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Juntongjin P, Srisinlapakig S, Nitayavardhana S. Botulinum toxin injection shows promise in nail psoriasis: A comparative randomized controlled trial. JAAD Int 2024; 16:105-111. [PMID: 38873171 PMCID: PMC11170438 DOI: 10.1016/j.jdin.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 06/15/2024] Open
Abstract
Background Nail psoriasis remains a challenging condition with limited satisfaction from current treatments. An increasing number of neuropeptides were reported in psoriatic tissue. Objective To compare the efficacy of botulinum toxin A (BoNT-A) injection, triamcinolone acetonide (TA) injection, topical combination of vitamin D/steroid (VitD/steroid) and placebo in improving nail psoriasis. Methods A 24-week randomized intraindividual comparative-controlled study involved participants with at least 4 psoriatic fingernails, each with a total target nail psoriasis severity index (NAPSI) score of at least 3 points. Nails were randomly received different treatments; intralesional BoNT-A injection at baseline, intralesional TA at baseline and eighth week, daily topical VitD/steroid application for 16 weeks and placebo. Results Evaluation of 64 psoriatic fingernails showed a 40% reduction in the total target NAPSI score at 24 weeks following BoNT-A injection (P = .001). BoNT-A significantly improved nail bed lesions more than TA and topical VitD/steroid (P = .038), with no reported serious adverse effects. Limitations Relatively small sample size; hand hygiene during the COVID-19 pandemic may interfere NAPSI score evaluation. Conclusions BoNT-A injection emerges as a promising and effective therapy for nail psoriasis, providing sustained efficacy lasting up to 6 months with a single injection.
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Affiliation(s)
- Premjit Juntongjin
- Division of Dermatology, Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand
| | - Suthima Srisinlapakig
- Division of Dermatology, Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand
| | - Sunatra Nitayavardhana
- Division of Dermatology, Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand
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Bertanha L, Damas II, Stelini RF, Cintra ML, Di Chiacchio N. Role of tangential biopsy in the diagnosis of nail psoriasis. An Bras Dermatol 2024; 99:696-705. [PMID: 38789365 PMCID: PMC11344000 DOI: 10.1016/j.abd.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Histopathology can be crucial for diagnosis of inflammatory nail diseases. Longitudinal excision and punch biopsies are the most used techniques to obtain the tissue sample. However, there is a low clinical-histopathological correlation, besides the risk of nail dystrophy. Tangential excision biopsy (TB) is a well-established technique for the investigation of longitudinal melanonychia. TB could also be used to evaluate diseases in which histopathological changes are superficial, as in psoriasis. OBJECTIVE To study the value of TB in the histopathological diagnosis of nail psoriasis. METHODS This is a prospective and descriptive study of the clinical-histopathological findings of samples from the nail bed or matrix and nail plate of 13 patients with clinical suspicion of nail psoriasis. Biopsies were obtained through partial nail avulsion and TB. RESULTS In nine patients, the hypothesis of psoriasis was confirmed by histopathology; in one, the criteria for diagnosing nail lichen planus were fulfilled. The tissue sample of only one patient did not reach the dermal papillae, and, in four of 13 patients, the adventitial dermis was not sampled. No patient developed onychodystrophy after the procedure. STUDY LIMITATIONS In three patients, the clinical and, consequently, histopathological nail changes were subtle. Also, in one patient's TB didn't sample the dermal papillae. CONCLUSIONS TB is a good option to assist in the histopathological diagnosis of nail psoriasis, especially when appropriate clinical elements are combined. Using this technique, larger and thinner samples, short postoperative recovery time, and low risk of onychodystrophy are obtained.
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Affiliation(s)
- Laura Bertanha
- Department of Pathological Anatomy, Medical Sciences College, Universidade Estadual de Campinas, Campinas, SP, Brazil; Dermatology Service, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil.
| | - Ingrid Iara Damas
- Department of Pathological Anatomy, Medical Sciences College, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Rafael Fantelli Stelini
- Department of Pathological Anatomy, Medical Sciences College, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Maria Letícia Cintra
- Department of Pathological Anatomy, Medical Sciences College, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Nilton Di Chiacchio
- Dermatology Service, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil
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Das G, Mathur M, Shrestha A, Jaiswal S, Maharjan S. Palmoplantar psoriasis: A clinicopathological correlation in a tertiary care hospital. Skin Res Technol 2024; 30:e13882. [PMID: 39099444 PMCID: PMC11298709 DOI: 10.1111/srt.13882] [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: 06/07/2024] [Accepted: 06/17/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Palmoplantar psoriasis is a clinical variant of psoriasis characterized by well-defined erythematous desquamating plaques on palms and soles, which may or may not include pustules. Hyperkeratotic lesions of palm and sole commonly include Psoriasis, Eczema and Tinea. These conditions often present with overlapping clinical and histopathological features requiring clinicohistopathological correlation for a conclusive diagnosis. The presence of munro's microabscess or spongiform pustule of kogoj differentiates psoriasis of palm and sole from other hyperkeratotic lesions of palm and sole. The objective of this study was to study the clinical and histopathological profile of palmoplantar psoriasis and correlate clinical diagnosis with histopathological diagnosis. METHOD A hospital-based, descriptive study was conducted from January 1, 2020, to December 31, 2020. Fifty-two patients were clinically diagnosed as palmoplantar psoriasis with or without involving other parts of body and routine histopathological evaluation was carried out as per standard protocols. RESULT Clinically diagnosed 52 cases of palmoplantar psoriasis showed varied histopathology with hyperkeratosis (100%), parakeratosis (100%), regular acanthosis (75%), Supra-papillary thinning (44.2%), spongiosis (65.4%), tortuous vessels in the papillary dermis (78.8%) and mixed inflammatory infiltrates (predominantly lymphocytic-100%), which were observed to be prominent findings in skin biopsies of our patients. Clinicopathological correlation was achieved in 88.5% of cases. CONCLUSION This study shows clinically diagnosed palmoplantar psoriasis with histopathological features consistent with palmoplantar psoriasis in 88.5% cases. Thus, clinically inconclusive hyperkeratotic lesions with palmoplantar psoriasis can be diagnosed with histopathological correlation improving the therapeutic intervention.
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Affiliation(s)
- Gautam Das
- Department of DermatologyCollege of Medical Sciences (COMS)BharatpurNepal
- Department of DermatologyKulhudhuffushi Regional Hospital (KRH)KulhudhuffushiMaldives
| | - Mahesh Mathur
- Department of DermatologyCollege of Medical Sciences (COMS)BharatpurNepal
| | - Ayasha Shrestha
- Department of Community MedicineCollege of Medical Sciences (COMS)BharatpurNepal
| | - Sunil Jaiswal
- Department of DermatologyCollege of Medical Sciences (COMS)BharatpurNepal
| | - Sailuja Maharjan
- Department of PathologyKulhudhuffushi Regional Hospital (KRH)KulhudhuffushiMaldives
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Sendrea AM, Cristea S, Salavastru CM. Nutritional Status in Pediatric Psoriasis: A Case-Control Study in a Tertiary Care Referral Centre. CHILDREN (BASEL, SWITZERLAND) 2024; 11:885. [PMID: 39062334 PMCID: PMC11275588 DOI: 10.3390/children11070885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/15/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Psoriasis and obesity are chronic, inflammatory diseases, sharing certain pathophysiological factors. Psoriasis, increasingly viewed as a systemic inflammatory condition, may have various symptoms beyond the skin manifestations. METHODS This research aimed to explore the connection between body mass index (BMI) and pediatric psoriasis, through a case-control study on 100 psoriasis cases and 100 controls who were matched in terms of age and sex. The percentiles of the BMI by age and sex determined the nutritional status of each patient and control. The severity of psoriasis was evaluated based on the psoriasis area and severity index (PASI), nail involvement based on the nail psoriasis severity index (NAPSI), and quality of life impairment with the dermatology life quality index (DLQI). RESULTS While no statistically significant relationship was identified between increased BMI and PASI (p = 0.074), the risk of being overweight and obesity was significantly higher in the psoriasis group (OR 6.93, p = 0.003; OR 12.6, p < 0.001, respectively). The BMI increased with the PASI for psoriasis vulgaris but not for psoriasis inverse. No connections were found between disease duration and BMI (p = 0.56) or between BMI and PASI based on sex (p = 0.26). The NAPSI increased significantly with increased BMI (p = 0.000015). CONCLUSIONS This study highlights the association between elevated BMI, psoriasis diagnosis, and severity of psoriatic onychopathy in pediatric patients, advocating for further large-scale studies to confirm these explorations and increasing awareness for better screening and management of such cases for overweight/obese patients.
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Affiliation(s)
- Adelina-Maria Sendrea
- Pediatric Dermatology Department, Carol Davila University of Medicine and Pharmacy, 8 Eroilor Sanitari Boulevard, 050474 Bucharest, Romania;
- Pediatric Dermatology Department, Colentina Clinical Hospital, 19-21 Stefan cel Mare Street, 020125 Bucharest, Romania
- Dermatology Research Unit, Colentina Clinical Hospital, 19-21 Stefan cel Mare Street, 020125 Bucharest, Romania
| | - Sinziana Cristea
- Certara Inc., Radnor Corporate Centre, Suite 350, Radnor, PA 19087, USA;
| | - Carmen Maria Salavastru
- Pediatric Dermatology Department, Carol Davila University of Medicine and Pharmacy, 8 Eroilor Sanitari Boulevard, 050474 Bucharest, Romania;
- Pediatric Dermatology Department, Colentina Clinical Hospital, 19-21 Stefan cel Mare Street, 020125 Bucharest, Romania
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Gopalarathinam R, Sankar R, Zhao SS. Role of Anti-Inflammatory Diet and Fecal Microbiota Transplant in Psoriatic Arthritis. Clin Ther 2024; 46:588-596. [PMID: 38862291 DOI: 10.1016/j.clinthera.2024.05.005] [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: 03/10/2024] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE Psoriatic arthritis (PsA) is a chronic inflammatory condition with complex and heterogenous manifestations. Although a myriad of treatment options including biologic medications are available to alleviate symptoms and slow disease progression, there is currently no cure for this condition. There has been a recent emergence of understanding about the relationship between the gut microbiome and immune-mediated inflammatory diseases. This has generated interest in the potential role of dietary interventions, particularly anti-inflammatory diets, and fecal microbiota transplant (FMT) as novel therapeutic approaches. The purpose of this narrative review is to examine the role of an anti-inflammatory diet and FMT in turn and whether their combination may offer alternate approaches for the management of PsA. METHODS Our non-systematic narrative review was informed by a literature search using PubMed and Google Scholar using the terms anti-inflammatory diet, FMT, nutrition supplements, and PsA. Preclinical studies and non-English language articles were excluded when synthesizing the narrative review. FINDINGS Current randomized controlled trials (RCTs) and observational evidence suggest that a hypocaloric diet or Mediterranean diet can help achieve weight loss among PsA patients who are overweight or obese, which in turn reduces inflammation and improves disease activity. However, there is no strong data to support the beneficial effects of intermittent fasting, vitamin supplements, turmeric supplements, probiotics, or omega-3 fatty acid supplements in PsA. Current evidence on the use of FMT in PsA is limited as only one small RCT has been conducted which did not demonstrate efficacy for improving clinical symptoms. IMPLICATIONS Clinicians can consider recommending hypocaloric or Mediterranean diets as an adjunct to standard management of PsA, possibly under the guidance of a dietician. Further research is needed to explore the beneficial effects of the synergistic role of combining an anti-inflammatory diet with FMT in PsA.
