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Caroppo F, Fagotto L, Belloni Fortina A. Impact of itching, burning and pain in children with psoriasis: An observational monocentric study. J Eur Acad Dermatol Venereol 2024; 38:e1003-e1004. [PMID: 38708776 DOI: 10.1111/jdv.20056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/12/2024] [Indexed: 05/07/2024]
Affiliation(s)
- Francesca Caroppo
- Unit of Dermatology, Department of Medicine - DIMED, University of Padova, Padova, Italy
- Pediatric Dermatology Regional Center, Department of Women's and Children's Health - SDB, University of Padova, Padova, Italy
| | - Laura Fagotto
- Unit of Dermatology, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Anna Belloni Fortina
- Pediatric Dermatology Regional Center, Department of Women's and Children's Health - SDB, University of Padova, Padova, Italy
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Docampo-Simón A, Belinchón I, Sánchez-Pujol MJ, Berbegal L, Miralles J, Lucas A, Quecedo E, Fuertes A, Mateu-Puchades A, Betlloch I. Psoriasis dermatitis, a common phenotype of early forms of both psoriasis and atopic dermatitis in children: A prospective multicenter study. Int J Dermatol 2024; 63:1392-1397. [PMID: 38433076 DOI: 10.1111/ijd.17100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/27/2024] [Accepted: 02/07/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Psoriasis (Ps) and atopic dermatitis (AD) are chronic systemic immune-mediated diseases that can coexist in an overlapping condition called psoriasis dermatitis (PD). PD patients have intermediate lesions with characteristics of both Ps and AD. PD is very rare in adults but much more frequent in children. Little is known, however, about the course of PD in the pediatric population. The aim of this study was to evaluate the percentage of PD cases in children that evolved to a definite form of Ps or AD and to identify any clinical or epidemiological variables that could predict the course of the disease. METHODS We performed a prospective multicenter cohort study of children diagnosed with PD between January 2018 and December 2020. We collected participants' clinical and epidemiological characteristics, and pediatric dermatologists determined the percentage of participants who developed Ps or AD. RESULTS The study included 24 children with PD, with a median age of 7.0 years. After a median follow-up period of 31 months, 83.3% of cases had evolved to a definite form of Ps or AD (44.4% to Ps and 38.9% to AD). Younger age and family history of Ps were associated with progression to AD. Participants who progressed to AD or Ps had a longer follow-up than those with an unchanged PD diagnosis. CONCLUSIONS Given sufficient time, a large percentage of PD cases in children will evolve into Ps or AD. Long-term clinical follow-up is necessary for a correct diagnosis.
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Affiliation(s)
- Alexandre Docampo-Simón
- Dermatology Department, Hospital General Universitario Dr Balmis, Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Isabel Belinchón
- Dermatology Department, Hospital General Universitario Dr Balmis, Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
- Department of Clinical Medicine, Universidad Miguel Hernández, Elche, Spain
| | - María J Sánchez-Pujol
- Dermatology Department, Hospital General Universitario Dr Balmis, Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Laura Berbegal
- Dermatology Department, Hospital de Dénia-Marina Salud, Denia, Spain
| | - Julia Miralles
- Dermatology Department, Hospital Universitario San Juan de Alicante, Sant Joan, Spain
| | - Ana Lucas
- Dermatology Department, Hospital General Universitario de Elda, Elda, Spain
| | - Esther Quecedo
- Dermatology Department, Hospital Arnau de Vilanova de Valencia, Valencia, Spain
| | - Amparo Fuertes
- Dermatology Department, Hospital Universitario Dr Peset, Valencia, Spain
| | | | - Isabel Betlloch
- Dermatology Department, Hospital General Universitario Dr Balmis, Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
- Department of Clinical Medicine, Universidad Miguel Hernández, Elche, Spain
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Sendrea AM, Cristea S, Salavastru CM. Nutritional Status in Pediatric Psoriasis: A Case-Control Study in a Tertiary Care Referral Centre. CHILDREN (BASEL, SWITZERLAND) 2024; 11:885. [PMID: 39062334 PMCID: PMC11275588 DOI: 10.3390/children11070885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/15/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Psoriasis and obesity are chronic, inflammatory diseases, sharing certain pathophysiological factors. Psoriasis, increasingly viewed as a systemic inflammatory condition, may have various symptoms beyond the skin manifestations. METHODS This research aimed to explore the connection between body mass index (BMI) and pediatric psoriasis, through a case-control study on 100 psoriasis cases and 100 controls who were matched in terms of age and sex. The percentiles of the BMI by age and sex determined the nutritional status of each patient and control. The severity of psoriasis was evaluated based on the psoriasis area and severity index (PASI), nail involvement based on the nail psoriasis severity index (NAPSI), and quality of life impairment with the dermatology life quality index (DLQI). RESULTS While no statistically significant relationship was identified between increased BMI and PASI (p = 0.074), the risk of being overweight and obesity was significantly higher in the psoriasis group (OR 6.93, p = 0.003; OR 12.6, p < 0.001, respectively). The BMI increased with the PASI for psoriasis vulgaris but not for psoriasis inverse. No connections were found between disease duration and BMI (p = 0.56) or between BMI and PASI based on sex (p = 0.26). The NAPSI increased significantly with increased BMI (p = 0.000015). CONCLUSIONS This study highlights the association between elevated BMI, psoriasis diagnosis, and severity of psoriatic onychopathy in pediatric patients, advocating for further large-scale studies to confirm these explorations and increasing awareness for better screening and management of such cases for overweight/obese patients.
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Affiliation(s)
- Adelina-Maria Sendrea
- Pediatric Dermatology Department, Carol Davila University of Medicine and Pharmacy, 8 Eroilor Sanitari Boulevard, 050474 Bucharest, Romania;
- Pediatric Dermatology Department, Colentina Clinical Hospital, 19-21 Stefan cel Mare Street, 020125 Bucharest, Romania
- Dermatology Research Unit, Colentina Clinical Hospital, 19-21 Stefan cel Mare Street, 020125 Bucharest, Romania
| | - Sinziana Cristea
- Certara Inc., Radnor Corporate Centre, Suite 350, Radnor, PA 19087, USA;
| | - Carmen Maria Salavastru
- Pediatric Dermatology Department, Carol Davila University of Medicine and Pharmacy, 8 Eroilor Sanitari Boulevard, 050474 Bucharest, Romania;
- Pediatric Dermatology Department, Colentina Clinical Hospital, 19-21 Stefan cel Mare Street, 020125 Bucharest, Romania
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Fiorillo L, Becker E, de Lucas R, Belloni-Fortina A, Armesto S, Elewski B, Maes P, Oberoi RK, Paris M, Zhang W, Zhang Z, Arkin L. Efficacy and safety of apremilast in pediatric patients with moderate-to-severe plaque psoriasis: 16-week results from SPROUT, a randomized controlled trial. J Am Acad Dermatol 2024; 90:1232-1239. [PMID: 38266683 DOI: 10.1016/j.jaad.2023.11.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/03/2023] [Accepted: 11/27/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Approved systemic treatment options are limited for pediatric patients with moderate to severe plaque psoriasis. OBJECTIVE To assess the efficacy and safety of apremilast over 16 weeks in pediatric patients with plaque psoriasis. METHODS SPROUT (NCT03701763) was a phase 3, multicenter, randomized, double-blind, placebo-controlled study of apremilast in patients aged 6-17 years with moderate-to-severe psoriasis (Psoriasis Area and Severity Index [PASI] ≥12, body surface area ≥10%, static Physician Global Assessment [sPGA] ≥3) inadequately controlled by/inappropriate for topical therapy. Patients were stratified by age group and randomized (2:1) to apremilast (20 or 30 mg BID based on weight) or placebo for 16 weeks, followed by apremilast extension to 52 weeks. RESULTS Of 245 patients randomized (apremilast: 163; placebo: 82), 221 (90%) completed the double-blind phase (apremilast: 149; placebo: 72). Significantly more patients achieved sPGA response and ≥75% reduction in PASI with apremilast than placebo, regardless of baseline age, weight, or disease severity. No new safety signals were observed. LIMITATIONS Sample size of subgroup analyses. CONCLUSIONS Improvements in global disease activity and skin involvement were significantly greater in pediatric patients treated with apremilast versus placebo. Adverse events were consistent with the known apremilast safety profile.
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Affiliation(s)
- Loretta Fiorillo
- Stollery Children's Hospital University of Alberta, Edmonton, Alberta, Canada.
| | - Emily Becker
- Driscoll Children's Hospital, Corpus Christi, Texas
| | | | | | - Susana Armesto
- Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Boni Elewski
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | | | | | | | - Lisa Arkin
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Sendrea AM, Iorga D, Dascalu M, Suru A, Salavastru CM. HOMA-IR Index and Pediatric Psoriasis Severity-A Retrospective Observational Study. Life (Basel) 2024; 14:700. [PMID: 38929683 PMCID: PMC11204742 DOI: 10.3390/life14060700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 05/25/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
Psoriasis is a chronic inflammatory disease with specific cutaneous and nail lesions. Recent data has emphasized its systemic nature, highlighting metabolic conditions found in patients. Insulin resistance was identified in adult psoriasis, sometimes related to psoriasis severity. Data regarding this relationship in children are limited. Consequently, we tested the association between the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and Psoriasis Area and Severity Index (PASI) using a retrospective dataset of 43 children with various types of psoriasis. First, we attempted to replicate the relationship between the HOMA-IR and PASI. Second, we explored potential associations between these variables and others in the dataset. The results illustrated no association between HOMA-IR and PASI (p-value = 0.512). The exploratory findings hinted at a connection between nail pitting and insulin resistance (p-value = 0.038), yet Bonferroni adjustments suggested the risk of a false-positive finding. Noteworthy associations were found between the HOMA-IR and body mass index (BMI) (p-value = 0.001), the PASI and quality of life impairment (p-value = 0.005), and psoriasis severity and type (p-value = 0.001). The null hypothesis that insulin resistance in children is not positively associated with psoriasis severity cannot be rejected. Pilot estimates of variables and covariates of interest are provided for further confirmatory studies assessing this hypothesis.
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Affiliation(s)
- Adelina Maria Sendrea
- Pediatric Dermatology Department, Carol Davila University of Medicine and Pharmacy, 8 Eroilor Sanitari Boulevard, 050474 Bucharest, Romania; (A.S.); (C.M.S.)
- Pediatric Dermatology Department, Colentina Clinical Hospital, 19-21 Stefan cel Mare Street, 020125 Bucharest, Romania
- Dermatology Research Unit, Colentina Clinical Hospital, 19-21 Stefan cel Mare Street, 020125 Bucharest, Romania
| | - Denis Iorga
- Computer Science & Engineering Department, National University of Science and Technology Politehnica Bucharest, 313 Splaiul Independentei, 060042 Bucharest, Romania; (D.I.); (M.D.)
| | - Mihai Dascalu
- Computer Science & Engineering Department, National University of Science and Technology Politehnica Bucharest, 313 Splaiul Independentei, 060042 Bucharest, Romania; (D.I.); (M.D.)
- Academy of Romanian Scientists, 3 Ilfov Street, 050044 Bucharest, Romania
| | - Alina Suru
- Pediatric Dermatology Department, Carol Davila University of Medicine and Pharmacy, 8 Eroilor Sanitari Boulevard, 050474 Bucharest, Romania; (A.S.); (C.M.S.)
- Pediatric Dermatology Department, Colentina Clinical Hospital, 19-21 Stefan cel Mare Street, 020125 Bucharest, Romania
- Dermatology Research Unit, Colentina Clinical Hospital, 19-21 Stefan cel Mare Street, 020125 Bucharest, Romania
| | - Carmen Maria Salavastru
- Pediatric Dermatology Department, Carol Davila University of Medicine and Pharmacy, 8 Eroilor Sanitari Boulevard, 050474 Bucharest, Romania; (A.S.); (C.M.S.)
- Pediatric Dermatology Department, Colentina Clinical Hospital, 19-21 Stefan cel Mare Street, 020125 Bucharest, Romania
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Morita A, Saeki H. Pediatric psoriasis: Understanding pathological conditions and advances in treatment. J Dermatol 2024; 51:185-195. [PMID: 38105636 PMCID: PMC11483894 DOI: 10.1111/1346-8138.17049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/30/2023] [Accepted: 11/05/2023] [Indexed: 12/19/2023]
Abstract
Psoriasis is a long-lasting skin disease that primarily affects the skin, nails, and joints and is characterized by inflammation. Genetic factors contribute to its development and environmental triggers can worsen symptoms. Pathologically, psoriasis is characterized by uncontrolled keratinocyte proliferation and abnormal differentiation, and histological features include acanthosis with inflammatory cell infiltration and neovascularization. Psoriasis often starts in childhood, with about one-third of cases beginning during this time. Its prevalence steadily increases from the ages of 1 to 18 years in a linear fashion. Young people with psoriasis often require treatment throughout their childhood and adolescence, and into adulthood. However, prolonged treatment may increase the risk of complications and adverse events, so it is important to adopt an effective treatment approach that minimizes this risk. In addition, psoriasis is often associated with various comorbidities that may place a great burden on the physical and mental health of the children beyond those due to psoriasis itself. To ensure good long-term health outcomes, individuals with psoriasis should undergo regular screening. Treatment should be provided not only for skin lesions, but also for any comorbidities; however, currently there is not enough evidence on the treatment of pediatric psoriasis and no globally agreed-on guidelines exist for treating psoriasis in children. This article describes the etiology, clinical symptoms, and disease burden of pediatric psoriasis, the pathological conditions and diagnosis of plaque psoriasis, psoriatic arthritis, and generalized pustular psoriasis, and the available treatments for these conditions in Japan.
