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Background and Design: In this study, we investigated whether Glutathione S-transferase Mu 1 (GSTM1) and Glutathione S-transferase Pi 1 (GSTP1) gene polymorphisms are risk factors for psoriasis development and characteristics of psoriasis. Materials and Methods: Venous blood samples were collected from both the patients and control subjects into 2 mL EDTA tubes. DNA was isolated from 260 psoriasis patients and 200 healthy control subjects, and GSTM1 and GSTP1 gene polymorphisms were genotyped by realtime polymerase chain reaction method. Results: According to the analysis results, although the frequency of the GSTM1 null genotype was 1.33 times higher in patients compared to controls, this difference was statistically insignificant [95% confidence interval (CI): 0.91-1.93, p=0.13]. GSTP1 AG heterozygous genotype and GG homozygous polymorphic genotype frequencies also did not differ between patients and controls [odds ratio (OR): 0.80, 95% CI: 0.55-1.18, p=0.27 for AG genotype; OR: 0.74, 95% CI: 0.35-1.56, p=0.42 for GG genotype]. When both polymorphisms were evaluated based on the onset age and severity of the disease, no significant difference was found between the early onset age group and the late onset age group, nor between the mild group and the severe group. Conclusion: The results show that GSTM1 and GSTP1 polymorphisms do not have a major effect on the etiopathogenesis and clinical characteristics of psoriasis.

Aim: Many psychiatric disorders are associated with psoriasis. A 16-item self-report maladaptive daydreaming (MD) scale (MDS-16) is described as a screening tool for MD. We aimed to explore whether MDS-16 scores differed in psoriasis patients compared to healthy individuals, hypothesizing higher scores and higher rates of probable maladaptive daydreamers (MDers) among psoriazis patients. Materials and Methods: We included 184 psoriazis patients and 93 age- and sex-matched people without any cutaneous disorders in this case-control, cross-sectional, and questionnaire-based study. Dermatology Quality of Life Instrument in Turkish (TQoL) and MDS-16 were applied. We considered the participants with a total MDS-16 score ≥50 as probable MDers. Results: Total MDS-16 score was higher in the psoriasis group (p=0.038). However, the difference between the frequencies of probable MDers was not significant (p=0.234). According to the multivariable analysis, psoriasis was not found as an independent risk factor for being probable MDer. In the psoriasis group, total MDS-16 scores were positively correlated with TQoL scores (rs=0.259, p=0.001), which were significantly higher in probable MDers (p=0.032). Conclusion: The association between psoriasis and MD may be related to the level of the impact of psoriasis on the quality of life.

In this case report, we present a 29-year-old patient with Down syndrome (DS) who manifested both psoriasis and hidradenitis suppurativa (HS) concurrently. The utilization of guselkumab, an interleukin 23 p19 subunit inhibitor that is approved for moderate to severe psoriasis vulgaris, resulted in significant improvement in symptoms for both conditions following the initial administration. The patient achieved a psoriasis area and severity index 90 response with significant amelioration of psoriatic plaques. Simultaneously, more than 50% improvement in abscess and inflammatory nodules secondary to HS was observed 4 weeks after the start of guselkumab therapy, resulting in a HiSCR score achievement. Throughout the 52-week follow-up, there were no observed exacerbations of symptoms or adverse effects. This case highlights the potential benefit of guselkumab in the simultaneous treatment of HS and psoriasis, and suggests that guselkumab is an effective and safe biologic agent of choice in individuals with DS, where the prevalence of both these diseases is increased, and treatment adherence may pose additional challenges compared to the normal population.

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Background and Design: The coronavirus disease-2019 (COVID-19) pandemic caused unexpected and drastic changes in the modus operandi of global healthcare. Psoriasis is a dermatosis that necessitates the provision of special healthcare services in dermatology clinics, due to its severe effects on quality of life and its socioeconomic consequences. This study aimed to identify pandemic-related problems experienced by psoriasis patients followed up in our outpatient clinic, thereby revealing the effects of the COVID-19 pandemic on these patients. Materials and Methods: This study included 64 patients with plaque psoriasis who were followed up at the Psoriasis Outpatient Clinic of Aydın Adnan Menderes University Faculty of Medicine, Department of Dermatology 6 months before and after the start of the pandemic in Turkey. A questionnaire was used to inquire how the patients were affected by the pandemic; median Psoriasis Area and Severity Index (PASI) scores and number of hospital visits were compared with pre-pandemic values. Results: Thirty-six patients (56.3%) stated that the pandemic had no effect on their disease, 20 patients (31.3%) reported a deterioration of their disease. The most common reasons thought to aggravate disease were pandemic-related stress and changes in treatment regimen. Treatment of 43 patients (67.2%) remained the same during the pandemic. There was a change in treatment in 21 patients (32.8%). The median number of patient visits to our outpatient clinic was 3 before the pandemic, which dropped to 2 during the first 6 months of the pandemic (p

Purpose: Psoriatic arthritis (PsA) is an inflammatory musculoskeletal disease. The exact causes of PsA have not been identified. ABO and Rh blood groups continue to be an area of interest for various diseases. In this study, we aimed to evaluate whether there is any difference in the distribution of ABO and Rh blood groups in PsA. Materials and Methods: 233 PsA patients (PsA group) consecutively referred to the adult rheumatology outpatient clinics of a tertiary care hospital of central Anatolia between January 2019 and June 2020 were enrolled. The blood groups of the PsA group were compared with the blood groups of 6280 individuals who tested before elective operations at the same hospital between 1 January 2019 and 31 June 2020 (Control Group). Fourteen of the control group were excluded due to the presence of psoriasis/PsA in their medical records. In addition, the blood groups of 38.416 people who voluntarily donated blood to the Turkish Red Crescent Kayseri Blood Center between January 1, 2019 and July 1, 2020 (donor group) were compared with the blood groups of the control group. Results: There was no significant difference between the PsA patients and the control group in any blood group, both in women, men and also cumulatively. Conclusion: The result of the study shows there is no significant difference in the blood groups between patients with PsA and the control group.

