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Gao Y, Li C, Tong M, Hu Y, Li Y. Characterization of psoriasis patients in special body areas: real-world evidence from the Chinese Psoriasis Standardized Diagnosis and Treatment Center. J DERMATOL TREAT 2024; 35:2337264. [PMID: 38991550 DOI: 10.1080/09546634.2024.2337264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/18/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND While extensive research has provided a wealth of information on psoriasis in general, there remains a critical gap in understanding the unique characteristics of psoriasis in special body areas, such as the scalp, nails, palms, and genitals. OBJECTIVE To investigate the characterization and treatment of psoriasis patients in special body areas. METHODS The study was a retrospective analysis of patients with psoriasis enrolled in the Psoriasis Standardized Diagnosis and Treatment Center Project between January 2020 and September 2021. RESULTS The study encompassed 346 patients, 81% of them had psoriasis in at least two special body areas, with the nails as the most common area. Patients with genital psoriasis reported higher Dermatology Life Quality Index (DLQI) scores. A higher propensity for scalp and palmoplantar psoriasis was noted in patients with genital psoriasis. The proportion of patients treated with biologics rose, as the number of specific areas involved increased. CONCLUSIONS Patients with genital psoriasis are more likely to have scalp and palmoplantar psoriasis. This study highlights the significant escalation in the proportion of biologics when the involvement of special body areas was ≥2.
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Affiliation(s)
- Yuge Gao
- Department of Dermatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Chao Li
- Department of Dermatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Meng Tong
- Department of Dermatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yizhou Hu
- Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden
| | - Yuzhen Li
- Department of Dermatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Wang Y, Li J, Guo C, Yang G, Lin H, Zhang Y. Bibliometric analysis and description of research trends in the treatment of psoriasis with biologic agents in the past two decades (2004-2023). J DERMATOL TREAT 2024; 35:2346282. [PMID: 38880492 DOI: 10.1080/09546634.2024.2346282] [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: 03/17/2024] [Accepted: 04/01/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Biologics are essential in treating psoriasis. In recent years, the pathogenesis exploration and development of new target drugs have provided a more complete evidence-based foundation for the biological treatment of psoriasis. This study aims to use bibliometrics to analyze the research status and development trends of biologics in psoriasis. METHODS The bibliometric analysis of publications related to biologics in psoriasis from 2004 to 2023 was conducted using the Web of Science Core Collection (WoSCC) database as the search data source. To perform the bibliometric analysis and create visual knowledge graphs, CiteSpace, the Bibliometrix R package, and VOSviewers were utilized. RESULTS The study included a total of 3800 articles. The United States had the highest number of publications. The leading authors and institutions were Steven R. Feldman and the University of Manchester, respectively, in the global partnership. The cluster plot divided all keywords into 11 categories. Currently, Secukinumab and Guselkumab are representative biological agents being studied due to their considerable efficacy and long-term safety. CONCLUSIONS Targeted therapy has emerged as a significant trend in the current treatment of psoriasis. Early and active use of biologics can effectively control disease progression, prevent or delay the occurrence of comorbidities, and may even alter the natural course of psoriasis. However, further investigation is required to fully understand the specific mechanisms of psoriasis and the use of biological agents.
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Affiliation(s)
- Yingdong Wang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Junchen Li
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Chenqi Guo
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Guojing Yang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Haiyue Lin
- Dermatology Department, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Yu Zhang
- Dermatology Department, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
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Caldarola G, De Luca E, Falco GM, Di Nardo L, Bocchino E, D'Agostino M, Peris K, De Simone C. Residual disease is the main, but not the only factor impacting satisfaction in psoriatic patients undergoing biological therapies. Int J Dermatol 2024. [PMID: 39375798 DOI: 10.1111/ijd.17509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 09/12/2024] [Accepted: 09/16/2024] [Indexed: 10/09/2024]
Abstract
BACKGROUND Despite advancements in psoriasis treatment, a gap remains in aligning patient satisfaction with clinical outcomes. Our study aimed to evaluate which clinical and psychological factors may impact treatment satisfaction in psoriatic patients undergoing long-term biological therapies. METHODS We performed an observational, cross-sectional, single-center study involving adult patients with moderate-to-severe psoriasis treated with biologics for at least 12 months. We collected sociodemographic characteristics and data on the course of the psoriasis. We also assessed the absolute (residual) Psoriasis Area and Severity Index (PASI), the site of the residual disease, and the severity of pruritus through the Visual Analogue Scale (VAS). Satisfaction was evaluated using the Treatment Satisfaction Questionnaire for Medication (TSQMv.II). The Type D Personality Scale (DS14 questionnaire and Patient Health Questionnaire-9 assessed the psychological profile. RESULTS Overall, 146 patients were included, and 82.1% were globally satisfied (global satisfaction TSQM score >75). Linear regression analysis showed a negative correlation between global satisfaction scoring and residual PASI. The multivariable analysis found a higher VAS-pruritus score (OR = 1.20, 95% CI = 1.01-1.44; P = 0.043) and not reaching a residual PASI < 2 (OR = 0.30, 95% CI = 0.09-0.94, P = 0.039) as the strongest predictors of global unsatisfied patients (TSQM < 75%). Other factors unrelated to residual disease, such as gender, class of biologic agent, and type D personality, have also been found to impact patient satisfaction. CONCLUSIONS Our study's findings underscore the complexity of patient satisfaction in psoriasis management and highlight the multifactorial nature of treatment success beyond traditional clinical measures.
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Affiliation(s)
- Giacomo Caldarola
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eleonora De Luca
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gennaro Marco Falco
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lucia Di Nardo
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Enrico Bocchino
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Magda D'Agostino
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Clara De Simone
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
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Choi JY, Kim H, Min KH, Song WH, Yu DS, Lee M, Lee YB. Bacteria, Fungi, and Scalp Psoriasis: Understanding the Role of the Microbiome in Disease Severity. J Clin Med 2024; 13:4846. [PMID: 39200988 PMCID: PMC11355785 DOI: 10.3390/jcm13164846] [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: 07/11/2024] [Revised: 08/05/2024] [Accepted: 08/14/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Psoriasis is a chronic skin condition affected by genetic and environmental factors. Changes in the skin microbiome may affect the immune system and skin barrier functions, thereby contributing to the development and progression of psoriasis. The scalp, which is a common site for psoriasis, is often resistant to therapy. Although several studies have investigated the scalp microbiome, analyses focusing on both bacteria and fungi remain scarce. Methods: We examined the scalp microbiomes of 11 patients with psoriasis complicated with scalp lesions and categorized them according to their Psoriasis Area Severity Index (PASI) scores. The bacterial and fungal data were analyzed using QIIME2 pipeline version 2021.04 and the UNITE database version 8.3, respectively. Results: The Shannon indices for mild (2 patients), moderate (4 patients), and severe (5 patients) groups were 0.97, 1.38, and 1.88, respectively. A significant correlation was observed between increased mycobiome diversity and disease severity (p = 4.07 × 10-5, Spearman's correlation: 0.9269). Compared with the mild and moderate groups, the severe group exhibited a higher abundance of Malassezia globosa. Pseudomonas and Staphylococcus were, respectively, more prevalent in the moderate and severe groups than in the mild group. Conclusions: This study highlights the potential role of increased fungal diversity and specific microbial compositions in the severity of scalp psoriasis, suggesting a possible avenue for targeted therapeutic interventions.
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Affiliation(s)
- Jin-Young Choi
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hyunseong Kim
- Department of Life Science, Dongguk University—Seoul, Goyang 10326, Republic of Korea
- Department of Tropical Medicine, Institute of Tropical Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Kyung-Hyun Min
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Woo-Hyun Song
- Department of Life Science, Dongguk University—Seoul, Goyang 10326, Republic of Korea
| | - Dong-Soo Yu
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Minho Lee
- Department of Life Science, Dongguk University—Seoul, Goyang 10326, Republic of Korea
| | - Young-Bok Lee
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Department of Dermatology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu 07345, Republic of Korea
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Bardazzi F, Filippi F, Mussi M, Lasagni C, Bigi L, Odorici G, Peccerillo F, Rovesti M, Satolli F, Tabanelli M, Schianchi S, Di Lernia V, Manfredini M. Psoriasis with Leg Involvement as the New Difficult-To-Treat Area: A Cohort Study of Patients Treated With Risankizumab. Dermatol Pract Concept 2024; 14:dpc.1403a171. [PMID: 39122529 PMCID: PMC11314018 DOI: 10.5826/dpc.1403a171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION Historically, difficult-to-treat areas in psoriasis included face, scalp, folds, genitalia, nails, and palmoplantar region. Recent studies have found that lower limbs behave like a "new" difficult-to-treat area as they can be the only site of residual disease even in patients undergoing biologic therapies. OBJECTIVES We aimed to evaluate whether legs had different response rates and response times to treatment with a new biologic drug, risankizumab, compared to other body sites. METHODS We conducted a real-life, observational, retrospective, multicenter study including patients affected by moderate-to-severe psoriasis with leg involvement and undergoing biological therapy with risankizumab for more than 16 weeks. The Psoriasis Area Severity Index (PASI) and Leg-PASI were collected at T0 and at weeks 16, 28, 40, 52, 64, and 76. Statistical analysis using Student's t test and linear regression analysis were performed. RESULTS A total of 124 patients were included. The difference between the improvement percentage compared to baseline was statistically significant at weeks 16 and 28, demonstrating that Leg-PASI improved less than PASI. From the linear regression it was deduced that the slope is statistically less steep for Leg-PASI than for overall PASI, confirming that this site responds more slowly to the therapy. CONCLUSIONS Leg response to risankizumab appears to differ significantly from other body sites in the first weeks of treatment, even if after 28 weeks, statistical significance is lost. Our preliminary finding suggests that risankizumab can be considered an effective treatment for leg psoriasis but with longer response times than other areas, demonstrating the relative nature of resistance to treatment of this district.
