45 results on '"Quinn Thibodeaux"'
Search Results
2. Verrucous Melanoma Presenting as a Cutaneous Horn
- Author
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Delfina Bur, Quinn Thibodeaux, and Brett Keeling
- Subjects
Diagnosis, Differential ,Skin Neoplasms ,Humans ,Dermatology ,General Medicine ,Keratosis ,Melanoma ,Pathology and Forensic Medicine - Abstract
Verrucous malignant melanoma (MM) is a rare variant of melanoma that often presents diagnostic challenges. This case highlights the unique presentation of verrucous MM underlying a cutaneous horn. It is vital for dermatologists to be aware of this potentially benign-appearing variant to be able to diagnose and treat MM early on.
- Published
- 2022
3. Should the Black Box Warning of Brodalumab and Apremilast Deter Prescribing in Psoriasis Patients with Depression?
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Leon H Kircik, Melissa Knuckles, George Han, John Koo, Gary Goldenberg, Ryan Rivera-Oyola, Jashin J Wu, Sylvia Hsu, Mark Lebwohl, Quinn Thibodeaux, Rick Fried, Graham H Litchman Do, and Andrea Murina
- Subjects
Chronic condition ,medicine.medical_specialty ,business.industry ,Brodalumab ,Disease ,medicine.disease ,Quality of life ,Psoriasis ,medicine ,Apremilast ,medicine.symptom ,business ,Intensive care medicine ,Suicidal ideation ,Depression (differential diagnoses) ,medicine.drug - Abstract
Introduction: Psoriasis, an immune-mediated disease that manifests cutaneously with possible arthritic complications, affects millions of people in the United States and worldwide. Depression and suicidal ideation and behavior (SIB) are two prevalent comorbidities associated with psoriasis, due to the chronic nature of the disease, lack of a cure, as well as social stigma, all of which are detrimental to quality of life. Among the options available for management of moderate-severe psoriasis, apremilast and brodalumab represent recent additions to the therapeutic armamentarium for managing psoriasis. It has been suggested that the aforementioned drugs can lead to depression and possibly increase the risk for SIB. Furthermore, a black box warning was issued for brodalumab. This review challenges opinions that the drugs are solely responsible for exacerbating depression and SIB, when in fact it could be psoriasis itself. Methods: An extensive search of available literature linking cytokines to suicidal behavior was performed. After filtering for relevance, 22 articles were reviewed in detail. Results: Brodalumab and apremilast, both molecularly and clinically, do not objectively increase the risk for depression and/or suicidal ideation and behavior. Conclusion: After careful review of the appropriate studies and relevant literature, patients with moderate-severe psoriasis, including those that experience depression resulting from their chronic condition, would likely benefit from early, rather than delayed initiation of effective medications like apremilast and brodalumab. The speed of response and high level of efficacy of brodalumab make it an ideal intervention for patients suffering depression caused by their psoriasis.
- Published
- 2021
4. Management strategies for borderline and narcissistic personality disorders in dermatology practice: a review
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Quinn Thibodeaux, John Koo, Bridget Myers, Vidhatha Reddy, Nicholas Brownstone, and Stephanie Chan
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030203 arthritis & rheumatology ,business.industry ,Dermatology ,medicine.disease ,Personality Disorders ,behavioral disciplines and activities ,Personality disorders ,Cosmetic dermatology ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Narcissistic personality ,Borderline Personality Disorder ,Narcissistic personality disorder ,mental disorders ,medicine ,Humans ,skin and connective tissue diseases ,business ,Borderline personality disorder ,Clinical psychology - Abstract
Dermatologists are often ill-equipped to promptly identify and manage patients with personality disorders. Patients with borderline personality disorder (BPD) and narcissistic personality disorder (NPD) frequently present to dermatology clinics, particularly those that provide esthetic services. Although dermatologists should ideally utilize specific management strategies when working with these patients, there is a lack of awareness and availability of resources on how to do so. Here, we review the psychiatry, plastic and reconstructive surgery, and dermatology literature to provide recommendations on tangible management strategies for dermatologists to avoid common mistakes that are made while managing patients with BPD and NPD. Additionally, we also discuss common dermatologic manifestations of BPD and NPD to improve providers' ability to identify patients with these conditions in their practices.
- Published
- 2020
5. Sleep, Immunological Memory, and Inflammatory Skin Disease
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Tina Bhutani, Vidhatha Reddy, Bridget Myers, Quinn Thibodeaux, Nicholas Brownstone, and Stephanie Chan
- Subjects
Sleep Wake Disorders ,business.industry ,Inflammatory skin disease ,Dermatitis ,Dermatology ,Immunological memory ,Sleep in non-human animals ,Immune System ,Chronic Disease ,Immunology ,Humans ,Medicine ,Sleep ,business ,Immunologic Memory - Published
- 2020
6. Brodalumab for Treatment-Resistant Psoriasis: Case Reports and Safety Update
- Author
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John Koo, Bridget Myers, Vidhatha Reddy, Quinn Thibodeaux, Tina Bhutani, Nicholas Brownstone, and Stephanie Chan
- Subjects
medicine.medical_specialty ,business.industry ,Treatment outcome ,Brodalumab ,Dermatology ,Biologic treatment ,medicine.disease ,Food and drug administration ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Psoriasis ,medicine ,030212 general & internal medicine ,business ,Treatment resistant ,Depression (differential diagnoses) - Abstract
Introduction: Brodalumab is an interleukin-17 receptor blocker that is effective for the treatment of psoriasis. However, due to a Food and Drug Administration black box warning on depression and suicide, many providers are hesitant to use this agent despite its efficacy. Methods: We present the cases of 2 brothers seen at our clinic with treatment-resistant psoriasis who were both successfully treated with brodalumab, despite failing 6 other biologics. We also review the safety profile of brodalumab regarding the currently available evidence on the increased risk of suicidality or depression in patients treated with brodalumab. Results: Both patients achieved completely clear skin and maintained clearance on brodalumab. Discussion: Brodalumab appears to be an effective agent in severe treatment-resistant cases of psoriasis. In addition, a causal relationship between increased risk of suicidality or depression and brodalumab use has not been established.
- Published
- 2020
7. Machine Learning in Dermatology: Current Applications, Opportunities, and Limitations
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Quinn Thibodeaux, Stephanie Chan, Nicholas Brownstone, Vidhatha Reddy, Bridget Myers, and Wilson Liao
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medicine.medical_specialty ,Artificial intelligence ,Image classification ,Clinical Sciences ,Personalized treatment ,Convolutional neural network ,Review ,Dermatology ,Machine learning ,computer.software_genre ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Mobile applications ,lcsh:Dermatology ,Medicine ,Personal monitoring devices ,Quality of Life Research ,Contextual image classification ,business.industry ,Deep learning ,Precision medicine ,Disease classification ,lcsh:RL1-803 ,030220 oncology & carcinogenesis ,Dermatopathology ,business ,computer - Abstract
Machine learning (ML) has the potential to improve the dermatologist’s practice from diagnosis to personalized treatment. Recent advancements in access to large datasets (e.g., electronic medical records, image databases, omics), faster computing, and cheaper data storage have encouraged the development of ML algorithms with human-like intelligence in dermatology. This article is an overview of the basics of ML, current applications of ML, and potential limitations and considerations for further development of ML. We have identified five current areas of applications for ML in dermatology: (1) disease classification using clinical images; (2) disease classification using dermatopathology images; (3) assessment of skin diseases using mobile applications and personal monitoring devices; (4) facilitating large-scale epidemiology research; and (5) precision medicine. The purpose of this review is to provide a guide for dermatologists to help demystify the fundamentals of ML and its wide range of applications in order to better evaluate its potential opportunities and challenges.
- Published
- 2020
8. Novel Coronavirus Disease (COVID-19) and Biologic Therapy in Psoriasis: Infection Risk and Patient Counseling in Uncertain Times
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Bridget Myers, Quinn Thibodeaux, Stephanie Chan, Nicholas Brownstone, Vidhatha Reddy, Tina Bhutani, and Wilson Liao
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medicine.medical_specialty ,Disease ,Dermatology ,Biologics ,medicine.disease_cause ,Placebo ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Psoriasis ,Pandemic ,Medicine ,Intensive care medicine ,Coronavirus ,business.industry ,SARS-CoV-2 ,Respiratory infection ,COVID-19 ,medicine.disease ,Clinical trial ,030220 oncology & carcinogenesis ,RL1-803 ,Commentary ,Viral disease ,business ,Infection - Abstract
With the emergence of the novel coronavirus disease (COVID-19) viral pandemic, there is uncertainty whether biologic agents for psoriasis may place patients at a higher risk for infection or more severe disease course. This commentary offers patient counseling recommendations based on the current available evidence. While there are currently no specific data for psoriasis biologics and COVID-19, data are presented here from phase III clinical trials of psoriasis biologics on rates of upper respiratory infection, influenza, and serious infection. Overall these data reveal that on the whole, psoriasis biologics do not show major increases in infection risk compared to placebo during the course of these trials. However, as the COVID-19 virus is a novel pathogen that is associated with mortality in a subset of patients, a cautious approach is warranted. We discuss factors that may alter the benefit–risk ratio of biologic use during this time of COVID-19 outbreak. Ultimately, treatment decisions should be made on the basis of dialogue between patient and provider, considering each patient’s individualized situation. Once this pandemic has passed, it is only a matter of time before a new viral disease reignites the same issues discussed here.
