed for different center types.

RESULTS

One hundred ninety-five patients from 34 office-based physicians, five non-university hospitals, and nine university hospitals were included. Questionnaires or imaging techniques were not routinely used (< 45%). Especially, ultrasounds (≤ 5%) and MRIs (< 6.3%) were rarely performed. Between 30% and 75% of suspected PsA could be confirmed. Referral to rheumatologists and/or appropriate therapy initiation were the most frequent consequences.

CONCLUSIONS

Results of this study reflect the status of PsA screening activity by dermatologists. Imaging techniques, particularly ultrasound or MRIs to detect early forms of PsA, were inadequately used, which may have contributed to continued underdiagnoses. Collaboration between dermatologists and rheumatologists should be reviewed with a view to improving effective PsA screening.

Association of psoriasis disease with physical activity and exercise: systematic review and meta-analysis

Introduction

Psoriasis (Pso) is an inflammatory autoimmune skin disease. High BMI, and elevated body fat and body weight is associated with risk of Pso development. People with Pso have lower physical activity than people without Pso, so they are at higher risk for comorbidities and underlying disease. Exercise has been shown to improve disease outcomes and inflammation in people with psoriasis.

Aim

Meta-analysis study to investigate the physical activity in psoriasis patients.

Methods

We designed this study according to the Systematic Reviews and Meta-Analyses (PRISMA) statement. The ISI, Scopus, PubMed, Cochrane Library, and Google Scholar have been used to search articles up to the end of May 2024.

Results

A total of 1319 articles were extracted from the databases, and 7 articles were selected for analysis. High-intensity exercise levels were significantly lower in Pso patients than in healthy people (RR = 0.75; 95% CI: 0.60-0.93; p = 0.010). But there was no significant difference between the 2 groups regarding moderate-intensity exercise (RR = 0.80; 95% CI: 0.57-1.12; p = 0.20) and low-intensity exercise (RR = 1.42; 95% CI: 0.36-5.60; p = 0.62). Also, the number of metabolic equivalent task (MET) minutes in the Pso group was significantly lower than in healthy controls (SMD = -0.71; 95% CI: -0.86-0.56; p < 000001). Finally, the post-exercise PASI score decreased significantly in psoriatic patients (SMD = 3.98; 95% CI: 0.48-7.48; p = 0.03).

Conclusions

High-intensity physical activity is significantly lower in Pso patients than in healthy people, MET in the Pso group was significantly lower than in healthy controls, and the post-exercise PASI score decreased significantly in psoriatic patients, which means physical activity intervention can be suggested as a therapeutic method for Pso patients.

The safety and efficacy of adipose tissue-derived exosomes in treating mild to moderate plaque psoriasis: A clinical study

AIM

This study evaluates the safety and efficacy of autologous adipose-derived mesenchymal stem cell-derived exosomes as a treatment for Psoriasis, a chronic immune-related skin and joint disorder, compared to current treatments like topicals, phototherapy, and systemic.

MATERIALS AND METHODS

The study isolated exosomes from Mesenchymal Stem Cells(MSCs) of healthy adipose tissue using ultracentrifugation. 12 patients with plaque psoriasis were divided into three groups and given single doses of exosomes. Tissue samples were collected pre- and post-treatment and examined for inflammatory(TNFα, IL23, IL17, IFNγ, CD3) and anti-inflammatory (FOXP3, IL10) markers. The severity of the lesion was also evaluated.

KEY FINDINGS

In this study, it was found that erythema and induration (P < 0.05) decreased significantly in patients receiving 200 μg. Still, this reduction in scaling was not significant, the thickness was significantly reduced in patients receiving 100 and 200 μg doses (P < 0.05). H&E evaluation showed that the decreasing trend in these patients was not significant (P > 0.05). IHC evaluation in patients receiving doses of 100 and 200 μg showed a decrease in the presence of IL17 (P < 0.05, <0.001) & CD3(P < 0.001, <0.05) and a considerable increase in FOXP3(P ≤ 0.001), in the tissue samples of the patients. Examining the expression of inflammatory factors also shows that dose 200 μg decreased the expression of IL17(P > 0.05), IFNγ(P > 0.05), IL23(P < 0.05), & TNFα(P ≤ 0.05) and increased the expression of the anti-inflammatory factor IL10(P < 0.05).

SIGNIFICANCE

The study indicates that a 200 μg dose is optimal for patients, but a larger patient population is needed for more reliable results. Additionally, higher doses or multiple injections with specific intervals can increase confidence.

Mitigative Effects of Topical Norfloxacin on an Imiquimod-Induced Murine Model of Psoriasis

