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Psoriasis is a chronic inflammatory skin disorder, and current treatments include topical therapies, phototherapy, systemic immune modulators, and biologics, aiming to alleviate symptoms and improve quality of life. The prevalence of psoriasis varies globally, affecting around 2% of the population. However, challenges persist, such as adverse effects, treatment resistance, high costs, and variability in response among individuals Phototherapy using PUVA or UVB is another option for moderate to severe cases.The future of psoriasis treatment shows promising emerging trends. New biologic agents targeting novel pathways, such as interleukin 23 inhibitors like mirikizumab, offer enhanced efficacy. Small molecule inhibitors like RORγt inhibitors and ROCK2 inhibitors provide additional treatment options. Combination therapies, including biologics with methotrexate, may improve treatment response. Advancements in topical treatments utilizing microneedles and nanoparticle-based carriers can enhance drug delivery and improve therapeutic outcomes. Biomarkers and multi-omics technologies hold potential for personalized treatment approaches, thus aiding in diagnosis, predicting treatment response, and guiding therapeutic decisions. Collaboration among researchers, clinicians, and industry stakeholders is crucial to translating these scientific break throughs into clinical practice. By addressing current challenges and exploring these promising trends, we can optimize psoriasis management and improve the lives of those affected by this chronic condition. [ABSTRACT FROM AUTHOR]

Background: This review explores the lived experience of people through the lens of their journey with psoriasis. Most of the efforts to understand the impact of psoriasis on a person's life have been quantitative studies focusing on quality of life. There is a need to understand more about what it is like living with psoriasis. This understanding may provide insight into the wellbeing and health priorities of those living with psoriasis and help health professionals provide them with more holistic care. Objective: To explore the lived experiences of adults with psoriasis. Methods: A qualitative meta-synthesis was undertaken using metaethnography. Databases searched included CINAHL, PubMed, MedNar, Gale and Sociology Source. Qualitative studies published in English and reporting primary data analysis including the experiences of people with psoriasis were considered for inclusion. Findings: Nineteen studies were included. Three themes emerged from the synthesis about the lived experience of psoriasis, including the impact on participants' self-identity, wellbeing and culture. Participant voices underline the daily struggles they experience, including how psoriasis is all-consuming, shaping their being, and how people with psoriasis use isolation as a coping mechanism, making themselves and their bodies invisible. Conclusion: Psoriasis affects all aspects of a person's life. The level of understanding a health professional has of what it is like to live with psoriasis underpins and informs their therapeutic approaches and can play a pivotal role in helping a person with psoriasis successfully manage their condition. [ABSTRACT FROM AUTHOR]

Chronic skin conditions pose complex treatment challenges, and treatment adherence issues are a common problem. Home phototherapy is a well-documented, effective treatment for chronic skin conditions such as psoriasis and atopic dermatitis. Nonetheless, its effectiveness is dependent on patient self-management at home, and lack of adherence to complex prescribed treatment protocols occurs frequently. Additional problems that can occur include clinical teams failing to address patient concerns or treatment challenges with home phototherapy or failing to increase or modify therapy when treatments are not meeting therapeutic goals. This phenomenon is referred to as clinical inertia. The aims of this article are to (a) describe the development and implementation of a nurse-led home phototherapy program designed to both prevent clinical inertia and support patients' success in learning self-management for their chronic skin conditions at home and (b) outline the study protocol designed to evaluate the health outcomes and clinical resource utilization from the home phototherapy program. [ABSTRACT FROM AUTHOR]

Copyright of Konuralp Medical Journal / Konuralp Tip Dergisi is the property of Duzce University Medical School and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Psoriasis is a common disease affecting people worldwide. Although many researchers have tried to understand, throughout history, the mechanisms involved in the pathogenesis of the disease and despite considerable progress that has been made, a plethora of key aspects are still waiting to be discovered. In the last 2,000 years, the treatment evolved from an empirical stage to the modern therapy oriented to targeting molecules shown to be involved in the occurrence of the disease. In this paper we are reviewing the great discoveries that have marked the history of psoriasis, as well as the latest advances in the treatment of the disease. [ABSTRACT FROM AUTHOR]

Background: Formal incorporation of patients' perspectives is becoming increasingly important in medical product development and decision making. This article shares practical advice regarding how patient advocacy organizations, the pharmaceutical industry, and academic experts in stated-preference research can effectively partner on benefit-risk patient preference studies. Methods: The authors partnered on a benefit-risk patient preference study related to the treatment of psoriasis. The authors from Duke Clinical Research Institute also share their experiences in collaborating with numerous other organizations in conducting benefit-risk patient preference studies. Results: Upon initiation of the study partnership with appropriate experts, training is important to ensure all collaborators have a common understanding of the methodology, what objectives stated-preference methods can support, and expectations for the project. To the extent possible, partners should align on and document relevant clinical and logistical details prior to study implementation. During study implementation, partners should use good communication practices and document and maintain a record of any changes to the original plan. Presentation of the study results should be tailored to the particular audience, with the appropriate partner leading the presentation based on its format and audience. Conclusion: Partners from patient advocacy organizations, the pharmaceutical industry, and academia can effectively collaborate on benefit-risk patient preference studies with sufficient planning and ongoing communication. This article is a call for action for other organizations to engage in sharing of experiences regarding effective partnering in quantifying patient preferences in medical product development. [ABSTRACT FROM AUTHOR]