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Affiliation(s)
- Federico Bardazzi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
- Division of Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federica Filippi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
- Division of Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Martina Mussi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
- Division of Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Claudia Lasagni
- Clinica Dermatologica, Dipartimento delle Medicine Specialistiche AOU Policlinico di Modena, Modena, Italy
| | - Laura Bigi
- Clinica Dermatologica, Dipartimento delle Medicine Specialistiche AOU Policlinico di Modena, Modena, Italy
| | - Giulia Odorici
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Francesca Peccerillo
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Miriam Rovesti
- Department of Dermatology, University of Parma, Parma, Italy
| | | | | | | | - Vito Di Lernia
- Dermatology Unit, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Manfredini
- Clinica Dermatologica, Dipartimento delle Medicine Specialistiche AOU Policlinico di Modena, Modena, Italy
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Hong EJ, Yoon HJ, Kwon MJ, Kim JY, Kim JE, Park YL, Lee S, Bae Y, Lee SH. Factors Associated With Achieving Complete Skin Clearance Compared to Almost Complete Skin Clearance in Patients With Moderate to Severe Psoriasis Treated With Biologics: A Retrospective Chart Review. Ann Dermatol 2024; 36:91-98. [PMID: 38576247 PMCID: PMC10995612 DOI: 10.5021/ad.23.074] [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: 07/30/2023] [Revised: 11/24/2023] [Accepted: 12/13/2023] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Biologics have demonstrated high efficacy in achieving 'almost complete' skin clearance in patients with moderate to severe psoriasis. Nonetheless, achieving 'complete' skin clearance remains a treatment goal for some highly biologics-resistant patients, as residual lesions impact their quality of life. OBJECTIVE The risk factors for failure to achieve a Psoriasis Area and Severity Index (PASI) 100 response in patients with good response to biologics remain unknown. METHODS This retrospective study evaluated the risk factors by comparing patients who achieved complete skin clearance (PASI100) with those who achieved almost complete skin clearance (PASI90). A database of 131 psoriasis patients treated with biologics, who achieved a PASI90 or PASI100 response, was reviewed from a tertiary referral hospital in South Korea. The patients were classified into PASI90 and PASI100 groups according to their PASI response. RESULTS The PASI100 group had a lower prevalence of smoking history (adjusted odds ratio [OR], 0.34; 95% confidence interval [CI], 0.14-0.85; p=0.021) and psoriasis on the anterior lower legs at baseline (adjusted OR, 0.18; 95% CI, 0.03-0.99; p=0.049) than patients in the PASI90 group. CONCLUSION This study suggested that smoking history and psoriatic skin lesions on the anterior lower legs are considered as the risk factors for the failure to achieve a PASI100 response in psoriasis patients treated with biologics.
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Affiliation(s)
- Eun Ji Hong
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hee Jung Yoon
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Min Jung Kwon
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jae Yun Kim
- Department of Dermatology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jung Eun Kim
- Department of Dermatology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Young Lip Park
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - SangHoon Lee
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Youin Bae
- Department of Dermatology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
| | - Sul Hee Lee
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
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Dissemond J, Eder S, Läuchli S, Protz K, Traber J, Stücker M. [Compression therapy for inflammatory dermatoses of the legs]. Dtsch Med Wochenschr 2024; 149:106-112. [PMID: 38262405 DOI: 10.1055/a-2197-6197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
In addition to venous and lymphatic diseases, there is increasing scientific evidence that inflammatory dermatoses of the legs are also indications for compression therapy. Specifically, diseases such as pyoderma gangrenosum, livedoid vasculopathy, cutaneous vasculitides, necrobiosis lipoidica, psoriasis, or erysipelas are conditions for which adjunctive compression therapy may be used when manifestations occur on the lower extremities. When inflammatory dermatoses are accompanied by edema, compression therapy is not an off-label use. Especially because of the often problematic pain symptoms, compression therapy can be performed with low resting pressures around 20 mmHg, especially in inflammatory dermatoses.In this review article, the current scientific aspects of compression therapy in inflammatory dermatoses of the legs and the corresponding limitations are presented in a differentiated manner.
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Affiliation(s)
- Joachim Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Essen, Deutschland
| | - Stephan Eder
- Schwarzwald-Baar Klinikum, Klinik für Gefäßchirurgie und Gefäßmedizin, Villingen-Schwenningen, Deutschland
| | | | - Kerstin Protz
- Competenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Jürg Traber
- Venenklinik Bellevue Kreuzlingen (VBK), Kreuzlingen, Schweiz
| | - Markus Stücker
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Venenzentrum der Dermatologischen und Gefäßchirurgischen Kliniken, Bochum, Deutschland
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Wang N, Yang Q, Liu Y, Liu H. Upadacitinib in nail psoriasis: a case report. J DERMATOL TREAT 2023; 34:2246604. [PMID: 37661936 DOI: 10.1080/09546634.2023.2246604] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/10/2023] [Indexed: 09/05/2023]
Abstract
THE PURPOSE OF THE ARTICLE Nail psoriasis is a refractory disease that affects 50-79% skin psoriasis patients and up to 80% of patients with psoriatic arthritis (PsA). The pathogenesis of nail psoriasis is still not fully illuminated, although some peculiar inflammatory cytokines and chemokines seems to be the same as described in psoriatic skin lesions. Treatment of nail psoriasis still with challenge and should be individualized. Upadacitinib, an oral highly selective JAK1 inhibitor, has been approved for PsA treatment. Whether it has the therapeutic advantages for nail psoriasis. RESULTS We report a case of a patient with nail psoriasis who responded well to upadacitinib therapy at a dose of 15mg once daily for 5 months. In addition, we reviewed the literature and compared the current treatment efficiency in the treatment of nail psoriasis. The therapeutic effects of JAK inhibitors for nail psoriasis may involve downstream cytokines, such as I IL-6, IL-10, and IL-23. CONCLUSION Upadacitinib may be a promising therapeutic option for patients with severe nail psoriasis.
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Affiliation(s)
- Na Wang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
- Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China
| | - Qing Yang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
- Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China
| | - Yongxia Liu
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
- Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China
| | - Hong Liu
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
- Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China
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Hou YL, Lin SH. Real-world efficacy of adjunctive calcipotriene/betamethasone dipropionate foam for recalcitrant psoriatic lesions on the scalp or lower legs with biologic therapy. J Dermatol 2023; 50:1272-1278. [PMID: 37350066 DOI: 10.1111/1346-8138.16867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/23/2023] [Accepted: 06/06/2023] [Indexed: 06/24/2023]
Abstract
Many patients with moderate-to-severe psoriasis may not achieve complete skin clearance with recalcitrant lesions despite being on biologics. We aimed to evaluate the real-world effectiveness and safety of combining topical calcipotriene/betamethasone dipropionate (Cal/BD) foam with biologic therapy for the treatment of recalcitrant psoriatic lesions over the scalp or lower legs. We retrospectively reviewed the medical charts of psoriasis patients receiving adjunctive topical Cal/BD foam with biologics for at least 16 weeks on recalcitrant psoriatic lesions of the scalp or lower legs between 2020 and 2021 at a tertiary referral medical center in southern Taiwan. Among the 18 recruited patients, the severity outcomes of body surface area (BSA), Physician's Global Assessment (PGA), and BSA × PGA of the recalcitrant areas decreased by approximately 31%, 48%, and 50%, respectively, after 4 weeks of once-daily adjunctive Cal/BD foam use. Thereafter, the effect remained nearly constant after dose reduction to twice weekly until week 16. The Dermatology Life Quality Index and the nine-item Treatment Satisfaction Questionnaire for Medication questionnaire revealed improved life quality and a high level of satisfaction, with only a few mild adverse effects reported. In conclusion, adjunctive topical Cal/BD foam might be an effective and safe option for patients with recalcitrant lesions on the scalp and lower legs despite biologics use.
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Affiliation(s)
- Yi-Li Hou
- Department of Dermatology, Kaohsiung Chang-Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Shang-Hung Lin
- Department of Dermatology, Kaohsiung Chang-Gung Memorial Hospital, Kaohsiung, Taiwan
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Cacciapuoti S, Potestio L, Guerrasio G, Fabbrocini G, Scalvenzi M, Ruggiero A, Caiazzo G, Megna M. Effectiveness of Brodalumab in Patients with Moderate-to-Severe Plaque Psoriasis Located in Difficult-to-Treat Areas. Clin Cosmet Investig Dermatol 2023; 16:2637-2644. [PMID: 37780688 PMCID: PMC10541085 DOI: 10.2147/ccid.s423234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
Background Recent knowledge of psoriasis pathogenesis has led to the development of selective drugs. Among these, brodalumab is a monoclonal antibody targeting the interleukin (IL)-17A receptor approved for the treatment of moderate-to-severe plaque psoriasis. Biologics may be considered in patients with milder diseases in case of active psoriatic arthritis, severe impact on patient's quality of life, and involvement of sensitive and difficult-to-treat areas. These skin locations commonly require systemic drugs. Recently, psoriasis severity monitoring has also changed. Indeed, the clinical evaluation by means of specific efficacy scores was combined with serological evaluation by means of the assay of specific inflammatory biomarkers. Methods An observational study enrolled patients affected by moderate-to-severe plaque psoriasis involving difficult-to-treat areas, undergoing treatment with brodalumab to evaluate the effectiveness and safety of brodalumab in patients with psoriasis affecting difficult-to-treat areas (scalp and palmoplantar regions). Secondary outcomes were the assessment of the development of serum markers of inflammation during the treatment period as well as the evaluation of the dermoscopic features of the affected sites to quantify disease activity and response to treatment. Results Twenty-five patients were included in the study. A statistically significant reduction from baseline in PASI, PSSI, ppPASI and DLQI values as early as week 24 was observed, with further improvement up to week 52. Plasma levels of MMP-3, VEGF-A, and hs-PCR decreased during treatment from week 0 to week 52. Conclusion Our real-life experience suggests brodalumab as a valuable option for the management of psoriasis located in difficult-to-treat areas. Moreover, our study highlights that the use of brodalumab reduces the plasmatic levels of inflammatory biomarkers (MMP-3, VEGF-A and hs-PCR), showing how the drug modulates the skin inflammatory response by reducing systemic inflammation.
