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Zhang X, Liu H, Li C, Wei Y, Kan X, Liu X, Han X, Zhao Z, An T, Fang ZZ, Ma S, Zheng R, Li J. Abdominal obesity in youth: the associations of plasma Lysophophatidylcholine concentrations with insulin resistance. Pediatr Res 2024:10.1038/s41390-024-03652-z. [PMID: 39427100 DOI: 10.1038/s41390-024-03652-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 09/19/2024] [Accepted: 09/30/2024] [Indexed: 10/21/2024]
Abstract
BACKGROUD This study aimed to explore the associations of lysophosphatidylcholines (LPCs) with insulin resistance (IR) and abdominal obesity among children and adolescents. METHODS A cross-sectional study was conducted on 612 young individuals, aged 7 to 18 years in Tianjin City, China. LC-MS metabolomic analysis was used to measure LPCs levels. The Homeostasis Model Assessment was used to estimate IR. Waist circumference measurements were used to assess abdominal obesity. Logistic regression models were employed to explore the relationships between LPCs and IR and abdominal obesity. Mediation analyses were performed to analyze whether LPCs affected IR through abdominal obesity. RESULTS Compared to their counterparts, five specific LPCs were significantly different in youth with IR. The levels of LPC 24:0 and 26:0 were significantly associated with IR after adjustment. Both decreased levels of LPC 24:0 and 26:0 associated with the increased risks of IR (OR: 0.64, 95%CI: 0.38-0.95; OR: 0.66, 95%CI: 0.40-1.00), and the ORs for abdominal obesity were 0.68 (95%CI: 0.38-1.00) and 0.51 (95%CI: 0.28-0.90), respectively. Mediation analysis indicated that abdominal obesity mediated the association between LPC 26:0 and IR, with a total effect (c) of -0.109 (P < 0.05), a direct effect (c') of -0.055 (P > 0.05), and an indirect effect through obesity (a × b) path with "a" of -0.125 (P < 0.05) and "b" of 0.426 (P < 0.05). CONCLUSION Overall findings suggest that decreased levels of LPC 24:0 and 26:0 were associated with increased risks of IR and abdominal obesity. Importantly, addressing abdominal obesity may mediate the impact of IR driven by LPC 26:0.
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Affiliation(s)
- Xinyi Zhang
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Huiying Liu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, and the Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
| | - Chenyu Li
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Ying Wei
- Department of Pediatrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Xuan Kan
- Department of Pediatrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaoxiao Liu
- Department of Pediatrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Xinyi Han
- Department of Pediatrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhenghao Zhao
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Tianfeng An
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Zhong-Ze Fang
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
- Tianjin Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| | - Shifeng Ma
- Department of Pediatrics, Tianjin Medical University General Hospital, Tianjin, China.
| | - Rongxiu Zheng
- Department of Pediatrics, Tianjin Medical University General Hospital, Tianjin, China.
| | - Jing Li
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.
- Tianjin Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China.
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.
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2
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Lebwohl MG, Armstrong AW, Alexis AF, Lain EL, Jacobson AA. Efficacy of Brodalumab in Patients with Psoriasis and Risk Factors for Treatment Failure: A Review of Post Hoc Analyses. Dermatol Ther (Heidelb) 2024; 14:2709-2726. [PMID: 39264399 PMCID: PMC11480272 DOI: 10.1007/s13555-024-01264-3] [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: 06/11/2024] [Accepted: 08/22/2024] [Indexed: 09/13/2024] Open
Abstract
Factors such as obesity, alcohol consumption, and tobacco use are associated with both increased psoriasis severity and inadequate response to systemic and biologic therapies. Obesity is linked to chronic inflammation, which can contribute to psoriasis pathogenesis. Fixed-dose therapies may have reduced efficacy in patients with a higher body mass index, while weight-based dosing can increase the burden of drug-specific side effects. Alcohol and nicotine from tobacco have also been shown to stimulate keratinocyte and immune cell proliferation and production of proinflammatory cytokines. While these risk factors are prevalent among patients with moderate-to-severe psoriasis, their influence on treatment outcomes may be overlooked when evaluating therapeutic options. Brodalumab is a fully human interleukin-17 receptor A antagonist approved for the treatment of moderate-to-severe psoriasis. In this review, we describe the lifestyle-related risk factors associated with decreased response to treatment. We further summarize the post hoc analyses of brodalumab in participant subgroups with moderate-to-severe psoriasis and a history of prior biologic failure, obesity, and alcohol or tobacco use from two phase 3 clinical trials (AMAGINE-2 and AMAGINE-3; ClinicalTrials.gov identifiers: NCT01708603 and NCT01708629, respectively). Our review of clinical trial and real-world data suggests that brodalumab is an efficacious and safe treatment option for patients with lifestyle factors that increase the likelihood of treatment failure, allowing them to achieve skin clearance and improve quality of life.
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Affiliation(s)
- Mark G Lebwohl
- Icahn School of Medicine at Mount Sinai, 5 East 98 Street, 5 Floor, New York, NY, 10029, USA.
| | | | - Andrew F Alexis
- Weill Cornell Graduate School of Medical Sciences, New York, NY, USA
| | - Edward L Lain
- Austin Institute for Clinical Research, Austin, TX, USA
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3
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Scala E, Mercurio L, Albanesi C, Madonna S. The Intersection of the Pathogenic Processes Underlying Psoriasis and the Comorbid Condition of Obesity. Life (Basel) 2024; 14:733. [PMID: 38929716 PMCID: PMC11204971 DOI: 10.3390/life14060733] [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: 04/15/2024] [Revised: 05/20/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
In the past decade, our understanding of psoriasis pathogenesis has made significant steps forward, leading to the development of multiple game-changing therapies. While psoriasis primarily affects the skin, it is increasingly recognized as a systemic disease that can have effects beyond the skin. Obesity is associated with more severe forms of psoriasis and can potentially worsen the systemic inflammation and metabolic dysfunction seen in psoriatic patients. The exact mechanisms underlying the link between these two conditions are not fully understood, but it is believed that chronic inflammation and immune dysregulation play a role. In this review, we examine the existing body of knowledge regarding the intersection of pathogenic processes responsible for psoriasis and obesity. The ability of biological therapies to reduce systemic and obesity-related inflammation in patients with psoriasis will be also discussed.
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4
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Antonatos C, Georgakilas GK, Evangelou E, Vasilopoulos Y. Transcriptomic meta-analysis characterizes molecular commonalities between psoriasis and obesity. Genes Immun 2024; 25:179-187. [PMID: 38580831 DOI: 10.1038/s41435-024-00271-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/07/2024]
Abstract
Despite the abundance of epidemiological evidence for the high comorbid rate between psoriasis and obesity, systematic approaches to common inflammatory mechanisms have not been adequately explored. We performed a meta-analysis of publicly available RNA-sequencing datasets to unveil putative mechanisms that are postulated to exacerbate both diseases, utilizing both late-stage, disease-specific meta-analyses and consensus gene co-expression network (cWGCNA). Single-gene meta-analyses reported several common inflammatory mechanisms fostered by the perturbed expression profile of inflammatory cells. Assessment of gene overlaps between both diseases revealed significant overlaps between up- (n = 170, P value = 6.07 × 10-65) and down-regulated (n = 49, P value = 7.1 × 10-7) genes, associated with increased T cell response and activated transcription factors. Our cWGCNA approach disentangled 48 consensus modules, associated with either the differentiation of leukocytes or metabolic pathways with similar correlation signals in both diseases. Notably, all our analyses confirmed the association of the perturbed T helper (Th)17 differentiation pathway in both diseases. Our novel findings through whole transcriptomic analyses characterize the inflammatory commonalities between psoriasis and obesity implying the assessment of several expression profiles that could serve as putative comorbid disease progression biomarkers and therapeutic interventions.
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Affiliation(s)
- Charalabos Antonatos
- Laboratory of Genetics, Section of Genetics, Cell Biology and Development, Department of Biology, University of Patras, 26504, Patras, Greece
| | - Georgios K Georgakilas
- Laboratory of Genetics, Section of Genetics, Cell Biology and Development, Department of Biology, University of Patras, 26504, Patras, Greece
- Information Management Systems Institute (IMSI), ATHENA Research Center, 15125, Athens, Greece
| | - Evangelos Evangelou
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, 45110, Greece
- Biomedical Research Institute, Foundation for Research and Technology-Hellas, 45110, Ioannina, Greece
- Department of Epidemiology & Biostatistics, MRC Centre for Environment and Health, Imperial College London, London, W2 1PG, UK
| | - Yiannis Vasilopoulos
- Laboratory of Genetics, Section of Genetics, Cell Biology and Development, Department of Biology, University of Patras, 26504, Patras, Greece.
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5
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Vilarrasa E, Nicolau J, de la Cueva P, Goday A, Gallardo F, Martorell-Calatayud A, Carrascosa JM. [Translated article] Glucagon-Like Peptide-1 Agonists for Treating Obesity in Patients With Immune-Mediated Skin Diseases. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T56-T65. [PMID: 37918631 DOI: 10.1016/j.ad.2023.10.019] [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: 05/11/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 11/04/2023] Open
Abstract
Psoriasis and hidradenitis suppurativa are often associated with obesity. Because chronic low-grade inflammation underlies these 2 diseases, they can progress to more severe forms in patients with obesity if weight-reduction measures are not taken. This review covers pharmacologic alternatives for treating obesity, with emphasis on the benefits associated with the novel use of glucagon-like peptide-1 (GLP-1) agonists that act on satiety receptors. These drugs have led to greater weight loss in clinical trials and real-world settings than orlistat, which until recently was the only drug approved for treating obesity in the European Union. Although experience with GLP-1 agonists in patients with obesity and inflammatory skin diseases is currently scarce, the promising results reported suggest they may offer a useful tool for managing obesity.
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Affiliation(s)
- E Vilarrasa
- Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J Nicolau
- Servicio de Endocrinología y Nutrición, Hospital Universitario Son Llàtzer, Instituto de Investigación Sanitaria Illes Balears (IdISBa), Clínica Rotger (Grupo Quirón), Palma de Mallorca, Baleares, Spain
| | - P de la Cueva
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Comunidad de Madrid, Spain
| | - A Goday
- Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona; Servicio de Endocrinología y Nutrición, Hospital del Mar, IMIM Institut Mar d'Investigacions Mediques, Parc de Salut Mar, Barcelona; CIBEROBN, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - F Gallardo
- Servicio de Dermatología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | | | - J M Carrascosa
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Vilarrasa E, Nicolau J, de la Cueva P, Goday A, Gallardo F, Martorell A, Carrascosa JM. Glucagon-Like Peptide-1 Agonists for Treating Obesity in Patients With Immune-Mediated Skin Diseases. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:56-65. [PMID: 37451337 DOI: 10.1016/j.ad.2023.06.017] [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: 05/11/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
Psoriasis and hidradenitis suppurativa are often associated with obesity. Because chronic low-grade inflammation underlies these 2 diseases, they can progress to more severe forms in patients with obesity if weight-reduction measures are not taken. This review covers pharmacologic alternatives for treating obesity, with emphasis on the benefits associated with the novel use of glucagon-like peptide-1 (GLP-1) agonists that act on satiety receptors. These drugs have led to greater weight loss in clinical trials and real-world settings than orlistat, which until recently was the only drug approved for treating obesity in the European Union. Although experience with GLP-1 agonists in patients with obesity and inflammatory skin diseases is currently scarce, the promising results reported suggest they may offer a useful tool for managing obesity.
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Affiliation(s)
- E Vilarrasa
- Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - J Nicolau
- Servicio de Endocrinología y Nutrición, Hospital Universitario Son Llàtzer, Instituto de Investigación Sanitaria Illes Balears (IdISBa), Clínica Rotger (Grupo Quirón), Palma de Mallorca, Baleares, España
| | - P de la Cueva
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Comunidad de Madrid, España
| | - A Goday
- Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona; Servicio de Endocrinología y Nutrición, Hospital del Mar, IMIM Institut Mar d'Investigacions Mediques, Parc de Salut Mar, Barcelona; CIBEROBN, Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - F Gallardo
- Servicio de Dermatología, Hospital del Mar, Parc de Salut Mar, Barcelona, España
| | - A Martorell
- Servicio de Dermatología y Venereología, Hospital de Manises, Valencia, España.
| | - J M Carrascosa
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Badalona, España
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7
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Nicolau J, Nadal A, Sanchís P, Pujol A, Nadal C, Masmiquel L. Effects of liraglutide among patients living with psoriasis and obesity. Med Clin (Barc) 2023; 161:293-296. [PMID: 37474395 DOI: 10.1016/j.medcli.2023.05.021] [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: 01/18/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND AND AIMS There is a bidirectional relationship between obesity and psoriasis. Liraglutide has been shown to improve the severity of psoriatic lesions in patients with type 2 diabetes. We aimed to study the effects of liraglutide 3mg in patients with obesity and psoriasis. METHODS Twenty patients started treatment with liraglutide 3mg for 3 months. Severity of the lesions was evaluated using the Psoriasis Area Severity Index (PASI) and the visual analogue scale of pain (VAS), and quality of life with the Dermatology Quality Index (DLQI). RESULTS There was a significant reduction in BMI (38.9±5.8 vs. 36.4±5.6; p<0.001), CRP (4.5±2.4 vs. 3±2mg/L; p<0.01), homocysteine (13.3±3.6 vs. 11.9±3μmol/L; p<0.01), ferritin (185.4±142.2 vs. 97.43±114.4ng/mL; p=0.04) and plasma cortisol (12±3.1 vs. 11.6±2.2μg/dL, p=0.04). PASI (10±8.4 vs. 5.1±6; p<0.0001), VAS (4.1±2 vs. 2.3±0.92; p=0.009) and DLQI (12.7±7 vs. 6.4±5.6, p<0.0001) improved significantly. In multiple regression analysis, weight loss did not correlate with any inflammatory parameter or PASI. CONCLUSIONS Liraglutide 3mg for three months is effective and safe in reducing weight and improving psoriatic lesions among patients with psoriasis and obesity. Besides, there is an improvement in psoriatic lesions regardless of weight loss that deserves further studies.