Psoriasis is a chronic, inflammatory dermatosis characterized by thickened, reddened, and scaly skin lesions. Norfloxacin is a fluoroquinolone antibiotic with enhanced antioxidant, anti-inflammatory, and immunomodulatory bioactivities. The aim of this study was to figure out the possible impact of topical norfloxacin on an imiquimod-induced model of psoriasis in mice. Thirty albino-type mice were split into five distinct groups of six animals each. The control group included healthy mice that had not received any treatment. The induction group was given the vehicle 2 h after the topical imiquimod, once daily for 8 days. Two hours after receiving topical imiquimod, the treatment groups including calcipotriol, norfloxacin 2.5%, and norfloxacin 5% were given topical ointments containing calcipotriol 0.005%, norfloxacin 2.5%, and norfloxacin 5%, for 8 days. Topical norfloxacin ointment significantly reduced the severity of imiquimod-exacerbated psoriatic lesions including erythema, shiny-white scaling, and acanthosis and fixed histological abnormalities. Furthermore, imiquimod-subjected mice treated with a higher concentration of norfloxacin ointment exhibited dramatically lower skin levels of inflammation-related biomarkers like IFN-γ, TNF-α, IL-6, IL-17A, IL-23, and TGF-β but higher levels of IL-10. They also demonstrated a notable decrease in angiogenesis parameters such as VEGF and IL-8, a substantial reduction in oxidative indicators like MDA and MPO, and a considerable rise in antioxidant enzymes like SOD and CAT. This study offers novel evidence that norfloxacin may assist in controlling inflammatory dermatoses like psoriasis by minimizing the severity of psoriatic plaques, correcting histological alterations, and diminishing the production of inflammatory, oxidative, and angiogenetic parameters.

Cost-effectiveness analysis of biologic sequential treatments for moderate-to-severe psoriasis: A Malaysian healthcare system perspective

OBJECTIVE

In Malaysia, there is now a dearth of recommendations pertaining to the priority of biologic treatments for the effective management of psoriasis, given the multitude of available therapeutic alternatives. Present analysis reports results of a cost-effectiveness model that determines the most optimal arrangement of biologic treatments, with a particular focus of adding biosimilars to the existing treatment pathway for psoriasis in Malaysia.

METHODS

A Markov model was developed to compare the cost effectiveness of various biologic sequential treatments in a hypothetical cohort of moderate to severe psoriasis patient in Malaysia over a lifetime horizon. The model simulated the progression of patients through three lines of active biologic therapy, before transitioning to best supportive care. Costs and effects were discounted annually at a rate of 3%.

RESULTS

First line secukinumab has produced lowest incremental cost effectiveness ratios (ICERs) when compared to first line systemic [ICERs value; US$152,474 (first set analysis) and US$110,572 (second set analysis)] and first line phototherapy [ICERs value; US$147,057 (first set analysis) and US$107,616 (second set analysis)]. However, these values were slightly higher than the Malaysian based threshold of three times gross domestic product per capita, US$104,337. A 40% reduction in the unit costs of reference biologics renders most of the evaluated treatment sequences cost-effective.

CONCLUSION

Adding biosimilar to the current treatment sequence could achieve cost savings ranging from 4.3% to 10.8% without significant loss of effectiveness. Given the significant impact of comorbidities and the resulting decline in quality of life among individuals with psoriasis, it may be justifiable to establish a threshold of up to US$184,000 per quality-adjusted life year (QALY) for the provision of therapies in the context of Malaysia.

Uncovering the Differences: How DLQI and WHO-5 Scores Vary in Moderate-to-Severe Psoriasis Patients Treated with Tildrakizumab 100 mg vs. 200 mg?

Background/Objectives: Psoriasis (PsO) is a chronic inflammatory skin disease that severely impacts patients' quality of life (QoL). Its global prevalence is about 2%, with significant regional variations. PsO manifests in the form of erythematous and scaly plaques, causing intense pruritus and discomfort and limiting daily activities. The condition often includes comorbidities such as psoriatic arthritis, cardiovascular diseases, and metabolic syndrome, further deteriorating QoL. Psychological well-being is notably affected, with high levels of depression and anxiety due to the visible lesions, leading to social stigma and isolation. QoL indexes like WHO-QoL and SF-36 assess various well-being aspects, while patient-reported outcomes (PROs) provide a comprehensive understanding of PsO's impact. However, there are no universally shared PROs in outpatient practice to fully understand the impact of the disease and associated therapies. This study aims to evaluate differences between DLQI and WHO-5 in adult patients with moderate-to-severe PsO treated with tildrakizumab 100 mg or 200 mg. Methods: The study was conducted at the University Hospital of Siena, Italy, from May 2023 to April 2024. Data from 15 patients treated with tildrakizumab 200 mg and 15 patients treated with tildrakizumab 100 mg, observed for at least 28 weeks, were recorded. Demographic data, PASI, DLQI, and WHO-5 scores were analyzed. Patients in the 100 mg group (G100) were selected to match the demographic characteristics of the 200 mg group (G200). Reduction rates of DLQI and WHO-5 were assessed at baseline values and after 4, 16, and 28 weeks. Results: Both groups experienced improvements in QoL. The group treated with 200 mg showed more pronounced and rapid reductions in DLQI and WHO-5 scores compared to the 100 mg group. WHO-5 demonstrated faster improvements in overall well-being than DLQI, indicating its greater sensitivity to changes in mental well-being and overall QoL. No differences in adverse events were observed between the two groups, with no major adverse events reported. Conclusions: In our study, WHO-5 proved more sensitive than DLQI in capturing well-being changes in PsO patients treated with tildrakizumab. However, a combined use of both WHO-5 and DLQI questionnaires should be encouraged in clinical practice. Furthermore, this study confirmed the superior QoL improvement associated with tildrakizumab 200 mg compared to 100 mg. Future research should explore the long-term impact on QoL and comparative effectiveness among other biologic therapies in diverse patient populations.