- Published
- 2020
9. Certolizumab Pegol for Psoriasis and Psoriatic Arthritis
- Author
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John Koo, Vidhatha Reddy, and Quinn Thibodeaux
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Plaque psoriasis ,medicine.medical_specialty ,business.industry ,Dermatology ,medicine.disease ,Clinical trial ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Safety profile ,Psoriatic arthritis ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Psoriasis ,Childbearing age ,medicine ,In patient ,Certolizumab pegol ,business ,medicine.drug - Abstract
The purpose of this review is to provide an overview of the use of certolizumab pegol (Cimzia®, UCB S.A.) for psoriasis and psoriatic arthritis and summarize important findings. Three pivotal phase three clinical trials CIMPASI-1, CIMPASI-2, and CIMPACT have demonstrated efficacy and safety of certolizumab pegol (CZP) in patients with plaque psoriasis. In addition, another multicenter phase three clinical trial, RAPID-PsA, has shown long-term efficacy and safety data of CZP in psoriatic arthritis. When compared with other TNF-alpha blockers, CZP has demonstrated increased efficacy in psoriasis. In addition, CZP has also shown clinically significant and sustained improvement in psoriatic arthritis based on symptoms and radiographic evidence in patients with up to 4 years of follow-up. The safety profile of CZP is comparable to other anti-TNF agents. Finally, CZP’s unique structure as a PEGylated monoclonal antibody fragment prevents placental transfer and therefore may make it an ideal choice as a biologic medication for women of childbearing age.
- Published
- 2020
10. Psoriasis Vulgaris Successfully Treated with Goeckerman Treatment at Home: A Patient and Physician’s Experience
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Tina Bhutani, Quinn Thibodeaux, Bridget Myers, Vidhatha Reddy, Wilson Liao, and Shawn Thomas
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medicine.medical_specialty ,Clinical Sciences ,Dermatology ,Goeckerman therapy ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Psoriasis ,medicine ,lcsh:Dermatology ,Effective treatment ,Intensive care medicine ,business.industry ,Modified Goeckerman regimen ,Treatment team ,lcsh:RL1-803 ,Phototherapy ,medicine.disease ,Heliotherapy psoriasis ,Regimen ,Ultraviolet B radiation ,Deferred treatment ,030220 oncology & carcinogenesis ,Commentary ,business ,Home therapy ,Coal tar - Abstract
Goeckerman therapy is a highly effective treatment regimen for moderate-to-severe psoriasis. It involves regular exposure to ultraviolet B radiation and the application of crude coal tar. To our knowledge, only three centers in the USA currently offer a formal Goeckerman therapy treatment program; thus, access to this therapy is geographically limited. In this article, a motivated patient discusses his experience with generalized plaque psoriasis. This patient, while living in a Goeckerman-inaccessible area, deferred treatment with biologics and outpatient phototherapy to develop a modified Goeckerman regimen for at-home use. This home regimen, which did not involve the use of prescription-strength medications, resulted in full clearance of his psoriasis. We also discuss the patient’s case from the perspective of a dermatology treatment team that has reviewed his experience.
- Published
- 2020
11. Treatment of Plaque Psoriasis With an Excimer Laser Utilizing an Optimal Therapeutic UVB Dose Protocol
- Author
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Ethan Levin, Tina Bhutani, John Koo, Neal Bhatia, Kristen M. Beck, Quinn Thibodeaux, and Benjamin Lockshin
- Subjects
Male ,Target lesion ,medicine.medical_specialty ,Erythema ,Severity of Illness Index ,Lesion ,Therapeutic index ,Psoriasis ,Humans ,Medicine ,Prospective Studies ,Dosing ,Radiometry ,Adverse effect ,business.industry ,Dose-Response Relationship, Radiation ,General Medicine ,Middle Aged ,medicine.disease ,Dermatology ,Hyperpigmentation ,Female ,Lasers, Excimer ,Ultraviolet Therapy ,medicine.symptom ,business - Abstract
Background: Traditionally, treatment with the excimer laser requires determining the minimal erythema dose on healthy skin or using plaque-based induration; however, these protocols often lead to underdosing of psoriatic plaques and reduced treatment efficacy. Objective: To prospectively evaluate the effect of the excimer laser on plaque psoriasis using an optimal therapeutic dose (OTD) protocol. Methods: Subjects with stable plaque psoriasis were tested with the Multi-Microdose (MMD) tip on the XTRAC excimer laser to determine a minimum blistering dose (MBD). Treatment was then initiated at 20% less than the MBD. A single psoriatic lesion was treated once weekly for up to 11 sessions. The change from baseline of the target lesion's modified psoriasis area severity index (mPASI), quality of life and safety were evaluated. Results: Thirteen subjects with a mean age of 48.9±14.9 years and Fitzpatrick skin types I-IV participated in the study. Target plaque mPASI significantly decreased at all time points relative to baseline with significant improvement by the second treatment. Patients reached mPASI-75 within 5±2 sessions. By the end of the study 92% of patients achieved mPASI-75. On average, patients maintained an mPASI score ≥50% for 60 days. Treatment was well tolerated with no erosions or hyperpigmentation. Erythema was the most common adverse event. Conclusion: The OTDTM protocol with the MMD® tip allows determining the optimal dose locally on the psoriatic plaque itself. Consequently, ineffectual dosing levels and treatments are minimized. The OTD protocol reduces treatment frequency from 2-3 times per week to once weekly. J Drugs Dermatol. 2020;19(4):349-354. doi:10.36849/JDD.2020.4891.
- Published
- 2020
12. Update on Sleep and Pulmonary Comorbidities in Psoriasis
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Nicholas Brownstone, Wilson Liao, Tina Bhutani, Stephanie Chan, Bridget Myers, Quinn Thibodeaux, and Vidhatha Reddy
- Subjects
education.field_of_study ,medicine.medical_specialty ,COPD ,business.industry ,Population ,Dermatology ,Disease ,medicine.disease ,Obstructive sleep apnea ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Internal medicine ,Psoriasis ,medicine ,Insomnia ,medicine.symptom ,education ,business ,Depression (differential diagnoses) ,Disease burden - Abstract
The purpose of this review article is to provide an overview of sleep and pulmonary comorbidities in patients with psoriasis and summarize important recent findings. Evidence continues to show that patients with psoriasis experience greater chronic sleep impairment when compared to healthy counterparts. In addition to other comorbidities seen in psoriasis patients, including cardiovascular disease, obesity, and diabetes, obstructive sleep apnea and chronic obstructive pulmonary disease have increased frequency in this population. Sleep and pulmonary comorbidities in psoriasis contribute to disease burden and impaired quality of life in psoriasis patients. The evaluation of sleep comorbidities is complicated by the overlap with other comorbidities such as depression and anxiety. Regardless, there is strong evidence to indicate an elevated prevalence of insomnia in psoriasis patients. A causal relationship between psoriasis and insomnia has yet to be determined. There is moderate evidence to suggest increased risk of developing OSA in psoriasis patients, even when accounting for increased BMI. Most studies on sleep impairment in psoriasis patients have used self-reported data, of which only a portion has been validated. As such, there is a need to better evaluate sleep dysfunction in psoriasis patients. Regarding pulmonary comorbidities, psoriasis patients are more likely to smoke compared to the general population, which complicates evaluation of risk of COPD, lung cancer, and pulmonary infections in this population.
- Published
- 2020
13. Beyond the Booth
- Author
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Quinn Thibodeaux, Wilson Liao, Kristen M. Beck, Mary Patricia Smith, Tina Bhutani, and Karen Ly
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medicine.medical_specialty ,integumentary system ,Excimer laser ,business.industry ,Treatment duration ,medicine.medical_treatment ,Ultraviolet b ,Dermatology ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Treatment modality ,030220 oncology & carcinogenesis ,Dermatologic diseases ,medicine ,Limited disease ,In patient ,business - Abstract
The excimer laser has emerged as an efficacious treatment modality for many dermatologic diseases. The excimer laser is an alternative to standard narrowband ultraviolet B (NBUVB) phototherapy treatment in patients with limited disease. In comparison to standard NBUVB, the excimer laser requires fewer treatment sessions, has reduced treatment duration, requires a lower cumulative UVB dose, and limits UVB exposure to lesional skin. This review addresses the mechanism, safety, application, and efficacy of the excimer laser for the treatment of these conditions.