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Affiliation(s)
- Rajesh Gopalarathinam
- Division of Rheumatology, Wrightington Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK.
| | - Reethika Sankar
- Meenakshi Medical College and Research Institute, Meenakshi Nagar, Tamil Nadu, India
| | - Sizheng Steven Zhao
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Science, School of Biological Sciences, Faculty of Biological Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Diniz BV, Ferreira SB, Negri M. Prevalence of psoriasis and cutaneous mycoses: A descriptive study in Paraná, Brazil. AN ACAD BRAS CIENC 2024; 96:e20230828. [PMID: 38808876 DOI: 10.1590/0001-3765202420230828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 03/17/2024] [Indexed: 05/30/2024] Open
Abstract
The epidemiology of psoriasis and cutaneous mycoses is scarce in Brazil. Thus, this cross-sectional study aimed to characterize the distribution of these diseases in Paraná. Data was obtained from the Outpatient Information System (SIA - Sistema de Informações Ambulatoriais), between 2016 and 2020. The procedures were filtered by the International Classification of Diseases (ICD). A total of 201,161 outpatient procedures were registered for psoriasis and psoriatic arthritis. The distribution concerning gender was similar (50.93% feminine; 49.07% masculine). The mean age was 51.55 years. The most frequent procedure was methotrexate dispensing (23.17%), followed by acitretin (14.29%) and adalimumab (12.55%). Adjusting to total population, the prevalence of procedures was 0.35%. Regarding cutaneous mycoses, 1,756 procedures were registered. 65% of them referred to females. White race/color was predominant (82.97%). The mean age was 37.6 years. The distribution concerning age varied according to the type of mycosis. Medical appointments (48.92%) and surgical pathology exam/biopsy (38.71%) were the most frequent procedures. The prevalence of procedures was 0.004%. This is the first epidemiological study using SIA about the population affected by psoriasis, psoriatic arthritis, and cutaneous mycoses in a Brazilian state. We believe that these findings allow relevant contribution to science and public policies in Brazil.
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Affiliation(s)
- Beatriz V Diniz
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Maringá, Departamento de Análises Clínicas e Biomedicina, Av. Colombo, 5790, Bloco 126, 87020-900 Maringá, PR, Brazil
| | - Sineida B Ferreira
- Clínica de Dermatologia Dra. Sineida Berbert Ferreira, Av. Dr. Luiz Teixeira Mendes, 1500, 87015-000 Maringá, PR, Brazil
| | - Melyssa Negri
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Maringá, Departamento de Análises Clínicas e Biomedicina, Av. Colombo, 5790, Bloco 126, 87020-900 Maringá, PR, Brazil
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7
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Pacifico A, Iorizzo M, Pasch M, Kridin K, Del Fabbro M, Mercuri SR, Peluso L, Damiani G. Telemedicine in Nail Psoriasis: Validation of a New Tool to Monitor (In-Person, In-Picture, and In-Video) Nail Psoriasis Severity in Patients with Concurrent Onychophagia and Onychotillomania. Dermatol Ther (Heidelb) 2024; 14:1161-1172. [PMID: 38700647 PMCID: PMC11116310 DOI: 10.1007/s13555-024-01160-w] [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: 07/29/2023] [Accepted: 04/04/2024] [Indexed: 05/24/2024] Open
Abstract
INTRODUCTION Since during the COVID-19 pandemic nail psoriasis was evaluated exclusively with teledermatology, dermatologists started to face the difficulty in rating it concurrent with other onycopathies (i.e., onychotillomania and onychophagy). Thus, we aimed to improve the existing severity scores and verify the value in different clinical settings (i.e., in person vs. teledermatology (video or picture)). METHODS This multicenter prospective observational study evaluated patients with nail psoriasis and screened them for onychophagy or onychotillomania in telemedicine from May 2020 to January 2021. For therapeutic purposes patients with nail psoriasis were followed and rated with the Nijmegen-Nail psoriasis Activity Index tooL (N-NAIL) for 9 months; at the same time, N-NAIL and a new dedicated index that monitor also the changes in nail dimension (Galeazzi-(G) N-NAIL) were tested for accuracy. We assessed inter- and intraobserver agreement for the three different settings (in person, video, and pictures). RESULTS In our cohort of 382 patients with nail psoriasis after a clinical and dermatoscopic assessment we found 20 (5.24%) patients with onychophagy and 17 (4.45%) patients with onychotillomania. Analysis of the impact of nail psoriasis on patients revealed that onycholysis and crumbing, followed by subungual hyperkeratosis, were the clinical signs that prevalently bothered patients. N-NAIL score displayed moderate intra- and interobserver agreement. Over the 9 months follow-up, N-NAIL vs. GN-NAIL displayed a solid correlation at all the examined time points, i.e., baseline and after 3, 6, and 9 months. CONCLUSION We created a new tool, the GN-NAIL capable of efficiently scoring nail psoriasis severity in complex cases, such as patients with onychotillomania and onychophagy, and monitor response to treatment during the COVID-19 pandemic.
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Affiliation(s)
- Alessia Pacifico
- Clinical Dermatology Department, IRCCS S. Gallicano Dermatological Institute, 00144, Rome, Italy
| | | | - Marcel Pasch
- Department of Dermatology, Radboud University Medical Center, 6525, Nijmegen, The Netherlands
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, 23538, Lübeck, Germany
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122, Milan, Italy
| | - Santo R Mercuri
- Unit of Dermatology, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Lorenzo Peluso
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, 1050, Brussels, Belgium
| | - Giovanni Damiani
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122, Milan, Italy.
- Clinical Dermatology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, 20161, Milan, Italy.
- Italian Center of Precision Medicine and Chronic Inflammation, Via Della Commenda 10, 20122, Milan, Italy.
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Conway J, Lipner SR. A case of rapid fingernail growth associated with nail psoriasis: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231213149. [PMID: 38033916 PMCID: PMC10687928 DOI: 10.1177/2050313x231213149] [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: 09/06/2023] [Accepted: 10/01/2023] [Indexed: 12/02/2023] Open
Abstract
Overall, 80%-90% of patients with psoriasis will have nail involvement at some point during their lifetime, and nail changes, on average, are more common in patients with longer disease duration. Since there is accelerated keratinocyte proliferation and cell turnover in cutaneous psoriasis plaques compared to normal skin, it has been hypothesized that psoriasis increases nail growth rate. We describe a case of a 44-year-old male with a 10-year history of cutaneous and nail psoriasis, with acceleration in nail growth rate for 2 years prior to presentation. Clinical examination of the fingernails showed very long nails with onychorrhexis, onycholysis, and koilonychia and scattered erythematous plaques involving the chest and arms. We report a case of rapid fingernail growth in a patient with a 10-year history of psoriasis with skin and nail manifestations. Our case supports the hypothesis that increased cell turnover in psoriasis patients affects nail growth rate.
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Affiliation(s)
- Jade Conway
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
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Tillett W, Egeberg A, Sonkoly E, Gorecki P, Tjärnlund A, Buyze J, Wegner S, McGonagle D. Nail psoriasis dynamics during biologic treatment and withdrawal in patients with psoriasis who may be at high risk of developing psoriatic arthritis: a post hoc analysis of the VOYAGE 2 randomized trial. Arthritis Res Ther 2023; 25:169. [PMID: 37715294 PMCID: PMC10503152 DOI: 10.1186/s13075-023-03138-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/09/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Nail psoriasis is a common, physiologically, and psychologically disruptive, and yet often under-treated manifestation of psoriasis. The objectives of this analysis were to investigate the trajectory of nail psoriasis, a risk factor for psoriatic arthritis (PsA), with guselkumab vs adalimumab treatment followed by withdrawal, and determine characteristics associated with nail response in patients treated with guselkumab. METHODS This post hoc analysis of the phase III trial VOYAGE 2 included patients with moderate-to-severe plaque psoriasis and baseline nail involvement. Nail Psoriasis Severity Index (NAPSI) and Psoriasis Area and Severity Index (PASI) were analyzed through week 48 in patients randomized to guselkumab or adalimumab. Multiple logistic regression analyzed factors associated with NAPSI 0/1 at week 24/week 48 following guselkumab treatment. In a separate analysis, patients were stratified by prior biologic experience. RESULTS Overall, 272 vs 132 patients receiving guselkumab vs adalimumab had nail psoriasis at baseline. Lower baseline NAPSI and week 16 PASI were associated with achieving NAPSI 0/1 at week 24 (NAPSI, odds ratio 0.685 [95% confidence interval: 0.586, 0.802]; week 16 PASI, 0.469 [0.281, 0.782]) and week 48 (NAPSI, 0.784 [0.674, 0.914]; week 16 PASI, 0.557 [0.331, 0.937]) with guselkumab. Previous biologic experience did not impact NAPSI response. Following treatment withdrawal at week 28, mean NAPSI was maintained in the guselkumab arm (week 24 1.7, week 48 1.9) and increased slightly in the adalimumab arm (week 24 1.4, week 48 2.3). Mean PASI increased across both treatment arms. CONCLUSIONS Higher skin efficacy at week 16 was associated with better nail responses during guselkumab treatment. Nail psoriasis improvements reflected skin improvements. Following guselkumab withdrawal, nail response was maintained longer than skin response. Future studies should investigate whether such improvements in nail response reduce patients' risk of later PsA development. TRIAL REGISTRATION ClinicalTrials.gov, NCT02207244. Registered July 31, 2014.
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Affiliation(s)
- William Tillett
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Combe Park, Bath, BA1 3NG, UK.
- Department of Life Sciences, University of Bath, Bath, UK.
| | - Alexander Egeberg
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Clinical Medical, University of Copenhagen, Copenhagen, Denmark
| | - Enikö Sonkoly
- Dermatology and Venereology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Division of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- National Institute for Health and Care Research Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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10
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Teoh XY, Suganthy R, Voo SYM, Tang MM. Pustular psoriasis in Malaysia: A review of the Malaysian Psoriasis Registry 2007-2018. Exp Dermatol 2023; 32:1253-1262. [PMID: 36794833 DOI: 10.1111/exd.14770] [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: 11/20/2022] [Revised: 01/25/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023]
Abstract
Pustular psoriasis (PP) is an uncommon subtype of psoriasis with distinct genetic features and clinical phenotypes. Patients with PP tend to experience frequent flares and significant morbidity. This study aims to determine the clinical characteristics, co-morbidities and treatment of PP patients in Malaysia. This was a cross-sectional study of patients with PP notified to the Malaysian Psoriasis Registry (MPR) between January 2007 and December 2018. Of 21 735 psoriasis patients, 148 (0.7%) had pustular psoriasis. Of these, 93 (62.8%) were diagnosed with generalized pustular psoriasis (GPP) and 55 (37.2%) with localized PP (LPP). The mean age for pustular psoriasis onset was 31.71 ± 18.33 years with a male to female ratio of 1:2.1. Patients with PP were more likely to have dyslipidaemia (23.6% vs. 16.5%, p = 0.022), severe disease (Body surface area >10 and/or Dermatology Life Quality Index [DLQI] >10) (64.8% vs. 50%, p = 0.003) and require systemic therapy (51.4% vs. 13.9%, p < 0.001) compared to non-PP patients. Patients with PP also suffered greater impairment to their quality of life (DLQI >10, 48.9% vs. 40.3%, p = 0.046), had more days off school/work (2.06 ± 6.09 vs. 0.5 ± 4.91, p = 0.004) and a higher mean number of hospitalizations (0.31 ± 0.95 vs. 0.05 ± 1.22, p = 0.001) in 6 months compared to non-PP patients. Overall, 0.7% of psoriasis patients in the MPR had pustular psoriasis. Patients with PP had a higher rate of dyslipidaemia, severe disease, greater impairment of quality of life and systemic therapy usage compared to other psoriasis subtypes.