Background and Design: Oxidative stress is known to play a role in the etiopathogenesis of psoriasis. Recent data suggest that osteopontin (OPN) can also play a role in the pathogenesis of psoriasis. In the current study, OPN levels and oxidative stress were evaluated in patients with psoriasis. Materials and Methods: The study included 61 patients with psoriasis and 62 healthy controls. The OPN levels, total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were measured using serum. The disease severity was evaluated using the psoriasis area and severity index (PASI). Results: No statistically significant differences in OPN, TAS, and OSI values were identified between the psoriasis and control groups. A negative correlation was found with the TAS. There was no statistically significant correlation between the PASI score and OPN, TAS, TOS, and OSI values. Conclusion: We did not find a statistically significant correlation between OPN levels and oxidative stress in patients with psoriasis. We believe that larger and more detailed studies are needed to highlight the role of OPN and oxidative stress in the etiopathogenesis of psoriasis.

Aim:Psoriasis is a chronic systemic inflammatory disease. A generally accepted laboratory marker for monitoring the treatment response of psoriasis is not yet available. The aim of this study was to evaluate the effects of biologic therapy on the novel inflammatory biomarkers neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), mean platelet volume (MPV), and plateletcrit (PCT) in psoriasis.Methods:Fifty-five patients with psoriasis who received biologic therapy including tumor necrosis factor-alpha, interleukin (IL)-17, IL- 12/23, and IL-23 inhibitors for at least three months were retrospectively evaluated. Psoriasis area severity index scores, hemogram data, and C-reactive protein (CRP) levels were analyzed before and after three months of therapy.Results:The CRP, neutrophil count, platelet count, NLR, PLR, and PCT values revealed a significant decrease after three months of therapy, irrespective of the type of biologics used (p=0.008, 0.012, 0.017, 0.001, 0.011, and 0.009, respectively). After treatment, NLR and PLR decreased promptly in parallel with a decrease in CRP, in which NLR has a low-moderate (p=0.025, r=0.303), and PLR has a moderate correlation (p=0.000, r=0.525).Conclusion:Neutrophil-lymphocyte ratio, PCT and particularly PLR parameters derived from hemogram data can be used to assess the effect of biological therapy on systemic inflammation among psoriasis patients.

Background and Design: The coronavirus disease-2019 (COVID-19) pandemic caused unexpected and drastic changes in the modus operandi of global healthcare. Psoriasis is a dermatosis that necessitates the provision of special healthcare services in dermatology clinics, due to its severe effects on quality of life and its socioeconomic consequences. This study aimed to identify pandemic-related problems experienced by psoriasis patients followed up in our outpatient clinic, thereby revealing the effects of the COVID-19 pandemic on these patients. Materials and Methods: This study included 64 patients with plaque psoriasis who were followed up at the Psoriasis Outpatient Clinic of Aydın Adnan Menderes University Faculty of Medicine, Department of Dermatology 6 months before and after the start of the pandemic in Türkiye. A questionnaire was used to inquire how the patients were affected by the pandemic; median Psoriasis Area and Severity Index (PASI) scores and number of hospital visits were compared with pre-pandemic values. Results: Thirty-six patients (56.3%) stated that the pandemic had no effect on their disease, 20 patients (31.3%) reported a deterioration of their disease. The most common reasons thought to aggravate disease were pandemic-related stress and changes in treatment regimen. Treatment of 43 patients (67.2%) remained the same during the pandemic. There was a change in treatment in 21 patients (32.8%). The median number of patient visits to our outpatient clinic was 3 before the pandemic, which dropped to 2 during the first 6 months of the pandemic (p<0.001). PASI scores were compared on an individual basis, and 30 patients (46.9%) in the study group had an increase in their median PASI scores during the pandemic. Conclusion: The COVID-19 pandemic led to fewer patient visits to the hospital and difficulties in managing patient compliance to treatment. Our study showed that approximately half the psoriatic patients being treated had an increase in the severity of their disease during the COVID-19 pandemic. A considerable percentage of these patients linked this deterioration with the pandemic. [ABSTRACT FROM AUTHOR]

Background and Design: This study aimed to prospectively evaluate the clinical and demographic characteristics of patients with psoriasis. Materials and Methods: This study included a total of 277 patients with psoriasis who applied to our clinic between December 2018 and February 2020. All patient parameters such as age, sex, height, weight, marital status, age at disease onset, triggering factors, joint and nail involvement, systemic disease history, alcohol and smoking history, family history, and topical and systemic treatments received were recorded prospectively. Statistical analysis was conducted using the SPSS version 24. Results: The mean age of the 277 patients aged 8-81 years was 37.1+-15.9 years. In this study, 125 (45.1%) patients were female and 152 (54.9%) were male, and 11.2% of the patients were

Background and Design: This study aimed to investigate the effects of the comorbidities on disease severity and outcomes in pediatric psoriasis patients. Materials and Methods: A total of 366 patients enrolled to the study were ≤18 years old and were followed up between January 2013 and December 2017. Age, gender, family history, localization, clinical type, severity, treatments, duration of treatment/response, and comorbidities were retrieved retrospectively. Physician Global Assessment was used for psoriasis severity. All parameters were compared statistically in between groups that patients with or without comorbidities. Statistical significance was accepted p0.05). Those with comorbidity were generally higher in patients with moderate to severe psoriasis (p=0.165). In patients with epilepsy, asthma, allergic rhinitis, and valvular disorders, the clinical manifestation was mild. Biological agent use is statistically higher in comorbidity group (p=0.045). It was found that the rates of complete and partial remission rates were lower, and relapse was higher in the comorbidity group, but this was not statistically significant. Conclusion: In this study, a significant relationship was found between comorbidity and disease duration (p=0.043). Comorbidities in cases of moderate to severe psoriasis and accompanying cases. Our results are compatible with previous literature, which indicates that the key to managing pediatric psoriasis is investigation and recognition of comorbidities.