- Published
- 2020
14. Expert Panel Discussion among Psoriasis and Psychodermatology Specialists: How Best to Manage Depressed Psoriasis Patients with Brodalumab
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Melissa Knuckles, Rick Fried, Gary Goldenberg, Sylvia Hsu, Quinn Thibodeaux, Jashin J Wu, Graham H. Litchman, Leon H Kircik, Ryan Rivera-Oyola, George Han, Jeffrey M Weinberg, Andrea Murina, John Koo, and Mark Lebwohl
- Subjects
medicine.medical_specialty ,education.field_of_study ,business.industry ,Brodalumab ,Population ,Psychodermatology ,medicine.disease ,Patient population ,Psoriasis ,Family medicine ,medicine ,In patient ,skin and connective tissue diseases ,education ,business ,Depression (differential diagnoses) ,Panel discussion - Abstract
Psoriasis patients with comorbid depression represent a common therapeutic challenge for dermatologists. Depressed patients often require the practicing dermatologist to go outside of their comfort zone, and the FDA’s labeling of medications such as brodalumab have further complicated an already difficult-to-treat patient population. A multi-disciplinary work-group consisting of a board-certified psychiatrist, a licensed clinical psychologist, and multiple dermatologists was convened to formulate practical recommendations for the evaluation and treatment of this at-risk population. How to broach the subject of depression and when to refer patients for formal evaluation were discussed. The expert panel also produced a consensus statement regarding the use of brodalumab in patients with both psoriasis and depression.
- Published
- 2019
15. Dupilumab-Induced Facial Flushing After Alcohol Consumption
- Author
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Wilson Liao, Stephanie Chan, Nicholas Brownstone, Bridget Myers, Quinn Thibodeaux, Vidhatha Reddy, and Tina Bhutani
- Subjects
2019-20 coronavirus outbreak ,medicine.medical_specialty ,Facial flushing ,Side effect ,Alcohol Drinking ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Atopic dermatitis ,medicine.disease ,Antibodies, Monoclonal, Humanized ,Dupilumab ,Dermatology ,Severity of Illness Index ,Dermatitis, Atopic ,Food and drug administration ,Treatment Outcome ,medicine ,Flushing ,Humans ,business ,Alcohol consumption - Abstract
Dupilumab is a biologic agent approved by the US Food and Drug Administration for the treatment of atopic dermatitis (AD). Here, we report 2 patients with AD who were treated with dupilumab and subsequently developed facial flushing after consuming alcohol. A possible mechanism of action for this side effect is discussed along with a potential role of dupilumab.
- Published
- 2021
16. Prescribing Isotretinoin for Transgender Patients: A Call to Action and Recommendations
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Tina Bhutani, Nicholas Brownstone, Daniela P Sanchez, Stephanie Chan, Bridget Myers, Vidhatha Reddy, and Quinn Thibodeaux
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Adult ,Male ,Pediatrics ,medicine.medical_specialty ,MEDLINE ,Dermatology ,Drug Prescriptions ,Transgender Persons ,Acne Vulgaris ,Transgender ,medicine ,Humans ,Testosterone ,Isotretinoin ,Acne ,business.industry ,Abnormalities, Drug-Induced ,Gender Identity ,General Medicine ,medicine.disease ,Call to action ,Transgender hormone therapy ,Sex Reassignment Procedures ,Practice Guidelines as Topic ,Intramuscular testosterone ,Female ,Dermatologic Agents ,business ,Transgender male ,medicine.drug - Abstract
Case Scenerio: A 26-year-old patient presents to the dermatology clinic with severe nodulocystic scarring acne. The patient identifies as a transgender male and notes that he has been receiving hormone replacement therapy for the past 4 years with weekly intramuscular testosterone injections.
- Published
- 2020
17. High-dose doxepin for the treatment of chronic, intractable scalp pruritus
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Quinn Thibodeaux, Bridget Myers, Stephanie Chan, Nicholas Brownstone, John Koo, and Vidhatha Reddy
- Subjects
medicine.medical_specialty ,doxepin ,business.industry ,Case Report ,Dermatology ,lcsh:RL1-803 ,medicine.disease ,Doxepin ,Therapeutic index ,Scalp pruritus ,lcsh:Dermatology ,doxepin serum levels ,Medicine ,itch ,therapeutic dose ,business ,chronic pruritus ,medicine.drug ,Chronic pruritus ,psychocutaneous disorders - Published
- 2020
18. Lymphomatoid papulosis successfully managed with excimer laser maintenance therapy
- Author
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Tina Bhutani, Jeffrey L Sugarman, Quinn Thibodeaux, and Vidhatha Reddy
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,CTCL, cutaneous T-cell lymphoma ,Case Report ,Dermatology ,Excimer ,Maintenance therapy ,LyP, lymphomatoid papulosis ,medicine ,lcsh:Dermatology ,NB-UVB, narrow-band ultraviolet B ,Lymphomatoid papulosis ,XTRAC ,Excimer laser ,business.industry ,PUVA, psoralen with ultraviolet A ,Cutaneous T-cell lymphoma ,CTCL - Cutaneous T-cell lymphoma ,excimer ,lcsh:RL1-803 ,medicine.disease ,lymphomatoid papulosis ,laser ,business ,lymphoproliferative disorder ,phototherapy - Published
- 2020
19. Acrodermatitis continua of Hallopeau: clinical perspectives
- Author
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Tina Bhutani, Karen Ly, Mary Patricia Smith, Wilson Liao, Quinn Thibodeaux, and Kristen M. Beck
- Subjects
Anakinra ,medicine.medical_specialty ,business.industry ,Pustular Eruption ,Dermatology ,medicine.disease ,Infliximab ,3. Good health ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,030220 oncology & carcinogenesis ,Psoriasis ,Ustekinumab ,Adalimumab ,Generalized pustular psoriasis ,Medicine ,Secukinumab ,business ,medicine.drug - Abstract
Acrodermatitis continua of Hallopeau (ACH) is a rare, sterile pustular eruption of one or more digits. The condition presents with tender pustules and underlying erythema on the tip of a digit, more frequently arising on a finger than a toe. As far as classification, ACH is considered a localized form of pustular psoriasis. The eruption typically occurs after local trauma or infection, but such a history is not always present and various other etiologies have been described including infectious, neural, inflammatory, and genetic causes. The natural progression of ACH is chronic and progressive, often resulting in irreversible complications such as onychodystrophy that can result in anonychia, as well as osteitis that can result in osteolysis of the distal phalanges. Because of the rarity of ACH, there have been no randomized controlled studies to evaluate therapies, resulting in an absence of standardized treatment guidelines. In clinical practice, a wide variety of treatments have been attempted, with outcomes ranging from recalcitrance to complete resolution. In recent years, the introduction of biologics has provided a new class of therapy that has revolutionized the treatment of ACH. Specifically, rapid and sustained responses have been reported with the use of anti-tumor necrosis factor agents like infliximab, adalimumab, and etanercept; IL-17 inhibitors like secukinumab; IL-12/23 inhibitors like ustekinumab; and IL-1 inhibitors like anakinra. Nevertheless, there remains a considerable need for more research into treatment for the benefit of individual patients with ACH as well as for the clinical knowledge gained by such efforts. The purpose of this review is to provide a comprehensive overview of the key features of ACH as well as a discussion of clinical management strategies for this unique and debilitating condition.
- Published
- 2019
20. Diagnosis and screening of patients with generalized pustular psoriasis
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Tina Bhutani, Mary Patricia Smith, Quinn Thibodeaux, Karen Ly, and Kristen M. Beck
- Subjects
medicine.medical_specialty ,business.industry ,Pustular psoriasis ,Dermatology ,medicine.disease ,030207 dermatology & venereal diseases ,03 medical and health sciences ,High morbidity ,0302 clinical medicine ,Acute onset ,Rheumatology ,030220 oncology & carcinogenesis ,Psoriasis ,Generalized pustular psoriasis ,medicine ,business - Abstract
Generalized pustular psoriasis (GPP) is a rare and potentially life-threatening variant of psoriasis that is characterized by recurrent, acute onset, widely distributed pustular eruptions on inflamed, erythematous skin. It is important to recognize acute GPP as a subtype of psoriasis associated with high morbidity and mortality so therapy can be initiated without delay. Since GPP was first described in 1910 by Leopold von Zumbusch, it has been inconsistently defined, stratified, and diagnosed in the literature. Multiple definitions and diagnostic criteria have been proposed over the years. Recently, formal consensus guidelines on GPP have been published by international groups. This article reviews the current evidence and understanding in the diagnosis and screening of GPP.
