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This article discusses psoriasis with a brief overview of the various types. It considers the symptoms, aetiology and treatment options and hopes to give nurses and non-medical prescribers more confidence in recognising and treating this disease. [ABSTRACT FROM AUTHOR]

Background: Psoriasis is a chronic, recurring, and immune-mediated inflammatory skin disease. Throughout the period of the last few decades, phototherapy has become widely used in treating stable psoriatic lesions. For the treatment of psoriasis, several light/laser therapies with distinct modes of action have been developed. Cold laser therapy might be an effective therapeutic choice for localized plaque psoriasis. Objective: To assess the safety and efficacy of cold laser therapy clinically and microscopically in localized plaque psoriasis treatment. Patients and methods: 40 patients with localized mild plaque psoriasis were selected from the Dermatology and Venereology outpatient clinic-Tanta University Hospitals and enrolled in the clinical trial. They were treated by cold laser 808nm wavelength (Endolaser 422, Enraf-nonious B.V. Rotterdam, Netherlands) one session for 10 min on each plaque twice weekly separated by 2 days until clinical cure or for a maximum of 8 weeks. Evaluation was done immediately after the last session by taking the average of three blinded dermatologists of the photos, the modified Psoriasis Area and Severity Index [mPASI], dermoscopic examination, patients' satisfaction scale and histopathological and electron microscopic examination of punch biopsy specimens taken before and after the end of treatment from psoriatic lesions in four patients only. Results: There was a statistically significant clinical improvement after the end of treatment compared with before treatment as 16 patients (40%) showed excellent improvement, 8 patients (20%) showed good improvement, 9 patients (22.5%) showed mild improvement, and 7 patients (17.5%) showed poor improvement. As regard mPASI, a statistically significant decrease in mPASI was found after the end of treatment (P<0.001). Regarding dermoscopic examination, a statistically significant reduction in the percentage of patients showing dermoscopic red dots and white scales after the end of treatment (P<0.01). As regard the patients' satisfaction scale, 82.5% of patients were satisfied from the results. Histopathological and ultrastructural evaluation revealed normalization of the psoriatic microscopic changes with cold laser. Conclusion: The use of cold laser therapy for the management of localized mild plaque psoriasis is safe, tolerable, effective, and can be used as an alternative therapy for psoriasis. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic inflammatory skin disorder, and current treatments include topical therapies, phototherapy, systemic immune modulators, and biologics, aiming to alleviate symptoms and improve quality of life. The prevalence of psoriasis varies globally, affecting around 2% of the population. However, challenges persist, such as adverse effects, treatment resistance, high costs, and variability in response among individuals Phototherapy using PUVA or UVB is another option for moderate to severe cases.The future of psoriasis treatment shows promising emerging trends. New biologic agents targeting novel pathways, such as interleukin 23 inhibitors like mirikizumab, offer enhanced efficacy. Small molecule inhibitors like RORγt inhibitors and ROCK2 inhibitors provide additional treatment options. Combination therapies, including biologics with methotrexate, may improve treatment response. Advancements in topical treatments utilizing microneedles and nanoparticle-based carriers can enhance drug delivery and improve therapeutic outcomes. Biomarkers and multi-omics technologies hold potential for personalized treatment approaches, thus aiding in diagnosis, predicting treatment response, and guiding therapeutic decisions. Collaboration among researchers, clinicians, and industry stakeholders is crucial to translating these scientific break throughs into clinical practice. By addressing current challenges and exploring these promising trends, we can optimize psoriasis management and improve the lives of those affected by this chronic condition. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic inflammatory skin condition affecting millions of individuals worldwide. Over the years, various treatment modalities have been explored to alleviate the symptoms and improve the quality of life for patients with psoriasis. Among these treatment options, lasers and lights have emerged as promising non-invasive approaches with significant efficacy. This review aims to provide an overview of the current understanding and clinical applications of lasers and lights in the management of psoriasis. We have discussed the mechanisms of action behind different laser and light therapies and their impact on psoriatic plaques. Additionally, we discuss the various types of lasers and lights utilized, including excimer lasers, pulsed dye lasers, and narrowband ultraviolet B (NB-UVB) phototherapy, highlighting their unique properties and clinical outcomes. Moreover, we have addressed important considerations related to patient selection, treatment protocols, and potential side effects associated with lasers and lights. We emphasize the need for proper evaluation, monitoring, and customization of treatment plans to ensure optimal outcomes and minimize adverse events. [ABSTRACT FROM AUTHOR]

Psoriasis is an inflammatory dermatosis manifested by the appearance of brown-red papules on the body, covered with silver scales. One of the most common and effective treatments for psoriasis is narrow-band UVB phototherapy. Narrow-band UVB has a wavelength of 311 nm, which results in shallow skin penetration, is absorbed only by the epidermis and the superficial layers of the dermis. The aim of the study was to assess the effect of narrow-band UVB 311 nm phototherapy on skin covered with psoriatic scales and without psoriatic lesions in patients with psoriasis vulgaris on the total directional hemispherical reflectance (DHR) of the skin, skin density and epidermis thickness. For this purpose, a 410 Solar DHR reflectometer and high-frequency ultrasonography DUB SkinScanner were used. A total of 48 volunteers were enrolled. There was a difference in the reflectance of skin without psoriatic scales and psoriatic skin. Depending on the wavelength range, the skin was characterized by different reflectance values. During the course of phototherapy, the reflectance values decreased, both in the psoriatic skin and skin without psoriatic scales. After the phototherapy, the epidermis thickness and SLEB layer decreased and skin density increased in the area with psoriatic plaque. The density of the skin without psoriasis after a series of 20 irradiations increased, while the thickness of the epidermis did not change. [ABSTRACT FROM AUTHOR]

The article provides information on psoriasis, a chronic, immune-mediated dermatological condition, and its implications for nursing care. Topics discussed include risk factors and aetiology of the disease, pathophysiology and clinical classification of psoriasis which includes inverse psoriasis, guttate psoriasis and pustular psoriasis, and diagnosis and treatment for the disease.

