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Methotrexate (MTX), an agent originally intended for anti-neoplastic use, has been successfully employed in the treatment of a variety of dermatologic conditions. In addition to its multiple clinical indications, variable dosing and modes of administration make it a viable option for patients of all ages and most comorbidities. MTX is a folate analog that antagonizes dihydrofolate reductase, thus inhibiting thymidylate synthesis and, ultimately, the production of pyrimidine. Depending on dosage, MTX can function as an anti-inflammatory agent, immunomodulator, or antimetabolite. Patients suffering from psoriasis have benefited from MTX in addition to those with atopic dermatitis, chronic urticaria, pemphigus vulgaris, bullous pemphigoid, cutaneous lupus erythematosus, cutaneous sarcoidosis, and mycosis fungoides. Although patients with these conditions can benefit from MTX treatment, the drug can cause adverse sequelae, including hematologic, pulmonary, gastrointestinal, and hepatic side effects. Therefore, the drug should be administered under careful physician supervision., Competing Interests: All of the authors have no conflicts to declare for this work., (Skin Therapy Letter © (ISSN 1201–5989) Copyright 2019 by SkinCareGuide.com Ltd. Skin Therapy Letter© is published 6 times annually by SkinCareGuide.com Ltd, 1003 - 1166 Alberni Street, Vancouver, British Columbia, Canada, V6E 3Z3. All rights reserved. Reproduction in whole or in part by any process is strictly forbidden without prior consent of the publisher in writing. While every effort is made to see that no inaccurate or misleading data, opinion, or statement appears in the Skin Therapy Letter©, the Publishers and Editorial Board wish to make it clear that the data and opinions appearing in the articles herein are the responsibility of the contributor. Accordingly, the Publishers, the Editorial Committee and their respective employees, officers, and agents accept no liability whatsoever for the consequences of any such inaccurate or misleading data, opinion, or statement. While every effort is made to ensure that drug doses and other quantities are presented accurately, readers are advised that new methods and techniques involving drug usage, and described herein, should only be followed in conjunction with the drug manufacturer’s own published literature. Printed on acid-free paper effective with Volume 1, Issue 1, 1995.)

Introduction • Psoriasis which affects the skin of palm and soles is called as Palmoplantar Psoriasis. The exact cause of it is unknown. It has predominantly hyperkeratotic plaques, thick scaly skin or an overlapping of both of them. Also called as chronic disease which produces functional disability or significant disfigurement and does substantial impairment of person’s life. Topical therapy, light therapy, oral medications are part of conventional treatment which offers only a palliative effect. Besides conventional treatment patient choose Homoeopathy because it’s a gentle and safe method of treatment that would appear to have positive effects in treatment of Palmoplantar Psoriasis Summary • A 48 years old Male presented with dry, rough cracked skin with intense itching and burning on both palms and right sole. As he was tabla teacher his day to day activities were hampered. After proper case taking and Repertorization by Kentian approach, Sulphur 1M was prescribed after considering all general and particular characteristic symptoms. The repertory used was SYNTHESIS REPERTORY 8.1 from the Homoeopathic software RADAR. After 3 doses of Sulphur 1M at the gap of 2 months & at the end of 8 months, Re-epithelialisation was seen with an absence of itching and burning and no cracks in skin. This evidence based case report is an example of a successful Homoeopathic Management in cases of Palmoplantar Psoriasis with Kent’s approach as Homoeopathy does not treat the disease but the diseased individual. [ABSTRACT FROM AUTHOR]

Generalized pustular psoriasis (GPP) is a rare but severe skin inflammatory disorder characterized by the eruption of widespread sterile neutrophilic pustules, often accompanied by systemic inflammation. Given its life-threatening potential, GPP requires prompt accurate diagnosis and effective treatment, but its rarity and relapsing-remitting nature pose challenges in performing large-scale randomized controlled clinical trials. Established international guidelines are currently lacking and management guidance often follows that for plaque psoriasis. However, while it can co-exist with plaque psoriasis and has traditionally been classified as a most severe form of psoriasis, GPP is now recognized as a distinct entity, with its own clinicopathological, autoinflammatory, immunologic and genetic features. Research conducted over the past decade revealed that an imbalance of interleukin (IL)-36 signaling favoring the proinflammatory activity is the central driver of the pathogenesis of GPP, thereby laying the groundwork for the development of targeted therapies for the disease. This article reviews the evidence thus far on spesolimab, a selective humanized antibody against the IL-36 receptor that was recently licensed in Europe and the United States for the treatment of GPP flares in adults. In phase II, randomized controlled clinical trials, spesolimab led to rapid and effective skin clearance in patients experiencing a GPP flare and demonstrated superiority to placebo in preventing flares for up to 48 weeks with maintenance treatment, with reassuring safety and tolerability profiles. Spesolimab is considered to be a first-in-class medication establishing itself as the standard of care for the treatment of GPP flares, thus changing the paradigm of the management of GPP to a new era of scientifically- and evidence-based targeted therapy for this distinctive disease. [ABSTRACT FROM AUTHOR]

