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Cytokines in the interleukin (IL)-23/IL-17 axis are central to psoriasis pathogenesis. Janus kinase (JAK) signal transducer and activator of transcription (STAT) regulates intracellular signalling of several cytokines (including IL-12, 23, 22, 6, 17, and interferon (IFN)-γ) in the IL-23/IL-17 axis, and, as a result, has become a therapeutic target for psoriasis treatment. Although several JAK1-3 inhibitors, with varying degrees of selectivity, have been developed for immune-mediated inflammatory diseases, use in psoriasis is limited by a low therapeutic index as anticipated by signals from other disease indications. More selective inhibition of the JAK family is an area of interest. Specifically, selective tyrosine kinase (TYK)2 inhibition suppresses IL-23/IL-17 axis signalling, and at therapeutic doses, has a favorable safety profile compared to therapeutic doses of JAK1-3 inhibitors. Phase III efficacy and safety data for the selective allosteric TYK2-inhibitor, deucravacitinib, in adult patients with moderate-to-severe plaque psoriasis is promising. Furthermore, phase II clinical trials for ropsacitinib (PF-06826647), a selective TYK2 inhibitor, and brepocitinib (PF-06700841), a JAK1/TYK2 inhibitor, have also demonstrated efficacy and an acceptable safety profile in adult patients with moderate-to-severe plaque psoriasis. Other novel TYK2 allosteric inhibitors, NDI-034858 and ESK-001, are currently being investigated in adult patients with plaque psoriasis. This article reviews the details of the JAK-STAT pathway in psoriasis pathophysiology, the rationale for selective targeting of JAKs in the treatment of psoriasis, and provides clinical perspective on clinical trial data for JAK and TYK2 inhibitors.

Adherence to topical treatment for a variety of chronic skin conditions, such as psoriasis, acne, and atopic dermatitis, is known to be very poor. A number of factors contribute to this phenomenon, including lack of treatment efficacy and patient concerns regarding side effects, among others. At the forefront of barriers facing optimal patient adherence to topical treatment is choosing the ideal topical vehicle formulation. Medical professionals have demonstrated a lack of understanding with respect to the composition and nomenclature of the various topical formulations. In this review, we clarify the properties and definitions of the following topical formulations: ointments, creams, lotions, topical solutions, topical suspensions, gels, foams, and sprays. We also provide suggested areas of application for the aforementioned formulations and a succinct, patient-geared summary of their advantages and disadvantages. This review hopes to deliver a clear and concise practical summary of the most commonly encountered topical formulations for the treatment of cutaneous disease for medical professionals. This will allow clinicians to provide their patients with accurate information to facilitate informed choice of topical formulation, which may serve to improve treatment adherence.

Background: Biologics have transformed the management of moderate to severe psoriasis. The persistency of biologics lacks real-world data., Objectives: To quantify drug survival of infliximab (IFX), adalimumab (ADA), etanercept (ETA), and ustekinumab (UST) and to identify potential factors affecting drug survival., Methods: An observational, retrospective 2-centre study consisting of 906 patients from private practices in Ontario between July 2003 and June 13, 2016, was conducted, including patients with plaque psoriasis receiving commercial treatment with ADA, ETA, IFX, and UST. Paper and electronic records of each patient were reviewed., Results: Median survival times for UST, IFX, ADA, and ETA were respectively, in months, 68, 23, 33, and 28. Female sex was determined to be a statistically significant positive predictor of drug survival. Our study was consistent with the literature in that UST had the highest survival rate compared to the other biologics, and the shape of our drug survival curve suggested that loss of drug efficacy is a stochastic occurrence. Compared to other studies, our data exhibited lower survival rates at various time points for all the biologics studied, and female sex did not predict drug survival in other studies. We also investigated potential reasons for differences in biologic survival times between different practices; the main differentiator was drug dosage, as higher dosages were associated with greater survival., Conclusion: UST has a higher drug survival rate than ADA, ETA, and IFX, as observed in other studies. When practice patterns are compared, dosage difference is the main factor that may cause differing survival rates.

Atopic dermatitis is one of the most common skin disorders in the developed world, affecting up to 20% of children and 1% to 3% of adults. This review concisely explains the pathophysiology and epidemiology of atopic dermatitis, as well as potential challenges facing its successful treatment. Furthermore, mainstay topical treatment modalities are evaluated, such as emollients, topical corticosteroids, and topical calcineurin inhibitors. The use of topical corticosteroids and topical calcineurin inhibitors in combination is discussed, as studies have indicated encouraging results. The proactive use of topical corticosteroids and topical calcineurin inhibitors is also investigated, in order to bring attention to a new possibility in long-term management of atopic dermatitis. Last, new and upcoming topical medications are described, including Janus kinase inhibitors, phosphodiesterase-4 inhibitors, and benvitimod. Although topical corticosteroids and topical calcineurin inhibitors can be very effective in the treatment of atopic dermatitis, it is important that practitioners are aware of mechanistically unique and new treatments for patients for whom more traditional topical therapies have failed. Overall, this review article hopes to serve as a comprehensive overview of currently available topical treatments for atopic dermatitis, while shedding light on new treatments coming in the future.

Background: Clinical trial data have shown apremilast, an oral phosphodiesterase-4 inhibitor, to be efficacious and safe for the treatment of psoriasis. However, little real-world experience using apremilast in the community setting has been documented., Objectives: Many patients with psoriasis are often unresponsive to various treatment modalities, including topical, systemic, and biologic medications. The aim of this chart review was to assess the overall patient experience while using apremilast to treat psoriasis., Methods: A retrospective chart review of electronic medical records was conducted of all patients prescribed apremilast in a community dermatology practice., Results: Of 99 patients who were prescribed apremilast, 81 patients took at least 1 dose. In 63 patients, apremilast improved clinical disease severity, with 37% of patients achieving a body surface area <1%. As a treatment, it was generally well tolerated and caused no serious adverse events. The most commonly reported side effect resulting in discontinuation of treatment of apremilast was nausea and vomiting., Conclusions: Overall, apremilast was a safe and well-tolerated treatment with significant clinical improvement in our patient population.

Background: The factors influencing the use of topical agents in combination with biologic therapies for the treatment of plaque psoriasis (PsO) are not well understood., Objective: To examine potential predictors of topical use in patients with moderate to severe plaque PsO receiving etanercept (ETN)., Methods: Post hoc descriptive analyses and a multinomial regression of the REFINE study data were used to examine associations between topical agent potency and covariates, including Psoriasis Area and Severity Index (PASI) score, study site, and province., Results: Not achieving PASI 90 at week 12 predicted topical use, with a lower PASI 90 rate in patients who used high-potency topical agents post randomization (P = .003). Additionally, statistically significant differences were found in patterns of topical use among Canadian provinces (P = .007), with the use of high-potency topical agents being greater in Ontario and Quebec than the rest of Canada., Conclusion: This analysis revealed that region and PASI 90 status at week 12 predict topical use., (© The Author(s) 2015.)