Purpose: The aim of this study was to examine the relationship between smoking and quality of life and to investigate the mediating role of disease severity on this relationship in psoriasis patients. Materials and Methods: In the study, 268 psoriasis patients were reached by the convenience sampling method. In the study, patients' quality of life was measured with “dermatology quality of life index (DLQI)” and disease severity was measured with “psoriasis area and severity index (PASI)”. The effect of the independent variable (smoking) on the dependent variable (quality of life), both directly and indirectly through the mediating variable (disease severity), was examined by process analysis. Results: Smoking status shows statistically significant differences according to gender, age, marital status, occupation, and income groups. 17.02% of women and 44.09% of men smoke. 19.74% of single and 33.85% of married smoke. 20% of unemployed and 39.13% of employees smoke. 17.76% of low-income, 50.91% of middle-income, and 40.98% of high-income people smoke. This cross-sectional study revealed that smoking in psoriasis has no direct effect on the quality of life, but that smoking has a full indirect effect on the quality of life through disease severity. Conclusion: In the study, it was found that smoking negatively affects the quality of life through both disease severity. Accordingly, it is recommended that patients be informed about the effect of smoking on their diseases.

Aim:Psoriasis is thought to result in vascular diseases, atherogenesis, peripheral insulin resistance, and cardiac comorbidities by causing metabolic function disorders, hypertension, and type 2 diabetes. To our best knowledge, there has not yet been a study evaluating psoriasis patients with regard to copeptin. The present study assesses cardiovascular disease in psoriasis patients based on metabolic function and copeptin levels.Methods:The presented case-control study, which is a type of analytical observational study, included 45 psoriasis patients and an age-sex matched control group admitted to University of Health Sciences Turkey, Istanbul Haseki Training and Research Hospital, Clinic of Dermatology, between March 2016 and May 2017. Patients’ blood pressure, height, weight, body mass index, and waistline were measured for both groups. All subjects were also given complete blood count, fasting blood glucose (FBG), uric acid, lipid profile, insulin, C-reactive protein (CRP), copeptin levels, neutrophil-lymphocyte rate, and thrombocyte-lymphocyte rate were analysed. Copeptin was measured by an ELISA kit.Results:Insulin and CRP averages were statistically significantly higher in psoriasis patients than in the control group (p=0.001 for both). The neutrophil-lymphocyte and thrombocyte-lymphocyte rates were significantly higher in psoriasis patients (p=0.008). Insulin resistance was also higher in psoriasis patients (p=0.001). In both the patient and control groups, there was no statistically significant relationship found between copeptin level, general characteristics, and laboratory parameters.Conclusion:To our best knowledge, this is the first study evaluating psoriasis patients with regard to copeptin. Psoriasis patients should be followed up with easily accessible parameters such as neutrophil-lymphocyte rate, thrombocyte-lymphocyte rate, insulin levels, FBG, and uric acid levels.

Macrophage activation syndrome (MAS) is a life-threatening condition associated with rheumatic diseases. It is rarely reported in juvenile dermatomyositis. An 8-year-old girl was admitted with complaints of joint swelling and psoriasiform plaques on the elbows. She was diagnosed with psoriatic arthritis, and methotrexate therapy was started. Three months later, she was readmitted with fever, fatigue, and weight loss. Hepatosplenomegaly was found on physical examination. The muscle strengths were 5/5. Dermatological examination revealed facial edema, widespread maculoerythematous rash, and xerosis. Erythematous-violaceous papulosquamous plaques were seen on the dorsal surfaces of the elbows and metacarpophalangeal and proximal interphalangeal joints. Based on the clinical and laboratory findings, the patient was considered to have MAS secondary to juvenile amyopathic dermatomyositis (JADM). The cutaneous manifestations seen in MAS are not specific but depend on the underlying rheumatic disease. Given the atypical onset, this was considered a case of JADM misdiagnosed as psoriasis, which rapidly progressed to MAS.

Background: In this study, we aimed to investigate the mRNA expression levels of ADAMTS9 and ADAMTS15 in peripheral blood mononuclear cells (PBMCs) of psoriasis (PsO) and psoriatic arthritis (PsA) patients and the effects of TNF-α/MAPK and IL-1β/NFkB signaling pathways on the regulation of the expression of these genes. Materials and Methods: 15 PsO and 15 PsA patients and 15 healthy individuals (control) were included in the study. After PBMCs were isolated from venous blood, ADAMTS9 and ADAMTS15 mRNA expression levels were measured by Real-Time Quantitative PCR (RT-qPCR). Results: It was found that ADAMTS9 mRNA expression in PBMCs did not change between groups, while the level of ADAMTS15 mRNA expression increased significantly in the PsA group compared to the control and PsO groups. ADAMTS9 expression was observed not changed in the control and PsA groups in response to TNF-α stimulation, but decreased in the PsO group. However; TNF-α stimulation led to an increase in ADAMTS15 expression in the control group but did not change in the PsO and PsA groups. It has been revealed that the formation of TNF-α response and related changes in ADAMTS9 and ADAMTS15 expressions were regulated by MAP kinase genes (Erk1/2, p38 and JNK). ADAMTS9 expression was determined not affected by IL-1β stimulation, however; ADAMTS15 mRNA expression was decreased only in the PsA group. In addition, NFkB signaling molecule was involved in the formation of the IL-1β response and the regulation of ADAMTS15 expression. Conclusions: ADAMTS15 expression increased in PBMCs of PsA patients is regulated by the IL-1β/NFkB signaling pathway. An increase in ADAMTS15 mRNA expressin level may play a role in PsA pathogenesis. Furthermore, the expression level of ADAMTS15 has a potential to be used as an important biomarker in monitoring the risk of PsA development for PsO patients. [ABSTRACT FROM AUTHOR]