Introduction: Introduction of novel biologic treatments for plaque psoriasis has revolutionized treatment approach and improved outcomes in patients with moderate-to-severe disease. New groups of biologics are even more effective and better tolerated compared to their predecessors. However, none of the currently available biologic drugs is associated with complete skin clearance in all treated patients. Moreover, the requirement to stop therapy in accordance with previous therapeutic program guidelines in Poland may have contributed to a gradual loss of efficacy of biologic drugs. Betamethasone dipropionate (BD) and calcipotriol (CAL) foam is the most widely studied topical drug in the therapy of mild forms of psoriasis. Numerous clinical trials have demonstrated its excellent efficacy not only in reactive therapy but also in preventing recurrences through the implementation of proactive therapeutic regimens. Case reports: We present two cases of patients with severe psoriasis and psoriatic arthritis who were treated with biologic drugs with incomplete remission of skin lesions. Topical therapy with BD/CAL foam was introduced to treat refractory psoriatic lesions, leading to excellent outcomes. Conclusions: The reported cases show that therapy with BD/CAL foam may be an effective adjuvant treatment of psoriasis in cases of incomplete and unsatisfactory response to systemic therapies, including biologics. [ABSTRACT FROM AUTHOR]

Background: Psoriasis is a chronic inflammatory immune-mediated hyperproliferative skin disease. Angiogenesis has an important role in the pathogenesis of psoriasis, occurring even before plaque formation. Angiopoietins have an important role in angiogenesis so described as angiogenic factors, this study aimed to evaluate Angiopoietin-2 serum level in psoriasis Vulgaris patients and to evaluate if there is a relation between serum Angiopoietin-2 level and the disease activity. Patients and Methods: This is a case-control study that included 40participants, 20 are patients and other 20 are healthy subjects. Complete general, family, past history was documented, the dermatological examination was done to all patients included in the study. The study was approved by the research ethical committee of Faculty of Medicine Zagazig University.The work has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for studies involving humans. Results: There is a highly statistically significant difference between the studied groups regarding serum angiopoietin 2 level, higher in the psoriasis group. In the psoriasis group, there is a significant positive correlation between angiopoietin 2 serum level and psoriasis area severity index. There is a statistically significant difference in serum angiopoietin 2 level and disease course, higher in progressive type. Conclusions: Angiopoietin 2 is closely associated with the evolving of microvascular proliferation in psoriasis and its level increase with the severity of the disease. Based on our results, we suggest that serum Ang2 level act as a possible useful biomarker of Psoriasis Vulgaris. Also, the major role of Ang2 in systemic pathological processes in psoriasis. [ABSTRACT FROM AUTHOR]

Background: Although dermatology is mostly an outpatient specialty, some patients with severe skin disease need hospital admission for management. There is a paucity of data regarding the profile of these dermatology in-patient admissions.Aims: We studied the profile of patients admitted to the dermatology ward of our tertiary care government hospital in North India.Methods: This was a retrospective analysis of discharge sheets of patients admitted in the dermatology ward from January 1, 2014 to December 31, 2017.Results: Discharge sheets of 2032 admissions for 1664 patients were analyzed. The most common diagnoses in the admitted patients were immunobullous disorders (576, 28%), connective tissue diseases (409, 20%), infections, including leprosy and sexually transmitted infections (179, 8.8%), psoriasis (153, 7.5%) and reactive arthritis (92, 4.5%). The mean duration of admission was 13.95±11.67 days (range 1-118 days). Two hundred and fifty-six patients (15.38%) were re-admitted, accounting for 368 (18.11%) re-admissions. Patients with immunobullous disorders (OR 1.72, 95% CI 1.29-2.28) and psoriasis (OR 1.62, 95% CI 1.02-2.55) were more likely to be re-admitted. Adult patients, those who were admitted for more than four weeks, those who had comorbidities, and those who developed a complication during the hospital stay also had a greater likelihood of being re-admitted.Limitations: The retrospective design of the study, and the non-availability of data regarding transfers to other specialties or intensive care units and deaths were the main limitations of this study.Conclusion: This study describes the profile of patients admitted in a dermatology ward of a tertiary care centre center in North India. The patient profile and admission characteristics associated with a higher probability of re-admission were identified. [ABSTRACT FROM AUTHOR]