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Affiliation(s)
- Joana Nicolau
- Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer, Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Baleares, Spain.
| | - Antoni Nadal
- Dermatology Department, Hospital Universitario Son Llàtzer, Palma de Mallorca, Baleares, Spain
| | - Pilar Sanchís
- Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer, Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Baleares, Spain
| | - Antelm Pujol
- Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer, Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Baleares, Spain
| | - Cristina Nadal
- Dermatology Department, Hospital Universitario Son Llàtzer, Palma de Mallorca, Baleares, Spain
| | - Lluís Masmiquel
- Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer, Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Baleares, Spain
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Michalak-Stoma A, Walczak K, Adamczyk M, Kowal M, Krasowska D. Selected miRNA and Psoriasis-Cardiovascular Disease (CVD)-Overweight/Obesity Network-A Pilot Study. Int J Mol Sci 2023; 24:13916. [PMID: 37762217 PMCID: PMC10530775 DOI: 10.3390/ijms241813916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Psoriasis is nowadays recognized as a multifactorial systemic disease with complex and not fully understood pathogenesis. In psoriatic patients, the increased cardiovascular disease (CVD) risk and frequent comorbidities like obesity are observed. The aim of this study was to investigate differences in miRNA (miR-22-3p, miR-133a-3p, miR-146a-5p, miR-369-3p, and Let-7b-5p) involved in CVD risk among psoriatic patients with overweight/obesity and with normal weight. The study comprised 28 male psoriatic patients and 16 male healthy controls. miRNA isolated from peripheral blood mononuclear cells was reverse-transcribed and RT-qPCR was performed. We have found decreased levels of miR-22, miR-133a, miR-146a, and miR-369 among the psoriatic patients. There was a statistically significant difference in miR-22 and miR-146a levels between psoriatic patients with overweight/obesity and with normal weight. There were positive correlations between miR-22 and miR-146a levels and psoriatic arthritis (PsA) in psoriatic patients with normal weight and between the miR-133a level and PsA in the overweight/obese patients. The decreased levels of selected miRNA are consistent with the levels observed in CVD indicating their impact on the CVD risk in psoriatic patients. miR-22 and miR-146 may be recognized as one of the contributing factors in the obesity-CVD-psoriasis network.
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Affiliation(s)
- Anna Michalak-Stoma
- Chair and Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, ul. Staszica 16, 20-081 Lublin, Poland; (K.W.); (M.A.); (M.K.); (D.K.)
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Mastroeni S, Sampogna F, Uras C, De Angelis M, Fusari R, Melo Salcedo N, Pallotta S, Abeni D. Comparison of self-reported and measured height and weight in patients with psoriasis. Arch Dermatol Res 2023; 315:2023-2026. [PMID: 36897368 DOI: 10.1007/s00403-023-02592-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/27/2023] [Accepted: 02/23/2023] [Indexed: 03/11/2023]
Affiliation(s)
- Simona Mastroeni
- Clinical Epidemiology Unit, Istituto Dermopatico Dell'Immacolata IDI-IRCCS, Via Monti Di Creta 104, 00167, Rome, Italy
| | - Francesca Sampogna
- Clinical Epidemiology Unit, Istituto Dermopatico Dell'Immacolata IDI-IRCCS, Via Monti Di Creta 104, 00167, Rome, Italy.
| | - Claudia Uras
- Clinical Epidemiology Unit, Istituto Dermopatico Dell'Immacolata IDI-IRCCS, Via Monti Di Creta 104, 00167, Rome, Italy
| | - Mara De Angelis
- Dermatology Unit, Istituto Dermopatico Dell'Immacolata IDI-IRCCS, Rome, Italy
| | - Roberta Fusari
- Clinical Epidemiology Unit, Istituto Dermopatico Dell'Immacolata IDI-IRCCS, Via Monti Di Creta 104, 00167, Rome, Italy
| | - Nidia Melo Salcedo
- Clinical Epidemiology Unit, Istituto Dermopatico Dell'Immacolata IDI-IRCCS, Via Monti Di Creta 104, 00167, Rome, Italy
| | - Sabatino Pallotta
- Dermatology Unit, Istituto Dermopatico Dell'Immacolata IDI-IRCCS, Rome, Italy
| | - Damiano Abeni
- Clinical Epidemiology Unit, Istituto Dermopatico Dell'Immacolata IDI-IRCCS, Via Monti Di Creta 104, 00167, Rome, Italy
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Mohamed Haris NH, Krishnasamy S, Chin KY, Mariappan V, Arumugam M. Metabolic Syndrome Screening and Nutritional Status of Patients with Psoriasis: A Scoping Review. Nutrients 2023; 15:2707. [PMID: 37375611 DOI: 10.3390/nu15122707] [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: 05/08/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Background: Patients with plaque psoriasis have an increased risk of metabolic syndrome. However, no studies have assessed the nutritional status or screening methods of this population. Aims: This review aimed to identify and summarise metabolic syndrome screening criteria and the tools/methods used in nutrition assessment in patients with plaque psoriasis. Data synthesis: PubMed, Web of Science, Ovid and Scopus were searched from inception to March 2023, following the Arkensey and O'Malley framework, to identify articles that report nutritional assessment methods/tools and metabolic screening criteria. Twenty-one studies were identified. Overall, these studies used four different screening criteria to define metabolic syndrome. Patients with psoriasis had a high prevalence of metabolic syndrome and had a poor nutritional status compared to controls. However, only anthropometric measures such as weight, height and waist circumference were employed to determine the nutritional status. Only two studies assessed the vitamin D status. Conclusions: Patients with psoriasis have a poor nutritional status, and they are at risk of nutrient deficiencies. However, these health aspects are not routinely assessed and may increase the risk of malnutrition among these patients. Therefore, additional assessments, such as body composition and dietary assessment, are needed to determine the nutritional status to provide a suitable intervention.
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Affiliation(s)
- Nur Hanisah Mohamed Haris
- Dietetics Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Shanthi Krishnasamy
- Dietetics Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
- Centre for Diagnostic, Therapeutic and Investigative Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Kok-Yong Chin
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia
| | - Vanitha Mariappan
- Centre for Toxicology and Health Risk Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Mohan Arumugam
- Internal Medicine & Dermatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia
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Kim H, Hong JY, Cheong S, Kang JH. Impact of biologic agents on body weight and obesity-related disorders in patients with psoriasis: A nationwide population-based cohort study. Obes Res Clin Pract 2023:S1871-403X(23)00042-X. [PMID: 37211465 DOI: 10.1016/j.orcp.2023.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 02/26/2023] [Accepted: 05/11/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE This large-scale population-based study aimed to analyze the effects of biologic agents on body weight and obesity-related disorders in patients with psoriasis for 10 years (January 2010 to December 2019), using the customized database provided by the Korean National Health Insurance Service. METHODS The demographic data and health charts of 620,885 psoriasis patients, divided into three groups according to their treatment modalities (biologics, non-biologic systemic agents, and other agents), were analyzed. RESULTS Patients with severe psoriasis who were prescribed biologic agents had a higher rate of comorbidities, such as diabetes, dyslipidemia, fatty liver, increased body weight, body mass index, and waist circumference than those in the other treatment groups. We found that the use of biologic agents was a significant independent risk factor for gaining weight after correcting for age, sex, initial weight, total prescription period, duration between the weight measurements before and after psoriasis treatment, exercise, smoking, drinking and presence of comorbidities. In contrast, the use of non-biologic systemic agents was not a significant independent risk factor for weight change. Gender-stratified regression analysis found that biologics were an independent variable affecting weight change for men, but not for women. CONCLUSIONS Patients with severe psoriasis who are prescribed biologic agents tend to have a higher body weight and a higher prevalence of obesity-related disorders than those in other treatment groups. Caution must be exercised when using biologics, as they may cause additional weight gain, especially in men.
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Affiliation(s)
- Hyunhee Kim
- Department of Dermatology, Konyang University College of Medicine, Daejeon, South Korea
| | - Jee-Young Hong
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, South Korea
| | - Seunghyun Cheong
- Department of Dermatology, Konyang University College of Medicine, Daejeon, South Korea.
| | - Jee-Hyun Kang
- Department of Family Medicine, Konyang University College of Medicine, Daejeon, South Korea.
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12
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Impact of Obesity on the IL-6 Immune Marker and Th17 Immune Cells in C57BL/6 Mice Models with Imiquimod-Induced Psoriasis. Int J Mol Sci 2023; 24:ijms24065592. [PMID: 36982669 PMCID: PMC10059802 DOI: 10.3390/ijms24065592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Obese psoriatic patients experience higher disease severity and exhibit poorer treatment responses and clinical outcomes. It has been proposed that proinflammatory cytokines produced by adipose tissue exacerbate psoriasis; however, the role of obesity in psoriasis remains unclear. This study aimed to elucidate the role of obesity in the pathogenesis of psoriasis, focusing on immunological changes. To induce obesity, mice were fed a high-fat diet for 20 weeks. We then applied imiquimod to the skin on a mouse’s back for seven consecutive days to induce psoriasis and scored lesion severity every day for seven days. Cytokine levels in serum and the Th17 cell population in the spleen and draining lymph nodes were studied to identify immunological differences. The clinical severity was more remarkable, and histologically the epidermis was also significantly thicker in the obese group. Increased levels of IL-6 and TNF-α were observed in serum after psoriasis. They were elevated to a greater degree, with greater expansion of the functional Th17 cell population in the obese group. It is concluded that obesity could exacerbate psoriasis through mechanisms that involve elevated proinflammatory cytokine secretion and an expanded Th17 cell population.
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Adesanya EI, Matthewman J, Schonmann Y, Hayes JF, Henderson A, Mathur R, Mulick AR, Smith CH, Langan SM, Mansfield KE. Factors associated with depression, anxiety and severe mental illness among adults with atopic eczema or psoriasis: a systematic review and meta-analysis. Br J Dermatol 2022; 188:460-470. [PMID: 36745557 DOI: 10.1093/bjd/ljac132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Evidence suggests an association between atopic eczema (AE) or psoriasis and mental illness; however, the factors associated with mental illness are unclear. OBJECTIVES To synthesize and evaluate all available evidence on factors associated with depression, anxiety and severe mental illness (SMI) among adults with AE or psoriasis. METHODS We searched electronic databases, grey literature databases and clinical trial registries from inception to February 2022 for studies of adults with AE or psoriasis. Eligible studies included randomized controlled trials (RCTs), cohort, cross-sectional or case-control studies where effect estimates of factors associated with depression, anxiety or SMI were reported. We did not apply language or geographical restrictions. We assessed risk of bias using the Quality in Prognosis Studies tool. We synthesized results narratively, and if at least two studies were sufficiently homogeneous, we pooled effect estimates in a random effects meta-analysis. RESULTS We included 21 studies (11 observational, 10 RCTs). No observational studies in AE fulfilled our eligibility criteria. Observational studies in people with psoriasis mostly investigated factors associated with depression or anxiety - one cross-sectional study investigated factors associated with schizophrenia. Pooled effect estimates suggest that female sex and psoriatic arthritis were associated with depression [female sex: odds ratio (OR) 1.62, 95% confidence interval (CI) 1.09-2.40, 95% prediction intervals (PIs) 0.62-4.23, I2 = 24.90%, τ2 = 0.05; psoriatic arthritis: OR 2.26, 95% CI 1.56-3.25, 95% PI 0.21-24.23, I2 = 0.00%, τ2 = 0.00] and anxiety (female sex: OR 2.59, 95% CI 1.32-5.07, 95% PI 0.00-3956.27, I2 = 61.90%, τ2 = 0.22; psoriatic arthritis: OR 1.98, 95% CI 1.33-2.94, I2 = 0.00%, τ2 = 0.00). Moderate/severe psoriasis was associated with anxiety (OR 1.14, 95% CI 1.05-1.25, I2 0.00%, τ2 = 0.00), but not depression. Evidence from RCTs suggested that adults with AE or psoriasis given placebo had higher depression and anxiety scores compared with comparators given targeted treatment (e.g. biologic agents). CONCLUSIONS Our review highlights limited existing research on factors associated with depression, anxiety and SMI in adults with AE or psoriasis. Observational evidence on factors associated with depression or anxiety in people with psoriasis was conflicting or from single studies, but some identified factors were consistent with those in the general population. Evidence on factors associated with SMIs in people with AE or psoriasis was particularly limited. Evidence from RCTs suggested that AE and psoriasis treated with placebo was associated with higher depression and anxiety scores compared with skin disease treated with targeted therapy; however, follow-up was limited. Therefore, long-term effects on mental health are unclear.