- Published
- 2019
21. Factors Influencing Sleep Difficulty and Sleep Quantity in the Citizen Pscientist Psoriatic Cohort
- Author
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Michael P. Siegel, April W. Armstrong, Joel M. Gelfand, Sarah Truman, Stacie Bell, Lindsey Shankle, Quinn Thibodeaux, Alisha Bridges, Frank Doris, Marilyn T. Wan, Ana Maria Orbai, Tina Bhutani, Marc Boas, Thulasi Weerasinghe, Kristen M. Beck, Junko Takeshita, Jashin J. Wu, Mary Patricia Smith, Wilson Liao, Karen Ly, and Brian Lafoy
- Subjects
medicine.medical_specialty ,Pediatrics ,Population ,Clinical Sciences ,Dermatology ,Sleep medicine ,Comorbidities ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Psoriatic arthritis ,0302 clinical medicine ,Psoriasis ,lcsh:Dermatology ,Medicine ,Survey research ,education ,Original Research ,2. Zero hunger ,Sleep disorder ,education.field_of_study ,business.industry ,Sleep apnea ,lcsh:RL1-803 ,medicine.disease ,Sleep in non-human animals ,3. Good health ,030220 oncology & carcinogenesis ,business ,Sleep ,Body mass index - Abstract
Introduction Sleep is essential for overall health and well-being, yet more than one-third of adults report inadequate sleep. The prevalence is higher among people with psoriasis, with up to 85.4% of the psoriatic population reporting sleep disruption. Poor sleep among psoriasis patients is particularly concerning because psoriasis is independently associated with many of the same comorbidities as sleep dysfunction, including cardiovascular disease, obesity, and depression. Given the high prevalence and serious consequences of disordered sleep in psoriasis, it is vital to understand the nature of sleep disturbance in this population. This study was designed to help meet this need by using survey data from Citizen Pscientist, an online patient portal developed by the National Psoriasis Foundation. Methods Our analysis included 3118 participants who identified as having a diagnosis by a physician of psoriasis alone or psoriasis with psoriatic arthritis. Demographic information, psoriasis severity and duration, sleep apnea status, smoking and alcohol consumption, itch timing, and sleep characteristics were included. Two separate multivariate logistic regression models in STATA were used to determine whether the presence of psoriatic arthritis, age, gender, body mass index, comorbid sleep apnea, psoriasis severity, timing of worst itch, smoking status, or high-risk alcohol consumption were associated with sleep difficulty or low sleep quantity, defined by the American Academy of Sleep Medicine as less than 7 h of sleep per night on average. Results Results from the multivariate logistic regressions found that sleep difficulty was associated with psoriatic arthritis (OR 2.15, 95% CI [1.79–2.58]), female gender (2.03 [1.67–2.46]), obese body mass index (BMI ≥ 30) (1.25 [1.00–1.56]), sleep apnea (1.41 [1.07–1.86]), psoriasis severity of moderate (1.59 [1.30–1.94]) or severe (2.40 [1.87–3.08]), and smoking (1.60 [1.26–2.02]). Low sleep quantity was associated with obese BMI (1.62 [1.29–2.03]), sleep apnea (1.30 [1.01–1.68]), psoriasis severity of moderate (1.41 [1.16–1.72]) or severe (1.40 [1.11–1.76]), and smoking (1.62 [1.31–2.00]). Sleep difficulty and low sleep quantity were not associated with age, alcohol consumption, or timing of worst itch. Conclusion These results are potentially meaningful in several aspects. We identify an important distinction between sleep difficulty and sleep quantity in psoriatic disease, whereby having psoriatic arthritis and being female are each associated with sleep difficulty despite no association with low sleep quantity. Furthermore, there is conflicting evidence from prior studies as to whether psoriasis severity is associated with sleep difficulty, but this well-powered, large study revealed a strong, graded relationship between psoriasis severity and both sleep difficulty and low sleep quantity. Overall, our results show that both sleep difficulty and low sleep quantity were associated with multiple factors in this analysis of a large psoriatic cohort. These findings suggest that dermatologists may gather clinically useful information by screening psoriatic patients for trouble sleeping and low sleep quantity to identify potential comorbidities and to more effectively guide disease management.
- Published
- 2019
22. Home phototherapy for patients with vitiligo: challenges and solutions
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Mary Patricia Smith, Tina Bhutani, Mio Nakamura, Quinn Thibodeaux, and Karen Ly
- Subjects
medicine.medical_specialty ,Standard of care ,integumentary system ,business.industry ,Early disease ,Treatment options ,Dermatology ,Vitiligo ,Physician education ,medicine.disease ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Depigmentation ,030220 oncology & carcinogenesis ,medicine ,medicine.symptom ,Autoimmune condition ,skin and connective tissue diseases ,business ,Intensive care medicine - Abstract
Vitiligo is a chronic autoimmune condition involving selective dysfunction and destruction of melanocytes in the skin, hair, or both. The typical presentation is well-demarcated depigmented skin patches. Given vitiligo is the most common cause of depigmentation worldwide and early disease responds best to treatment, prompt diagnosis and proactive management of vitiligo are critical. While a wide variety of treatments has demonstrated variable effectiveness in treating vitiligo, phototherapy remains standard of care because of its proven efficacy and favorable side effect profile. However, many patients with vitiligo are unable to access affordable, consistent, or convenient phototherapy. To address these issues, home-based phototherapy has emerged as a patient-centered alternative. The purpose of this review is to discuss management of vitiligo with a specific focus on access to home-based phototherapy (HBPT) for patients with this condition. Key challenges to HBPT include misperceptions around safety and efficacy, inadequate physician education and training, insurance and financial barriers, and appropriate patient selection. Solutions to these challenges are presented, such as approaches to improve physician education and increasing the evidence surrounding the effectiveness and safety of this treatment for vitiligo. In addition, various practical considerations are discussed to guide dermatologists on how to approach HBPT as a treatment option for patients with vitiligo.
- Published
- 2019
23. A review of dupilumab in the treatment of atopic diseases
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Mary Patricia Smith, Wilson Liao, Tina Bhutani, Karen Ly, Kristen M. Beck, and Quinn Thibodeaux
- Subjects
Eczema ,Dermatitis ,Severity of Illness Index ,0302 clinical medicine ,Product Review ,Maintenance therapy ,Monoclonal ,Eosinophilic ,Immunology and Allergy ,030212 general & internal medicine ,Humanized ,Lung ,Skin ,Clinical Trials as Topic ,atopic dermatitis ,Subcutaneous ,Pharmacology and Pharmaceutical Sciences ,Atopic dermatitis ,Dupilumab ,Treatment Outcome ,5.1 Pharmaceuticals ,Medical Microbiology ,IL-13 ,6.1 Pharmaceuticals ,Combination ,Respiratory ,Drug Therapy, Combination ,Development of treatments and therapeutic interventions ,biologic ,Dupixent ,Biotechnology ,medicine.medical_specialty ,Injections, Subcutaneous ,030231 tropical medicine ,Immunology ,review ,Antibodies, Monoclonal, Humanized ,Atopic ,Antibodies ,Dermatitis, Atopic ,Injections ,03 medical and health sciences ,Drug Therapy ,Virology ,medicine ,Humans ,Adverse effect ,Asthma ,Pharmacology ,United States Food and Drug Administration ,business.industry ,Prevention ,Inflammatory and immune system ,IL-4 ,Evaluation of treatments and therapeutic interventions ,asthma ,medicine.disease ,Dermatology ,United States ,Good Health and Well Being ,Clinical research ,business - Abstract
Dupilumab is a fully human monoclonal IgG4 antibody directed against the alpha subunit of the IL-4 receptor and prevents the signaling of IL-4 and IL-13, two type 2 cytokines known to be important drivers of atopic diseases. In March of 2017, the United States Food and Drug Administration (FDA) approved dupilumab for the treatment of moderate-to-severe atopic dermatitis in adults that is uncontrolled with topical medications, becoming the first biologic agent approved to treat this chronic skin condition. In October of 2018, Dupilumab received approval by the FDA as an add-on maintenance therapy in patients with moderate-to-severe asthma aged 12years or older with an eosinophilic phenotype or with oral corticosteroid-dependent asthma. This review summarizes the characteristics of dupilumab and the clinical research that has been published to date, including treatment efficacy and adverse events.
- Published
- 2019
24. The Use of Brodalumab in Three Patients with Psoriasis and Psychiatric Comorbidities
- Author
-
Ryan, Rivera-Oyola, Roselyn, Stanger, Graham H, Litchman, Quinn, Thibodeaux, John, Koo, Richard, Fried, Gary, Goldenberg, George, Han, Sylvia, Hsu, Leon, Kircik, Melissa, Knuckles, Andrea, Murina, Jeffrey, Weinberg, Jashin J, Wu, and Mark, Lebwohl
- Subjects
Emerging Authors in Dermatology - Abstract
Brodalumab, a first-in-class interleukin-17 (IL-17) receptor blocker, carries a black box warning for suicidal ideation and behavior, yet it is also one of the most powerful biologic agents in our armamentarium. We wish to highlight three patients with moderate-to-severe psoriasis and comorbid depression who were successfully treated with brodalumab. The patients were chosen by an expert panel comprising dermatologists, psychiatrists, and psychologists. Psoriasis disease severity was measured using the Psoriasis Area and Severity Index (PASI) score. All three patients experienced PASI 100 after treatment with brodalumab (N=3). Importantly, depressive symptoms improved or resolved in two out of three patients. One patient, who had a history of psychiatric hospitalizations, required in-patient psychiatric treatment during treatment. The use of brodalumab in patients with psoriasis can provide rapid-onset improvement in both skin and depressive symptoms.
