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In summary, the STYLE phase III study supports apremilast as an effective treatment for scalp psoriasis in different types of patients, including those with scalp psoriasis inadequately controlled by other therapies. During the extension phase, patients initially randomized to placebo were switched to apremilast [placebo/apremilast (P/A) group; with titration during week 16] and patients initially randomized to apremilast continued active treatment [apremilast/apremilast (A/A) group; with dummy titration during week 16] through week 32. Achievement of Numeric Rating Scale (NRS)-Scalp Itch and NRS-Whole Body Itch response was maintained at week 32 in patients continuing with apremilast and observed in patients initially randomized to placebo after switching to apremilast. [Extracted from the article]

All of the patients and the control group had no other autoimmune disease, and patients with psoriatic arthritis or other finger-joint disease were excluded. Those patients with psoriasis on systemic therapy or phototherapy were excluded when the correlation between the blood flow velocity and Psoriasis Area and Severity Index (PASI) or body surface area (BSA) was analysed, and the results were not statistically significant. Based on these findings, it was concluded that patients with PV had significant NFC abnormalities, including decreased capillary density, increased proportion of abnormal morphological capillaries, decreased blood flow velocity and dilated capillary loops. [Extracted from the article]

Intramatricial injection of anti-interleukin-17A antibody for six patients with nail psoriasis Our study suggests that intramatricial secukinumab injection is safe and effective in the treatment of NP, and that the clinical efficacy in the nail bed is superior to that in the nail matrix. Significant improvements were seen in both the nail bed (onycholysis, subungual hyperkeratosis and splinter haemorrhages) and nail matrix (nail plate crumbling), and the overall clinical efficacy in nail bed was superior to nail matrix. [Extracted from the article]

Background Although elevated serum IgE levels have been reported in psoriasis, the role of IgE in psoriasis still needs to be clarified. Objectives To analyse serum total IgE levels in addition to the presence and distribution of IgE and Fcε RI in psoriatic lesions, and to investigate alteration of IgE and Fcε RI after successful systemic treatment. Methods Total serum IgE levels were determined using enzyme-linked immunosorbent assay. The expression and localization of IgE and Fcε RI was investigated using immunohistochemistry and double immunofluorescence. Results Elevated total serum IgE levels were found in 39% of patients with psoriasis. The levels of total serum IgE were significantly higher in male patients compared with female patients. Furthermore, total serum IgE levels decreased after successful systemic treatment. A positive correlation between IgE+ and Fcε RI+ cells and a significant increase of these cells was found in psoriatic lesions when compared with normal skin. Interestingly, IgE+ and Fcε RI+ cells decreased significantly after successful therapy with ustekinumab. IgE and Fcε RI were coexpressed on mast cells, epidermal Langerhans cells, dermal dendritic cells, macrophages and a small number of neutrophils. Conclusions IgE might participate in the development of psoriasis by activating Fcε RI-bearing cells. [ABSTRACT FROM AUTHOR]

Background Differences in the number of Foxp3+ regulatory T cells (Tregs) in lesional skin and peripheral blood and their functioning in plaque vs. guttate psoriasis have not been reported. Objectives To investigate whether there is a differential expression of Foxp3+ Tregs and a differential regulation of inflammatory cytokines in plaque vs. guttate psoriasis vulgaris. Methods The number and the percentage of Foxp3+ cells in different phases of skin lesions of patients with plaque and guttate psoriasis vulgaris were assessed by immunohistochemical staining. The expression of Foxp3 and interleukin (IL)-17 protein in CD4 populations was measured by flow cytometry. Inflammatory cytokine production by transforming growth factor-β1-induced Foxp3+ Tregs was assessed in an in vitro study. The cytokines in supernatant and serum were determined by enzyme-linked immunosorbent assay. Results The percentage of Foxp3+ CD3+ cells in the papillary layer was higher than in the reticular layer of dermis and in epidermis ( P < 0·05). The numbers of Foxp3+ Tregs in skin lesions and peripheral blood were higher in plaque than in guttate psoriasis, whereas the percentage of IL-17+ CD4+ cells was higher in guttate than in plaque psoriasis ( P < 0·05). The numbers of Foxp3+ cells were positively correlated with the Psoriasis Severity Index score of skin lesions ( P < 0·0001), and the percentages of Foxp3+ CD4+ cells in peripheral blood were positively correlated with the Psoriasis Area and Severity Index score of patients ( P < 0·05). The inhibitory functions of Tregs to IL-17 and IL-6 in guttate psoriasis and to tumour necrosis factor-α in plaque psoriasis were deficient. Conclusions Differential expression and regulatory functioning for inflammatory cytokine production by Foxp3+ Tregs may imply a different immunopathogenesis for plaque and guttate psoriasis. [ABSTRACT FROM AUTHOR]