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Affiliation(s)
- Elizabeth I Adesanya
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Julian Matthewman
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Yochai Schonmann
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Department of Quality Measurements and Research, Clalit Health Services, Tel Aviv, Israel
| | - Joseph F Hayes
- Division of Psychiatry, University College London, London, UK
| | - Alasdair Henderson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rohini Mathur
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Amy R Mulick
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Catherine H Smith
- St John's Institute of Dermatology, Guys and St Thomas' Foundation Trust and King's College London, London, UK
| | - Sinéad M Langan
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Health Data Research UK, London, UK
| | - Kathryn E Mansfield
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Zanesco S, Hall W, Gibson R, Griffiths C, Maruthappu T. Approaches to nutrition intervention in plaque psoriasis, a multi-system inflammatory disease-The Diet and Psoriasis Project (DIEPP). NUTR BULL 2022; 47:524-537. [PMID: 36082746 DOI: 10.1111/nbu.12580] [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: 04/30/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 01/04/2023]
Abstract
Psoriasis is an immune-mediated inflammatory skin disease affecting approximately 2% of the UK population. Its pathogenesis is suggested to be an outcome of genetic and environmental interplay. People with psoriasis have an increased likelihood of developing other conditions such as type 2 diabetes and cardiovascular disease. Systemic inflammation is hypothesised to be the common link between psoriasis and cardio-metabolic diseases. Emerging evidence shows diet as a potential therapeutic adjunct in the management of psoriasis. The Diet and Psoriasis Project (DIEPP) aims to investigate whether dietary factors are related to psoriasis severity by conducting an observational study followed by a dietary intervention trial, to assess the effect of the Mediterranean diet (MedD) and time-restricted eating (TRE) on psoriasis. This review article will explore the potential mechanisms by which the MedD and TRE may exert protective effects on psoriasis, evaluate the current evidence, and outline the design of the DIEPP. Given the early-stage evidence, we hope to be able to build knowledge to derive medically approved dietary recommendations and contribute to the research gaps exploring the role of diet and psoriasis.
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Affiliation(s)
- Sylvia Zanesco
- Department of Nutritional Sciences, King's College London, London, UK
| | - Wendy Hall
- Department of Nutritional Sciences, King's College London, London, UK
| | - Rachel Gibson
- Department of Nutritional Sciences, King's College London, London, UK
| | - Christopher Griffiths
- Division of Musculoskeletal & Dermatological Sciences, The University of Manchester, Manchester, UK
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Nowowiejska J, Baran A, Flisiak I. Fatty Acid-Binding Proteins in Psoriasis-A Review. Metabolites 2022; 12:metabo12090833. [PMID: 36144237 PMCID: PMC9500650 DOI: 10.3390/metabo12090833] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/29/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Psoriasis is one of the most common skin diseases in dermatological practice. It affects about 1–3% of the general population and is associated with different comorbidities, especially metabolic syndrome. Fatty-acid-binding proteins (FABPs) are a family of cytosolic proteins which are an important link in lipid metabolism and transport; moreover, they have different tissue specificity and properties. So far, ten FABPs have been discovered and seven have been investigated in psoriasis. In this review, we discuss the nature of all FABPs and their role in psoriasis. FABPs have different organ and tissue expression, and hence various functions, and may be markers of different disorders. Considering the concentration of a few of them tends to be elevated in psoriasis, it confirms the current perception of psoriasis as a multiorgan disorder associated with plenty of comorbidities. Some FABPs may be also further investigated as biomarkers of psoriasis organ complications. FABP-1 and FABP-5 may become potential markers of metabolic complications and inflammation in psoriasis. FABP-7 could perhaps be further investigated as an indicator of the neurodegenerative processes in psoriatic patients.
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Pirro F, Caldarola G, Chiricozzi A, Burlando M, Mariani M, Parodi A, Peris K, De Simone C. Impact of Body Mass Index on the Efficacy of Biological Therapies in Patients with Psoriasis: A Real-World Study. Clin Drug Investig 2021; 41:917-925. [PMID: 34537921 PMCID: PMC8481196 DOI: 10.1007/s40261-021-01080-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The efficacy of biological therapies used for the treatment of chronic plaque psoriasis can be influenced by numerous variables including body mass index (BMI). OBJECTIVE This study aimed to evaluate the impact of BMI on the short-term and long-term efficacy of biological therapies in clinical practice and to identify the best therapeutic options in obese patients (BMI ≥ 30 kg/m2). METHODS A multicentric retrospective study was conducted in patients who initiated a biological therapy during the period January 2006-December 2019. The proportion of patients achieving a 90% improvement of baseline Psoriasis Area and Severity Index at weeks 12 and 24 was calculated also recording the 12- and 24-month drug survival as a measure of long-term efficacy, performing multivariate analyses to assess the impact of different variables. RESULTS Five hundred and four patients with psoriasis were included. After 12 and 24 weeks, the proportion of patients achieving a 90% improvement of baseline Psoriasis Area and Severity Index response was higher in patients with a BMI < 30 kg/m2 compared with those with a BMI ≥ 30 kg/m2 [54.90% vs 43.45% (p = 0.014) at week 12 and 66.84% vs 56.55% (p = 0.021) at week 24]. The Kaplan-Meier survival curves showed how obese patients had a higher probability of discontinuation due to a lack or loss of efficacy (p = 0.0192) compared with non-obese patients. The drug survival analysis also showed that BMI negatively affected the drug survival of secukinumab (odds ratio 1.27, p < 0.001) and ustekinumab (odds ratio 1.06, p = 0.050), while the long-term efficacy of adalimumab, etanercept, and ixekizumab was not influenced by BMI. CONCLUSIONS Obesity (BMI ≥ 30 kg/m2) negatively affects the clinical response of biological drugs in psoriatic patients, with anti-interleukin drugs being more affected by BMI than anti-tumor necrosis factor drugs.
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Affiliation(s)
- Federico Pirro
- Istituto di Dermatologia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00135, Rome, Italy.
- Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Giacomo Caldarola
- Istituto di Dermatologia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00135, Rome, Italy
- Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Chiricozzi
- Istituto di Dermatologia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00135, Rome, Italy
- Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Martina Burlando
- Division of Dermatology (DissaL), Policlinico San Martino Hospital, IRCCS, Genoa, Italy
| | - Marco Mariani
- Department of Health Sciences and Public Health, Catholic University, Rome, Italy
| | - Aurora Parodi
- Division of Dermatology (DissaL), Policlinico San Martino Hospital, IRCCS, Genoa, Italy
| | - Ketty Peris
- Istituto di Dermatologia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00135, Rome, Italy
- Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Clara De Simone
- Istituto di Dermatologia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00135, Rome, Italy
- Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Sardana K, Sachdeva S. Role of nutritional supplements in selected dermatological disorders: A review. J Cosmet Dermatol 2021; 21:85-98. [PMID: 34564936 DOI: 10.1111/jocd.14436] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/26/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND While a plethora of literature continues to be published on the role of nutritional agents both in lay press and indexed journals, the data is not on a firm footing and leaves the dermatologist in a quandry and the patient confused. The various agents include vitamins, minerals, amino acids, antioxidants, diets & gluten. A proper knowledge of the role of nutritional supplements in dermatological diseases can be a useful tool in advising the patients and in certain cases ameliorating the disorder. PATIENTS/METHODS Literature review of last 15 years was made using the terms "diet in dermatology," "nutrition and skin," "nutritional supplements in dermatology," "nutritional agents and acne," "nutritional agents and alopecia," and "nutritional agents and psoriasis." RESULTS While there are multiple publications on the use of nutritional supplements for amelioration of skin diseases, most of them are based on either associations or in vitro studies, but very few transcend the rigors of a clinical trial or the holey grail of a double-blinded randomized controlled trial. There seem to be some evidence in acne, psoriasis, telogen effluvium, urticaria & vitiligo. Coeliac disease and dermatitis herpetiformis have a strong link with diet. Rosacea has a strong link with certain foods, but the other disorders like melasma, aphthous stomatitis do not have any scientifically validated association with diet. CONCLUSIONS Our updated review examines the role of nutritional supplements and antioxidants in various dermatological disorders. We have found that there are varying levels of evidence with notable associations of low glycemic diet & acne, fish oil & weight loss with psoriasis, fish oils & probiotics with atopic dermatitis & vitamins & botanical extracts with vitiligo. The evidence for diet and nutrition in bullous disorders and photoageing is scarce. The role of low histamine diet in urticaria is useful in select cases of episodic urticaria. Rosacea is triggered by hot and spicy food . Apart from gluten and Dermatitis Herpetiformis, no diet can be considered disease modifying in our reveiw. The lack of comparison of nutritional or dietary modiffication with conventional validated agents, makes the data difficult to translate in real world patient management.
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Affiliation(s)
- Kabir Sardana
- Department of Dermatology, Venereology and Leprosy, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Soumya Sachdeva
- Department of Dermatology, Venereology and Leprosy, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India
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Biologic Treatment in Combination with Lifestyle Intervention in Moderate to Severe Plaque Psoriasis and Concomitant Metabolic Syndrome: Rationale and Methodology of the METABOLyx Randomized Controlled Clinical Trial. Nutrients 2021; 13:nu13093015. [PMID: 34578893 PMCID: PMC8471656 DOI: 10.3390/nu13093015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/19/2021] [Accepted: 08/27/2021] [Indexed: 01/04/2023] Open
Abstract
Inflammatory diseases including psoriasis are associated with metabolic and cardiovascular comorbidities, including obesity and metabolic syndrome. Obesity is associated with greater psoriasis disease severity and reduced response to treatment. Therefore, targeting metabolic comorbidities could improve patients’ health status and psoriasis-specific outcomes. METABOLyx is a randomized controlled trial evaluating the combination of a lifestyle intervention program with secukinumab treatment in psoriasis. Here, the rationale, methodology and baseline patient characteristics of METABOLyx are presented. A total of 768 patients with concomitant moderate to severe plaque psoriasis and metabolic syndrome were randomized to secukinumab 300 mg, or secukinumab 300 mg plus a tailored lifestyle intervention program, over 24 weeks. A substudy of immunologic and metabolic biomarkers is ongoing. The primary endpoint of METABOLyx is PASI90 response at week 24. Other endpoints include patient-reported outcomes and safety. METABOLyx represents the first large scale clinical trial of an immunomodulatory biologic in combination with a standardized lifestyle intervention.
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Rajagopalan M, Dogra S, Saraswat A, Varma S, Banodkar P. The Use of Apremilast in Psoriasis: An Indian Perspective on Real-World Scenarios. Psoriasis (Auckl) 2021; 11:109-122. [PMID: 34430450 PMCID: PMC8375310 DOI: 10.2147/ptt.s320810] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/20/2021] [Indexed: 12/27/2022] Open
Abstract
Apremilast, an oral phosphodiesterase-4 inhibitor, is approved for use in the management of psoriasis and psoriatic arthritis. Although its efficacy and safety have been well established in clinical studies, in real-world settings, different practice scenarios have been reported. This review paper serves to evaluate clinical real-world scenarios and aspects of treatment for which the information in the literature was considered to be lacking or controversial. Following a literature review, a panel of five dermatologists with expertise in psoriasis considered five scenarios; namely, the positioning of apremilast in psoriasis, its use in difficult-to-treat areas, special conditions and populations, safety, dose titration and dose in maintenance therapy. These were then assessed with psoriasis experts in India using a web-based questionnaire. A total of 28 questions were discussed regarding these scenarios. According to the responses, apremilast is effective in stable mild to moderate psoriasis as monotherapy and in severe psoriasis in combination. Also, a positive response was received with regard to its effectiveness in difficult locations such as the scalp, palms and soles. To reduce adverse effects, prolonged titration therapy over 4 weeks is required and lower doses can be prescribed to maintain remission. Apremilast therapy should be continued for a minimum of 8 weeks once initiated to achieve the desired results, and the total duration of therapy should be about 24 weeks for better efficacy. It is also effective in many other cases, such as obese patients, patients with hepatitis B or C and HIV, or patients on polypharmacy. It was also reported that apremilast requires less prescreening and monitoring than other conventional and biologic systemic therapies. Overall, apremilast is an attractive option for the individualized treatment of psoriasis owing to its favorable safety profile, its ease of oral administration without the need for screening or ongoing laboratory monitoring, and its positive impact on symptoms and lesions in difficult-to-treat areas.
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Affiliation(s)
- Murlidhar Rajagopalan
- Department of Dermatology, Apollo Hospitals, Chennai, Tamilnadu, India
- Correspondence: Murlidhar Rajagopalan Dermatology, Apollo Hospital, No 21, Greams Lane, Off Greams Road, Chennai, 600006, Tamil Nadu, IndiaTel +91 9840045500 Email
| | - Sunil Dogra
- Department of Dermatology, Venereology & Leprology, PGIMER, Chandigarh, India
| | - Abir Saraswat
- Indushree Skin Clinic, Lucknow, Uttar Pradesh, India
| | - Sachin Varma
- Skinvita Clinic Kolkata, Department of Dermatology, Apollo Hospital, Kolkata, West Bengal, India
| | - Pravin Banodkar
- Skin Crest Clinic, Mumbai, Department of Dermatology, Saifee Hospital, Breach Candy Hospital, and St. Elizabeth’s Hospital, Mumbai, Maharashtra, India
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The Association of Psoriasis and Obesity: Focusing on IL-17A-Related Immunological Mechanisms. INTERNATIONAL JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2021. [DOI: 10.1097/jd9.0000000000000155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Korsakova YL, Korotaeva TV, Loginova EI, Gubar EE, Vasilenko EA, Vasilenko AA, Kuznetsova NA, Patrikeeva IM, Nasonov EL. The relationship between obesity, cardiometabolic disorders and disease activity in psoriatic arthritis patients: data from the Russian register. TERAPEVT ARKH 2021; 93:71511. [DOI: 10.26442/00403660.2021.05.200789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 06/12/2021] [Indexed: 02/08/2023]
Abstract
Aim. To study the relationship between obesity, cardiometabolic disorders and disease activity in patients with psoriatic arthritis (PsA) in real practice.