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Affiliation(s)
- Akimichi Morita
- Department of Geriatric and Environmental DermatologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Hidehisa Saeki
- Department of DermatologyNippon Medical School HospitalTokyoJapan
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Zhao S, Wu T, Fu M, Zhang Z. Histone Lactylation Participates in Psoriasis Progression by Regulating the Adiponectin Expression. Clin Cosmet Investig Dermatol 2024; 17:219-227. [PMID: 38292324 PMCID: PMC10826714 DOI: 10.2147/ccid.s450254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/18/2024] [Indexed: 02/01/2024]
Abstract
Background Psoriasis is a chronic inflammatory skin disease characterized by erythema, papules, and plaques. Adiponectin (ADIPOQ) is an important protein hormone secreted by adipose tissue. Here, we aimed to explore the expression of ADIPOQ in psoriasis patients and the moderation effect of histone lactylation on ADIPOQ. Methods The GSE78097 data set was downloaded from GEO database to analyze the differentially expressed genes (DEGs) in psoriasis. A total of 36 psoriasis patients were recruited to obtain the skin samples. The ADIPOQ protein levels, global lactylation and histone lactylation (H3K18lac) levels were detected by Western blot assay. Chromatin immunoprecipitation (CHIP) assay was performed to detect the combination between H3K18lac and promoter regions of the ADIPOQ. The receiver operating curve (ROC) analysis was used to evaluate the diagnostic value of ADIPOQ in psoriasis. Results ADIPOQ was decreased in the skin tissues of psoriasis patients. In addition, the global lactylation and H3K18lac levels were significantly decreased in the skin tissues of psoriasis patients. In HaCaT cells, promoting the global lactylation and H3K18lac levels increased the ADIPOQ protein levels, while si-LDHA transfection decreased the ADIPOQ protein levels. The CHIP results indicated that lactylation promoted the binding of promoter regions of the ADIPOQ and H3K18lac. Finally, the ROC analysis showed that ADIPOQ exhibited diagnostic value in psoriasis. Conclusion This study demonstrated ADIPOQ was decreased in the skin tissues of psoriasis patients, and ADIPOQ has diagnostic value for psoriasis. Furthermore, down-regulation of H3K18lac levels inhibited the transcription of ADIPOQ, which was the key factor of decrease of ADIPOQ levels in psoriasis patients.
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Affiliation(s)
- Sicheng Zhao
- Department of Dermatology, Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou, People’s Republic of China
| | - Tingyan Wu
- Department of Dermatology, Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou, People’s Republic of China
| | - Mingjing Fu
- Department of Dermatology, Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou, People’s Republic of China
| | - Zhe Zhang
- Department of Dermatology, Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou, People’s Republic of China
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Wang W, Hwang S, Park D, Park YD. The Features of Shared Genes among Transcriptomes Probed in Atopic Dermatitis, Psoriasis, and Inflammatory Acne: S100A9 Selection as the Target Gene. Protein Pept Lett 2024; 31:356-374. [PMID: 38766834 DOI: 10.2174/0109298665290166240426072642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/30/2024] [Accepted: 04/05/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Atopic dermatitis (AD), psoriasis (PS), and inflammatory acne (IA) are well-known as inflammatory skin diseases. Studies of the transcriptome with altered expression levels have reported a large number of dysregulated genes and gene clusters, particularly those involved in inflammatory skin diseases. OBJECTIVE To identify genes commonly shared in AD, PS, and IA that are potential therapeutic targets, we have identified consistently dysregulated genes and disease modules that overlap with AD, PS, and IA. METHODS Microarray data from AD, PS, and IA patients were downloaded from Gene Expression Omnibus (GEO), and identification of differentially expressed genes from microarrays of AD, PS, and IA was conducted. Subsequently, gene ontology and gene set enrichment analysis, detection of disease modules with known disease-associated genes, construction of the protein-protein interaction (PPI) network, and PPI sub-mapping analysis of shared genes were performed. Finally, the computational docking simulations between the selected target gene and inhibitors were conducted. RESULTS We identified 50 shared genes (36 up-regulated and 14 down-regulated) and disease modules for each disease. Among the shared genes, 20 common genes in PPI network were detected such as LCK, DLGAP5, SELL, CEP55, CDC20, RRM2, S100A7, S100A9, MCM10, AURKA, CCNB1, CHEK1, BTC, IL1F7, AGTR1, HABP4, SERPINB13, RPS6KA4, GZMB, and TRIP13. Finally, S100A9 was selected as the target gene for therapeutics. Docking simulations between S100A9 and known inhibitors indicated several key binding residues, and based on this result, we suggested several cannabinoids such as WIN-55212-2, JZL184, GP1a, Nabilone, Ajulemic acid, and JWH-122 could be potential candidates for a clinical study for AD, PS, and IA via inhibition of S100A9-related pathway. CONCLUSION Overall, our approach may become an effective strategy for discovering new disease candidate genes for inflammatory skin diseases with a reevaluation of clinical data.
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Affiliation(s)
- Wei Wang
- College of Biological and Environmental Sciences, Zhejiang Wanli University, Ningbo, P.R. China
| | - Sungbo Hwang
- Department of Predictive Toxicology, Korea Institute of Toxicology, Daejeon, 34114, Korea
| | - Daeui Park
- Department of Predictive Toxicology, Korea Institute of Toxicology, Daejeon, 34114, Korea
| | - Yong-Doo Park
- College of Biological and Environmental Sciences, Zhejiang Wanli University, Ningbo, P.R. China
- Zhejiang Provincial Key Laboratory of Applied Enzymology, Yangtze Delta Region Institute of Tsinghua University, Jiaxing, 314006, P.R. China
- Skin Diseases Research Center, Yangtze Delta Region Institute of Tsinghua University, Jiaxing, P.R. China
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Corp N, Bray L, Chew‐Graham CA, Polidano K, Fisher T, Farmer AD, McDermott‐Hughes M, Saunders B. Self-directed self-management interventions to prevent or address distress in young people with long-term physical conditions: A rapid review. Health Expect 2023; 26:2164-2190. [PMID: 37533152 PMCID: PMC10632640 DOI: 10.1111/hex.13845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/15/2023] [Accepted: 08/01/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Comorbid distress in adolescents and young adults with physical long-term conditions (LTCs) is common but can be difficult to identify and manage. Self-directed self-management interventions to reduce distress and improve wellbeing may be beneficial. It is unknown, however, which intervention characteristics are successful in supporting young people. This rapid review aimed to identify characteristics of self-directed self-management interventions that aimed, in whole or part, to address distress, wellbeing or self-efficacy in this population. METHODS A systematic search was conducted for relevant controlled studies in six databases. Data on study settings, population, intervention characteristics, outcome measures, process measures and summary effects were extracted. The risk of bias was assessed using the Cochrane Risk of Bias tool v1, and the strength of evidence was rated (informed by Grading of Recommendations, Assessment, Development and Evaluations). Patient and public involvement members supported the review process, including interpretation of results. The rapid review was registered with PROSPERO (ID: CRD42021285867). RESULTS Fourteen studies were included, all of which were randomised trials. Heterogeneity was identified in the health conditions targeted; type of intervention; outcome measures; duration of intervention and follow-up. Three had distress, wellbeing or self-efficacy as their primary outcome. Four modes of delivery were identified across interventions-websites, smartphone applications, text messages and workbooks; and within these, 38 individual components. Six interventions had a significant benefit in mental health, wellbeing or self-efficacy; however, intervention characteristics were similar for beneficial and non-beneficial interventions. CONCLUSIONS There is a paucity of interventions directly targeting distress and wellbeing in young people with physical LTCs. In those identified, the heterogeneity of interventions and study design makes it difficult to identify which characteristics result in positive outcomes. We propose the need for high-quality, evidence-based self-management interventions for this population; including (1) more detailed reporting of intervention design, content and delivery; (2) robust process evaluation; (3) a core outcome set for measuring mental health and wellbeing for self-management interventions and (4) consistency in follow up periods. PUBLIC CONTRIBUTION Seven young people with an LTC were involved throughout the rapid review, from the development of the review protocol where they informed the focus and aims, with a central role in the interpretation of findings.
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Affiliation(s)
- Nadia Corp
- School of MedicineKeele UniversityStaffordshireUK
| | - Lucy Bray
- School of Nursing, Midwifery and Allied Health, Faculty of Health, Social Care and MedicineEdge Hill UniversityOrmskirkUK
| | | | - Kay Polidano
- School of MedicineKeele UniversityStaffordshireUK
- Department of SociologyUniversity of MaltaMsidaMalta
| | | | - Adam D. Farmer
- School of MedicineKeele UniversityStaffordshireUK
- Department of GastroenterologyUniversity Hospitals of North Midlands NHS TrustStoke‐on TrentUK
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Biermann M, Kolb B. Epidemiology, comorbidity, and use of systemic therapies in patients with paediatric psoriasis in Germany. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 182-183:1-7. [PMID: 37977896 DOI: 10.1016/j.zefq.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 09/25/2023] [Accepted: 10/06/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Psoriasis is a chronic, inflammatory disorder with a physical and psychosocial burden. Recent epidemiological data on paediatric psoriasis in Germany is lacking. The aim of this study was to examine the prevalence, the incidence and associated epidemiological features of paediatric psoriasis in Germany using health claims data from a national health claims database. METHODS Continuously insured patients with paediatric psoriasis (2014-2017) from the Institute of Applied Health Research Berlin (InGef) database were included in this analysis. Between 2014 and 2017, we analysed the prevalence and incidence of paediatric psoriasis (aged ≤17 years), relevant comorbidities, the most frequently attended and diagnosing medical specialties, and the number of systemic treatment prescriptions. RESULTS Overall, psoriasis prevalence (0.15-0.16%) and incidence (0.06-0.07%) remained stable between 2014 and 2017; both prevalence and incidence were higher in female patients. Psoriasis prevalence gradually increased with age between the age groups <6 years and 16-17 years. Obesity (11.5%) and somatoform disorders (7.0%) were the most common comorbidities identified. Overall, 90.4% of the psoriasis cases were diagnosed by either a dermatologist (50.9%), general practitioner (27.8%), or paediatrician (11.7%). Patients most frequently attended general practitioners (74.5%), dermatologists (57.9%) and paediatricians (56.5%). The use of systemic treatment(s) increased from 4.7% to 5.4% between 2014 and 2017. DISCUSSION The prevalence and incidence of paediatric psoriasis in Germany remained stable between 2014 and 2017, with a higher prevalence and incidence observed in females and older adolescents. Obesity and somatoform disorders were the most common comorbidities. General practitioners, dermatologists, and paediatricians were most often involved in the treatment of patients, highlighting the need for interdisciplinary management of paediatric psoriasis.
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Tao RE, Pixley JN, Holovach PG, Fleischer AB, Feldman SR. Management of Pediatric Psoriasis: A U.S. Survey Based on Visits from the National Ambulatory Medical Care Survey (NAMCS). Dermatol Ther (Heidelb) 2023; 13:3221-3227. [PMID: 37831297 PMCID: PMC10689594 DOI: 10.1007/s13555-023-01051-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Approximately one-third of psoriasis cases present in the first two decades of life. Many psoriasis treatments are approved by the U.S. Food and Drug Administration (FDA) for adults, including topical agents, systemic non-biologic agents, and systemic biologic agents. Only a handful of psoriasis treatments are FDA approved for children. Given the constantly evolving landscape of pediatric psoriasis management, our aim is to characterize how children with psoriasis are treated in the U.S. METHODS Data from the 2003-2016 and 2018 National Ambulatory Medical Care Survey (NAMCS) were used to evaluate patient demographics and treatment patterns for visits of children with psoriasis. Visits were stratified by those with a diagnosis of psoriasis and those for children with a diagnosis of psoriasis. Separate analyses for visits of children with a diagnosis of psoriasis were performed, including for sex, race, ethnicity, age, specialty of provider seen, and medications prescribed. RESULTS Pediatric psoriasis visits accounted for 3.3% of visits with psoriasis from 2003 to 2016 and in 2018; about one-third of those visits were to primary care providers. Children with psoriasis were prescribed a variety of topical and systemic medications, of which the most frequently prescribed treatments were topical tacrolimus, followed by topical clobetasol and topical betamethasone dipropionate or betamethasone valerate. Etanercept was the only biologic prescribed to children. At least 59% of the visits for children with a diagnosis of psoriasis included a topical prescription while at least 5.3% of the visits included a systemic prescription. CONCLUSION Use of off-label treatments was common for pediatric psoriasis. Most children with psoriasis were treated with topicals, of which tacrolimus, an unapproved treatment, was the most common. The frequent use of tacrolimus could indicate an avoidance of corticosteroids in children.
