Psoriasis: a brief overview

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.

Safety and effectiveness of secukinumab in Japanese patients with generalized pustular psoriasis: A post-marketing surveillance

Secukinumab is one of the human monoclonal antibodies recommended in the Japanese guidelines for patients with psoriasis, but few case reports and clinical studies on secukinumab for pustular psoriasis are available because of the rarity of the disease. This was an open-label, multicenter, uncontrolled, single-arm, prospective observational surveillance conducted in a clinical practice setting to evaluate the safety and effectiveness of secukinumab in Japanese patients with generalized pustular psoriasis (GPP). Patients were monitored for 1 year after starting secukinumab and followed up for an additional 2 years. Of 99 patients from 71 sites, 95 were included in safety and 82 in effectiveness analysis. The mean (standard deviation) observation period was 346.2 (64.87) days, and 91.58% of patients were observed over 52 weeks. Adverse events, serious adverse events, and adverse reactions were reported in 51.58%, 12.63%, and 35.79% of patients, respectively. Safety evaluations showed no significant difference in the incidence of events based on the history of biologics The proportion of patients with either "complete response" or "partial response" was ~90% from week 2 and remained stable until week 52. The proportion of patients with "remission (no symptom)" in the Japanese Dermatological Association total score increased from week 4 (22.22%) to week 52 (47.83%). The mean Psoriasis Area and Severity Index score decreased from week 1 (17.26) to week 16 (1.18), with the mean percentage change decreasing from -28.07% to -90.18%. The mean Dermatology Life Quality Index (DLQI) total score decreased from 8.7 at the start of secukinumab treatment to 1.9 at week 52. At week 52, the proportion of patients with DLQI total score of 0/1 was 57.14%. No new safety signals for secukinumab in long-term treatment were observed from this surveillance, and no additional measures needed to be taken. Moreover, secukinumab showed sustained effectiveness in patients with GPP in Japan.

Intradermal delivery of teriflunomide loaded emulsomes using hollow microneedles for effective minimally invasive psoriasis management

Conventional topical psoriasis treatments suffer from limited delivery to affected areas along with skin irritation due to high local drug concentration. Herein an attempt to improve the delivery of leflunomide's active metabolite (teriflunomide (TER)) by improving its solubility through nanoencapsulation in emulsomes (EMLs) besides ensuring effective intradermal delivery using hollow microneedles. Evaluation of colloidal characteristics of EMLs, encapsulation efficiency and drug release were performed. Additionally, the antipsoriatic activity in an imiquimod-induced psoriatic mouse model was evaluated by the measurement of inflammatory mediators' levels and histopathological assessment of anatomized skin. The particle size of the chosen EMLs formulation was 147.9 nm and the zeta potential value was -21.7. Entrapment efficiency was 97.23 % and EMLs provided sustained drug release for 48 h. No statistically significant differences in the in vivo levels of NF-KB, IL 8, MMP1, GSH, SOD and catalase between the animals treated by TER-EMLs and the negative control cohort were observed. Also, histopathological inspection of dissected skin samples reflected the superiority of TER-EMLs over TER suspension. Collectively, combining nanoencapsulation and hollow microneedles application improved TER properties and ensured effective TER delivery to the affected psoriatic areas.

Vildagliptin topical ointment: an effective treatment for imiquimod-induced psoriasis in mice

Psoriasis is a chronic immune-related dermatosis characterized by inflamed, thickened, brownish-red, peeling skin patches. Vildagliptin is an anti-diabetic drug with novel anti-inflammatory, anti-oxidative, and anti-proliferative activities. This study aimed to assess the anti-psoriatic activity of topical vildagliptin. 40 Swiss albino mice were sorted into five groups, each with 8 animals. The control group obtained no treatment. The induction group obtained imiquimod cream (5%) at a dose of 62.5 mg per day. The vehicle group obtained imiquimod (as did the induction group), accompanied by topical vehicle application. The clobetasol group obtained imiquimod cream (as did the induction group), and two hours later, clobetasol ointment (0.05%) was administered. The vildagliptin group obtained imiquimod (as in the induction group), followed by topical vildagliptin ointment (3%), two hours after induction. The experiment lasts for 8 consecutive days. Evaluations were conducted on the results of biochemical indicators, histological assessments, and clinical observations. Vildagliptin administered topically effectively corrected psoriatic histological irregularities, improved the psoriasis-like skin lesions such as erythema, flacking, and acanthosis, and attenuated the imiquimod-provoked elevations of PASI and Baker's score. Further, overexpression of inflammatory markers (TNF-α, IL-17 A, IL-23, and IL-22), angiogenic markers (VEGF), oxidative-stress components (MDA and SOD), and proliferative factors (Ki-67) were dramatically mitigated by vildagliptin treatment. Topical vildagliptin has profound anti-psoriatic effects.

MiR-718-mediated inhibition of prohibitin 1 influences mitochondrial dynamics, proliferation, and migration of keratinocytes

Keratinocyte hyperproliferation is a key characteristic of psoriasis. Prohibitins (PHB) are known to be associated with keratinocyte proliferation and cell cycle regulation, influenced by mitochondrial processes. The objective of this study was to examine the impact of miR-718 overexpression and downregulation on the various PHB1-mitochondria-driven activities in HaCaT keratinocytes. We demonstrated that PHB1 expression is downregulated through direct targeting by miR-718, which then leads to a reduction in the expression of MFN1, MFN2, and OPA1 in miR-718-transfected cells, as evidenced by western blot analysis. Mitochondrial fusion and DRP1-mediated fission, as indicated by western blot results, were further validated using confocal imaging with CMXRoS labeling, contrasting with the effects of AM-718. JC-1 dye staining results demonstrated the miR-718 overexpression facilitates the mitochondrial membrane depolarization that highlighting the PHB1-OPA1 mediated depolarization. Moreover, OPA1 maintains mitochondrial cristae structure and its dysfunction can trigger cell death. Further PHB1 is known to regulate OPA1 function, alters mitochondrial morphology and significantly influences epithelial cell migration. Herein, our data demonstrated a reduction in keratinocyte proliferation and migration, as evidenced by the CCK assay and wound healing assay, respectively, following 24 h of transfection. Ultimately, our data indicates the potential involvement of miR-718 in the mitochondria-mediated suppression of cell proliferation and migration in HaCaT keratinocytes, likely due to modified mitochondrial processes via PHB1.

Future Prospects and Regulatory Pathways for Invasome Technologies in Transdermal Drug Delivery

Skin is one of the largest organs in the human body. It acts as an outer protective cover and comprises the epidermis, dermis, and hypodermis. Liposomes are formed by phospholipids and have a vesicular character that improves the encapsulation of lipophilic, hydrophilic, and amphiphilic drugs. The invasome structure is flexible as opposed to regular liposomes; this is due to the presence of ethanol and terpene that increases lipid fluidity in the vesicle structure. Terpenes, ethanol, or terpene mixes are potential carriers that invasomes' tiny liposomal vesicles used to improve skin penetration. Terpenes that are primarily derived from natural sources are the most efficient and secure kind of penetration enhancers (PEs). There are some methods for the preparation of invasomes, but mostly the techniques used for the preparation of invasomes are mechanical dispersion and film hydration methods. Although PEs are effective when applied topically, only a small number are clinically approved due to concerns about skin irritation and toxicity. Invasomes exhibit a higher rate of skin penetration than liposomes and ethosomes. This review examines the structure, components, preparation methods, and applications of invasomes in pharmaceutical formulations, focusing on their potential to treat skin disorders and improve therapeutic outcomes. The primary objective is to assess the future potential of invasome technologies in transdermal drug delivery, alongside an exploration of the regulatory challenges and pathways for their development and approval. Graphical abstract illustrating the composition, mechanism of action, and therapeutic applications of invasomes in transdermal drug delivery systems.

A new era of psoriasis treatment: Drug repurposing through the lens of nanotechnology and machine learning

Psoriasis is a persistent inflammatory skin disorder characterized by hyper-proliferation and abnormal epidermal differentiation. Conventional treatments such as; topical therapies, phototherapy, systemic immune modulators, and biologics aim to relieve symptoms and improve patient quality of life. However, challenges like adverse effects, high costs, and individual response variability persist. Thus, the need for novel anti-psoriatic drugs has led to the exploration of drug repurposing, an approach that identifies new applications for existing drugs. This method is in its early stages but has gained popularity across both public and private sectors. Furthermore, artificial intelligence (AI) integration is revolutionizing the healthcare industry by enhancing efficiency, delivery, and personalization. Machine learning and deep learning algorithms have significantly impacted drug discovery, repurposing, and designing new molecules or drug delivery carriers. Nanotechnology, in addition to AI, plays a pivotal role in targeting repurposed drugs via the topical route with suitable nanocarriers. This method overcomes challenges associated with oral delivery, such as systemic toxicities, slow onset of action, first-pass effect, and poor bioavailability. This review addresses the practice of repurposing existing drugs for managing psoriasis, discussing the challenges of conventional therapy and how the incorporation of nanotechnology and AI can overcome these hurdles, facilitating the discovery of anti-psoriatic drugs and presenting promising strategies for novel therapeutics. Additionally, it discusses the general benefits of drug repurposing compared to de novo drug development and the potential drawbacks of drug repurposing.