Materials and methods. The Russian register included 614 PsA patients [female 331 (54%)/283 (46%)]. Average age 45.20.52 years, PsA duration 5.70.27 years, psoriasis 15.710.56 years. Patients underwent examination, body mass index (BMI), PsA activity according to DAPSA, cDAPSA, analysis of concomitant diseases were assessed. The patients were divided into 3 groups depending on BMI (kg/m2): normal 25 (group 1), increased 2530 (group 2), obesity 30 (group 3).
Results. The average BMI was 27.70.23 kg/m2, normal BMI in 213 (34.7%), increased in 214 (34.8%) and obesity in 187 (30.5%). Concomitant diseases in 297 (48%). In group 3, arterial hypertension was observed significantly more often than in groups 1 and 2 (p0.0001); more often than in group 2 diabetes mellitus (p0.0001), metabolic syndrome (p0.0001); more often than in group 1 ischemic heart disease (p=0.026). PsA activity at Baseline, after 6/12 months was significantly higher in group 3 (p0.031). In obese patients, the chance of a decrease in disease activity to a moderate/low level and remission during therapy for 6/12 months is 2.484 times lower than in group 1, and 2.346 times lower than in group 2: odds ratio 2.346 (95% сonfidence interval 1.075.143) and 2.484 (95% сonfidence interval 1.1355.439), respectively.
Conclusion. In the majority (65.3%) of PsA patients, BMI exceeded the norm. Obesity is associated with a high incidence of cardiometabolic disorders, with higher PsA activity and lower treatment efficacy.
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Busca Arenzana C, Quintana Castanedo L, Chiloeches Fernández C, Nieto Rodríguez D, Herranz Pinto P, Delgado Hierro AB, Olveira Martín A, Montes Ramírez ML. Psoriasis and Liver Damage in HIV-Infected Patients. Cells 2021; 10:cells10051099. [PMID: 34064387 PMCID: PMC8147812 DOI: 10.3390/cells10051099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 12/13/2022] Open
Abstract
Background/objectives: Psoriasis is the most frequent skin disease in HIV-infected patients. Nonalcohol fatty liver disease (NAFLD) is more prevalent in patients with psoriasis. We report the prevalence of psoriasis and NAFLD and investigate risk factors of liver damage in HIV-infected patients with psoriasis. Methods: We performed a retrospective observational study. Steatosis was defined as indicative abdominal ultrasound findings, CAP (controlled attenuated parameter by transient elastography) > 238 dB/m, and/or triglyceride and glucose index (TyG) > 8.38. Significant (fibrosis ≥ 2) and advanced liver fibrosis (fibrosis ≤ F3) were studied by transient elastography (TE) and/or FIB-4 using standard cutoff points. FIB-4 (Fibrosis 4 score) results were adjusted for hepatitis C (HCV)-coinfected patients. Results: We identified 80 patients with psoriasis (prevalence, 1.5%; 95% CI, 1.1–1.8). Psoriasis was severe (PASI > 10 and/or psoriatic arthritis) in 27.5% of cases. The prevalence of steatosis was 72.5% (95% CI, 65–85). Severe psoriasis was an independent risk factor for steatosis (OR, 12; 95% CI, 1.2–120; p = 0.03). Significant liver fibrosis (p < 0.05) was associated with HCV coinfection (OR 3.4; 95% CI, 1.1–10.6), total CD4 (OR 0.99; 95% CI, 0.99–1), and time of efavirenz exposure (OR 1.2; 95% CI, 1.0–1.3). Conclusions: The prevalence of psoriasis in HIV-infected patients was similar to that of the general population. Steatosis is highly prevalent, and severe psoriasis is an independent risk factor for steatosis in HIV-infected patients.
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Affiliation(s)
- Carmen Busca Arenzana
- HIV Unit. Department of Internal Medicine, La Paz University Hospital, 28046 Madrid, Spain; (A.B.D.H.); (M.L.M.R.)
- Correspondence: ; Tel.: +34-651-630-523
| | - Lucía Quintana Castanedo
- Department of Dermatology, La Paz University Hospital, 28046 Madrid, Spain; (L.Q.C.); (C.C.F.); (D.N.R.); (P.H.P.)
| | - Clara Chiloeches Fernández
- Department of Dermatology, La Paz University Hospital, 28046 Madrid, Spain; (L.Q.C.); (C.C.F.); (D.N.R.); (P.H.P.)
| | - Daniel Nieto Rodríguez
- Department of Dermatology, La Paz University Hospital, 28046 Madrid, Spain; (L.Q.C.); (C.C.F.); (D.N.R.); (P.H.P.)
| | - Pedro Herranz Pinto
- Department of Dermatology, La Paz University Hospital, 28046 Madrid, Spain; (L.Q.C.); (C.C.F.); (D.N.R.); (P.H.P.)
| | - Ana Belén Delgado Hierro
- HIV Unit. Department of Internal Medicine, La Paz University Hospital, 28046 Madrid, Spain; (A.B.D.H.); (M.L.M.R.)
| | - Antonio Olveira Martín
- Hepatology Unit, Department of Gastroenterology, La Paz University Hospital, 28046 Madrid, Spain;
| | - María Luisa Montes Ramírez
- HIV Unit. Department of Internal Medicine, La Paz University Hospital, 28046 Madrid, Spain; (A.B.D.H.); (M.L.M.R.)
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Castaldo G, Pagano I, Grimaldi M, Marino C, Molettieri P, Santoro A, Stillitano I, Romano R, Montoro P, D’Ursi AM, Rastrelli L. Effect of Very-Low-Calorie Ketogenic Diet on Psoriasis Patients: A Nuclear Magnetic Resonance-Based Metabolomic Study. J Proteome Res 2021; 20:1509-1521. [PMID: 33164516 PMCID: PMC8016365 DOI: 10.1021/acs.jproteome.0c00646] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Indexed: 12/15/2022]
Abstract
Psoriasis is an inflammatory disease of the epidermis based on an immunological mechanism involving Langerhans cells and T lymphocytes that produce pro-inflammatory cytokines. Genetic factors, environmental factors, and improper nutrition are considered triggers of the disease. Numerous studies have reported that in a high number of patients, psoriasis is associated with obesity. Excess adipose tissue, typical of obesity, causes a systemic inflammatory status coming from the inflammatory active adipose tissue; therefore, weight reduction is a strategy to fight this pro-inflammatory state. This study aimed to evaluate how a nutritional regimen based on a ketogenic diet influenced the clinical parameters, metabolic profile, and inflammatory state of psoriasis patients. To this end, 30 psoriasis patients were subjected to a ketogenic nutritional regimen and monitored for 4 weeks by evaluating the clinical data, biochemical and clinical parameters, NMR metabolomic profile, and IL-2, IL-1β, TNF-α, IFN-γ, and IL-4 concentrations before and after the nutritional regimen. Our data show that a low-calorie ketogenic diet can be considered a successful strategy and therapeutic option to gain an improvement in psoriasis-related dysmetabolism, with significant correction of the full metabolic and inflammatory status.
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Affiliation(s)
- Giuseppe Castaldo
- NutriKeto_LAB
Unisa−“San Giuseppe Moscati” National Hospital
(AORN), Contrada Amoretta, 83100 Avellino, Avellino, Italy
| | - Imma Pagano
- NutriKeto_LAB
Unisa−“San Giuseppe Moscati” National Hospital
(AORN), Contrada Amoretta, 83100 Avellino, Avellino, Italy
- Department
of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Salerno, Italy
| | - Manuela Grimaldi
- Department
of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Salerno, Italy
| | - Carmen Marino
- Department
of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Salerno, Italy
| | - Paola Molettieri
- NutriKeto_LAB
Unisa−“San Giuseppe Moscati” National Hospital
(AORN), Contrada Amoretta, 83100 Avellino, Avellino, Italy
| | - Angelo Santoro
- Department
of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Salerno, Italy
| | - Ilaria Stillitano
- Department
of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Salerno, Italy
| | - Rocco Romano
- Department
of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Salerno, Italy
| | - Paola Montoro
- Department
of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Salerno, Italy
| | - Anna Maria D’Ursi
- Department
of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Salerno, Italy
| | - Luca Rastrelli
- NutriKeto_LAB
Unisa−“San Giuseppe Moscati” National Hospital
(AORN), Contrada Amoretta, 83100 Avellino, Avellino, Italy
- Department
of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Salerno, Italy
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Srivastava AK, Chand Yadav T, Khera HK, Mishra P, Raghuwanshi N, Pruthi V, Prasad R. Insights into interplay of immunopathophysiological events and molecular mechanistic cascades in psoriasis and its associated comorbidities. J Autoimmun 2021; 118:102614. [PMID: 33578119 DOI: 10.1016/j.jaut.2021.102614] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 02/07/2023]
Abstract
Psoriasis is an inflammatory skin disease with complex pathogenesis and multiple etiological factors. Besides the essential role of autoreactive T cells and constellation of cytokines, the discovery of IL-23/Th17 axis as a central signaling pathway has unraveled the mechanism of accelerated inflammation in psoriasis. This has provided insights into psoriasis pathogenesis and revolutionized the development of effective biological therapies. Moreover, genome-wide association studies have identified several candidate genes and susceptibility loci associated with this disease. Although involvement of cellular innate and adaptive immune responses and dysregulation of immune cells have been implicated in psoriasis initiation and maintenance, there is still a lack of unifying mechanism for understanding the pathogenesis of this disease. Emerging evidence suggests that psoriasis is a high-mortality disease with additional burden of comorbidities, which adversely affects the treatment response and overall quality of life of patients. Furthermore, changing trends of psoriasis-associated comorbidities and shared patterns of genetic susceptibility, risk factors and pathophysiological mechanisms manifest psoriasis as a multifactorial systemic disease. This review highlights the recent progress in understanding the crucial role of different immune cells, proinflammatory cytokines and microRNAs in psoriasis pathogenesis. In addition, we comprehensively discuss the involvement of various complex signaling pathways and their interplay with immune cell markers to comprehend the underlying pathophysiological mechanism, which may lead to exploration of new therapeutic targets and development of novel treatment strategies to reduce the disastrous nature of psoriasis and associated comorbidities.
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Affiliation(s)
- Amit Kumar Srivastava
- Department of Biotechnology, Indian Institute of Technology Roorkee, Roorkee, 247667, Uttarakhand, India
| | - Tara Chand Yadav
- Department of Biotechnology, Indian Institute of Technology Roorkee, Roorkee, 247667, Uttarakhand, India
| | - Harvinder Kour Khera
- Tata Institute for Genetics and Society, Centre at InStem, Bangalore, 560065, Karnataka, India; Division of Biological Sciences, University of California, San Diego, La Jolla, CA, 92093, United States
| | - Purusottam Mishra
- Department of Biotechnology, Indian Institute of Technology Roorkee, Roorkee, 247667, Uttarakhand, India
| | - Navdeep Raghuwanshi
- Vaccine Formulation & Research Center, Gennova (Emcure) Biopharmaceuticals Limited, Pune, 411057, Maharashtra, India
| | - Vikas Pruthi
- Department of Biotechnology, Indian Institute of Technology Roorkee, Roorkee, 247667, Uttarakhand, India
| | - Ramasare Prasad
- Department of Biotechnology, Indian Institute of Technology Roorkee, Roorkee, 247667, Uttarakhand, India.
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25
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Fu H, Tang Z, Wang Y, Ding X, Rinaldi G, Rahmani J, Xing F. Relationship Between Vitamin D Level and Mortality in Adults With Psoriasis: A Retrospective Cohort Study of NHANES Data. Clin Ther 2020; 43:e33-e38. [PMID: 33358542 DOI: 10.1016/j.clinthera.2020.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Studies have shown an increased risk for mortality in patients with psoriasis. Furthermore, research has demonstrated an inverse relationship between 25-hydroxyvitamin D (25[OH]D) level and all-cause mortality. This study investigated the association between 25(OH)D level and all-cause mortality in US adults with psoriasis. METHODS Data from NHANES (1999-2014 and mortality data through December 31, 2015) were analyzed. Quartiles of 25(OH)D level were created based on 25(OH)D levels among patients. Cox proportional hazards models were used for estimating hazard ratios (95% CI) for all-cause mortality. FINDINGS A total of 82,091 participants were enrolled in the NHANES study from 1999 to 2014. Overall, 610 patients with psoriasis were identified in NHANES. The mean (SD) duration of follow-up was 5.61 (3.38) years (3427.92 person-years). The hazard ratio for mortality in the fully adjusted model was 0.12 (95% CI, 0.02-0.60; Ptrend = 0.01) in patients with a high 25(OH)D concentration compared to those with 25(OH)D deficiency. IMPLICATIONS The 25(OH)D concentration was significantly inversely associated with all-cause mortality among these patients with psoriasis. Studies have shown an increased risk for mortality in patients with psoriasis compared to the general population. Vitamin D is not regularly metabolized in patients with psoriasis due to their skin abnormality. Vitamin D supplementation has been associated with a reduced mortality in patients with psoriasis. In practice, attention to vitamin D level is crucial, as is the use of vitamin D supplementation, for improving the health of these patients.
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Affiliation(s)
- Hongyang Fu
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhiming Tang
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yihan Wang
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xueying Ding
- College of Basic Medical Science of Zhejiang Chinese Medical University, Hangzhou, China
| | - Giulia Rinaldi
- Guys and St. Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Jamal Rahmani
- Department of Community Nutrition, Faculty of Nutrition and Food, Technology, National Nutrition, And Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fengling Xing
- Department of Dermatology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China.