Studies for vaccine development have been completed in an unprecedented time to prevent further outbreak of the dangerous and potentially fatal coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Some of these vaccines have been approved by various authorities and made available worldwide. While vaccine applications continue globally, the number of dermatological side effects reported after vaccination is increasing daily. Many cutaneous reactions have been reported in the literature, such as injection site reactions, pernio lesions, pityriasis rosacea, herpes zoster, and exacerbations of chronic inflammatory dermatoses such as atopic dermatitis and psoriasis. Most COVID-19 vaccines require two doses and a booster dose, and considering the new variants of the coronavirus, vaccination is estimated to continue for a while. In this context, dermatologists are more likely to encounter vaccine-related dermatological side effects in their daily practice. Dermatologists play an essential role in many issues such as diagnosis and treatment of cutaneous reactions after COVID-19 vaccination, informing patients and providing necessary counseling. This perspective will also provide helpful information for the future in terms of vaccination strategies to be developed for repeated doses. In this study, most of the cutaneous reactions reported after COVID-19 vaccination in the current literature are reviewed. [ABSTRACT FROM AUTHOR]

Purpose: Psoriasis has been accepted as a T-cell mediated systemic disease and systemic inflammation may also cause immunemediated hearing loss. We aimed to evaluate cochlear function with otoacoustic emission (OAE) measurement in psoriasis patients and to evaluate whether there is a relationship between duration and severity of the disease and OAEs. Materials and Methods: Forty-four patients diagnosed with psoriasis were included in the study. The control group consisted of 35 healthy volunteers. The patients' age, gender, onset age, family history, disease duration, and additional diseases were questioned, and psoriasis area severity index (PASI) was calculated. Audiological and otological evaluations were performed. Distortion Product Otoacoustic Emission (DPOAE) were measured at 500, 1000, 2,000, 4,000, 6000, 8000 and 10000 Hz frequencies. Results: There was no significant difference in DPOAE values at 500, 1000, 2000, 4000, 6000, 8000, and 10000 Hz between healthy volunteers and psoriasis patients. There was a significant difference between PASI score and SNR value at 1000 Hz (p=0.031), disease duration, and DPAOE values at 4000 and 6000 Hz (p=0.033, p=0.038 respectively) Conclusion: Considering that psoriasis is a long-term, chronic systemic disease, patients should be follow-up closely even if they do not have hearing complaints in the early period, and as the duration and severity of the disease increases, the hearing of the patients may be affected.

Methotrexate is a drug used in the treatment of psoriasis and psoriatic arthritis. It shows its effect by binding to dihydrofolate reductase, reducing purine synthesis and cell proliferation. When used as a monotherapy, methotrexate shows its effect late and achieves a 50-75% recovery in skin lesions. Patients using methotrexate should periodically be monitored for toxicity with relevant laboratory parameters. Its use in combination with folic acid reduces the risk of toxicity. Using it in combination with cyclosporine in low doses may lower the toxicity risk of both. Its use in combination with phototherapy and acitretin has been found considerably effective.

Acitretin is a synthetic retinoid and an active metabolite of etretinate. It shows its action in psoriasis treatment by suppressing proliferation and enhancing the differentiation of keratinocytes. It differs from other systemic anti-psoriatic agents in that it is not immunosuppressive or cytotoxic. It is used as a monotherapy or in combination with phototherapy in various clinical forms of psoriasis. Due to its teratogenicity, its use in women of reproductive age is not recommended unless there is no alternative. Studies of this drug show that acitretin monotherapy is less effective in plaque psoriasis than other conventional systemic therapies but is superior to them in generalized, palmoplantar, pustular, and hyperkeratotic variants.

Infliximab is a TNF-α inhibitor in the form of a chimeric monoclonal antibody. It received FDA approval in 2006 for the treatment of adult patients with severe chronic plaque psoriasis who developed side effects with conventional therapies or in whom these therapies were contraindicated or did not produce any response. Infliximab is administered via intravenous infusion, and infusion reactions are one of its common side effects. It is not suitable for intermittent treatment due to the high risk of infusion reaction, risk of developing antibodies, and loss of efficacy. Infliximab has the advantage of showing rapid clinical response in the treatment of unstable psoriasis and generalized pustular psoriasis.

Biological agents are used to treat psoriasis in patients who do not respond to conventional systemic therapies such as cyclosporine, acitretin, methotrexate, phototherapy/photochemotherapy, or for whom these therapies are contraindicated. Patients who will use these agents are selected based on the eligibility criteria for biological agents. Patients are assessed at regular intervals with relevant laboratory parameters before and during the treatment. Patients should be assessed particularly for tuberculosis, malignancies, congestive heart failure, demyelinating diseases, and infections. All necessary vaccinations should be completed before starting the treatment, if possible. Live vaccines should be avoided during the treatment, and patients who require surgical intervention should be assessed for postoperative infection risk on a case-tocase basis, and the treatment should be suspended if deemed necessary.

Adalimumab, an entirely human monoclonal antibody, specifically blocks the cell-surface receptor relationship of tumor necrosis factor-alpha (TNF-α) with p55 and p75 TNF-α, thereby suppressing the biological activity of TNF-α. It received FDA approval in 2008 for the treatment of moderate to severe psoriasis that does not respond to conventional treatments or for which these treatments are contraindicated or intolerable. Adalimumab is also indicated for the treatment of moderate to severe chronic plaque psoriasis in children aged 4 and over. Administered via subcutaneous injections, adalimumab is also suitable for intermittent use under certain conditions.

Etanercept is a recombinant human receptor fusion protein that suppresses, as a contestant, the interaction of TNF-α with cell surface receptors. It received FDA approval in 1999 to be used in children older than 2 years for the treatment of juvenile idiopathic arthritis. In September 2004, it received approval for the treatment of patients with moderate to severe psoriasis who do not respond to conventional systemic treatments or for whom these therapies are contraindicated or intolerable.

Treatment of psoriasis differs in special cases such as in women who wish to become pregnant, during pregnancy and lactation, in pediatric and geriatric populations, in the presence of obesity or chronic viral diseases, and during the COVID-19 pandemic. Due to their well-known teratogenic effect, neither topical nor systemic use of retinoids is recommended in any period of pregnancy and lactation. Literature data on treatment approaches in psoriasis in children is less than in adults, and safety data usually relate to short-term use. There is a multifactorial relationship between psoriasis and obesity; response to treatment is lower in obese patients with a body mass index greater than 30. It should be noted that the elderly have comorbidities and concomitant drug use, which increases the likelihood of side effects and drug interactions of psoriasis medications. In the presence of a viral disease, many agents used in the treatment of psoriasis carry the risk of exacerbating the infection due to their immunosuppressive properties. In such a case, the option that can be considered apart from topical therapies is narrowband phototherapy. It was observed during the COVID-19 pandemic that there had been no increase in the risk of infection-related mortality and morbidity solely due to biological therapy.