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Affiliation(s)
- Rachel E Tao
- Department of Dermatology, Wake Forest University School of Medicine, 4618 Country Club Road, Winston-Salem, NC, 27104, USA
| | - Jessica N Pixley
- Department of Dermatology, Wake Forest University School of Medicine, 4618 Country Club Road, Winston-Salem, NC, 27104, USA.
| | - Phillip G Holovach
- Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
| | - Alan B Fleischer
- Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
| | - Steven R Feldman
- Department of Dermatology, Wake Forest University School of Medicine, 4618 Country Club Road, Winston-Salem, NC, 27104, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, 27101, USA
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, 27101, USA
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12
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Guo J, Zhang H, Lin W, Lu L, Su J, Chen X. Signaling pathways and targeted therapies for psoriasis. Signal Transduct Target Ther 2023; 8:437. [PMID: 38008779 PMCID: PMC10679229 DOI: 10.1038/s41392-023-01655-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/10/2023] [Accepted: 09/14/2023] [Indexed: 11/28/2023] Open
Abstract
Psoriasis is a common, chronic, and inflammatory skin disease with a high burden on individuals, health systems, and society worldwide. With the immunological pathologies and pathogenesis of psoriasis becoming gradually revealed, the therapeutic approaches for this disease have gained revolutionary progress. Nevertheless, the mechanisms of less common forms of psoriasis remain elusive. Furthermore, severe adverse effects and the recurrence of disease upon treatment cessation should be noted and addressed during the treatment, which, however, has been rarely explored with the integration of preliminary findings. Therefore, it is crucial to have a comprehensive understanding of the mechanisms behind psoriasis pathogenesis, which might offer new insights for research and lead to more substantive progress in therapeutic approaches and expand clinical options for psoriasis treatment. In this review, we looked to briefly introduce the epidemiology, clinical subtypes, pathophysiology, and comorbidities of psoriasis and systematically discuss the signaling pathways involving extracellular cytokines and intracellular transmission, as well as the cross-talk between them. In the discussion, we also paid more attention to the potential metabolic and epigenetic mechanisms of psoriasis and the molecular mechanistic cascades related to its comorbidities. This review also outlined current treatment for psoriasis, especially targeted therapies and novel therapeutic strategies, as well as the potential mechanism of disease recurrence.
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Affiliation(s)
- Jia Guo
- Department of Dermatology, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, 410008, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, 410008, Hunan, China
- Hunan Engineering Research Center of Skin Health and Disease, Changsha, 410008, Hunan, China
| | - Hanyi Zhang
- Department of Dermatology, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, 410008, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, 410008, Hunan, China
- Hunan Engineering Research Center of Skin Health and Disease, Changsha, 410008, Hunan, China
| | - Wenrui Lin
- Department of Dermatology, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, 410008, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, 410008, Hunan, China
- Hunan Engineering Research Center of Skin Health and Disease, Changsha, 410008, Hunan, China
| | - Lixia Lu
- Department of Dermatology, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, 410008, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, 410008, Hunan, China
- Hunan Engineering Research Center of Skin Health and Disease, Changsha, 410008, Hunan, China
| | - Juan Su
- Department of Dermatology, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China.
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, 410008, Hunan, China.
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, 410008, Hunan, China.
- Hunan Engineering Research Center of Skin Health and Disease, Changsha, 410008, Hunan, China.
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China.
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, 410008, Hunan, China.
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, 410008, Hunan, China.
- Hunan Engineering Research Center of Skin Health and Disease, Changsha, 410008, Hunan, China.
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13
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Marzouk A, Mezzi R, Zelfani S, Jelaila N, Ayeb S, Bouaziz A. Pediatric Psoriasis Associated with Van Wyk Grumbach Syndrome: A case report. LA TUNISIE MEDICALE 2023; 101:780-782. [PMID: 38465761 PMCID: PMC11261491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/04/2023] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Psoriasis is a common chronic inflammatory condition, often beginning in childhood in approximately one-third of cases. It can be associated with various other autoimmune diseases such as rheumatoid arthritis, celiac disease, and thyroid disorders. However, its co-occurrence with Van Wyk Grumbach syndrome has not been described in the pediatric population. This syndrome, resulting from untreated hypothyroidism, is characterized by early puberty and ovarian cysts. OBSERVATION A 15-year-old adolescent with a diagnosis of psoriasis since the age of 9 presented with chronic constipation and headaches. She exhibited early puberty (menarche at 9 years) and academic regression. Clinical examination revealed growth retardation and arterial hypertension. Hormonal analyses revealed primary hypothyroidism : Free Thyroxine (FT4)=7pmol/mL(9- 20 pmol/l), Thyroid Stimulating Hormone (TSH)=200 mIU/mL( 0,4 - 5 mUI/ml.). The ultrasound and scintigraphic appearance were suggestive of thyroiditis. Additionally, she experienced menstrual irregularities and pelvic pain. Radiological exploration revealed a left ovarian cyst. The diagnosis of Van Wyk Grumbach syndrome was established due to early puberty, hypothyroidism, and polycystic ovary. Treatment with l-thyroxine led to stabilization of blood pressure and hormonal levels. Her height remained below the target adult height. CONCLUSION Assessment of thyroid function appears necessary in pediatric patients with psoriasis. Early hormonal replacement therapy for hypothyroidism may alleviate the symptoms of Van Wyk Grumbach syndrome and mitigate its impact on stature.
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Affiliation(s)
- Asma Marzouk
- Pediatrics and Neonatology department, Yasminet Ben Arous, Tunisia. University El Manar, Faculty of Medicine of Tunis
| | - Rania Mezzi
- Pediatrics and Neonatology department, Yasminet Ben Arous, Tunisia. University El Manar, Faculty of Medicine of Tunis
| | - Saida Zelfani
- Pediatrics and Neonatology department, Yasminet Ben Arous, Tunisia. University El Manar, Faculty of Medicine of Tunis
| | - Nour Jelaila
- Pediatrics and Neonatology department, Yasminet Ben Arous, Tunisia. University El Manar, Faculty of Medicine of Tunis
| | - Saad Ayeb
- Pediatrics and Neonatology department, Yasminet Ben Arous, Tunisia. University El Manar, Faculty of Medicine of Tunis
| | - Asma Bouaziz
- Pediatrics and Neonatology department, Yasminet Ben Arous, Tunisia. University El Manar, Faculty of Medicine of Tunis
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Fan K, Wei Y, Ou Y, Gong J. Integrated analysis of multiple methods reveals characteristics of the immune microenvironment in medulloblastoma. Brain Tumor Pathol 2023; 40:191-203. [PMID: 37558814 DOI: 10.1007/s10014-023-00467-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/18/2023] [Indexed: 08/11/2023]
Abstract
To explore the characteristics of the immune microenvironment (IME) of medulloblastoma (MB) by four methods: flow cytometry (FCM), immunohistochemical (IHC), bulk RNA expression and single cell RNA sequencing (scRNA-seq), we collected the intraoperative specimens of MB, ependymoma (EPN), high-grade glioma (HGG), and low-grade glioma (LGG) to make a cross-cancer comparison. The specimens were subjected to FCM and IHC respectively, and deconvolution from bulk RNA expression data and scRNA-seq analysis were performed in MB from the GEO database. FCM and IHC analysis found that the proportion of lymphocytes (LC) and T cells between MB and other brain tumors were significantly different. The deconvolution of bulk RNA expression data showed that only the proportion of cell types in MCPCOUNTER changed greatly. scRNA-seq found that the proportion of various immune cells in the IME of MB differed between different subtypes. Techniques such as FCM, IHC, bulk RNA expression, and scRNA-seq can sort out different immune cell subsets to a certain extent and quantify their proportions. The four methods have their own strengthens and limitations, but for highly heterogeneous tumor such as MB, integrated analysis of multiple methods is a better choice.
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Affiliation(s)
- Kaiyu Fan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Yifan Wei
- MOE Key Laboratory of Bioinformatics, Tsinghua-Peking Joint Center for Life Sciences, Beijing Advanced Innovation Center for Structural Biology, School of Life Sciences, Tsinghua University, Beijing, 100084, China
| | - Yunwei Ou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
- Beijing Neurosurgical Institute, Beijing, 100070, China
| | - Jian Gong
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China.
- Beijing Neurosurgical Institute, Beijing, 100070, China.
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15
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Lapi F, Cassano N, Barbieri E, Marconi E, Vena GA, Giaquinto C, Cricelli C. Epidemiology of pediatric psoriasis: a population-based study using two Italian data sources. Curr Med Res Opin 2023; 39:1257-1262. [PMID: 37526047 DOI: 10.1080/03007995.2023.2243216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Psoriasis can be associated with certain comorbidities. This information is important for family pediatricians (FPs) and general practitioners (GPs) who have a key role in the identification and management of skin diseases. This study aimed to assess the incidence and prevalence rates of pediatrics psoriasis and its association with specific comorbidities. METHODS A retrospective cohort study was performed in patients aged less than 18 years registered in two Italian primary care databases (Pedianet and HSD) between 2015 and 2019. Prevalence and incidence of psoriasis were estimated, and a case-control design was adopted to assess specific comorbidities in psoriasis patients. RESULTS The annual prevalence rate of psoriasis was 0.2% in Pedianet and between 0.5% and 0.7% in HSD. The incidence rate ranged from 0.47 to 0.58 and from 1.3 to 1.77 per 1000 person-years in Pedianet and HSD, respectively. Allergic rhinitis, asthma, celiac disease, other malabsorption disease and non-infective cutaneous diseases showed a statistically significant association with psoriasis in Pedianet, while no statistically significant difference was found in HSD. CONCLUSION Given the FP-GP transition of patients, there is a need for accurate registration of clinical correlates, enabling GPs to implement strategies to minimize the lifetime risk of psoriatic progression.
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Affiliation(s)
- Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Nicoletta Cassano
- Dermatology and Venereology Private Practice, Bari, Italy
- Dermatology and Venereology Private Practice, Barletta, Italy
| | - Elisa Barbieri
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - Ettore Marconi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Gino Antonio Vena
- Dermatology and Venereology Private Practice, Bari, Italy
- Dermatology and Venereology Private Practice, Barletta, Italy
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
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16
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Zimmer A, Klein A, Kuemmerle-Deschner JB, Dressler F, Onken N, Brueck N, Fasshauer M, Hospach T, Hufnagel M, Foell D, Horneff G. Incident psoriasis under treatment with tumor necrosis factor-α inhibitors in juvenile idiopathic arthritis patients-analysis of the BiKeR registry. Rheumatol Int 2023; 43:1675-1684. [PMID: 37291093 DOI: 10.1007/s00296-023-05352-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/25/2023] [Indexed: 06/10/2023]
Abstract
The efficacy of tumor necrosis factor inhibitors (TNFi) for the treatment of psoriasis is well established, but patients may develop psoriasis for the first time while on TNFi as a paradoxical effect. Limited data on this association in patients with juvenile idiopathic arthritis (JIA) are available. Safety data from patients registered to the German Biologics registry (BiKeR) were analyzed. Patients were grouped by treatment regime: single TNFi, multiple TNFi, non-TNFi biologics or bDMARD-naïve control group receiving methotrexate. TNFi-associated psoriasis was defined as incident diagnosis of psoriasis after starting TNFi treatment. Patients with a history of psoriasis or psoriasis arthritis prior to TNFi therapy were excluded. Event rates using AEs reported after first dose were compared by Wald's test. A total of 4149 patients were treated with a TNFi (etanercept, adalimumab, golimumab, infliximab), 676 with a non-TNFi biologic (tocilizumab, abatacept, anakinra, canakinumab) and 1692 with methotrexate only. A total of 31 patients were diagnosed with incident psoriasis while on one of the above treatments. Compared with methotrexate, psoriasis was more frequent in the TNFi cohorts (RR 10.8, p = 0.019), specifically in the subgroup of TNF antibodies (RR 29.8, p = 0.0009), whereas no significant signal was observed with etanercept. Also, non-TNFi-treated patients presented high incident psoriasis rates (RR 25.0, p = 0.003). Our findings indicate a higher rate of incident psoriasis in JIA patients treated with TNFi monoclonal antibodies or non-TNFi biologic treatment. JIA patients receiving monoclonal antibody TNFi or non-TNFi bDMARD should be monitored for incident psoriasis. Medication change, if topical skin treatment remains insufficient, may be considered.