One of the most commonly used and effective lines of treatment in chronic skin diseases is phototherapy. A protocol of the Kasr Al-Ainy Phototherapy Unit has been proposed for the treatment of different dermatological diseases such as psoriasis, mycosis fungoides, and vitiligo based on the best current research-based guidelines and the experience of the phototherapy team. This protocol is the cornerstone of the everyday practice in Kasr Al-Ainy Phototherapy Unit and the authors believe that dermatologists dealing with such diseases in their hospitals or clinics can find it helpful and applicable to get better results with their patients. In part 2, the specific measures of the protocol for phototherapeutic management of different skin diseases will be discussed. [ABSTRACT FROM AUTHOR]

Psoriasis can affect many areas of the body, respectively; treatment should be directed to the affected areas according to their localization. The most difficult in treatment and aesthetic care are considered to be psoriasis of the nails, scalp, and palmar-plantar localization. These areas are visible all the time and well-groomed condition is of great importance for women. This article is devoted to the analysis of data on the peculiarities of care and the complexities of the treatment of psoriasis of aesthetic areas. Nail psoriasis is difficult to treat with topical therapy since the remedy must be optimized for penetration into the nail and surrounding tissues. Part of the inflammation in nail disease is located deep in the nail matrix and, therefore, is difficult to treat locally. Psoriasis of the scalp is difficult to treat with local and phototherapy, due to the need for specific hair and scalp care. Palms and soles often have particularly thick psoriasis plaques, which can interfere with the absorption of topical therapy and resist phototherapy. Patients with predominantly palmar-plantar disease often do not respond to several treatments, and many require combination therapy to control the disease. Collectively, psoriasis of the nails, scalp, and palmar-plantar psoriasis are considered complex conditions and often do not respond to standard treatment protocols and require aesthetic medicine measures. [ABSTRACT FROM AUTHOR]

Psoriasis is an inflammatory dermatosis manifested by the appearance of brown-red papules on the body, covered with silver scales. One of the most common and effective treatments for psoriasis is narrow-band UVB phototherapy. Narrow-band UVB has a wavelength of 311 nm, which results in shallow skin penetration, is absorbed only by the epidermis and the superficial layers of the dermis. The aim of the study was to assess the effect of narrow-band UVB 311 nm phototherapy on skin covered with psoriatic scales and without psoriatic lesions in patients with psoriasis vulgaris on the total directional hemispherical reflectance (DHR) of the skin, skin density and epidermis thickness. For this purpose, a 410 Solar DHR reflectometer and high-frequency ultrasonography DUB SkinScanner were used. A total of 48 volunteers were enrolled. There was a difference in the reflectance of skin without psoriatic scales and psoriatic skin. Depending on the wavelength range, the skin was characterized by different reflectance values. During the course of phototherapy, the reflectance values decreased, both in the psoriatic skin and skin without psoriatic scales. After the phototherapy, the epidermis thickness and SLEB layer decreased and skin density increased in the area with psoriatic plaque. The density of the skin without psoriasis after a series of 20 irradiations increased, while the thickness of the epidermis did not change.

Considering its effects, side effects, and contraindications, phototherapy is a treatment option that can be used in patients who do not respond to topical treatments, suffer side effects, or have diffuse lesions. By showing antiproliferative, immunomodulatory, and anti-inflammatory actions, phototherapy may help heal psoriatic lesions. Phototherapy can be administered as narrow-band UVB or PUVA. It can be combined with other anti-psoriatic therapies. Since it may increase the risk of non-melanoma skin cancer, its use should be limited to a certain number of sessions, and any maintenance treatment involving phototherapy should be avoided. [ABSTRACT FROM AUTHOR]

Objective: To examine the association of biologic therapy use for psoriasis with incident psoriatic arthritis (PsA) diagnosis.Methods: A retrospective cohort study was conducted in the OptumInsights Electronic Health Record Database between 2006 and 2017 among patients with psoriasis between the ages of 16 and 90 initiating a therapy for psoriasis (oral, biologic or phototherapy). The incidence of PsA was calculated within each therapy group. Multivariable Cox models were used to calculate the HR for biologic versus oral or phototherapy using biologics as a time-varying exposure and next in a propensity score-matched cohort.Results: Among 1 93 709 patients with psoriasis without PsA, 14 569 biologic and 20 321 cumulative oral therapy and phototherapy initiations were identified. Mean age was lower among biologic initiators compared with oral/phototherapy initiators (45.9 vs 49.8). The incidence of PsA regardless of therapy exposure was 9.75 per 1000 person-years compared with 77.26 among biologic users, 61.99 among oral therapy users, 26.11 among phototherapy users and 5.85 among those without a prescription for one of the target therapies. Using a multivariable adjustment approach with time-varying exposure, adjusted HR (95% CI) for biologic users was 4.48 (4.23 to 4.75) compared with oral or phototherapy users. After propensity score matching, the HR (95% CI) was 2.14 (2.00 to 2.28).Conclusions: In this retrospective cohort study, biologic use was associated with the development of PsA among patients with psoriasis. This may be related to confounding by indication and protopathic bias. Prospective studies are needed to address this important question. [ABSTRACT FROM AUTHOR]

Objectives: To compare the incidence of psoriatic arthritis (PsA) in patients with psoriasis (PsO) according to different treatments for their skin: topics/no treatment, conventional disease-modifying antirheumatic drugs (DMARDs) (cDMARDs) or biological DMARDs (bDMARDs).Methods: Patients with PsO without PsA followed at a university hospital were included in this retrospective cohort study. Patients were classified according to their treatment in topics (topics, phototherapy or no treatment), cDMARDs (methotrexate and cyclosporine) and bDMARDs (tumour necrosis factor inhibitors (TNFi), interleukin 17 inhibitors (IL-17i) and IL-12-23i ((interleukin (IL) 12/IL-23 inhibitor))) groups. Incident cases of PsA were attributed to one treatment if developed during the administration of that treatment. A Cox proportional hazards model was used to evaluate the adjusted risk of PsA development by treatment group.Results: 1719 patients with PsO contributed a total of 14 721 patient/years (py). 1387 (81%) patients were in the topics, 229 (13%) in cDMARDs and 103 (6%) in the bDMARDs group. During follow-up, 239 patients (14%) developed PsA (231 under topics, six under cDMARDs and two under bDMARDs). Global incidence was 1.6 per 100 py. The risk of developing PsA in patients with PsO treated with bDMARDs was significantly lower (incidence rate ratio (IRR)=0.26; 95% CI 0.03 to 0.94; p=0.0111), compared with topics, but not compared with cDMARDs (IRR=0.35; 95% CI 0.035 to 1.96; p=0.1007). Adjusted Cox proportional hazards regression analysis showed that male sex, nail involvement and higher body max index were associated with increased risk of developing PsA, while biologics use was protective (HR: 0.19; 95% CI 0.05 to 0.81).Conclusion: Treatment with biologics in patients with PsO reduced the risk of PsA development. [ABSTRACT FROM AUTHOR]

Background Methotrexate and phototherapy are traditional treatments for psoriasis, but their prolonged use is associated with cumulative toxicity, so physicians are in a continuous need for tools to predict and monitor the progress of the disease. Objective To detect if there is any role for dermoscopy in determining the psoriatic patients’ response to phototherapy and methotrexate. Patients and methods A total of 70 patients with psoriasis were treated by methotrexate or phototherapy with narrow-band ultraviolet B for four months according to their local and general conditions. Psoriasis Area and Severity Index score calculation and dermoscopic examination were done at baseline, after 1 month, and after 4 months of starting treatment. Results A significant association was noted between changes in the vessel distribution in psoriatic lesions and the response to treatment according to Psoriasis Area and Severity Index score assessment along treatment visits, whereas presence of hemorrhagic dots was significantly associated with poor clinical response. Conclusion The use of dermoscopy in assessing vascular distribution and hemorrhagic dots may reflect the severity of psoriasis and can predict the clinical response to either methotrexate or phototherapy.