Background and Design: Although multiple investigations have been conducted to identify important serum biomarkers in patients with psoriasis, no simple, useful biomarker that could be specific for psoriasis has been identified. Objectives: 1) To determine the levels of serum uric acid (SUA), C-reactive protein (CRP), and neutrophil-to-lymphocyte ratio (NLR) among individuals with psoriasis and controls, 2) to assess the correlation of SUA and CRP levels and NLR with disease severity calculated through the psoriasis area severity index (PASI) in patients with psoriasis. Materials and Methods: A hospital-based, case-control study included 45 patients clinically diagnosed with psoriasis and 45 age- and sexmatched controls attending the outpatient dermatology clinic of our hospital. After a complete history was taken, and general, systemic, and cutaneous examinations were performed, all the cases were subjected to the following investigations: Complete blood count (NLR), CRP, and SUA. Results: Mean SUA level was significantly higher in the patients with psoriasis compared to the controls (p0.05). A significant correlation of SUA level and NLR was found with disease severity in the patients with psoriasis as determined by the PASI. In multivariate analysis, only SUA was found to be independently associated with psoriasis severity (p

Aim:Psoriasis is a chronic disease and requires follow-up settings to manage. The aim of the study is to evaluate the clinical characteristics, disease course, the factors associated with the psoriasis area severity score index (PASI), comorbidities, and treatment of psoriasis in our follow-up psoriasis outpatient clinic.Methods:Clinical data from patients who were followed in the University of Health Sciences Turkey, Haseki Training and Research Hospital psoriasis outpatient clinic between January 2015 and March 2021 were examined. The relationships between age, age of the disease onset, gender, joint involvement, and nail involvement were analyzed.Results:In total, 618 patients were included in our study (320 males and 298 females). The median age of the patients was 42 (1- 87) years. Family history was present in 25.9% of the patients. The most common clinical type was plaque psoriasis (80.2%). The median value of the PASI was 8.1. The disease course of the patients was progressive (46.4%), remission and exacerbations (37%), and regressive (16.7%). Nail involvement and joint involvement were observed in 58.1% and 24.2% of the patients, respectively. A significant correlation was found between PASI and joint involvement (p=0.009). Onycholysis (a type of nail involvement) was a positive predictive indicator for joint involvement (p=0.004). Comorbidity was present in 34.5% of the patients. Obesity, hypertension, diabetes mellitus, and dyslipidemia were the most common comorbidities. While 19.9% of the patients received only topical treatment, 80.1% underwent systemic treatment.Conclusions:The socio-demographic and enriched clinical data of psoriasis highlight the features that should be considered, especially in follow-up outpatient clinics. Patients showing an early onset of the disease should be investigated for severe involvement, such as the presence of onycholysis in the nail or evidence of joint involvement. The follow-up and treatment of patients with psoriasis are important in terms of comorbidities.

Background and Design: Psoriasis is a multifactorial, chronic inflammatory skin disease. Clinical and epidemiological parameters in psoriasis may vary in different age groups. The age of the patient is significant in the choice of treatment. We therefore aimed at performing a general and comparative assessment of epidemiologic and clinical parameters of patients with psoriasis according to four age groups. Materials and Methods: We assessed the files of patients with psoriasis who applied to our clinic between 2006 and 2016. Sex, age, duration of disease, family history of psoriasis, clinical types, psoriasis area and severity index, nail and joint involvement, associated comorbidities and dermatoses, and treatments for psoriasis were obtained from the patient files. They were then evaluated comparatively in four age groups: 0-18 years, 19-40 years, 41-65 years and over 65 years. Results: We enrolled 374 patients (54.3% male, 45.7% female). Age of the patients were between 6 years and 85 years (mean: 42.17±18.54 years), with 16% of the patients between the age of 0-18, 26.7% between 19-40, 45.5% between 41-65 and 11.8% above 65. Guttate psoriasis and generalized pustular psoriasis were observed more frequently in females (p=0.001). Plaque psoriasis was the most observed clinical type in all age groups, while between the age of 0-18 years, the frequency of guttate psoriasis (31,7%) increased significant compared to that in other age groups (p

Objective: Psoriasis is a chronic inflammatory skin dis- ease that has a strong genetic background. Elevated serum levels of en- dothelin-1 (ET-1) and nitric oxide (NO) were observed in psoriasis patients. We aimed to explore serum ET-1 and NO in psoriasis patients and healthy controls and analyze the possible correlation between these molecules and disease severity. Material and Methods: The present study was conducted with 34 eligible psoriasis patients and 35 age and gender matched healthy controls. Disease severity was analyzed based on the Psoriasis Area Severity Index (PASI) scores. The patients were divided as mild, moderate and severe according to disease severity. Serum ET-1 levels were determined with ELISA method. NO levels were determined by using Griess reagent. Results: The mean age of patients were 34.82±11 and the mean age of controls were 31.86±8.5 years (p>0.05). The mean ET-1 level was 13.7±9.43 pg/mL in psoria- sis and 9.90±3.05 pg/mL in control group (p=0.02). The mean nitrite (NO 2 ) levels were 42.77±14.28 μmol/L in psoriasis and 37.53±10.72 μmol/L in control group (p>0.05). The mean nitrate (NO3) levels were 39.04±14.68 μmol/L in psoriasis and 33.76±10.56 μmol/L in control group. There was also no statistically significant difference between them (p>0.05). The mean NO2 and NO 3 values were statistically significantly higher in the severe group compared to the control and mild groups (p=0.003, p=0.01). Correlations were found between serum NO levels and PASI scores of psoriasis as in ET-1 levels. Conclusion: Serum ET-1 and NO levels were found as high in psoriasis. We found corelations between ET-1, NO levels and PASI scores. Therefore these 2 parameters may be used as indicators of disease severity. [ABSTRACT FROM AUTHOR]

