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Background Anti-tumour necrosis factor ( TNF)-α therapies have revolutionized the treatment of psoriasis; however, up to 50% of patients do not respond satisfactorily. Identification of pharmacogenetic markers of treatment response is an important stop in the development of individually tailored treatment. The objective of this study was to assess the association of human leucocyte antigen ( HLA)- C, killer immunoglobulin receptor ( KIR) and vitamin D receptor ( VDR) genotypes with response to treatment by etanercept and adalimumab. Methods This was a study of 138 patients with severe chronic plaque psoriasis who were treated with etanercept and/or adalimumab. Patients were classified as responders if they achieved a 75% reduction in PASI ( PASI75) or were almost clear of psoriasis after 24 weeks of therapy. The frequencies of HLA- C and KIR haplotypes and VDR polymorphisms were compared in responders and nonresponders. The frequency of all HLA- C and KIR genotypes were compared between the 138 patients with psoriasis and 247 healthy donors. Results The number of patients classified as responders was 46 of 94 (49%) in the etanercept group and 50 of 76 (66%) in the adalimumab group. None of the HLA- C, KIR or VDR genotypes examined was predictive of treatment response. Compared with healthy controls, patients with psoriasis were more likely to have the HLA- C*06 genotype ( P < 0.001) and less likely to have the HLA- C*07 genotype ( P < 0.001), whereas there was no significant difference in frequencies of any KIR subtype. Conclusions Using the candidate gene approach to identify biomarkers of treatment response in psoriasis may have limited utility. This was a small study with limited power. Future larger studies are needed to further examine these findings and to explore alternative approaches to identify predictors of treatment response to biological agents. [ABSTRACT FROM AUTHOR]

The association between psoriasis and alcohol consumption is complex. Epidemiological evidence suggests that patients with moderate to severe psoriasis have an increased incidence of alcohol-related diseases and mortality. This appears to be unique to psoriasis compared with other autoimmune diseases. Excessive alcohol consumption may contribute to systemic inflammation and the comorbidities associated with psoriasis, including cardiovascular disease and depression. Screening for hazardous alcohol consumption and appropriate interventions may be useful in patients with moderate to severe psoriasis. [ABSTRACT FROM AUTHOR]

Psoriasis is a hyperproliferative, cutaneous disorder with the potential to lower levels of folate. This may result in raised levels of homocysteine, an independent risk factor for the development of cardiovascular disease. A study was conducted to compare levels of red-cell folate (RCF) and homocysteine in patients with psoriasis and in healthy controls. Levels of homocysteine were also examined in the context of other major cardiovascular risk factors. In total, 20 patients with psoriasis and 20 controls had their RCF, homo-cysteine and other conventional cardiovascular risk factors assessed. Patients with psoriasis had a trend towards lower levels of RCF. Significantly raised levels of homocysteine were found in patients with psoriasis compared with controls ( P = 0.007). There was no correlation between homocysteine levels, RCF levels or disease activity as measured by the Psoriasis Area and Severity Index. Patients with psoriasis had higher body mass index ( P < 0.004) and higher systolic blood pressure ( P < 0.001) than controls. This may contribute to the excess cardiovascular mortality observed in patients with psoriasis. [ABSTRACT FROM AUTHOR]

Aim. To assess the efficacy and safety profile of adalimumab in patients with severe, recalcitrant chronic plaque psoriasis, and to assess short-term overlapping of other systemic treatment with adalimumab to prevent flaring of disease. Methods. This was a retrospective study comprising 39 patients with chronic plaque psoriasis treated with adalimumab between October 2005 and January 2008. All had failed treatment with other systemic agents, including biological therapies in 59% of patients. Patients were started on adalimumab 40 mg weekly or fortnightly, as clinically indicated. Severity of psoriasis was assessed by the Psoriasis Area and Severity Index (PASI). Therapeutic response was assessed by 75% improvement on PASI (PASI 75). All adverse events were recorded. Results. Results were analysed separately for those treated with adalimumab only and those on combination treatment. PASI 75 was achieved in 38% (8 of 21 patients at week 16), 62% (13 of 21 patients) at week 24, 69% (9 of 13 patients) at week 48% and 71% (5 of 7 patients) at week 72 in the adalimumab-only group, compared with 56% (5 of 9 patients) at week 16, 50% (4 of 8 patients) at week 24, 80% (4 of 5 patients) at week 48% and 67% (2 of 3 patients) at week 72 in the combined group. Of the 39 patients, 15 (38%) achieved a PASI of 0 at some point in their treatment. Adalimumab was well tolerated; 38% of patients experienced side-effects, which were generally mild. Conclusion. Adalimumab was effective in a group of patients with psoriasis refractory to other systemic therapies, including biological treatments, and was well tolerated. [ABSTRACT FROM AUTHOR]