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Affiliation(s)
- Sara Cacciapuoti
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luca Potestio
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gianluca Guerrasio
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Massimiliano Scalvenzi
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Angelo Ruggiero
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppina Caiazzo
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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11
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Dissemond J, Protz K, Stücker M. Compression therapy in dermatology. J Dtsch Dermatol Ges 2023; 21:1003-1019. [PMID: 37565365 DOI: 10.1111/ddg.15161] [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] [Accepted: 05/28/2023] [Indexed: 08/12/2023]
Abstract
Compression therapy is a conservative therapy that can be used in many patients with dermatological conditions, especially those associated with edema. In addition to its well-established use in venous and lymphatic disorders, there is increasing evidence that compression therapy supports the healing of inflammatory dermatoses. The presence of edema, regardless of its etiology, is an indication for the use of compression therapy. Nowadays, a variety of materials and treatment options are available for compression therapy, each with their own advantages and disadvantages. Often, compression therapy with low resting pressures is sufficient for effective therapy and is better tolerated by patients. The main contraindications to compression therapy are advanced peripheral arterial disease and decompensated heart failure. Individual factors and economic considerations should be taken into account when deciding on compression therapy with the patient. Patient self-management should be encouraged whenever possible. This requires education and support tools.
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Affiliation(s)
- Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, Essen, Germany
| | - Kerstin Protz
- Competence Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Markus Stücker
- Department for Dermatology, Venerology and Allergology, Ruhr-University Bochum, Vein Center of Dermatology and Vascular Surgery, Bochum, Germany
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12
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Dissemond J, Protz K, Stücker M. Kompressionstherapie in der Dermatologie. J Dtsch Dermatol Ges 2023; 21:1003-1020. [PMID: 37700410 DOI: 10.1111/ddg.15161_g] [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: 01/18/2023] [Accepted: 05/28/2023] [Indexed: 09/14/2023]
Abstract
ZusammenfassungDie Kompressionstherapie ist eine konservative Therapie, die bei vielen Patienten mit dermatologischen Krankheiten durchgeführt werden kann, insbesondere wenn diese mit Ödemen assoziiert sind. Neben den wissenschaftlich sehr gut belegten Indikationen bei venösen und lymphatischen Erkrankungen, gibt es auch zunehmend wissenschaftliche Hinweise, dass durch die Kompressionstherapie die Abheilung entzündlicher Dermatosen unterstützt wird. Wenn Ödeme vorliegen, handelt es sich, unabhängig von deren Genese, um einen Einsatz im Rahmen der Zulassung der Kompressionstherapie.Für die Kompressionstherapie stehen heute verschiedene Materialien und Versorgungsoptionen mit systemspezifischen Vor‐ und Nachteilen zur Verfügung. Oft ist eine Kompressionstherapie mit niedrigen Ruhedruckwerten für einen Therapieerfolg ausreichend und wird von den Patienten besser toleriert. Als wichtigste Kontraindikationen der Kompressionstherapie sind die fortgeschrittene periphere arterielle Verschlusskrankheit und die dekompensierte Herzinsuffizienz zu beachten.Bei der gemeinsam mit dem Patienten getroffenen Entscheidung für eine Kompressionstherapie, sollten individuelle Faktoren und wirtschaftliche Aspekte berücksichtigt werden. Wann immer möglich, ist ein Selbstmanagement des Patienten zu unterstützen. Hierfür sind Edukation und Hilfsmittel erforderlich.
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Affiliation(s)
- Joachim Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
| | - Kerstin Protz
- CompetenzzentrumVersorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Markus Stücker
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Venenzentrum der Dermatologischen und Gefäßchirurgischen Kliniken, Bochum
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13
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Sitaru S, Oueslati T, Schielein MC, Weis J, Kaczmarczyk R, Rueckert D, Biedermann T, Zink A. Automatische Körperteil-Identifikation in dermatologischen klinischen Bildern durch maschinelles Lernen. J Dtsch Dermatol Ges 2023; 21:863-871. [PMID: 37574684 DOI: 10.1111/ddg.15113_g] [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: 11/07/2022] [Accepted: 03/30/2023] [Indexed: 08/15/2023]
Abstract
ZusammenfassungHintergrundDermatologische Erkrankungen sind in allen Bevölkerungsgruppen weit verbreitet. Das betroffene Körperteil ist für ihre Diagnose, Therapie und Forschung von Bedeutung. Die automatische Identifizierung der abgebildeten Körperteile in dermatologischen Krankheitsbildern könnte daher die klinische Versorgung verbessern, indem sie zusätzliche Informationen für klinische Entscheidungsalgorithmen liefert, schwer zu behandelnde Bereiche aufdeckt und die Forschung durch die Identifizierung neuer Krankheitsmuster unterstützt.Patienten und MethodikIn dieser Studie wurden 6219 annotierte dermatologische Bilder aus unserer klinischen Datenbank verwendet, womit ein neuronales Netz trainiert und validiert wurde. Als Anwendung wurden mit diesem System qualitative Heatmaps für die Verteilung von Körperteilen bei häufigen dermatologischen Erkrankungen erstellt.ErgebnisseDer Algorithmus erreichte eine mittlere balancierte Genauigkeit (Accuracy) von 89% (74,8%–96,5%). Die Fotos von nichtmelanozytärem Hautkrebs betrafen vor allem das Gesicht und den Oberkörper, während die größte Häufigkeit der Ekzem‐ und Psoriasis‐Bildverteilung den Oberkörper, die Beine und die Hände umfassten.SchlussfolgerungenDie Genauigkeit dieses Systems ist vergleichbar mit den besten bisher veröffentlichten Algorithmen für Bildklassifizierungsaufgaben, was darauf hindeutet, dass dieser Algorithmus die Diagnose, Therapie und Forschung bei dermatologischen Erkrankungen verbessern könnte.
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Affiliation(s)
- Sebastian Sitaru
- Klinik für Dermatologie und Allergologie, Technische Universität München, Medizinische Fakultät, München, Deutschland
| | - Talel Oueslati
- Klinik für Dermatologie und Allergologie, Technische Universität München, Medizinische Fakultät, München, Deutschland
| | - Maximilian C Schielein
- Klinik für Dermatologie und Allergologie, Technische Universität München, Medizinische Fakultät, München, Deutschland
| | - Johanna Weis
- Klinik für Dermatologie und Allergologie, Technische Universität München, Medizinische Fakultät, München, Deutschland
| | - Robert Kaczmarczyk
- Klinik für Dermatologie und Allergologie, Technische Universität München, Medizinische Fakultät, München, Deutschland
| | - Daniel Rueckert
- Institut für künstliche Intelligenz und Informatik in der Medizin Fakultät, Technische Universität München, München, Deutschland
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, Großbritannien
| | - Tilo Biedermann
- Klinik für Dermatologie und Allergologie, Technische Universität München, Medizinische Fakultät, München, Deutschland
| | - Alexander Zink
- Klinik für Dermatologie und Allergologie, Technische Universität München, Medizinische Fakultät, München, Deutschland
- Abteilung für Dermatologie und Venerologie, Medizinische Fakultät Solna, Karolinska Institutet, Stockholm, Schweden
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14
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Sitaru S, Oueslati T, Schielein MC, Weis J, Kaczmarczyk R, Rueckert D, Biedermann T, Zink A. Automatic body part identification in real-world clinical dermatological images using machine learning. J Dtsch Dermatol Ges 2023; 21:863-869. [PMID: 37306036 DOI: 10.1111/ddg.15113] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/30/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Dermatological conditions are prevalent across all population sub-groups. The affected body part is of importance to their diagnosis, therapy, and research. The automatic identification of body parts in dermatological clinical pictures could therefore improve clinical care by providing additional information for clinical decision-making algorithms, discovering hard-to-treat areas, and research by identifying new patterns of disease. PATIENTS AND METHODS In this study, we used 6,219 labelled dermatological images from our clinical database, which were used to train and validate a convolutional neural network. As a use case, qualitative heatmaps for the body part distribution in common dermatological conditions was generated using this system. RESULTS The algorithm reached a mean balanced accuracy of 89% (range 74.8%-96.5%). Non-melanoma skin cancer photos were mostly of the face and torso, while hotspots of eczema and psoriasis image distribution included the torso, legs, and hands. CONCLUSIONS The accuracy of this system is comparable to the best to-date published algorithms for image classification challenges, suggesting this algorithm could boost diagnosis, therapy, and research of dermatological conditions.