Light-emitting diode treatments are an established therapy in many medical aesthetic clinics. Most machines are designed for facial treatment and work by non-thermal photobiomodulation-stimulating fibroblast proliferation, collagen synthesis and growth factors. They use mainly blue, red and near infrared light and are efficacious in treating acne, psoriasis, photorejuvenation and wound healing. The treatment has relatively few side effects and has a short downtime. They tend to be used in combination with other treatment modalities, such as radiofrequency, skin-tightening and lasers, but can be used as a standalone treatment. Treatment protocols vary but usually require several treatments over a few weeks, with the effects taking 3 to 6 months to become evident. Recently, light-emitting diode masks have become popular, but their evidence base for effectiveness is currently weak. [ABSTRACT FROM AUTHOR]

Background: There are independent studies on PUVA and NB-UVB therapy for the treatment of psoriasis, but studies comparing both PUVA and NB-UVB are scarce. Aim: The aim of this study was to compare the efficacy and safety of PUVA and NB-UVB therapy in chronic plaque psoriasis. Materials and Methods: Fifty patients of chronic plaque psoriasis of more than 20% of body surface area and of more than 2 years duration with Psoriasis Area Severity Index (PASI) score of more than 10, aged above 12 years, were subjects in the study. PASI score was recorded. Patients were randomly allocated to one of the two groups, each consisting of 25 patients and administered therapy as per protocol: Group A: PUVA--psoralens + UVA or Group B: NB-UVB phototherapy. Therapeutic response of patients was followed up every week and PASI score was calculated at 0, 2, 4, 6, 8, 10, and 12 weeks. Observations: Commonest age group afflicted in both the groups was 31-40 years. There was significant improvement (P-value <0.0001) from baseline to 12th week in patients subjected to PUVA as well as NB-UVB therapy. In the PUVA group, minimum and maximum duration of treatment for PASI 75 was 5 and 11 weeks, respectively, whereas in the NB-UVB group it was 6 and 12 weeks, respectively. In the PUVA group, minimum and maximum number of exposures for PASI 75 was 10 and 22, respectively, and in the NB-UVB group it was 18 and 36, respectively. Conclusion: PUVA and NB-UVB are both effective therapies. However, NB-UVB is considered as good, effective, and safer treatment for plaque psoriasis with no or minimal long-term carcinogenic risk, and it can be safely used in children, pregnant women, and in patients with hepatic and renal insufficiency. However, more number of exposures and less energy (joules) are required in NB-UVB to achieve therapeutic target. Limitations: The number of cases in the study is less. [ABSTRACT FROM AUTHOR]

Introduction: Psoriasis is one of the most common chronic skin diseases affecting up to 2% of the general population. In recent years, an important direction for the development of treatment for psoriasis has been the use of blue light emitted by LED lamps. Aim: To evaluate the efficacy of blue-light emitting device in psoriasis vulgaris treatment. Material and methods: The study involved 30 adults with a mild form of psoriasis vulgaris not previously receiving biological treatment and other forms of phototherapy. Participants of the study used a device emitting blue LED light for 3 months. Each participant received a device for use at home, with which he/she exposed 2 psoriatic lesions located on the limbs. Before and after the study, the severity of the disease was evaluated using PASI, DLQI and LPSI. Results: During 3 months of the therapy, a statistically significant in the mean LPSI (in both treated locations) and DLQI was noted (LPSI decrease from 5.25 ±1.82 to 1.98 ±1.74, p < 0.0001; DLQI from 7.36 ±5.59 before the study to 5.23 ±4.62 after the study. Conclusions: Our results confirm that phototherapy using blue LED lights is both a safe and highly effective way to treat psoriasis. [ABSTRACT FROM AUTHOR]

Psoriasis is a clinically heterogeneous lifelong skin disease that presents in multiple forms such as plaque, flexural, guttate, pustular or erythrodermic. An estimated 60 million people have psoriasis worldwide, with 1.52% of the general population affected in the UK. An immune-mediated inflammatory disease, psoriasis has a major genetic component. Its association with psoriatic arthritis and increased rates of cardiometabolic, hepatic and psychological comorbidity requires a holistic and multidisciplinary care approach. Psoriasis treatments include topical agents (vitamin D analogues and corticosteroids), phototherapy (narrowband ultraviolet B radiation (NB-UVB) and psoralen and ultraviolet A radiation (PUVA)), standard systemic (methotrexate, ciclosporin and acitretin), biologic (tumour necrosis factor (TNF), interleukin (IL)-17 and IL-23 inhibitors) or small molecule inhibitor (dimethyl fumarate and apremilast) therapies. Advances in the understanding of its pathophysiology have led to development of highly effective and targeted treatments. [ABSTRACT FROM AUTHOR]

Paul Charlson discusses the evidence on the efficacy of low-level light treatments and the common skin conditions that can be treated [ABSTRACT FROM AUTHOR]

Background: Psoriasis is a chronic inflammatory disease affecting ~2–3% of the Australasian population. Therapeutic options include topical agents, phototherapy, systemic immunomodulators and biologic agents. Biologics present an acceptable short‐ and medium‐term safety profile, derived mainly from randomised controlled trials (RCTs) and, however, may not represent real‐world rates of adverse events (AEs). Methods: A retrospective, observational study of patients enrolled in The Australasian Psoriasis Registry from April 2008 to October 2018 was conducted. Data were collected from 104 sites in Australia and New Zealand. Patient characteristics, treatments and AE data were collected. AEs were classified by MedDRA System events. Results: 2094 patients were included (3765 patient‐treatments), comprising; 1110 phototherapy, 1280 systemic and 1375 biologic therapy patient‐treatments. Treatment arms were not mutually exclusive. The mean ± SD from date of diagnosis of psoriasis to commencement of biologic therapy was 8.9 ± 12.3 years. Methotrexate had the longest exposure time (3740.3 patient‐years), and ustekinumab had the longest median (95% CI) time on treatment, 4.3 years (2.2, 6.6). AE differences on biologic treatment were present between patients who would have been eligible or ineligible for RCTs. Approximately 29% of registry patients would have been excluded from clinical trials enrolment. Patients ineligible for RCTs had increased adjusted hazard ratios (95% CI) of: infections and infestations (2.3, 1.7–3.1; P < 0.001), cardiac (8.2, 3.5–25.6; P < 0.001), gastrointestinal (3.5, 1.52–8.0; P < 0.001), hepatobiliary (5.6 1.7–19.1; P < 0.001), psychiatric (4.7, 1.5–14.1; P = 0.006) and eye disorders (4.8 1.5–15.6; P = 0.008), compared to those eligible for RCTs. Incidence rates in the trial eligible patients were similar to those reported from RCT rates. Conclusions: This study establishes treatment modalities in use for severe psoriasis and the clinical rates of AEs associated with biologic therapy. [ABSTRACT FROM AUTHOR]