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Affiliation(s)
- Xin Yun Teoh
- Department of Dermatology, Hospital Queen Elizabeth, Ministry of Health Malaysia, Kota Kinabalu, Malaysia
| | - Robinson Suganthy
- Department of Dermatology, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Sook Yee Michelle Voo
- Department of Dermatology, Hospital Queen Elizabeth, Ministry of Health Malaysia, Kota Kinabalu, Malaysia
| | - Min Moon Tang
- Department of Dermatology, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
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Agache M, Popescu CC, Enache L, Dumitrescu BM, Codreanu C. Nail Ultrasound in Psoriasis and Psoriatic Arthritis-A Narrative Review. Diagnostics (Basel) 2023; 13:2236. [PMID: 37443629 PMCID: PMC10341279 DOI: 10.3390/diagnostics13132236] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/22/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Ultrasonography has advantages for assessing psoriatic arthritis (PsA) due to its ability to evaluate several targets, including joints, entheses, and tendons, but also skin and nails. Although ultrasound is widely used in PsA, nail ultrasound, despite its potential as a non-invasive method for the early detection of inflammation in the nail apparatus, has low applicability in medical practice, as probes with a higher frequency are needed compared with the frequency of probes usually used. In the present article, we have narratively evaluated the studies published in the last 5 years (19 February 2018-18 February 2023) on nail ultrasound value in the diagnosis and monitoring of PsA. The studies published during this period share common measurement parameters, such as the OMERACT definition of enthesis published in 2018. We included original articles published in PubMed and Web of Science using the following search terms in all possible combinations: psoriatic arthritis, psoriasis, ultrasound, and nail. Articles were declared relevant if they presented data on nail morphology, power Doppler evaluation and nearby structure evaluation, while focusing on digitorum extensor enthesitis. In most of the studies, common morphological parameters were generally increased in patients with psoriasis or PsA and were demonstrated to change with medication. The thickness of the extensor tendon was greater in patients with PsA and psoriasis versus controls and it was correlated with nail clinical changes, especially the presence of onycholysis. The presence of PD showed large variability in healthy individuals. The link between enthesitis and nail involvement is still a subject of controversy, taking into account the latest histological findings. The use of ultrasound in the evaluation of nail and DIP enthesitis remains a challenge and an area of research in the coming years.
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Affiliation(s)
- Mihaela Agache
- Department of Internal Medicine and Rheumatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania (C.C.)
- Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
| | - Claudiu C. Popescu
- Department of Internal Medicine and Rheumatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania (C.C.)
- Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
| | - Luminița Enache
- Department of Internal Medicine and Rheumatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania (C.C.)
- Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
| | - Bianca M. Dumitrescu
- Department of Internal Medicine and Rheumatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania (C.C.)
- Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
| | - Cătălin Codreanu
- Department of Internal Medicine and Rheumatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania (C.C.)
- Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
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12
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Fargnoli MC, Bardazzi F, Bianchi L, Dapavo P, Fabbrocini G, Gisondi P, Micali G, Offidani AM, Pellacani G, Skroza N, Angileri RG, Burlando M, Campanati A, Carrera CG, Chiricozzi A, Conti A, Simone CD, Di Lernia V, Errichetti E, Galluzzo M, Guarneri C, Lasagni C, Lembo S, Loconsole F, Megna M, Musumeci ML, Prignano F, Richetta AG, Trovato E, Venturini M, Peris K, Pinton PC. Brodalumab for the Treatment of Moderate-to-Severe Psoriasis: An Expert Delphi Consensus Statement. J Clin Med 2023; 12:jcm12103545. [PMID: 37240650 DOI: 10.3390/jcm12103545] [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: 03/20/2023] [Revised: 05/05/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Brodalumab is a recombinant, fully human immunoglobulin IgG2 monoclonal antibody specifically targeted against interleukin-17RA that has been approved for the treatment of moderate-to-severe psoriasis in Europe. We developed a Delphi consensus document focused on brodalumab for the treatment of moderate-to-severe psoriasis. Based on published literature and their clinical experience a steering committee drafted 17 statements covering 7 domains specific to the treatment of moderate-to-severe psoriasis with brodalumab. A panel of 32 Italian dermatologists indicated their level of agreement using a 5-point Likert scale (from 1 = "strongly disagree" to 5 = "strongly agree") using an online modified Delphi method. After the first round of voting (32 participants), positive consensus was reached for 15/17 (88.2%) of the proposed statements. Following a face-to-face virtual meeting, the steering committee decided that 5 statements would form "main principles" and 10 statements formed the final list. After a second round of voting, consensus was reached in 4/5 (80%) of the main principles and 8/10 (80%) for consensus statements. The final list of 5 main principles and 10 consensus statements identify key indications specific to the use of brodalumab in the treatment of moderate-to-severe psoriasis in Italy. These statements aid dermatologists in the management of patients with moderate-to-severe psoriasis.
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Affiliation(s)
- Maria Concetta Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
- Dermatology Unit, Ospedale San Salvatore, 67100 L'Aquila, Italy
| | - Federico Bardazzi
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola Malpighi, 40126 Bologna, Italy
| | - Luca Bianchi
- Department of Systems Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy
- Dermatology Unit, Azienda Ospedaliera Universitaria "Policlinico Tor Vergata", 00133 Rome, Italy
| | - Paolo Dapavo
- Dermatology Clinic, Department of Medical Sciences, University of Turin, 10124 Turin, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical, Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37129 Verona, Italy
| | - Giuseppe Micali
- Department of Dermatology, University of Catania, 95123 Catania, Italy
| | - Anna Maria Offidani
- Department of Clinical and Molecular Sciences, Dermatology Unit, Polytechnic Marche University, 60121 Ancona, Italy
| | - Giovanni Pellacani
- Dermatology Clinic, Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza Medical School, Sapienza University of Rome, 00185 Rome, Italy
| | - Nevena Skroza
- Dermatology Unit "D. Innocenzi", Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome-Polo Pontino, 04100 Latina, Italy
| | | | - Martina Burlando
- Clinica Dermatologica, DissaL, Ospedale Policlinico San Martino-IRCCS, 16132 Genova, Italy
| | - Anna Campanati
- Department of Clinical and Molecular Sciences, Dermatology Clinic, Polytechnic Marche University, 60121 Ancona, Italy
| | - Carlo Giovanni Carrera
- Dermatology Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Andrea Chiricozzi
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy
| | - Andrea Conti
- Dermatologic Unit, Department of Surgery, Infermi Hospital, AUSL Romagna, 47923 Rimini, Italy
| | - Clara De Simone
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy
| | - Vito Di Lernia
- Dermatology Unit, Arcispedale S. Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Enzo Errichetti
- Institute of Dermatology, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), University of Udine, 33100 Udine, Italy
| | - Marco Galluzzo
- Department of Systems Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy
- Dermatology Unit, Azienda Ospedaliera Universitaria "Policlinico Tor Vergata", 00133 Rome, Italy
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98122 Messina, Italy
| | - Claudia Lasagni
- Clinica Dermatologica, Dipartimento delle Medicine Specialistiche AOU Policlinico di Modena, 41121 Modena, Italy
| | - Serena Lembo
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, 84084 Fisciano, Italy
| | - Francesco Loconsole
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, 70121 Bari, Italy
- Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Clinical, Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | | | - Francesca Prignano
- Department of Health Sciences, Section of Dermatology, University of Florence, 50125 Florence, Italy
| | - Antonio Giovanni Richetta
- Unit of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, 00185 Rome, Italy
| | - Emanuele Trovato
- Section of Dermatology, Department of Medical, Surgical and Neurological Science, S. Maria alle Scotte Hospital, University of Siena, 53100 Siena, Italy
| | - Marina Venturini
- Dermatology Department, University of Brescia, 25121 Brescia, Italy
| | - Ketty Peris
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy
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13
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Cengiz G, Nas K, Keskin Y, Kılıç E, Sargin B, Acer Kasman S, Alkan H, Sahin N, Cüzdan Balta N, Gezer İA, Keskin D, Mülkoğlu C, Reşorlu H, Ataman Ş, Bal A, Baykul M, Duruöz MT, Küçükakkaş O, Yurdakul OV, Alkan Melikoğlu M, Ayhan FF, Bodur H, Çaliş M, Çapkin E, Devrimsel G, Gök K, Hizmetli S, Kamanlı A, Ecesoy H, Kutluk Ö, Şen N, Şendur ÖF, Tekeoğlu İ, Toprak M, Tolu S, Tuncer T. The impact of nail psoriasis on disease activity, quality of life, and clinical variables in patients with psoriatic arthritis: A cross-sectional multicenter study. Int J Rheum Dis 2023; 26:43-50. [PMID: 36165674 DOI: 10.1111/1756-185x.14442] [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: 03/02/2022] [Revised: 08/20/2022] [Accepted: 09/07/2022] [Indexed: 01/04/2023]
Abstract
AIM Nail involvement is common in psoriatic arthritis. This study assesses clinical characteristics, nail psoriasis prevalence, and impact of nail psoriasis on disease activity in patients with psoriatic arthritis (PsA). METHOD This cross-sectional multicenter study was conducted by the Turkish League Against Rheumatism using PsA patients recruited from 25 centers. Demographic and clinical characteristics of PsA patients, such as disease activity measures, quality of life, and nail involvement findings were assessed during routine follow-up examinations. Patients were divided into two groups according to the presence or absence of nail psoriasis and compared using the χ2 test or Fisher exact test for categorical variables and the t-test or Mann-Whitney U test for continuous variables. RESULTS In 1122 individuals with PsA, 645 (57.5%) displayed nail psoriasis. The most frequent features of fingernails were ridges (38%), followed by pitting (21%) and onycholysis (19%). More females were present in both groups (with and without nail psoriasis; 64% vs 67%, P < 0.282). Patients with nail psoriasis were older, indicated more pain and fatigue, experienced greater swelling, tender joint counts, and skin disease severity, and had a higher disease activity score compared with those without nail psoriasis (all P < 0.05). CONCLUSION We demonstrate an increased prevalence of nail psoriasis observed in patients with psoriatic arthritis. Patients with nail involvement experience increased disease activity, lower quality of life, and diminished mental and physical status compared with those without nail involvement.