Background The comparative efficacy and tolerability of conventional and biologic treatments for moderate-to-severe plaque psoriasis are unknown. Objectives To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) reporting efficacy of systemic treatments approved for moderate-to-severe psoriasis by means of the Psoriasis Area and Severity Index (PASI). Methods We identified relevant articles by systematic electronic searches (Cochrane Library, Medline, Embase, Scopus). Efficacy was defined as proportion of participants with ≥ 75% decrease in PASI (PASI-75) at primary efficacy measurement (week 8–16). PASI-75 response rates of double-blind placebo-controlled trials were summarized as risk differences (RDs) and pooled using random effects models. Tolerability was assessed from rates of withdrawals and adverse events. Results Twenty-four RCTs totalling 9384 patients were analysed qualitatively. Sixteen double-blind placebo-controlled trials were eligible for meta-analysis. Infliximab was significantly superior to all other interventions [RD 77%, 95% confidence interval (CI) 72–81%]. Adalimumab (RD 64%, 95% CI 61–68%) was superior to ciclosporin (RD 33%, 95% CI 13–52%), efalizumab (RD 24%, 95% CI 19–30%), etanercept 50 mg twice weekly (RD 44%, 95% CI 40–48%) and etanercept 25 mg twice weekly (RD 30%, 95% CI 25–35%). Efalizumab was significantly less efficacious than fumaric acid esters (RD 48%, 95% CI 32–64%). Rates of withdrawals due to adverse events were highest for methotrexate and fumaric acid esters. Conclusions The efficacy of systemic agents approved for moderate-to-severe psoriasis differs considerably both within and between biologics and nonbiologics. Infliximab is most efficacious, followed by adalimumab. Patients receiving infliximab have an excess chance of 77% over placebo to achieve PASI-75 response. Published evidence questions regulatory guidelines that recommend biologics as second-line therapy for moderate-to-severe plaque psoriasis. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about telomerase activity in peripheral blood mononuclear cells of psoriatic patients correlates with disease severity.

Summary: Psoriasis is a common skin disease that affects about 2% to 3% of people. The cause is unknown and believed to involve the genes and immune system, and the treatments we use now can control psoriasis but do not cure it. This study, from China, aimed to find out the effect and mechanism (way of working) of a drug called methotrexate on cells called regulatory T cells, which have the power to fight back and calm down the skin, as well as its relationship with the pathway of a chemical in the body called adenosine, which is a target in psoriasis therapy. Regulatory T cells (and effector T cells, which can trigger psoriasis) were isolated from the blood of healthy people and patients with psoriasis. Various laboratory tests were used to examine the effect of methotrexate on the adenosine pathway. The authors found that psoriasis patients have regulatory T cells with decreased function, meaning they do not work so well, and reduced CD73 level, which was the starting section of adenosine pathway. Furthermore, methotrexate could restore the immunosuppressive function of regulatory T cells by affecting part of the adenosine pathway, including increasing CD73 expression and regulating its related signal pathway. In conclusion, the study deepens doctors' and patients' understanding of methotrexate in the treatment of psoriasis, and contributes to our understanding of psoriasis. Linked Article: Yan et al. Br J Dermatol 2018; 179:896–905 [ABSTRACT FROM AUTHOR]