Erythrodermic psoriasis is a relatively rare, more dangerous inflammatory variant of psoriasis associated with high morbidity and mortality. It can be exceptionally challenging to manage, defeating even the most experienced dermatologist's arsenal of treatment strategies. Goeckerman therapy, a regimen of ultraviolet B phototherapy and crude coal tar, has demonstrable efficacy in severe and recalcitrant plaque-type psoriasis. However, its utility in erythrodermic psoriasis has not been explored within the dermatology literature. Herein, we present a patient with a long-standing history of erythrodermic psoriasis refractory to eleven treatment modalities including four biologic agents, who had his erythroderma 'turned around' following Goeckerman therapy. 'Turned around' is used to describe dramatically reducing a patient's cutaneous inflammation so that previously recalcitrant disease can now respond to maintenance therapy. The importance of a one to three week 'cool down' period of topical corticosteroid therapy prior to phototherapy or crude coal tar use is highlighted in this case as well. Although Goeckerman therapy is no longer regularly used, it remains one of the most efficacious treatments available for intractable psoriasis, attracting patients from all over the country desperate for symptom relief. This case suggests it may be useful in 'turning around' extremely difficult-to-treat erythrodermic psoriasis as well. [ABSTRACT FROM AUTHOR]

The article discusses the treatment of psoriasis in pregnancy, particularly the safety of using topical and systemic agents. Also cited are the 2019 American Academy of Dermatology--National Psoriasis Foundation guidelines on biologics as psoriasis treatment, the possible comorbidities and worse pregnancy outcomes in women with psoriasis, and the possible psoriasis treatments in pregnant women like phototherapy, oral medications, and small-molecule inhibitors.

The article discusses the 2019 guidelines for the use of phototherapy in the treatment of patients with psoriasis, which was released by the American Academy of Dermatology (AAD) and National Psoriasis Foundation (NPF). It is noted that psoriasis was a systemic immune-mediated disorder and phototherapy may be used for patients with psoriasis that affects more than 3% body surface area. The recommendation included narrowband UVB (NB-UVB), broadband UVB (BB-UVB) and targeted phototherapy.

Chronic skin conditions pose complex treatment challenges, and treatment adherence issues are a common problem. Home phototherapy is a well-documented, effective treatment for chronic skin conditions such as psoriasis and atopic dermatitis. Nonetheless, its effectiveness is dependent on patient self-management at home, and lack of adherence to complex prescribed treatment protocols occurs frequently. Additional problems that can occur include clinical teams failing to address patient concerns or treatment challenges with home phototherapy or failing to increase or modify therapy when treatments are not meeting therapeutic goals. This phenomenon is referred to as clinical inertia. The aims of this article are to (a) describe the development and implementation of a nurse-led home phototherapy program designed to both prevent clinical inertia and support patients' success in learning self-management for their chronic skin conditions at home and (b) outline the study protocol designed to evaluate the health outcomes and clinical resource utilization from the home phototherapy program. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic, multisystem inflammatory disease, predominantly affecting the skin and joints, which is present in 2−3% of the world's population. Narrow band ultraviolet B (NB-UVB) and Psoralen + ultraviolet A (PUVA) are recognised, effective and, in the case of UVB, economical second-line treatments for psoriasis where topical therapies fail to control the disease or are an impracticable option due to the extent of skin involvement. This article examines the history of phototherapy and photochemotherapy and looks at current phototherapy treatments used for psoriasis. It discusses side effects of treatment and regimens that can be followed to increase effectiveness of treatment and minimise risks. The role of the nurse phototherapist is also discussed. [ABSTRACT FROM AUTHOR]

Background: Neopterin is a biochemical marker of cellular immunity. It has been reported that serum and urine neopterin levels increase in psoriasis and decrease with treatment. Nevertheless, assessment of a direct link between narrowband ultraviolet B (UVB) therapy and neopterin level in association with Psoriasis Area and Severity Index (PASI) scores has not been performed yet. We aimed to evaluate the serum neopterin level in patients with psoriasis treated with narrowband UVB therapy in association with disease severity. Materials and Methods: The study included 35 patients with chronic plaque-type psoriasis who had PASI scores of >10 or below 10 but resistant to topical therapies and 30 healthy individuals. The narrowband UVB therapy was administered to the patient group (n = 35). Serum neopterin analysis was performed with an enzyme-linked immunosorbent assay method before and after treatment. Results: There was statistically significant correlation between neopterin level and PASI score in the patient group (P = 0.011). The serum neopterin level was significantly increased in patients with higher PASI score. Moreover, the serum neopterin level was found to be statistically higher in severe psoriasis group (PASI score ≥10, n = 14) than the mild-moderate group (PASI score <10, n = 21) (P = 0.001). Furthermore, a significant decrease was observed according to serum neopterin level after the narrowband UVB therapy in the remaining 20 patients who were able to comply with the scheduled therapy and follow-up procedure (P = 0.026). Conclusion: Serum neopterin levels were found to be an useful marker for evaluating disease severity and efficacy of narrowband UVB treatment. Thus, our findings may provide a new approach with the management of disease and follow-up strategies in patients with psoriasis. [ABSTRACT FROM AUTHOR]