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Affiliation(s)
- Sebastian Sitaru
- Technical University of Munich, School of Medicine, Department of Dermatology and Allergy, Munich, Germany
| | - Talel Oueslati
- Technical University of Munich, School of Medicine, Department of Dermatology and Allergy, Munich, Germany
| | - Maximilian C Schielein
- Technical University of Munich, School of Medicine, Department of Dermatology and Allergy, Munich, Germany
| | - Johanna Weis
- Technical University of Munich, School of Medicine, Department of Dermatology and Allergy, Munich, Germany
| | - Robert Kaczmarczyk
- Technical University of Munich, School of Medicine, Department of Dermatology and Allergy, Munich, Germany
| | - Daniel Rueckert
- Technical University of Munich, School of Medicine, Institute of AI and Informatics in Medicine, Munich, Germany
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
| | - Tilo Biedermann
- Technical University of Munich, School of Medicine, Department of Dermatology and Allergy, Munich, Germany
| | - Alexander Zink
- Technical University of Munich, School of Medicine, Department of Dermatology and Allergy, Munich, Germany
- Division of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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15
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Mastorino L, Burzi L, Frigatti G, Fazio A, Celoria V, Macagno N, Rosset F, Passerini SG, Roccuzzo G, Verrone A, Stroppiana E, Ortoncelli M, Dapavo P, Quaglino P, Ribero S. Clinical effectiveness of IL-17 and IL-23 inhibitors on difficult-to-treat psoriasis areas (scalp, genital, and palmoplantar sites): a retrospective, observational, single-center, real-life study. Expert Opin Biol Ther 2023; 23:929-936. [PMID: 37458181 DOI: 10.1080/14712598.2023.2236023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Psoriasis affecting the genital, palmoplantar, and scalp regions is recognized as difficult-to-treat, and data on the efficacy of biologics in these areas remains limited. RESEARCH DESIGN AND METHODS This single-center study evaluated the effectiveness of anti-IL-17 and anti-IL-23 agents on scalp, genital, and palmoplantar psoriasis. We retrospectively analyzed data from all patients with psoriasis being treated with IL inhibitors at our clinic. Effectiveness was evaluated at 16, 28, and 52 weeks, according to the achievement of relative and mean PSSI, PGA-G, and ppPASI. RESULTS In all, 308 patients showed involvement of the scalp, 136 in the genital area, and 94 in the palmoplantar regions. On scalp psoriasis, anti-IL-17 agents demonstrated superiority in disease control compared to anti-IL-23 agents. PSSI100 at week 16 was reached by 59% of patients on an anti-IL17 vs 39.8% on an anti-IL-23 (p < 0.003). At genital sites, no significant differences between anti-IL-17 and anti-IL-23 agents were observed, and all classes achieved PGA-G 0/1. No significant differences between anti-IL-17 and anti-IL-23 agents were observed in palmoplantar areas. CONCLUSIONS The present data support the utility of both anti-IL-17 and anti-IL-23 agents for the treatment of difficult-to-treat areas in patients with psoriasis. Anti-IL-17 agents achieved better control of scalp psoriasis.
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Affiliation(s)
- Luca Mastorino
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Lorenza Burzi
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Giada Frigatti
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Alessandra Fazio
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Valentina Celoria
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Nicole Macagno
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Francois Rosset
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | | | - Gabriele Roccuzzo
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Anna Verrone
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Elena Stroppiana
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Michela Ortoncelli
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Paolo Dapavo
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Simone Ribero
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
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16
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Castillo RL, Sidhu I, Dolgalev I, Chu T, Prystupa A, Subudhi I, Yan D, Konieczny P, Hsieh B, Haberman RH, Selvaraj S, Shiomi T, Medina R, Girija PV, Heguy A, Loomis CA, Chiriboga L, Ritchlin C, Garcia-Hernandez MDLL, Carucci J, Meehan SA, Neimann AL, Gudjonsson JE, Scher JU, Naik S. Spatial transcriptomics stratifies psoriatic disease severity by emergent cellular ecosystems. Sci Immunol 2023; 8:eabq7991. [PMID: 37267384 PMCID: PMC10502701 DOI: 10.1126/sciimmunol.abq7991] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/10/2023] [Indexed: 06/04/2023]
Abstract
Whereas the cellular and molecular features of human inflammatory skin diseases are well characterized, their tissue context and systemic impact remain poorly understood. We thus profiled human psoriasis (PsO) as a prototypic immune-mediated condition with a high predilection for extracutaneous involvement. Spatial transcriptomics (ST) analyses of 25 healthy, active lesion, and clinically uninvolved skin biopsies and integration with public single-cell transcriptomics data revealed marked differences in immune microniches between healthy and inflamed skin. Tissue-scale cartography further identified core disease features across all active lesions, including the emergence of an inflamed suprabasal epidermal state and the presence of B lymphocytes in lesional skin. Both lesional and distal nonlesional samples were stratified by skin disease severity and not by the presence of systemic disease. This segregation was driven by macrophage-, fibroblast-, and lymphatic-enriched spatial regions with gene signatures associated with metabolic dysfunction. Together, these findings suggest that mild and severe forms of PsO have distinct molecular features and that severe PsO may profoundly alter the cellular and metabolic composition of distal unaffected skin sites. In addition, our study provides a valuable resource for the research community to study spatial gene organization of healthy and inflamed human skin.
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Affiliation(s)
- Rochelle L. Castillo
- Division of Rheumatology, Department of Medicine, NYU Langone Health, NY, NY 10016
- NYU Psoriatic Arthritis Center, NYU Langone Health, NY, NY 10016
| | - Ikjot Sidhu
- Department of Pathology, NYU Langone Health, NY, NY 10016
- Applied Bioinformatics Laboratories, NYU Langone Health, NY, NY 10016
| | - Igor Dolgalev
- Applied Bioinformatics Laboratories, NYU Langone Health, NY, NY 10016
- Translational Immunology Center, NYU Langone Health, NY, NY 10016
| | - Tinyi Chu
- Computational and Systems Biology program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, NY, NY 10065
| | - Aleksandr Prystupa
- Department of Pathology, NYU Langone Health, NY, NY 10016
- Applied Bioinformatics Laboratories, NYU Langone Health, NY, NY 10016
| | - Ipsita Subudhi
- Department of Pathology, NYU Langone Health, NY, NY 10016
| | - Di Yan
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, NY, NY 10016
| | | | - Brandon Hsieh
- Department of Pathology, NYU Langone Health, NY, NY 10016
| | - Rebecca H. Haberman
- Division of Rheumatology, Department of Medicine, NYU Langone Health, NY, NY 10016
- NYU Psoriatic Arthritis Center, NYU Langone Health, NY, NY 10016
| | | | - Tomoe Shiomi
- Center for Biospecimen Research and Development, NYU Langone Health, NY, NY 10016
| | - Rhina Medina
- Division of Rheumatology, Department of Medicine, NYU Langone Health, NY, NY 10016
- NYU Psoriatic Arthritis Center, NYU Langone Health, NY, NY 10016
| | - Parvathy Vasudevanpillai Girija
- Division of Rheumatology, Department of Medicine, NYU Langone Health, NY, NY 10016
- NYU Psoriatic Arthritis Center, NYU Langone Health, NY, NY 10016
| | - Adriana Heguy
- Department of Pathology, NYU Langone Health, NY, NY 10016
- Genome Technology Center, NYU Langone Health, NY, NY 10016
| | | | - Luis Chiriboga
- Department of Pathology, NYU Langone Health, NY, NY 10016
- Center for Biospecimen Research and Development, NYU Langone Health, NY, NY 10016
| | - Christopher Ritchlin
- Allergy, Immunology and Rheumatology Division, Center of Musculoskeletal Research, University of Rochester Medical School, Rochester NY 14642
| | - Maria De La Luz Garcia-Hernandez
- Allergy, Immunology and Rheumatology Division, Center of Musculoskeletal Research, University of Rochester Medical School, Rochester NY 14642
| | - John Carucci
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, NY, NY 10016
| | - Shane A. Meehan
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, NY, NY 10016
| | - Andrea L. Neimann
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, NY, NY 10016
| | - Johann E. Gudjonsson
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109
| | - Jose U. Scher
- Division of Rheumatology, Department of Medicine, NYU Langone Health, NY, NY 10016
- NYU Psoriatic Arthritis Center, NYU Langone Health, NY, NY 10016
| | - Shruti Naik
- Department of Pathology, NYU Langone Health, NY, NY 10016
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, NY, NY 10016
- Perlmutter Cancer Center, NYU Langone Health, NY, NY 10016
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17
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Krefting F, Hölsken S, Moelleken M, Dissemond J, Sondermann W. [Randomized clinical trial of compression therapy of the lower legs in patients with psoriasis]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00105-023-05155-0. [PMID: 37160420 PMCID: PMC10366302 DOI: 10.1007/s00105-023-05155-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Psoriatic plaques at the distal lower extremities are notoriously treatment resistant. Medical compression therapy could potentially be a useful supplementary therapeutic measure at this site. However, there is concern that the Koebner phenomenon may cause a worsening of the skin condition. Therefore, the purpose of this study was to investigate the effects of compression therapy on psoriatic plaques in the presence of coexisting edema of the lower legs. PATIENTS AND METHODS Compression therapy was performed in addition to standard of care on one lower leg for 4 weeks (half-side test) in patients with psoriatic plaques and edema on both lower legs. The primary endpoint of the study was clinical response of the psoriatic plaques on the lower legs measured with the lesion severity score (LSS) and the locally affected body surface area in a side-by-side comparison at week 4 compared with baseline. Secondary endpoints were related to patient-reported outcomes. RESULTS Data from 30 patients were included in the analysis. In the descriptive analysis, the mean LSS results and the subjective pain reported by the patients showed a slightly greater improvement on the compressed lower leg compared with the non-compressed lower leg. None of the patients showed evidence of the Koebner phenomenon induced by compression therapy. CONCLUSION This is the first clinical study that systematically investigated the impact of compression therapy on psoriatic plaques. During the study period of 4 weeks, there was no significant improvement in psoriatic plaques; however, there was also no evidence of worsening of the skin condition. Thus, anti-edematous compression therapy can be performed in psoriasis patients without causing complications if basic contraindications are considered.