Vulgar Psoriasis Triggered by Active Pulmonary Tuberculosis: A Case Report and Literature Review Highlighting Immunological Interactions and Genetic Susceptibility

Introduction: About one in four people show an immunological reaction to an infection with Mycobacterium tuberculosis, which can remain latent or lead to active forms of the disease. Psoriasis is a chronic, immune-mediated skin disease that can be associated with numerous comorbidities. Biologic therapies have revolutionized psoriasis treatment but carry the risk of reactivating latent tuberculosis infection. However, the link between tuberculosis as a triggering factor for the onset of psoriasis remains unknown. Clinical Case: We present the case of a patient initially diagnosed with secondary pulmonary tuberculosis, who, two months after the diagnosis, showed a remarkable clinical evolution by developing lesions consistent with vulgar psoriasis, necessitating a multidisciplinary treatment approach. Discussions: This unique case highlights the shared immune mechanism of these diseases, particularly involving TNF-α, IL-17, and CD4+ T cells. Conclusions: The coexistence of these conditions raises critical questions about the interplay between infectious and autoimmune diseases and the impact of genetic susceptibility.

Pinitol Improves Lipopolysaccharide-Induced Cellular Damage in Human Dermal Microvascular Endothelial Cells

3-O-Methyl-D-chiro-inositol (pinitol) has been reported to possess insulin-like effects and is known as one of the anti-diabetic agents for improving muscle and liver function. However, the beneficial effects of pinitol on human dermal microvascular endothelial cells (HDMECs) are not well understood. In this study, we investigated whether pinitol could protect HDMECs from damage induced by lipopolysaccharides (LPSs), which cause various cell defects. We observed that pinitol enhanced wound healing for LPS-damaged HDMECs. We found that pinitol significantly downregulated the LPS-induced upregulation of reactive oxygen species (ROS). Pinitol also significantly restored the mitochondrial membrane potential in these cells. Immunofluorescence analysis revealed that pinitol notably reduced the nuclear localization of NF-κB in LPS-damaged HDMECs. Furthermore, we demonstrated that pinitol decreased the phosphorylation levels of the MAPK family in LPS-damaged HDMECs. Interestingly, we observed that pinitol improved tube formation in LPS-damaged HDMECs. Taken together, we suggest that pinitol exerts several beneficial effects on LPS-damaged HDMECs and may be a promising therapeutic agent for improving vascular-related skin diseases.

Assessment of salivary biomarkers in psoriasis: a comprehensive scoping review

OBJECTIVE

To map the evidence on altered salivary biomarkers in individuals with psoriasis.

STUDY DESIGN

A comprehensive literature search was conducted across six databases and gray literature sources using keywords related to psoriasis and salivary biomarkers, with no restrictions on time or language, up to November 2024. Studies evaluating salivary biomarkers in humans with psoriasis were considered eligible. Identified outcomes were categorized based on biomarker type and analyzed descriptively.

RESULTS

A total of 661 studies were initially identified, of which 22 met the inclusion criteria. These comprised 15 cross-sectional studies, 6 cohort studies, and 1 randomized clinical trial, collectively involving 987 individuals with psoriasis. The primary altered salivary biomarkers identified included inflammatory cytokines (IL-1β, IL-2, IL-6, IL-10, TNF-α, INF-γ), oxidative stress mediators (nitric oxide, nitrotyrosine), antioxidant enzymes (catalase, superoxide dismutase), immunological markers (salivary alpha-amylase, secretory immunoglobulin A), and stress-related hormones. Many of these biomarkers were significantly associated with disease severity and therapeutic response.

CONCLUSION

Cortisol, inflammatory cytokines and oxidative stress mediators are the most frequently altered salivary biomarkers in individuals with psoriasis. However, the methodological heterogeneity among the studies highlights the need for well-designed prospective studies with representative sample sizes to validate these findings.

Efficient blockLASSO for polygenic scores with applications to all of us and UK Biobank

We develop a "block" LASSO (blockLASSO) approach for training polygenic scores (PGS) and demonstrate its use in All of Us (AoU) and the UK Biobank (UKB). blockLASSO utilizes the approximate block diagonal structure (due to chromosomal partition of the genome) of linkage disequilibrium (LD). The new implementation can be used for exploratory and methods research where repeated PGS training is necessary and expensive. For 11 different phenotypes, in two different biobanks, and across 5 different ancestry groups (African, American, East Asian, European, and South Asian) - we demonstrate that blockLASSO is generally as effective for training PGS as a (global) LASSO. Previous work has shown penalized regression methods produce competitive PGS to alternative approaches. It has been shown that some phenotypes are more/less polygenic than others. Using sparse algorithms, an accurate PGS can be trained for type 1 diabetes (T1D) using ∼ 100 single nucleotide variants (SNVs), but a PGS for body mass index (BMI) would need more than 10k SNVs. blockLASSO produces similar PGS for phenotypes while training with just a fraction of the variants per block. Within AoU (using only genetic information) block PGS for T1D reaches an AUC of 0 . 63 ± 0.02 and for BMI a correlation of 0 . 21 ± 0.01 , whereas a global LASSO approach which finds for T1D an AUC 0 . 65 ± 0.03 and BMI a correlation 0 . 19 ± 0.03 . This new block approach is more computationally efficient and scalable than naive global machine learning approaches and makes it ideal for exploratory methods investigations based on penalized regression.

HDL-associated vitamin D binding protein levels are inversely associated with necrotic plaque burden in psoriasis

Background and aims

Vitamin D binding protein (DBP) serves a dual function as a vitamin D carrier and actin scavenger. Free DBP is present in high concentrations in serum, while a smaller pool is bound to lipoproteins like HDL and VLDL. The role of DBP's interaction with lipoproteins remains unclear. Given that HDL has been proposed to have both atheroprotective and anti-inflammatory properties, we sought to compare whether HDL-associated DBP and/or total serum DBP could serve as useful biomarkers for assessing disease severity in psoriasis and cardiovascular disease.

Methods

Psoriasis (PSO) patients (N = 83), which were part of a prospective, observational cohort and non-psoriasis (non-PSO) subjects (n = 35) underwent blood collection for HDL purification by liquid chromatography and CCTA scans to assess coronary plaque burden. Serum and HDL-bound DBP levels were measured by ELISA.

Results

The psoriasis cohort was middle-aged (mean ± IQR: 50 (38-59), predominantly male (n = 55, 66 %) and had moderate-to-severe skin disease [psoriasis area severity index score, PASI score, med (IQR): 9.6 (6-18.3)]. Consistent with our previous reports, PSO patients had significantly higher Framingham Risk Score (FRS), high sensitivity C-reactive protein (hs-CRP), Body Mass Index (BMI), insulin resistance (HOMA-IR) and total coronary plaque burden, driven by the rupture-prone non-calcified necrotic core. However, while the concentration of serum DBP (S-DBP) between PSO and non-PSO was unchanged (PSO: 177.80 (125.77-250.99) vs non-PSO: 177.74 (104.32-254.04), the concentration of DBP associated with HDL (HDL-DBP) was decreased in psoriatics (PSO μg/ml: 1.38 (0.64-2.75) vs non-PSO: 1.72 (1.18-3.90). Although both S-DBP and HDL-DBP levels showed inverse correlations with a measure of skin disease severity (PASI) (S-DBP, Rho = -0.022 vs HDL-DBP, Rho = -113), only HDL-DBP exhibited an inverse relationship with necrotic plaque burden [Rho -0.226, p = 0.085 vs S-DBP (0.041, p = 0.76)]. This relationship was strengthened after adjusting for traditional cardiovascular risk factors such as age and sex (β = -0.237, p = 0.045), FRS (β = -0.295, p = 0.033) and including biological treatment and HDL-cholesterol (β = -0.213, p = 0.048).

Conclusions

In conclusion, we found HDL-DBP levels may better capture the severity of psoriatic disease and association with cardiovascular risk factors than S-DBP.

Predicting psoriasis severity using machine learning: a systematic review

BACKGROUND

In dermatology, the applications of machine learning (ML), an artificial intelligence (AI) subset that enables machines to learn from experience, have progressed past the diagnosis and classification of skin lesions. A lack of systematic reviews exists to explore the role of ML in predicting the severity of psoriasis.

OBJECTIVES

To identify and summarize the existing literature on predicting psoriasis severity using ML algorithms and to identify gaps in -current clinical applications of these tools.