Background: There is limited evidence detailing the cost-effectiveness of psoriasis treatments in the Asian region. Therefore, this study is aimed to evaluate the cost-effectiveness of 3 psoriasis treatments tailored for moderate to severe psoriasis, namely topical and phototherapy (TP), topical and systemic (TS), and topical and biologic (TB) regimens, respectively. Methods: This has been achieved by the participation of a prospective cohort involving a total of 90 moderate to severe psoriasis patients, which has been conducted at 5 public hospitals in Malaysia. The main outcome measures have been evaluated via cost and effectiveness psoriasis area severity index (PASI)-75 and/or body surface area (BSA) <5 and/or dermatology life quality index (DLQI) ≤5), estimated from the societal perspective over a 6-months duration. All costs are based on 2015's recorded Malaysian Ringgit (RM) currency. Results: Consequently, TS has been found to be the most cost-effective treatment with the lowest cost/PASI-75/and/or BSA <5 and/or DLQI ≤5, valued at RM9034.56 (US$2582.55). This is followed by TP, which is valued at RM28 080.71 (US$8026.93) and TB, valued at RM54 287.02 (US$15 518.06). Furthermore, one-way sensitivity analysis has highlighted the cost of medication as the most sensitive parameter. Conclusion: Thus, the input from this study is helpful for policy-makers in determining the first line treatment for moderate to severe psoriasis with consideration of the costs and its effectiveness in Malaysia. This will consequently allow hospitals to justify and provide the essential resources for further research and development, as well as the adoption of better treatment options. [ABSTRACT FROM AUTHOR]

Psoriasis imposes a great economic burden as a result of higher expenditures for different interventions, diagnostic procedures, pharmaceuticals and loss of productivity. Less is known about the economic impact of psoriasis treatment in Asean region. The aim of this research was to calculate the costs associated with four psoriasis treatment modalities. A prospective cohort study was conducted in five hospitals involving 91 moderate to severe psoriasis patients. Costs were calculated from the societal perspective using the principle of Step Down and Activity Based Costing (ABC) within a six (6) months follow-up duration. The components of the costs borne by the provider were inpatient cost, cost of medication, laboratory investigation and radiology. Patient's cost included out of pocket expenses, travelling cost and loss of productivity. Cost per patient per day was RM1,105.24 (inpatient) (US$315.94) and RM298.02 (outpatient) (US$85.19). Medication accounted for almost 90% (RM457,014.00) (US$130 638.45) of the total provider cost. Meanwhile, loss of productivity represented 84% (RM167,439.00) (US$47,862.80) of the total patient's cost. Biologic treatment exhibited the highest cost which was RM342,377.00 (US$97,869.21), followed by systemic treatment (RM105,607.00) (US$30,187.99), topical treatment (RM38,280.00) (US$10,942.42) and topical phototherapy treatment (RM21,824.00) (US$6,238.44). Understanding the relationship between direct and indirect costs from both perspectives is important to accurately identify and evaluate effective treatment for psoriasis. [ABSTRACT FROM AUTHOR]

Summary: Background: Scalp psoriasis is a major therapeutic challenge due to the hindrance caused by hair. Treatment with the 308‐nm excimer lamp is purported to provide many benefits over conventional phototherapy. This retrospective study evaluates the efficacy, safety, and effective dosage of 308‐nm excimer light in the treatment of scalp psoriasis. Methods: We retrospectively reviewed the medical records of patients with scalp psoriasis who received treatment with 308‐nm excimer light. Clinical and epidemiological data as well as details regarding treatment were statistically analyzed to determine the treatment outcomes. Results: Twenty patients with scalp psoriasis were included in the study. Their mean age was 47.45 ± 17.93 years. Eleven patients responded to treatment at the end of 10 sessions. The median baseline Psoriatic Scalp Severity Index (PSSI) was 12 (range, 3‐32). At the end of the protocol, the median PSSI was 4.5 (range, 0‐24), indicating a statistically significant reduction (P < 0.001). Common adverse effects included erythema, irritation, and desquamation. Conclusion: The 308‐nm excimer light appears to be an effective and safe modality that requires short treatment time. The modality could be considered as an alternative or adjuvant treatment for scalp psoriasis. [ABSTRACT FROM AUTHOR]

Background: This study aimed to explore the correlation of circulating inflammatory cytokines' levels with treatment response to etanercept (ETN) treatment in psoriasis patients. Methods: 97 moderate-to-severe plaque-psoriasis patients were continuously recruited in this prospective cohort study, and all patients received ETN treatment. Serum samples were collected before and at 6 months (M6) after treatment, and nine inflammatory cytokines expressions were detected by enzyme-linked immuno sorbent assay. Psoriasis Area and Severity Index (PASI) score was evaluated at baseline (M0), 1 month (M1), 3 months (M3) and M6 after treatment, and the corresponding PASI 75/90 responses' rates were calculated. Results: Tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1β, IL-6, IL-12, IL-17A, IL-22, IL-23, and IL-32 levels were reduced, while IL-10 level was elevated at M6 after ETN treatment compared to baseline. PASI 75/90 responses' rates to ETN were 69.1 and 38.1% at M6, respectively. IL-1β and IL-17A levels were elevated in PASI 75-response patients compared to PASI 75 non-response patients, while IL-17A level was also increased in PASI 90-response patients compared to PASI 90 non-response patients. Multivariate logistic regression revealed that IL-1β, IL-17A and combined phototherapy during study predicted higher, while previous systemic biologic treatment predicted lower PASI 75 response to ETN independently. In addition, IL-17A independently predicted higher PASI 90 response to ETN as well. Conclusions: IL-1β, IL-17A, and combined phototherapy predicts higher while previous systemic biologic treatment predicts lower treatment response to ETN independently in psoriasis patients. [ABSTRACT FROM AUTHOR]

Objective: Neutrophil lymphocyte ratio (NLR) -- Platelet lymphocyte ratio (PLR), erythrocyte distribution change (RDW), mean platelet volume (MPV) levels are an indicator of systemic inflammation. Recent studies have shown that these values are associated with many cardiovascular diseases, malignancies, rheumatic diseases, infectious diseases, prognosis and mortality. The aim of this study was to evaluate the changes in leukocyte, neutrophil, platelet, NLR, PLR, MPV and RDW levels in patients with systemic chronic inflammatory disease psoriasis patients who reached the PASI75 value before the systemic treatment and at the 12th week of the treatment. Methods: The hematological parameters of 60 patients with chronic plaque psoriasis who were treated with methotrexate (Mtx)-Cyclosporin-Acitretin-NBUVB-Infliximab and Adalimumab were investigated. Results: The initial PASI values of the patients were 16.68 ± 6.5 (Min: 6.6, Max: 29.6). Post-treatment leukocyte, neutrophil and thrombocyte averages decreased significantly (p = 0.011; p <0.001; p <0.001), but there was no statistically significant difference between pre-treatment and post-treatment lymphocytes, MPV and RDW averages (each p> 0.05). After treatment, NLR and PLR averages were found to be statistically lower than the pre-treatment averages (p = 0.043; p = 0.009). When compared to the pre-and post-treatment average, Mtx was effective on neutrophil, platelet and RDW, Acitretin and cyclosporine were effective on neutrophil and MPV. Conclusion: Significant differences in NLR and PLR levels after treatment are similar to those in the literature. The most effective drug on hematological parameters, known as cardiovascular risk markers, is thought to be Mtx. [ABSTRACT FROM AUTHOR]