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Affiliation(s)
- Frederik Krefting
- Klinik für Dermatologie, Venerologie und Allergologie, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Stefanie Hölsken
- Institut für Medizinische Psychologie und Verhaltensimmunbiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - Maurice Moelleken
- Klinik für Dermatologie, Venerologie und Allergologie, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Joachim Dissemond
- Klinik für Dermatologie, Venerologie und Allergologie, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Wiebke Sondermann
- Klinik für Dermatologie, Venerologie und Allergologie, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
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18
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Jiang Y, Lu S, Lai Y, Wang L. Topical histone deacetylase 1 inhibitor Entinostat ameliorates psoriasiform dermatitis through suppression of IL-17A response. J Dermatol Sci 2023:S0923-1811(23)00117-2. [PMID: 37173222 DOI: 10.1016/j.jdermsci.2023.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 04/29/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Biologics against IL-17A, IL-23 and TNF-α achieve a great success in treating psoriasis. However, the majority of patients still have some residual lesions left and require combination therapy to reach complete clearance. Topical medicine is an optional choice but only has limited categories. Besides, drug resistance is very often. Thus, topical medicine targeting new signaling pathway is still in an urgent need in the biologics era. OBJECTIVE To investigate the role of topical Entinostat, a selective inhibitor of histone deacetylases 1 (HDAC1) that has been tested in clinic trials to treat solid tumors and hematological malignancies, in psoriasis therapy. METHODS Efficacious Entinostat were tested in a mouse imiquimod (IMQ)-induced psoriasiform dermatitis (PsD) model. An in vitro model consisting of human CD4 + T cell, murine T cells and NHEKs were used to screen Entinostat for inhibition of cutaneous inflammatory genes. RESULTS Topical application of Entinostat significantly improved psoriasiform inflammation in imiquimod-induced mice model with great reduction of IL-17A+ γδT cell infiltration in skin. Entinostat is powerful agent in inhibition of Th17 cell generation and the expression of psoriasis-related inflammatory mediators by primary keratinocytes upon CD4+ T cells stimulation. CONCLUSION Our findings suggest Entinostat is a promising topical medicine for psoriasis treatment.
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Affiliation(s)
- Yanyun Jiang
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Siyao Lu
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuhsien Lai
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liangchun Wang
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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19
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Won SH, Shin BS, Bae KN, Son JH, Shin K, Kim HS, Ko HC, Kim MB, Kim BS. Which Areas Are Still Left in Biologics Responsive Korean Patients with Moderate to Severe Plaque Psoriasis. Ann Dermatol 2023; 35:6-10. [PMID: 36750453 PMCID: PMC9905854 DOI: 10.5021/ad.21.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/17/2022] [Accepted: 10/12/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Psoriasis localized to certain body areas, such as the scalp, nails, palms, soles, intertriginous regions, and genital regions, is reportedly difficult to treat. OBJECTIVE To investigate the biologics-resistant areas in South Korean patients with psoriasis treated with biologics. METHODS The study included 50 patients with chronic moderate to severe plaque psoriasis from the Pusan National University Hospital and Chosun University Hospital between October 2019 and September 2020. The patients had at least one psoriatic lesion, were treated with biologics for more than six months, and exhibited a partial or good response (reaching a Psoriasis Area and Severity Index [PASI] score of 1~5 after biologics treatment). RESULTS A total of 50 patients with psoriasis (32 male, mean±standard deviation 47.8±11 years), with a median PASI score of 1.8, were included. The most common biologics-resistant areas were the anterior lower leg (56.0%), followed by the knee (48.0%) and posterior lower leg (42.0%). The proportion of biologics-resistant areas were obtained for body regions traditionally considered as difficult-to-treat entities, including the fingernails (10.0%), toenails (14.0%), scalp (38.0%), palm (12.0%), sole (14.0%), and genital areas (10.0%). CONCLUSION This study determined the biologics-resistant areas in South Korean patients, successfully treated with biologics, in a real-world clinical setting.
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Affiliation(s)
- Sang-Hyeon Won
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Bong Seok Shin
- Department of Dermatology, Chosun University Hospital, Gwangju, Korea
| | - Kyung-Nam Bae
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Jin-Hwa Son
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Kihyuk Shin
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Hoon-Soo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyun-Chang Ko
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Moon-Bum Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Byung-Soo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
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20
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Cheng PS, Hou PC, Yang CC, Chu CB. Variation of body regional responses to Ustekinumab and Secukinumab in psoriasis patients: A real-world retrospective study and literature review. Dermatol Ther 2022; 35:e15950. [PMID: 36263747 DOI: 10.1111/dth.15950] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/19/2022] [Accepted: 10/18/2022] [Indexed: 11/30/2022]
Abstract
Psoriasis in different body regions displays varying therapeutic responses to biologics, whereas currently relevant studies remain scarce. We retrospectively reviewed the treatment responses of patients with moderate-to-severe psoriasis, who completed the two-year reimbursed ustekinumab or secukinumab treatment in two medical centers in Southern Taiwan. Demographic profiles and body regional PASI scores (head/neck, trunk, upper and lower limbs) along the treatment course were recorded. The proportions of patients attaining PASI 75, 90, 100 and the extent of body regional PASI score improvements were compared in biologic naïve or experienced patients. A total of 57 and 67 patients receiving ustekinumab and secukinumab injections, respectively, were included. Overall, patients receiving secukinumab showed higher degrees of PASI score improvements along the two-year treatment course. The lower limbs had the highest, and the upper extremities and head/neck had the lowest post-treatment PASI scores regardless of prior biologic use in the groups of ustekinumab and secukinumab. The upper limbs showed the highest, while the lower limbs had the lowest complete remission rate (regional specific PASI 100) in response to ustekinumab (upper limbs 48.7%, lower limbs 25.6%) and secukinumab (upper limbs 77.1%, lower limbs 42.8%) in biologic naïve groups. Our study demonstrated that lower limbs were the most treatment-refractory area in response to ustekinumab and secukinumab injections, while the upper limbs and head/neck region had a better response.
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Affiliation(s)
- Pai-Shan Cheng
- Department of Dermatology, Chi Mei Medical Center, Tainan, Taiwan
| | - Ping-Chen Hou
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, Tainan, Taiwan
| | - Chao-Chun Yang
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, Tainan, Taiwan
- International Center for Wound Repair and Regeneration, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Bao Chu
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, Tainan, Taiwan
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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21
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Choi JY, Kim H, Koo HYR, You J, Yu DS, Lee YB, Lee M. Severe Scalp Psoriasis Microbiome Has Increased Biodiversity and Relative Abundance of Pseudomonas Compared to Mild Scalp Psoriasis. J Clin Med 2022; 11:7133. [PMID: 36498707 PMCID: PMC9739726 DOI: 10.3390/jcm11237133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/04/2022] Open
Abstract
Psoriasis is a chronic inflammatory skin disease associated with various factors. Recently, alterations in the gut and skin microbiomes have been shown to interact with host immunity, affect skin barrier function, as well as development and progression of psoriasis. We aimed to analyze the microbiota of the scalp of patients with psoriasis and determine the characteristics of the microbiome according to disease severity. We investigated the scalp microbiome of 39 patients with psoriasis scalp lesions and a total of 47 samples were analyzed. The patients were divided into mild, moderate, and severe groups according to the European recommendations for scalp psoriasis. For bacterial identification, we utilized the SILVA database targeting the V3 region of the 16 S rRNA gene. The mean Shannon index escalated along with disease severity, and the diversity of the scalp microbiome tended to increase with disease severity (R = 0.37, p < 0.01). The relative abundance of Pseudomonas was increased in severe scalp psoriasis (0.49 ± 0.22) compared to the mild group (0.07 ± 0.03, p = 0.029), and Diaphorobacter was enriched in the mild group (0.76 ± 0.16%) compared to the severe group (0.44 ± 0.22, p < 0.001). We identified that increased diversity of the scalp microbiome and the relative abundance of Pseudomonas are associated with the severity of scalp psoriasis.
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Affiliation(s)
- Jin-Young Choi
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hyunseong Kim
- Department of Life Science, Dongguk University-Seoul, Ilsandong-gu, Goyang-si 10326, Republic of Korea
| | - Ha-Yeh-Rin Koo
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jaeyoon You
- Department of Life Science, Dongguk University-Seoul, Ilsandong-gu, Goyang-si 10326, Republic of Korea
| | - Dong-Soo Yu
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Young-Bok Lee
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Minho Lee
- Department of Life Science, Dongguk University-Seoul, Ilsandong-gu, Goyang-si 10326, Republic of Korea
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22
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Attwa E, Khater MH, Selim HM, Essam R. Comparative efficacy of intralesional 5 Flurouracil and intralesional Triamcinolone acetonide in localized plaque psoriasis. Dermatol Ther 2022; 35:e15796. [PMID: 36039604 DOI: 10.1111/dth.15796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/14/2022] [Accepted: 08/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Psoriasis is a papulosquamous disorder that causes significant social and psychological trauma to the patient. It is characterized by the presence of erythematous, indurated plaques covered with silvery-white scales. Despite the availability of several systemic agents that have been approved for the treatment of psoriasis, usually there are some residual lesions and there is a need to treat them for cosmetic reasons or symptomatic control. AIMS 1. Treatment of resistant localized psoriatic plaques or residuals after systemic treatment. 2. Recently, some intralesional agents have been used successfully for the treatment of psoriatic plaques as 5-FU, methotrexate, and botulinum toxin type-A, and nearly for 4 decades, no study focused on the effect of intralesional corticosteroids in the treatment of these psoriatic plaques. We decided to highlight their role and compare intralesional Triamcinolone to intralesional 5-FU regarding efficacy and safety in the treatment of plaque psoriasis. METHODS This study included 24 patients with localized plaque psoriasis. Each patient was treated by split-body therapy where one psoriatic plaque was treated with intralesional 5FU and another plaque with intralesional TAC. A total of three injections were given at two- week intervals and follow up was regularly every 2 weeks up to 12 weeks. RESULTS There was a statistically significant difference between both groups (p = 0.008) as the response rate on 5-FU side was 12.5% with no response, 29.2% with a moderate response, 41.7% with an excellent response, and 16.7% with a complete clearance, while on the TAC side it was16.7% with a moderate response, 20.8% with an excellent response and 62.5% with a complete clearance. Hyperpigmentation was the most irritating side effect of 5-FU that occurred. Pain, during and after injection, was greater in 5-FU group. Hypopigmentation and atrophy only occurred in TAC group in some patients but it seems to be reversible and not disfiguring. CONCLUSION 1-Intralesional TAC injection may have more efficacy and less side effects than 5-FU injection in the treatment of localized plaque psoriasis. Hyperpigmentation and pain were the most irritating side effects of 5-FU 2-Intralesional TAC can be effective in the treatment of localized psoriatic plaques with minimal side effects, especially in patients not suitable for systemic agents.