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Affiliation(s)
- Angela Zimmer
- Asklepios Clinic Sankt Augustin, Kinderrheumatologie, Arnold-Janssen-Str. 29, 53757, Sankt Augustin, Germany.
| | - Ariane Klein
- Asklepios Clinic Sankt Augustin, Kinderrheumatologie, Arnold-Janssen-Str. 29, 53757, Sankt Augustin, Germany
| | - Jasmin B Kuemmerle-Deschner
- Pädiatrische Rheumatologie and Autoinflammation Reference Center Tübingen, Klinik für Kinder- und Jugendmedizin, Member of ERN-RITA, Universitätsklinikum Tübingen, 72076, Tübingen, Germany
| | - Frank Dressler
- Kinderklinik der Medizinischen Hochschule Hannover, Kinderrheumatologische Ambulanz, 30625, Hannover, Germany
| | - Nils Onken
- Kinder- und Jugendärztliche Gemeinschaftspraxis, 21337, Lüneburg, Germany
| | - Normi Brueck
- Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Maria Fasshauer
- Städt. Klinikum St. Georg, Klinik für Kinder- und Jugendmedizin, 04129, Leipzig, Germany
| | - Toni Hospach
- Olgahospital, Kinderrheumatologie, 70174, Stuttgart, Germany
| | - Markus Hufnagel
- Division of Pediatric Infectious Diseases and Rheumatology, Department of Pediatrics and Adolescent Medicine, Medical Faculty, University Medical Center Freiburg, University of Freiburg, 79106, Freiburg, Germany
| | - Dirk Foell
- Universitätsklinikum Münster, Klinik für Pädiatrische Rheumatologie und Immunologie, 48149, Munster, Germany
| | - Gerd Horneff
- Asklepios Clinic Sankt Augustin, Kinderrheumatologie, Arnold-Janssen-Str. 29, 53757, Sankt Augustin, Germany
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17
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Sticherling M, Nikkels AF, Hamza AM, Kwong P, Szepietowski JC, El Sayed M, Ghislain PD, Khotko AA, Patekar M, Ortmann CE, Forrer P, Papanastasiou P, Keefe D. Secukinumab in Pediatric Patients with Plaque Psoriasis: Pooled Safety Analysis from Two Phase 3 Randomized Clinical Trials. Am J Clin Dermatol 2023; 24:821-835. [PMID: 37341961 PMCID: PMC10460311 DOI: 10.1007/s40257-023-00782-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Plaque psoriasis affects ~ 1% of the pediatric population, negatively impacting quality of life. The efficacy and safety of secukinumab in pediatric patients with moderate to severe or severe chronic plaque psoriasis have been established in two pivotal phase 3 trials (open-label, NCT03668613; double-blind, NCT02471144). OBJECTIVES The aims were to report the pooled safety of secukinumab up to 52 weeks from two studies in subgroups of pediatric patients stratified by age and bodyweight, and to present, alongside the pediatric data, the pooled safety data from four pivotal adult secukinumab trials. METHODS The safety of secukinumab was evaluated in subgroups of pediatric patients defined by age (6 to < 12 and 12 to < 18 years) and bodyweight (< 25 kg, 25 to < 50 kg, and ≥ 50 kg) in the pooled population. Patients received secukinumab low dose (LD; 75/75/150 mg), secukinumab high dose (HD; 75/150/300 mg), placebo, or etanercept (0.8 mg/kg). For safety analyses, data were pooled from the pediatric studies NCT03668613 and NCT02471144, and presented alongside the pooled data from four adult pivotal studies (NCT01365455, NCT01636687, NCT01358578, NCT01555125). RESULTS A total of 198 pediatric patients (overall exposure: 184.6 patient-years [PY]) and 1989 adult patients (1749.5 PY) receiving secukinumab up to week 52 were included in this analysis. At week 52, the incidence of adverse events (AEs) was lower in the lower age and bodyweight subgroups. The AEs reported within these subgroups were consistent with the overall AEs reported in this analysis. Overall, exposure-adjusted incidence rates for treatment-emergent AEs were lower in the secukinumab-treated pediatric pool (198.8/100 PY) compared with the etanercept (266.3/100 PY) and adult pools (256.1/100 PY). Up to 52 weeks, the incidence rates of the AEs in the secukinumab-treated patients in the 6 to < 12 years subgroup and 12 to < 18 years subgroup were 167.7/100 PY and 214.7/100 PY, respectively. Similarly, incidence rates of the AEs in the secukinumab-treated patients in the < 25 kg, 25 kg to < 50 kg, and ≥ 50 kg subgroups were 177.3/100 PY, 192.5/100 PY, and 206.8/100 PY, respectively. Nasopharyngitis was the most frequently reported AE in secukinumab-treated pediatric patients across age (< 12 years: 11.8/100 PY; ≥ 12 years: 42.4/100 PY) and bodyweight (< 25 kg: 22.8/100 PY; 25 kg to < 50 kg: 19.0/100 PY; ≥ 50 kg: 43.0/100 PY). Of the 198 secukinumab-treated pediatric patients, one reported nail Candida, one reported skin Candida, and two reported vulvovaginal Candida. Transient and mostly mild events of neutropenia were observed with secukinumab, none leading to study treatment discontinuation. No incidence of treatment-emergent anti-drug antibodies was reported in pediatric patients treated with secukinumab. CONCLUSIONS Secukinumab was well tolerated in pediatric patients with moderate to severe and severe plaque psoriasis across age and bodyweight subgroups. The overall safety profile of secukinumab in pediatric patients was consistent with that of adult patients. CLINICALTRIALS GOV IDENTIFIER NCT03668613 (Novartis Study Code CAIN457A2311, referred to as A2311), actual study start date: August 29, 2018; actual primary completion date: September 19, 2019; estimated study completion date: September 14, 2023. NCT02471144 (Novartis Study Code CAIN457A2310, referred to as A2310), study start date: September 29, 2015; primary completion date: December 13, 2018; estimated study completion date: March 31, 2023.
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Affiliation(s)
- Michael Sticherling
- Hautklinik, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU) Department of Dermatology, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
| | - Arjen F Nikkels
- Department of Dermatology, University Hospital Centre, CHU of Sart Tilman, University of Liège, 4000, Liège, Belgium
| | - Ashraf M Hamza
- Department of Dermatology and Andrology, Alexandria University, Alexandria, Egypt
| | - Pearl Kwong
- Solutions through Advanced Research, Jacksonville, FL, USA
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Medical University, Wrocław, Poland
| | | | | | - Alkes A Khotko
- GBUZ Clinical Dermatology and Venereological Dispensary, Krasnodar, Russia
| | | | | | | | | | - Deborah Keefe
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Nikolaishvili M, Di Lernia V. Biological therapies for the treatment of psoriasis in pediatrics. Expert Opin Biol Ther 2023; 23:1219-1226. [PMID: 37936485 DOI: 10.1080/14712598.2023.2281496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/06/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Psoriasis is a multifactorial, immune-mediated condition with predominant skin involvement. It may develop at any age. In one-third of patients, the first symptoms of psoriasis start during childhood or adolescence. A marked impairment of the quality of life of patients and their caregivers is often associated. AREAS COVERED Databases including PubMed and Clinicaltrials.gov were used to identify clinical studies involving pediatric patients with psoriasis. In the last few years, the implementation of therapy with drugs targeting cytokines like interleukin (IL)-12/23 and IL-17A has expanded the number of available therapeutic options in pediatric psoriasis. This review focuses on the latest evidence on the clinical efficacy and safety profile of drugs licensed for severe pediatric psoriasis. EXPERT OPINION Increasing knowledge about the pathogenetic mechanisms underlying pediatric psoriasis is leading to an improvement in disease management. Effective treatment is crucial in patients affected with moderate to severe disease to reduce the burden of the disease and avoid stigmatization. The treatment of pediatric psoriasis remains challenging for specific clinical subtypes, when difficult areas are involved, after resistance to multiple treatments, and when psoriatic arthritis is associated. A personalized approach and a thorough understanding of the disease are required to advance pediatric psoriasis care.
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Affiliation(s)
- Mariam Nikolaishvili
- Faculty of Medicine, Ivane Javakhishvili, Tbilisi State University, Tbilisi, Georgia
| | - Vito Di Lernia
- Dermatology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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19
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Influence of aldo-keto reductase 1C3 polymorphisms in early-onset female psoriasis patients. Sci Rep 2023; 13:3280. [PMID: 36841845 PMCID: PMC9968313 DOI: 10.1038/s41598-023-30464-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/23/2023] [Indexed: 02/27/2023] Open
Abstract
The principal pathology of psoriasis is impaired skin barrier function, epidermal thickening, and granular layer loss. Exposure to extrinsic factors such as tobacco smoke and air pollutants is associated with the development of psoriasis. Aryl hydrocarbon receptors (AHRs) are activated by extrinsic factors associated with the development of psoriasis and act as transcriptional regulators. Expression of aldo-keto reductase (AKR) 1C3 in the epidermal spinous layer regulates epidermal keratinocyte differentiation via the AHR signaling pathway. We investigated whether single nucleotide polymorphisms (SNPs) in AKR1C3 are associated with the pathogenesis of psoriasis. The proportions of rs12529 G/C, C/C variants, and rs12387 A/A, A/G variants were twofold higher in Japanese psoriasis patients (n = 231) compared with a Japanese healthy cohort. The SNPs were significantly more common than the majority variants in female patients with disease onset ≤ 22 years of age. Patients with rs12529 G > C and rs12387 A > G SNPs exhibited significantly lower AKR1C3 expression and higher expression of late differentiation markers. In conclusion, AKR1C3 downregulation caused by rs12529 G > C and rs12387 A > G SNPs in the epidermis induces abnormal early differentiation of keratinocytes and skin barrier dysfunction, which may contribute to the genetic pathogenesis of psoriasis in young females.
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20
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Can Essential Oils/Botanical Agents Smart-Nanoformulations Be the Winning Cards against Psoriasis? Pharmaceutics 2023; 15:pharmaceutics15030750. [PMID: 36986611 PMCID: PMC10056241 DOI: 10.3390/pharmaceutics15030750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 02/26/2023] Open
Abstract
Although psoriasis remains one of the most devastating inflammatory disorders due to its huge negative impact on patients’ quality of life, new “green” treatment approaches still need to be fully explored. The purpose of this review article is to focus on the utilization of different essential oils and active constituents of herbal botanical origin for the treatment of psoriasis that proved efficacious via both in vitro and in vivo models. The applications of nanotechnology-based formulations which displayed great potential in augmenting the permeation and delivery of these agents is also addressed. Numerous studies have been found which assessed the potential activity of natural botanical agents to overcome psoriasis. Nano-architecture delivery is applied in order to maximize the benefits of their activity, improve properties, and increase patient compliance. This field of natural innovative formulations can be a promising tool to optimize remediation of psoriasis while minimizing adverse effects.
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21
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Wang WM, Jin HZ. Biologics in pediatric psoriasis. J Dermatol 2023; 50:415-421. [PMID: 36651087 DOI: 10.1111/1346-8138.16702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/30/2022] [Accepted: 12/17/2022] [Indexed: 01/19/2023]
Abstract
Psoriasis is a chronic inflammatory skin disorder with a chronic relapsing course. Biologics have revolutionized the treatment of adult psoriasis with higher efficacy and favorable safety profile. Recently, more studies have focused on the use of biologics in pediatric psoriasis, and several biologics have been approved for use therein. This review is divided into two sections: the first part focuses on real-world studies on the use of biologics in pediatric psoriasis and the second part summarizes the findings of other clinical trials related to biologics in pediatric psoriasis. Case reports have been excluded from this review. Several biologics were used for treating pediatric psoriasis and the efficacy is encouraging. According to the studies included in this review, anti-IL-12/23 and anti-IL-17A for treating pediatric psoriasis might have a better efficacy than anti-TNF-α, but more data are needed.
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Affiliation(s)
- Wen-Ming Wang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hong-Zhong Jin
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Megna M, Camela E, Battista T, Genco L, Martora F, Noto M, Picone V, Ruggiero A, Monfrecola G, Fabbrocini G, Potestio L. Efficacy and safety of biologics and small molecules for psoriasis in pediatric and geriatric populations. Part I: focus on pediatric patients. Expert Opin Drug Saf 2023; 22:25-41. [PMID: 36718762 DOI: 10.1080/14740338.2023.2173170] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Psoriasis management is challenging, especially in pediatric age for different factors. The introduction of biologic drugs and oral small molecules (OSM) revolutionized the armamentarium of available weapons in psoriasis treatment. Despite the use of these drugs in adult patients has been widely investigated, pediatric patients have often been unconsidered in clinical trials and real-life studies. However, the high efficacy and speed of action, the safety profile and the ease-to-use administration make these innovative drugs an invaluable therapeutic opportunity. AREAS COVERED The aim of this manuscript is to perform a review of the current literature examining data on the effectiveness and safety of biologic drugs and OSM for the management of psoriasis in pediatric patients in order to put the basis for universally shared treatment algorithm following available evidence. PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines were used for the literature research. EXPERT OPINION/COMMENTARY Our review based on currently available evidence suggests biologics and OSM as an ideal treatment option for pediatric patients, with an excellent profile in terms of efficacy and safety as compared to traditional systemic drugs.
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Affiliation(s)
- Matteo Megna
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Elisa Camela
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Teresa Battista
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Lucia Genco
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Fabrizio Martora
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Matteo Noto
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Vincenzo Picone
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Angelo Ruggiero
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Giuseppe Monfrecola
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Luca Potestio
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
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Schaap MJ, Bruins FM, van den Brink NJ, Orro K, Groenewoud HM, de Jong EM, van den Bogaard EH, Seyger MM. Challenges in Noninvasive Skin Biomarker Measurements in Daily Practice: A Longitudinal Study on Skin Surface Protein Detection by the Transdermal Analysis Patch in Pediatric Psoriasis. Skin Pharmacol Physiol 2022; 35:319-327. [PMID: 36202075 PMCID: PMC9811417 DOI: 10.1159/000527258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 09/20/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Skin surface proteins are potential biomarkers in psoriasis and can be measured noninvasively with the transdermal analysis patch (TAP). This study aimed to assess markers measured by TAP over time in daily clinical practice, explore their correlation with disease severity in pediatric psoriasis, and compare the TAP and tape stripping detection capability. METHODS In this prospective observational daily clinical practice study, pediatric psoriasis patients (aged >5 to <18 years) were followed during 1 year. At each visit, TAPs were applied to lesional (n = 2), peri-lesional (n = 2), and non-lesional (n = 1) sites. Post-lesional skin was sampled if all lesions on the arms, legs, or trunk cleared. Treatment and psoriasis severity data were collected. IL-1RA, hBD-2, IL-1α, IL-8, VEGF, CXCL-1/2, CCL-27, IL-23, hBD-1, IL-22, IL-17A, KLK-5, and IL-4 levels were quantified by spot-ELISA. For the statistical analysis, Wilcoxon signed rank tests, Mann-Whitney U tests, and Spearman correlations were used. Detection capability of the TAP was compared to tape stripping in a separate cohort of adult psoriasis patients. RESULTS 32 patients (median age 15.0 years, median Psoriasis Area and Severity Index [PASI] 5.2) were followed for a mean of 11.3 (±3.4) months with a total of 104 visits. In lesional skin (n = 197), significantly higher IL-1RA, hBD-2, IL-8, VEGF, CXCL-1/2, IL-23, hBD-1, IL-22, CCL-27, and IL-17A levels were found compared to non-lesional skin (n = 104), while IL-1α was higher in non-lesional skin. Marker levels were highly variable over time and did not correlate with disease severity measured by PASI or SUM scores. Comparison of the TAP and tape strip detection capability in adult psoriasis patients (n = 10) showed that lesional hBD-2, IL1-α, IL-8, and VEGF and non-lesional IL-1RA, hBD-2, IL-8, and VEGF were more frequently detected in tape extracts than TAPs. CONCLUSION Due to the lack of correlation with clinical disease severity and the current detection capability of the markers measured by TAP in psoriasis, its use in regular practice is still a bridge too far.