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Affiliation(s)
- Gizem Cengiz
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Kemal Nas
- Division of Rheumatology and Immunology, Department of Physical Medicine and Rehabilitation, School of Medicine, Sakarya University, Sakarya, Turkey
| | - Yaşar Keskin
- Department of Physical Medicine and Rehabilitation, Bezmialem Vakif University, Istanbul, Turkey
| | - Erkan Kılıç
- Rheumatology Clinic, Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Betül Sargin
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Sevtap Acer Kasman
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Marmara University, İstanbul, Turkey
| | - Hakan Alkan
- Department of Physical Medicine and Rehabilitation, School of Medicine, Pamukkale University, Denizli, Turkey
| | - Nilay Sahin
- Department of Physical Medicine and Rehabilitation, School of Medicine, Balikesir University, Balikesir, Turkey
| | - Nihan Cüzdan Balta
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
| | - İlknur Albayrak Gezer
- Department of Physical Medicine and Rehabilitation, School of Medicine, Selcuk University, Konya, Turkey
| | - Dilek Keskin
- Department of Physical Medicine and Rehabilitation, School of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Cevriye Mülkoğlu
- Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey
| | - Hatice Reşorlu
- Department of Physical Medicine and Rehabilitation, School of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Şebnem Ataman
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Ankara University School of Medicine, Ankara, Turkey
| | - Ajda Bal
- Department of Physical Medicine and Rehabilitation, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Merve Baykul
- Division of Rheumatology and Immunology, Department of Physical Medicine and Rehabilitation, School of Medicine, Sakarya University, Sakarya, Turkey
| | - Mehmet Tuncay Duruöz
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Marmara University, İstanbul, Turkey
| | - Okan Küçükakkaş
- Department of Physical Medicine and Rehabilitation, Bezmialem Vakif University, Istanbul, Turkey
| | - Ozan Volkan Yurdakul
- Department of Physical Medicine and Rehabilitation, Bezmialem Vakif University, Istanbul, Turkey
| | - Meltem Alkan Melikoğlu
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Atatürk University School of Medicine, Erzurum, Turkey
| | - Fikriye Figen Ayhan
- Department of Physical Medicine and Rehabilitation, School of Medicine, Atılım University, Ankara, Turkey
| | - Hatice Bodur
- Department of Physical Medicine and Rehabilitation, School of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Mustafa Çaliş
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Erhan Çapkin
- Department of Physical Medicine and Rehabilitation, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Gül Devrimsel
- Department of Physical Medicine and Rehabilitation, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Kevser Gök
- Rheumatology Clinic, Ankara City Hospital, Ankara, Turkey
| | - Sami Hizmetli
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation. School of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Ayhan Kamanlı
- Division of Rheumatology and Immunology, Department of Physical Medicine and Rehabilitation, School of Medicine, Sakarya University, Sakarya, Turkey
| | - Hilal Ecesoy
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Öznur Kutluk
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Nesrin Şen
- Department of Rheumatology, Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey
| | - Ömer Faruk Şendur
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Adnan Menderes University, Aydın, Turkey
| | - İbrahim Tekeoğlu
- Division of Rheumatology and Immunology, Department of Physical Medicine and Rehabilitation, School of Medicine, Sakarya University, Sakarya, Turkey
| | - Murat Toprak
- Department of Physical Medicine and Rehabilitation, School of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Sena Tolu
- Department of Physical Medicine and Rehabilitation, School of Medicine, Medipol University, Istanbul, Turkey
| | - Tiraje Tuncer
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Akdeniz University, Antalya, Turkey
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14
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AlAjlan A, Qasim R, AlTassan F, Qadoumi T, AlKaff T. A case of nail psoriasis improved with treatment by risankizumab. Oxf Med Case Reports 2022; 2022:omac127. [PMID: 36447464 PMCID: PMC9693772 DOI: 10.1093/omcr/omac127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/25/2022] [Accepted: 09/20/2022] [Indexed: 08/01/2023] Open
Abstract
Nail psoriasis causes significant aesthetic and functional disabilities. The treatment of nail psoriasis is essential to improve the health outcomes and quality of life among patients. Pain associated with intralesional injections, inadequate penetration into the nail and underlying tissue, poor adherence to therapy, limited efficacy and recurrent relapses are among the many challenging issues with topical therapy. While conventional systemic therapies are still useful and often appropriate for some patients, current evidence indicates that highly selective agents including anti-tumor necrosis factor-alpha, anti-interleukin (IL)-17 and anti-IL-12/23 antibodies that are primarily available for plaque psoriasis and psoriatic arthritis have also demonstrated long-term efficacy in the treatment of nail psoriasis. We report a case of nail psoriasis improved with treatment by risankizumab.
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Affiliation(s)
- Abdulmajeed AlAjlan
- Dermatology Department, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Raghda Qasim
- Dermatology Department, Dammam Medical Complex, Dammam, Saudi Arabia
| | - Fatimah AlTassan
- Correspondence address. College of Medicine, King Saud University, Riyadh 11472, Saudi Arabia. Tel/Fax: +966114864842; E-mail:
| | - Tala Qadoumi
- Dermatology Department, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Tuqa AlKaff
- Dermatology Department, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
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15
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Hsieh KY, Chen HY, Kim SC, Tsai YJ, Chiu HY, Chen GY. A mask R-CNN based automatic assessment system for nail psoriasis severity. Comput Biol Med 2022; 143:105300. [PMID: 35172223 DOI: 10.1016/j.compbiomed.2022.105300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/06/2022] [Accepted: 01/28/2022] [Indexed: 11/03/2022]
Abstract
Nail psoriasis significantly impacts the quality of life in patients with psoriasis, which affects approximately 2-3% of the population worldwide. Disease severity measures are essential in guiding treatment and evaluation of therapeutic efficacy. However, due to subsidy, convenience and low costs of health care in Taiwan, doctor usually needs to manage nearly hundreds of patients in single outpatient clinic, leading to difficulty in performing complex assessment tools. For instance, Nail Psoriasis Severity index (NAPSI) is used by dermatologists to measure the severity of nail psoriasis in clinical trials, but its calculation is quite time-consuming, which hampers its application in daily clinical practice. Therefore, we developed a simple, fast and automatic system for the assessment of nail psoriasis severity by constructing a standard photography capturing system combined with utilizing one of the deep learning architectures, mask R-CNN. This system not only assist doctors in capturing signs of disease and normal skin, but also able to extract features without pre-processing of image data. Expectantly, the system could help dermatologists make accurate diagnosis, assessment as well as provide precise treatment decision more efficiently.
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Affiliation(s)
- Kuan Yu Hsieh
- Department of Electrical and Computer Engineering, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu, 30010, Taiwan; Institute of Biomedical Engineering, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu, 30010, Taiwan.
| | - Hung-Yi Chen
- Institute of Biomedical Engineering, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu, 30010, Taiwan.
| | | | - Yun-Ju Tsai
- Department of Dermatology, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan; Department of Dermatology, National Taiwan University Hospital Taipei, Taiwan; Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Dermatology, National Taiwan University BioMedical Park Hospital, Hsinchu, Taiwan.
| | - Hsien-Yi Chiu
- Department of Medical Research, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan; Department of Dermatology, National Taiwan University Hsin-Chu Hospital, Hsinchu, Taiwan; Department of Dermatology, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan; Department of Dermatology, National Taiwan University Hospital Taipei, Taiwan; Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Guan-Yu Chen
- Department of Electrical and Computer Engineering, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu, 30010, Taiwan; Institute of Biomedical Engineering, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu, 30010, Taiwan; Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, 30010, Taiwan.
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16
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Ortner VK, Mandel VD, Bertugno S, Philipsen PA, Haedersdal M. Imaging of the Nail Unit in Psoriatic Patients - a Systematic Scoping Review of Techniques and Terminology. Exp Dermatol 2022; 31:828-840. [PMID: 35353919 PMCID: PMC9323418 DOI: 10.1111/exd.14572] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/14/2022] [Accepted: 03/26/2022] [Indexed: 11/28/2022]
Abstract
Background The growing interest in the visualization of psoriatic nail unit changes has led to the discovery of an abundance of image characteristics across various modalities. Objective To identify techniques for non‐invasive imaging of nail unit structures in psoriatic patients and review extracted image features to unify the diverse terminology. Methods For this systematic scoping review, we included studies available on PubMed and Embase, independently extracted image characteristics, and semantically grouped the identified features to suggest a preferred terminology for each technique. Results After screening 753 studies, 67 articles on the visualization of clinical and subclinical psoriatic changes in the nail plate, matrix, bed, folds and hyponychium were included. We identified 4 optical and 3 radiological imaging techniques for the assessment of surface (dermoscopy [n = 16], capillaroscopy [n = 12]), sub‐surface (ultrasound imaging [n = 36], optical coherence tomography [n = 4], fluorescence optical imaging [n = 3]), and deep‐seated psoriatic changes (magnetic resonance imaging [n = 2], positron emission tomography‐computed tomography [n = 1]). By condensing 244 image feature descriptions into a glossary of 82 terms, overall redundancy was cut by 66.4% (37.5%–77.1%). More than 75% of these image features provide additional disease‐relevant information that is not captured using conventional clinical assessment scales. Conclusions This review has identified, unified, and contextualized image features and related terminology for non‐invasive imaging of the nail unit in patients with psoriatic conditions. The suggested glossary could facilitate the integrative use of non‐invasive imaging techniques for the detailed examination of psoriatic nail unit structures in research and clinical practice.
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Affiliation(s)
- V K Ortner
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiskberg, Denmark
| | - V D Mandel
- 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.,Porphyria and Rare Diseases Unit, San Gallicano Dermatological Institute - IRCCS, Rome, Italy
| | - S Bertugno
- Radiology Unit, Bernardino Ramazzini Hospital, Carpi, Italy
| | - P A Philipsen
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiskberg, Denmark
| | - M Haedersdal
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiskberg, Denmark
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17
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Karamova AE, Olisova OY, Bakulev AL, Kokhan MM, Khairutdinov VR, Sokolovskiy EV, Khobeych MM. Revisiting the question of psoriasis classification. VESTNIK DERMATOLOGII I VENEROLOGII 2021. [DOI: 10.25208/vdv1267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Currently there are a large number of psoriasis classifications, slightly different from each other, used worldwide. Some of these classifications contain the disease forms allocated descriptively, without the pathogenesis characteristics in their basis. Among the dermatologists, there is lack of common understanding of various psoriasis forms peculiarities. And that affects both the diagnostic process and the approaches to therapy. The authors propose a revised unified clinical classification of psoriasis, including psoriatic arthritis. This method reflects the up-to-date view on the classification of psoriasis in Russia and globally.