Objective: Psoriasis is a chronic inflammatory skin disease, and psychiatric comorbidities are common in these patients. Skin lesions can cause shame, anxiety, social avoidance, irritability, and depressive symptoms in psoriasis patients. This study aimed to investigate anxiety, depression, social anxiety, anxiety sensitivity, and perceived stress in patients with psoriasis and their relationship with disease severity and duration. Methods: Forty patients and 40 healthy controls were included in our study. All study patients were administered the Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI), the Liebowitz Social Anxiety Scale (LSAS), the Perceived Stress Scale (PSS-14), and the Anxiety Sensitivity Index (ASI-3). Disease severity in psoriasis patients was assessed using the Psoriasis Area Severity Index (PASI). Results: Anxiety, depression, social anxiety, perceived stress, and anxiety sensitivity were significantly higher in psoriasis patients than in healthy controls. There was no correlation between PASI scores and BAI, BDI, LSAS, PASS-14 and ASI-3 scores. Also, no correlation was found between disease duration and BAI, BDI, LSAS, PSS-14 and ASI-3 scores. Conclusion: Our results show that anxiety, depression, social anxiety, anxiety sensitivity, and perceived stress are high in psoriasis patients regardless of disease duration and severity. This is the first study to examine anxiety sensitivity in psoriasis patients to the best of our knowledge. Clinicians should consider the possible psychiatric comorbidity at all stages of the disease in patients with psoriasis. Collaboration between the disciplines of dermatology and psychiatry is necessary to ensure full recovery and maintain patient well-being.

Background and Design: Psoriasis is a multifactorial disease whose causal origin is unclear. Macrophage migration inhibitory factors (MIF) seem pivotal in inflammation and immune response in psoriasis pathogenesis. We aimed to investigate the serum MIF levels and MIF gene polymorphism (rs755622 and rs1007888) in patients with psoriasis. Materials and Methods: In this study, the association of serum MIF levels and MIF gene polymorphisms with psoriasis were investigated among 100 patients in Turkey. Genotyping was performed by real-time polymerase chain reaction. Serum MIF levels were evaluated by ELISA, and the results were presented in ng/mL. Results: The distribution of rs755622 genotype frequencies in the psoriasis group was: 75, 18, and 4 patients with CC, CG, and GG, respectively. The distribution of rs1007888 genotype frequencies in the psoriasis group was: 22, 48, and 26 patients with AA, AG, and GG, respectively. There was no statistically significant difference between the two groups. However, there was a statistically significant difference between the mean serum MIF levels of psoriasis patients (3.29 ng/mL) compared with the control group (1.08 ng/mL) (p

Background and Design: Secukinumab is an effective treatment option in moderate-to-severe plaque type psoriasis. However, there are a few real-life data studies comparing the efficacy of 150 mg and 300 mg dosages. The aim of this study was to evaluate the efficacy and safety of secukinumab at 150 mg and 300 mg in clinical practice in chronic plaque type psoriasis patients attending our center. Materials and Methods: The medical records of 33 patients consecutively treated with secukinumab 150 mg or 300 mg for a minimum threemonth period were analyzed retrospectively. Treatment response was defined as the achievement of a minimum psoriasis area and severity index (PASI) 75 response at week 12. Results: Eighteen (55.5%) of the patients were men. The mean duration of the disease was 20±9.38 (1-40) years. Most (75.7%) patients had previously received at least one biological therapy. Seventeen patients were treated with 300 mg and 14 with 150 mg during the induction and maintenance periods. Two patients received induction therapy at 150 mg and maintenance therapy at 300 mg. At week 12, PASI 75, 90, and 100 responses were achieved in 78.8%, 66.7%, and 22.3% of patients, respectively. Treatment responses were similar between patients receiving 150 mg and 300 mg, and also between biologic naive and non-naive patients (p>0.05). Adverse events were observed in three patients, but these did not necessitate discontinuation of therapy. Conclusion: Secukinumab at doses of 150 mg and 300 mg is a fast-acting, effective and safe treatment option in patients with chronic plaque type psoriasis, both biologic naive and non-naive.

Background and Design: Psoriasis is a common chronic inflammatory skin disease believed to affect renal functions. Glomerular filtration rate (GFR) is the most important indicator used to assess renal functions. The present study aims to measure the renal function of psoriasis patients via the technetium-99m diethylenetriamine pentaacetate (Tc-99m DTPA) method and compare the values obtained with those determined through indirect measurement methods, such as the modification of diet in renal disease (MDRD) and chronic kidney disease epidemiology collaboration (CKD-EPI), considering the effects of systemic treatments and comorbidities. Materials and Methods: Eighty-seven patients diagnosed with chronic plaque-type psoriasis vulgaris were included in this study. The patients’ demographic characteristics, disease duration, psoriasis area and severity index score, drugs received for psoriasis treatment, comorbidities, and drugs received for comorbidity treatment were noted. Estimated GFRs were also calculated using the MDRD and CKD-EPI formulas. Results: Tc-99m DTPA values were affected only by age. As the patient age increased, a significant decrease in GFR measured with Tc-99m DTPA (r=0.289, p

Background and Design: Several randomized clinical trials demonstrated the safety and efficacy of secukinumab in the systemic treatment of moderate-severe psoriasis; however, real-life data is limited. Thus, this study aimed to assess the efficacy and safety of secukinumab in patients with psoriasis. Materials and Methods: In this study, 32 patients treated with secukinumab were retrospectively reviewed. The efficacy of secukinumab was evaluated as psoriasis area and severity index (PASI) 50, 75, and 90 response rates at 16., 24., and 36. weeks, respectively. Side effects of secukinumab treatment were recorded. Results: The mean PASI of 32 patients before treatment was 12.38±6.49, which decreased to 1.96, 1.85, and 3.01, after 16, 24, and 36 weeks, respectively. At 16 weeks of treatment, 83.3% of patients reached PASI 50, 70.0% had PASI 75, and 50.0% had PASI 90 response rates. At 16, 24, and 36 weeks, PASI 50, 75, and 90 responses were generally higher in patients naive to biologic than the non-naive; however, differences were not statistically significant (p>0.05). Secukinumab was discontinued in 7 (21.9%) patients during the treatment. Of the 7 patients, 5 (15.6%) patients failed to respond to secukinumab and 2 (6.2%) developed various side effects. Oral candidiasis was observed in 4 (12.5%) patients, which was the most common side effect of secukinumab treatment. Conclusion: Secukinumab is an effective and safe treatment option in patients with psoriasis. The secukinumab efficacy in clinical practice is higher in patients naive to biologic.