Introduction: A wide range of treatments are available for psoriasis, including pharmaceuticals and phototherapy. Calcipotriol/betamethasone dipropionate and narrow‐band ultraviolet phototherapy (NB‐UVB) are both effective monotherapies for psoriasis; however, these two therapies have never been directly compared in a prospective clinical study. In this study, we compared the efficacy of combined calcipotriol/betamethasone dipropionate to NB‐UVB in psoriatic patients with Psoriasis Area Severity Index (PASI) 9–10 treated in a routine clinical practice. Patients and methods: This prospective, observational study included 58 consecutive patients (age range, 19–65 years) diagnosed with recurrent chronic small plaque psoriasis. Patients were offered either topical therapy with a two‐compound ointment containing calcipotriol (50 μm/g) and betamethasone dipropionate (0.5 mg/g) or NB‐UVB (311 nm). Disease severity was assessed at baseline and posttreatment according to PASI and target lesion score (TLS) and by high‐frequency (20 MHz) ultrasonography (HF‐USG). Results: No statistically significant difference between the groups was observed in baseline or posttreatment PASI scores. Both treatments resulted in substantial reductions in PASI: 85% and 82%, respectively, for the calcipotriol/betamethasone group and the NB‐UVB group. Both treatments significantly decreased the subepidermal low echogenic band (SLEB) thickness, with no significant differences between the two groups in terms of the percentage reduction in SLEB. Conclusions: This study demonstrates, for the first time, that NB‐UVB phototherapy and fixed combination calcipotriol/betamethasone ointment are equally effective in treating plaque psoriasis in patients with PASI 9–10 in routine clinical practice. In addition, measurement of SLEB thickness with HF‐USG may be a useful objective parameter to assess skin lesions. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to identify clinical factors associated with dose reduction and dose escalation in the treatment with ustekinumab in patients with moderate-to-severe plaque psoriasis. Materials and methods: An observational, longitudinal and retrospective study was conducted using patients with moderate-to-severe plaque psoriasis. We reviewed clinical histories and variables were recorded on a database (patients’ characteristics, pharmacotherapeutics, effectiveness and safety). We evaluated correlation between dose reduction, dose escalation and used dose with other variables. Results: Of the study’s 62 patients, Ustekinumab dose was adjusted in 45.2% (22.6% with reduced doses and 22.6% with increased doses). We found a statistically significant correlation between extending the dosing interval and the absence of psoriatic arthritis, no concomitant systemic therapies, treatment time with ustekinumab, lower PASI at week 28 and achieving PASI75 at week 28. There was also a statistically significant correlation between dose escalation and diabetes mellitus, psoriatic arthritis, prior biological treatments, concomitant systemic therapies, concomitant phototherapy and not achieving PASI75 at week 28. Conclusions: Dose-reduction strategies would increase ustekinumab efficiency in patients that achieve PASI 75 without psoriatic arthritis, diabetes mellitus, previous BT and concomitant treatment with conventional systemic drugs. [ABSTRACT FROM AUTHOR]

Background: The prevalence of narrow-band ultraviolet B (NB-UVB) use in Europe for moderate and severe psoriasis is unknown, because national registries for psoriasis do not monitor this treatment.Objectives: To quantify the use of phototherapy, biologics or conventional treatments in psoriasis, in a setting where European Medicines Agency (EMA) eligibility criteria for biologics were strictly applied, and phototherapy was included among first-line treatments.Methods: We followed a cohort of 1,090 patients who were referred to the only centre entitled to prescribe biologics and phototherapy during a 5-year period.Results: The cumulative number of treatment cycles was: 1,047 with NB-UVB phototherapy, 650 with systemic treatments and 239 with biologics; 754 patients received at least 1 course of NB-UVB phototherapy, 422 at least 1 course with a systemic treatment and 137 with a biologic; 595 patients were treated only with phototherapy.Conclusions: Regular use of NB-UVB as first-line treatment for moderate and severe psoriasis and adherence to the EMA eligibility criteria for biologics led to a relatively restricted use of biologics. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic autoimmune skin disorder affecting 2–3% of the world population. It has characteristic features such as increased keratinocyte proliferation and production of inflammatory mediators. The treatment involves various strategies including topical, systemic, phototherapy and biologics. Topical therapies are preferred for mild to moderate psoriasis conditions over the systemic therapies which are ideal in severe disease conditions. The systemic therapies include immunosuppressants, biological agents and recently approved phosphodiesterase-4 (PDE4) inhibitors. There are various limitations associated with the existing therapies where the new findings in the pathogenesis of psoriasis are paving a path for newer therapeutics to target at the molecular level. Various small molecules, PDE-4 inhibitors, biologics, and immunomodulator proved efficacious including the new molecules targeting Janus kinases (JAK) inhibitors that are under investigation. Furthermore, the role of genetic and miRNAs in psoriasis is still not completely explored and may further help in improving the treatment efficacy. This review provides an insight into various emerging therapies along with currently approved treatments for psoriasis. [ABSTRACT FROM AUTHOR]

Abstract: Background/Objectives: Pruritus is the most frequently reported complaint or symptom for psoriasis patients. Despite the morbidity associated with pruritus in psoriasis few studies have evaluated the prevalence of itch in psoriasis with the current use of biological agents. Method: This was a multi‐site cross‐sectional observational study conducted in New South Wales, Australia. Psoriasis patients were approached during their outpatient clinic, phototherapy or private consultations. Data on psoriasis characteristics, severity and treatment were collected. The patients were then asked to complete a survey regarding the frequency, severity and aggravators of their psoriasis. Results: Data were collected from 179 patients with a mean age of 52.3 years, of whom 55% were male. Altogether 63 (35%) had a psoriasis area severity index (PASI) > 10, 42 (24%) were on biological agents and 84 (47%) were receiving phototherapy. The number of patients who reported itch all the time was 40 (22%), most of the time 48 (27%), and never 19 (11%). Patients with nail psoriasis were significantly less likely to have itch all or most of the time (P = 0.01). Itch all or most of the time was significantly more likely in patients with PASI > 10 (P = 0.013). No treatment was associated with reduced itch. Itch was reported to be most frequent in the winter season. Conclusion: Few patients with psoriasis do not suffer from pruritus. Despite their promise, biological agents are not associated with reduced itch. [ABSTRACT FROM AUTHOR]