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Zong J, Cheng J, Fu Y, Song J, Pan W, Yang L, Zhang T, Zhou M. Serum Metabolomic Profiling Reveals the Amelioration Effect of Methotrexate on Imiquimod-Induced Psoriasis in Mouse. Front Pharmacol 2020; 11:558629. [PMID: 33364938 PMCID: PMC7751755 DOI: 10.3389/fphar.2020.558629] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 10/12/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The imiquimod (IMQ)-induced psoriasis mouse model has been used as a model for pathogenic mechanism research, and methotrexate (MTX) is widely employed to treat various clinical manifestations of psoriasis. We explored the underlying pathogenesis of psoriasis and the treatment mechanism of the conventional drugs from the metabolic perspective of the psoriasis mouse model. METHODS Male BALB/c mice were smeared IMQ for 7 days to induce treatment-resistant psoriasis and intragastrically administered 1 mg/kg MTX. We evaluated inflammation of psoriasis-like lesions and therapeutic effects of MTX based on histological changes and immunohistochemistry. Based on gas chromatography-mass spectrometer detection of serum samples, a comprehensive metabolomics analysis was carried out to identify alterations of metabolites. RESULTS It was found that MTX ameliorated psoriatic lesions (representative erythema, scaling, and thickening) by inhibiting proliferation and differentiation of keratinocytes. Using multivariate statistical analysis to process metabolomics data, the results displayed alterations in serum metabolites among mice of the control group, IMQ group, and MTX group. Compared with group, psoriasis mice had the higher level of d-galactose and lower expression of myo-inositol, 9,12-octadecadienoic acid, and cholesterol. In contrast with the model set, serum levels of glycine, pyrrolidone carboxylic acid, d-galactose, and d-mannose were significantly decreased in the MTX group. CONCLUSION The differential metabolites, reflecting the perturbation in the pathways of inositol phosphate metabolism; galactose metabolism; glyoxylate and dicarboxylate metabolism; glycine, serine, and threonine metabolism; and glutathione metabolism, may lead to the pathogenesis of psoriasis, and they are also related to the pharmacological treatment effect of MTX on psoriasis. This study established the foundation for further research on the mechanism and therapeutic targets of psoriasis.
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Affiliation(s)
- Jiaxin Zong
- Murad Research Center for Modernized Chinese Medicine, Institute for Interdisciplinary Medicine Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jieyi Cheng
- Center for Chinese Medicine Therapy and Systems Biology, Institute for Interdisciplinary Medicine Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuanfeng Fu
- Murad Research Center for Modernized Chinese Medicine, Institute for Interdisciplinary Medicine Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jing Song
- Center for Chinese Medicine Therapy and Systems Biology, Institute for Interdisciplinary Medicine Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Weisong Pan
- Guangzhou Institute for Drug Control, Guangzhou, China
| | - Li Yang
- Center for Chinese Medicine Therapy and Systems Biology, Institute for Interdisciplinary Medicine Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ting Zhang
- Murad Research Center for Modernized Chinese Medicine, Institute for Interdisciplinary Medicine Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mingmei Zhou
- Center for Chinese Medicine Therapy and Systems Biology, Institute for Interdisciplinary Medicine Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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27
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Barrea L, Megna M, Cacciapuoti S, Frias-Toral E, Fabbrocini G, Savastano S, Colao A, Muscogiuri G. Very low-calorie ketogenic diet (VLCKD) in patients with psoriasis and obesity: an update for dermatologists and nutritionists. Crit Rev Food Sci Nutr 2020; 62:398-414. [PMID: 32969257 DOI: 10.1080/10408398.2020.1818053] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Psoriasis is a chronic skin immune-mediated disease with systemic pro-inflammatory activation; both genetic and lifestyles factors contribute to its pathogenesis and severity. In this context, nutrition plays a significant role, per se, in psoriasis' pathogenesis. Obesity is another important risk factor for psoriasis, and weight reduction may improve psoriasis' clinical severity. The excess body weight, particularly visceral fat mass, can affect both drug's pharmacokinetics and pharmacodynamics. Therefore, psoriasis and obesity share a certain degree of synergy, and the chronic inflammatory state represents the basis of this vicious cycle. Evidence reported that nutrition has different impact on the clinical severity of psoriasis, though some specific diets have been more investigated in clinical studies compared to others. Diets with systemic anti-inflammatory properties seem to have a higher effect on improving the clinical severity of psoriasis. Of interest, very-low-calorie ketogenic diet (VLCKD), through the production of ketone bodies, has been associated with both a significant reduction of body weight and inflammatory state. VLCKD leading to both weight loss and reduction of systemic inflammation may decrease the exacerbation of the clinical manifestations or even it may block the trigger of psoriatic disease. This dietary pattern could represent a potential first-line treatment in psoriatic patients with obesity. The review aims to summarize the current evidence regarding VLCKD and psoriasis with specific reference to antioxidant and anti-inflammatory effects of this dietary pattern.
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Affiliation(s)
- Luigi Barrea
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Naples, Italy.,Department of Clinical Medicine and Surgery, Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Endocrinology Unit, University Medical School of Naples, Naples, Italy
| | - Matteo Megna
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Sara Cacciapuoti
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Evelyn Frias-Toral
- Research Committee, SOLCA Guayaquil, Guayaquil, Ecuador.,Clinical Research Associate Professor for Palliative Care Residency, Universidad Católica Santiago de Guayaquil, Guayaquil, Ecuador
| | - Gabriella Fabbrocini
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Silvia Savastano
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Naples, Italy.,Department of Clinical Medicine and Surgery, Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Endocrinology Unit, University Medical School of Naples, Naples, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Naples, Italy.,Department of Clinical Medicine and Surgery, Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Endocrinology Unit, University Medical School of Naples, Naples, Italy.,Cattedra Unesco "Educazione alla salute e allo sviluppo sostenibile", University Federico II, Naples, Italy
| | - Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Naples, Italy.,Department of Clinical Medicine and Surgery, Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Endocrinology Unit, University Medical School of Naples, Naples, Italy
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28
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Theodoridis X, Grammatikopoulou MG, Stamouli EM, Talimtzi P, Pagkalidou E, Zafiriou E, Haidich AB, Bogdanos DP. Effectiveness of oral vitamin D supplementation in lessening disease severity among patients with psoriasis: A systematic review and meta-analysis of randomized controlled trials. Nutrition 2020; 82:111024. [PMID: 33183899 DOI: 10.1016/j.nut.2020.111024] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/01/2020] [Accepted: 09/09/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Many treatment modalities have been used to manage psoriasis; however, there is, to our knowledge, no pooled estimate for the effectiveness of oral vitamin D supplements in patients with psoriasis. Hence, the aim of the present study was to systematically review and meta-analyze the efficacy of oral vitamin D supplementation in lessening disease severity of patients with psoriasis. METHODS A systematic literature review was performed on the electronic databases PubMed, Embase, and Cochrane Central and the gray literature for retrieving randomized controlled trials comparing oral vitamin D supplementation with placebo. The primary outcome was the change of Psoriasis Area and Severity Index (PASI) score. We used the random effects model for synthesizing the evidence. RESULTS Of the total 5018 search results, 4 studies were included in the qualitative and 3 studies in quantitative analysis. Vitamin D supplementation was effective in ameliorating the PASI score after 6 mo of intervention (mean difference [MD] = -0.92, 95% confidence interval [CI] = -1.72 to -0.11). However, after the Hartung-Knapp adjustment, the results became non-significant (MD = -0.92, 95% CI = -2.21 to 0.38). CONCLUSIONS A favorable effect of oral vitamin D supplementation in patients with psoriasis could not be verified. More randomized controlled trials with larger sample sizes are needed to produce robust results.
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Affiliation(s)
- Xenophon Theodoridis
- Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
| | - Maria G Grammatikopoulou
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Eleni-Maria Stamouli
- Department of Biological Sciences, University of Edinburgh, Medical School, Edinburgh, UK
| | - Persefoni Talimtzi
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eirini Pagkalidou
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efterpi Zafiriou
- Department of Dermatology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Anna-Bettina Haidich
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios P Bogdanos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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29
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Tsigalou C, Vallianou N, Dalamaga M. Autoantibody Production in Obesity: Is There Evidence for a Link Between Obesity and Autoimmunity? Curr Obes Rep 2020; 9:245-254. [PMID: 32632847 DOI: 10.1007/s13679-020-00397-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW During the last decades, obesity and autoimmune disorders have shown a parallel significant rise in industrialized countries. This review aims at providing a comprehensive update of the relationship between the adipose tissue in obesity and autoimmune disorders, highlighting the underlying mechanisms with a particular emphasis on adipokines and pro-inflammatory cytokines, the impaired B cell activity, and the production of natural and pathogenic autoantibody repertoire in the context of obesity. RECENT FINDINGS Obesity is related to a higher risk of rheumatoid arthritis, psoriasis and psoriatic arthritis, multiple sclerosis, and Hashimoto's thyroiditis, while it may promote inflammatory bowel disorders and type 1 diabetes mellitus. Interestingly, subjects with obesity present more severe forms of these autoimmune disorders as well as decreased therapeutic response. Both obesity and autoimmune disorders present elevated levels of leptin, resistin, and visfatin. Autoantibody production, a hallmark of autoimmune disorders, has been demonstrated in obese animal models and human subjects. Obesity results in deficiencies of the human self-tolerance mechanisms by promoting pro-inflammatory processes, reducing Bregs as well as Tregs, and the latter resulting in increased Th17 and Th1 cells, creating the perfect milieu for the development of autoimmune disorders. More mechanistic, animal, and clinical studies are required to delineate the exact mechanisms underlying auto-reactivity in obesity as well as the adipose-immune crosstalk for potential successful therapeutic strategies.
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Affiliation(s)
- Christina Tsigalou
- Laboratory of Microbiology, Medical School, Democritus University of Thrace, 6th Km Alexandroupolis-Makri, Alexandroupolis, Greece.
| | - Natalia Vallianou
- Department of Endocrinology, 'Evangelismos' General Hospital of Athens, 45-47 Ypsilantou street, 10676, Athens, Greece
| | - Maria Dalamaga
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Goudi, 11527, Athens, Greece
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30
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Owczarczyk-Saczonek A, Purzycka-Bohdan D, Nedoszytko B, Reich A, Szczerkowska-Dobosz A, Bartosiñska J, Batycka-Baran A, Czajkowski R, Dobrucki IT, Dobrucki LW, Górecka-Sokołowska M, Janaszak-Jasiecka A, Kalinowski L, Krasowska D, Radulska A, Reszka E, Samotij D, Słominski A, Słominski R, Sobalska-Kwapis M, Stawczyk-Macieja M, Strapagiel D, Szczêch J, Żmijewski M, Nowicki RJ. Pathogenesis of psoriasis in the "omic" era. Part III. Metabolic disorders, metabolomics, nutrigenomics in psoriasis. Postepy Dermatol Alergol 2020; 37:452-467. [PMID: 32994764 PMCID: PMC7507147 DOI: 10.5114/ada.2020.98284] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/28/2020] [Indexed: 12/15/2022] Open
Abstract
Psoriasis is a systemic disease that is strictly connected with metabolic disorders (insulin resistance, atherogenic dyslipidemia, arterial hypertension, and cardiovascular diseases). It occurs more often in patients with a more severe course of the disease. Obesity is specially an independent risk factor and it is associated with a worse treatment outcome because of the high inflammatory activity of visceral fatty tissue and the production of inflammatory mediators involved in the development of both psoriasis and metabolic disorders. However, in psoriasis the activation of the Th17/IL-17 and the abnormalities in the Th17/Treg balance axis are observed, but this pathomechanism does not fully explain the frequent occurrence of metabolic disorders. Therefore, there is a need to look for better biomarkers in the diagnosis, prognosis and monitoring of concomitant disorders and therapeutic effects in psoriasis. In addition, the education on the use of a proper diet as a prophylaxis for the development of the above disorders is an important element of holistic care for a patient with psoriasis. Diet may affect gene expression due to epigenetic modification which encompasses interactions of environment, nutrition and diseases. Patients with psoriasis should be advised to adopt proper diet and dietician support.