METHODS

OVID Embase, OVID MEDLINE, ACM Digital Library, Scopus and IEEE Xplore were searched from inception to August 2024.

RESULTS

In total, 30 articles met our inclusion criteria and were included in this review. One article used serum biomarkers, while the remaining 29 used image-based models. The most common severity assessment score employed by these ML models was the Psoriasis Area and Severity Index score, followed by body surface area, with 15 and 5 articles, respectively.

CONCLUSIONS

The small size and heterogeneity of the existing body of literature are the primary limitations of this review. Progress in assessing skin lesion severity through ML in dermatology has advanced, but prospective clinical applications remain limited. ML and AI promise to improve psoriasis management, especially in nonimage-based applications requiring further exploration. Large-scale prospective trials using diverse image datasets are necessary to evaluate and predict the clinical value of these predictive AI models.

Next-Generation Anti-IL-17 Agents for Psoriatic Disease: A Pipeline Review

Innovations in biologics are transforming the treatment of psoriatic diseases. The ability to target specific levels of immune activation provides a distinct advantage. Interleukin (IL)-17 inhibitors fall into this class of biologics, and they are effectively used to treat a spectrum of psoriatic diseases, such as psoriasis vulgaris and psoriatic arthritis. In recent years, anti-IL-17 agents have been the focus of therapeutic development, with various formulations and routes of administration. In this manuscript, we review pipeline anti-IL-17 therapies for psoriatic diseases identified through a search of ClinicalTrials.gov (January 2019-December 2024) and other databases. Key agents under investigation include netakimab, vunakizumab, xeligekimab, gumokimab, HB0017, CJM 112, JS005, 608, LZM012, ZL-1102, izokibep, sonelokimab, DC-806, DC-853, and LEO 153339. Both preclinical and clinical trial data for each agent are summarized, with an emphasis on their efficacy, adverse effects, immunogenicity, and future outlooks.

Perception and portrayal: The depiction of psoriasis in dermatology cartoons

Psoriasis is a frequently misunderstood condition that is associated with significant stigma. Media portrayals of skin disorders can influence public beliefs about those disorders. This study aimed to describe the portrayal of psoriasis in cartoons to inform education campaigns about the condition in a creative manner. The image sections of the internet search engines Google, Yahoo, Bing, and DuckDuckGo were inspected for single-panel cartoons that specifically referenced psoriasis. Each cartoon about psoriasis was then examined according to an instrument with categories for describing the treatment, outcome, impact of diagnosis, nature of the cartoonist's intended humor, and apparent messages about psoriasis. Twelve cartoons were identified. There is scope for more positive and imaginative portrayals of psoriasis in cartoons. The phrase heartbreak of psoriasis was commonly used by cartoonists, and this medium has overlooked various treatment options for psoriasis.

Topical delivery of siRNA to psoriatic skin model using high molecular weight chitosan derivatives: In vitro and in vivo studies

Psoriasis is a chronic inflammatory skin disease that, like other immune-mediated conditions, may benefit from small interfering RNA (siRNA)-based therapies, which are emerging as a promising alternative by addressing several limitations of current treatments. In this study, topical formulations of chitosan-based vectors were developed to deliver siRNA targeting tumor necrosis factor alpha (TNFα) to inflamed skin. Grafting diisopropylethylamine (DIPEA) and polyethylene glycol (PEG) onto the chitosan backbone enhanced siRNA delivery efficiency under physiological conditions, forming robust polymeric vectors with high structural and colloidal stability. These vectors provided siRNA protection against RNAse degradation and oxidative damage. Additionally, the chitosan derivatives displayed lysozyme-mediated biodegradability comparable to native chitosan, while PEG was released in response to reductive environments, supporting controlled vector disassembly. The PEGylated DIPEA-chitosan/siRNA polyplexes demonstrated positive zeta potentials (up to + 11 mV), particle sizes of 100-200 nm, and very low cytotoxicity in keratinocyte and fibroblast cell lines. In vitro, the polyplexes achieved TNFα knockdown levels (65%) in RAW macrophages, comparable to those obtained with Lipofectamine™. Topical formulations showed enhanced interaction of vectors with skin models (Strat-M® and porcine ear skin) compared to naked siRNA. Furthermore, in vivo studies indicated that hair follicles were a key route for polyplexes to penetrate deeper skin layers. A rodent model of psoriasis induced by imiquimod was treated topically with these vectors, resulting in approximately a 50% reduction in TNFα levels at inflammation sites, decreased immune cell infiltration, and preservation of epidermal structure. These findings collectively underscore the potential of DIPEA-chitosan-based vectors for topical siRNA-based therapies.

Anti-Cytokine Active Immunotherapy Based on Supramolecular Peptides for Alleviating IL-1β-Mediated Inflammation

IL-1β is a principal proinflammatory cytokine underlying multiple local and systemic chronic inflammatory conditions including psoriasis, rheumatoid arthritis, inflammatory bowel disease, and type 2 diabetes. Passive immunotherapies and biologic drugs targeting IL-1β, while offering significant clinical benefit, nevertheless have limitations such as significant non-response rates, induction of anti-drug antibodies, and high costs. Here, an active immunotherapy raising antibody responses against IL-1β employing self-assembling peptide nanofibers is described. The nanofibers contain defined quantities of B-cell epitopes from IL-1β and exogenous T helper epitopes and employ the Q11 self-assembling peptide platform. Without adjuvant, the nanofibers raised durable anti-IL-1β antibody responses that inhibit IL-1β activity in vitro and in vivo. In a mouse model of imiquimod-induced psoriasis, prophylactic immunizations with the nanofibers diminished symptoms of epidermal thickening. This therapeutic effect is associated with biasing the immune response toward an anti-inflammatory IgG1/Th2 phenotype and a lowered expression of proinflammatory genes in the skin. Further, anti-IL-1β nanofibers induced therapeutic immunosuppressive CD62L+ Treg cells. This technology represents a potential alternative for passive immunotherapies and other biologics for treating chronic inflammatory conditions.

Emerging Novel Therapies for the Treatment of Psoriasis: A Narrative Review

Psoriasis is a chronic autoimmune and autoinflammatory disorder defined by abnormal skin cell turnover and inflammation, resulting in the formation of plaques on the skin. Although biologic therapies targeting interleukin (IL)-17 and IL-23 have significantly improved the treatment landscape for moderate-to-severe psoriasis, they are not effective for all patients. This highlights the need for additional therapeutic strategies. In recent years, exploring novel treatment avenues such as targeting IL-21, small nucleolar RNA (snoRNA) Snora73, the gut microbiome, and natural remedies have shown increasing promise in managing psoriasis. Interleukin-21 is a cytokine that plays a critical role in the differentiation and function of Th17 cells, which are central to the pathogenesis of psoriasis. Recent studies have demonstrated that neutralizing IL-21 with specific antibodies can help restore immune homeostasis, reducing disease severity and improving patient outcomes. Targeting IL-21 may be particularly beneficial for patients resistant to conventional therapies like IL-17 and IL-23 inhibitors. In addition to IL-21, snoRNA Snora73 has emerged as a novel target for psoriasis treatment. Snora73 regulates cell proliferation by interacting with miR-3074-5p and pre-B-cell leukemia homeobox 1 (PBX1), promoting abnormal cell turnover in psoriasis. The gut microbiome is increasingly recognized for its role in autoimmune diseases, including psoriasis. Imbalances in the microbiome have been linked to disease exacerbation, triggering systemic inflammation and altering immune responses. Moreover, various natural treatments have gained attention for their anti-inflammatory properties. These natural therapies could serve as adjuncts to existing treatments, offering a complementary approach that minimizes side effects while improving patient outcomes. Targeting IL-21, Snora73, and the gut microbiome, as well as utilizing natural treatments, may provide new opportunities for more effective, personalized management of psoriasis.

Naturally derived bioactive compounds as precision modulators of immune and inflammatory mechanisms in psoriatic conditions

Psoriasis represents a chronic autoimmune skin condition defined by various clinical forms, including inverse, erythrodermic, pustular, guttate, plaque types. While current therapies, including topical treatments but also systemic through conventional synthetic drugs and biologics, have improved symptom management, no treatment completely cures the disease, and numerous options are linked to considerable adverse effects, including immunosuppression and carcinogenic risks. Therefore, there is growing interest in bioactive compounds from natural sources due to their potential to reduce inflammation and oxidative stress in psoriasis with fewer adverse effects. The present narrative review aimed to address the limitations of current psoriasis therapies by exploring the therapeutic potential of bioactive compounds in the classes of flavonoids, terpenoids, omega-3 fatty acids, and alkaloids assessed through complex experimental models, focusing on their immunomodulatory and anti-inflammatory properties. Recent studies highlight the efficacy of natural bioactive compounds in reducing psoriasis symptoms, either as standalone treatments or in combination with conventional therapies. While these compounds show promise in alleviating psoriasis-related inflammation, further research is needed to optimize their therapeutic use, understand their mechanisms of action, and assess long-term safety. Future studies should focus on clinical trials to establish standardized protocols for incorporating bioactive compounds into psoriasis management and explore their potential role in personalized treatment strategies. Continued research is essential to develop more effective, safer, and affordable therapeutic options for psoriasis patients.