Cyclosporine is an immunosuppressive agent used in the treatment of psoriasis. It shows its action through calcineurin inhibition and T-lymphocytes. With its rapid effect, it can be used as an induction therapy in plaque, pustular and erythrodermic psoriasis. Its most common side effects are elevated serum creatinin values and arterial hypertension. In long-term treatment not to exceed 2 years, it may be used under nephrology control.

Certolizumab is a Fab fragment of a humanized monoclonal antibody against tumor necrosis factor-alpha (TNF-α). Differing from the other TNF-α inhibitors due to the absence of Fc fragment and pegylation, it binds to both the soluble and transmembrane forms of TNF-α, creating a strong TNF-α blockage. Previously approved for psoriatic arthritis, certolizumab received another approval from FDA in 2018 for the treatment of moderate to severe chronic plaque psoriasis that does not respond to conventional systemic treatments or for which these treatments are contraindicated. Administered via subcutaneous injections, certolizumab also has a low-dose option for patients weighing less than 90 kg. Certolizumab is considered a safe biological drug that can be preferred during pregnancy and lactation.

Secukinumab is a human immunoglobulin G1/κ monoclonal antibody targeting interleukin-17A. In clinical trials, 77-81% of the secukinumab patients achieved a PASI75 response in 12 weeks. As well as in chronic plaque psoriasis, secukinumab has also been found effective and safe as monotherapy in nail and hairy skin psoriasis and psoriatic arthritis. Secukinumab should be used with caution in patients or their first-degree relatives who have inflammatory bowel disease. It has a safe side effect profile in terms of latent tuberculosis activation.

Brodalumab is a human monoclonal antibody that inhibits interleukin-17 (IL-17) pathway by binding to IL-17 receptor. In clinical trials, a PASI75 response has been achieved in 82-84% of the patients at week 12. It was shown to be effective also in generalized pustular and erythrodermic psoriasis. As with other IL-17 inhibitors, brodalumab should be used with caution in patients with inflammatory bowel disease.

Tofacitinib is an oral inhibitor of janus kinases, which is approved for the treatment of rheumatoid arthritis, psoriatic arthritis, and ulcerative colitis in adults; its efficacy in the treatment of psoriasis has also been demonstrated in clinical studies. A 10 mg daily dose has been observed to achieve a PASI75 response in 40-64% of the patients with moderate to severe psoriasis at week 12 or 16. It provides advantage in the treatment of psoriasis due to oral use, lower cost compared to other biologics, and absence of organ toxicity.

Topical corticosteroids and vitamin D analogs can be combined with other topical, systemic, and biological agents. The effect of methotrexate can be enhanced with ultraviolet B (UVB) or psoralen ultraviolet A (PUVA). When a biological agent remains insufficient, the first agent to be added to the treatment is methotrexate. The use of acitretin in combination with phototherapy (both UVB and PUVA) has a synergistic effect. A UVB therapy may be combined with topical tar and anthralin as well as with etanercept and adalimumab, which are anti-tumor necrosis factor-α therapies.

Aim:Psoriasis is an inflammatory skin disease characterized by hyperproliferation of keratinocytes. The imbalance between Interleukin-1 (IL-1)/IL-1 receptor antagonist (IL-1Ra) is associated with increased pro-inflammatory cytokine production and the development of inflammatory disorders. The number of repeats in the polymorphic site where IL-1Ra has an 86 bp sequential repeat sequence is of functional importance as it includes possible binding sites for transcription factors. In this context, we aimed to investigate the relationship between psoriasis and IL-1Ra VNTR in Turkish society.Methods:One hundred twenty one patients (79 female/42 male), 250 controls (142 women/108 male) were included in the study groups and genotyped by polymerase chain reaction-restriction fragment length polymorphism method. Genotype and allele distributions were examined between the patient and control groups. The gene counting method was used to calculate the allele frequencies.Results:The A1 allele is excessive in the control group (p=0.001). In addition, the fact that all of our patients with psoriasis area and severity index

Psoriasis is a polygenic, systemic inflammatory disease seen in 2% to 3% of the population and leads to a serious deterioration in the quality of life. As a result, studies on the pathophysiology of this disease have led to the development of cytokine-targeted therapies, especially the widespread use of treatments targeting tumor necrosis factor-alpha (TNF-α). The role of TNF-α in inflammation and important physiological pathways has increased safety concerns. In the literature, it has been reported that infections, cardiac failure, neurological diseases, and malignancies may develop related to the use of anti-TNF-α agents. In this case report, a 59-year-old male patient was started on adalimumab as a biological agent for erythrodermic psoriasis. Twenty-four months after starting biological agent therapy, hard nodules occurred under his skin in both the inguinal and axillary regions. The patient was diagnosed with diffuse large B-cell lymphoma based on his histopathological and laboratory examinations. This case report aims to discuss the specific malignancies that may develop from anti-TNF-α agents and the potential pathophysiological mechanisms suggested in the current literature.