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Affiliation(s)
- Agnieszka Owczarczyk-Saczonek
- Chair and Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Dorota Purzycka-Bohdan
- Chair and Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Bogusław Nedoszytko
- Chair and Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Adam Reich
- Department of Dermatology, University of Rzeszow, Rzeszow, Poland
| | - Aneta Szczerkowska-Dobosz
- Chair and Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Joanna Bartosiñska
- Chair and Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - Aleksandra Batycka-Baran
- Chair and Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Rafał Czajkowski
- Chair and Department of Dermatology, Sexually Transmitted Diseases and Immunodermatology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Iwona T. Dobrucki
- Beckman Institute for Advanced Science and Technology, Urbana, IL, USA
| | - Lawrence W. Dobrucki
- Beckman Institute for Advanced Science and Technology, Urbana, IL, USA
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Medical Laboratory Diagnostics, Medical University of Gdansk, Gdansk, Poland
- Biobanking and Biomolecular Resources Research Infrastructure Poland (BBMRI.PL), Gdansk, Poland
| | | | - Anna Janaszak-Jasiecka
- Department of Medical Laboratory Diagnostics, Medical University of Gdansk, Gdansk, Poland
| | - Leszek Kalinowski
- Department of Medical Laboratory Diagnostics, Medical University of Gdansk, Gdansk, Poland
- Department of Molecular Genetics and Epigenetics, Nofer Institute of Occupational Medicine, Lodz, Poland
- Gdansk University of Technology, Gdansk, Poland
| | - Dorota Krasowska
- Chair and Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - Adrianna Radulska
- Department of Pharmaceutical Biochemistry, Medical University of Gdansk, Gdansk, Poland
| | - Edyta Reszka
- Department of Molecular Genetics and Epigenetics, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Dominik Samotij
- Department of Dermatology, University of Rzeszow, Rzeszow, Poland
| | - Andrzej Słominski
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, USA
| | - Radomir Słominski
- Department of Medicine and Microbiology, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, USA
| | | | - Marta Stawczyk-Macieja
- Chair and Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
| | | | - Justyna Szczêch
- Department of Dermatology, University of Rzeszow, Rzeszow, Poland
| | - Michał Żmijewski
- Department of Histology, Medical University of Gdansk, Gdansk, Poland
| | - Roman J. Nowicki
- Chair and Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
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Tsigalou C, Konstantinidis T, Paraschaki A, Stavropoulou E, Voidarou C, Bezirtzoglou E. Mediterranean Diet as a Tool to Combat Inflammation and Chronic Diseases. An Overview. Biomedicines 2020; 8:E201. [PMID: 32650619 PMCID: PMC7400632 DOI: 10.3390/biomedicines8070201] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 12/17/2022] Open
Abstract
Since ancient times, the quality of nourishment is a milestone for the maintenance of health and as it is stated 'prevention is better than cure', amongst the so-called 'healthy' diets Mediterranean diet (MD) claims the lion's share. It stands in good stead because of a variety of valuable macro- and micronutrients. So, adherence to a MD is associated with the reduction of inflammation and non-communicable (NCD) OR chronic diseases. Numerous studies try to scrutinize the role of MD components as regards reducing inflammation, lowering rate, and mortality for disorders and illnesses, and preventing NCD. MD regime of the inhabitants of the Mediterranean basin includes a variety of ethnic nutritional habits and regulates an array of effects and epigenetic changes that affect human wellbeing. The research is still ongoing and endeavors to elucidate every aspect of this issue. This review focuses on the impact of MD on inflammation highlights positive results regarding NCD and indicates the need for more high-quality experiments and trials in order to overcome any discrepancies.
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Affiliation(s)
- Christina Tsigalou
- Laboratory of Microbiology, Medical School, Democritus University of Thrace, 68100 Dragana, Alexandroupolis, Greece; (T.K.); (A.P.)
| | - Theocharis Konstantinidis
- Laboratory of Microbiology, Medical School, Democritus University of Thrace, 68100 Dragana, Alexandroupolis, Greece; (T.K.); (A.P.)
| | - Afroditi Paraschaki
- Laboratory of Microbiology, Medical School, Democritus University of Thrace, 68100 Dragana, Alexandroupolis, Greece; (T.K.); (A.P.)
| | - Elisavet Stavropoulou
- Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon, Vaud, CH-1011 Lausanne, Switzerland;
| | | | - Eugenia Bezirtzoglou
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, 68100 Dragana, Alexandroupolis, Greece;
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Polo TCF, Corrente JE, Miot LDB, Papini SJ, Miot HA. Dietary patterns of patients with psoriasis at a public healthcare institution in Brazil. An Bras Dermatol 2020; 95:452-458. [PMID: 32471756 PMCID: PMC7335888 DOI: 10.1016/j.abd.2020.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 02/03/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Psoriasis is a chronic inflammatory disease with systemic repercussions and an association with comorbidities such as metabolic syndrome, cardiovascular diseases, and obesity. Psoriasis patients have a higher prevalence of obesity compared to the general population. Diet is a relevant environmental factor, since malnutrition, inadequate body weight, and metabolic diseases, in addition to the direct health risk, impair the treatment of psoriasis. OBJECTIVES To evaluate food intake patterns, anthropometric, and metabolic syndrome-related aspects in psoriasis patients. METHODS Cross-sectional study through anthropometric assessment and food frequency questionnaire. Food frequency questionnaire items were evaluated by exploratory factor analysis and identified dietary patterns were analyzed by multivariate methods. RESULTS This study evaluated 94 patients, 57% female, with a mean age of 54.9 years; the prevalence of obesity was 48% and of metabolic syndrome, 50%. Factor analysis of the food frequency questionnaire identified two dietary patterns: Pattern 1 - predominance of processed foods; Pattern 2 - predominance of fresh foods. Multivariate analysis revealed that Patterns 1 and 2 showed inverse behaviors, and greater adherence to Pattern 2 was associated with females, eutrophic individuals, absence of lipid and blood pressure alterations, and lower waist-to-hip ratio and skin disease activity. STUDY LIMITATIONS Monocentric study conducted at a public institution, dependent on dietary memory. CONCLUSION Two dietary patterns were identified in a Brazilian sample of psoriasis patients. The prevalence of obesity and metabolic syndrome were greater than in the adult Brazilian population. The fresh diet was associated with lower indicators of metabolic syndrome in this sample.
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Affiliation(s)
| | - José Eduardo Corrente
- Department of Biostatistics, Instituto de Biociências de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Luciane Donida Bartoli Miot
- Department of Dermatology and Radiotherapy, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Silvia Justina Papini
- Department of Nursing, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Hélio Amante Miot
- Department of Dermatology and Radiotherapy, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil.
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Del Alcázar E, Suárez-Pérez JA, Armesto S, Rivera R, Herrera-Acosta E, Herranz P, Martín I, Montesinos E, Hospital M, Vilarrasa E, Ferran M, Ruiz-Villaverde R, Sahuquillo-Torralba A, Ruiz-Genao DP, Pérez-Barrio S, Muñoz C, Llamas M, Valentí F, Mitxelena MJ, López-Ferrer A, Carretero G, Vidal D, Mollet J, Belinchón I, Carrascosa JM. Real-world effectiveness and safety of apremilast in psoriasis at 52 weeks: a retrospective, observational, multicentre study by the Spanish Psoriasis Group. J Eur Acad Dermatol Venereol 2020; 34:2821-2829. [PMID: 32271966 DOI: 10.1111/jdv.16439] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/16/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Little has been published on the real-world effectiveness and safety of apremilast in psoriasis. OBJECTIVES To evaluate the effectiveness, safety and drug survival of apremilast at 52 weeks in patients with moderate to severe plaque psoriasis or palmoplantar psoriasis in routine clinical practice. METHODS Retrospective, multicentre study of adult patients with moderate to severe plaque psoriasis or palmoplantar psoriasis treated with apremilast from March 2016 to March 2018. RESULTS We studied 292 patients with plaque psoriasis and 85 patients with palmoplantar psoriasis. The mean (SD) Psoriasis Area and Severity Index (PASI) score was 10.7 (7.0) at baseline and 3.0 (4.2) at 52 weeks. After 12 months of treatment, 73.6% of patients had a PASI score of 3 or less. In terms of relative improvement by week 52, 49.7% of patients achieved PASI-75 (≥75% reduction in PASI score) and 26.5% achieved PASI-90. The mean physician global assessment score for palmoplantar psoriasis fell from 4.2 (5.2) at baseline to 1.3 (1.3) at week 52. Overall drug survival after 1 year of treatment with apremilast was 54.9 %. The main reasons for treatment discontinuation were loss of efficacy (23.9%) and adverse events (15.9%). Almost half of the patients in our series (47%) experienced at least one adverse event. The most common events were gastrointestinal problems. CONCLUSIONS Apremilast may be a suitable alternative for the treatment of moderate to severe psoriasis and palmoplantar psoriasis. Although the drug has a good safety profile, adverse gastrointestinal effects are common.
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Affiliation(s)
- E Del Alcázar
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Badalona, Spain
| | - J A Suárez-Pérez
- Department of Dermatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - S Armesto
- Department of Dermatology, Hospital Universitario de Valdecilla, Santander, Spain
| | - R Rivera
- Department of Dermatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E Herrera-Acosta
- Department of Dermatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - P Herranz
- Department of Dermatology, Hospital Universitario La Paz, Madrid, Spain
| | - I Martín
- Department of Dermatology, Hospital Universitario Getafe, Madrid, Spain
| | - E Montesinos
- Department of Dermatology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - M Hospital
- Department of Dermatology, Hospital Universitario Puerta de Hierro Majadahonda Madrid, Spain
| | - E Vilarrasa
- Department of Dermatology, Hospital Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - M Ferran
- Department of Dermatology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - R Ruiz-Villaverde
- Department of Dermatology, Hospital Universitario San Cecilio, Granada, Spain
| | - A Sahuquillo-Torralba
- Department of Dermatology, Hospital Universitario y Politécnico La Fe - Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - D P Ruiz-Genao
- Department of Dermatology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - S Pérez-Barrio
- Department of Dermatology, Hospital Universitario Basurto, Bilbao, Spain
| | - C Muñoz
- Department of Dermatology, Hospital de Granollers, Granollers, Spain
| | - M Llamas
- Department of Dermatology, Hospital Universitario La Princesa, Madrid, Spain
| | - F Valentí
- Department of Dermatology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - M J Mitxelena
- Department of Dermatology, Hospital Universitario de Navarra, Pamplona, Spain
| | - A López-Ferrer
- Department of Dermatology, Hospital Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - G Carretero
- Department of Dermatology, Hospital Universitario Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - D Vidal
- Department of Dermatology, Hospital Moisès Broggi, Sant Joan Despí, Spain
| | - J Mollet
- Department of Dermatology, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - I Belinchón
- Department of Dermatology, Hospital Universitario de Alicante -ISABIAL, UMH Alicante, Alicante, Spain
| | - J M Carrascosa
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Badalona, Spain
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Colls-Gonzalez M, Notario-Rosa J, Bas-Minguet J, Padullés-Zamora A, Morandeira-Rego F, Valentí-Medina F, Colom-Codina H, Padullés-Zamora N. Association between infliximab concentrations and clinical response in psoriasis: a prospective cohort study. J DERMATOL TREAT 2019; 32:180-187. [PMID: 31696747 DOI: 10.1080/09546634.2019.1690623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Infliximab (IFX) trough concentrations (Cmin) have been linked to treatment efficacy in psoriatic patients. Inter-individual IFX Cmin variability and factors influencing IFX pharmacokinetics could explain differences in treatment response. OBJECTIVE To evaluate the association between IFX Cmin and clinical outcomes in psoriatic patients. METHODS Prospective study of 33 patients with moderate to severe psoriasis receiving IFX at Bellvitge University Hospital, between October 2013 and November 2016. IFX Cmin and antibodies toward infliximab (ATI) were measured. RESULTS We collected 155 IFX Cmin and ATI values (mean age, 46 (14) years; 11 (33.3%) women). Mean IFX Cmin was 2.5 (2.4) mg/L and ATIs were detected in six patients, resulting in undetectable IFX Cmin. IFX Cmin was significantly associated with ATI and body mass index (BMI) (β -2.51, 95% CI -3.56 to -1.4 and β -0.05, 95% CI -0.09 to -0.01). PASI score and PASI 90/100 response were significantly associated with IFX Cmin (IRR 0.80, 95% CI 0.70 to 0.92; OR 1.79, 95% CI 1.18 to 2.71 and OR 1.79, 95% CI 1.14 to 2.81). CONCLUSION IFX Cmin significantly influences PASI 90/100 response rates. IFX Cmin wa significantly associated with ATI and BMI. The observed inter-individual variability in IFX Cmin supports the need for IFX drug monitoring.
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Affiliation(s)
- M Colls-Gonzalez
- Department of Pharmacy, Hospital Universitari de Bellvitge, Pharmacotherapy, Pharmacogenetics and Pharmaceutical Technology Program, Institut D'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - J Notario-Rosa
- Department of Dermatology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - J Bas-Minguet
- Department of Immunology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - A Padullés-Zamora
- Department of Pharmacy, Hospital Universitari de Bellvitge, Pharmacotherapy, Pharmacogenetics and Pharmaceutical Technology Program, Institut D'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - F Morandeira-Rego
- Department of Immunology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - F Valentí-Medina
- Department of Dermatology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - H Colom-Codina
- Pharmacy and Pharmaceutical Technology Department, School of Pharmacy, Universitat de Barcelona - UB, Pharmacotherapy, Pharmacogenetics and Pharmaceutical Technology Program, Institut D'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - N Padullés-Zamora
- Department of Pharmacy, Hospital Universitari de Bellvitge, Pharmacotherapy, Pharmacogenetics and Pharmaceutical Technology Program, Institut D'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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Gerdes S, Pinter A, Papavassilis C, Reinhardt M. Effects of secukinumab on metabolic and liver parameters in plaque psoriasis patients. J Eur Acad Dermatol Venereol 2019; 34:533-541. [PMID: 31599476 PMCID: PMC7065121 DOI: 10.1111/jdv.16004] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 09/13/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Psoriasis is associated with metabolic, liver and cardiovascular comorbidity. Secukinumab, a fully human monoclonal antibody that selectively neutralizes interleukin-17A, has shown significant and sustained efficacy in the treatment of moderate to severe psoriasis. OBJECTIVES This was an exploratory post hoc analysis of pooled data from three phase 3 studies in plaque psoriasis patient populations. The objective was to show the course of metabolic and liver parameters under secukinumab, etanercept or placebo treatment over time. A further objective was to assess the impact of selected comorbidities and metabolic characteristics on high-sensitivity C-reactive protein (hs-CRP), as a surrogate marker of systemic inflammation. METHODS Data from the phase 3 randomized controlled trials [FIXTURE (NCT01358578), ERASURE (NCT01365455) and SCULPTURE (NCT01406938); n = 3010] were included in this analysis. Patients were treated with secukinumab 150 mg or 300 mg, placebo or etanercept 50 mg (FIXTURE only) as active comparator. A set of metabolic and liver parameters was longitudinally assessed over 52 weeks. Multivariate regression analyses assessed the impact of selected comorbidities and metabolic characteristics on hs-CRP levels at baseline and under treatment. RESULTS Secukinumab treatment reduced hs-CRP levels. Body weight and uric acid levels tended to decrease over 52 weeks with secukinumab. Secukinumab showed a neutral effect on fasting plasma glucose, lipid parameters and liver enzymes. Psoriatic arthritis, metabolic syndrome, obesity, impaired glucose metabolism, and hyperuricemia were each associated with increased hs-CRP levels at baseline. Concomitant obesity attenuated the decline in hs-CRP under treatment. CONCLUSIONS These analyses suggest neutral to favourable long-term trends in metabolic and liver parameters under secukinumab treatment. Metabolic comorbidities were associated with increased hs-CRP levels, reflecting the role of systemic inflammatory processes in their pathophysiology.