Psoriasis is a common, immune-mediated skin disorder that can manifest as multiple clinical phenotypes. Although psoriasis affecting the scalp, face, nails, palms, soles, and intertriginous regions has not been studied as extensively as chronic plaque psoriasis in other body areas, these phenotypes can be associated with significant physical, psychosocial, and functional impairments, which impact quality of life. In addition, recent evidence has shown that psoriasis affecting these areas is more prevalent than traditionally thought. In this article, we discuss the clinical characteristics of these hard-to-treat areas and review newer treatment options, which have shown significant efficacy for psoriasis affecting these body regions. To provide optimal care to patients with difficult-to-treat psoriasis, nurses, nurse practitioners, and physician assistants should evaluate patients for scalp, facial, nail, palmoplantar, and inverse psoriasis to provide more effective therapeutic options. [ABSTRACT FROM AUTHOR]

Aryl hydrocarbon receptor (AhR) is a transcription factor expressed in all skin cells type. It responds to exogenous and endogenous chemicals by inducing/repressing the expression of several genes with toxic or protective effects in a wide range of species and tissues. In healthy skin, AhR signalling contributes to keratinocytes differentiation, skin barrier function, skin pigmentation, and mediates oxidative stress. In the last years, some studies have shown that AhR seems to be involved in the pathogenesis of some skin diseases, even if the currently available data are contradictory. Indeed, while the blocking the AhR signalling activity could prevent or treat skin cancer, the AhR activation seems to be advantageous for the treatment of inflammatory skin diseases. Therefore, for its multifaceted role in skin diseases, AhR seems to be an attractive therapeutic target. Indeed, recently some molecules have been identified for the prevention of skin cancer and the treatment of inflammatory skin diseases. [ABSTRACT FROM AUTHOR]

Background Psoriasis (PSO) is an immune-mediated inflammatory disease associated with metabolic and cardiovascular comorbidities. It is now known that resolution of inflammation is an active process locally controlled by specialized proresolving mediators (SPMs), named resolvins (Rvs), protectins, and maresins. Objective It is unknown whether these potent lipid mediators (LMs) are involved in PSO pathophysiology and if the skin and blood have disease-specific SPMs phenotype profiles. Methods We used liquid chromatography-tandem mass spectrometry–based LM metabololipidomics to obtain skin and peripheral blood LM profiles from PSO compared to healthy subjects. Some LMs were tested in cell culture experiments with corresponding gene expression and protein concentration analyses. Results The levels of several LM were significantly elevated in lesional PSO skin compared to nonlesional and skin from healthy subjects. Particularly, RvD5, protectins Dx, and aspirin-triggered forms of lipoxin were present only in lesional PSO skin, whereas protectin D1 was present in nonlesional PSO skin. To determine specific roles of SPMs on skin-related inflammatory cytokines, RvD1 and RvD5 were incubated with human keratinocytes. RvD1 and RvD5 reduced the expression levels of interleukin 24 and S100A12 , whereas only RvD1 significantly abrogated interleukin-24 production by keratinocytes. Conclusions These findings suggest that an imbalance between locally produced proresolution and proinflammatory LMs identified in PSO skin and blood compartments might play a role in PSO pathophysiology. Moreover, some of the PSO-related cytokines can be modified by specific SPMs and involved mechanisms support investigation of targeting novel proresolving lipid mediators as a therapy for PSO. [ABSTRACT FROM AUTHOR]

In this article, we present a literature review of the most popular and commonly used therapeutic procedures belonging to complementary and alternative medicine, which is part of the modern concept of integrative medicine, used in the treatment of psoriasis. Psoriasis is a chronic, systemic, inflammatory disease wherein skin changes are the most visible sign. It occurs in approximately 1% to 3% of the world population, and the National Psoriasis Foundation of the United States estimates the number of patients in the whole world at about 125 million. Psoriasis primarily affects the skin, burdening patients with inflamed, pruritic, and sometimes painful lesions covered with whitish scales that last for years. Because of its prevalence in the general population, diversity of the clinical picture (from minimal and localized lesions without subjective symptoms to life-threatening conditions), and disease duration (practically a lifetime), psoriasis is a disease that has become a focus of modern medicine, and therapeutic options for the treatment of psoriasis are currently very numerous and diverse. Conventional treatment of psoriasis is guided by the so-called principle of "steps," where treatment options are applied according to the severity of illness assessed by a physician. Apart from the official therapy for psoriasis, as it is defined and understood in modern developed societies, there exists in parallel a great number of traditional, complementary, and alternative psoriasis treatments, which are based on the beliefs, experiences, and theories inherent to different cultures; in this article, we have analyzed the literature related to some of these procedures. [ABSTRACT FROM AUTHOR]

This series focuses on the patient treatment pathway in managing psoriasis as laid out by the National Institute for Health and Care Excellence guidelines (NICE, 2016). This disease affects up to 1.8 million people within the UK, necessitating up to 60% of these patients requiring a form of secondary care input (Jackson, 2012). Secondary care is often required to provide further topical treatment advice, but equally this also falls within the remit of all healthcare professionals, such as community nurses, who have face-to-face contact with patients with psoriasis. As these topical treatments may not manage the symptoms of psoriasis alone, referral to dermatology departments where more specialist treatments can be prescribed may be needed. The first option is to offer a course of phototherapy. There are several forms of treatment under this umbrella, with which community nurses should be familiar. [ABSTRACT FROM AUTHOR]