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Treatment with anti-tumour necrosis factor-alpha (anti-TNF-α) drugs provides significant improvements in many chronic inflammatory diseases with common pathogenesis, including Crohn’s disease, ankylosing spondylitis and psoriasis. However, during these treatments, paradoxically, cutaneous side effects such as psoriasis can be seen. Although its pathophysiology is well understood, it is thought that TNF-α blockade triggers locally excessive interferon-α production in predisposed subjects and causes psoriatic lesions. In this case report, we present a 50-year-old female patient with ankylosing spondylitis and Crohn’s disease who used adalimumab and then infliximab and developed psoriasiform lesions due to these drugs. Anti-TNF-α treatment was discontinued, and ustekinumab was started. Psoriasiform rashes improved; disease activity of ankylosing spondylitis and Crohn’s disease was suppressed. Ustekinumab may be a good option to manage ankylosing spondylitis and patients with Crohn’s disease who develop psoriasiform rashes due to anti-TNF-α drugs.

Background and Design: Psoriasis is a chronic inflammatory skin condition associated with several systemic comorbidities including cardiovascular diseases (CVD). Epicardial fat pad (EFP) is defined as a visceral fat tissue surrounding the heart and coronary vessels. Recent studies revealed epicardial fat thickness, which is also increased in psoriasis, as an early sign of CVD. The aim of this study was to evaluate EFP prevalence and its associations in psoriasis patients. Materials and Methods: Two hundred thirty-seven psoriasis and 113 control patients were assessed for CVD risk factors, Psoriasis Area Severity Index, body composition parameters and laboratory work-up. Controls were chosen from outpatients who lack any chronic inflammatory skin disease and/or systemic inflammatory disease. Evaluation of chest X-rays were performed by a radiologist who was unaware of clinical data. Results: 42.2% of psoriasis patients (n=100) and 31% of controls (n=35) had EFP detected on chest X-ray revealing psoriasis patients had significantly more prevalent EFP than the controls (p=0.047). Prevalence of major CVD risk factors was statistically higher in psoriasis patients (60%, n=142) compared to controls (32%, n=36), (p

Objective: Patients with psoriasis have increased systemic inflammation and monocytes levels compared with the general population. However, the role of monocytes in modulating inflammation in these patients is not clearly known. Psoriasis patients, where inflammation plays a role, are also at risk for cardiovascular diseases. The monocyte-to-lymphocyte ratio (MLR) may reflect a systemic inflammatory status. The aim of this study was to investigate the usefulness of MLR in patients with psoriasis. Materials and Methods: A total of 180 consecutive patients who had been routinely referred to psoriasis outpatient clinic,and 40 healthy individuals were included in our case-control study between January 2015, and January 2017. Demographic features, Psoriasis Area and Severity Index (PASI) scores,and laboratory data were collected from electronic database system. Results: Patients with psoriasis had higher leukocyte, neutrophil, monocyte counts and MLR compared with control group (p=0.003, p

This study aimed at investigating the themes that emerged after an art therapy and assessing the effectiveness of art therapy using psychological scales and dermatological evaluation indices before and after the therapy in individuals with psoriasis. The study included patients aged 18-65 with moderate psoriasis who had the disease for 5 or more years and were in need of systemic treatment. Those who had a concomitant physical disorder including another skin disease, an active joint disorder or a psychiatric diagnosis other than adjustment disorder were excluded from the study. A total of 15 sessions each lasting 150 minutes were held once a week. Various art techniques including music, painting, and ceramics were practiced to evaluate within the group patients’ understanding of the illness and their self-awareness. The outcomes of the study were presented over three patients who attended the sessions regularly. The dermatological evaluations, patient feedback, and observations of the psychotherapists have shown that art therapy can be an effective method in attenuating the symptoms of psoriasis and evoking awareness of repressed experiences or feelings.

The purpose of this study was to examine alexithymia levels and abilities to recognize facial emotions among psoriasis patients and compare with healthy controls. Sixty psoriasis patients diagnosed in dermatology clinics, and 65 age, sex and educationally matched healthy controls were assessed for this randomized controlled trial. Psoriasis Area Severity Index (PASI) was applied to patients in dermatology clinics, Structured Clinical Interview for DSM-IV Axis-1 Disorders, 20-item Toronto Alexithymia Scale (TAS-20), Facial Emotion Recognition Test (FERT) were applied to patients and controls in psychiatry clinics. Patients’ mean TAS-20 total scores were higher, while their ability to recognize negative facial emotions were lower than the control group Patients might have underestimated especially negative emotions over time, for a possible defense mechanism against depression and anxiety. Alexithymia levels were significantly related with psoriasis disease severity. Thus, alexithymia might be a predictor for severity of psoriasis.

Background and Design: Psoriasis is a chronic, inflammatory disease, and several biochemical markers play role in its inflammatory process. This study measured the levels of interleukin-12 (IL-12), IL-17a, IL-22 and IL-23, high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-α) and serum growth differentiation factor-15 (GDF-15) and aimed to detect the relationship of serum GDF-15 level with inflammation and disease severity. Materials and Methods: This study included 50 consecutive patients diagnosed with plaque-type psoriasis. For all patients, dermatological examinations were performed, and psoriasis area severity index (PASI) scores were recorded. Patients with PASI <10 were considered to have mild (group 1), 10-20 moderate (group 2), and >20 severe (group 3) psoriasis. Results: No difference was observed between the patient and the control groups in terms of age, sex, IL-17a and IL-22. A statistically non- significant difference was detected in terms of IL-12 and IL-23. However, there was significant difference between two groups in terms of hs-CRP, TNF-α and GDF-15. GDF-15 was significantly different in all three groups (p<0.001). A significant correlation was observed between PASI score and disease duration (p=0.005), hs-CRP (p=0.003), TNF-α (p=0.002), and serum GDF-15 levels (p<0.001). The serum GDF-15 level that can predict a high PASI score was >1498.5 pg/mL (area under the curve: 0.813, p<0.001) in the receiver operating characteristic curve analysis. This study is mainly limited by the lack of follow-up and pre- and post-treatment assessment. Inflammatory markers were measured only in the serum, and their tissue levels are unknown. Conclusion: In addition to PASI score, GDF-15 levels can be a guide in monitoring treatment and systemic inflammation, determining the disease severity, and providing efficient treatment. [ABSTRACT FROM AUTHOR]