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18
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Fungal Infections among Psoriatic Patients: Etiologic Agents, Comorbidities, and Vulnerable Population. Autoimmune Dis 2021; 2021:1174748. [PMID: 34567800 PMCID: PMC8461225 DOI: 10.1155/2021/1174748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/25/2021] [Accepted: 09/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background Psoriasis is a chronic inflammatory disorder of the skin and joint, affecting nearly 2-3% of the general population. It is assumed that imbalance between the types of natural microflora can accelerate the onset of the disease. Some fungi can play the role of superantigens and prolong chronic inflammation in the skin of psoriatic patients. The aim of the present investigation was to identify fungal species isolated from patients with psoriasis. Methods From March 2016 to May 2019, 289 patients with prior diagnosis of psoriasis were included in this survey. Direct microscopy with potassium hydroxide (KOH 10%), culture, urea hydrolysis, hair perforation test, and growth on rice grains were used to identify clinical isolates, phenotypically. For molecular identification of Candida species and Malassezia species, PCR-RFLP and PCR-sequencing were used, respectively. Results Forty-six out of 289 psoriatic patients had fungal infections (15.9%). Dermatophytes (54.3%), Candida spp. (19.5%), Malassezia spp. (15.2%), Aspergillus spp. (6.5%), and Fusarium spp. (4.3%) were the causative agents of fungal infections. Among Malassezia and Candida species, M. restricta (10.8%) and C. glabrata (8.7%) were the most prevalent species, respectively. Conclusion Our findings suggested that fungal pathogens, particularly dermatophytes, may play an important role in the pathogenicity of psoriasis. Also, due to the high rate of yeast colonization in the clinical samples of psoriatic patients, concomitant use of anti-inflammatory drugs and antifungals may represent an effective therapeutic approach for better management of chronic lesions among these patients. Mycological tests should be applied to indicate the incidence of fungal diseases in psoriatic patients.
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19
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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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20
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De Rossi SD, Mendonça JA, Palominos PE, Kohem CL, Cestari TF, da Silva Chakr RM. Ultrasonographic and resistance index evaluation of nails in psoriatic arthritis, psoriasis, and control groups: a cross-sectional study. Adv Rheumatol 2021; 61:48. [PMID: 34321109 DOI: 10.1186/s42358-021-00207-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nail psoriasis occurs frequently in patients with psoriatic disease, it can lead to functional impairment, pain, discomfort, decreased quality of life and can also be a predictor for the development of arthritis. Early recognition of this condition can provide early and effective treatment and prevent structural impairment. This study aims to identify nail ultrasonographic characteristics in three groups: psoriasis (PsO), psoriatic arthritis (PsA) and controls patients, to determine if the ultrasonography (US) can identify early signs of nail psoriatic impairment or local inflammation. We conducted nail US to determine nail matrix resistance index (NMRI), nail bed resistance index (NBRI), and power Doppler (PD) and grayscale (GS) parameters in these 3 groups. METHODS Single-center, cross-sectional study. GS, PD, and spectral doppler images of bilateral 2nd and 3rd fingernails were acquired from 35 PsO, 31 PsA, and 35 controls patients. An US equipment with an 18 MHz linear transducer for GS and 8.0 MHz for PD was used. PD, NMRI, NBRI, nail plate thickness (NPT), nail bed thickness (NBT), nail matrix thickness (NMT), and morphostructural characteristics of the trilaminar structure (TS) were evaluated in saved images, blind. RESULTS Mean NMRI and NBRI did not differ between groups. Linear regression analysis detected no relationships between PsO or PsA and NMRI or NBRI. Nail PD grade did not differ between groups. Type I and IV TS changes were more frequent in PsO; types II and III changes were more frequent in PsA (p < 0.001). NPT was greater in PsA and PsO groups than controls: PsA 0.73 ± 0.14 mm, PsO 0.72 ± 0.15 mm, Controls 0.67 ± 0.10 mm (p = 0.001). CONCLUSION Echographic TS characteristics of the nail plate and NPT evaluated by GS are useful and can distinguish PsO and PsA nails from controls. NMRI, NBRI, and US nail microcirculation parameters could not distinguish psoriatic nails. TRIAL REGISTRATION 72762317.4.0000.5327 (Certificate of Presentation of Ethical Appreciation - CAAE - Plataforma Brasil) Avaiable in https://plataformabrasil.saude.gov.br/login.jsf .
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Affiliation(s)
- Samanta Daiana De Rossi
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. .,Divisiont of Dermatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - José Alexandre Mendonça
- Department of Rheumatology, Celso Pierro Hospital, Pontifícia Universidade Católica de Campinas, São Paulo, Brazil
| | - Penelope Ester Palominos
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Charles Lubianca Kohem
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Tania Ferreira Cestari
- Divisiont of Dermatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafael Mendonça da Silva Chakr
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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21
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Colunga-Pedraza IJ, Galarza-Delgado DA, Azpiri-Lopez JR, Rodriguez-Romero AB, Guajardo-Jauregui N, Cardenas-de la Garza JA, Lugo-Perez S, Meza-Garza A, Loya-Acosta J, Garza-Acosta AC. Nail involvement in psoriatic arthritis patients is an independent risk factor for carotid plaque. Ann Rheum Dis 2021; 80:1629-1631. [PMID: 34167948 DOI: 10.1136/annrheumdis-2021-220782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/15/2021] [Indexed: 11/03/2022]
Affiliation(s)
| | | | | | | | | | | | - Salvador Lugo-Perez
- Cardiology, Dr Jose Eleuterio Gonzalez University Hospital, Monterrey, Nuevo Leon, Mexico
| | - Alejandro Meza-Garza
- Cardiology, Dr Jose Eleuterio Gonzalez University Hospital, Monterrey, Nuevo Leon, Mexico
| | - Julieta Loya-Acosta
- Rheumatology, Dr Jose Eleuterio Gonzalez University Hospital, Monterrey, Nuevo Leon, Mexico
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22
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Rocha ACL, Bortoletto MC, da Costa AC, Oyafuso LKM, Sanudo A, Tomita LY. Low serum lycopene, and adequate α-tocopherol levels in patients with psoriasis: A cross-sectional study. Nutr Health 2021; 28:239-248. [PMID: 33960217 DOI: 10.1177/02601060211014127] [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] [Indexed: 01/04/2023]
Abstract
BACKGROUND Psoriasis is a chronic, immune-mediated skin disease. It affects skin and joints, characterized by abnormal hyperproliferation of keratinocytes. The worldwide prevalence of psoriasis ranges from 2% to 4%. Environmental factors as smoking, alcohol consumption obesity can also work as triggers. During the inflammatory process, there is an exacerbated formation of free radicals and antioxidants are required to maintain redox balance. AIM Assess antioxidant profiles. METHODS A cross-sectional study was conducted between August/2012 and March/2014. Sociodemographic, lifestyle, and biochemical measurements, dietary intake, serum lycopene and α-tocopherol, psoriasis severity according to Psoriasis Area and Severity Index were obtained. Comparisons between serum lycopene and α-tocopherol distributions according to variables were conducted using a one-way analysis of variance. Multiple linear regression was used to investigate factors associated with serum antioxidants. RESULTS 81 participants (56% female, 62% non-white), 34% without psoriatic lesions, 51% diagnosed with mild psoriasis, and 15% with moderate psoriasis. Median (IQR) age of 54 (41, 62) years, 10 (4, 11) years of education, 17% smokers, 46% overweight and 25% obesity. In total, 72% did not reach the daily recommendation of fruit and vegetable intake. Serum lycopene and α-tocopherol were 0.2 (0.1-0.3) µmol/L and 22.5 (18.5-25.6) µmol/L, respectively. Only 14% presented adequate concentration of lycopene, but adequate α-tocopherol level was observed among 88%. CONCLUSIONS Patients reported a diet low in vegetables and fruits and rich in ultra-processed foods and fatty acids. Adequate circulating α-tocopherol but low serum lycopene, was observed among patients. A linear trend was observed for lycopene according to the severity of psoriasis.
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Affiliation(s)
- Ana C L Rocha
- Departament of Preventive Medicine, Universidade Federal de São Paulo, Brazil
| | | | | | | | - Adriana Sanudo
- Departament of Preventive Medicine, Universidade Federal de São Paulo, Brazil
| | - Luciana Y Tomita
- Departament of Preventive Medicine, Universidade Federal de São Paulo, Brazil
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23
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Lim WL, How CH, Tan KW. Management of psoriasis in primary care. Singapore Med J 2021; 62:109-112. [PMID: 33846752 DOI: 10.11622/smedj.2021026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Choon How How
- Care and Health Integration, Changi General Hospital, Singapore.,Family Medicine Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore
| | - Ki Wei Tan
- Department of Dermatology, Changi General Hospital, Singapore
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24
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Kaeley GS, Eder L, Aydin SZ, Rich P, Bakewell CJ. Nail Psoriasis: Diagnosis, Assessment, Treatment Options, and Unmet Clinical Needs. J Rheumatol 2021; 48:1208-1220. [PMID: 33589557 DOI: 10.3899/jrheum.201471] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE An estimated 40-50% of patients with psoriasis (PsO) have psoriatic nail disease, which is associated with and directly contributes to a greater clinical burden and worse quality of life in these patients. In this review, we examine how recent advances in the use of new diagnostic techniques have led to improved understanding of the link between nail and musculoskeletal manifestations of psoriatic disease (PsD; e.g., enthesitis, arthritis) and we review targeted therapies for nail PsO (NP). METHODS We performed a literature search to identify which systemic therapies approved for the treatment of PsO and/or psoriatic arthritis (PsA) have been evaluated for the treatment of NP, either as a primary or secondary outcome. A total of 1546 articles were identified on February18, 2019, and evaluated for relevance. RESULTS We included findings from 66 articles on systemic therapies for the treatment of NP in PsD. With several scoring systems available for the evaluation of psoriatic nail disease, including varied subtypes and application of the Nail Psoriasis Area Severity Index, there was a high level of methodological heterogeneity across studies. CONCLUSION NP is an important predictor of enthesitis, which is associated with the early stages of PsA; therefore, it is important for rheumatologists and dermatologists to accurately diagnose and treat NP to prevent nail damage and potentially delay the onset and progression of joint disease. Further research is needed to address the lack of both standardized NP scoring systems and well-defined treatment guidelines to improve management of PsD.