This fourth article in a seven-part series looks at scalp psoriasis. Managing this condition can be difficult as treatments are often messy, time-consuming or ineffective. The impact of scalp psoriasis can effect several aspects of daily living, notably choice of clothes, intense itching, which can be embarrassing for patients. Finding suitable treatments can be life-changing to some. This piece focuses on treatment options, from bland and simple techniques through to the variety of treatments available on prescription. This should enable community nurses to facilitate patients in managing their scalp psoriasis when asked [ABSTRACT FROM AUTHOR]

Background: Home phototherapy is a safe and effective treatment for psoriasis but is not commonly utilized as a treatment option in the United States. Recently, there has been renewed interest in home phototherapy. This pilot study describes the nursing support needed to facilitate effective transition of ongoing office-based phototherapy patients to home phototherapy. Methods: Ten patients with a diagnosis of psoriasis receiving office-based phototherapy were identified as candidates for home phototherapy. They received group education on self-administration by specialized phototherapy nurses. Some patients required additional one-on-one training. Units were installed, and home phototherapy was initiated. Subsequent nursing care consisted of telephone support with the study nurse on a weekly basis for 4-8 weeks with follow-up telephone calls on an as-needed basis. Results: Eleven patients initially participated in the 8-month trial. Ten were successfully transitioned to home treatments, One patient discontinued the study. The 10 patients were independently self-administering home phototherapy with minimal nursing support by Week 8 of the study. Conclusion: Transition of patients with psoriasis receiving office-based phototherapy to home phototherapy can be done successfully while maintaining control of psoriasis. Considerable nursing resources are required for initial patient education, but they decrease significantly with time. [ABSTRACT FROM AUTHOR]

Thymoquinone (TMQ) is reported with good anti-psoriatic activity; however, the hydrophobicity, poor aqueous solubility, light and pH sensitive nature of TMQ hinder its delivery to target site. To address these delivery challenges of TMQ, lipospheres were explored. The topical use of lipospheres offers an effective mean of penetration along with stability and scalability. TMQ lipospheres of particle size below 70 nm were prepared and evaluated. These lipospheres resulted in deeper skin penetration, slow release and skin compatibility. Anti-inflammatory and anti-psoriatic potential of lipospheres was determined using in vitro cell lines and imiquimod induced psoriatic plaque model. Cell lines studies indicated reduction in the level of nitric oxide and IL-2, IL-6, IL-1β, TNF-α, whereas in vivo results indicated improvement in the phenotypic, histopathological features and reduced level of IL-17 and TNF-α in psoriatic skin. These results suggest the potential of TMQ lipospheres in the management of psoriasis. [ABSTRACT FROM AUTHOR]

This third article in a seven-part series looking at the identification and treatment of psoriasis, explores the active ingredients and action of the main topical treatments for psoriasis. Community nurses are perfectly placed to help patients take control of their skin condition, particularly in advising them on the benefits of topical treatments, which, as they can be applied directly to the skin, allow the area to be targeted, lowering the level of absorption into the bloodstream and reducing side-efiects (Psoriasis and Psoriatic Arthritis Alliance (PAPAA, 2017a). [ABSTRACT FROM AUTHOR]

Current work reports the development and optimization of clobitasol propionate (CP) and calcipotriol (CT) loaded nanoemulsion based gel for topical treatment of psoriasis. Components of nanoemulsion viz. , oil and surfactant/co-surfactant were selected depending upon solubility and emulsification potential respectively. The optimized ratio of 5:3:2 of Capmul MCM C8 EP, Cremophor RH 40 and Labrafil 1944 CS was selected. Carbopol 980 was used as gelling agent to achieve final drug concentration of 0.05% w/w and 0.005% w/w respectively for CP and CT. HaCaT cell lines showed higher uptake of drug from nanoemulsion in correlation with the enhancement in penetration of both drugs in stratum corneum (SC) and viable layer from nanoemulsion and gel as compared to free drugs. Imiquimod induced psoriatic BALB/c mice revealed significantly higher anti-psoriatic activity of nanoemulsion gel as compared to free drugs and marketed formulation. The developed formulation showed negligible skin irritation despite increased penetration into the skin. [ABSTRACT FROM AUTHOR]

Aim: To analyze psoriasis risk in type 2 diabetes mellitus (T2DM) patients treated in German primary care practices.Methods: The study included 87,964 T2DM patients aged 40 years or over who received their initial diabetes diagnosis between 2004 and 2013. Patients were excluded if they had been diagnosed with psoriasis prior to diabetes diagnosis or if the observation period prior to the index date was less than 365 days. After applying these exclusion criteria, 72,148 T2DM patients were included. A total of 72,148 non-diabetic controls were matched (1:1) to T2DM cases based on age, gender, type of health insurance (private or statutory), number of medical visits, and index date. The primary outcome was the diagnosis of psoriasis. Skin infections, dermatitis/eczema, hyperlipidemia, and medications associated with psoriasis (beta blockers, angiotensin-converting enzyme (ACE) inhibitors, lithium, antimalarials, nonsteroidal anti-inflammatory drugs, and benzodiazepines) were included as potential confounders.Results: The mean age was 68.7 years (SD=12.7 years) and 48.6% of subjects were men. Hyperlipidemia, dermatitis/eczema, and skin infections were more frequent in T2DM patients than in controls. Beta blockers, ACE inhibitors, and nonsteroidal anti-inflammatory drugs were also more commonly used in people with T2DM than in controls. A total of 3.4% of T2DM patients and 2.8% of matched controls developed psoriasis within ten years of follow-up (p-value <0.001). T2DM patients were at a higher risk of developing psoriasis than controls (HR=1.18, 95% CI: 1.08-1.29).Conclusion: T2DM was positively associated with psoriasis in patients treated in German primary care practices. [ABSTRACT FROM AUTHOR]