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Affiliation(s)
- S Gerdes
- Psoriasis-Center, Department of Dermatology, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - A Pinter
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - M Reinhardt
- Novartis Pharma AG, Basel, Switzerland.,Novartis Pharma GmbH, Nürnberg, Germany
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Schwarz PEH, Pinter A, Melzer N, Barteczek P, Reinhardt M. ERAPSO: Revealing the High Burden of Obesity in German Psoriasis Patients. Dermatol Ther (Heidelb) 2019; 9:579-587. [PMID: 31297711 PMCID: PMC6704194 DOI: 10.1007/s13555-019-0314-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Plaque psoriasis is a chronic, systemic-inflammatory disease characterized by skin erythema, plaques and scaling, and is associated with different comorbidities like psoriatic arthritis, obesity, and cardiometabolic diseases. Obesity aggravates cardiovascular risk in psoriasis patients and can negatively affect psoriasis disease severity with proinflammatory adipocytokine production by adipocytes and infiltrated immune cells. METHODS An online survey on nutrition and physical activity in psoriasis participants (ERAPSO) collected cross-sectional data about eating behavior, physical activity, and prevalence of obesity and metabolic syndrome components from 9940 psoriasis participants in Germany. RESULTS ERAPSO revealed a high burden of obesity in German psoriasis participants with 66.9% overweight or obese (body mass index [BMI] ≥ 25 kg/m2), compared to approximately 50% of the German general population. Affected body surface area (BSA), cardiovascular risk factors, and cardiovascular event frequency increased with increasing BMI. Severe psoriasis was more frequent in overweight participants and impaired engagement in weight loss diets and physical activity. Most German psoriasis participants (90.2%) with BMI ≥ 25 kg/m2 perceived themselves as overweight. A minority (21.2%) were currently exercising with the aim of losing weight, and 12.6% were currently on a weight loss diet. In overweight participants, just 13.3% stated that their physicians and/or health insurance offered specific weight loss programs. CONCLUSION ERAPSO revealed inadequate medical care of obese psoriasis participants with insufficient support for weight loss through diet or increased physical activity. Although psoriasis participants showed an intact self-perception of obesity, they seemed to lack intrinsic motivation to lose weight, highlighting the need for external support in losing weight via tailored programs. Since psoriasis severity correlates with impairment in diets and sports, treating psoriasis adequately may allow participants to follow weight loss programs more successfully. FUNDING Novartis Pharma GmbH, Nuremberg, DE.
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Affiliation(s)
| | - Andreas Pinter
- University Hospital Frankfurt, Frankfurt am Main, Germany
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Miao C, Li J, Li Y, Zhang X. Obesity and dyslipidemia in patients with psoriasis: A case-control study. Medicine (Baltimore) 2019; 98:e16323. [PMID: 31374004 PMCID: PMC6709019 DOI: 10.1097/md.0000000000016323] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 12/17/2022] Open
Abstract
The aim of this study was to conduct a more comprehensive analysis of the association between psoriasis and abnormal lipid metabolism.The case-control study included 222 psoriatic patients and 445 non-psoriatic control patients matched for age and gender. Clinical parameters included age, gender, and body mass index (BMI). Serum lipid levels were recorded and included cholesterol (CHO), triglycerides (TG), low-density lipoprotein (LDL), high density lipoprotein (HDL), phospholipids (PLIP), free fatty acids (FFA), lipoprotein (a) [Lp(a)], and apolipoproteins (apoA1, apoB, and apoE). Statistical analysis was carried out through the IBM Statistical Package for the Social Studies version 23.0.Compared with controls, levels of BMI and the prevalence of obesity were significantly higher in psoriatic patients. The results revealed that when compared to controls, significant elevation of serum TG (P <.001) and Lp(a) (P = .022) was observed. Levels of HDL (P <.001) and apoA1 (P <.001) were significantly lower in psoriatic patients. There was no significant difference in CHO (P = .367), LDL (P = .400), apoB (P = .294), apoE (P = .05), PLIP (P = .931) and FFA (P = .554) between patients and controls. The levels of CHO, TG, PLIP, FFA, and apoE were positively correlated with BMI level.Dyslipidemia was more common in psoriatic patients, compared with non-psoriatic controls.
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Affiliation(s)
- Chaoyang Miao
- Peking University China-Japan Friendship School of Clinical Medicine
| | - Jing Li
- The 306th Hospital of People's Liberation Army, Beijing, China
| | - Ying Li
- Peking University China-Japan Friendship School of Clinical Medicine
| | - Xiaoyan Zhang
- Peking University China-Japan Friendship School of Clinical Medicine
- China-Japan Friendship Hospital
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Kunz M, Simon JC, Saalbach A. Psoriasis: Obesity and Fatty Acids. Front Immunol 2019; 10:1807. [PMID: 31417571 PMCID: PMC6684944 DOI: 10.3389/fimmu.2019.01807] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/17/2019] [Indexed: 01/10/2023] Open
Abstract
Psoriasis is chronic inflammatory skin disease affecting skin, joints, cardiovascular system, brain, and metabolism. The pathogenesis of psoriasis is mediated by a complex interplay between the immune system, inflammatory mediators of different pathways, e.g., TNF-alpha and the IL-23/IL-17 pathways, psoriasis-associated susceptibility loci, autoantigens, and multiple environmental factors. Psoriasis is triggered by the combination of genetic and environmental factors. A novel environmental risk factor with rising importance is obesity. Several studies proved that obesity is an independent risk factor for the onset and severity of psoriasis. Due to the dramatic increase of obesity worldwide this minireview focuses on obesity as a major environmental risk factor for psoriasis and the mechanisms of obesity-mediated exacerbation of psoriasis.
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Affiliation(s)
- Manfred Kunz
- Department of Dermatology, Venereology and Allergology, University of Leipzig, Leipzig, Germany
| | - Jan C Simon
- Department of Dermatology, Venereology and Allergology, University of Leipzig, Leipzig, Germany
| | - Anja Saalbach
- Department of Dermatology, Venereology and Allergology, University of Leipzig, Leipzig, Germany
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Pinter A, Gerdes S, Papavassilis C, Reinhardt M. Characterization of responder groups to secukinumab treatment in moderate to severe plaque psoriasis. J DERMATOL TREAT 2019; 31:769-775. [PMID: 31287332 DOI: 10.1080/09546634.2019.1626973] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: Secukinumab is a fully human monoclonal antibody that neutralizes interleukin-17A (IL-17A), a key cytokine involved in the development of psoriasis. Here, we characterized secukinumab treatment-responder profiles and identified baseline factors affecting response.Methods: Pooled phase 3 data from moderate to severe plaque psoriasis patients treated with secukinumab for 16 weeks (FIXTURE [NCT01358578], ERASURE [NCT01365455], and CLEAR [NCT02074982]) were analyzed to characterize responder groups, identifying factors associated with treatment response, and to evaluate early response kinetics as a biomarker for treatment response. Etanercept and ustekinumab were evaluated as comparators.Results: Patients treated with secukinumab 300 mg (n = 867), ustekinumab 45/90 mg (n = 318), and etanercept 50 mg (n = 298) were evaluated. For secukinumab 300 mg, more patients were in higher responder groups than etanercept and ustekinumab. In higher response groups, fewer patients had previous systemic or biologic treatment, metabolic syndrome, hypertension, diabetes, and fewer were current smokers. Mean body weight, waist circumference, and BMI decreased as response level increased. Early onset of response (PASI50 at Week 4 or 8) correlated with sustained efficacy at Week 16.Conclusions: Baseline factors, including weight and cardiometabolic status, were associated with response to secukinumab. Early onset of response may indicate treatment efficacy later on.
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Affiliation(s)
- Andreas Pinter
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Sascha Gerdes
- Psoriasis-Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Kiel, Germany
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Baran A, Kiluk P, Świderska M, Maciaszek M, Myśliwiec H, Flisiak I. Adipocyte Fatty Acid-Binding Protein as a Novel Marker of Psoriasis and Clinical Response to Acitretin. Lipids 2019; 54:445-452. [PMID: 31281982 DOI: 10.1002/lipd.12173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/23/2019] [Accepted: 05/28/2019] [Indexed: 01/04/2023]
Abstract
Psoriasis is a systemic disease associated with metabolic syndrome and cardiometabolic diseases. Adipocyte fatty acid-binding protein (A-FABP, FABP4) is a relevant mediator of lipid metabolism and several comorbidities development. Aim of the study was to explore the possible role of FABP4 in psoriasis and assess its relationship with disease activity, inflammation or metabolic disturbances, and impact of systemic treatment. Fasting blood samples were obtained from 33 patients with active plaque-type psoriasis before and after 12 weeks of therapy and from 11 healthy volunteers. Serum FABP4 concentrations were analyzed by the enzyme-linked immunosorbent assay (ELISA) and statistically analyzed for their correlations with clinical outcomes and the treatment introduced. Serum FABP4 levels were significantly increased in psoriatics compared to controls (p = 0.03). No relationship between the protein and psoriasis severity expressed through psoriasis area and severity index (PASI) was noted (p = 0.57). FABP4 did not correlate with CRP (p = 0.41), lipid profile, and body mass index (BMI) nor the glucose level or liver enzyme activity. FABP4 significantly correlated with morphotic blood elements. After total therapy, FABP4 did not statistically change (p = 0.07), but significantly decreased after administering acitretin (p = 0.03). FABP4 is a potential marker of psoriasis and clinical outcome after therapy with acitretin. Adipocyte-type FABP may be related to hematological disorders or obesity-mediated comorbidities in psoriasis.
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Affiliation(s)
- Anna Baran
- Department of Dermatology and Venereology Medical University of Bialystok, 15-540 Bialystok, Zurawia 14 St, Poland
| | - Paulina Kiluk
- Department of Dermatology and Venereology Medical University of Bialystok, 15-540 Bialystok, Zurawia 14 St, Poland
| | - Magdalena Świderska
- Department of Physiology, Medical University of Bialystok, 15-222 Bialystok, Mickiewicza 2C St, Poland
| | - Magdalena Maciaszek
- Department of Infectious Diseases and Hepatology Medical University of Bialystok, 15-540 Bialystok, Zurawia 14 St, Poland
| | - Hanna Myśliwiec
- Department of Dermatology and Venereology Medical University of Bialystok, 15-540 Bialystok, Zurawia 14 St, Poland
| | - Iwona Flisiak
- Department of Dermatology and Venereology Medical University of Bialystok, 15-540 Bialystok, Zurawia 14 St, Poland
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Baran A, Kiluk P, Maciaszek M, Świderska M, Flisiak I. Liver fatty acid-binding protein might be a predictive marker of clinical response to systemic treatment in psoriasis. Arch Dermatol Res 2019; 311:389-397. [PMID: 30993401 PMCID: PMC6546856 DOI: 10.1007/s00403-019-01917-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/08/2019] [Accepted: 03/21/2019] [Indexed: 12/13/2022]
Abstract
Fatty acid-binding proteins play an inconclusive role in lipid metabolism and cardiometabolic diseases (CMDs) which are closely related with psoriasis. Aim of the study was to investigate the diagnostic value of serum liver fatty acid-binding protein (FABP1) level and associations with disease severity, inflammation or metabolic parameters and influence of systemic treatment in psoriatic patients. The study included thirty-three patients with active plaque-type psoriasis and eleven healthy volunteers. Blood samples were obtained before and after 12 weeks of therapy with methotrexate and acitretin. Serum FABP1 concentrations were analyzed by the enzyme-linked immunosorbent assay. Statistical analysis was performed for correlation of FABP1 with anthropometric, metabolic or inflammatory indices and treatment used. Serum liver-type FABP levels were significantly increased in psoriatic patients compared to the controls (p < 0.001). No statistical correlations between FABP1 and PASI (p = 0.25) was noted, however patients with severe psoriasis had the highest level of FABP1. No significance with metabolic parameters was obtained, beside a positive significant relation with BMI after therapy (p = 0.03). Liver-type FABP significantly correlated with CRP (p = 0.01) and morphotic blood elements. Systemic treatment combined resulted in significant decrease of FABP1 (p = 0.04), regardless of the drug: p = 0.1 in acitretin group, p = 0.3 in methotrexate group. Liver-type FABP might be a novel marker of psoriasis and predictor of clinical response to systemic therapy. FABP1 could be involved in CMDs risk assessment and perhaps link psoriasis with hematological disorders.