Multi-ancestry genome-wide meta-analysis with 472,819 individuals identifies 32 novel risk loci for psoriasis

BACKGROUND

Psoriasis is a common chronic, recurrent, immune-mediated disease involved in the skin or joints or both. However, deeper insight into the genetic susceptibility of psoriasis is still unclear.

METHODS

Here we performed the largest multi-ancestry meta-analysis of genome-wide association study including 28,869 psoriasis cases and 443,950 healthy controls.

RESULTS

We identified 74 genome-wide significant loci for psoriasis. Of 74 loci, 32 were novel psoriasis risk loci. Across 74 loci, 801 likely causal genes are indicated and 164 causal genes are prioritized. SNP-based heritability analyses demonstrated that common variants explain 15% of genetic risk for psoriasis. Gene-set analyses and the genetic correlation revealed that psoriasis-related genes have the positive correlations with autoimmune diseases such as ulcerative colitis, inflammatory bowel diseases, and Crohn's disease. Gene-drug interaction analysis suggested that psoriasis-associated genes overlapped with targets of current medications for psoriasis. Finally, we used the multi-ancestry meta-analysis to explore drug repurposing and the potential targets for psoriasis.

CONCLUSIONS

We identified 74 genome-wide significant loci for psoriasis. Based on 74 loci, we provided new biological insights to the etiology of psoriasis. Of clinical interest, we gave some hints for 76 potential targets and drug repurposing for psoriasis.

A complete sojourn on nanotechnological advancements and nanocarrier applications in psoriasis management

Psoriasis, a chronic autoimmune and non-communicable skin disease, affects 2-3% of the global population, creating a significant financial burden on healthcare systems worldwide. Treatment approaches are categorized based on disease severity, with first-line therapy focusing on topical treatments and second-line therapy encompassing phototherapy, systemic therapy, and biological therapy. Transdermal drug delivery methods present a promising alternative by enhancing drug absorption through the skin, potentially improving therapeutic outcomes while minimizing systemic adverse effects. Among these, microneedles (MNs) emerge as an innovative transdermal delivery device offering controlled and sustained drug release, reduced systemic exposure, and painless, minimally invasive targeted drug delivery, making them highly suitable for managing skin-related immune disorders. Other transdermal techniques, such as sonophoresis, patches, iontophoresis, and electroporation, also play critical roles in psoriasis treatment. Nanotechnological approaches offer transformative solutions to overcome the limitations of traditional formulations by enhancing efficacy, reducing dosing frequency, and minimizing dose-dependent side effects. Various nanocarriers, including liposomes, ethosomes, transferosomes, niosomes, solid lipid nanoparticles (SLNs), liquid crystalline nanoparticles (LCNPs), nanoemulsions (NEs), and micelles, demonstrate significant potential to improve drug penetration, targeted distribution, safety, and efficacy. This review aims to comprehensively analyze the advancements in nanotechnological approaches and nanocarrier applications for psoriasis management. It discusses the types, pathophysiology, and history of psoriasis while exploring current treatment strategies, including herbal formulations and nanotechnology-based interventions. The review also evaluates the potential of nanotechnological advancements as innovative therapeutic options, emphasizing their mechanisms, benefits, and clinical applicability in addressing the shortcomings of conventional therapies. Together, these insights highlight nano-formulations as a promising frontier for effective psoriasis management.

YTHDF2 contributes to psoriasis by promoting proliferation and inflammatory response through regulation of the Wnt signaling pathway

YT521-B homology domain family 2 (YTHDF2), a pivotal m6A-binding protein, is now understood to significantly influence a diverse array of biological functions, including cell migration, proliferation, differentiation, and inflammatory responses. Additionally, YTHDF2 participates in mRNA decay and pre-rRNA processing. This study explored the specific role of YTHDF2 in the pathogenesis of psoriasis and its underlying mechanisms. Our preliminary findings revealed upregulation of YTHDF2 expression in psoriasis. Subsequent silencing of YTHDF2 in a psoriatic cell model resulted in a marked decrease in mRNA expression of IL-17A, S100A8, and S100A9, accompanied by a reduction in cell proliferation. Conversely, overexpression of YTHDF2 led to the opposite effects. Treatment with DC-Y27-13, a YTHDF2 inhibitor, demonstrated a therapeutic effect in psoriasis mice. Next, mRNA sequencing analysis identified significant enrichment of differentially expressed genes within the Wnt signaling pathway. Further investigation revealed that deletion of YTHDF2 increased the half-life and expression of Dickkopf homolog 3 (DKK3), a potent inhibitor of the Wnt signaling pathway. Consequently, the inhibition of Wnt signaling attenuated the inflammatory response and inhibited cell proliferation.

Breakthrough Opportunities of Nanotheranostics in Psoriasis: From Pathogenesis to Management Strategy

BACKGROUND

In this paper, we have discussed recent advances in our understanding of the aetiology of psoriasis, particularly as they relate to aryl hydrocarbon receptors in DCs, Langerhans cells, macrophages, signal transducer and activator of transcription 3 pathways, and dermal vascular endothelial cells. Here, we have shown that the ability to target specific cellular and molecular components of psoriasis pathogenesis with nanoscale precision using phosphodiesterase 4 inhibitors represents a transformative opportunity to address the complex nature of this dermatological condition.

OBJECTIVE

In this review, we have examined the molecular mechanisms behind the pathogenic features of psoriasis and new treatments being tested in clinical settings. There is research being done on new treatments created in the last ten years. This field highlights the advantages of nanotechnological technologies as cutting-edge candidates for drug delivery systems in psoriasis and other inflammatory chronic skin disorders. Future Developments: Nanotechnology-based treatments currently under study show good efficacy and low side effect profiles. However, long-term prospective trials are required to demonstrate long-term safety and effectiveness. Phosphodiesterase inhibitors, Janus kinase inhibitors, nonsteroidal anti-inflammatory drugs, combinations of vitamin D3 derivatives and corticosteroids, and coal tar formulations are some of the newer topical treatments for psoriasis.

CONCLUSION

The psoriasis treatment continues to involve conventional medications (i.e., medicines that are generally acknowledged as either normal therapy or outdated remedies), whether used topically or orally. Nonetheless, we are starting to see initiatives to create pharmaceuticals and biosimilars with better therapeutic results, fewer side effects, and greater efficacy.

The Potential Anti-psoriatic Effects of Andrographolide: A Comparative Study to Topical Corticosteroids

BACKGROUND

Andrographolide (AP), a bioactive anti-inflammatory compound of Sambiloto, inhibits NF-κB, TNF-α, and interleukin IL-6. Nowadays, molecular docking simulation between AP and dexamethasone against NF-κB receptor presented the energy AP higher than dexamethasone. This becomes a potential treatment for psoriasis.

OBJECTIVE

This manuscript reported the effectiveness of AP from Sambiloto in treating psoriasis compared to topical steroids.

METHODS

This study conducted TLC analysis of AP content and its metabolite impurities, emulgel formulation, molecular docking, in-silico skin toxicity study, and in-vivo anti-psoriatic activity. This was a combination study of an in-silico study and an in-vivo study. This in-silico study was analyzed through multivariate statistical analysis (PCA) to elucidate the data constellation relationship of andrographolide derivatives with several target proteins. The intervention was performed in seven days. The PASI score, molecular parameters (IL-6, IL-17, VEGF, and TNF-a levels), and histopathological findings were assessed.

RESULTS

Molecular docking results revealed andrographolide to exhibit a relatively high binding affinity towards IL-6, NF-kB, and TNF-α which is comparable to the corticosteroids, andrographolide also shares similar residue interaction profile with each of the respective protein's native ligand. In the in-vivo study, we found several parameters statistically significantly different regarding the intervention, including final PASI score (p = 0.017), redness (p = 0.017), scale (p = 0.040), thickness (p = 0.023), total histopathology of psoriasis score (p = 0.037), keratin layer score (p = 0.018).

CONCLUSION

Emulgel AP 0.1% could lower the anti-inflammatory agent, which is vital to psoriasis progression.

Efficacy and Safety Analysis in Chinese Patients with Moderate-to-Severe Psoriasis from a Phase 3 Trial: Impact of Treatment Withdrawal and Retreatment of Ixekizumab

INTRODUCTION

In China, approximately 2.3 million people have psoriasis. Continuous treatment is recommended for moderate-to-severe psoriasis. This study aimed to evaluate the outcomes of continuous versus interrupted ixekizumab (IXE) treatment and retreatment with IXE after disease worsening in Chinese patients.