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Affiliation(s)
- Gurjit S Kaeley
- G.S. Kaeley, MRCP, Department of Medicine, University of Florida College of Medicine, Division of Rheumatology, Jacksonville, Florida, USA;
| | - Lihi Eder
- L. Eder, MD, PhD, University of Toronto, Women's College Research Institute, Toronto, Ontario, Canada
| | - Sibel Zehra Aydin
- S.Z. Aydin, MD, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Phoebe Rich
- P. Rich, MD, Oregon Dermatology & Research Center, Portland, Oregon, USA
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25
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Mease P, Elaine Husni M, Chakravarty SD, Kafka S, Parenti D, Kim L, Hung Lo K, Hsia EC, Kavanaugh A. Evaluation of Improvement in Skin and Nail Psoriasis in Bio-naïve Patients With Active Psoriatic Arthritis Treated With Golimumab: Results Through Week 52 of the GO-VIBRANT Study. ACR Open Rheumatol 2020; 2:640-647. [PMID: 33073933 PMCID: PMC7672302 DOI: 10.1002/acr2.11180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 08/04/2020] [Indexed: 11/12/2022] Open
Abstract
Objective To evaluate whether intravenous (IV) golimumab produces improvements in skin and nail symptoms that are concomitant with improvements in quality of life (QoL) and joint symptoms in patients with psoriatic arthritis. Methods Patients were randomized to either IV golimumab 2 mg/kg at weeks 0, 4, then every 8 weeks (q8w) through week 52 or placebo at weeks 0, 4, then q8w, with crossover to IV golimumab 2 mg/kg at weeks 24, 28, and then q8w through week 52. Assessments included Psoriasis Area and Severity Index (PASI), modified Nail Psoriasis Severity Index (mNAPSI), Dermatology Life Quality Index (DLQI), and American College of Rheumatology (ACR) rheumatoid arthritis response criteria. Results Through week 24, achievement of PASI 75/90/100 responses (P ≤ .0098) and mean improvements in mNAPSI (−11.4 vs −3.7; P < .0001) and DLQI (−9.8 vs −2.9; P < .0001) were significantly greater with golimumab versus placebo. Responses were maintained in patients treated with golimumab through week 52. In placebo‐crossover patients, increases in the proportion of patients achieving PASI 75/90/100 responses were observed from weeks 24 to 52, and mean improvements in mNAPSI (from −3.7 to −12.9) and DLQI (from −2.9 to −7.8) increased from weeks 24 to 52. Simultaneous achievement of PASI and DLQI responses, PASI and ACR responses, and mNAPSI and DLQI responses were also observed. Similar responses were observed for all assessments regardless of concomitant methotrexate use. Conclusion Improvements in skin and nail psoriasis symptoms with IV golimumab in patients with psoriatic arthritis were concomitant with improvements in QoL and arthritis disease activity through 1 year.
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Affiliation(s)
- Philip Mease
- Swedish Medical Center, Seattle, Washington and University of Washington School of Medicine, Seattle
| | | | - Soumya D Chakravarty
- Janssen Scientific Affairs, LLC, Horsham, Pennsylvania, and, Drexel University College of Medicine, Philadelphia, PA
| | - Shelly Kafka
- Janssen Scientific Affairs, LLC, Horsham, Pennsylvania
| | | | - Lilianne Kim
- Janssen Research & Development, LLC, Spring House, Pennsylvania
| | - Kim Hung Lo
- Janssen Research & Development, LLC, Spring House, Pennsylvania
| | - Elizabeth C Hsia
- Janssen Research & Development, LLC, Spring House, Pennsylvania, and University of Pennsylvania, Philadelphia
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26
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Bakshi H, Nagpal M, Singh M, Dhingra GA, Aggarwal G. Treatment of Psoriasis: A Comprehensive Review of Entire Therapies. Curr Drug Saf 2020; 15:82-104. [DOI: 10.2174/1574886315666200128095958] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 12/19/2022]
Abstract
Background:
Psoriasis is an autoimmune disease that ingeminates itself with the repeated
proliferation of keratinocytes. It globally strikes a 2-5 % population on an average. Management
of psoriasis remains a daunting task with various challenges influencing treatment, such as patient
conformity and adherence to therapy, delicate patient profiles, psychological aspects, and skin as a
barrier to topical delivery. The first part reviewed pathophysiology, triggering factors, and clinical
classification. The second part reviewed all the therapies, such as topical, oral, biological, parenteral
therapy, phototherapy, and the phyto-pharmaceuticals.
Methods:
The research data related to the existing and upcoming therapies for psoriasis treatment,
several nanocarriers, existing marketed formulations, and detailed description of phytopharmaceuticals
with their mechanism.
Results:
Topical therapy is the mainstay treatment option with limited adverse effects. Biological therapy
has reformed conventional psoriasis treatment by being more efficacious and has increased patient
acceptance due to decreased adverse events. Nanoformulations present an edge over conventional
therapy due to improved anti-psoriatic effect and decreased side effects. Phyto-pharmaceuticals act as
a complementary and alternative therapy for diminishing psoriasis symptoms.
Conclusion:
A rationalized cost-effective patient compliant therapy is required for effective management
and complete cure of psoriasis.
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Affiliation(s)
- Harman Bakshi
- Chitkara College of Pharmacy, Chitkara University, Chandigarh-Patiala, NH 7, 64, Tehsil, Rajpura, Punjab, India
| | - Manju Nagpal
- Chitkara College of Pharmacy, Chitkara University, Chandigarh-Patiala, NH 7, 64, Tehsil, Rajpura, Punjab, India
| | - Manjinder Singh
- Chitkara College of Pharmacy, Chitkara University, Chandigarh-Patiala, NH 7, 64, Tehsil, Rajpura, Punjab, India
| | | | - Geeta Aggarwal
- Delhi Pharmaceutical Sciences and Research University, New Delhi-110017, India
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27
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Onychomycosis in Psoriatic Patients with Nail Disorders: Aetiological Agents and Immunosuppressive Therapy. Dermatol Res Pract 2020; 2020:7209518. [PMID: 32411192 PMCID: PMC7212309 DOI: 10.1155/2020/7209518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/15/2020] [Indexed: 11/23/2022] Open
Abstract
Psoriasis and psoriatic arthritis are chronic, relapsing, immune-based diseases. Psoriatic patients may have nail involvement in 50 to 80% of cases, and this may reach 85% in patients with joint disease, in spite of the fact that the relationship between psoriasis and onychomycosis is not well established. The aim of this study was to investigate the occurrence of onychomycosis in patients with nail disorders and diagnosis of psoriasis and psoriatic arthritis. This was a cross-sectional study in which 38 patients diagnosed with psoriasis and/or psoriatic arthritis were interviewed and had altered nail samples analysed by mycological and histopathological exams. Twenty-two (57.89%) patients had a confirmed diagnosis for onychomycosis. Seventeen (44.8%) had a positive direct mycological examination, 16 (42.1%) had positive cultures, and 12 (31.6%) were positive for fungi by histopathological examination. Dermatophytes were identified in nine (56.3%) cultures, and of these, eight were Trichophyton rubrum and one T. tonsurans. Yeasts were isolated in seven patients (43.75%), which included four Candida parapsilosis and three C. albicans. Six patients (15.78%) were not using immunosuppressive therapy, and the others were using methotrexate, etanercept, adalimumab, infliximab, secukinumab, or golimumab, in monotherapy or in combination with other drugs. The confirmed onychomycosis rate in patients using methotrexate alone was 92.8% (n = 13). We concluded that it is possible that there is a positive relationship between psoriatic disease and onychomycosis. And we highlight that it is also worth investigating in the future the possible role of immunosuppressive therapy (mainly methotrexate) as a predisposing factor for the development of fungal infections in psoriatic patients.
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28
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Efficacy of brodalumab in the treatment of scalp and nail psoriasis: results from three phase 3 trials. J DERMATOL TREAT 2020; 33:261-265. [DOI: 10.1080/09546634.2020.1749546] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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29
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Duarte AA, Carneiro GP, Murari CM, de Jesus LCB. Nail psoriasis treated with intralesional methotrexate infiltration. An Bras Dermatol 2019; 94:491-492. [PMID: 31644634 PMCID: PMC7007033 DOI: 10.1590/abd1806-4841.20198170] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 08/19/2018] [Indexed: 11/22/2022] Open
Affiliation(s)
- Artur Antônio Duarte
- Connective Tissue Disease Unit, Dermatology Service, Universidade de Santo Amaro, São Paulo, SP, Brasil
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30
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Fassio A, Giovannini I, Idolazzi L, Zabotti A, Iagnocco A, Sakellariou G. Nail ultrasonography for psoriatic arthritis and psoriasis patients: a systematic literature review. Clin Rheumatol 2019; 39:1391-1404. [PMID: 31440917 DOI: 10.1007/s10067-019-04748-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/23/2019] [Accepted: 08/12/2019] [Indexed: 01/11/2023]
Abstract
To systematically review the role of ultrasound (US) in the assessment of the joint-enthesial-nail apparatus in patients with psoriatic arthritis (PsA) or psoriasis (PSO) in terms of prevalence, diagnosis, prognosis, monitoring and treatment. A systematic literature review was conducted through medical databases (PubMed, Embase) and the grey literature up to February 2018. The main areas of application of nail US were first identified, allowing the development of research questions, which were rephrased following the PICOs methodology to develop inclusion criteria. Of the 585 studies produced by PubMed and Embase searches, 17 studies met the criteria for inclusion. Five additional studies were included: 1 from the hand search and 4 from the 2016-2017 ACR and EULAR congresses. The prevalence of nail plate changes varied from < 10 to 97%, for power Doppler signal from 20-30 to 96% and distal interphalangeal joint (DIJ) involvement from 8.9 to 100%. The performance of US nail/DIJ abnormalities in the diagnosis of PsA and PSO elementary lesions was analysed by five studies, with a wide heterogeneity. Reproducibility and reliability of US nil/DIJ were assessed by interclass correlation coefficient or Cohen's k and their values ranged from 0.6 to 0.9. The value of US nail/DIJ in the monitoring of the lesions was analysed only by a single study. The analysis revealed applications for US nail/DIJ in PsA and PSO and highlights limitations. Validation is strongly needed to demonstrate its appropriateness in the clinical practice and to define its diagnostic and prognostic role.
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Affiliation(s)
- A Fassio
- Rheumatology Unit, University of Verona, Piazzale A. Stefani 1, 137126, Verona, Italy
| | - I Giovannini
- Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Udine, Italy
| | - L Idolazzi
- Rheumatology Unit, University of Verona, Piazzale A. Stefani 1, 137126, Verona, Italy.
| | - A Zabotti
- Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Udine, Italy
| | - A Iagnocco
- Academic Rheumatology Centre, Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy
| | - G Sakellariou
- Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
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31
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Galluzzo M, D'Adamio S, Chimenti MS, Teoli M, Bianchi L, Talamonti M. Successful treatment of psoriatic crumbly nails with ustekinumab. Dermatol Ther 2019; 32:e12914. [DOI: 10.1111/dth.12914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Marco Galluzzo
- Dermatology UnitUniversity of Rome “Tor Vergata” Rome Italy
| | | | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina dei SistemiUniversity of Rome “Tor Vergata” Rome Italy
| | - Miriam Teoli
- Dermatology UnitUniversity of Rome “Tor Vergata” Rome Italy
| | - Luca Bianchi
- Dermatology UnitUniversity of Rome “Tor Vergata” Rome Italy
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32
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Platonova AV, Zhukov AS, Khairutdinov VR, Samtsov AV. Psoriatic onychodystrophy: clinical manifestations (part 1). VESTNIK DERMATOLOGII I VENEROLOGII 2018. [DOI: 10.25208/0042-4609-2018-94-6-7-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Psoriatic onychodystrophy is quite common in patients with psoriasis. Changes in psoriatic nails have a wide range of clinical manifestations, including symptoms of damage of the nail bed and/or nail matrix. The article presents information about clinical and pathological manifestations of psoriatic onychodystrophy, the mechanisms of formation of pathological changes. The existence of the relationship between the change of nail plates in patients with psoriasis and the development of psoriatic arthritis is explained, the prognostic value of individual symptoms is analyzed. The diagnostic criteria for the histological diagnosis of psoriatic onychodystrophy are described. The information about the occurrence of each symptom in patients with psoriasis with dystrophic nail changes is given.