- Published
- 2021
25. The use of Goeckerman therapy in managing erythrodermic psoriasis resistant to multiple medications
- Author
-
Quinn Thibodeaux, John Koo, Vidhatha Reddy, Bridget Myers, Stephanie Chan, and Nicholas Brownstone
- Subjects
Male ,medicine.medical_specialty ,business.industry ,Topical Corticosteroid Therapy ,Drug Resistance ,Erythroderma ,Dermatology ,General Medicine ,Disease ,Goeckerman therapy ,medicine.disease ,Combined Modality Therapy ,Regimen ,Maintenance therapy ,Symptom relief ,Psoriasis ,Humans ,Medicine ,Female ,Ultraviolet Therapy ,business ,Coal Tar ,Dermatitis, Exfoliative - Abstract
Erythrodermic psoriasis is a relatively rare, more dangerous inflammatory variant of psoriasis associated with high morbidity and mortality. It can be exceptionally challenging to manage, defeating even the most experienced dermatologist's arsenal of treatment strategies. Goeckerman therapy, a regimen of ultraviolet B phototherapy and crude coal tar, has demonstrable efficacy in severe and recalcitrant plaque-type psoriasis. However, its utility in erythrodermic psoriasis has not been explored within the dermatology literature. Herein, we present a patient with a long-standing history of erythrodermic psoriasis refractory to eleven treatment modalities including four biologic agents, who had his erythroderma 'turned around' following Goeckerman therapy. 'Turned around' is used to describe dramatically reducing a patient's cutaneous inflammation so that previously recalcitrant disease can now respond to maintenance therapy. The importance of a one to three week 'cool down' period of topical corticosteroid therapy prior to phototherapy or crude coal tar use is highlighted in this case as well. Although Goeckerman therapy is no longer regularly used, it remains one of the most efficacious treatments available for intractable psoriasis, attracting patients from all over the country desperate for symptom relief. This case suggests it may be useful in 'turning around' extremely difficult-to-treat erythrodermic psoriasis as well.
- Published
- 2021
26. Biologic Treatment of 4 HIV-Positive Patients: A Case Series and Literature Review
- Author
-
Quinn Thibodeaux, Stephanie Chan, Wilson Liao, Tina Bhutani, Vidhatha Reddy, Nicholas Brownstone, and Bridget Myers
- Subjects
medicine.medical_specialty ,Human immunodeficiency virus (HIV) ,Dermatology ,Psoriatic disease ,Biologic treatment ,medicine.disease_cause ,acute immunodeficiency virus ,Autoimmune Disease ,Article ,biologic treatment ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Psoriatic arthritis ,0302 clinical medicine ,Rheumatology ,Acquired immunodeficiency syndrome (AIDS) ,Clinical Research ,Psoriasis ,medicine ,Skin ,psoriatic arthritis ,human immunodeficiency virus ,business.industry ,Inflammatory and immune system ,Evaluation of treatments and therapeutic interventions ,psoriasis ,medicine.disease ,Infectious Diseases ,030220 oncology & carcinogenesis ,6.1 Pharmaceuticals ,HIV/AIDS ,business ,Infection - Abstract
Background: The management of psoriatic disease in HIV-positive patients is challenging. Psoriasis in HIV-positive patients is often severe, progressive, and resistant to first- and second-line therapies, including topical treatments, phototherapy, highly active antiretroviral therapy (HAART), and oral retinoids. Other systemic agents used to treat psoriasis, such as methotrexate and cyclosporine, are immunosuppressants and thus many dermatologists may not feel comfortable prescribing them to HIV-positive patients who are already immunocompromised. Biologic agents, which target specific aspects of overactive immune pathways in psoriasis, have revolutionized the management of moderate-to-severe psoriasis. However, data are limited regarding their safety and efficacy in HIV-positive patients. Objective: Report 4 cases of HIV-positive patients managed on biologic therapy and summarize the cases of psoriasis in HIV-positive patients managed on biologic therapy that have been published in dermatologic literature to date. Methods: We searched PubMed and Embase databases using the terms HIV and psoriasis or HIV and psoriatic arthritis combined with one of the 11 biologics currently approved for treating psoriasis. Results: We identified 48 cases of anti-psoriasis biologic therapy (including adalimumab, infliximab, etanercept, ustekinumab, and guselkumab) in HIV-positive patients and added 4. While data are limited, the evidence available suggests biologic agents are safe and efficacious in moderate-to-severe psoriasis and may even have a favorable effect on CD4 and HIV viral counts when used with concomitant HAART. Conclusion: Further research would be helpful to establish practical guidelines for the use of anti-psoriasis biologic therapy in the HIV population, including that of newer agents.
- Published
- 2021
27. Laser Therapy in Psoriasis
- Author
-
Quinn Thibodeaux and John Koo
- Subjects
medicine.medical_specialty ,Dye laser ,business.industry ,Disease ,medicine.disease ,Therapeutic radiation ,Dermatology ,Laser therapy ,Nd:YAG laser ,Psoriasis ,Localized disease ,Medicine ,business ,Adverse effect - Abstract
Treatment options for psoriasis are numerous and span a wide array of modalities. For mild-to-moderate disease, topical therapy may be adequate for complete control; however, moderate-to-severe disease often requires systemic agents or phototherapy. Laser therapy is also a helpful tool in the armamentarium against psoriasis. For localized disease that is not adequately controlled with topicals or for lesions in difficult-to-treat areas, laser therapy may be an ideal treatment option. Lasers enable the delivery of therapeutic radiation to lesional skin only, thus sparing non-lesional skin from any possible adverse events. Over the past few decades, various lasing devices have been demonstrated to be safe and effective treatment options for psoriasis. The most commonly used devices include the 308-nm excimer laser and the 585 or 595-nm pulsed dye laser. Despite recent advances in targeted biologic therapy, lasers continue to play an important role in the management of psoriatic disease.
- Published
- 2020
28. Sleep and the gut microbiome in psoriasis: clinical implications for disease progression and the development of cardiometabolic comorbidities
- Author
-
Nicholas Brownstone, Tina Bhutani, Quinn Thibodeaux, Wilson Liao, Bridget Myers, Hsin-Wen Chang, Stephanie Chan, and Vidhatha Reddy
- Subjects
0301 basic medicine ,medicine.medical_specialty ,insomnia ,microbiome ,Dermatology ,Autoimmune Disease ,Article ,03 medical and health sciences ,flora ,0302 clinical medicine ,Rheumatology ,Clinical Research ,Psoriasis ,Internal medicine ,Complementary and Integrative Health ,Insomnia ,microbiota ,Medicine ,2.1 Biological and endogenous factors ,Microbiome ,Aetiology ,obstructive sleep apnea ,sleep dysfunction ,sleep disorder ,Sleep disorder ,business.industry ,dysbiosis ,psoriasis ,medicine.disease ,Sleep in non-human animals ,sleep deprivation ,Obstructive sleep apnea ,Sleep deprivation ,030104 developmental biology ,Good Health and Well Being ,medicine.symptom ,business ,Sleep Research ,Digestive Diseases ,Dysbiosis ,030217 neurology & neurosurgery - Abstract
Background: Sleep dysfunction and sleep disorders are important comorbidities of psoriasis. Not only do these sleep comorbidities contribute to reduced quality of life, but they may also lead to worsening psoriasis and increased susceptibility to cardiometabolic diseases. While psoriasis and sleep dysfunction are thought to be linked by itch, depression, and immune system dysregulation, the relationship between psoriasis and sleep dysfunction is not yet fully understood. Objective: We sought to compare previous studies characterizing the gut microbiome in psoriasis and sleep dysfunction and examine the potential relevance of shared findings on cardiometabolic and overall health. Methods: We performed literature searches of PubMed and Embase databases to find studies evaluating the gut microbiome in psoriasis, sleep dysfunction, and cardiometabolic diseases. Results: Studies characterizing the gut microbiome in psoriasis and sleep dysfunction reveal shared findings, specifically an increased Firmicutes to Bacteroidetes ratio and reduced abundance of short-chain fatty acid–producing bacteria. These dysbiotic features have also been shown to promote systemic inflammation and cardiometabolic disease. Conclusion: In favoring an increased Firmicutes to Bacteroidetes ratio and reduced abundance of short-chain fatty acid–producing bacteria, sleep dysfunction could be contributing to worsening psoriasis and cardiometabolic comorbidities through intestinal dysbiosis. Future studies are needed to determine whether gut- and sleep-targeting interventions could be therapeutic in patients with psoriasis having poor sleep.