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Affiliation(s)
- Mirjam J. Schaap
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands,*Mirjam J. Schaap,
| | - Finola M. Bruins
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Kadri Orro
- FibroTx LLC, Tallinn, Estonia,Department of Chemistry and Biotechnology, Tallinn University of Technology, Tallinn, Estonia
| | | | - Elke M.G.J. de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Marieke M.B. Seyger
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
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Liu M, Xue M, Zhang T, Lin R, Guo B, Chen Y, Cheng ZJ, Sun B. Detection of interstitial pneumonia with autoimmune features and idiopathic pulmonary fibrosis are enhanced by involvement of matrix metalloproteinases levels and clinical diagnosis. J Clin Lab Anal 2022; 36:e24734. [PMID: 36250225 DOI: 10.1002/jcla.24734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/06/2022] [Accepted: 10/05/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Higher detection of interstitial pneumonia with autoimmune features (IPAF), and idiopathic pulmonary fibrosis (IPF), has significant diagnostic and therapeutic implications. Some matrix metalloproteinases (MMPs) have become reliable diagnostic biomarkers in IPAF and IPF in previous studies, yet relevant reliability remains to be recognized. MATERIALS AND METHODS In this study, 36 ILDs patients, including 31 IPAF patients (Mean ± SD, 50.20 ± 5.10 years; 16 [51.6%] females) and five IPF patients (Mean ± SD, 61.20 ± 6.73 years; one [20.0%] females) were retrospectively enrolled. Serial serum samples were collected from patients with IPAF and IPF between January 2019 and December 2020. Notably, Serum MMPs levels were measured by U-PLEX Biomarker Group 1(Human) Multiplex Assays (MSD, USA). RESULTS A combination of MMPs and combinatorial biomarkers was strongly associated with clinical subjects in this study (AUC, 0.597 for Stability vs. Improvement and 0.756 for Stability vs. Exacerbation). Importantly, the AUC of MMP-12 reaches 0.730 (p < 0.05, Stability AUC vs. Improvement AUC) while MMP-13 reaches 0.741 (p < 0.05, Stability AUC vs. Exacerbation AUC) showed better performance than other MMPs in two comparisons. CONCLUSIONS Clinical risk factors and MMPs are strongly associated with either stratification of the disease of progression of IPAF or in two IPAF and IPF independent cohorts. To our knowledge, this is the first to illustrate that MMP-12 and MMP-13 may be expected to become typical promising biomarkers in Improvement - IPAF and Exacerbation - IPAF, respectively.
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Affiliation(s)
- Mingtao Liu
- Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Mingshan Xue
- Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Teng Zhang
- Faculty of Health Sciences, University of Macau, Taipa, China
| | - Runpei Lin
- Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Baojun Guo
- Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Zhangkai J Cheng
- Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Baoqing Sun
- Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Muacevic A, Adler JR. Beta-Blocker-Induced Erythrodermic Psoriasis: A Case Report. Cureus 2022; 14:e29809. [PMID: 36337823 PMCID: PMC9621099 DOI: 10.7759/cureus.29809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2022] [Indexed: 11/08/2022] Open
Abstract
Beta-blockers are well-known for their wide range of therapeutic applications, particularly in patients with cardiac diseases. Physicians worldwide are aware of their potential side effects, including hypoglycemia, dizziness, slow heart rate, fatigue, and heart block. We report a case of erythrodermic psoriasis caused by beta-blockers in a 61-year-old woman with no prior history of the skin condition. The diagnosis was made based on the characteristic histopathological picture and a Naranjo score of 6. She was administered 15 mg of methotrexate weekly and received supportive care. She recovered completely within two months and exhibited no recurrence of symptoms.
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26
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Dhabale A, Nagpure S. Types of Psoriasis and Their Effects on the Immune System. Cureus 2022; 14:e29536. [PMID: 36312680 PMCID: PMC9592057 DOI: 10.7759/cureus.29536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/18/2022] [Indexed: 11/21/2022] Open
Abstract
Psoriasis is a chronic inflammatory skin disease which is identified by the appearance of erythematous that is clearly demarcated, scaly plaques. It is a skin disease seen regularly around the elbow, scalp, trunk, and also on the knees. Psoriasis is a commonly occurring chronic disease with no cure. In psoriasis, which is thought to be an immune system-related problem, the cells of the skin grow quicker than normal cells. The rapid turnover of cells is responsible for the dry scaly patches seen clinically, also called plaque type of psoriasis. The etiopathogenesis of psoriasis is not yet fully understood. It is considered an outcome of some alteration of the cells in the immune system, which fights infections, but here, it attacks healthy cells, which is the problem. Researchers believe both environmental and genetic factors play a role. It is commonly known that psoriasis is not contagious as it does not spread by air or water. There is a chance of increasing the risk of acquiring psoriasis, also worsening the disease severity by smoking and tobacco consumption. Anyone irrespective of age or gender can develop psoriasis. Psoriasis is divided into various kinds: plaque, nail type, guttate, or inverse, also pustular. The most commonly occurring type of psoriasis is plaque psoriasis, seen with itchy, dry, scales covering patches of skin that are raised.
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Biological Treatments for Pediatric Psoriasis: State of the Art and Future Perspectives. Int J Mol Sci 2022; 23:ijms231911128. [PMID: 36232430 PMCID: PMC9569815 DOI: 10.3390/ijms231911128] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
Psoriasis is a chronic systemic inflammatory disease that primarily affects the skin and is associated with multiple comorbidities with a considerable reduction in quality of life of affected patients. One-third of psoriasis cases begin in childhood and are associated with significant medical comorbidities such as obesity, metabolic syndrome, arthritis, and psychiatric disorders. In addition, because of its chronic nature and frequent relapses, psoriasis tends to require long-term treatment. Treatment of pediatric psoriasis usually involves the same methods used for adults. However, most treatments for pediatric psoriasis are used off-label, and research in this regard is still lacking. Targeted therapies involving the use of newly developed biologic drugs are also increasingly being applied to childhood psoriasis. This review summarizes the clinical features of pediatric psoriasis and focuses mainly on the updated concepts of pathogenesis and biological treatments of pediatric psoriasis.
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McNiven A, Ryan S. Unsettling experiences: A qualitative inquiry into young peoples’ narratives of diagnosis for common skin conditions in the United Kingdom. Front Psychol 2022; 13:968012. [PMID: 36186350 PMCID: PMC9521611 DOI: 10.3389/fpsyg.2022.968012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/09/2022] [Indexed: 12/02/2022] Open
Abstract
Skin conditions such as eczema and psoriasis are relatively prevalent health concerns in children, adolescents and young adults. Experiences of these dermatology diagnoses in adolescence have hitherto not been the focus of research, perhaps owing to assumptions that these diagnoses are not particularly impactful or intricate processes, events or labels. We draw on a thematic secondary analysis of in-depth interviews with 42 adolescents and young people living in the United Kingdom and, influenced by the sociologies of diagnosis and time, highlight the psychological, emotional, social and temporal complexities involved in their diagnosis experiences. Firstly, we describe how participants remembered, re- and co-constructed their diagnosis experiences during the interview. Secondly, we explore the pace and rhythm of diagnosis, including mis-diagnoses, highlighting the jarring potential for adolescents on being diagnosed, even for conditions typically deemed minor. Thirdly, we consider the ways in which these diagnoses have the capacity to reformulate notions of past, present and future, including projecting into imagined futures and reinterpreting past bodily sensations. Finally, we examine how memories about and the meaning of diagnosis are revisited, revised and potentially replaced as a child or adolescent grows older, and increases their management of their condition and encounters with healthcare professionals. In unsettling an assumption that diagnosis experiences for adolescents of common skin conditions is unproblematic or straightforward, our qualitative analysis critically engages with and contribute to tenets of health research that are of interest to quantitative and qualitative researchers, clinicians and patients.
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Affiliation(s)
- Abigail McNiven
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- *Correspondence: Abigail McNiven,
| | - Sara Ryan
- Department of Social Care and Social Work, Manchester Metropolitan University, Manchester, North West England, United Kingdom
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29
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Yu Q, Ge X, Jing M, Mi X, Guo J, Xiao M, Lei Q, Chen M. A Systematic Review with Meta-Analysis of Comparative Efficacy and Safety of Risankizumab and Ustekinumab for Psoriasis Treatment. J Immunol Res 2022; 2022:2802892. [PMID: 36033390 PMCID: PMC9410857 DOI: 10.1155/2022/2802892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022] Open
Abstract
Biological targeted therapy serves as a new alternative treatment for psoriasis due to its minimal side effects. This study is aimed at examining the drug effectiveness and safety of risankizumab and ustekinumab for psoriasis treatment, so as to provide a reference for clinical decision-making. Databases from Embase, Web of Science, PubMed, and Cochrane Library were gathered, starting from inception to March 1, 2022, for randomized controlled trials regarding risankizumab and ustekinumab for psoriasis treatment. All retrieved articles were carefully selected in strict accordance with a set of inclusion and exclusion criteria. Stata 15.0 and RevMan 5.4 were applied to perform meta-analysis and risk of bias assessment. A total of two trials with three NCTs were selected, with 384 participants in the risankizumab group and 140 participants in ustekinumab. Meta-analysis showed that in the long-term and short-term PASI100, risankizumab was more effective than ustekinumab (RR = 2.27, 95% CI (1.77, 2.90), p < 0.05; RR = 2.33, 95% CI (1.75, 3.08), p < 0.05). In PASI90, RR = 1.77, 95% CI (1.54, 2.03), and p < 0.05 and RR = 1.72, 95% CI (1.48, 2.00), and p < 0.05. In short-term PASI75, RR = 1.23, 95% CI (1.13, 1.34), and p < 0.05. In sPGA of 0, the results at week-16 and week-52 showed that risankizumab was significantly more effective than ustekinumab (RR = 2.24, 95% CI (1.67, 3.01), p < 0.05; RR = 2.30, 95% CI (1.80, 2.95), p < 0.05). Risankizumab was significantly more effective than ustekinumab in improving the quality of life and PSS scores (RR = 1.48, 95% CI (1.26, 1.75), p < 0.05; RR = 2.01, 95% CI (1.41, 2.85), p < 0.05). Nevertheless, risankizumab and ustekinumab did not show significant difference in the incidence of adverse responses (RR = 1.02, 95% CI (0.75, 1.39), p > 0.05). Risankizumab was more effective than ustekinumab for the treatment of psoriasis. The adverse reactions of both risankizumab and ustekinumab were similar and could be tolerated. Risankizumab might be a better alternative option for their treatment.
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Affiliation(s)
- Qianying Yu
- Department of Dermatology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075 Sichuan Province, China
| | - Xiaopei Ge
- Department of Dermatology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075 Sichuan Province, China
| | - Mingyi Jing
- Department of Dermatology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075 Sichuan Province, China
| | - Xiongfei Mi
- Department of Dermatology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075 Sichuan Province, China
| | - Jing Guo
- Department of Dermatology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075 Sichuan Province, China
| | - Min Xiao
- Department of Dermatology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075 Sichuan Province, China
| | - Qing Lei
- Department of Dermatology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075 Sichuan Province, China
| | - Mingling Chen
- Department of Dermatology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075 Sichuan Province, China
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Kapoor B, Gulati M, Rani P, Gupta R. Psoriasis: Interplay between dysbiosis and host immune system. Clin Exp Rheumatol 2022; 21:103169. [PMID: 35964945 DOI: 10.1016/j.autrev.2022.103169] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/07/2022] [Indexed: 11/30/2022]
Abstract
With advancement in human microbiome research, an increasing number of scientific evidences have endorsed the key role of both gut and skin microbiota in the pathogenesis of psoriasis. Microbiome dysbiosis, characterized by altered diversity and composition, as well as rise of pathobionts, have been identified as possible triggers for recurrent episodes of psoriasis. Mechanistically, gut dysbiosis leads to "leaky gut syndrome" via disruption of epithelial bilayer, thereby, resulting in translocation of bacteria and other endotoxins to systemic circulation, which in turn, results in inflammatory response. Similarly, skin dysbiosis disrupts the cutaneous homeostasis, leading to invasion of bacteria and other pathogens to deeper layers of skin or even systemic circulation further enhanced by injury caused by pruritus-induced scratching, and elicit innate and adaptive inflammation. The present review explores the correlation of both skin and gut microbiota dysbiosis with psoriasis. Also, the studies highlighting the potential of bacteriotherapeutic approaches including probiotics, prebiotics, metabiotics, and fecal microbiota transplantation for the management of psoriasis have been discussed.