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Affiliation(s)
- Enayat Attwa
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed H Khater
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Heba M Selim
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Reham Essam
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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23
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Yeh CP, Huang YW, Tsai TF. Comparison of the relative efficacy of different biologics in different body areas in patients with moderate to severe psoriasis receiving biologics and tofacitinib in phase 3 randomized controlled trials: a 15-year single-center experience. Expert Rev Clin Pharmacol 2022; 15:887-895. [PMID: 35848067 DOI: 10.1080/17512433.2022.2103538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND : The treatment of psoriasis has been revolutionized after the advent of biologics. However, focal resistant plaques are still common which may impose a significant impact on quality-of-life. RESEARCH DESIGN AND METHODS : We compared the relative efficacy of different biologics and tofacitinib in different body areas in Asian patients with psoriasis. We retrospectively included the clinical data of 177 patients (228 treatment courses) with moderate-to-severe psoriasis in 10 biologic or tofacitinib trials conducted between 2004 and 2019. Pooled data was analyzed at week 12-16 and week 44-52 respectively for total and four regional PASI 75, 90, and 100 responses. RESULTS : The result showed that secukinumab, ixekizumab, guselkumab and risankizumab had more favorable efficacy, followed by adalimumab, ustekinumab, and tofacitinib, while etanercept showed the least efficacy. The regional PASI response peaked early in the head area with subsequent decline while the lower extremities improved slowly. At week 52, the head-and-neck and lower extremities were less likely to achieve PASI responses compared to the trunk and upper extremities. CONCLUSIONS : The treatment responses of different body regions of biologics and tofacitinib were in line with the overall response. However, the head region responds fast but total clearance at 52 weeks was similarly lower as the leg region. More subjects and prospective studies may be required to compare the efficacy of different biologics in different body regions.
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Affiliation(s)
- Chen-Pu Yeh
- Department of Dermatology, National Taiwan University Hospital, Yun-Lin Branch, No.579, Sec. 2, Yunlin Rd., Douliu City, Taiwan
| | - Yi-Wei Huang
- Department of Dermatology, National Taiwan University Hospital, No.7, Zhongshan S. Rd., Zhongzheng Dist., Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital, No.7, Zhongshan S. Rd., Zhongzheng Dist., Taipei, Taiwan
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24
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Menter A, Bhutani T, Ehst B, Elewski B, Jacobson A. Narrative Review of the Emerging Therapeutic Role of Brodalumab in Difficult-to-Treat Psoriasis. Dermatol Ther (Heidelb) 2022; 12:1289-1302. [PMID: 35672564 PMCID: PMC9209590 DOI: 10.1007/s13555-022-00746-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/09/2022] [Indexed: 12/01/2022] Open
Abstract
Psoriatic involvement in areas of the body such as nails, palms and soles (palmoplantar), and scalp is associated with dramatically negative effects on quality of life relative to involvement elsewhere in the body. Although numerous evidence-based studies demonstrate the efficacy of biologics for overall skin clearance in moderate-to-severe plaque psoriasis (including tumor necrosis factor α [TNFα] inhibitors and interleukin [IL]-17A, IL-12/IL-23, IL-23, IL-17F, and IL-17A/F inhibitors), large, randomized, placebo-controlled clinical studies of psoriasis with nail, palmoplantar, and scalp involvement are needed to better inform decision-making in clinical practice. Moreover, biologic failure caused by drug ineffectiveness is a common occurrence in patients who do not respond, lose response, or are intolerant to treatment. Brodalumab is a fully human IL-17 receptor A antagonist that demonstrates high rates of skin clearance among the latest generation of biologic therapies for treatment of moderate-to-severe psoriasis. This review summarizes current literature on the efficacy of brodalumab and other therapies in difficult-to-treat psoriasis including psoriasis in difficult-to-treat locations (such as psoriasis with nail, palmoplantar, or scalp involvement) and psoriasis in patients whose disease did not respond to other biologics.
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Affiliation(s)
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, CA, USA
| | | | - Boni Elewski
- Department of Dermatology School of Medicine, University of Alabama, Birmingham, AL, USA
| | - Abby Jacobson
- Ortho Dermatologics (a Division of Bausch Health US, LLC), Bridgewater, NJ, USA
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25
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de Ruiter CC, Rustemeyer T. Biologics Can Significantly Improve Dermatology Life Quality Index (DLQI) in Psoriatic Patients: A Systematic Review. Psoriasis (Auckl) 2022; 12:99-112. [PMID: 35637943 PMCID: PMC9148207 DOI: 10.2147/ptt.s356568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Materials and Methods Results Conclusion
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Affiliation(s)
| | - Thomas Rustemeyer
- Dermato-Allergology and Occupational Dermatology, Amsterdam UMC, Amsterdam, the Netherlands
- Correspondence: Thomas Rustemeyer, Dermato-Allergology and Occupational Dermatology, Amsterdam UMC, Amsterdam, the Netherlands, Tel +31 20 5662584, Email
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26
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Bardazzi F, Viviani F, Filippi F, Carpanese MA, Piraccini BM, Abbenante D. The legs: An underestimated difficult-to-treat area of psoriasis. Dermatol Ther 2022; 35:e15485. [PMID: 35383406 DOI: 10.1111/dth.15485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/03/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | - Filippo Viviani
- Dermatology, IRCCS Policlinico di Sant'Orsola, Bologna, Italy.,Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Federica Filippi
- Dermatology, IRCCS Policlinico di Sant'Orsola, Bologna, Italy.,Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Miriam Anna Carpanese
- Dermatology, IRCCS Policlinico di Sant'Orsola, Bologna, Italy.,Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Bianca Maria Piraccini
- Dermatology, IRCCS Policlinico di Sant'Orsola, Bologna, Italy.,Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Diego Abbenante
- Dermatology, IRCCS Policlinico di Sant'Orsola, Bologna, Italy.,Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
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27
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Mastorino L, Sara S, Megna M, Siliquini N, Quaglino P, Ortoncelli M, Avallone G, Rubatto M, Fabbrocini G, Dapavo P, Ribero S. Risankizumab Shows High Efficacy and Maintainance in Improvement of Response Until Week 52. Dermatol Ther 2022; 35:e15378. [PMID: 35156278 PMCID: PMC9286040 DOI: 10.1111/dth.15378] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 11/28/2022]
Abstract
Risankizumab has been recently approved for moderate‐to‐severe plaque psoriasis; however, real‐life studies are scarce. Analysis of possible predictor factors of treatment response are limited to body mass index (BMI) and previous biologic experience. Our objectives were to evaluate the effectiveness and safety of Risankizumab and to investigate on possible predictor factors response. We retrospectively analyzed 166 patients from two centers in Italy who undergone Risankizumab for psoriasis. The proportion of patients achieving a 100%, 90%, 75% of improvement in Psoriasis Area Severity Index (PASI) and PASI <3 were collected at weeks 16, 28, 40, and 52. Study population was analyzed in subgroups to investigate possible predictors of response to Risankizumab since week 40. At the time of analysis 165, 103, 30, and 11 patients had completed 16, 28, 40, and 52 weeks of treatment, respectively. The mean PASI score decreased from 12.5 ± 5.1 at baseline to 1.9 ± 2.4 at week 16. Similar reductions were observed when considering PASI <3, PASI 75, PASI 90, and PASI 100. Previous biologics failure, different smoking habits, obesity, and joint involvement resulted in a lower response to risankizumab. In particular, significant differences in mean PASI at any time‐points was observed between psoriatic arthritis (PSA) and non‐PSA patients: 2.7 versus 1.7 (p = 0.036), 1.9 versus 0.4 (p = 0.006), and 4.1 versus 0.5 (p = 0.016) at 16, 28, and 40 weeks, respectively. No difference in response to risankizumab occurred in the case of involvement of difficult‐to‐treat areas. In this population, Risankizumab was effective and safe. Smoking habits, joint involvement, obese status, and previous biologic experience may negatively affect treatment response, while difficult body sites involvement have minor impact.