METHODS

In this Phase 3, multicenter, randomized, double-blind, placebo-controlled study, patients were randomized to IXE or placebo at Week 0. At Week 12, IXE responders (static Physician's Global Assessment [sPGA] score, 0 or 1 [0,1]) were re-randomized (2:1) to IXE (IXE/IXE, continuous treatment) or placebo (IXE/PBO, interrupted treatment). After re-randomization, treatment in IXE/PBO patients with disease worsening (relapse, sPGA ≥ 3) was switched to IXE every 4 weeks (IXE/PBO + IXEQ4W, retreatment). Efficacy was assessed by evaluating the response rates of Psoriasis Area and Severity Index (PASI) 75/90/100, sPGA (0,1), Dermatology Life Quality Index (DLQI) (0,1), mean PASI, and Itch Numerical Rating Scale (NRS) scores and improvements of special body areas. Safety was evaluated by assessing treatment-emergent adverse events (AEs) and serious AEs.

RESULTS

At Week 12, 289 IXE responders were re-randomized to the IXE/IXE group (192 patients) and IXE/PBO group (97 patients). High rates of PASI 75 and sPGA (0, 1) responses were maintained in the IXE/IXE group until Week 60. At Week 60, 88 (90.7%) patients in the IXE/PBO group had disease relapse; the median time to relapse was approximately 20 weeks. After 24 weeks of retreatment, PASI 75 and sPGA (0, 1) were recaptured (97.2% and 74.6%, respectively, in the IXE/PBO + IXEQ4W group). AEs were comparable in patients who received continuous treatment and retreatment.

CONCLUSION

In Chinese patients who received continuous IXE treatment, high response rates were maintained through 60 weeks. Most patients had disease relapse after treatment withdrawal. After retreatment, most of these patients had regained and maintained response since Week 12.

TRIAL REGISTRATION NUMBER

NCT03364309.

RNAi in psoriasis: A melodic exploration of miRNA, shRNA, and amiRNA with a spotlight on siRNA

Psoriasis (Pso) is an autoimmune inflammatory skin disease characterised by well-demarcated, red plaques covered in silver scales. It affects people of all ages and can be passed down through generations. Genetics play an important role in determining vulnerability to develop Pso. Several large-scale genome-wide association studies have identified over 80 genetic loci associated with Pso susceptibility. Gene expression can be regulated via RNA interference (RNAi). RNAi suppresses gene expression by degrading mRNA molecules. Since its discovery, RNAi has generated considerable excitement over its potential therapeutic benefits. RNAi is mediated by endogenous small RNA molecules like microRNA (miRNA) or exogenous small RNA molecules like small interfering RNA (siRNA), short hairpin RNA (shRNA), and artificial micro RNA (amiRNA). These small RNA molecules can silence a disease-related gene in a sequence-specific manner. Targeting RNAi pathways can help modify disease-related biological processes in various medical conditions, including autoimmune disorders. In Pso, RNAi can downregulate the expression of molecules involved in the pathophysiology of the disease. Significant progress has been made in the field of RNAi therapeutics. However, further research is needed to fine-tune the design and delivery of RNAi therapeutics in humans. In this review, we discuss various effectors of RNAi, some challenges related to RNAi therapeutics (emphasizing siRNA) and strategies to overcome these challenges. Furthermore, we have discussed some studies that employ RNAi therapeutics for Pso.

Exploring role of citrus fruits in comorbid neurodegenerative disorders associated with psoriasis

A neurodegenerative illness is a disorder in which the brain and/or spinal cord's neurons, or nerve cells, gradually deteriorate and disappear. These illnesses often get worse with time and can seriously affect movement, cognition, and other neurological functions. Psoriasis is a long-term autoimmune skin condition marked by fast skin cell growth that results in red, elevated areas coated in silvery-white scales. It can affect several body parts, such as the elbows, knees, scalp, and lower back, and it is not communicable. The build-up of amyloid beta [Aβ] protein is linked to elevated levels of reactive oxygen species (ROS) (Kim et al. 2020). These ROS can trigger multiple pathways, including MAPK, NFkB, JAK/STAT, and interleukin 1 beta (IL-1β), ultimately playing a role in the development of neurodegenerative illnesses like Alzheimer's disease (AD) and psoriasis. People who have psoriasis are more likely to acquire AD, as psoriasis is a chronic inflammatory skin condition that is genetically connected. Because of the antioxidants and anti-inflammatory properties of citrus fruits neurodegenerative and psoriasis disease may be prevented. The neuroprotective action of bioactives in citrus fruits involves the inhibition of inflammation through the control of p38 mitogen-activated protein kinase (MAPK) and the activation of nuclear factor erythroid 2-related factor 2 (Nrf2). Due to their immunomodulatory and anti-inflammatory qualities, polyphenols may be able to control the immune response in psoriasis. We performed a thorough review in order to investigate for the first time to understand the role of citrus fruits in comorbid neurodegenerative disorders associated with psoriasis. For better understanding into the possible applications of citrus fruits in treating psoriasis and neurodegenerative disease would require additional studies focusing directly on the relationship between citrus fruits consumption in managing neurodegenerative and psoriasis disease.

Systemic treatment type is not associated with abnormal post-treatment noninvasive liver stiffness measurement in psoriasis

Background

Psoriasis is commonly associated with metabolic dysfunction-associated steatotic liver disease, raising concerns about the hepatic effects of systemic treatments on psoriasis and its comorbid conditions. This study evaluates liver stiffness measurement (LSM) alterations and identifies predictors of abnormal LSM in psoriatic patients following systemic treatments, including biologics and methotrexate.

Methods

This prospective cohort study is based on the PSOWCH database (Psoriasis Cohort of West China Hospital). We initially included psoriatic patients who had undergone sound touch elastography (STE), then recruited patients who had STE before systemic treatment and reassessed them after at least six months. Three treatment subgroups were formed (interleukin inhibitors, tumor necrosis factor inhibitors, and methotrexate), classifying post-treatment STE outcomes using threshold values of 6.5 kPa and 10.3 kPa.

Results

Among the 52 recruited patients, overall STE values significantly increased during follow-up. Univariate regression analysis showed that age, gender, psoriasis severity, psoriatic arthritis status, and current treatment type were not significantly correlated with abnormal STE outcomes at cutoff values of 6.5 kPa and 10.3 kPa. In the multivariate model, body mass index (BMI) was identified as a risk factor for post-treatment STE ≥ 6.5 kPa (odds ratio [OR], 1.26; 95% CI, 1.04 to 1.60, P=0.031).

Conclusions

This exploratory study reveals that systemic treatment type is not associated with abnormal post-treatment LSM. However, a significant association exists between BMI and abnormal LSM outcomes. These findings highlight the critical importance of BMI management in therapeutic interventions for psoriasis.

Clinical Utility of Various Formulations of Calcipotriene and Betamethasone Dipropionate for the Treatment of Plaque Psoriasis in Patients Aged 12 Years or Older

Plaque-type psoriasis is a chronic immune-mediated inflammatory skin disease of uncertain etiology, significantly impacting patient well-being. This chronic condition not only contributes to stigmatization and mental health challenges but also poses an independent risk for cardiovascular and other comorbid diseases. Affecting approximately 60 million people globally, psoriasis manifests primarily as mild-to-moderate disease in about 80% of cases, where topical therapy is pivotal. The most commonly used topical antipsoriatic therapy involves a combination of vitamin D3 analog (calcipotriene - Cal) and a synthetic potent corticosteroid (betamethasone dipropionate - BD). Various formulations of Cal/BD, including ointment, gel (topical suspension), and aerosol foam, have been approved by the US Food and Drug Administration (FDA). The cream based on the PAD (Polyaphron Dispersion) technology is another formulation of this combination drug, expanding the therapeutic options for patients with psoriasis. This article summarizes the most relevant published studies concerning the efficacy and safety of different calcipotriol and betamethasone formulations treating of plaque-type psoriasis in patients aged 12 or older.

Real-world use, perception, satisfaction, and adherence of calcipotriol and betamethasone dipropionate PAD-cream in patients with plaque psoriasis in Spain and Germany: results from a cross-sectional, online survey

BACKGROUND

Psoriasis significantly impacts patients' quality of life (QoL). Dissatisfaction and non-adherence are major barriers associated with topical treatments. A cream based on the polyaphron dispersion (PAD) Technology containing a fixed-dose of calcipotriol (CAL) and betamethasone dipropionate (BDP) was designed for a patient-friendly psoriasis management. The CAL/BDP PAD-cream demonstrated efficacy, convenience, and safety/tolerability in clinical trials.

OBJECTIVES

This research assesses the real-world use, perception, satisfaction, and adherence of CAL/BDP PAD-cream among plaque psoriasis patients.

