Search

Objective: In clinical studies, it is crucial to assess psoriasis severity accurately and with no substantial variation between different raters. The Psoriasis Area and Severity Index (PASI) and Physician Global Assessment (PGA) are the two most commonly used tools for the assessment of psoriasis severity. The aim of this study was to evaluate the intra-rater and inter-rater reliability of these methods and to determine whether inter-rater reliability is affected by rater experience. Design: An open uncontrolled study Setting: Dermatology Department of Ege University, Medical Faculty Subjects: Fifty-five patients with plaque psoriasis who were examined between 15 August 2012 and 15 November 2012 in the dermatology department of Ege University Interventions: Three dermatology residents with varying experience evaluated the patients individually using both the PASI and PGA for each patient (in that order). Main Outcome Measure: PASI and PGA Results: PASI and PGA scores showed high intra-rater correlation for all three residents. Inter-rater reliability for PASI was high between the most experienced and second most experienced resident and between the most experienced and least experienced resident. However, inter-rater reliability for PGA was high between the most experienced and second most experienced residents, but only moderate between the most experienced and least experienced resident. Conclusions: There were no significant interrater differences between PGA and PASI scores in our study. However, because PGA is more subjective and may be affected by rater experience, PASI is considered to be a more reliable method for assessing severity of psoriasis. © 2021, Kuwait Medical Association. All rights reserved.

Although we tend to be reluctant in exposing mother and child to drugs, treatment with medicinal products during pregnancy cannot always be avoided. In the past decades several safety issues occurred that highlighted the need for special attention for the use of medicinal products during pregnancy. Whether or not a drug causes a potential teratogenic effect depends on several factors. Moreover, effects may be visible at birth, but may also become apparent later in life, among which developmental disorders. Before marketing of a drug the information about the safety in pregnancy is sparse and mainly limited to animal studies and scarce observational data. Clinical trials carried out before marketing, rarely include pregnant women, except when the product is specifically intended to be used in pregnancy. For the most part, effects of drug use during pregnancy can only be identified after marketing of the drug and when used by pregnant women. The optimal method for evaluating the risk of exposure to drugs in pregnancy strongly depends on the stage of drug development. Preapproval data on risks during pregnancy is limited and most information in this phase comes from embryo-fetal toxicity studies in animals. In the post-marketing phase observational studies are preferred. Next to the clinical presentation, epidemiology, and mechanisms of congenital malformations, the most prominent study types used in the premarketing phase; case reports and case series, cohort- and case control studies, will be discussed. Subsequently, possible ways to study the safety of drugs after marketing will be highlighted as well as current regulations for monitoring drug safety during pregnancy will be addressed.

The data on long-term efficacy, safety and drug survival rates of conventional systemic therapeutics in pediatric psoriasis is lacking. The primary aim of this study is to investigate acitretin, methotrexate, cyclosporin efficacy, safety and drug survival rates in pediatric patients as well as predictors of drug survival. This is a multicenter study including 289 pediatric cases being treated with acitretin, methotrexate and cyclosporin in four academic referral centers. Efficacy, adverse events, reasons for discontinuation, 1, 2- and 3-year drug survival rates, and determinants of drug survival were analyzed. A 75% reduction of Psoriasis Area and Severity Index score or better response rate was obtained in 47.5%, 34.1% and 40% of the patients who were treated with acitretin, methotrexate and cyclosporin, respectively. One-year drug survival rates for acitretin, methotrexate and cyclosporin were 36.3%, 21.1% and 15.1%, respectively. The most significant determinant of drug survival, which diminished over time, was treatment response whereas arthritis, body mass index and sex had no influence. Although all three medications are effective and relatively safe in children, drug survival rates are low due to safety concerns at this age group. Effective disease control through their rational use can be expected to improve survival rates. Pfizer Novartis Merck & Company - Schering Plough Corporation AbbVie Merck & Company Johnson & Johnson - Johnson & Johnson USA - Janssen Biotech Inc

Psoriasis is a common chronic inflammatory skin condition in which patients suffer from mild to chronic plaque skin plaques. The disease manifests through an excessive inflammatory response in the skin due to complex interactions between different genetic and environmental factors. Psoriasis can affect the physical, emotional, and psychosocial well-being of patients, and currently there is no cure with treatments focusing primarily on the use of anti-inflammatory agents to control disease symptoms. Traditional anti-inflammatory agents can cause immunosuppression and adverse systemic effects. Further understanding of the disease has led to current areas of research aiming at the development of selective molecular targets to suppress the pathogenic immune responses. Refereed/Peer-reviewed

Psoriasis affects approximately 2% of the world’s population and results in disability similar to or exceeding that associated with other major illnesses such as diabetes mellitus, rheumatoid arthritis (RA), depression, and cancer. 1,2 It is chronic and incurable and can develop at any age. The disease is characterized by unpredictable periods of remission and relapse. As an added complication, the nature and morphology of the disease may be altered by therapy such as psoralen plus UVA. The lifelong nature of psoriasis invariably means a requirement for therapy that may be used long term. Clinical management is currently dictated by the physical and psychologic aspects of the disease coupled with historic response to therapy, with physical aspects identified as mild to severe. Perhaps we should instead consider psoriasis as easy or difficult to treat. This philosophy is exemplified by the holistic tool used for psoriasis measurement, the Salford Psoriasis Index. 3 New systemic therapies require reconsideration of psoriasis treatment paradigms.