- Published
- 2020
29. Optimizing doxepin therapy in dermatology: introducing blood level monitoring and genotype testing
- Author
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Vidhatha Reddy, Bridget Myers, Quinn Thibodeaux, Nicholas Brownstone, John Koo, and Stephanie Chan
- Subjects
030203 arthritis & rheumatology ,Blood level ,medicine.medical_specialty ,Genotype ,business.industry ,medicine.drug_class ,Tricyclic antidepressant ,Dermatology ,Doxepin ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Treatment Outcome ,medicine ,Humans ,Treatment Failure ,business ,Antipruritic ,medicine.drug - Abstract
Doxepin, a tricyclic antidepressant, is the most efficacious antipruritic available to dermatologists; however its use is often suboptimal because of significant interindividual variability in doxepin plasma levels and clinical response between patients taking the same dose. As result, the Food and Drug Administration approves a maximum dose of 300 mg of doxepin per day and a 10 mg per cc liquid doxepin concentrate. These allow patients to significantly increase or decrease their dose, due to either a lack of clinical efficacy or side effects at typical dermatologic doses (often 10-25 mg per day). This review initially discusses the unique advantages of doxepin in dermatology. Then, it explores internal and external reasons why doxepin plasma levels and clinical response vary so significantly between patients, including genetic polymorphisms, drug interactions, comorbidities, sex, and ethnicity. Blood level monitoring is introduced, a tool dermatologists can use to optimize doxepin dosing in patients responding subtherapeutically to typical dermatologic doses. Without blood level monitoring, patients initially unresponsive to treatment could be labeled treatment failures when in fact they may be cases of inadequate dosing. Blood level monitoring allows for safe dose adjustments in these individuals to maximize patients' chances of achieving therapeutic success with this agent.
- Published
- 2020
30. Evaluation of a Genetic Risk Score for Diagnosis of Psoriatic Arthritis
- Author
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Tina Bhutani, Joanne Nititham, Eric J. Yang, Wilson Liao, Kristen M. Beck, Quinn Thibodeaux, Karen Ly, Isabelle M. Sanchez, and Mary Patricia Smith
- Subjects
medicine.medical_specialty ,diagnosis ,Dermatology ,Autoimmune Disease ,Article ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Psoriatic arthritis ,0302 clinical medicine ,Rare Diseases ,Rheumatology ,Quality of life ,Clinical Research ,Psoriasis ,medicine ,Genetics ,2.1 Biological and endogenous factors ,Genetic risk ,Aetiology ,030203 arthritis & rheumatology ,psoriatic arthritis ,business.industry ,Prevention ,Arthritis ,Human Genome ,psoriasis ,medicine.disease ,Joint damage ,symptoms ,blood tests ,business - Abstract
Background: Diagnosis of psoriatic arthritis (PsA) can be challenging, resulting in delays that contribute to irreversible joint damage, reduced quality of life, and increased mortality. Objective: Use genetic markers to develop and evaluate a PsA genetic risk score (GRS) for its ability to discriminate between psoriasis (PsO) only and PsO with PsA among a psoriatic cohort with full genome-wide genotype data. Methods: Genome-wide single-nucleotide polymorphism genotyping was performed on 724 psoriatic patients. A set of 11 candidate risk genes previously shown to be preferentially associated with PsO or PsA were selected. To evaluate the cumulative effects of these risk loci, a PsA GRS was developed using an unweighted risk allele count (cGRS) and a weighted (wGRS) approach. Additional analyses included only human leukocyte antigen (HLA) risk alleles. Results: The discriminative power attributable to each GRS was evaluated by calculating the areas under the receiver operator characteristic curve (AUROC). The AUROC for the wGRS is 56.2% versus 54.1% for the cGRS, and the AUROC for the HLA-only wGRS model was 56.9% versus 55.7% for the HLA-only cGRS. Conclusion: The AUROC of 56.9% for HLA-only wGRS indicates that this approach has the greatest power in discriminating PsA from PsO among these models. Given that an AUROC of 56.9% is quite modest, this study suggests that using a small number of well-validated genetic loci provides limited predictive power for PsA, and that future approaches may benefit from using a larger number of genetic loci.
- Published
- 2020
31. A review of current phase III clinical trials of plaque psoriasis: under-representation of nonwhite participants and need for reform
- Author
-
Wilson Liao, Jenna C. Lester, Stephanie Chan, Tina Bhutani, Nicholas Brownstone, Bridget Myers, John Koo, Vidhatha Reddy, and Quinn Thibodeaux
- Subjects
Plaque psoriasis ,education.field_of_study ,business.industry ,Population ,Phases of clinical research ,Antibodies, Monoclonal ,Dermatology ,medicine.disease ,Southeast asia ,Geographic distribution ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Treatment Outcome ,Clinical Trials, Phase III as Topic ,Psoriasis ,Chronic inflammatory skin condition ,Medicine ,Humans ,business ,education ,Demography - Abstract
Plaque psoriasis is a chronic inflammatory skin condition that affects an estimated 0.91% to 8.5% of the global population.1 The prevalence of psoriasis varies based on ethnoracial and geographic distribution. In the United States, psoriasis affects approximately 3.6% of Caucasians (non-Hispanic white), 1.9% of African Americans (non-Hispanic black), and 1.6% of Hispanic-identifying adults.2 Population-based studies in East and Southeast Asia have estimated a prevalence ranging from 0.05 to 0.47%.3.
- Published
- 2020
32. Implementation of an Ultraviolet Phototherapy Service at a National Referral Hospital in Western Kenya: Reflections on Challenges and Lessons Learned
- Author
-
Toby Maurer, Wilson Liao, Isabel Muraguri, Karen Ly, Tina Bhutani, Mary Patricia Smith, Marissa Gualberto, Margaret Mungai, Sarah Hulse, Mio Nakamura, Samson K. Kiprono, Sarah J. Coates, Aileen Y. Chang, Sahil Sekhon, Caleb Jeon, Margareth V. Jose, Kristen M. Beck, and Quinn Thibodeaux
- Subjects
Kenya ,Referral ,Service delivery framework ,education ,Clinical Sciences ,Specialty ,MEDLINE ,8.1 Organisation and delivery of services ,Dermatology ,7.3 Management and decision making ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Clinical Research ,Health care ,Ultraviolet light ,lcsh:Dermatology ,Medicine ,Dermatologic surgery ,Original Research ,Low- and middle-income countries ,and middle-income countries ,business.industry ,lcsh:RL1-803 ,Phototherapy ,Health Services ,medicine.disease ,Resource-limited settings ,3. Good health ,Low ,030220 oncology & carcinogenesis ,Africa ,Medical emergency ,Patient Safety ,business ,UVB - Abstract
Introduction In order to manage skin conditions at a national referral hospital level in Kenya, specialized dermatology services, such as dermatologic surgery, dermatopathology, phototherapy, and sub-specialty care, should be offered, as is typically available in referral hospitals around the world. A Kenyan patient with prurigo nodularis, whose severe itch remitted after phototherapy treatment at the University of California, San Francisco (UCSF), inspired the development of a phototherapy service at Academic Model Providing Access to Healthcare (AMPATH), a partnership in Western Kenya between Moi Teaching and Referral Hospital, Moi University College of Health Sciences, and a consortium of North American academic medical centers. Methods Initial project funds were raised through a crowdfunding campaign and fundraising events. A new narrowband ultraviolet B phototherapy unit and replacement bulbs were donated and air shipped to Eldoret, Kenya. A team of dermatologists and phototherapy nurses from UCSF conducted a 2-day training session. US-based dermatologists affiliated with AMPATH provide ongoing support through regular communication and on-site visits. Results Early in implementation, challenges faced included training clinical staff with limited experience in phototherapy and improving communication between nurses and clinicians. More recent challenges include frequent rotation of specialty clinic nurses in the dermatology clinic, adaptation of phototherapy guidelines to balance patient volume with service delivery capacity, and training assessment of disease activity in darkly pigmented skin. Conclusion Strategies that have been helpful in addressing implementation challenges include: increasing on-site and remote training opportunities for clinicians and nurses, developing a tiered payment schema, educating patients to combat misconceptions about phototherapy, dynamic phototherapy referral guidelines to accommodate service delivery capacity, and prioritizing the engagement of a multidisciplinary team.