Generalized pustular psoriasis (GPP) is a rare neutrophilic skin condition characterized by episodes of widespread eruption of sterile macroscopic pustules that can be associated with systemic inflammation. The rarity of GPP and its heterogeneous cutaneous and extracutaneous symptoms pose considerable challenges to the development and adoption of comprehensive accurate disease measures for the routine clinical assessment of disease severity and the evaluation of new treatments in clinical trials. Psoriasis disease measures remain among the most commonly used methods for evaluating patients with GPP, despite their limitations owing to a lack of assessment of pustules (a hallmark of GPP), systemic inflammation, and disease symptoms. The adaptation of psoriasis disease measures and the development of assessment tools specific for GPP severity will enable more effective and accurate monitoring of patients with GPP and enhance the clinical development of new therapies. Further clinical validation of recently developed modified assessment tools, such as the Generalized Pustular Psoriasis Physician Global Assessment and the Generalized Pustular Psoriasis Area and Severity Index, and international consensus on using quantitative tools and patient-reported outcome measures in the development of new treatments are needed to advance patient care. [ABSTRACT FROM AUTHOR]

The article offers information on the Nail psoriasis. Topics include highly prevalent in patients with cutaneous psoriasis and also may present as an isolated finding, strong association between nail psoriasis and development of psoriatic arthritis, analyze the nail psoriasis literature for content, citations, and media attention,the Wilcoxon rank sum test was calculated to compare the relationship of Altmetric scores between nail psoriasis.

Background: Patients with psoriasis are often dissatisfied with available treatments, but contributing factors are not well defined.Objective: Examine relationships between psoriasis severity, patient characteristics, and treatment satisfaction.Methods: Patients with psoriasis were classified into mild and moderate-to-severe groups based on self-reported data. Demographics, comorbidities, symptoms, and multiple treatment satisfaction outcomes were compared between groups. Predictors of patient satisfaction with treatment were examined using linear regression models.Results: The analyses included 773 patients (407 mild; 366 moderate-to-severe). The percentage of patients reporting satisfaction with treatment was low overall, ranging from 8.6% to 61.7% for the mild and 13.9% to 49.5% for the moderate-to-severe group. Satisfaction among biologics users was also low (≤53%; 50% of satisfaction rates

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]

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.

Although the pathogenesis of Alzheimer's disease (AD) is unclear, neuroinflammation appears to play a role in its development. Psoriasis is a chronic inflammatory skin disease that has recently been found to genetically overlap with AD. We aimed to investigate the risk of AD in patients with psoriasis. Subjects with psoriasis (n = 535,927) and age- and sex-matched controls without psoriasis (at a 5:1 ratio; n = 2,679,635) who underwent ≥3 health examinations between 2008 and 2014 were included, drawn from the Korean National Health Insurance System database. There were 50,209 cases of AD (1.87%) in controls without psoriasis and 11,311 cases (2.11%) in patients with psoriasis, and the median follow-up was 3.35 years. In a multivariable-adjusted model, patients with psoriasis showed a significantly increased risk of AD (hazard ratio, 1.09; 95% CI, 1.07–1.12, p < 0.0001) compared to controls without psoriasis. Among patients with psoriasis, the risk of AD was significantly increased in psoriasis patients not receiving systemic therapy compared to those receiving systemic therapy (hazard ratio, 1.10; 95% CI, 1.08–1.12 vs. hazard ratio, 0.99; 95% CI: 0.90–1.09, p < 0.0001). The incidence of AD was significantly increased in patients with psoriasis compared to control subjects without psoriasis. Of note, systemic treatment for psoriasis was associated with a reduced risk of AD. [ABSTRACT FROM AUTHOR]