METHODS

Between September-November 2023, psoriasis patients from Spain and Germany using or having used CAL/BDP PAD-cream for >2 weeks were recruited via Wefight network to complete a 30-questions online survey. Anonymized results were pooled for descriptive statistical analysis.

RESULTS

The survey was completed by 129 patients (mean age: 43 years; 66% females; mean psoriasis duration: 12 years). Most patients (93%) were satisfied with CAL/BDP PAD-cream. The 66% reported high adherence (visual analogue scale 80-100) and 91% preferred CAL/BDP PAD-cream to their previous topical(s). Patients highlighted its ease/convenience of application, tolerability, and lack of itching/burning.

CONCLUSIONS

Psoriasis patients treated with CAL/BDP PAD-cream in a real-world setting show high satisfaction, good adherence, and a positive perception of the product, suggesting that favorable outcomes observed in clinical trials translate to real clinical practice.

Prescribing patterns and persistence of biological therapies for psoriasis management: a retrospective cohort study from Saudi Arabia

BACKGROUND

Biological therapies are effective for psoriasis, but patient responses vary, often requiring therapy switching or discontinuation.

OBJECTIVES

To identify physicians' prescribing patterns of biological therapies at a referral tertiary center in Saudi Arabia and assess the probability of biologic persistence following treatment initiation.

METHODS

We conducted a retrospective study of biologic-naïve adult psoriasis patients who initiated therapy from October 2013 to July 2022 in Dammam. Descriptive statistics and a Kaplan-Meier analysis evaluated treatment persistence at 6, 12, 24, and 36 months.

RESULTS

A total of 151 patients received adalimumab (n = 89), etanercept (n = 17), risankizumab (n = 30), ustekinumab (n = 14), and ixekizumab (n = 1). At 6 months, all therapies demonstrated 100% persistence. At 12 months, persistence was highest for ustekinumab (100%) and lowest for etanercept (88.2%). At 24 months, ustekinumab maintained 100% persistence, followed by risankizumab (96.6%), adalimumab (94.3%), and etanercept (76.4%). At 36 months, risankizumab had the highest persistence (96.6%), followed by adalimumab (83.1%), ustekinumab (78%), and etanercept (70.6%). The most common reasons for discontinuation were lack of effectiveness and intolerability.

CONCLUSION

This study shows changing psoriasis treatment patterns with new therapies. Risankizumab demonstrated high long-term persistence, while etanercept and ustekinumab showed declining persistence, suggesting evolving treatment considerations.

Gut microbiota and skin pathologies: Mechanism of the gut-skin axis in atopic dermatitis and psoriasis

Atopic dermatitis (AD) and psoriasis are chronic skin diseases with a global impact, posing significant challenges to public health systems and severely affecting patients' quality of life. This review delves into the key role of the gut microbiota in these diseases, emphasizing the importance of the gut-skin axis in inflammatory mediators and immune regulation and revealing a complex bidirectional communication system. We comprehensively assessed the pathogenesis, clinical manifestations, and treatment strategies for AD and psoriasis, with a particular focus on how the gut microbiota and their metabolites influence disease progression via the gut-skin axis. In addition, personalized treatment plans based on individual patient microbiome characteristics have been proposed, offering new perspectives for future treatment approaches. We call for enhanced interdisciplinary cooperation to further explore the interactions between gut microbiota and skin diseases and to assess the potential of drugs and natural products in modulating the gut-skin axis, aiming to advance the treatment of skin diseases.

Insilico discovery of novel Phosphodiesterase 4 (PDE4) inhibitors for the treatment of psoriasis: Insights from computer aided drug design approaches

Psoriasis is chronic immune-mediated inflammatory disorder characterized by various comorbidities, erythematous plaques with silvery scale which can lead to psoriatic arthritis. The phosphodiesterase 4 (PDE4) protein is a potential drug target to control Psoriasis. In the current study, pharmacophore-based virtual screening of Diversity library of ChemDiv database was first performed, and then the screened hits were docked to the active site of PDE4 to choose the best binding modes. Forty-six hits generated during the virtual screening were prepared and docked to the PDE4 receptor by SP docking module of glide. The binding affinities of the selected hits were calculated by molecular docking and based on the affinities, ten hits were selected for the bioactivity scores prediction and ADMET analysis. Based on the ADMET profiling, four hits D356-2630, C700-2058, G842-0420 and F403-0203 were processed to MD simulations for stability analysis. The outcomes showed that these compounds showed strong binding with proteins with better binding free energies. Based on the results of our study, we proposed that these hits can function as lead in the biological assays and in vitro studies are required to develop the novel drug candidates.

Atypical presentation of psoriasis on the breast of an elderly woman: A case report

Psoriasis is a chronic, inflammatory skin disease that affects over 60 million adults and children globally. It is classically characterized by pink plaques covered with silver scales on the extensor surfaces, trunk, or scalp. In this report, we describe the case of a woman in her late 60s with psoriasis presenting as a painful plaque on her left breast. This case highlights the importance of considering psoriasis as a differential diagnosis in patients with unilateral breast plaques, even in the absence of typical psoriasis scaling elsewhere on the body.

Hydrogel-Forming Microneedles in the Management of Dermal Disorders Through a Non-Invasive Process: A Review

Microneedle (MN) technology has emerged as a promising approach for delivering therapeutic agents to the skin, offering significant potential in treating various dermal conditions. Among these technologies, hydrogel-forming microneedles (HFMNs) represent a transformative advancement in the management of dermal diseases through non-invasive drug delivery. These innovative devices consist of micrometer-sized needles made of native or crosslinked hydrophilic polymers, capable of penetrating the stratum corneum without damaging underlying tissues. Upon insertion, HFMNs rapidly absorb interstitial fluid, swelling to form a hydrogel conduit that enables the efficient transport of therapeutic agents directly into the dermal microcirculation. The non-invasive nature of HFMNs enhances patient compliance by eliminating the pain and discomfort associated with traditional hypodermic needles. This technology allows for the delivery of a wide range of drugs, including macromolecules and biomacromolecules, which are often difficult to administer dermally due to their size and polarity. Moreover, HFMNs provide controlled and regulated release profiles, enabling sustained therapeutic effects while minimizing systemic side effects. Additionally, HFMNs can be used for both drug delivery and real-time interstitial fluid monitoring, offering valuable insights into disease states and treatment responses. This dual functionality positions HFMNs as a versatile dermatology tool capable of effectively addressing various dermal complications. This review explores the potential use of polymeric biomaterials in HFMN fabrication and their application in treating major dermal disorders, such as acne, psoriasis, and other skin conditions. Furthermore, the review highlights the non-invasive nature of MN-based treatments, underscoring their potential to reduce patient discomfort and improve treatment adherence, as supported by the recent literature.

CAD-PsorNet: deep transfer learning for computer-assisted diagnosis of skin psoriasis

Psoriasis, being a chronic, inflammatory, lifelong skin disorder, has become a major threat to the human population. The precise and effective diagnosis of psoriasis continues to be difficult for clinicians due to its varied nature. In northern India, the prevalence of psoriasis among adult population ranges from 0.44 to 2.8%. Chronic plaque psoriasis accounts for over 90% of cases. This study utilized a dataset of 325 raw images collected from a reputable local hospital using a digital camera under uniform lighting conditions. These images were processed to generate 496 image patches (both diseased and normal), which were then normalized and resized for model training. An automated psoriasis image recognition framework was developed using four state-of-the-art deep transfer learning models: VGG16, VGG19, MobileNetV1, and ResNet-50. The convolutional layers adopted various edge, shape, and color filters to generate the feature map for psoriasis detection. Each pre-trained model was adapted with two dense layers, one dropout layer, and one output layer to classify input images. Among these models, MobileNetV1 achieved the best performance, with 94.84% sensitivity, 89.37% specificity, and 97.24% overall accuracy. Hyper-parameter tuning was performed using grid search to optimize learning rates, batch sizes, and dropout rates. The AdaGrad (Adaptive gradient)) optimizer was chosen for its adaptive learning rate capabilities, facilitating quicker convergence in model performance. Consequently, the methodology's performance improved to 94.25% sensitivity, 96.42% specificity, and 99.13% overall accuracy. The model's performance was also compared with non-machine learning-based diagnostic methods, yielding a Dice coefficient of 0.98. However, the model's effectiveness is dependent upon high-quality input images, as poor image conditions may affect accuracy, and it may not generalize well across diverse demographics or psoriasis variations, highlighting the need for varied training datasets for robustness.