- Published
- 2020
33. Depression and suicidality in psoriasis and clinical studies of brodalumab: a narrative review
- Author
-
John, Koo, Roger S, Ho, and Quinn, Thibodeaux
- Subjects
Depressive Disorder ,Suicide ,Humans ,Psoriasis ,Dermatologic Agents ,Antibodies, Monoclonal, Humanized - Abstract
Patients with psoriasis have high rates of depression and may be at increased risk for suicidal ideation and behavior (SIB). Attempted and completed suicides during clinical trials and other studies of psoriasis therapies, including brodalumab, highlight the importance of understanding psychiatric risk factors in patients with psoriasis. Recent meta-analyses, research studies, and published data from brodalumab clinical studies were reviewed. We also summarize research on effects of brodalumab on depression symptoms and occurrences of SIB in brodalumab clinical trials. Psoriasis elevates the risk for depression and possible suicide. Brodalumab has a boxed suicide warning; however, it states that there is no established causal association between treatment with brodalumab and increased risk for SIB. Clinicians are urged to evaluate patients with psoriasis for psychiatric risk factors regardless of their therapy and to consider the package insert and a comprehensive evaluation of relevant literature to make a well-balanced decision.
- Published
- 2020
34. Abdominal Pyoderma Gangrenosum, Harbinger of Takayasu Arteritis in an African American Patient
- Author
-
Nirupa J. Patel and Quinn Thibodeaux
- Subjects
030203 arthritis & rheumatology ,African american ,medicine.medical_specialty ,business.industry ,Takayasu arteritis ,030204 cardiovascular system & hematology ,medicine.disease ,Takayasu Arteritis ,Dermatology ,Pyoderma Gangrenosum ,Black or African American ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,medicine ,Humans ,business ,Pyoderma gangrenosum - Published
- 2018
35. Dupilumab in patients with chronic hepatitis B on concomitant entecavir
- Author
-
Tina Bhutani, Kristen M. Beck, Mary Patricia Smith, Quinn Thibodeaux, Wilson Liao, and Karen Ly
- Subjects
medicine.medical_specialty ,AD, Atopic Dermatitis ,Case Report ,Dermatology ,Disease ,medicine.disease_cause ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Immune system ,Internal medicine ,dupilumab ,Concomitant Therapy ,medicine ,HBV ,Hepatitis B virus ,atopic dermatitis ,business.industry ,interleukin ,virus diseases ,AD ,IL ,Entecavir ,Atopic dermatitis ,medicine.disease ,Dupilumab ,digestive system diseases ,IL, interleukin ,HBV, Hepatitis B Virus ,030220 oncology & carcinogenesis ,Concomitant ,business ,Hepatitis B Virus ,biologic ,hepatitis B virus ,Dupixent ,medicine.drug - Abstract
Biologics such as dupilumab are a highly efficacious and relatively safe treatment option for patients with recalcitrant immune-mediated disease; however, because of their modulation of the immune system, biologics have been associated with severe infections, including reactivation of latent hepatitis B virus (HBV).1, 2, 3 As a result of the increased morbidity and mortality associated with active HBV, physicians are often reluctant to prescribe biologics in patients with chronic HBV infection. Dupilumab is the first biologic therapy approved for the treatment of moderate-to-severe atopic dermatitis (AD).4 We present 2 cases of patients with AD and chronic HBV treated with dupilumab while receiving concomitant therapy for HBV.
- Published
- 2019
36. Chronic erythema nodosum with koebnerization to plaque psoriasis
- Author
-
Quinn Thibodeaux, Mary Patricia Smith, Karen Ly, and Tina Bhutani
- Subjects
Plaque psoriasis ,medicine.medical_specialty ,business.industry ,Medicine ,Dermatology ,Chronic erythema ,business ,Article - Published
- 2019
37. Anti IL-17 in psoriasis
- Author
-
Tina Bhutani, Quinn Thibodeaux, Wilson Liao, Vidhatha Reddy, Mary Patricia Smith, and Karen Ly
- Subjects
0301 basic medicine ,Immunology ,Brodalumab ,Disease ,Systemic inflammation ,Antibodies, Monoclonal, Humanized ,Pathogenesis ,03 medical and health sciences ,0302 clinical medicine ,Psoriasis ,medicine ,Immunology and Allergy ,Humans ,030203 arthritis & rheumatology ,business.industry ,Interleukin-17 ,medicine.disease ,Ixekizumab ,030104 developmental biology ,Th17 Cells ,Secukinumab ,Interleukin 17 ,medicine.symptom ,business - Abstract
Introduction: Psoriasis is a chronic, immune-mediated disease with significant associated comorbidities. Its pathogenesis is likely multifactorial, however, the interleukin-23/T helper 17 pathway has been identified as a critical axis in its pathogenesis. Interleukin-17A is the primary effector of this pathway and overexpression of IL-17A results in epidermal hyperplasia and an overly robust inflammatory response, resulting in the skin plaques and systemic inflammation seen in psoriasis. Targeted anti IL-17 therapies have demonstrated efficacy in the treatment of moderate-to-severe plaque psoriasis.Areas covered: A PubMed search was conducted for relevant literature. Secukinumab, ixekizumab, and brodalumab are anti IL-17 inhibitors currently approved for the treatment of moderate-to-severe plaque psoriasis. The efficacy and safety data from key phase III clinical trials are reviewed here.Expert opinion: By targeting a key mediator of the interleukin-23/T helper 17 pathway, IL-17 antagonists are an effective treatment for plaque psoriasis. It has demonstrated efficacy and a favorable safety profile in key phase III clinical trials. In addition to efficacy, IL-17 antagonists have also shown long-term maintenance of treatment response and a quick onset of action. The efficacy of IL-17 inhibitors in the treatment of moderate-to-severe psoriasis underscores the importance of the IL-23/Th17 pathway in the pathogenesis of psoriasis.
- Published
- 2019
38. Dual biologic therapy for recalcitrant psoriasis and psoriatic arthritis
- Author
-
Vidhatha Reddy, Mary Patricia Smith, Quinn Thibodeaux, Wilson Liao, and Karen Ly
- Subjects
medicine.medical_specialty ,Urinary system ,tumor necrosis factor ,TNF ,Case Report ,Dermatology ,Etanercept ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Psoriatic arthritis ,0302 clinical medicine ,Psoriasis ,dual biologic therapy ,Ustekinumab ,medicine ,Adverse effect ,psoriatic arthritis ,TNF, tumor necrosis factor ,business.industry ,psoriasis ,medicine.disease ,combined biologic therapy ,Guselkumab ,030220 oncology & carcinogenesis ,Secukinumab ,business ,medicine.drug - Abstract
Numerous biologic medications are available to treat psoriasis and psoriatic arthritis; however, many patients experience differential responses of their skin and joints to the same agent. In patients who do not respond to biologic monotherapy or combination of a biologic with an oral systemic agent, dual biologic therapy is a possible treatment option. Dual biologic therapy is rarely reported in the psoriatic literature (Table I).1, 2, 3, 4, 5, 6 We present a patient with severe psoriatic skin and joint disease who has been treated with multiple combinations of dual biologic therapy, including ustekinumab plus etanercept for 12 months, secukinumab plus etanercept for 6 months, and guselkumab plus etanercept for 15 months. Throughout the patient's treatment, adverse events only occurred with the ustekinumab plus etanercept combination and consisted of an increased incidence of urinary tract and upper respiratory infections, including a hospitalization for H2N1 flu. Table I Reported cases of dual biologic therapy for psoriasis and psoriatic arthritis
- Published
- 2019
39. Transcriptomic profiling of plaque psoriasis and cutaneous T cell subsets during treatment with secukinumab
- Author
-
Sahil Sekhon, Quinn Thibodeaux, J. Liu, Eric J. Yang, Kristen M. Beck, Zhi-Ming Huang, Richard Ahn, Timothy H. Schmidt, Tina Bhutani, Di Yan, Wilson Liao, Shrishti Bhattarai, Isabelle M. Sanchez, Hsin-Wen Chang, Michael Rosenblum, and Mio Nakamura
- Subjects
0303 health sciences ,business.industry ,T cell ,Cell ,medicine.disease ,3. Good health ,Pathogenesis ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Immune system ,030220 oncology & carcinogenesis ,Psoriasis ,Immunology ,medicine ,Secukinumab ,IL17A ,business ,CD8 ,030304 developmental biology - Abstract
The IL17A inhibitor secukinumab is efficacious for the treatment of psoriasis. In order to define its mechanism of action, it is important to understand its impact on psoriatic whole skin tissue as well as specific skin-resident immune cell populations such as T lymphocytes. In this study, we treated 15 moderate-to-severe plaque psoriasis patients with secukinumab and characterized the longitudinal transcriptomic changes of whole lesional skin tissue and cutaneous CD4+ T effector cells (Teffs), CD4+ T regulatory cells (Tregs), and CD8+ T effector cells during 12 weeks of treatment. Secukinumab was clinically effective, with 100%, 47%, and 27% of patients in the study achieving PASI75, PASI90, and PASI100 by week 12, respectively. At baseline prior to treatment, we observed that IL17A overexpression predominates in psoriatic CD8+ T cells rather than Teffs, supporting the importance of IL-17-secreting CD8+ T cells (Tc17) compared to IL-17-secreting CD4+ T cells (Th17) cells in the pathogenesis of psoriasis. Although secukinumab targets only IL17A, we observed rapid reduction of IL17A, IL17F, IL23A, IL23R, and IFNG expression in lesional skin as soon as 2 weeks after initiation of treatment and normalization of expression by week 12. Secukinumab treatment resulted in resolution of 89-97% of psoriasis-associated expression differences in both bulk tissue and T cell subsets by week 12 of treatment. Overall, secukinumab appears to rapidly reverse many of the molecular hallmarks of psoriasis.