Psoriasis is a complex inflammatory disorder of the skin that affects up to 3.2% of the people in the United States. It is associated with psoriatic arthritis, a potentially debilitating inflammatory joint condition. Psoriatic patients also have an increased risk of lymphoma, heart disease, Type II diabetes, obesity, and metabolic syndrome. The degree to which each patient is affected with and by psoriasis can vary greatly. The treatment available for these patients includes topical products, phototherapy, traditional systemic medications, and biologics. With the high cost of healthcare in the United States, as healthcare providers, we must consider the direct and indirect costs of psoriasis. The annual cost of psoriasis in the United States for the year 2013 was approximately $1 12 billion. Current guidelines, which utilize evidence-based practice recommendations, help to provide patients with the most cost-effective treatment to yield the best results. [ABSTRACT FROM AUTHOR]

Psoriasis is an incurable autoimmune disease characterized by patches of abnormal red, itchy and scaly skin. This work examined the modulation of inflammation, hyperproliferation and immune cell markers following topical application of fish oil ( FO) in comparison to the antipsoriatic agents, betamethasone dipropionate ( BD) and salicylic acid ( SA), to GsdmA3Dfl/+ mice, a hair loss mutant which also exhibits epidermal hyperproliferation akin to psoriasis. The mice were dosed with 100 mg of the test formulation and after 10 days, the mice were sacrificed, skin sections excised and subjected to immunohistochemical determination of COX-2, K17 and MAC-1; and immunofluorescence of Ki-67. Unchanged expression of the proinflammatory enzyme COX-2 was observed in all treatments, suggesting the noninvolvement of COX-2 in the aetiology of cutaneous aberration seen in GsdmA3Dfl/+ mice. Intense staining of K17 and MAC-1 in the FO-treated group mirrored the epidermal thickening seen observed in live mice by optical coherence tomography ( OCT). The ratio of Ki-67-positive nuclei per 100 basal cells indicated that hyperproliferation of keratinocytes occurred in FO-treated mice and the opposite was true for BD-treated mice. There was a positive correlation ( R2 0.995) between Ki-67 and the epidermal thickness data observed previously. In all immunochemical procedures, the combined BD, SA and FO formulation did not show any significant difference with the control group, reflecting observations seen previously. In conclusion, the epidermal changes observed following topical FO treatment on GsdmA3Dfl/+ mice involves an increase in cellular proliferation and macrophages, although COX-2 does not appear to play an important role. [ABSTRACT FROM AUTHOR]

Psoriasis is a common, chronic, autoimmune inflammatory disease that affects a substantial number of women annually during pregnancy and childbirth. Some of these women will need and seek guidance before or during their pregnancies and during lactation. The childbirth educator needs a basic knowledge base and ability to answer questions that may arise regarding psoriasis during the childbirth experience. This article will define psoriasis and its effects on pregnancy and childbirth, consider genetic concerns, and explore treatment options. [ABSTRACT FROM AUTHOR]

There is no standard definition regarding the severity of psoriasis, and a number of factors should be considered, including the extent and stability of skin disease, involvement of joints, response to treatment, and impact on quality of life. Erythrodermic psoriasis and pustular psoriasis are severe conditions and the patient may be systemically unwell and febrile. NICE recommends that four key areas should be evaluated and recorded when assessing patients: severity, using the static Physician's Global Assessment (sPGA); disease impact on physical, psychological and social wellbeing using the Dermatology Life Quality Index (DLQI); the presence of psoriatic arthritis; and comorbidities. Ideally, patients should be assessed annually for psoriatic arthritis: the Psoriasis Epidemiology Screening Tool is a validated tool to screen for psoriatic arthritis in primary and secondary care. Patients with severe psoriasis should undergo cardiovascular risk assessment at presentation and every five years, or more frequently if indicated. Referral to secondary care should be made for patients with any type of psoriasis with poor response to topical therapy (after 2 or 3 months according to SIGN) and for extensive psoriasis. Cases where the psoriasis is having a significant physical or psychological impact on an individual's quality of life warrant early referral, as do those where the diagnosis is uncertain. Patients with generalised pustular psoriasis or erythroderma should be referred urgently for same-day specialist input. Patients with acute guttate psoriasis who may require phototherapy should also be referred. Children and adolescents with any type of psoriasis should be referred to a specialist at initial presentation. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic immune-mediated disease, and several cytokine pathways in the psoriatic cascade have been identified and investigated as clinical targets for systemic therapy. This review provides an overview of psoriasis, including discussion of clinical variants, environmental and genetic risk factors, known comorbidities, treatment strategies, and limitations in evaluating disease severity. The manuscript then focuses on addressing how existing biologics target the various pathways described in the pathogenesis of psoriasis, how modulating these mechanisms can improve outcomes over time, and how new insights have led to the development of agents that can target different pathways associated with the disease. Overall, biologics that target tumor necrosis factor-a or interleukin-12/23 have established themselves as effective, well-tolerated treatment options for chronic plaque psoriasis that can quickly produce dramatic clinical improvement. Unlike topical, phototherapy, and conventional systemic therapies that do not specifically target the underlying pathogenesis of psoriasis, biologics have been, and continue to be, developed based on identifying therapeutic targets within the immune and inflammatory pathways associated with disease development and progression. Recently, interleukin-17A has been identified as a central cytokine driver in the pathogenesis of psoriasis, and biologic therapy targeting this cytokine has recently been approved. [ABSTRACT FROM AUTHOR]