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Affiliation(s)
- Anna Baran
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St, 15-540, Białystok, Poland.
| | - Paulina Kiluk
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St, 15-540, Białystok, Poland
| | - Magdalena Maciaszek
- Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Zurawia 14 St, 15-540, Białystok, Poland
| | - Magdalena Świderska
- Department of Physiology, Medical University of Bialystok, Mickiewicza 2C St, 15-222, Białystok, Poland
| | - Iwona Flisiak
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St, 15-540, Białystok, Poland
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Han JH, Lee JH, Han KD, Kim HN, Bang CH, Park YM, Lee JY, Kim TY. Increased risk of psoriasis in subjects with abdominal obesity: A nationwide population-based study. J Dermatol 2019; 46:695-701. [PMID: 31149744 DOI: 10.1111/1346-8138.14939] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 05/06/2019] [Indexed: 12/19/2022]
Abstract
Psoriasis is a chronic inflammatory skin disease known to be associated with a variety of systemic comorbidities, such as metabolic syndrome and obesity. Obesity represents a major comorbidity and has been suggested to be related to psoriasis. This nationwide population-based prospective cohort study was performed to investigate the impacts of body mass index (BMI) and waist circumference (WC) on psoriasis. We used the health check-up database and the study population consisted of subjects who had undergone health screening between January 2009 and December 2012. This study investigated patients newly diagnosed with psoriasis (International Classification of Disease, Tenth Revision, code L40) by dermatologists during the follow-up period (5.32 years), based on claims data. The total population consisted of 22 633 536 subjects, among whom 399 461 had newly developed psoriasis. Subjects with BMI of more than 30 had a higher risk of psoriasis (hazards ratio [HR], 1.118; 95% confidence interval [CI], 1.100-1.137) compared with the BMI 18.5-23 group. WC showed a dose-dependent association with psoriatic risk. Subjects with WC over 105 cm showed the highest risk of psoriasis (HR, 1.305; 95% CI, 1.261-1.349) compared with subjects with WC lower than 80/75 after adjusting for confounding factors, including BMI. The risk of psoriasis was highest in males with normal BMI and abdominal obesity (HR, 1.175; 95% CI, 1.150-1.200). Our study indicates that WC is a specific factor affecting psoriatic risk and highlights the association between abdominal obesity and psoriasis, thus increasing awareness of the role of abdominal obesity in the pathogenesis and comorbidities of psoriasis.
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Affiliation(s)
- Ju Hee Han
- Department of Dermatology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hyun Lee
- Department of Dermatology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung Do Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ha-Na Kim
- Department of Family Medicine, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Hwan Bang
- Department of Dermatology, Seoul St Mary's Hospital, Seoul, Korea
| | - Young Min Park
- Department of Dermatology, Seoul St Mary's Hospital, Seoul, Korea
| | - Jun Young Lee
- Department of Dermatology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae Yoon Kim
- Department of Dermatology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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43
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Biomarkers of Inflammation in Obesity-Psoriatic Patients. Mediators Inflamm 2019; 2019:7353420. [PMID: 31275060 PMCID: PMC6558610 DOI: 10.1155/2019/7353420] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 04/18/2019] [Indexed: 02/06/2023] Open
Abstract
Psoriasis is a common chronic inflammatory multisystemic disease with a complex pathogenesis consisting of genetic, immunological, and environmental components. It is associated with a number of comorbidities, including diabetes, metabolic syndrome, obesity, and myocardial infarction. In addition, the severity of psoriasis seems to be related to the severity of obesity. Patients with higher levels of obesity show poorer response to systemic treatments of psoriasis. Several studies have demonstrated that white adipose tissue is a crucial site of the formation of proinflammatory adipokines such as leptin, adiponectin, and resistin and classical cytokines such as interleukin- (IL-) 6 and tumour necrosis factor-α. In psoriasis, due to the proliferation of Th1, Th17, and Th22 cells, IL-22, among others, is produced in addition to the abovementioned cytokines. With respect to leptin and resistin, both of these adipokines are present in high levels in obese persons with psoriasis. Further, the plasma levels of leptin and resistin are related to the severity of psoriasis. These results strongly suggest that obesity, through proinflammatory pathways, is a predisposing factor to the development of psoriasis and that obesity aggravates existing psoriasis. Different inflammatory biomarkers link psoriasis and obesity. In this paper, the most important ones are described.
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del Alcázar E, Ferran M, López-Ferrer A, Notario J, Vidal D, Riera J, Aparicio G, Gallardo F, Vilarrasa E, Alsina M, Puig L, Ferrándiz C, Carrascosa JM. Effectiveness and safety of ustekinumab 90 mg in patients weighing 100 kg or less: a retrospective, observational, multicenter study. J DERMATOL TREAT 2019; 31:222-226. [DOI: 10.1080/09546634.2019.1597245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Elena del Alcázar
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Badalona, Spain
| | - Marta Ferran
- Department of Dermatology, Hospital del Mar- Institut Mar d’Investigacions Mèdiques, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Anna López-Ferrer
- Department of Dermatology, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Jaime Notario
- Department of Dermatology, Hospital Universitari de Bellvitge, Universitat de Barcelona (UB), L’Hospitalet de Llobregat, Spain
| | - David Vidal
- Department of Dermatology, Hospital de Sant Joan Despi Moises Broggi, Sant Joan Despí, Spain
| | - José Riera
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona (UB), Barcelona, Spain
| | - Gloria Aparicio
- Department of Dermatology, Hospital Universitari Vall d’Hebrón, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Fernando Gallardo
- Department of Dermatology, Hospital del Mar- Institut Mar d’Investigacions Mèdiques, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Eva Vilarrasa
- Department of Dermatology, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Mercè Alsina
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona (UB), Barcelona, Spain
| | - Lluís Puig
- Department of Dermatology, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Carlos Ferrándiz
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Badalona, Spain
| | - José M Carrascosa
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Badalona, Spain
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45
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Mehta A, Hasija Y. Meta-analyses of associations of obesity with risk of melanoma and acne based on case-control studies. BIOMEDICAL DERMATOLOGY 2019. [DOI: 10.1186/s41702-019-0041-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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46
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Visser MJE, Kell DB, Pretorius E. Bacterial Dysbiosis and Translocation in Psoriasis Vulgaris. Front Cell Infect Microbiol 2019; 9:7. [PMID: 30778377 PMCID: PMC6369634 DOI: 10.3389/fcimb.2019.00007] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/11/2019] [Indexed: 12/16/2022] Open
Abstract
Psoriasis vulgaris is a chronic inflammatory skin condition, associated with both a physical and a psychological burden. Our understanding of the etiology of this disease remains incomplete. Conventionally, psoriasis has been viewed as a condition that manifests solely in the skin. However, the systemic inflammatory nature of this disease has been confirmed by the presence of a wide array of dysregulated cytokines and inflammatory markers in the serum of these patients. Both dysregulated gut and skin microbiomes have been found in association with psoriasis. An evident association also exists between inflammatory bowel disease and this condition. Regarding the skin microbiome, changes have been observed in the relative abundance of Firmicutes, Actinobacteria, and Proteobacteria. Additionally, Staphylococcus and Streptococcus spp. were detected more frequently in lesional skin. Alterations in the gut microbiome have been characterized by a decrease in the Bacteroidetes phylum and an increase in the Faecalibacterium genus. We suggest that dysbiosis of the skin and gut microbiota may contribute to psoriasis, by promoting the translocation of microbes from these sites into the bloodstream. Consistent with the Iron Dysregulation and Dormant Microbes hypothesis, these microorganisms are in a physiologically dormant state, but may be awakened periodically and shed their cell wall components, such as lipopolysaccharide and lipoteichoic acid. Both of these inflammagens may contribute significantly to maintaining a chronic inflammatory state in the host, such as is seen in individuals diagnosed with psoriasis.
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Affiliation(s)
- Maria J E Visser
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Douglas B Kell
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa.,School of Chemistry, The University of Manchester, Manchester, United Kingdom.,The Manchester Institute of Biotechnology, The University of Manchester, Manchester, United Kingdom
| | - Etheresia Pretorius
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
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47
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Relationship between the Degrees of Itch and Serum Lipocalin-2 Levels in Patients with Psoriasis. J Immunol Res 2019; 2019:8171373. [PMID: 30805373 PMCID: PMC6360588 DOI: 10.1155/2019/8171373] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 11/29/2018] [Indexed: 11/18/2022] Open
Abstract
Background Lipocalin-2 (LCN2), a protein secreted mainly by activated neutrophils, has been associated with neurodegeneration, obesity, and inflammatory responses. Serum LCN2 concentration has been reported elevated in patients with psoriasis, but lower in patients with atopic dermatitis (AD). Spinal astrocyte-derived LCN2 was found to be involved in enhancement of itch in a mouse model of AD. However, the relationship between LCN2 and itch in patients with psoriasis has not been determined. Objective. This study examined the correlation between serum LCN2 levels and the degrees of itch in patients with psoriasis. Methods Serum LCN2 concentrations were measured by enzyme-linked immunosorbent assays (ELISA) in patients with psoriasis and AD and in healthy controls. The degree of itch was assessed using a visual analog scale (VAS), and disease severity was determined by measuring psoriasis area and severity index (PASI) and scoring atopic dermatitis (SCORAD). Correlations among serum LCN2 level, VAS, PASI, and SCORAD were analyzed statistically. We further examined the serum LCN levels in psoriasis patients before and after biological treatment. Results Serum LCN2 concentrations were significantly higher in patients with psoriasis and AD than those in healthy controls. In patients with psoriasis, serum LCN2 concentrations were significantly correlated with VAS, but not with PASI. In contrast, serum LCN2 concentrations did not correlate with VAS or SCORAD in patients with AD. Serum LCN2 levels in psoriasis patients significantly decreased after the biological treatment along with improvement of VAS. Conclusion Serum LCN2 concentration is associated with the degree of itch in patients with psoriasis, suggesting that serum LCN2 may be a useful clinical marker for itch in psoriasis.
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48
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Umano GR, Pistone C, Tondina E, Moiraghi A, Lauretta D, Miraglia Del Giudice E, Brambilla I. Pediatric Obesity and the Immune System. Front Pediatr 2019; 7:487. [PMID: 31824900 PMCID: PMC6883912 DOI: 10.3389/fped.2019.00487] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/06/2019] [Indexed: 01/04/2023] Open
Abstract
Obesity has reached pandemic proportion and represents a major risk for several comorbidities. In addition to metabolic and cardiovascular obesity-related diseases, recent evidence suggested that obesity might affect immune system function. Adipose tissue is considered an endocrine organ that actively secretes cytokines also referred to as "adipokines." Adipokines play an important role in the control of human metabolism. The dysfunctional adipose tissue in obese individuals is characterized by an altered cytokine secretion pattern that promotes chronic low-grade inflammation. Epidemiological evidence highlights the association between obesity and allergic and immune-mediated diseases, such as asthma, allergic rhinitis, rheumatic arthritis, and psoriasis. Less is known about underlying pathogenic mechanisms. However, several recent in vivo and in vitro studies have reported that adipokines are involved in inflammatory and autoimmune disorders by influencing both innate and acquired immune responses. In addition, obesity has been associated with reduced immune surveillance and increased risk of cancer. This paper reviews the evidence regarding the role of adipokines in immune system regulation, with particular emphasis on autoimmune, allergic, and inflammatory disorders. Understanding how obesity affects immune system functions may enable researchers to find new potential therapeutic targets in the management of allergic and autoimmune diseases.
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Affiliation(s)
- Giuseppina Rosaria Umano
- Department of the Woman, Child, General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | | | | | - Daria Lauretta
- Department of the Woman, Child, General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Emanuele Miraglia Del Giudice
- Department of the Woman, Child, General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ilaria Brambilla
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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49
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Bilal J, Malik SU, Riaz IB, Kurtzman DJB. Psoriasis and Psoriatic Spectrum Disease: A Primer for the Primary Care Physician. Am J Med 2018; 131:1146-1154. [PMID: 29864415 DOI: 10.1016/j.amjmed.2018.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 05/04/2018] [Accepted: 05/08/2018] [Indexed: 01/18/2023]
Abstract
Psoriasis is a chronic, immune-mediated disorder that affects approximately 7.5 million people in the United States. Individuals with psoriasis may develop cutaneous, articular, and systemic manifestations, which are a source of significant morbidity and a heightened risk of mortality, and may adversely impact patient-reported quality of life measures. Psoriasis is now recognized as a risk factor for cardiovascular disease, metabolic syndrome, peripheral vascular disease, inflammatory bowel disease, certain malignancies, and chronic renal disease. Therefore, it has become increasingly relevant that primary care physicians have a basic working knowledge and an understanding of fundamental management principles of psoriasis. This review highlights the salient clinical features of psoriasis and psoriatic spectrum disease, emphasizing key updates with respect to systemic disease and associated conditions, and briefly outlines a therapeutic algorithm for the primary care physician.
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Affiliation(s)
- Jawad Bilal
- Department of Medicine, University of Arizona, Tucson.
| | | | | | - Drew J B Kurtzman
- Complex Medical Dermatology Clinic, St. Elizabeth Physicians, Florence, Ky
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50
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López-Estebaranz J, de la Cueva-Dobao P, de la Torre Fraga C, Galán Gutiérrez M, González Guerra E, Mollet Sánchez J, Belinchón Romero I. Manejo de la psoriasis moderada-grave en condiciones de práctica habitual en el ámbito hospitalario español. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:631-642. [DOI: 10.1016/j.ad.2018.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/12/2018] [Accepted: 02/26/2018] [Indexed: 10/14/2022] Open
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