- Published
- 2019
40. Emerging Methods to Objectively Assess Pruritus in Atopic Dermatitis
- Author
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Jashin J. Wu, Mary Patricia Smith, Thulasi Weerasinghe, Karen Ly, Tina Bhutani, Quinn Thibodeaux, Wilson Liao, and Gil Yosipovitch
- Subjects
Prioritization ,medicine.medical_specialty ,Clinical Sciences ,MEDLINE ,Eczema ,Dermatology ,Review ,Itch ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Clinical Research ,Behavioral and Social Science ,Diagnosis ,lcsh:Dermatology ,medicine ,Set (psychology) ,Intensive care medicine ,skin and connective tissue diseases ,Atopic dermatitis ,screening and diagnosis ,business.industry ,Inflammatory skin disease ,Study Type ,Pruritus ,Neurosciences ,Actigraphy ,lcsh:RL1-803 ,medicine.disease ,3. Good health ,Detection ,030220 oncology & carcinogenesis ,business ,4.2 Evaluation of markers and technologies - Abstract
Introduction Atopic dermatitis (AD) is an inflammatory skin disease with a chronic, relapsing course. Clinical features of AD vary by age, duration, and severity but can include papules, vesicles, erythema, exudate, xerosis, scaling, and lichenification. However, the most defining and universal symptom of AD is pruritus. Pruritus or itch, defined as an unpleasant urge to scratch, is problematic for many reasons, particularly its negative impact on quality of life. Despite the profoundly negative impact of pruritus on patients with AD, clinicians and researchers lack standardized and validated methods to objectively measure pruritus. The purpose of this review is to discuss emerging methods to assess pruritus in AD by describing objective patient-centered tools developed or enhanced over the last decade that can be utilized by clinicians and researchers alike. Methods This review is based on a literature search in Medline, Embase, and Web of Science databases. The search was performed in February 2019. The keywords were used “pruritus,” “itch,” “atopic dermatitis,” “eczema,” “measurements,” “tools,” “instruments,” “accelerometer,” “wrist actigraphy,” “smartwatch,” “transducer,” “vibration,” “brain mapping,” “magnetic resonance imaging,” and “positron emission tomography.” Only articles written in English were included, and no restrictions were set on study type. To focus on emerging methods, prioritization was given to results from the last decade (2009–2019). Results The search yielded 49 results in PubMed, 134 results in Embase, and 85 results in Web of Science. Each result was independently reviewed in a standardized manner by two of the authors (M.S., K.L.), and disagreements between reviewers were resolved by consensus. Relevant findings were categorized into the following sections: video surveillance, acoustic surveillance, wrist actigraphy, smart devices, vibration transducers, and neurological imaging. Examples are provided along with descriptions of how each technology works, instances of use in research or clinical practice, and as applicable, reports of validation studies and correlation with other methods. Conclusion The variety of new and improved methods to evaluate pruritus in AD is welcomed by clinicians, researchers, and patients alike. Future directions include next-generation smart devices as well as exploring new territories, such as identifying biomarkers that correlate to itch and machine-learning programs to identify itch processing in the brain. As these efforts continue, it will be essential to remain patient-centered by developing techniques that minimize discomfort, respect privacy, and provide accurate data that can be used to better manage itch in AD.
- Published
- 2019
41. Phototherapy: is it still important?
- Author
-
Quinn, Thibodeaux and John, Koo
- Subjects
Humans ,Phototherapy ,Skin Diseases ,Health Services Accessibility - Published
- 2019
42. Dupilumab for the treatment of severe photodermatitis
- Author
-
Quinn Thibodeaux, Mary Patricia Smith, Tina Bhutani, Timothy G. Berger, Rita Khodosh, Kristen M. Beck, Karen Ly, and Wilson Liao
- Subjects
medicine.medical_specialty ,therapy ,atopic dermatitis ,business.industry ,Dermatology ,Atopic dermatitis ,medicine.disease ,Dupilumab ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Photodermatitis ,030220 oncology & carcinogenesis ,photodermatitis ,medicine ,Case Series ,biologics ,business - Abstract
Author(s): Smith, Mary Patricia; Ly, Karen; Thibodeaux, Quinn; Beck, Kristen; Berger, Timothy; Khodosh, Rita; Liao, Wilson; Bhutani, Tina
- Published
- 2019
43. Home phototherapy for patients with vitiligo: challenges and solutions
- Author
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Mary Patricia, Smith, Karen, Ly, Quinn, Thibodeaux, Tina, Bhutani, and Mio, Nakamura
- Subjects
vitiligo ,integumentary system ,pigmentation disorders ,Review ,photomedicine ,skin and connective tissue diseases ,phototherapy - Abstract
Vitiligo is a chronic autoimmune condition involving selective dysfunction and destruction of melanocytes in the skin, hair, or both. The typical presentation is well-demarcated depigmented skin patches. Given vitiligo is the most common cause of depigmentation worldwide and early disease responds best to treatment, prompt diagnosis and proactive management of vitiligo are critical. While a wide variety of treatments has demonstrated variable effectiveness in treating vitiligo, phototherapy remains standard of care because of its proven efficacy and favorable side effect profile. However, many patients with vitiligo are unable to access affordable, consistent, or convenient phototherapy. To address these issues, home-based phototherapy has emerged as a patient-centered alternative. The purpose of this review is to discuss management of vitiligo with a specific focus on access to home-based phototherapy (HBPT) for patients with this condition. Key challenges to HBPT include misperceptions around safety and efficacy, inadequate physician education and training, insurance and financial barriers, and appropriate patient selection. Solutions to these challenges are presented, such as approaches to improve physician education and increasing the evidence surrounding the effectiveness and safety of this treatment for vitiligo. In addition, various practical considerations are discussed to guide dermatologists on how to approach HBPT as a treatment option for patients with vitiligo.
- Published
- 2019
44. Diagnosis and screening of patients with generalized pustular psoriasis
- Author
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Karen, Ly, Kristen M, Beck, Mary P, Smith, Quinn, Thibodeaux, and Tina, Bhutani
- Subjects
pustular psoriasis ,diagnostic criteria ,Review ,generalized pustular psoriasis ,acute generalized pustular psoriasis of von Zumbusch - Abstract
Generalized pustular psoriasis (GPP) is a rare and potentially life-threatening variant of psoriasis that is characterized by recurrent, acute onset, widely distributed pustular eruptions on inflamed, erythematous skin. It is important to recognize acute GPP as a subtype of psoriasis associated with high morbidity and mortality so therapy can be initiated without delay. Since GPP was first described in 1910 by Leopold von Zumbusch, it has been inconsistently defined, stratified, and diagnosed in the literature. Multiple definitions and diagnostic criteria have been proposed over the years. Recently, formal consensus guidelines on GPP have been published by international groups. This article reviews the current evidence and understanding in the diagnosis and screening of GPP.
- Published
- 2019
45. The gut microbiome in psoriasis and psoriatic arthritis
- Author
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Quinn Thibodeaux, Wilson Liao, Hsin-Wen Chang, Tina Bhutani, Bridget Myers, Vidhatha Reddy, Alexa Truong, Nicholas Brownstone, and Stephanie Chan
- Subjects
030203 arthritis & rheumatology ,Intestinal permeability ,business.industry ,Microbiota ,Arthritis, Psoriatic ,Disease ,medicine.disease ,Inflammatory bowel disease ,Gastrointestinal Microbiome ,Pathogenesis ,03 medical and health sciences ,Psoriatic arthritis ,0302 clinical medicine ,Rheumatology ,Psoriasis ,Immunology ,medicine ,Dysbiosis ,Humans ,030212 general & internal medicine ,Microbiome ,business - Abstract
This review summarizes existing research on the gut microbiome composition and function in psoriasis and psoriatic arthritis, exploring potential roles in disease pathogenesis, progression, and management. A strong relationship between skin, joint, and gastrointestinal inflammation exists, as demonstrated by an increased prevalence of psoriasis, psoriatic arthritis, and inflammatory bowel disease co-occurring together; however, the link between them has not been fully elucidated. Studies analyzing the gut microbiome in psoriasis and psoriatic arthritis reveal a unique pattern of dysbiosis. With regard to the gut microbiome's role in psoriasis and psoriatic arthritis pathogenesis, we discuss several theories including intestinal permeability, altered immune homeostasis, and imbalance of short- and medium-chain fatty acid-producing bacteria. We also discuss how the gut microbiome affects patient risk of psoriatic arthritis and other serious comorbidities, and how fecal microbes could be used clinically as therapeutic targets or markers of disease.
- Published
- 2019
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