Background: Information and communication technologies (ICTs) are changing the traditional health care model and redefining personalized health. ICTs offer effective communication and real-time monitoring of patients and provide additional data to support clinical decision-making, improve the quality of care, and contribute to the empowerment of patients. However, evidence on the use of ICTs and digital preferences of immune-mediated inflammatory disease (IMID) patients is scarce.Objective: The aim of this study is to describe the degree of use of ICTs in patients with IMIDs (including rheumatic diseases, inflammatory bowel diseases, and psoriasis), identify their needs, and analyze their interest in the use of apps as tools for better management of their disease.Methods: A questionnaire was created by a multidisciplinary team including pharmacists, rheumatologists, gastroenterologists, dermatologists, and nurses with experience in ICTs applied to the field of IMID. The survey included 27 questions organized into 3 blocks: (1) sociodemographic characteristics, (2) ICT use for health-related information, and (3) patient expectations about mobile health.Results: A total of 472 questionnaires were analyzed. Overall, 52.9% (250/472) of patients were diagnosed with a rheumatologic disease, 39.4% (186/472) with inflammatory bowel disease, and 12.3% (58/472) with psoriasis. The state of health was considered good by 45.6% (215/472) of patients. Patients were interested in staying informed about health issues in 86.9% (410/427) of cases and sought health-related information mainly from the internet (334/472, 70.8%) and health care professionals (318/472, 67.4%). Overall, 13.6% (64/472) did not trust the health information they found in internet. Of the patients, 42.8% (202/472) had a health app, and 42.2% (199/472) had found it on their own. Patients would like a health app to help mainly to manage appointments (281/472, 59.5%), obtain information about their diseases and treatments (274/472, 58.1%), and get in contact with health professionals (250/472, 53.0%). Overall, 90.0% (425/472) of patients reported they would use an app to manage their IMID if their health professional recommended it, and 58.0% (274/472) would pay or probably be willing to pay for it.Conclusions: IMID patients were very interested in finding health-related information via ICTs, especially using smartphones and apps recommended by health professionals. Appointment management, advice on disease and treatment management, and personalized communication with health professionals were the most desired app features identified. Health professionals should play an essential role in recommending and validating these tools to ensure they are of high quality. [ABSTRACT FROM AUTHOR]

The article presents several case studies of men and women with different skin diseases and their recommended treatments. An increased androgen sensitivity identified to cause facial acne in women can be treated with a daily dose of spironolactone. It is further suggested that severe mouth ulcers require systematic medications like colchicine and dapsone. Moreover, the forms of psoriasis, its symptoms and the use of clobetasol ointment in its treatment are discussed.

Background Newer psoriasis treatments tout higher efficacy but are generally more expensive. Objective We sought to estimate the cost efficacy of systemic psoriasis treatments that have been approved by the US Food and Drug Administration (FDA). Methods A literature review of systemic psoriasis treatments that have been approved by the FDA was performed for the primary end point of a 75% reduction in the Psoriasis Area and Severity Index score (PASI 75). Medication cost was referenced by wholesale acquisition cost (WAC), laboratory fees were obtained from the American Medical Association, and office visit fees are standard at our university. Total expenses were standardized by calculating cost per month of treatment considering the number needed to treat (NNT) to achieve PASI 75. Results Methotrexate ($794.05-1502.51) and cyclosporine ($1410.14-1843.55) had the lowest monthly costs per NNT to achieve PASI 75. The most costly therapies were infliximab ($8704.68-15,235.52) and ustekinumab 90 mg ($12,505.26-14,256.75). Monthly costs per NNT to achieve PASI 75 for other therapies were as follows: narrowband ultraviolet B light phototherapy ($2924.73), adalimumab ($3974.61-7678.78), acitretin ($4137.71-14,148.53), ustekinumab 45 mg ($7177.89-7263.99), psoralen plus ultraviolet A light phototherapy ($7499.46-8834.98), and etanercept ($8284.71-10,674.89). Limitations Drug rebates and incentives, potential adverse effects, comorbidity risk reduction, ambassador programs, and combination therapies were excluded. Conclusion Our study provides meaningful cost efficacy data that may influence psoriasis treatment selection. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic, relapsing, immune-mediated disease that can have a profound negative impact on patients' quality of life. Five different types of psoriasis have been characterised according to their clinical features. A working group sanctioned by the Dermatology Society of South Africa engaged in discussions which resulted in the development of guidelines for the diagnosis and management of psoriasis in the South African context. Healthcare professionals can use these recommended guidelines to promote a strategic evidence-based approach when treating patients with psoriasis to ensure optimal treatment outcomes. Topical agents are the mainstay of treatment in mild psoriasis, and phototherapy and systemic agents should be considered if the treatment is ineffective or the severity of the psoriasis heightened. [ABSTRACT FROM AUTHOR]