Background. Excessive alcohol use has been implicated as a risk factor in the development of psoriasis, particularly in men. Despite this, little is known of the incidence or prevalence of psoriasis in patients who misuse alcohol. Objective. To assess the prevalence of psoriasis in patients with alcoholic liver disease. Methods. In total, 100 patients with proven alcoholic liver disease were surveyed for a history of psoriasis and a full skin examination was performed if relevant. Results. Of the 100 patients, 15 reported a history of psoriasis and another 8 had evidence of current activity, suggesting a prevalence (past or present) of 15% in this group of patients. Conclusion. It would appear that the prevalence of psoriasis in patients who misuse alcohol is much higher than the 1–3% variously quoted in the general population. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa (HS) is a chronic incurable disease of apocrine gland-bearing skin characterized by double comedones, recurrent nodules, draining tracts and scarring, predominantly in the axilla, groin and inframammary folds. At presentation, the patient had Hurley stage III disease, with inflammatory nodules, abscesses, and confluent, actively draining tracts and scarring in the axillae, along with scarring in the groin and on the buttocks. While the IL-23/IL-17 axis has been shown to modulate the host response to TB in mouse models, there has only been one reported case of TB in a patient on guselkumab who was QuantiFERON-negative prior to treatment.[[2]] There are no reported cases of latent TB reactivation in patients treated with IL-23p19 inhibitors, and it is thought that IL-23 plays a less significant role in TB immunity than tumour necrosis factor, IL-12 or IL-17. [Extracted from the article]

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent nodules, abscesses and sinus tract formation. Mean lesion count was 2 (range 0-5) pre-treatment and 1 (range 0-5) at follow-up, while mean DLQI was 13 (range 1-23) and 10 (range 0-22), respectively. Spironolactone appears to be a safe and effective treatment option for female patients with HS. [Extracted from the article]

There is little literature on the use of folic acid supplementation in psoriasis patients being treated with methotrexate. Under the auspices of the British Association of Dermatologists we surveyed, using a questionnaire, the use of folic acid supplementation with methotrexate therapy for psoriasis by dermatologists in the UK. Six-hundred and fifteen questionnaires were sent and 153 responses were received (25%). One-hundred and fourteen of the responders (75%) used folic acid supplementation with methotrexate in psoriasis patients. Thirty (26%) of these used folic acid supplementation in all patients taking methotrexate and 84 (74%) used folic acid only under certain circumstances, the most common of which was an elevated erythrocyte mean corpuscular volume. Forty-six per cent of respondents believed that folic acid supplementation reduced nausea and 60% believed that folic acid did not interfere with the efficacy of methotrexate. A wide variety of dosing regimens were used for folic acid supplementation. In the absence of guidelines and controlled trials, there is great variation in the indication for use, dosing regimens used and beliefs regarding methotrexate supplementation for psoriasis. Randomized controlled trials are necessary to address these questions. [ABSTRACT FROM AUTHOR]

Focuses on an article published in the 'Clinical and Experimental Dermatology' periodical, which described a clinical case of dermatomyositis-like eruption and leg ulceration caused by hydroxyurea in a patient with psoriasis. Pathogenesis; Characterization of the disease condition.