Psoriasis is a common condition that affects the skin and joints. Skin psoriasis tends to wax and wane throughout life without obvious reasons, and thus causes considerable distress. Someone with psoriasis may have other family members with the same problem but this is not usually the case. In psoriasis, more skin cells are made leading to buildup on the top layer and formation of flaky patches on the skin or severe dandruff of the scalp. The cause is unknown and believed to involve the genes and immune system, and the treatments we use now can control psoriasis but don't cure it. This study from Aberdeen, UK looked into two types of cells of the immune system; one of them can start or cause psoriasis to happen, while the other has the power to fight back and calm down the skin. We tested the effect of certain injections, cream and light which we frequently use to treat psoriasis, on those cells by taking blood and skin samples. We found that the skin became better after six weeks. The light made the numbers of the "good" cells go higher, while the injection caused the "bad" cells to become fewer and had no effect on the "good" cells. The cream increased the "good" cells and reduced the "bad" cells. We noticed these changes in both the blood and skin which means that the cream and light can have an effect on cells in the circulation and this can be used in the future to make new and safer treatments. [ABSTRACT FROM AUTHOR]

Psoriasis is a common, immune-mediated skin disorder that can manifest as multiple clinical phenotypes. Although psoriasis affecting the scalp, face, nails, palms, soles, and intertriginous regions has not been studied as extensively as chronic plaque psoriasis in other body areas, these phenotypes can be associated with significant physical, psychosocial, and functional impairments, which impact quality of life. In addition, recent evidence has shown that psoriasis affecting these areas is more prevalent than traditionally thought. In this article, we discuss the clinical characteristics of these hard-to-treat areas and review newer treatment options, which have shown significant efficacy for psoriasis affecting these body regions. To provide optimal care to patients with difficult-to-treat psoriasis, nurses, nurse practitioners, and physician assistants should evaluate patients for scalp, facial, nail, palmoplantar, and inverse psoriasis to provide more effective therapeutic options. [ABSTRACT FROM AUTHOR]

This series focuses on the patient treatment pathway in managing psoriasis as laid out by the National Institute for Health and Care Excellence guidelines (NICE, 2016). This disease affects up to 1.8 million people within the UK, necessitating up to 60% of these patients requiring a form of secondary care input (Jackson, 2012). Secondary care is often required to provide further topical treatment advice, but equally this also falls within the remit of all healthcare professionals, such as community nurses, who have face-to-face contact with patients with psoriasis. As these topical treatments may not manage the symptoms of psoriasis alone, referral to dermatology departments where more specialist treatments can be prescribed may be needed. The first option is to offer a course of phototherapy. There are several forms of treatment under this umbrella, with which community nurses should be familiar. [ABSTRACT FROM AUTHOR]

Background Biologics have greatly improved psoriasis management. However, primary and secondary non-response to treatment requires innovative strategies to optimize outcomes. Objective To describe the use of combined treatment of biologics with conventional systemic agents or phototherapy in daily clinical practice. Methods We collected data on frequency of use, demographics, treatment characteristics and drug survival of biologics combined with conventional systemic agents or phototherapy in five PSONET registries. Results Of 9922 biologic treatment cycles, 982 (9.9%) were identified as combination treatment. 72.9% of treatment cycles concerned concomitant use of methotrexate, 25.3% concerned concomitant UVB therapy, acitretin or cyclosporin and 1.8% concerned combined treatment with PUVA, fumaric acids or a second biologic. Substantial variation was detected in type and frequency of combination treatments prescribed across registries. Patients initiated on combined treatment had generally severe disease and were affected with psoriasis for many years. The extent to which patients had been priory treated with biologic monotherapy and the proportion of patients affected with psoriatic arthritis differed between registries. Survival rates for etanercept, adalimumab, infliximab and ustekinumab with methotrexate ranged between 43 and 92%, 28 and 83%, 65 and 87% and 53 and 77%, respectively, across registries after one year with no consistent superior survival for a particular biologic. Longest survival on a biologic combined with methotrexate, acitretin or cyclosporin was 103, 78 and 34 months, respectively. Conclusion Methotrexate was the most commonly used concomitant treatment for patients on a biologic. Wide geographical variations in treatment selection and persistence of combination treatment exist. Data derived from ongoing studies may help to determine whether combined treatment is superior to biologic monotherapy. [ABSTRACT FROM AUTHOR]

Abstract: Background/Objectives: The simplified psoriasis index (SPI) is a three‐part multidimensional tool incorporating disease severity, psychosocial impact and historical course completed by the health‐care professional (professional SPI, [proSPI]) or the patient (self‐assessment SPI, [saSPI]). We aimed to assess the validity and response distribution of proSPI and saSPI in patients with psoriasis undergoing phototherapy. Methods: The validity and response distribution of SPI was assessed by recording saSPI and proSPI in patients with psoriasis before and after a course of phototherapy. Recruitment ended once 100 complete data sets were available for analysis. Results: Altogether 52 of the 100 patients evaluated were male and most (93) underwent narrowband UVB phototherapy. There was a close correlation between the proSPI‐current severity score (proSPI‐s) with the psoriasis area and severity index (PASI) score (r = 0.76, r = 0.86) before and after treatment, respectively. Although pretreatment correlation between the saSPI‐current severity score (saSPI‐s) and PASI was weak (r = 0.39), a more close correlation was noted at the end of treatment (r = 0.50). A moderate correlation was observed between the SPI‐psychosocial impact score (SPI‐p) and the dermatology life quality index (DLQI), both before and after phototherapy (r = 0.64, r = 0.73). The SPI had wide response distributions in all three domains. Conclusions: Both versions of SPI demonstrated wide response distributions and the proSPI‐s in particular was shown to have good validity with PASI. [ABSTRACT FROM AUTHOR]

Psoriasis is an autoimmune inflammatory skin disease. In the past several decades, phototherapy has been widely used to treat stable psoriatic lesions, including trunk, scalp, arms and legs, and partial nail psoriasis. A variety of light/lasers with different mechanisms of action have been developed for psoriasis including ultraviolet B (UVB), psoralen ultraviolet A (PUVA), pulsed dye laser (PDL), photodynamic therapy (PDT), intense pulsed light (IPL), light-emitting diodes (LED), and so on. Because light/laser each has specific therapeutic and adverse effects, it is important to adequately choose the sources and parameters in management of psoriasis with different pathogenic sites, severities, and duration of the disorder. This review aims at providing most updated clinic information to physicians about how to select light/laser sources and individual therapeutic regimens. To date, UV light is primarily for stable plaque psoriasis and PDL for topical psoriatic lesions with small area, both of which are safe and effective. On the other hand, PUVA has better curative effects than UVB for managing refractory psoriasis plaques, if its side effects can be better controlled. PDL provides optimal outcomes on nail psoriasis compared with other lasers. Although the trails of low-level light/laser therapy (LLLT) are still small, the near infrared (NIR) and visible red light with low energy show promise for treating psoriasis due to its strong penetration and encouraging photobiomodulation. IPL is rarely reported for psoriasis treatment, but PDT-IPL has been found to offer a moderate effect on nail psoriasis. In brief, various phototherapies have been used either in different combinations or as monotherapy. The modality has become a mainstay in the treatment of mild-to-moderate psoriasis without systemic adverse events in today's clinical practice. [ABSTRACT FROM AUTHOR]