Copyright of Collegium Antropologicum is the property of Croatian Anthropological Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Over the past 2 decades, considerable progress has been made to further elucidate the complex pathogenesis of psoriasis, facilitating the development of a new armamentarium of more effective, targeted therapies. Despite these important advances, substantial deficits remain in our understanding of psoriasis and its treatment, necessitating further research in many areas. In the sixth section of the American Academy of Dermatology Psoriasis Guidelines of Care, gaps in research and care were identified. We discuss the most important gaps in research that currently exist and make suggestions for studies that should be performed to address these deficits. These encompass both basic science and clinical research studies, including large, prospective epidemiologic studies to determine the true prevalence and natural history of psoriasis; further molecular studies in patients with psoriatic and psoriatic arthritis to understand the function of psoriasis susceptibility genes and to identify novel therapeutic targets; studies to examine the role of environmental factors in the development of psoriasis; further investigation of the relationship between psoriasis and cardiometabolic disease; studies that examine the role of adjunctive therapies such as psychological interventions in appropriate patient groups; and finally, studies to identify biomarkers of disease severity and treatment response to optimize patient therapy. [Copyright &y& Elsevier]

Abstract: Background: Psoriasis is a T-cell mediated hyperproliferative cutaneous disease of multifactorial etiology. Prolactin (PRL) has been implicated in the pathogenesis of psoriasis and several studies have pointed to a potential therapeutic role of bromocriptine in psoriasis. Aim: To assess the clinical efficacy of bromocriptine and the influence of serum prolactin levels on disease severity in patients with chronic plaque-type psoriasis. Methods: Forty-five patients with chronic plaque-type psoriasis and 45 healthy control subjects were included in the study. The patients were divided into three equal groups; a group treated with narrow-band ultraviolet B (NB-UVB), a group treated with bromocriptine, and a group treated with both NB-UVB and bromocriptine. Serum PRL levels and psoriasis area severity index (PASI) scores were measured before and after a 12-week treatment period. Results: There was no significant difference in the serum PRL levels between the patients prior to treatment and the controls. Correlations between PASI scores and serum PRL levels before and after treatment were insignificant. Post-treatment PASI scores were significantly lower than pre-treatment values in each of the treated groups. Post-treatment serum PRL levels were significantly lower in both groups receiving bromocriptine than the group receiving NB-UVB alone, they were also significantly lower in the group treated with NB-UVB and bromocriptine than the group treated with bromocriptine alone. Conclusions: Bromocriptine may be of value in the treatment of chronic plaque-type psoriasis in the absence of hyperprolactinemia. NB-UVB may have an additive effect to bromocriptine on serum PRL levels. [Copyright &y& Elsevier]

The article discusses the diagnosis, assessment and treatment of patients with psoriasis. Psoriasis is described as an inflammation of the skin and joints that typically manifest as pink or red scaly plaques. Though its diagnosis is straightforward, it can reportedly develop into unstable pustular or erythrodermic forms. Guidelines on care of psoriasis from the National Institute for Health and Clinical Excellence (NICE) and the Scottish Intercollegiate Guidance Network (SIGN) are discussed.

Abstract: Aim: Anti-tumor necrosis factor (TNF)-alpha agents are widely used for the treatment of both inflammatory bowel disease (IBD) and psoriasis. Psoriatic skin lesions induced by anti-TNF have been described in patients with IBD. We report a case series of psoriasis induced by anti-TNF agents in IBD patients. Methods: Systematic analysis of cases of psoriasis induced by anti-TNF in an IBD patient cohort in tertiary hospitals of Madrid. Results: A total of 21 of 1294 patients with IBD treated with anti-TNF-alpha agents developed drug-induced psoriasis (cumulative incidence 1.62%; 95% CI 1.06%–2.47%): 14 patients with infliximab and 7 with adalimumab; seventeen with Crohn''s disease, 4 with ulcerative colitis. The onset of skin lesions varied in a wide range of time (after a mean 13±8 doses). The most frequent site of skin lesions was the limbs (62%) followed by the trunk (48%) and the scalp (43%). The psoriasis phenotypes were plaque psoriasis (57%), scalp (14%), palmoplantar pustulosis (14%), pustular generalized psoriasis (5%), guttate (5%) and inverse (5%). Four patients interrupted the anti-TNF treatment, and that led to the complete regression of lesions in 1 of them. The other 17 patients were maintained on anti-TNF therapy and managed with topical steroids. Conclusion: Psoriatic lesions can be induced by anti-TNF drugs. Plaque psoriasis on the extremities and trunk were the most frequent presentations in our series. Topical steroid treatment is effective in most patients. Anti-TNF discontinuance may be reserved for patients with severe psoriasis or patients without response to topical therapy. [Copyright &y& Elsevier]

The article offers an overview of nail conditions such as psoriasis, lichen planus, and pterygium. It provides a description, aetiology, features, causes and treatment for these conditions. It also presents a quiz relative to these conditions including the skin disease that manifests itself in the nail, the skin condition characterized by flat topped itchy papules, and most common cause of nail condition.