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) held its annual meeting in 2020 in an online format due to travel restrictions during the coronavirus disease 2019 (COVID-19; caused by SARS-CoV-2) pandemic. The virtual meeting was attended by 351 rheumatologists, dermatologists, representatives of biopharmaceutical companies, and patient research partners. Similar to previous years, GRAPPA's annual meeting focused on the 3 overlapping missions of education, research, and clinical care of psoriatic disease. Trainee sessions this year included the annual trainee symposium and a grant-writing workshop. Plenary sessions included updates on COVID-19 and psoriatic disease from multispecialty and patient perspectives, and updates on pustular psoriasis and associated musculoskeletal manifestations. Progress on research and updates were presented for the following groups: Collaborative Research Network, Outcome Measures in Rheumatology (OMERACT) Psoriatic Arthritis Working Group, International Dermatology Outcome Measures, Composite Measures, Education Committee, and Treatment Guidelines. New this year were 3 concurrent workshops on ultrasound assessment of joints and entheses, magnetic resonance imaging of psoriatic arthritis, and pustular psoriasis efficacy endpoints; 6 "Meet the Expert" sessions; and facilitated "poster tours." In our prologue, we introduce the papers that summarize this meeting. [ABSTRACT FROM AUTHOR]

Summary: Secukinumab is an interleukin (IL)‐17 monoclonal antibody inhibiting T‐helper (Th)1‐mediated immune response. It has proven high efficacy for moderate to severe psoriasis but data on its long‐term toxicities are limited. We describe two patients who received secukinumab for clinically presumed psoriasis, but were subsequently diagnosed with mycosis fungoides (MF) following skin biopsies triggered by skin deterioration while on secukinumab. Previous studies suggested decreased numbers of regulatory T cells (Tregs) with increasing stage of MF, which may lead to the shift in the Treg/Th17 balance towards the Th17 pathway. Theoretically, the use of IL‐17 monoclonal antibodies to inhibit Th17 pathway may lead to further immunosuppression and disease progression in cutaneous T‐cell lymphoma (CTCL) by shifting the balance towards Tregs, although this hypothesis has not been proven. With uncertainty over the role of IL‐17 and Treg/Th17 as well as diagnostic challenges in CTCL, we recommend that patients should have a confirmatory skin biopsy prior to the commencement of biologic therapy. [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]

In this, the second of a two-part review, we will expand our discussion of psoriasis as an immunemediated inflammatory skin disorder to explore the systemic effects of psoriatic inflammation beyond skin and the immunopathology that underlies comorbidity as a holistic paradigm for psoriatic disease treatment. For the first part of the review see May RJ, Franklin A. Fundamentals of skin immunology in psoriasis: Part 1. Dermatological Nursing 2018. 17(2): 40-47. [ABSTRACT FROM AUTHOR]

Psoriasis is a common disease affecting people worldwide. Although many researchers have tried to understand, throughout history, the mechanisms involved in the pathogenesis of the disease and despite considerable progress that has been made, a plethora of key aspects are still waiting to be discovered. In the last 2,000 years, the treatment evolved from an empirical stage to the modern therapy oriented to targeting molecules shown to be involved in the occurrence of the disease. In this paper we are reviewing the great discoveries that have marked the history of psoriasis, as well as the latest advances in the treatment of the disease. [ABSTRACT FROM AUTHOR]

Background: Psoriasis causes work productivity impairment that increases with disease severity. Whether differential treatment efficacy translates into differential indirect cost savings is unknown. Objective: To assess work hours lost and indirect costs associated with secukinumab versus ustekinumab and etanercept in the United Kingdom (UK). Methods: This was a post hoc analysis of work impairment data collected in the CLEAR study (secukinumab vs. ustekinumab) and applied to the FIXTURE study (secukinumab vs. etanercept). Weighted weekly and annual average indirect costs per patient per treatment were calculated from (i) overall work impairment derived from Work Productivity and Activity Impairment data collected in CLEAR at 16 and 52 weeks by Psoriasis Area and Severity Index (PASI) response level; (ii) weekly/annual work productivity loss by PASI response level; (iii) weekly and annual indirect costs by PASI response level, based on hours of work productivity loss; and (iv) weighted average indirect costs for each treatment. In the primary analysis, work impairment data for employed patients in CLEAR at Week 16 were used to compare secukinumab and ustekinumab. Secondary analyses were conducted at different time points and with patient cohorts, including FIXTURE. Results: In CLEAR, 452 patients (67%) were employed at baseline. At Week 16, percentages of weekly work impairment/mean hours lost decreased with higher PASI: PASI < 50: 22.8%/7.60 h; PASI 50–74: 13.3%/4.45 h; PASI 75–89: 6.4%/2.14 h; PASI ≥ 90: 4.9%/1.65 h. Weighted mean weekly/annual work hours lost were significantly lower for secukinumab than ustekinumab (1.96/102.51 vs. 2.40/125.12; P = 0.0006). Results were consistent for secukinumab versus etanercept (2.29/119.67 vs. 3.59/187.17; Ρ<0.0001). Average annual indirect cost savings with secukinumab were £355 vs. ustekinumab and £1061 versus etanercept. Results at 52 weeks were similar. Conclusions: Secukinumab significantly reduced work impairment and associated indirect costs of psoriasis compared with ustekinumab and etanercept at Week 16 through 52 in the United Kingdom. [ABSTRACT FROM AUTHOR]