A Rare Case of Juvenile Psoriatic Arthritis

This is a case report of a one-year-and-nine-month-old girl with multiple guttate psoriasis skin lesions, non-traumatic knee arthritis, and no family history of autoimmune diseases. Laboratory tests revealed no suggestive markers of juvenile psoriatic arthritis (JPsA), while the dermatological examination described scaly erythematous lesions with a positive Auspitz sign. The diagnosis was confirmed by a skin biopsy and histopathological examination. The psoriasis lesions were preceded by the onset of arthritis within two weeks. The negative family history, age of onset, clinical presentation, and negative antinuclear antibodies make it a particular case of JPsA.

Correlation and Clinical Significance of HBD-2 and CXCL-1/2 Levels at Skin Lesions with Psoriasis Vulgaris Severity

OBJECTIVE

This study was performed to explore the clinical significance of the expression of human beta-defensin 2 (HBD-2) and chemokine ligand 1/2 (CXCL-1/2) in psoriasis vulgaris.

METHODS

This study retrospectively included the study group (n = 160) and control group (n = 100) for analysis. The levels of inflammatory indicators, blood biochemical indicators, and immune indicators using ELISA. The psoriasis area and severity index (PASI) was used to evaluate disease severity. Levels of HBD-2, CXCL-1, CXCL-2 and CCL20 were determined by RT-PCR. The correlations of HBD-2, CXCL-1 and CXCL-2 levels with CCL20 and PASI scores were analyzed. The diagnostic value of HBD-2, CXCL-1 and CXCL-2 in psoriasis vulgaris was analyzed by ROC curve.

RESULTS

HBD-2, CXCL-1 and CXCL-2 were highly expressed in the lesions of psoriasis vulgaris patients, and were positively correlated with CCL20 and PASI score. HBD-2, CXCL-1 and CXCL-2 alone or in combination had high diagnostic value for psoriasis vulgaris and severe psoriasis, and the combined diagnostic value of the three was higher than that of a single indicator.

CONCLUSION

HBD-2, CXCL-1, and CXCL-2 levels are closely related to the severity of psoriasis vulgaris and can effectively diagnose the occurrence and progression of psoriasis vulgaris.

Development of 3D printed microneedles of varied needle geometries and lengths, designed to improve the dermal delivery of topically applied psoriasis treatments

The aim of this study was to investigate the impact of using microneedle patches in addition to topical therapy for the treatment of psoriasis. Using continuous liquid interface production (CLIP) 3D printing we manufactured round microneedle array patches (MAPs) with a diameter of 14 mm. Needle geometries were varied from square pyramidal, conical, and obelisk, with varied needle lengths of 400 µm, 600 µm, 800 µm, or 1000 µm. MAPs were characterized for force to fracture, skin penetration, skin damage, as well as their ability to deliver a novel oleogel-based corticosteroid (betamethasone dipropionate (BDP) formulation into ex-vivo porcine skin. We found that the obelisk shaped MAPs are more durable compared to the conical and square pyramidal-shaped MAPs. When the obelisk shaped MAPs were used in combination with the oleogel-based BDP formulation, the amount of BDP penetrating the skin was significantly increased with greater needle lengths.

Association of METS-IR index with psoriasis in US adults: a cross-sectional study

Psoriasis is linked to insulin resistance (IR). Nevertheless, the applicability of the METS-IR index, a new IR evaluation tool, for evaluating changes in insulin sensitivity in psoriasis populations is currently unknown. This study aimed to investigate the relationship between the METS-IR index and psoriasis in a US adult population. This cross-sectional study utilized data from adults aged 20 to 80 years from the U.S. National Health and Nutrition Examination Survey (NHANES) spanning 2003-2006 and 2009-2014. The associations between the METS-IR index and psoriasis were examined using multivariate logistic regression and smoothed curve fitting. Subgroup analyses and interaction tests were conducted to verify the stability of the association within the population. This study included 5,966 participants, of whom 182 had psoriasis. In the fully adjusted model, the METS-IR index was positively associated with psoriasis, showing a 1.7% increase in psoriasis prevalence for each one-unit increase in the METS-IR index (Model 2: OR 1.017, 95% CI 1.006-1.028). Participants in the highest quartile group were 91.9% more likely to develop psoriasis compared to those in the lowest quartile group (OR = 1.919, 95% CI 1.180-3.118). Smooth curve fitting revealed a nonlinear association between the METS-IR index and psoriasis, with an inflection point of 41.675. This positive association was more pronounced in females, non-obese individuals, those with light alcohol consumption, comorbid coronary heart disease and hyperlipidemia, non-hypertensive and non-diabetic individuals. The results of the study suggest that higher METS-IR scores are associated with an increased likelihood of psoriasis among U.S. adults. The METS-IR index is specifically recommended as a clinical indicator for the management and treatment of psoriasis in women, non-obese individuals, light alcohol consumers, individuals with comorbid coronary artery disease andhyperlipidemia, non-hypertensive and non-diabetic individuals. However, Considering the many known and unknown covariates that may be associated with psoriasis and influence theresults of the study, we remain cautious about the results obtained and look forward to the addition of subsequent studies.

A guide to prescribing systemic treatments for psoriasis during pregnancy, breastfeeding and in those trying to conceive: what does the current evidence suggest?

Psoriasis is a common inflammatory skin condition with an estimated prevalence of 1.5% in the UK. Its management has evolved rapidly over the past 15 years as our understanding of its pathogenesis has progressed. Treatment initiation often overlaps with peak reproductive years, posing specific therapeutic challenges for individuals hoping to conceive. Certain systemic agents are well established to be teratogenic during pregnancy, such as methotrexate and acitretin, but data on newer drug classes for psoriasis remain limited. This literature review evaluated recent data on the systemic agents for psoriasis, explicitly considering the context of male and female fertility, pregnancy and breastfeeding. Our goal was to equip clinicians with an accessible, concise summary of up-to-date evidence to help them educate patients and facilitate informed, shared decision-making aligned with their reproductive health.

Psoriasis: The Versatility of Mesenchymal Stem Cell and Exosome Therapies

Mesenchymal stem cells (MSCs) are multilineage differentiating stromal cells with extensive immunomodulatory and anti-inflammatory properties. MSC-based therapy is widely used in the treatment of various pathologies, including bone and cartilage diseases, cardiac ischemia, diabetes, and neurological disorders. Along with MSCs, it is promising to study the therapeutic properties of exosomes derived from MSCs (MSC-Exo). A number of studies report that the therapeutic properties of MSC-Exo are superior to those of MSCs. In particular, MSC-Exo are used for tissue regeneration in various diseases, such as healing of skin wounds, cancer, coronary heart disease, lung injury, liver fibrosis, and neurological, autoimmune, and inflammatory diseases. In this regard, it is not surprising that the scientific community is interested in studying the therapeutic properties of MSCs and MSC-Exo in the treatment of psoriasis. This review summarizes the recent advancements from preclinical and clinical studies of MSCs and MSC-Exo in the treatment of psoriasis, and it also discusses their mechanisms of therapeutic action involved in the treatment of this disease.

CGF therapy: bridging androgenetic alopecia observations to psoriasis treatment via IL-17 pathway

INTRODUCTION

Concentrated Growth Factor (CGF), rich in CD34 + stem cells, is widely used in treatments for androgenetic alopecia and skin rejuvenation due to its immune-modulating properties. Psoriasis, a chronic inflammatory skin condition, presents significant treatment challenges, particularly for patients who cannot use biologics due to conditions such as cancer and lesions resistant to treatments. The potential of CGF in treating psoriasis is promising, given its broad immunoregulatory effects which confirmed in our previous androgenetic alopecia work.

METHODS

We evaluated the impact of CGF on IL-17 levels in two contexts: patients treated for androgenetic alopecia and a psoriasis mouse model. Twelve patients received three monthly injections of CGF, with serum IL-17 levels measured before and after treatment. In the psoriasis mouse model, groups were treated with CGF, and outcomes were assessed using the Psoriasis Area and Severity Index (PASI), skin barrier scores, histological analysis, and RNA sequencing. Additionally, in vitro experiments applied CD34 + cells from CGF to keratinocytes to measure levels of TNF-α, IFN-γ, IL-23, and IL-17.

RESULTS

In patients with androgenetic alopecia, three monthly CGF injections resulted in significantly reduced serum IL-17 levels. In the psoriatic mouse model, CGF-treated groups exhibited lower PASI scores and improved skin barrier scores compared to controls. Histological analysis revealed enhanced skin characteristics, while RNA sequencing demonstrated downregulated IL-17 and upregulated CD34 expression, as well as improved expression of barrier-related genes. In vitro, the application of CD34 + cells from CGF to keratinocytes led to a significant reduction in TNF-α, IFN-γ, IL-23, and IL-17 levels, indicating strong anti-inflammatory effects. A clinical case of a psoriasis patient unresponsive to IL-23 therapy (Guselkumab) showed significant improvement following CGF treatment.

CONCLUSION

These findings indicate that CGF could serve as an effective and versatile treatment for psoriasis, especially for patients who have already undergone biologic therapies but continue to experience resistant lesions.