Background: Home phototherapy is a safe and effective treatment for psoriasis but is not commonly utilized as a treatment option in the United States. Recently, there has been renewed interest in home phototherapy. This pilot study describes the nursing support needed to facilitate effective transition of ongoing office-based phototherapy patients to home phototherapy. Methods: Ten patients with a diagnosis of psoriasis receiving office-based phototherapy were identified as candidates for home phototherapy. They received group education on self-administration by specialized phototherapy nurses. Some patients required additional one-on-one training. Units were installed, and home phototherapy was initiated. Subsequent nursing care consisted of telephone support with the study nurse on a weekly basis for 4-8 weeks with follow-up telephone calls on an as-needed basis. Results: Eleven patients initially participated in the 8-month trial. Ten were successfully transitioned to home treatments, One patient discontinued the study. The 10 patients were independently self-administering home phototherapy with minimal nursing support by Week 8 of the study. Conclusion: Transition of patients with psoriasis receiving office-based phototherapy to home phototherapy can be done successfully while maintaining control of psoriasis. Considerable nursing resources are required for initial patient education, but they decrease significantly with time. [ABSTRACT FROM AUTHOR]

Background: Psoriasis is a chronic inflammatory condition associated with considerable morbidity and economic burden. Objectives: To estimate and compare the costs of home phototherapy versus biologics over a 3-year time horizon in patients with moderate to severe plaque psoriasis. Methods: The biologics compared were adalimumab, etanercept, infliximab, ustekinumab, and secukinumab. Average wholesale prices of biologics were obtained through Lexicomp. Home phototherapy costs were estimated by obtaining quotes from phototherapy device manufacturers. Three-year cost horizon, 3-month cost, and cost per success were calculated. To assess cost-effectiveness, Psoriasis Area Severity Index (PASI) 75 rates served as the surrogate for the rate of treatment success. Cost per success represents the cost for 3 months of treatment relative to the percent of patients who achieved PASI 75. Results: Secukinumab is the most expensive biologic with a 3-year cost of $182,718 compared with a 3-year cost of $5,000 for phototherapy. Limitations: Studies on the efficacy of home phototherapy tended to have small sample sizes. Larger studies would be useful to improve the generalizability of the data. The cost estimates are an average, which may not accurately represent the costs different insurance companies negotiate. These limitations were considered to have minimal effect on analysis. Conclusions: The economic burden of psoriasis is substantial. It is important to consider the costs to the healthcare system over a patient's lifetime when they start biologics or home phototherapy. Phototherapy is an effective and economical option for the treatment of moderate to severe plaque psoriasis. [ABSTRACT FROM AUTHOR]

The largest proportion of psoriasis patients are candidates for topical treatment rather than treatment paradigms encompassing systemic, biologic and apremilast, and phototherapy, making skillfulness with topical therapy of paramount importance. As such, numerous studies have been conducted to demonstrate the benefits of using topical therapy in combination with other therapies. In addition, innovative uses of otherwise conventional methods, such as proactive use to minimize flare, have been developed. This article reviews five types of strategies for improved efficacy from topical agents beyond monotherapy. These strategies include proactive use, rotational therapy, sequential therapy, using topical agents to shorten the onset of therapeutic action for slower internal agents or phototherapy, and combination use for added efficacy. Each of these is reviewed in detail. [ABSTRACT FROM AUTHOR]

UVA1 phototherapy, a new therapeutic approach, has recently been shown good efficacy in the treatment of palmoplantar pustulosis (PPP). The purpose of this study was to compare the efficacy of UVA1 and narrowband UVB (NB-UVB) therapy in the treatment of PPP. Patients with PPP were randomly assigned to either UVA1 or NB-UVB therapy according to a left-right randomization table. Both treatments were performed three times weekly for up to 30 sessions. Clinical evaluation was based on the Palmoplantar Pustular Psoriasis Area and Severity Index (PPPASI) score. Totally 64 patients completed the study. Both UVA1 and NB-UVB therapy showed a statistically significant reduction of PPPASI score compared with the baseline value at the end of the treatment period (P < 0.05). There was a significantly greater mean reduction of PPPASI score in the UVA1 treated group when compared to the NB-UVB treated patients at 30 sessions (6.0 ± 2.4 vs. 4.4 ± 1.4, P < 0.05). No phototoxic reaction or bullous changes were observed in either group. Both NB-UVB and UVA1 phototherapy of PPP resulted in significant improvement. UVA1 phototherapy was more effective than NB-UVB irradiation in the treatment of PPP. [ABSTRACT FROM AUTHOR]

This article provides comprehensive recommendations for the systemic treatment of severe pediatric psoriasis based on evidence obtained from a systematic review of the literature and the consensus opinion of expert dermatologists and pediatricians. For each systemic treatment, the grade of recommendation (A, B, C) based on the treatment's approval by the European Medicines Agency for childhood psoriasis and the experts' opinions is discussed. The grade of recommendation for narrow-band-ultraviolet B phototherapy, cyclosporine, and retinoids is C, while that for methotrexate is C/B. The use of adalimumab, etanercept, and ustekinumab has a grade A recommendation. No conventional systemic treatments are approved for pediatric psoriasis. Adalimumab is approved by the European Medicines Agency as a first-line treatment for severe chronic plaque psoriasis in children (≥ 4 years old) and adolescents. Etanercept and ustekinumab are approved as second-line therapy in children ≥ 6 and ≥ 12 years, respectively.Conclusion: A treatment algorithm as well as practical tools (i.e., tabular summaries of differential diagnoses, treatment mechanism of actions, dosing regimens, control parameters) are provided to assist in therapeutic reasoning and decision-making for individual patients. These treatment recommendations are endorsed by major Italian Pediatric and Dermatology Societies. What is Known: • Guidelines for the treatment of severe pediatric psoriasis are lacking and most traditional systemic treatments are not approved for use in young patients. Although there has been decades of experience with some of the traditional agents such as phototherapy, acitretin, and cyclosporine in children, there are no RCTs on their pediatric use while RCTs investigating new biologic agents have been performed. What is New: • In this manuscript, an Italian multidisciplinary team of experts focused on treatment recommendations for severe forms of psoriasis in children based on an up-to-date review of the literature and experts' opinions. [ABSTRACT FROM AUTHOR]