Copyright of Revista de la Asociación Colombiana de Dermatología y Cirugía Dermatológica is the property of Asociacion Colombiana de Dermatologia y Cirugia Dermatologica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de la Asociación Colombiana de Dermatología y Cirugía Dermatológica is the property of Asociacion Colombiana de Dermatologia y Cirugia Dermatologica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The last decade has witnessed a significant advance in the management of refractory moderate-to-severe psoriasis. This advance is the introduction of biological therapies to clinical practice. Three classes of biological therapies have been used. Of the first 2 classes to be introduced, the T-cell inhibitors and tumor necrosis factor (TNF)-α inhibitors, there have been differing fates with one of the T-cell inhibitors, efalizumab, being withdrawn because of a rare, unpredictable association with a usually fatal neurological condition, progressive multifocal leukoencephalopathy. In contrast, anti-TNF treatments are now firmly established offering a high level of efficacy and a good safety record across several indications, including psoriasis. A new approach involves targeting the p40 subunit, common to interleukins 12 and 23. Ustekinumab, the first drug in this class, now offers a viable alternative to anti-TNFs in the treatment of moderate-to-severe psoriasis. In this article, we discuss approaches that may be utilized to refine these existing therapies and examine future therapeutic targets for biological therapies. [Copyright &y& Elsevier]

The development of biologics has dramatically altered the treatment of moderate-to-severe psoriasis while also introducing new standards of care for therapeutic monitoring. Currently, the biologics approved by the US Food and Drug Administration are divided into 3 classes: T-cell modulators, tumor necrosis factor-α inhibitors, and interleukin-12/23 inhibitors. Although the US Food and Drug Administration has established recommendations for pre- and peri-treatment screening evaluations, much of the evidence comes from clinical trials evaluating the short-term safety and efficacy of each medication, rather than long-term data, or studies that summarize either the appropriateness or feasibility of screening. Instead of following a blanket algorithm, providers must understand the evidence as it relates to each medication to determine which tests are appropriate for any specific patient. This chapter summarizes the current body of evidence and recommends a practical approach for monitoring psoriasis patients who are receiving biologic therapies. [Copyright &y& Elsevier]

The choice of therapeutic agents for patients with moderate-to-severe psoriasis has expanded significantly in the past decade. With new understanding of the immunologic basis of psoriasis, multiple new potential targets for therapy have been identified. It is likely that a series of new medications to focus on the newly identified pathways is on the horizon. The first pathway targeted by new medications focuses on the p40 subunit that is shared by interleukin (IL)-12 and IL-23. Two human anti-p40 antibodies have been used therapeutically in psoriasis to date, ustekinumab (CNTO-1275, Stelara, Centocor, Horsham, PA) and briakinumab (ABT-874, Abbott, Abbott Park, IL). Ustekinumab was recently approved by the United States Food and Drug Administration, making it the first medication approved in the United States to work by this pathway while briakinumab is currently in phase III clinical trials. [Copyright &y& Elsevier]

Psoriasis is one of the most common systemic inflammatory diseases and affects the quality of life of the affected persons profoundly. Further knowledge of the pathogenesis and new biotechnological techniques have made it possible to develop new targeted therapies, such as antibodies against tumor necrosis factor (TNF)-alpha. Today, 3 TNF inhibitors, infliximab, adalimumab, and Etanercept, have been approved for the treatment of psoriasis arthritis, psoriasis, and other indications like Crohn''s disease, depending on the distinct substance by the European Medicines Agency. Golimumab was approved in September 2009 for the use in psoriasis arthritis, respectively. These substances have added new effective treatment options to the therapeutic armamentarium of psoriasis. To use these new treatments for the best of our patients, it is important to know the correct application, the advantages, as well as contraindications or possible adverse effects of the substances. This article provides an update on the TNF-alpha inhibitors with emphasis on practical daily use. Most data are on the basis of high-quality studies and official guidelines, but if necessary, data from recent publications or clinical expertise have been added. In summary, with TNF inhibitors we have gained effective new treatment options showing a favorable safety profile when paying attention to safety aspects before and during therapy (screening, monitoring). [Copyright &y& Elsevier]

Copyright of Revista de la Asociación Colombiana de Dermatología y Cirugía Dermatológica is the property of Asociacion Colombiana de Dermatologia y Cirugia Dermatologica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Lasers frequently are used by dermatologists for their multiple aesthetic applications, but they also can be used to treat a variety of medical dermatology conditions. Conditions such as acne vulgaris, psoriasis, and vitiligo can all be successfully treated with laser, thereby providing the patient with additional therapeutic options. Lasers have also been used for years to improve the appearance of scars. The newer fractionated lasers have been especially effective in enhancing the clinical outcomes of scar revision. [Copyright &y& Elsevier]

Introduction: Feelings of stigmatization can strongly influence quality of life in individuals with chronic skin diseases. The Short-Form of the Questionnaire on Experience with Skin Complaints (SF-QES) differentiates four factors of stigmatization: self-esteem and retreat, experienced refusal, concealment, and composure. The current study aimed to investigate the construct validity of the SF-QES. Method: The analysis was based on the complete SF-QES records of a clinical psoriasis trial, which yielded 1,005 records at baseline, 1,010 records at the end of therapy, and 885 and 827 records, respectively, at two follow-ups. Factor analyses and corresponding structural equation models (SEMs) using robust maximum likelihood estimation (RML) were applied. Additionally, the responsiveness of the scales to judgments of treatment success and two different interventions were compared. Results: The factor analyses provided results that widely agreed with the supposed four factors. SEM, however, showed moderately insufficient fit for this model, but supported five factors and the discrimination between affected self-esteem and retreat. The retreat scale was clearly most responsive to treatment success and intervention type. Conclusion: The construct validity of the SF-QES was largely supported, but the factor retreat should be separated from affected self-esteem and is most sensitive to physical intervention. [ABSTRACT FROM AUTHOR]