PIN1‑silencing mitigates keratinocyte proliferation and the inflammatory response in psoriasis by activating mitochondrial autophagy

Peptidyl-prolyl cis/trans isomerase, NIMA-interacting 1 (PIN1) has been suggested to be a critical regulator in skin-related diseases. However, the role and molecular mechanism of PIN1 in psoriasis remain unclear. HaCaT cells were stimulated with five cytokines (M5) to induce psoriatic inflammation-like conditions. Reverse transcription-quantitative PCR and western blotting were performed to examine PIN1 expression in M5-induced HaCaT cells. A Cell Counting Kit-8 assay and 5-ethynyl-2'-deoxyuridine staining were employed to examine cell proliferation. Inflammatory factors were evaluated using ELISA kits and western blot analysis. Mitochondrial autophagy was examined by immunofluorescence staining, western blotting and a JC-1 assay. Western blot analysis was adopted to assess the levels of psoriasis marker proteins. PIN1 expression was markedly elevated in M5-induced HaCaT cells. Silencing of PIN1 inhibited M5-induced hyperproliferation and the inflammatory response, while it promoted mitochondrial autophagy in HaCaT cells. The addition of the mitochondrial autophagy inhibitor mitochondrial division inhibitor-1 reversed the effects of PIN1 interference on proliferation, the inflammatory response and mitochondrial autophagy in M5-induced HaCaT cells. The present study revealed that PIN1 inhibition protected HaCaT cells against M5-induced hyperproliferation and inflammatory injury through the activation of mitochondrial autophagy.

Secukinumab in the Treatment of Psoriasis: A Narrative Review on Early Treatment and Real-World Evidence

Psoriasis is a chronic, immune-mediated, inflammatory skin disease, associated with multiple comorbidities and psychological and psychiatric disorders. The quality of life of patients with this disease is severely compromised, especially in moderate-to-severe plaque psoriasis. Secukinumab, a fully humanized monoclonal antibody, was the first anti-interleukin (IL)-17 biologic approved for treating psoriasis. Secukinumab demonstrated long-lasting efficacy and a good safety profile in individuals with plaque psoriasis, and it is associated with an improvement in health-related quality of life. While there is evidence that early treatment with systemic therapy can affect disease progression and improve long-term outcomes in other autoimmune diseases, evidence is limited in psoriasis, especially in real-world settings. This review provides an overview of studies describing the effectiveness of secukinumab in the treatment of psoriasis summarizing the literature and focusing on real-world evidence and early intervention.

Impact of Disease Factors of Patients with Psoriasis and Psoriatic Arthritis on Biologic Therapy Switching: Real-World Evidence from the CorEvitas Psoriasis Registry

INTRODUCTION

Patients with psoriasis (PSO) and psoriatic arthritis (PsA) may frequently switch biologic therapies over the course of treatment because of symptom variability and individual responses. Real-world studies analyzing patient characteristics and clinical factors associated with biologic switching are limited.

METHODS

This longitudinal cohort study used real-world data from the CorEvitas Psoriasis Registry to evaluate the relationship between associated disease factors and biologic switching among patients with PSO and PsA in the United States (US) and Canada following initiation of a biologic. Patients were evaluated between April 2015-August 2022. Combinations of disease severity (as measured by Psoriasis Area Severity Index [PASI]) and Dermatology Life Quality Index (DLQI) as a measure of health-related quality of life (HRQoL) were assessed, and the association with time to switching was calculated using Cox proportional hazards regression modeling.

RESULTS

Among 2580 patient-initiations (instances of patients initiating a biologic), 504 (19.5%) switched biologics within 30 months of initiation. Switching was more frequent when either PASI > 10 or DLQI > 5 compared with PASI ≤ 10 or DLQI ≤ 5 at follow-up. Patients with higher skin involvement (PASI > 10) and impact on HRQoL (DLQI > 5) were 14 times more likely to switch (hazard ratio = 14.2, 95% confidence interval: 10.7, 18.9) than those with lower skin involvement (PASI ≤ 10) and HRQoL (DLQI ≤ 5).

CONCLUSIONS

Patients with PSO and PsA treated in a real-world dermatology setting with substantial disease factors following biologic initiation were more likely to switch therapies. Those with PASI > 10 and DLQI > 5 switched more frequently than those with PASI ≤ 10 and DLQI ≤ 5.

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.

Efficacy and safety of culture-expanded mesenchymal stromal cell therapy in the treatment of 4 types of inflammatory arthritis: A systematic review and meta-analysis of 36 randomized controlled trials

OBJECTIVE

This study aims to assess the effectiveness and safety of mesenchymal stem cell (MSC) transplantation in the treatment of inflammatory arthritis.

METHODS

Two researchers conducted a comprehensive search of Chinese and English databases from their inception until July 2023. The literature screening and data extraction were then performed. Statistical analysis was carried out using RevMan 5.4 software.

RESULTS

A total of 36 relevant RCTs, involving 2,076 participants, were ultimately included in this study. These RCTs encompassed four types of inflammatory arthritis, namely rheumatoid arthritis (RA), osteoarthritis (OA), ankylosing spondylitis (AS), and systemic sclerosis (SSc). The results demonstrated that MSC therapy exhibited improvements in the Visual Analog Scale (VAS) for pain in OA patients (bone marrow: SMD=-0.95, 95 % CI: -1.55 to -0.36, P = 0.002; umbilical cord: SMD=-2.03, 95 % CI: -2.99 to -1.07, P < 0.0001; adipose tissue: SMD=-1.26, 95 % CI: -1.99 to -0.52, P = 0.0009). Specifically, MSCs sourced from adipose tissue showed enhancements in Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain (P = 0.0001), WOMAC physical function (P = 0.001), and total WOMAC scores (P = 0.0003). As for MSC therapy in RA, AS, and SSc, the current systematic review suggests a potential therapeutic effect of MSCs on these inflammatory arthritic conditions. Safety assessments indicated that MSC therapy did not increase the incidence of adverse events.

CONCLUSION

MSCs have the potential to alleviate joint pain and improve joint function in patients with inflammatory arthritis. Moreover, MSC therapy appears to be relatively safe and could be considered as a viable alternative treatment option for inflammatory arthritis.

Unlocking milk thistle's anti-psoriatic potential in mice: Targeting PI3K/AKT/mTOR and KEAP1/NRF2/NF-κB pathways to modulate inflammation and oxidative stress

Silybum marianum, known as milk thistle (MT), is traditionally used to manage liver diseases. This study aimed to investigate the role of MT extract topical application as a potential treatment for imiquimod (IMQ)-induced psoriatic lesions in mice with particular emphasis on phosphoinositol-3 Kinase (PI3K)/ protein kinase B (AKT)/ mammalian target of rapamycin (mTOR) and Kelch-like ECH-associated protein 1 (KEAP1)/ nuclear factor erythroid-2-related factor (NRF2)/ nuclear factor-kappa B (NF-κB) molecular cascades involvement. To address this aim, forty male Swiss albino mice were subdivided into four groups (n = 10 mice/group): control, IMQ model, standard group where mice were treated topically with IMQ, then the anti-psoriatic mometasone cream, and MT extract-treated group where mice were treated topically with IMQ followed by MT extract. In most measured parameters, MT extract, rich in silymarin, exhibited potent anti-psoriatic activity comparable to the standard cortisone treatment. MT extract mitigated dorsal skin erythema, scaling, and epidermal thickening, reflected by lowering the Psoriasis Area Severity Index (PASI) score. Moreover, it alleviated IMQ-induced splenomegaly. Mechanistically, the PI3K/AKT/mTOR pathway was the main functional pathway behind such improvements, where it was significantly inhibited by MT extract application. This led to NRF2 activation via KEAP1 downregulation with subsequent anti-inflammatory effect proven by reducing NF-κB, interleukin (IL)-23, and IL-17A and antioxidant ability proven by boosting the antioxidant glutathione and heme oxygenase-1. Such improvements were confirmed by alleviating the histopathological alteration. Thus, MT extract could be a promising therapeutic agent for psoriasis treatment by inhibiting PI3K/AKT/mTOR cascade, along with NRF2 signaling activation.

Secukinumab Causing Medication-Related Osteonecrosis of the Jaw, in a Patient Diagnosed with Psoriasis and Rheumatoid Arthritis

The use of antiangiogenic and antiresorptive medications, particularly in patients with cancer or osteoporosis, can lead to osteonecrosis of the jaw following tooth extraction, trauma or arising spontaneously- A condition known as medication-related osteonecrosis of the jaw (MRONJ). In this article, we present a unique case of MRONJ in a patient with no history of antiresorptive or antiangiogenic drug use, who was instead taking the anti-interleukin 17-A (Secukinumab) medication for severe psoriasis. This association has not been previously reported in the literature.