Idiopathic solar urticaria (SU) is a rare, debilitating photodermatosis, which may be difficult to treat. First-line treatment with antihistamines is effective in mild cases, but remission after phototherapeutic induction of tolerance is often short-lived. Other treatment options include plasma exchange, photopheresis and ciclosporin. We present two cases of severe, idiopathic SU, which were resistant to conventional treatment. Both patients achieved remission after administration of intravenous immunoglobulin (IVIg) and have remained in remission at 13 months and 4 years, respectively. There are only two case reports of successful treatment of solar urticaria with IVIg. In our experience IVIg given at a total dose of 2 g/kg over several 5-day courses about a month apart is an effective treatment option for severe idiopathic SU. It is also generally safe, even if certainly subject to significant theoretical risks, such as induction of viral infection or anaphylaxis. [ABSTRACT FROM AUTHOR]

Subacute cutaneous lupus erythematosus (SCLE) is a recognised variant of lupus erythematosus (LE), which accounts for 10–15% of all cases of cutaneous LE, occurring most commonly in young to middle-aged white women. Diagnosis is based on the detection of anti-Ro/SS-A antibodies in the skin and serum, characteristic clinical and histological cutaneous involvement, and relatively mild systemic involvement. Several unusual variants of SCLE have been reported including erythrodermic SCLE, SCLE with vitiligo-like lesions, acral SCLE and bullous SCLE. Poikoilodermatous SCLE is a recognised but rare variant of SCLE. There are currently only two case reports, comprising five individual cases, in the literature. We present a case of SCLE in which the main clinical findings were an extensive photodistributed poikilodermatous rash and alopecia. [ABSTRACT FROM AUTHOR]

We report a case of a 42-year-old woman with a background of autoimmune polyglandular syndrome, who developed a type I immediate hypersensitivity reaction to intramuscular cyanocobalamin. Intradermal testing showed a positive reaction to cyanocobalamin. The patient was subsequently treated with intramuscular hydroxycobalamin after negative intradermal testing to this alternative B12 compound. A review of previously described cases of hypersensitivity to either compound provides a rationale for the management of this rare but serious side-effect. [ABSTRACT FROM AUTHOR]

We report a case of a 56-year-old woman who presented with a severe exacerbation of psoriasis with concurrent hypoglycaemic episodes. Methotrexate 17.5 mg weekly was required to control her psoriasis. Investigation of her hypoglycaemia showed raised levels of insulin, C-peptide and proinsulin. Radiological investigation showed a tumour at the tail of the pancreas and the diagnosis was insulinoma. A spleen-preserving distal pancreatectomy was performed and the hypoglycaemic symptoms resolved. Immediately following the pancreatectomy, methotrexate was stopped and the patient’s psoriasis went into remission. During a 2-year follow-up, she has required only minimal topical treatment for her skin. [ABSTRACT FROM AUTHOR]

The article offers information about the completion of an audit in 2016 which assess compliance with tuberculosis screening recommendations prior to commencing biologic therapy in psoriasis. The application of the 2009 BAD guidelines for biologic interventions for psoriasis as audit standard is presented.

The article presents a case study of a 66-year-old obese woman with psoriasis and multiple nonmelanoma skin cancers (NMSCs). Topics discussed include the application of infliximab therapy, methotrexate therapy, and sitagliptin therapy to treat the patient's condition, the efficacy of sitagliptin, and the dipeptidyl peptidase (DPP)-4 suppresses keratinocyte proliferation.

The article presents the case study of two women who developed generalized pustular psoriasis after using calcipotriol and betamethasone dipropionate ointmen. Patient 1 was a 66-year-old woman who was prescribed calcipotriol and betamethasone ointment. A myelodysplasia with transformation to acute myeloid leukaemia was seen in a bone marrow biopsy. Patient 2 was a 60-year-old woman had a history of chronic stable plaque psoriasis of the elbows and knees.

A 58-year-old man was referred by his general practitioner to the dermatology department with a 4-year-history of an intermittent facial rash. It is possible that the solar elastosis on the scalp plays a role in the aetiology of this patient's rosacca. A previous study looking at the histopathological changes of rosacca found that solar elastosis was more frequent and of greater severity in rosacea patients compared with controls. Rosacea is a chronic acneiform disorder often presenting with flushing erythema, papules pustules and telangiectasia on the face.

A letter to the editor is presented regarding the case of a 41-year old man with T-cell proliferation related with efalizumab therapy.