Biological therapies targeting T cell activation and trafficking, and the cytokine TNF-α have recently been approved for use in psoriasis and/or psoriatic arthritis. Clinical evidence suggests that they are both safe and efficacious for moderate to severe psoriasis and suitable for relatively long-term use. Causes for concern include T lymphocyte depletion (alefacept) and reactivation of mycobacterial infections (infliximab and adalimumab). Biological agents against further immunotargets, such as the Th-1 differentiating cytokines IL-12 and IL-23, are being developed. [Copyright &y& Elsevier]

Abstract: Spa (thermal) tourism is gaining increasing importance in health tourism. Turkey has numerous thermal sources that have been used to cure a number of common diseases. Among these thermal sources, Kangal Fish Spring has a unique nature with its doctor fish known to cure psoriasis. To date, a number of studies analyzed Kangal Fish Spring as a thermal source with its water and fish characteristics but no research to the authors’ knowledge has been conducted to analyze the spring''s demand and destination characteristics. In Turkey, research about thermal health centers and their visitors, is fairly limited from a tourism experience point of view. The current paper reports a case study of psoriasis treatment by doctor fish in Kangal Fish Spring as part of health tourism in Turkey. The paper describes Kangal Fish Spring as a health tourism destination and investigates socio-economic and visitor characteristics of the people visiting Kangal Fish Spring. As part of the study, 104 visitors to the destination were surveyed and visitor perceptions about the destination and visitor characteristics were reported. The paper concludes with a discussion about the future of the destination and health tourism in Turkey. [Copyright &y& Elsevier]

Background: Efalizumab is a T cell-targeted therapy for psoriasis.Objective: We sought to evaluate the efficacy and safety of long-term, continuous efalizumab therapy.Methods: Of 339 patients enrolled in this ongoing, open-label, phase III study, after 3 months 290 qualified for and entered the maintenance treatment phase.Results: Results for the first 27 months of this 36-month continuous therapy trial are available. At month 3, 41% of patients achieved at least a 75% reduction in Psoriasis Area and Severity Index (PASI) score; at month 27, 47% achieved at least a 75% reduction in PASI score (intent to treat, n = 339). Among patients eligible for maintenance therapy (n = 290), 56% achieved at least a 75% reduction in PASI score at month 27. Moreover, the at least 90% reduction in PASI score rate increased through 18 months (33%). The safety profile with efalizumab was sustained throughout 27 months of continuous treatment with no new common events over time.Limitations: Because the extended treatment period was not a randomized clinical trial, no formal comparative analyses versus placebo were conducted. Three-month placebo data from randomized, parallel, placebo-controlled studies are briefly discussed.Conclusions: These results suggest that efalizumab maintains, and in some patients continues to improve, efficacy during long-term therapy. [ABSTRACT FROM AUTHOR]

Background: Psoriasis of the hands and feet is a chronic disease which is often resistant to the usual topical therapies. It has considerable morbidity and seriously affects the quality of life of patients. Objective: We sought to prospectively evaluate the efficacy and safety of pulsed dye laser (PDL) treatment of psoriasis of the hands and feet. Methods: In all, 41 patients with therapy-resistant psoriasis of the hands and feet were treated once every 4 to 6 weeks with PDL at 585-nm wavelength, 450-microsecond pulse duration, 7-mm spot diameter, and 5- to 6.5-J/cm2 fluence. Calcipotriol ointment and salicylic acid 5% to 10% ointment were used as keratolytic agents. Treatment efficacy was evaluated by blinded comparison of photographs of the lesions taken before and after PDL treatment in each patient. Results: A good to very good improvement in the lesions was observed in 76% of the patients after treatment. An average duration of remission was 11 months. Side effects were transient purpura, moderate discomfort during the treatment, transient hyperpigmentation or hypopigmentation, and incidental transient crustae. Limitations: This was an open prospective study with a limited number of patients who were concomitantly treated with calcipotriol and salicylic acid ointment. Patients with photointolerance, on medication with phototoxic or photoallergic drugs, and with widespread psoriasis were excluded. Conclusions: Concomitant treatment with PDL and topical calcipotriol, salicylic acid, or both was a satisfactory modality for treating psoriasis of the hands and feet. There was a subjective improvement in the symptoms and quality of life in all patients. [Copyright &y& Elsevier]

An 81-year-old male patient presented with a large gingival ulcer of 2 months' duration. He had been taking methotrexate, a potent anti-inflammatory/immunosuppressant, for the past 50 years to treat psoriasis. A biopsy revealed diffuse large B-cell lymphoma Epstein-Barr virus positive. Remission occurred after discontinuing the medication. Clinicians noting a non-healing ulcer in the mucosal or keratinized tissue of the oral cavity of a patient on immunosuppressants should perform a biopsy examination to rule out lymphoma or other malignancy. [ABSTRACT FROM AUTHOR]

Focuses on the prevalence of psoriasis in the United Kingdom. Comparison to its prevalence to that of diabetes mellitus; Underestimation of the handicap associated with severe psoriasis; Information on topical Vitamin D analogues as an important treatment for psoriasis; Other treatments that are used to combat psoriasis. INSET: Clinical focus..