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Affiliation(s)
- Bhupinder Kapoor
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India.
| | - Monica Gulati
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India; Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, NSW 2007, Australia.
| | - Pooja Rani
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
| | - Reena Gupta
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
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Chung M, Yeroushalmi S, Hakimi M, Bartholomew E, Liao W, Bhutani T. A critical review of halobetasol propionate foam (0.05%) as a treatment option for adolescent plaque psoriasis. Expert Rev Clin Immunol 2022; 18:997-1003. [PMID: 35930002 DOI: 10.1080/1744666x.2022.2110071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Halobetasol propionate foam has been established as an efficacious and easy-to-use topical treatment for adults with plaque psoriasis. Its recent approval in the United States expanded its use to adolescents from ages 12 to 17 years old. AREAS COVERED : We briefly summarize the chemistry of halobetasol and review clinical trials involving halobetasol propionate 0.05% foam to evaluate its efficacy and safety profile with a specific focus on adolescents with plaque psoriasis. EXPERT OPINION Halobetasol propionate 0.05% foam is an effective and cosmetically elegant superpotent topical corticosteroid, with a tolerable safety profile in adolescents. The use of this foam offers another option to address patient-specific needs and preferences, adding to the toolbox of currently available treatments for adolescent psoriasis.
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Affiliation(s)
- Mimi Chung
- Department of Dermatology, University of California, San Francisco
| | | | - Marwa Hakimi
- Department of Dermatology, University of California, San Francisco
| | - Erin Bartholomew
- Department of Dermatology, University of California, San Francisco
| | - Wilson Liao
- Department of Dermatology, University of California, San Francisco
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco
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32
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Gruber V, Weger W, Cerroni L, Binder B. [Uncommon presentation of psoriasis vulgaris in an 11-year-old patient]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2022; 73:641-646. [PMID: 34985573 PMCID: PMC9358968 DOI: 10.1007/s00105-021-04933-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 11/21/2022]
Abstract
Psoriasis vulgaris occurs with a prevalence of up to 2% in childhood and adolescence. In most cases, diagnosis can be made clinically. We report about a pediatric patient with psoriasis vulgaris who posed a diagnostic challenge due to uncharacteristic manifestation. The most important differential diagnoses of various forms of psoriasis vulgaris as well as actual treatment recommendations in childhood and adolescence are discussed.
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Affiliation(s)
- Viktoria Gruber
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Auenbruggerplatz 8, 8036, Graz, Österreich
| | - Wolfgang Weger
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Auenbruggerplatz 8, 8036, Graz, Österreich
| | - Lorenzo Cerroni
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Auenbruggerplatz 8, 8036, Graz, Österreich
| | - Barbara Binder
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Auenbruggerplatz 8, 8036, Graz, Österreich.
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Sticherling M, McPherson T, de Lucas Laguna R, Costanzo A, Reed C, Artime E, Robert C, Lucas J, Schuster C, Mahé E. Patient Characteristics and Treatment Patterns in European Pediatric Patients with Psoriasis: A Real-World, Cross-Sectional Study. Dermatol Ther (Heidelb) 2022; 12:1793-1808. [PMID: 35797001 PMCID: PMC9357581 DOI: 10.1007/s13555-022-00761-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/15/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction This study evaluated patient characteristics and treatment patterns according to weight in pediatric patients with psoriasis in a real-world setting. Methods Primary care and specialist physicians treating pediatric patients with psoriasis aged 6–17 years in five European countries were surveyed in the 2019–2020 Adelphi Real World Pediatric Psoriasis Disease Specific Programme. At least two patients with current or previous biologic use were included per physician. Patient characteristics and treatment patterns were analyzed overall and for patients weighing 25–50 kg or more than 50 kg. Results Data from 772 patients weighing 25–50 kg and 1147 weighing more than 50 kg were analyzed. Median age at diagnosis was significantly less in lighter than heavier patients (10.0 vs. 14.0 years; p < 0.001), as was median disease duration (2.2 vs. 3.0 years; p < 0.001). Topical treatments were prescribed in 59.0% of patients overall (70.3% of lighter and 51.4% of heavier patients; p < 0.001), and were used to treat mild rather than moderate-to-severe psoriasis. Conventional systemic use was low (10.8% of patients overall) and predominantly for moderate-to-severe psoriasis. In this biologic-enriched sample, most biologics (78.2%) were prescribed in older (> 13 years) patients. Biologic use increased with line of therapy (6.6% of first-line, 18.0% of second-line, 33.7% of third-line, 44.7% of fourth-line treatments). Conclusion Biologics are predominantly prescribed in older (> 13 years) and heavier (> 50 kg) patients, with little first- or second-line use. The low use of biologics in European pediatric patients with psoriasis may represent an unmet treatment need, as topical or conventional systemic agents remain the main treatment option for moderate or severe psoriasis in these patients through the treatment pathway. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-022-00761-7. This study looked into types of treatments according to body weight in children with psoriasis, since approved dosing regimens for some treatments are based on body weight. Primary care and specialist physicians treating children with psoriasis aged 6–17 years in five European countries completed a survey. Patient information for those receiving specific types of psoriasis treatments were collected. Of the children included, 772 weighed 25–50 kg and 1147 weighed more than 50 kg. Most children received treatments applied to the skin, such as creams and ointments; this occurred in 70% of lighter patients and in 51% of heavier patients. Conventional treatments taken via the mouth were prescribed in a few patients (11% [overall]), while newer biologic drugs were taken to a greater extent in heavier (30%) than lighter (16%) patients. Most biologics (78%) were prescribed in older (> 13 years) patients. Biologic use increased with the number of failed previous treatments, comprising 7%, 18%, 34%, and 45% of first, second, third, and fourth treatments, respectively. We conclude that children with psoriasis who are treated with biologic drugs are predominantly older and heavier, and have more severe psoriasis. Prescriptions for biologics are given after many other treatments have been tried.
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Affiliation(s)
- Michael Sticherling
- Department of Dermatology, Psoriasic-Center, Deutsches Zentrum Immuntherapie (DZI), University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Tess McPherson
- Churchill Hospital, Old Road, Headington, Oxford, OX3 7LE UK
| | - Raúl de Lucas Laguna
- Servicio de Dermatología Infantil, Hospital Universitario La Paz, P.º de la Castellana, 261, 28046 Madrid, Spain
| | - Antonio Costanzo
- Dermatology, Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milan, Italy
- Dermatology, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milan, Italy
| | - Catherine Reed
- Eli Lilly and Company, 8 Arlington Square West, Downshire Way, Bracknell, Berkshire, RG12 1PU UK
| | - Esther Artime
- Eli Lilly and Company, Av. de la Industria, 30, 28108 Alcobendas, Madrid, Spain
| | - Camille Robert
- Lilly France SAS, 24 Bd Vital Bouhot, 92521 Neuilly Sur Seine, France
| | - James Lucas
- Adelphi Real-World, Adelphi Mil, Grimshaw Lane, Macclesfield, SK10 5JB UK
| | | | - Emmanuel Mahé
- Service de Dermatologie, Hôpital Victor Dupouy, 69, Rue du Lieutenant-Colonel Prud’hon, 95107 Argenteuil, France
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Update on the Management of Pediatric Psoriasis: An Italian Consensus. Dermatol Ther (Heidelb) 2022; 12:1753-1775. [PMID: 35776408 PMCID: PMC9247936 DOI: 10.1007/s13555-022-00758-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/08/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Psoriasis affects children with a considerable burden in early life. Treating pediatric psoriasis is challenging also because of the lack of updated specific guidelines. With the recent approval of several biologics for pediatric psoriasis and the ongoing COVID-19 pandemic, the management of young psoriatic patients is facing major changes. A revision of treatment recommendations is therefore needed. Methods In September 2021, a board of six Italian dermatologists convened to update treatment recommendations. The board issued evidence- and consensus-based statements covering relevant areas of pediatric psoriasis, namely: assessment of psoriasis severity, management of children with psoriasis, and treatment of pediatric psoriasis. To reach consensus, the statements were submitted to a panel of 24 experts in a Delphi process performed entirely via videoconference. A treatment algorithm was produced. Results There was full consensus that psoriasis severity is determined by the extension/severity of skin lesions, site of lesions, and impact on patient quality of life. Agreement was reached on the need for a multidisciplinary approach to pediatric psoriasis and the importance of patient/parents education. The relevance of vaccinations, including COVID-19 vaccination, for psoriatic children was acknowledged by all participants. Management issues that initially failed to reach consensus included the screening for psoriasis comorbidities and early treatment with biologics to prevent them and the use of telemedicine to facilitate patient follow-up. There was full consensus that topical corticosteroids are the first choice for the treatment of mild pediatric psoriasis, while phototherapy and systemic therapy are used in children with moderate-severe psoriasis. According to the proposed treatment algorithm, biologics are the first line of systemic therapy. Conclusions Targeted systemic therapies are changing the treatment of moderate-severe pediatric psoriasis, while topical corticosteroids continue to be the first choice for mild disease. Children-centered research is needed to further improve the treatment of pediatric psoriasis.
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Jung JM, Jung CJ, Yang HJ, Lee WJ, Won CH, Lee MW, Chang SE. Clinical implications of facial psoriasis in children and adolescents. Pediatr Dermatol 2022; 39:528-534. [PMID: 35347761 DOI: 10.1111/pde.14986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/15/2022] [Accepted: 03/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVES The clinical implications of facial involvement in pediatric patients with psoriasis have not been adequately studied. The objectives of this study are to evaluate the association between facial involvement and clinical features including disease severity of psoriasis in children and adolescents. METHODS The clinical features of patients aged below 20 years diagnosed with psoriasis were retrospectively evaluated and grouped based on the presence or absence of facial involvement at presentation. Demographic and clinical data were compared between groups. RESULTS Of the 175 patients, 110 patients (62.9%) had facial involvement of psoriasis at presentation. The group with facial involvement was significantly younger at disease onset (p = .032) and had a higher body mass index (BMI) (p = .043) and psoriasis area and severity index (PASI) score (p <.001). The severity of pruritus was significantly higher in the facial than in the non-facial group (p = .020). Involvement of the nose was associated with the highest disease severity as assessed by the PASI score and affected body surface area. A significantly higher number of treatment modalities were used in the facial group than in the non-facial group (p = .013). The BMI (odds ratio (OR), 1.39; 95% CI (confidence interval), 1.07-1.80) and PASI score (OR, 1.45; 95% CI, 1.03-2.03) were independent factors associated with facial involvement of psoriasis. CONCLUSIONS Facial involvement in psoriasis was associated with higher disease severity and more treatment modalities in children and adolescents.
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Affiliation(s)
- Joon Min Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Jin Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Joo Yang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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De Brandt E, Hillary T. Comorbid Psoriasis and Metabolic Syndrome: Clinical Implications and Optimal Management. PSORIASIS (AUCKLAND, N.Z.) 2022; 12:113-126. [PMID: 35651599 PMCID: PMC9149586 DOI: 10.2147/ptt.s293107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/30/2022] [Indexed: 11/26/2022]
Abstract
Purpose To review the literature on guidance on the follow-up of psoriasis and its comorbidities and to provide practical recommendations. Patients and Methods A PubMed search was conducted using MeSH terms and free text keywords related to "psoriasis", "obesity", "hypertension", "diabetes", "dyslipidemia", "metabolic syndrome" and "Psoriatic arthritis". The search was conducted between September 2021 and January 2022. References of selected articles were scanned to identify additional articles. Results Recommendations on the follow-up of hypertension, obesity, dyslipidemia, type 2 diabetes, metabolic syndrome, psoriatic arthritis, non-alcoholic fatty liver disease and inflammatory bowel disease in psoriasis patients were extracted from the included articles. These data are presented in summary tables for both adults and children. A practical and feasible approach for each comorbidity is discussed. Conclusion Awareness among dermatologists for relevant psoriasis-associated comorbidities is crucial. The dermatologist should function as gatekeeper and screen for comorbidities, in order to make timely referrals when indicated.
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Affiliation(s)
- Eveline De Brandt
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - Tom Hillary
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
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Bardowska K, Krajewski PK, Tyczyńska K, Szepietowski JC. Safety evaluation of secukinumab in paediatric patients with plaque psoriasis. Expert Opin Drug Saf 2022; 21:867-872. [PMID: 35502692 DOI: 10.1080/14740338.2022.2073349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION : Psoriasis (Ps) is a common chronic, recurrent, immune-mediated, inflammatory skin disease affecting up to 2% children. It has well-established impact on patients' quality of life. Moreover, patients with psoriasis exhibit a higher prevalence of comorbidities, including hypertension, diabetes, and inflammatory bowel disease. Secukinumab is a fully human monoclonal IL-17A antibody, which has been approved in use for children with psoriasis. Nevertheless, there is very little data on the safety of this therapy in paediatric population. AREAS COVERED : The aim of this article was to perform an extensive review of available data concerning secukinumab safety and efficiency in pediatric population used for the treatment of plaque psoriasis. Moreover, special attention was put to underline the adverse effects of secukinumab. EXPERT OPINION : Although there is very little evidence on the long-term safety of secukinumab use in pediatric population, this therapy may be a promising modality in children with moderate to severe psoriasis. The available data confirms its favorable safety profile with no serious adverse events and unexpected events. Moreover, the clinical trials revealed sustained efficiency in respect of reaching PASI 75 and decreasing impact of the disease on quality of life.