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Affiliation(s)
- Luca Mastorino
- Department of Medical Sciences, Section of Dermatology, University of Turin, C.so Dogliotti, 14 - 10126 Torino +39-011.670 5396, Italy
| | - Susca Sara
- Department of Medical Sciences, Section of Dermatology, University of Turin, C.so Dogliotti, 14 - 10126 Torino +39-011.670 5396, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Niccolò Siliquini
- Department of Medical Sciences, Section of Dermatology, University of Turin, C.so Dogliotti, 14 - 10126 Torino +39-011.670 5396, Italy
| | - Pietro Quaglino
- Department of Medical Sciences, Section of Dermatology, University of Turin, C.so Dogliotti, 14 - 10126 Torino +39-011.670 5396, Italy
| | - Michela Ortoncelli
- Department of Medical Sciences, Section of Dermatology, University of Turin, C.so Dogliotti, 14 - 10126 Torino +39-011.670 5396, Italy
| | - Gianluca Avallone
- Department of Medical Sciences, Section of Dermatology, University of Turin, C.so Dogliotti, 14 - 10126 Torino +39-011.670 5396, Italy
| | - Marco Rubatto
- Department of Medical Sciences, Section of Dermatology, University of Turin, C.so Dogliotti, 14 - 10126 Torino +39-011.670 5396, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Paolo Dapavo
- Department of Medical Sciences, Section of Dermatology, University of Turin, C.so Dogliotti, 14 - 10126 Torino +39-011.670 5396, Italy
| | - Simone Ribero
- Department of Medical Sciences, Section of Dermatology, University of Turin, C.so Dogliotti, 14 - 10126 Torino +39-011.670 5396, Italy
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28
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Son SW, Yu DY, Kim Y, Ahn HH, Jang YH, Roh JY, Lee YB, Lee JY, Kim MH, Lee Y, Park GH, Yoon HS, Youn SW. Differences in Clinical Responses to Ustekinumab Treatment among Body Regions: Results from a Real-World Prospective, Observational, and Multi-Center Study in Korea. Ann Dermatol 2022; 34:14-21. [PMID: 35221590 PMCID: PMC8831313 DOI: 10.5021/ad.2022.34.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/14/2021] [Accepted: 07/25/2021] [Indexed: 11/08/2022] Open
Abstract
Background Objective Methods Results Conclusion
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Affiliation(s)
- Sang Wook Son
- Department of Dermatology, Korea University Ansan Hospital, Ansan, Korea
| | - Dae Young Yu
- Department of Public Health, Korea University College of Medicine, Seoul, Korea
- Medical Affairs, Janssen Korea, Seoul, Korea
| | | | - Hyo Hyun Ahn
- Department of Dermatology, Korea University Anam Hospital, Seoul, Korea
| | - Yong Hyun Jang
- Department of Dermatology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Joo Young Roh
- Department of Dermatology, Gachon University Gil Medical Center, Incheon, Korea
| | - Young Bok Lee
- Department of Dermatology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Ji Yeoun Lee
- Department of Dermatology, Chungbuk National University Hospital, Cheongju, Korea
| | - Myung Hwa Kim
- Department of Dermatology, Dankook University Hospital, Cheonan, Korea
| | - YoungJa Lee
- Medical Affairs, Janssen Korea, Seoul, Korea
| | - Gyeong-Hun Park
- Department of Dermatology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Hyun-Sun Yoon
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Sang Woong Youn
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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29
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Suzuki T, Ito T, Gilhar A, Tokura Y, Reich K, Paus R. The hair follicle-psoriasis axis: Shared regulatory mechanisms and therapeutic targets. Exp Dermatol 2021; 31:266-279. [PMID: 34587317 DOI: 10.1111/exd.14462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/09/2021] [Accepted: 09/24/2021] [Indexed: 12/17/2022]
Abstract
It has long been known that there is a special affinity of psoriasis for the scalp: Here, it occurs most frequently, lesions terminate sharply in frontal skin beyond the hair line and are difficult to treat. Yet, surprisingly, scalp psoriasis only rarely causes alopecia, even though the pilosebaceous unit clearly is affected. Here, we systematically explore the peculiar, insufficiently investigated connection between psoriasis and growing (anagen) terminal scalp hair follicles (HFs), with emphasis on shared regulatory mechanism and therapeutic targets. Interestingly, several drugs and stressors that can trigger/aggravate psoriasis can inhibit hair growth (e.g. beta-blockers, chloroquine, carbamazepine, interferon-alpha, perceived stress). Instead, several anti-psoriatic agents can stimulate hair growth (e.g. cyclosporine, glucocorticoids, dithranol, UV irradiation), while skin/HF trauma (Köbner phenomenon/depilation) favours the development of psoriatic lesions and induces anagen in "quiescent" (telogen) HFs. On this basis, we propose two interconnected working models: (a) the existence of a bidirectional "hair follicle-psoriasis axis," along which keratinocytes of anagen scalp HFs secrete signals that favour the development and maintenance of psoriatic scalp lesions and respond to signals from these lesions, and (b) that anagen induction and psoriatic lesions share molecular "switch-on" mechanisms, which invite pharmacological targeting, once identified. Therefore, we advocate a novel, cross-fertilizing and integrative approach to psoriasis and hair research that systematically characterizes the "HF-psoriasis axis," focused on identification and therapeutic targeting of selected, shared signalling pathways in the future management of both, psoriasis and hair growth disorders.
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Affiliation(s)
- Takahiro Suzuki
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Taisuke Ito
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Amos Gilhar
- Skin Research Laboratory, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yoshiki Tokura
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Allergic Disease Research Center, Chutoen General Medical Center, Kakegawa, Japan
| | - Kristian Reich
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Monasterium Laboratory, Münster, Germany
| | - Ralf Paus
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Monasterium Laboratory, Münster, Germany.,Centre for Dermatology Research, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Center, Manchester, UK
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Ji C, Wang H, Bao C, Zhang L, Ruan S, Zhang J, Gong T, Cheng B. Challenge of Nail Psoriasis: An Update Review. Clin Rev Allergy Immunol 2021; 61:377-402. [PMID: 34478047 DOI: 10.1007/s12016-021-08896-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 12/11/2022]
Abstract
Nail psoriasis is a refractory disease that affects 50-79% skin psoriasis patients and up to 80% of patients with psoriatic arthritis (PsA). The pathogenesis of nail psoriasis is still not fully illuminated, although some peculiar inflammatory cytokines and chemokines seems to be the same as described in psoriatic skin lesions. Psoriatic nail involving matrix can cause pitting, leukonychia, red spots in lunula, and nail plate crumbling, while nail bed involvement can result in onycholysis, oil-drop discoloration, nail bed hyperkeratosis, and splinter hemorrhages. The common assessment methods of evaluating nail psoriasis includes Nail Psoriasis Severity Index (NAPSI), Nail Assessment in Psoriasis and Psoriatic Arthritis (NAPPA), Nail Psoriasis Quality of life 10 (NPQ10), and so on. Treatment of nail psoriasis should be individualized according to the number of involving nail, the affected site of nail and presence of skin and/or joint involvement. Generally, topical therapies are used for mild nail psoriasis, while biologic agents such as etanercept are considered for severe nail disease and refractory nail psoriasis. Even though the current literature has shown some support for the pathogenesis, clinical presentation, or therapies of nail psoriasis, systemic review of this multifaceted disease is still rare to date. We elaborate recent developments in nail psoriasis epidemiology, pathogenesis, anatomy, clinical manifestation, diagnosis, differential diagnosis, and therapies to raise better awareness of the complexity of nail psoriasis and the need for early diagnosis or intervention.
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Affiliation(s)
- Chao Ji
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China
| | - Haiqing Wang
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China
| | - Chengbei Bao
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China
| | - Liangliang Zhang
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China
| | - Shifan Ruan
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China
| | - Jing Zhang
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China
| | - Ting Gong
- Central Laboratory, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China.
| | - Bo Cheng
- Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China.
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31
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Kamiya K, Oiso N, Kawada A, Ohtsuki M. Epidemiological survey of the psoriasis patients in the Japanese Society for Psoriasis Research from 2013 to 2018. J Dermatol 2021; 48:864-875. [PMID: 33580908 PMCID: PMC8247979 DOI: 10.1111/1346-8138.15803] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/25/2021] [Indexed: 01/01/2023]
Abstract
In Japan, the Japanese Society for Psoriasis Research (JSPR) has been conducting annual epidemiological surveys of patients with psoriasis since 1982. The aim of this study was to conduct a recent epidemiological analysis of the psoriasis patients who were enrolled in the JSPR from 2013 to 2018. A total of 15 287 cases were enrolled from 132 medical institutions, out of which 65.3% (9989 cases) were male and 34.7% (5298 cases) were female. Approximately 50.0% of the cases had past history and comorbidities, such as hypertension (42.0%), dyslipidemia (30.0%), diabetes mellitus (23.7%), hyperuricemia (15.1%), cardiovascular disease (6.0%), and cerebral vascular disorders (6.0%). There was a yearly increase in the use of corticosteroid/vitamin D3 combinations and apremilast for treating psoriasis. In contrast, the use of phototherapy gradually decreased. From 2013 to 2018, approximately 18.6% of the cases were treated with biologics, such as infliximab (17.6%), adalimumab (23.3%), ustekinumab (21.4%), secukinumab (11.6%), ixekizumab (7.6%), brodalumab (6.3%), and guselkumab (4.3%). In the past decade, the biologics have changed the treatment and management of psoriasis. This survey includes significant information regarding the recent perspective of psoriasis in the Japanese Society, especially focusing on the treatment trends after the introduction of biologics.