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Abstract
Psoriasis is a chronic inflammatory disease that affects approximately 7.5 million people in the United States. The disease results in significant suffering, morbidity, and economic impact. Psoriasis is a multifaceted disease with a strong genetic component. Genetic data has revealed the presence of particular risk alleles in patients with psoriasis. Triggers of the disease have been elucidated and include factors such as trauma, obesity, infection, stress, and medications. At its core, psoriasis is a result of a dysfunctional immune response with T-cells at the center of immunogenesis. Clinically, psoriasis is characterized by discrete, erythematous scaly plaques. These lesions are often found on extensor surfaces, especially the elbows and knees. Although extensor surfaces are the prototypical destination of lesions, psoriasis may affect any area of the skin including the scalp, intertriginous areas, nails, palms, and soles. Location of lesions are important in assessing the impact on quality of life for patients. Diagnosis of psoriasis can typically be made clinically based on characteristic history and physical examination findings. In rare cases, biopsy may be needed to rule out other papulosquamous disease. Histologic findings of psoriasis can be non-specific and include marked epidermal hyperplasia, dilated vessels within the dermal papilla, and elongated rete ridges. Importantly, psoriasis is a systemic disease and organ systems outside of the skin must be considered. Co-morbidities of psoriasis include psoriatic arthritis, type 2 diabetes mellitus, cardiovascular disease, psychiatric disease, inflammatory bowel disease, neoplasms, and ocular disease. Management of psoriasis depends on the severity of the disease. In mild to moderate cases, topical medications are the cornerstone of treatment. Topical corticosteroids are the most commonly used and have limited systemic effects due to the localized application of medication. In moderate to severe cases of psoriasis, topical medications are ineffective and not feasible. Phototherapy and non-biologic systemic medications have been useful treatments; however, phototherapy is time consuming and non-biologic systemics have only modest response rates. In the last decade, biologic medications have become an important component of care for treating moderate to severe psoriasis. These medications target various cytokines responsible for psoriasis manifestations such as tumor necrosis factor (TNF-α), interleukin-12, interleukin-23, and interleukin-17. In the past 15 years, numerous biologic medications have been granted FDA approval, with the majority approved in the past several years. Some of the commonly used biologics include etanercept, adalimumab, infliximab, ixekizumab, secukinumab, brodalumab, guselkumab, ustekinumab, and tildrakizumab. Given the wealth of new biologics, current treatment guidelines have rapidly become outdated. This review provides summarized information of landmark trials that led to the approval of these medications.
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34
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Nguyen HX, Banga AK. Effect of ablative laser on in vitro transungual delivery. Int J Pharm 2017; 544:402-414. [PMID: 28951347 DOI: 10.1016/j.ijpharm.2017.09.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/26/2017] [Accepted: 09/16/2017] [Indexed: 10/18/2022]
Abstract
Topical therapy of nail psoriasis using methotrexate has not been realized due to the high molecular weight and low permeability of the compound. In this study, we used a 2940nm fractional ablative laser to disrupt the nail barrier to enhance the in vitro transungual delivery of methotrexate. Bovine hoof membrane-an in vitro model of the human nail-was treated by the laser at different energy levels and pore densities. A successful microporation was characterized by mechanical properties, scanning electron microscopy, Fourier transform infrared spectrophotometer, dye binding, histology, pore uniformity, confocal laser microscopy, nail integrity measurement, and permeation studies. No significant difference in the pore dimension was found in different treatment groups (p>0.05). Increases in pore depth corresponded with increases in the laser energy. Laser ablation was found to affect the mechanical properties of the hoof membrane. In in vitro permeation studies, laser ablation resulted in a significant increase in the drug cumulative delivery, flux, and permeability coefficient as compared to the untreated group (n=3, p<0.05). A change in the laser energy and pore density was found to alter the drug permeability. Thus, transungual methotrexate delivery was enhanced by the fractional laser ablation.
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Affiliation(s)
- Hiep X Nguyen
- Department of Pharmaceutical Sciences, College of Pharmacy, Mercer University, Atlanta GA, 30341,USA
| | - Ajay K Banga
- Department of Pharmaceutical Sciences, College of Pharmacy, Mercer University, Atlanta GA, 30341,USA.
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35
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Abstract
Nail psoriasis is considered a significant psychological and social problem causing functional impairment in affected patients. Nail changes hamper their daily and occupational activities and contribute to a worse quality of life. Almost 50% of patients with psoriasis vulgaris and up to 80% of patients with psoriatic arthritis are afflicted with nail lesions. The important correlation between psoriatic arthritis and nail changes is well established - the presence of the latter is a strong predictor of the development of arthritis. There is a broad spectrum of nail dystrophies associated with psoriasis, ranging from the common pitting, subungual hyperkeratosis and loosening of the nail plate to less frequent discolouration and splinter haemorrhages. Some of these symptoms are also observed in other nail diseases, and further diagnostics should be performed. The assessment tools NAPSI (Nail Psoriasis Severity Index), mNAPSI (Modified Nail Psoriasis Severity Index), and PNSS (Psoriasis Nail Severity Score) are most commonly used to grade the severity of nail involvement in psoriasis and enable the evaluation of therapy effectiveness. The treatment of nail psoriasis is a major clinical challenge. It should be adjusted to the extent of dermal, articular and ungual lesions. Systemic therapies of psoriasis, especially biological agents, are most likely to be effective in treating nail psoriasis. However, as their use is limited in scope and safety, topical therapy remains a mainstay, and the combination of corticosteroids and vitamin D3 analogues is considered to be most helpful.
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36
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Afshar A, Tabrizi A. Nail Psoriasis Triggered by the Reconstruction of Syndactyly. THE ARCHIVES OF BONE AND JOINT SURGERY 2017; 5:193-195. [PMID: 28656168 PMCID: PMC5466865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/19/2016] [Indexed: 06/07/2023]
Abstract
Koebner phenomenon is observed in a number of inflammatory skin diseases. Psoriasis is one of the most common skin diseases associated with Koebner phenomenon. Nail psoriasis may be developed independently from inflammatory arthritis and skin psoriasis. This study reports on the reconstruction of third web of a 30-year-old woman, which performed on her right, due to congenital syndactyly. Four months postoperatively, she developed nail dystrophy, onycholysis and onychorrhexis of the middle, ring and little fingernails. The clinical and histopathology findings were compatible with diagnosis of isolated nail psoriasis.
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Affiliation(s)
- Ahmadreza Afshar
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Ali Tabrizi
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
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37
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Nail psoriasis - what a rheumatologist should know about. Reumatologia 2017; 55:44-47. [PMID: 28386142 PMCID: PMC5380772 DOI: 10.5114/reum.2017.66687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 02/13/2017] [Indexed: 02/06/2023] Open
Abstract
Psoriasis is a chronic recurrent inflammatory skin disease with prevalence of 1–3%. Nail psoriasis affects 10–90% of patients with plaque psoriasis. The aim of the article is to review the literature for the correlation between nail psoriasis and psoriatic arthritis (PsA) to provide rheumatologists a short review on features of nail psoriasis, methods of their assessment and possible clinical repercussions. The PubMed database was searched using the key words ‘nail psoriasis’ and ‘psoriatic arthritis’. Psoriasis involving the nail matrix shows up as changes such as pitting, Beau lines, leukonychia, red spots in the lunula, or nail plate crumbling. Nail bed psoriasis manifests as onycholysis, oil drops (or salmon patches), dyschromia, splinter hemorrhages, or subungual hyperkeratosis. Nail psoriasis and psoriatic lesions in the gluteal cleft and on the scalp usually accompany PsA, especially in adult men.
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38
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Di Chiacchio N, André J, Haneke E, Di Chiacchio NG, Fonseca Noriega L, Ocampo-Garza J. Pseudo-pitting of the nail in psoriasis. J Eur Acad Dermatol Venereol 2017; 31:e347-e348. [PMID: 28129473 DOI: 10.1111/jdv.14141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- N Di Chiacchio
- Dermatology Department, Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
| | - J André
- Head of the Dermatology and Dermatopathology Department, University Hospitals Saint-Pierre, Brussels, Belgium
| | - E Haneke
- Department of Dermatology, Inselspital, University of Bern, Bern, Switzerland.,Dermatology Clinic Dermaticum, Freiburg i.Br., Germany.,Centro de Dermatología Epidermis, Instituto CUF, Porto, Portugal.,Department of Dermatology, Academic Hospital, University of Gent, Gent, Belgium
| | - N G Di Chiacchio
- Dermatology Department, Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil.,Dermatology Department, Faculty of Medicine of ABC, São Paulo, Brazil
| | - L Fonseca Noriega
- Dermatology Department, Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
| | - J Ocampo-Garza
- Dermatology Department, Faculty of Medicine of ABC, São Paulo, Brazil.,Dermatology Department, University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Mexico
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39
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Hair and Nail Manifestations of Systemic Disease. CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0169-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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40
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Young M, Aldredge L, Parker P. Psoriasis for the primary care practitioner. J Am Assoc Nurse Pract 2017; 29:157-178. [PMID: 28233460 DOI: 10.1002/2327-6924.12443] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/15/2016] [Accepted: 12/16/2016] [Indexed: 01/23/2023]
Abstract
Primary care practitioners (PCPs) are playing an increasingly important role in the management and care of psoriasis. Thus, it is important for PCPs to be knowledgeable about the disease and to be able to differentiate between common myths and facts related to diagnosis and treatment. By building relationships with their patients and working collaboratively with dermatology health professionals and other specialists, PCPs can facilitate communication about the patient's treatment preferences and expectations for symptom relief, and they may be better able to work with the patient to optimize treatment adherence. This review aims to provide PCPs with a primer on psoriasis, its associated comorbidities, and its impact on patients' quality of life. Discussion topics include psoriasis epidemiology, triggering factors, clinical presentation, differential diagnosis, comorbidities, and approaches to treatment. This review also highlights the importance of staying abreast of advances in the understanding of psoriasis pathogenesis as well as emerging therapeutic treatment options, because these advances may change the treatment landscape and increase patients' expectations for skin clearance.
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Affiliation(s)
- Melodie Young
- Modern Dermatology, Baylor-Health Texas Affiliate, Dallas, Texas
| | - Lakshi Aldredge
- Dermatology Service, Operative Care Division, VA Portland Health Care System, Portland, Oregon
| | - Patti Parker
- College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, Texas
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A study of dermoscopic features of nail psoriasis. Postepy Dermatol Alergol 2017; 34:28-35. [PMID: 28286468 PMCID: PMC5340855 DOI: 10.5114/ada.2017.65618] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 12/03/2015] [Indexed: 11/26/2022] Open
Abstract
Introduction Dermoscopy is a non-invasive imaging method that enables the evaluation of pigmented and non-pigmented skin lesions. More recently, dermoscopy has been recognized as an effective tool in the diagnosis of nail diseases. Aim To evaluate the dermoscopic features of nail psoriasis and to assess the relationship between these features and disease severity. Material and methods A total of 67 patients with clinically evident nail psoriasis (14 women, 53 men) were prospectively enrolled. Following a thorough clinical examination, patients were graded according to the Nail Psoriasis Severity Index and physician’s global assessment score. A dermoscopic examination of all fingernails and toenails was performed using a videodermatoscope. Mann-Whitney U and χ2 tests were used for statistical analysis, with a significance threshold of p < 0.05. Results The most frequently observed dermoscopic features were splinter haemorrhage (73.1%), pitting (58.2%), distal onycholysis (55.2%), dilated hyponychial capillaries (35.8%) and the pseudo-fiber sign (34.3%). The pseudo-fiber sign, dilated hyponychial capillaries, nail plate thickening and crumbling, subungual hyperkeratosis, transverse grooves, trachyonychia, pitting and salmon patches were positively associated with disease severity. Conclusions The pseudo-fiber sign described in this study appears to be a novel dermoscopic feature of nail psoriasis. We have demonstrated positive associations between a number of dermoscopic manifestations and disease severity. Further studies are required to support the present findings.