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Affiliation(s)
- Klaudia Bardowska
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chalubinskiego Street 1, Wrocław 50-368, Poland
| | - Piotr K Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chalubinskiego Street 1, Wrocław 50-368, Poland
| | - Kinga Tyczyńska
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chalubinskiego Street 1, Wrocław 50-368, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chalubinskiego Street 1, Wrocław 50-368, Poland
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Paller AS, Seyger MMB, Magariños GA, Pinter A, Cather JC, Rodriguez-Capriles C, Zhu D, Somani N, Garrelts A, Papp KA. Long-term Efficacy and Safety of Up to 108 Weeks of Ixekizumab in Pediatric Patients With Moderate to Severe Plaque Psoriasis: The IXORA-PEDS Randomized Clinical Trial. JAMA Dermatol 2022; 158:533-541. [PMID: 35416908 PMCID: PMC9008559 DOI: 10.1001/jamadermatol.2022.0655] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Question What is the long-term (up to 108 weeks) efficacy and safety of ixekizumab for pediatric patients with moderate to severe psoriasis? Findings In this randomized clinical trial of 139 pediatric patients with plaque psoriasis, those who completed treatment with ixekizumab through week 108 achieved improvement in the Psoriasis Area and Severity Index as well as static Physician’s Global Assessment scores, and these results were sustained through week 108. There were no new safety findings, including no new cases of inflammatory bowel disease or candidal infection. Meaning Findings of this trial show that the safety of ixekizumab in this pediatric population was consistent with previously reported data and the known safety profile of this treatment. Importance About 1% of children and adolescents worldwide are affected by plaque psoriasis. Objective To evaluate the long-term efficacy and safety of ixekizumab for pediatric patients with moderate to severe psoriasis. Design, Setting, and Participants This multicenter randomized clinical trial (IXORA-PEDS) evaluated pediatric patients with plaque psoriasis. Participants were aged 6 years to younger than 18 years; had moderate to severe psoriasis, which was defined as Psoriasis Area and Severity Index (PASI) of 12 or higher, static Physician’s Global Assessment (sPGA) score of 3 or higher, and psoriasis-affected body surface area of 10% or greater at screening and baseline; were candidates for phototherapy or systemic therapy; or had psoriasis that was not adequately controlled by topical therapies. Data analysis, which followed the intention-to-treat principle, was conducted from May to October 2021. Interventions Pediatric patients were randomized 2:1 to receive either a weight-based dose of ixekizumab every 4 weeks or placebo. After a 12-week placebo-controlled period, patients entered a 48-week, open-label ixekizumab maintenance period (weeks 12-60), followed by an extension period that lasted through 108 weeks. A substudy evaluated the randomized withdrawal of ixekizumab after week 60. Main Outcomes and Measures Efficacy outcomes at week 108 included the percentage of patients achieving 75% (PASI 75), 90% (PASI 90), or 100% (PASI 100) improvement from baseline; an sPGA score of 0 or 1 or score of 0; and improvement of 4 points or higher from baseline in the Itch Numeric Rating Scale. Safety outcomes included assessments of adverse events (AEs), including treatment-emergent AEs, serious AEs, and AEs of special interest, as well as improvement from baseline in a range of challenging body areas. Missing data for categorical outcomes were imputed using modified nonresponder imputation. Results A total of 171 patients (mean [SD] age, 13.5 [3.04] years; 99 female children [57.9%]) were randomized to either ixekizumab (n = 115) or placebo (n = 56). Of 166 patients who entered the maintenance period, 139 (83.7%) completed week 108 of the trial. Primary and gated secondary end points were sustained through week 108, with patients achieving PASI 75 (91.7% [n = 86]), PASI 90 (79.0% [n = 74]), PASI 100 (55.1% [n = 52]), sPGA 0 or 1 (78.3% [n = 74]), and sPGA 0 (52.4% [n = 49]). Fifty-five patients (78.5%) reported an Itch Numeric Rating Scale improvement of 4 points or higher. In patients who received ixekizumab, at week 108, clearance of nail psoriasis was reported in 68.1% (n = 28), clearance of palmoplantar psoriasis was reported in 90.0% (n = 10), clearance of scalp psoriasis was reported in 76.2% (n = 83), and clearance of genital psoriasis was reported in 87.5% (n = 24). There were no new safety findings during weeks 48 to 108 of the trial, including no new cases of inflammatory bowel disease or candida infection. Conclusions and Relevance Results of this study showed improvements across patient-reported outcomes and objective measures of complete skin clearance of psoriasis among pediatric patients who received ixekizumab, and these response rates were sustained through week 108 of the trial. Safety of ixekizumab was consistent with previously reported findings in this population and the known safety profile of this treatment. Trial Registration ClinicalTrials.gov Identifier: NCT03073200
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Affiliation(s)
- Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Marieke M B Seyger
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Andreas Pinter
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | | | - Danting Zhu
- Eli Lilly and Company, Indianapolis, Indiana
| | | | | | - Kim A Papp
- K Papp Clinical Research and Probity Medical Research, Waterloo, Ontario, Canada
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Ornelas J, Cordoro KM. Clinical Decisions in Pediatric Psoriasis. Dermatol Clin 2022; 40:145-166. [DOI: 10.1016/j.det.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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40
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Mahé E, Geldhof A, Jazra M, Bergmans P, Azzabi A, Seyger MMB. Safety of ustekinumab in adolescent patients with moderate-to-severe plaque psoriasis: real-world evidence from an ongoing European study (NCT03218488). J Eur Acad Dermatol Venereol 2022; 36:e646-e648. [PMID: 35349743 DOI: 10.1111/jdv.18110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/15/2022] [Accepted: 03/24/2022] [Indexed: 11/28/2022]
Affiliation(s)
- E Mahé
- Department of Dermatology, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - A Geldhof
- Medical Affairs, Janssen Biologics BV, Leiden, Netherlands
| | - M Jazra
- Medical Affairs, Janssen-Cilag, Paris, France
| | - P Bergmans
- Biostatistics, Janssen-Cilag BV, Breda, Netherlands
| | - A Azzabi
- Medical Affairs, Janssen Near East, Maghreb & Africa, Casablanca, Morocco
| | - M M B Seyger
- Department of Dermatology, Radboud University Medical Center, Nijmegen, Netherlands
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Han X, Bai J, Zhi L. Annular Pustular Psoriasis Localized Back Area in a Child: An Unusual Clinical Presentation. J Cosmet Dermatol 2022; 21:5272-5273. [PMID: 35332667 DOI: 10.1111/jocd.14935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Xiao Han
- Departemnt of Neurosurgery, Jinan Children's Hospital, Jinan, China, 250001
| | - Jianxue Bai
- Department of Dermatology Traditional, Chinese Medicine Hospital of Huantai, Zibo, China, 256400
| | - Lili Zhi
- Shandong Qianfoshan Hospital, Jinan, China, 250014
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Jackson K, Chua L, Velez de Mendizabal N, Pitou C, Rodriguez Capriles C, Paller AS, Lansang P, Seyger MMB, Papp K. Population pharmacokinetic and exposure-efficacy analysis of ixekizumab in paediatric patients with moderate-to-severe plaque psoriasis (IXORA-PEDS). Br J Clin Pharmacol 2022; 88:1074-1086. [PMID: 34378230 PMCID: PMC9291793 DOI: 10.1111/bcp.15034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/23/2021] [Accepted: 07/31/2021] [Indexed: 12/24/2022] Open
Abstract
AIMS Ixekizumab is a high-affinity monoclonal antibody that selectively targets interleukin-17A used in the treatment of adult and paediatric patients with moderate-to-severe psoriasis. This analysis evaluated the pharmacokinetics (PK) of ixekizumab and the exposure-efficacy relationship in paediatric patients aged 6 to <18 years with psoriasis. METHODS Population PK and exposure-efficacy models were developed. The models used data from paediatric patients with psoriasis participating in the Phase 3 IXORA-PEDS trial in which patients were dosed according to weight categories. The exposure-efficacy model is a Psoriasis Area and Severity Index (PASI) time course model using data up to Week 12, a co-primary efficacy endpoint. RESULTS A 2-compartment population PK model describes the PK of ixekizumab in paediatric patients with the effect of body weight incorporated on clearance and volume terms using an allometric relationship. The weight category-based dosing ensured that ixekizumab mean trough serum concentrations in paediatric patients with psoriasis (3.20-3.33 μg/mL) were within the range of concentrations observed in adult patients with psoriasis (mean [standard deviation]: 3.48 [2.16] μg/mL) administered an efficacious dosing regimen. The observed PASI response rates at Week 12 in paediatric patients (91.9/81.8/52.5% for PASI75/90/100) are well predicted by the final exposure-efficacy model and response rates are similar or higher than those achieved in adults (86.2/66.6/35.0% for PASI75/90/100). CONCLUSION This analysis is the first to describe the PK and exposure-efficacy relationship of ixekizumab in paediatric patients with psoriasis. The analyses support the selection of the weight category-based ixekizumab dosing regimens approved for use in paediatric patients with psoriasis.
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Affiliation(s)
| | - Laiyi Chua
- Lilly Centre for Clinical PharmacologySingaporeSingapore
| | | | | | | | - Amy S. Paller
- Department of DermatologyNorthwestern University Feinberg School of MedicineChicagoILUSA
| | | | - Marieke M. B. Seyger
- Department of DermatologyRadboud University Medical CentreNijmegenThe Netherlands
| | - Kim Papp
- K Papp Clinical Research and Probity Medical ResearchWaterlooONCanada
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Kim ES, Lee A. Several approved biologic agents are now available to treat paediatric plaque psoriasis. DRUGS & THERAPY PERSPECTIVES 2022. [DOI: 10.1007/s40267-022-00896-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hebert AA, Bobonich MA, Rodriguez Capriles C, Gallo G, Li L, Somani N, Ridenour T, Wang Y, Edson-Heredia E, Becker EM. Higher rates of skin clearance and efficacy in challenging body areas are associated with better health-related quality of life following ixekizumab maintenance treatment in pediatric patients with plaque psoriasis. Pediatr Dermatol 2022; 39:55-60. [PMID: 34931346 PMCID: PMC9299936 DOI: 10.1111/pde.14892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND/OBJECTIVES Information is limited on the relationship between skin clearance, resolution of challenging body areas, and improvement of patient-reported outcomes (PROs) in pediatric psoriasis. Ixekizumab, a high-affinity monoclonal antibody that selectively targets interleukin-17A, is approved for the treatment of moderate-to-severe psoriasis in patients aged 6 to <18 years. This study examines improvement in psoriasis clearance in challenging body areas in pediatric patients relative to health-related quality of life. METHODS Data from the IXORA-PEDS trial (NCT03073200) were analyzed, and changes from baseline were measured for overall Psoriasis Area and Severity Index (PASI), static Physicians' Global Assessment of psoriasis (sPGA), Psoriasis Scalp Severity Index (PSSI), Palmoplantar Psoriasis Area and Severity Index (PPASI), and Nail Psoriasis Severity Index. Rates of Dermatology Life Quality Index (DLQI), or Children's DLQI (CDLQI), scores of 0 or 1 were evaluated using the Cochran-Armitage trend test. RESULTS Higher rates of DLQI/CDLQI (0,1) scores were significantly associated with greater PASI and PSSI responses at both Week 12 and Week 48 (p < .0001). A significant association was also observed between DLQI/CDLQI (0,1) and sPGA scores (p < .0001). Significantly higher rates of DLQI/CDLQI (0,1) scores were achieved in patients with greater levels of palmoplantar clearance as measured by PPASI at Week 12 (p = .0139), but significance was not sustained at Week 48 (p = .0896). CONCLUSIONS Greater skin clearance and scalp resolution are associated with better PROs over a short-term (12-week) and long-term (48-week) period. This demonstrates that greater improvement of skin clearance and scalp resolution may benefit quality of life in pediatric patients with psoriasis.
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Affiliation(s)
| | - Margaret A Bobonich
- CWRU Schools of Medicine and Nursing, Case Western Reserve University Cleveland, Cleveland, Ohio, USA
| | | | - Gaia Gallo
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Lingnan Li
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Najwa Somani
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | - Yan Wang
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | - Emily M Becker
- University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
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Dhar S, Srinivas SM. Psoriasis in Pediatric Age Group. Indian J Dermatol 2022; 67:374-380. [PMID: 36578742 PMCID: PMC9792015 DOI: 10.4103/ijd.ijd_570_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Psoriasis is a common, chronic, immune-mediated, multisystem, inflammatory disorder. It affects all age groups, including infancy. In one-third of the cases, the onset of the disease is in the first and second decades of life. Childhood psoriasis significantly affects the quality of life of the child as well as that of the entire family. Pediatric psoriasis has distinct clinical presentations and evolves with time. Like in adults, chronic plaque psoriasis has been found to be the most common type of childhood psoriasis. Psoriatic plaques in children are less pruritic, smaller and thinner with less prominent scaling. In pigmented skin, the erythema is less prominent and plaques appear violaceous or hyperpigmented. Pediatric psoriasis can be associated with arthritis, metabolic syndrome, depression and anxiety. Hence all children should be screened routinely for associated comorbidities. Management of pediatric psoriasis is challenging owing to the limitation of approved therapies. 'Proactive therapy' is a recent approach in childhood-onset psoriasis that would help to prevent the severity of flare-ups, thus improving the quality of life.