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Affiliation(s)
- Koji Kamiya
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Naoki Oiso
- Department of Dermatology, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan
| | - Akira Kawada
- Department of Dermatology, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan
| | - Mamitaro Ohtsuki
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
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Imafuku S, Kanai Y, Murotani K, Nomura T, Ito K, Ohata C, Yamazaki F, Miyagi T, Takahashi H, Okubo Y, Saeki H, Honma M, Tada Y, Mabuchi T, Higashiyama M, Kobayashi S, Hashimoto Y, Seishima M, Kakuma T. Utility of the Dermatology Life Quality Index at initiation or switching of biologics in real-life Japanese patients with plaque psoriasis: Results from the ProLOGUE study. J Dermatol Sci 2021; 101:185-193. [PMID: 33495058 DOI: 10.1016/j.jdermsci.2021.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/27/2020] [Accepted: 01/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Plaque psoriasis significantly affects patients' health-related quality of life. To aid treatment decisions, not only objective assessment by physicians but also subjective assessment by patients is important. OBJECTIVE To assess the significance of Dermatology Life Quality Index (DLQI) evaluation at the time of biologics introduction in clinical practice in Japanese patients with plaque psoriasis. METHODS This was a single-arm, open-label, multicenter study. At baseline, Psoriasis Area and Severity Index (PASI) and DLQI scores were measured and stratified based on DLQI scores ≥6/≤5 and PASI scores ≤10/>10. Other patient-reported outcomes assessed included EQ-5D-5L, itch numerical rating scale (NRS), skin pain NRS, Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-8 (PHQ-8), Sleep Problem Index-II (SPI-II), and Treatment Satisfaction Questionnaire for Medication-9 (TSQM-9). RESULTS Of the 73 enrolled patients, 23 had PASI scores ≤10. Those with PASI/DLQI scores >10/≥6 had a significantly higher median PASI score than those with PASI/DLQI scores >10/≤5 (p = 0.0125). Regardless of PASI scores (>10/≤10), median itch NRS and GAD-7 scores were significantly higher in patients with DLQI scores ≥6 than in those with DLQI scores ≤5 (itch NRS, p = 0.0361 and p = 0.0086, respectively; GAD-7, p = 0.0167 and p = 0.0273, respectively). Patients with PASI/DLQI scores ≤10/≥6 had significantly higher skin pain NRS (p = 0.0292) and PHQ-8 (p = 0.0255) scores and significantly lower median SPI-II scores (p = 0.0137) and TSQM-9 Effectiveness domain scores (p = 0.0178) than those with PASI/DLQI scores ≤10/≤5. CONCLUSION DLQI may be useful for assessing patients' concerns that cannot be identified by PASI alone while initiating biologics or switching from other biologics in clinical practice.
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Affiliation(s)
- Shinichi Imafuku
- Department of Dermatology, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
| | | | | | | | - Kei Ito
- Department of Dermatology, JR Sapporo Hospital, Sapporo, Hokkaido, Japan
| | - Chika Ohata
- Department of Dermatology, Osaka General Medical Center, Osaka, Japan
| | | | - Takuya Miyagi
- Department of Dermatology, University of the Ryukyus, Okinawa, Japan
| | | | - Yukari Okubo
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Masaru Honma
- Department of Dermatology, Asahikawa Medical University, Hokkaido, Japan
| | - Yayoi Tada
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Tomotaka Mabuchi
- Department of Dermatology, Tokai University School of Medicine, Kanagawa, Japan
| | | | - Satomi Kobayashi
- Department of Dermatology, Seibo International Catholic Hospital, Tokyo, Japan
| | - Yuki Hashimoto
- Department of Dermatology, Toho University School of Medicine, Tokyo, Japan
| | - Mariko Seishima
- Department of Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan
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Polat Ekinci A, Bölük KN, Babuna Kobaner G. Secukinumab and acitretin as a combination therapy for three clinical forms of severe psoriasis in multi-drug refractory patients: A case series of high efficacy and safety profile. Dermatol Ther 2021; 34:e14704. [PMID: 33368934 DOI: 10.1111/dth.14704] [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: 10/27/2020] [Revised: 12/10/2020] [Accepted: 12/16/2020] [Indexed: 01/06/2023]
Abstract
Secukinumab, the first monoclonal antibody that inhibits interleukin-17A, has been shown to have rapid and long-lasting efficacy in the treatment of moderate-to-severe psoriasis. However, there are still difficult-to-treat cases in which even dose-escalation fails to provide a clinical response. In such cases, combining secukinumab with a conventional systemic agent may be a rational approach. Although methotrexate is most commonly preferred, acitretin may also be considered a good alternative, with its lower hepatotoxic potential. Data are limited regarding the use of combination therapy of secukinumab and acitretin for psoriasis. We herein present three patients with chronic plaque, generalized pustular and erythrodermic psoriasis, respectively, accompanied by multiple comorbidities, in whom skin clearance could not be achieved with several conventional and biologic therapies (including escalated dose regimens of secukinumab in two patients). Alternatively, we used a combination of secukinumab with low-dose acitretin, which resulted in a complete or almost complete skin clearance in all patients, with no adverse events or increased toxicity. Based on our real-life clinical experience with those patients, acitretin seems an effective and safe option to be used in combination with secukinumab. Even in patients who are refractory to multiple drugs including escalated doses of secukinumab, the addition of low-dose acitretin may be helpful in achieving treatment goals, decreasing the need for switching to another biologic therapy.
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Affiliation(s)
- Algün Polat Ekinci
- Department of Dermatology and Venereology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Kübra Nursel Bölük
- Department of Dermatology and Venereology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Goncagül Babuna Kobaner
- Department of Dermatology and Venereology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
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Muslimani MA, Bolcato V, Silvestri A, Brazzelli V. Psoriatic patients undergoing long‐term therapy with biologics: Impact of residual localization of psoriasis on quality of life in an Italian clinical setting. Dermatol Ther 2020; 33:e14337. [DOI: 10.1111/dth.14337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/09/2020] [Accepted: 09/19/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Muhammad Ali Muslimani
- Institute of Dermatology Fondazione IRCCS Policlinico San Matteo and University of Pavia Pavia Italy
| | - Vittorio Bolcato
- Department of Public Health, Experimental, and Forensic Medicine, Forensic Science Section “Antonio Fornari” University of Pavia Pavia Italy
| | - Annalisa Silvestri
- Scientific Direction, Clinical Epidemiology and Biometric Unit Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Valeria Brazzelli
- Institute of Dermatology Fondazione IRCCS Policlinico San Matteo and University of Pavia Pavia Italy
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Calcipotriol/Betamethasone Dipropionate Cutaneous Foam Treatment for Psoriasis in Patients With BSA 5-15% and PGA ≥ 3: Post-Hoc Analysis From Three Randomized Controlled Trials. Dermatol Ther (Heidelb) 2020; 10:1111-1120. [PMID: 32785881 PMCID: PMC7477061 DOI: 10.1007/s13555-020-00419-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Psoriasis is a chronic, inflammatory disease, which ranges in severity from mild to severe. Although topical therapies are frequently used to treat mild disease, they are not routinely used to treat patients with moderate-to-severe disease who have a larger proportion of their body surface area (BSA) affected (≥ 5% BSA). Based on well-controlled trials in adults with mild-to-severe disease, fixed-dose combination calcipotriol 50 μg/g + betamethasone dipropionate 0.5 mg/g (Cal/BD) cutaneous foam has been approved (Enstilar®, LEO Pharma) in the USA and EU for the treatment of psoriasis vulgaris for up to 4 weeks in adults. In this post-hoc subgroup analysis, we used pooled data from phase II/III trials to investigate the efficacy and safety of Cal/BD cutaneous foam in patients with moderate-to-severe psoriasis. METHODS Patients included in this analysis had psoriasis affecting 5-15% BSA and a physician's global assessment (PGA) ≥ 3. Endpoints included: treatment success by PGA (rating: clear/almost clear), patient's global assessment (PaGA) at week 4 (rating: clear/very mild) and safety. RESULTS A total of 340 patients in the three randomized trials met the BSA/PGA inclusion criteria, of whom 254 were treated with Cal/BD foam and 86 with vehicle foam. Treatment success by PGA and PaGA at week 4 was achieved in 143 (58.1%) and 138 (56.1%) patients receiving Cal/BD foam, respectively, versus three (3.6%) and 14 (16.7%) patients receiving vehicle foam. Sixty-six adverse events (AEs) occurred in 47 (18.5%) patients receiving Cal/BD foam and 11 AEs occurred in 11 (12.8%) patients receiving vehicle foam. Three severe AEs and 15 non-serious treatment-related AEs occurred in patients receiving Cal/BD foam. CONCLUSION The results from three clinical trials analyzed together show that topical Cal/BD foam is well tolerated and efficacious for treating patients with moderate-to-severe disease. Data support Cal/BD foam as a potential topical therapy for moderate-to-severe psoriasis. TRIAL REGISTRATIONS ClinicalTrials.gov registration numbers: NCT01866163, NCT02132936, NCT01536886.
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Lacarrubba F, Verzì AE, Musumeci ML, Micali G. High capillary diameter in psoriatic plaques of the lower legs. Br J Dermatol 2020; 182:1064-1065. [PMID: 31758806 DOI: 10.1111/bjd.18733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- F Lacarrubba
- Dermatology Clinic, University of Catania, Catania, Sicily, Italy
| | - A E Verzì
- Dermatology Clinic, University of Catania, Catania, Sicily, Italy
| | - M L Musumeci
- Dermatology Clinic, University of Catania, Catania, Sicily, Italy
| | - G Micali
- Dermatology Clinic, University of Catania, Catania, Sicily, Italy
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Katsuo K, Honda T, Kabashima K. Improvement of recalcitrant psoriatic lesions on the lower legs by changing the injection site of secukinumab from the abdomen to lower legs. J Dermatol 2019; 47:e54-e55. [PMID: 31742721 DOI: 10.1111/1346-8138.15159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kosuke Katsuo
- Department of Dermatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tetsuya Honda
- Department of Dermatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenji Kabashima
- Department of Dermatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Affiliation(s)
- I. Belinchón
- Department of Dermatology Hospital General Universitario de Alicante‐ISABIAL Universidad Miguel Hernández Alicante Spain
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