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42
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Marina EM, Botar-Jid C, Bolboaca SD, Roman II, Senila CS, Mihu CM, Tataru DA. Patterns of clinical nail appearances in patients with cutaneous psoriasis. ACTA ACUST UNITED AC 2017; 90:22-27. [PMID: 28246493 PMCID: PMC5305083 DOI: 10.15386/cjmed-679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 05/17/2016] [Accepted: 06/13/2016] [Indexed: 11/25/2022]
Abstract
Background and aim Nail manifestations are often an overlooked aspect in psoriatic disease, cutaneous and joint involvement being far more often reported and investigated. The reported prevalence of nail changes varies in literature, specific fingernail clinical features having different degrees of occurrence. The aim of this study was to describe specific clinical patterns of fingernail alterations in adult patients with plaque-type psoriasis in a university hospital in the North-West of Romania. Methods Clinical data of 35 patients with fingernail psoriasis were collected and analyzed. Psoriasis Area and Severity Index (PASI) and Nail Psoriasis Severity Index (NAPSI) scores were used to quantify disease extension in each patient. Results PASI score proved linearly correlated with NAPSI score (p<0.05). The age of onset of fingernail psoriasis was positively correlated with age of onset cutaneous psoriasis (p<0.0001). Furthermore, the duration of cutaneous involvement and NAPSI proved significantly related (p<0.05). The third fingernail in the right hand and first fingernail in the left hand were in most of the cases severely affected. The most common observed nail pattern was pitting, followed by salmon patches and subungual hyperkeratosis. Conclusion Important nail changes appear even in moderate forms of cutaneous psoriasis. Particular localization of specific fingernail psoriasis pattern enables the possibility of detecting early stage disease.
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Affiliation(s)
- Elena Mihaela Marina
- Histology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Carolina Botar-Jid
- Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sorana Daniela Bolboaca
- Medical Informatics and Biostatistics Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Iulia Ioana Roman
- Physiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Corina Simona Senila
- Dermatology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Carmen Mihaela Mihu
- Histology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dumitru Alexandru Tataru
- Dermatology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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43
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Saulite I, Pilmane M, Guenova E, Kisis J. Expression of inflammatory cytokines in psoriatic nails. J Eur Acad Dermatol Venereol 2016; 31:e210-e212. [DOI: 10.1111/jdv.13970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- I. Saulite
- Faculty of Continuing Education; Rīga Stradiņš University; Riga Latvia
- Department of Infectology and Dermatology; Rīga Stradiņš University; Riga Latvia
| | - M. Pilmane
- Institute of Anatomy and Anthropology; Rīga Stradiņš University; Riga Latvia
| | - E. Guenova
- Department of Dermatology; University Hospital Zurich; University of Zurich; Zurich Switzerland
| | - J. Kisis
- Department of Infectology and Dermatology; Rīga Stradiņš University; Riga Latvia
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44
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Walker J, Baran R, Vélez N, Jellinek N. Koilonychia: an update on pathophysiology, differential diagnosis and clinical relevance. J Eur Acad Dermatol Venereol 2016; 30:1985-1991. [PMID: 27531645 DOI: 10.1111/jdv.13610] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 12/04/2015] [Indexed: 11/28/2022]
Abstract
Koilonychia, a concave nail dystrophy, has multiple aetiologies and may be hereditary, acquired or idiopathic. Within dermatology, koilonychia is often a manifestation of an inflammatory dermatosis such as psoriasis or lichen planus, or a sign of onychomycosis. Other disease associations include iron store abnormalities, Plummer-Vinson Syndrome, nutritional deficiencies and occupational or traumatic aetiologies. In young children, koilonychia of the toenails is commonly transient and idiopathic, although familial and syndromic cases are reported. The dermatologist must be aware of the potential cutaneous and systemic associations with koilonychia in order to guide appropriate workup, treatment and/or referral. An algorithm for evaluation of koilonychia is presented along with discussion of common causes of koilonychia and a comprehensive list of all known associations.
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Affiliation(s)
- J Walker
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - R Baran
- Nail Disease Centre, Dermatology, Cannes, France
| | - N Vélez
- Division of Dermatology, Allegheny Health Network, Pittsburgh, PA, USA
| | - N Jellinek
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA. .,Dermatology Professionals, Inc., East Greenwich, RI, USA. .,Division of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA.
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45
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BAŞ Y, SEÇKİN HY, KALKAN G, TAKCI Z, ÇITIL R, ÖNDER Y, ŞAHİN Ş, DEMİR AK. Prevalence and related factors of psoriasis and seborrheic dermatitis: a community-based study. Turk J Med Sci 2016; 46:303-9. [DOI: 10.3906/sag-1406-51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 05/15/2015] [Indexed: 11/03/2022] Open
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46
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Joshi M, Sharma V, Pathak K. Nail psoriasis: An updated review of clinical reports on therapy and formulation aspects for topical delivery. J Drug Deliv Sci Technol 2015. [DOI: 10.1016/j.jddst.2015.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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47
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Abstract
Nail disorders are a common presenting complaint for both the primary care physician and the dermatologist. Nail diagnoses are broad in scope and include infectious, inflammatory, and neoplastic conditions. Onychomycosis is an especially common nail condition, and treatment should always be preceded by appropriate fungal studies for confirmation of diagnosis. Inflammatory conditions of the nail unit can mimic onychomycosis, and a dermatologist can assist with diagnosis and treatment recommendations. Likewise, subungual tumors often require biopsy, and should be evaluated by a dermatologist who is experienced in nail evaluation and treatment.
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Affiliation(s)
- Lauren K Biesbroeck
- Division of Dermatology, University of Washington School of Medicine, 1959 Northeast Pacific Street, BB-1353, Box 356524, Seattle, WA 98195-6524, USA.
| | - Philip Fleckman
- Division of Dermatology, University of Washington School of Medicine, 1959 Northeast Pacific Street, BB-1353, Box 356524, Seattle, WA 98195-6524, USA
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48
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Falahati M, Ghojoghi A, Abastabar M, Ghasemi Z, Farahyar S, Roudbary M, Hedayati MT, Armaki MT, Hoseinnejad A. The First Case of Total Dystrophic Onychomycosis Caused by Aspergillus clavatus Resistant to Antifungal Drugs. Mycopathologia 2015; 181:273-7. [PMID: 26474550 DOI: 10.1007/s11046-015-9954-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 10/04/2015] [Indexed: 10/22/2022]
Abstract
Onychomycosis is a common fungal infection of nails which is mainly caused by dermatophyte species and less often by yeasts and non-dermatophyte molds. We present a case of onychomycosis due to Aspergillus clavatus for the first time worldwide. The patient was an immunocompetent 32-year-old woman who identified with Psoriasis of the nail. The presence of A. clavatus in a nail sample was confirmed using microscopic and culture analysis followed by PCR of the β-tubulin gene. After antifungal susceptibility test, it is revealed that the isolate was resistant to the majority of common antifungal drugs, but finally the patient was treated with itraconazole 200 mg daily. A. clavatus and drug-resistant A. clavatus have not previously been reported from onychomycosis.
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Affiliation(s)
- Mehraban Falahati
- Department of Medical Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Aynaz Ghojoghi
- Department of Medical Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Abastabar
- Invasive Fungi Research Center (IFRC), Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, P.O. Box 48175-1665, Sari, Iran.
| | - Zeinab Ghasemi
- Department of Medical Mycology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Farahyar
- Department of Medical Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Roudbary
- Department of Medical Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Taghi Hedayati
- Invasive Fungi Research Center (IFRC), Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, P.O. Box 48175-1665, Sari, Iran
| | - Mojtaba Taghizadeh Armaki
- Invasive Fungi Research Center (IFRC), Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, P.O. Box 48175-1665, Sari, Iran
| | - Akbar Hoseinnejad
- Invasive Fungi Research Center (IFRC), Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, P.O. Box 48175-1665, Sari, Iran
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49
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Joshi M, Sharma V, Pathak K. Matrix based system of isotretinoin as nail lacquer to enhance transungal delivery across human nail plate. Int J Pharm 2014; 478:268-277. [PMID: 25445993 DOI: 10.1016/j.ijpharm.2014.11.050] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/21/2014] [Accepted: 11/23/2014] [Indexed: 02/07/2023]
Abstract
The project was aimed at development of isotretinoin nail lacquer and assessment of its penetration efficiency across human nail plate. Preliminary studies (hydration enhancement factor and SEM) aided the selection of thioglycolic acid as permeation and eugenol was selected as local anesthetic in the formulation. The nail lacquer was optimized by 3(2) factorial design and a total of nine formulations were prepared and screened. In vitro adhesion and ex vivo permeation (cumulative drug permeation per unit area (CDP/A) = 6.61 ± 0.57 mg/cm(2)) across bovine hoof guided the selection of F3 as optimized formulation that was improvised. Viscosity adjustments to improve handling characteristics were affected by incorporation of ethyl cellulose (6%; F3M1) that scaled the viscosity to 312.681 cp and insignificantly (p > 0.05) affected CDP/A (6.32 ± 0.45 mg/cm(2)). In comparison to marketed preparation (Retino-A cream) F3M1 afforded two fold increase in CDP/A. The permeation characteristics were defined by Higuchi model (r(2) = 0.964) and flux value of 176 μg/cm(2)/h. Confocal laser scanning microscopy, after 72 h of nail lacquer application, revealed extensive distribution of the fluorescent tracer across the human nail plate in comparison to control that was confined to the top layer. Conclusively, an efficacious and stable nail lacquer of isotretinoin was developed for potential clinical topical use to target the drug to nail bed in treatment of nail psoriasis.
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Affiliation(s)
- Monika Joshi
- Department of Pharmaceutics, Rajiv Academy for Pharmacy, N.H.# 2, Delhi Mathura Road, P.O. Chhatikkara, Mathura 281001, India
| | - Vijay Sharma
- Department of Pharmaceutics, Rajiv Academy for Pharmacy, N.H.# 2, Delhi Mathura Road, P.O. Chhatikkara, Mathura 281001, India
| | - Kamla Pathak
- Department of Pharmaceutics, Rajiv Academy for Pharmacy, N.H.# 2, Delhi Mathura Road, P.O. Chhatikkara, Mathura 281001, India.
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