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Affiliation(s)
- Sandipan Dhar
- From the Departments of Pediatric Dermatology, Institute of Child Health, Kolkata, West Bengal, India,Address for correspondence: Dr. Sandipan Dhar, Flat 9C, Palazzo, 35, Panditia Road, Kolkata - 700 029, West Bengal, India. E-mail:
| | - Sahana M. Srinivas
- Department of Pediatric Dermatology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
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Wagner MFMG, Theodoro TR, Filho CDASM, Oyafuso LKM, Pinhal MAS. Extracellular matrix alterations in the skin of patients affected by psoriasis. BMC Mol Cell Biol 2021; 22:55. [PMID: 34715781 PMCID: PMC8555298 DOI: 10.1186/s12860-021-00395-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 10/15/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Psoriasis is a chronic inflammatory disease dependent upon a complex interaction between genetic predisposition and immunological factors. It is characterized by skin lesions throughout the body, causing great morbidity and affecting life quality. The present study aimed to evaluate the protein and mRNA expression of heparanase-1 (HPSE), heparanase-2 (HPSE2), syndecan-1 (SYND1), metalloproteinases (MMP2, MMP9), and tissue inhibitor metalloproteinases 2 (TIMP2) in skin samples. METHODS From each psoriasis patient, two samples were collected, one sample from a psoriasis plaque (n = 23) and the other sample from non-affected skin (n = 23), as well as tissue collected by blepharoplasty from control individuals (n = 18). Protein expression was investigated by immunohistochemistry, followed by digital quantification. Quantitative RT-PCR obtained mRNA expression. Statistical analyses were done, and p values < 0.05 were considered significant. RESULTS A significant increase in protein and mRNA expression was observed in both heparanases (HPSE and HPSE2), and higher protein levels of MMP9 and TIMP2 were observed in the psoriasis plaque compared to the non-affected skin. The data point to a probable activation of MMP2 by TIMP2. Moreover, there was a significant increase in HPSE2, SYND1, MMP9, and TIMP2 in non-affected skin samples from patients with psoriasis than in the control sample (tissue obtained by individuals who do not have psoriasis). CONCLUSIONS These results show a possible correlation between the characteristic inflammatory process and alterations in the expression of the extracellular matrix in psoriasis. The increased expression of HPSE2, SYND1, MMP9, and TIMP2, even in the absence of psoriatic plaque, indicates that these molecules may be involved with extracellular matrix changes in the initial alterations the psoriatic process and may be candidates for the development of target treatments.
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Affiliation(s)
| | - Thérèse Rachell Theodoro
- Biochemistry Department of Centro Universitário Saúde ABC (FMABC), Avenida Lauro Gomes 2000, Santo André, São Paulo, CEP 09060870, Brazil
| | | | | | - Maria Aparecida Silva Pinhal
- Biochemistry Department of Centro Universitário Saúde ABC (FMABC), Avenida Lauro Gomes 2000, Santo André, São Paulo, CEP 09060870, Brazil.
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Persechino F, Galli G, Persechino S, Valitutti F, Zenzeri L, Mauro A, Corleto VD, Parisi P, Ziparo C, Evangelisti M, Quatrale G, Di Nardo G. Skin Manifestations and Coeliac Disease in Paediatric Population. Nutrients 2021; 13:3611. [PMID: 34684612 PMCID: PMC8537533 DOI: 10.3390/nu13103611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/16/2022] Open
Abstract
Celiac disease (CD) is an immune-mediated enteropathy caused by gluten ingestion, affecting approximately 1% of the worldwide population. Extraintestinal symptoms may be present as the first signs of CD, years before the CD diagnosis is made. A great variety of extraintestinal manifestations may be associated with CD. Cutaneous manifestations represent the main extraintestinal manifestations, with dermatitis herpetiformis being the most common in patients with CD. In adults, it has been demonstrated that the role of a gluten-free diet is crucial not only for the recovery of signs and symptoms associated with CD but also for cutaneous manifestations, which often improve after gluten avoidance. In children with CD, the association with skin disorders is well documented regarding dermatitis herpetiformis, but studies considering other dermatological conditions, such as psoriasis and atopic dermatitis, are few. The prevalence and manifestations of dermatological disorders in celiac children are often different from those in adults, explaining the gap between these populations. In addition, the therapeutic role of a gluten-free diet in the improvement in skin alterations is not fully understood in children and in adult population except for dermatitis herpetiformis. Therefore, cutaneous CD symptoms need to be known and recognized by physicians despite their specialties to improve early CD diagnosis, which is critical for a better prognosis. This review describes the current scientific evidence on skin manifestations associated with CD in the pediatric population.
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Affiliation(s)
- Flavia Persechino
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy;
| | - Gloria Galli
- Department of Medical-Surgical and Translational Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, 00185 Rome, Italy; (G.G.); (V.D.C.)
| | - Severino Persechino
- Dermatology Unit, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00185 Rome, Italy;
| | - Francesco Valitutti
- Pediatric Unit, AOU San Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy and EBRIS (European Biomedical Research Institute of Salerno), 84121 Salerno, Italy;
| | - Letizia Zenzeri
- Pediatric Emergency Unit, Emergency Pediatric Department, AORN Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy; (L.Z.); (A.M.)
- Pediatric Unit, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00185 Rome, Italy; (P.P.); (C.Z.); (M.E.); (G.Q.)
| | - Angela Mauro
- Pediatric Emergency Unit, Emergency Pediatric Department, AORN Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy; (L.Z.); (A.M.)
| | - Vito Domenico Corleto
- Department of Medical-Surgical and Translational Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, 00185 Rome, Italy; (G.G.); (V.D.C.)
| | - Pasquale Parisi
- Pediatric Unit, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00185 Rome, Italy; (P.P.); (C.Z.); (M.E.); (G.Q.)
| | - Chiara Ziparo
- Pediatric Unit, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00185 Rome, Italy; (P.P.); (C.Z.); (M.E.); (G.Q.)
| | - Melania Evangelisti
- Pediatric Unit, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00185 Rome, Italy; (P.P.); (C.Z.); (M.E.); (G.Q.)
| | - Giovanna Quatrale
- Pediatric Unit, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00185 Rome, Italy; (P.P.); (C.Z.); (M.E.); (G.Q.)
| | - Giovanni Di Nardo
- Pediatric Unit, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00185 Rome, Italy; (P.P.); (C.Z.); (M.E.); (G.Q.)
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48
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Schaap MJ, Broekhuis SCE, Spillekom-van Koulil S, Groenewoud HMM, de Jong EMGJ, Seyger MMB. Treatment goals and preferences of pediatric psoriasis patients, young adults, and parents. J DERMATOL TREAT 2021; 33:2527-2533. [PMID: 34620033 DOI: 10.1080/09546634.2021.1985058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Treatment needs of young psoriasis patients and parents are not widely studied and could advance patient-centered care. OBJECTIVE To explore treatment goals and preferences of pediatric psoriasis patients, young adults, and parents. METHODS A web-based survey among Dutch psoriasis patients aged ≥6 to ≤30 years and parents included multiple-choice, open-ended, and 4-point Likert scale questions. Treatment goals and characteristic preferences of pediatric patients (≤17 years) were compared to young adults (≥18 years) and parents. RESULTS 195 young patients (20.2 ± 6.3 years) and 45 parents were included. The most important treatment goals were 'preventing lesions', 'reducing lesions', 'no itch', and 'no lesions'. Regarding treatment characteristics, 'long-term safety', 'high effectiveness', and 'short-term safety' were most important. We found differences by age, gender, and current treatment. Pediatric patients rated 'not sticky', 'quick results', and 'no/few blood samples needed' higher than parents and/or young adults. Young adults rated 'feeling more confident' and 'better quality of sleep' higher than pediatric patients. Parents considered safety most important. Psychosocial goals were more important for women and patients on biologics. CONCLUSION Young psoriasis patients and parents mainly strive to clear lesions and itch with effective and safe treatment. However, revealed differences underline the relevance of addressing individual needs.
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Affiliation(s)
- Mirjam J Schaap
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Susanne C E Broekhuis
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Saskia Spillekom-van Koulil
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans M M Groenewoud
- Department for Health Evidence, Radboud University, Nijmegen, The Netherlands
| | - Elke M G J de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke M B Seyger
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
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49
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Burden-Teh E, Murphy R, Gran S, Nijsten T, Hughes C, Abdul-Wahab A, Bewley A, Burrows N, Darne S, Gach JE, Katugampola R, Jury CS, Kuet K, Llewellyn J, McPherson T, Ravenscroft JC, Taibjee S, Wilkinson C, Thomas KS. Identifying the best predictive diagnostic criteria for psoriasis in children (< 18 years): a UK multicentre case-control diagnostic accuracy study (DIPSOC study). Br J Dermatol 2021; 186:341-351. [PMID: 34477218 PMCID: PMC9298773 DOI: 10.1111/bjd.20689] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND In children, psoriasis can be challenging to diagnose. Difficulties arise from differences in the clinical presentation compared with adults. OBJECTIVES To test the diagnostic accuracy of previously agreed consensus criteria and to develop a shortlist of the best predictive diagnostic criteria for childhood psoriasis. METHODS A case-control diagnostic accuracy study in 12 UK dermatology departments (2017-2019) assessed 18 clinical criteria using blinded trained investigators. Children (< 18 years) with dermatologist-diagnosed psoriasis (cases, N = 170) or a different scaly inflammatory rash (controls, N = 160) were recruited. The best predictive criteria were identified using backward logistic regression, and internal validation was conducted using bootstrapping. RESULTS The sensitivity of the consensus-agreed criteria and consensus scoring algorithm was 84·6%, the specificity was 65·1% and the area under the curve (AUC) was 0·75. The seven diagnostic criteria that performed best were: (i) scale and erythema in the scalp involving the hairline, (ii) scaly erythema inside the external auditory meatus, (iii) persistent well-demarcated erythematous rash anywhere on the body, (iv) persistent erythema in the umbilicus, (v) scaly erythematous plaques on the extensor surfaces of the elbows and/or knees, (vi) well-demarcated erythematous rash in the napkin area involving the crural fold and (vii) family history of psoriasis. The sensitivity of the best predictive model was 76·8%, with specificity 72·7% and AUC 0·84. The c-statistic optimism-adjusted shrinkage factor was 0·012. CONCLUSIONS This study provides examination- and history-based data on the clinical features of psoriasis in children and proposes seven diagnostic criteria with good discriminatory ability in secondary-care patients. External validation is now needed.
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Affiliation(s)
- E Burden-Teh
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - R Murphy
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Dermatology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - S Gran
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - T Nijsten
- Department of Dermatology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - C Hughes
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - A Abdul-Wahab
- Department of Dermatology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - A Bewley
- Department of Dermatology, Barts Health NHS Trust, London, UK
| | - N Burrows
- Department of Dermatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - S Darne
- Department of Dermatology, The James Cook University Hospital, Middlesbrough, UK
| | - J E Gach
- Department of Dermatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - R Katugampola
- Department of Dermatology, Cardiff and Vale University Health Board, Cardiff, UK
| | - C S Jury
- Department of Dermatology, Royal Hospital for Children, Glasgow, UK
| | - K Kuet
- Department of Dermatology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - J Llewellyn
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - T McPherson
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - J C Ravenscroft
- Department of Paediatric Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Taibjee
- Department of Dermatology, Dorset County Hospital NHS Foundation Trust, Dorchester, UK
| | - C Wilkinson
- Department of Dermatology, University Hospital Plymouth NHS Trust, Plymouth, UK
| | - K S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
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50
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Cyrenne BM, Parpia AS, Sibbald C. Paradoxical psoriasis in pediatric patients: A systematic review. Pediatr Dermatol 2021; 38:1086-1093. [PMID: 34402108 DOI: 10.1111/pde.14712] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 06/05/2021] [Accepted: 07/04/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Paradoxical psoriasis occurs in pediatric patients following treatment with biologic agents. These presentations are not well described, and optimal treatment strategies have not been established. OBJECTIVE To describe the reported rates, demographic characteristics, clinical presentation, and treatment options for TNF-α inhibitor-induced psoriasis. METHODS Systematic review of published cases and cohort studies of paradoxical psoriasis induced by biologic agents, with specific reference to TNF-α inhibitors. RESULTS We identified 4564 pediatric patients treated with TNF-α inhibitors, of whom 210 (4.6%) developed paradoxical psoriasis. Infliximab was the drug most likely to induce psoriasis (8.3%), followed by adalimumab (3.3%). Individual-level data were acquired from 129 individuals with a mean age of 13.6 years (SD: 4.0); 45.0% were male. The scalp was the most commonly affected area (47.5%), followed by the ears (30.8%). Most (63.3%) patients were continued on TNF-α inhibitor therapy. Among those who switched TNF-α inhibitors, only 32.0% had complete clearance of their skin lesions. Among patients who were switched to a non-TNF-α inhibitor, 81% had complete clearance of their paradoxical psoriasis. LIMITATIONS Data were acquired from retrospective studies including case reports and case series. CONCLUSION TNF-α inhibitor-induced psoriasis is a common adverse effect; however, most patients can continue their original therapy and be managed with skin-directed topical or systemic medications. If a patient requires medication discontinuation, switching to a new TNF-α inhibitor is unlikely to lead to resolution of their skin lesions.
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Affiliation(s)
- Benoit M Cyrenne
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alyssa S Parpia
- Department of Epidemiology of Microbial Disease, Yale School of Public Health, New Haven, CT, USA
| | - Cathryn Sibbald
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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