Background: Therapeutic advances have made the achievement of clear/almost clear skin possible for many patients with moderate‐to‐severe plaque psoriasis. Objective: To determine patient perceptions of the impact of psoriasis and of attaining clear/almost clear skin. Methods: Global survey of patients with moderate‐to‐severe psoriasis. Results: A total of 8338 patients from 31 countries participated. The majority (57%) had not achieved self‐assessed clear/almost clear skin with their current therapy, and 56% of those who had not met this goal believed it would be impossible to do so. Among the patients who had clear/almost clear skin, 73% had not initiated their current treatment until >1 year after psoriasis diagnosis, and 28% had to wait >5 years. Eighty‐four percent of all respondents experienced discrimination and/or humiliation due to psoriasis, and many reported negative effects on work, intimate relationships, sleep and mental health. Patients without clear/almost clear skin reported that such achievement would open new possibilities, such as swimming (58%), a wider choice of clothing (40%), and meeting new people (26%). A limitation of this study, as with any survey‐based research, is that selection and recall bias may have been present. Additionally, respondent definitions of clear/almost clear skin were subjective and may have varied. Conclusion: Despite the importance of clear/almost clear skin to psoriasis patients, most are still not achieving it, and many are unaware it is possible. [ABSTRACT FROM AUTHOR]

Purpose: Patients with moderate plaque psoriasis are often undertreated and may experience unsatisfactory clinical outcomes. Undertreatment may stem partly from a lack of consensus on the definition of moderate psoriasis and appropriate treatments for patients with moderate disease severity. Materials and Methods: An online survey was conducted during October 2015 to determine how US dermatologists in the clinical setting define and treat moderate psoriasis. Results: A total of 150 dermatologists responded to the survey (mean time in practice: 13.5 years). On average, they saw 72 patients with psoriasis per month; 40% of these patients were considered to have moderate psoriasis. Most (95%) reported assessing disease severity based on the percentage of psoriasis-affected body surface area (BSA); 59% also considered location of the affected area. BSA cutoffs used to define moderate psoriasis varied widely (median low and high cutoffs: 5-10%; range: 1-70%). Similarly, wide variation in cutoff ranges was observed for the Psoriasis Area and Severity Index (PASI), Physician Global Assessment (PGA), and Dermatology Life Quality Index (DLQI). Primary therapy comprised biologics (47%), prescription topicals (28%), and oral systemics (18%). Conclusions: The current findings indicate lack of consensus surrounding the definition of moderate psoriasis among US dermatologists. [ABSTRACT FROM AUTHOR]

Background: In the late 2000s, the introduction of biologics transformed the prognosis for patients with moderate‐to‐severe psoriasis. We hypothesized that treatment with biologics may associate with a reduction in the hospitalization rate for psoriasis flares. Objective: To analyse changes over time in the hospitalization rate for psoriasis flares. Methods: We included inpatient stays in any of nine French hospitals between 2005 and 2015 for a psoriasis flare, as documented in the national inpatient database. In two centres, we also analysed data from the individual patients' electronic medical records. Results: A total of 3572 stays were included. The introduction of biologics was not associated with a decrease in the number of hospitalizations for a psoriasis flare; on the contrary, we observed a non‐significant increase in the number of hospitalizations (13 hospitalizations for psoriasis flares per quarter per 10 000 beds). In the two‐centre study, the introduction of biologics was associated with a significant increase in the hospitalization of patients receiving topical treatments only (520 hospitalizations per year per 10 000 beds) and those with a first psoriasis flare. Conclusion: The number of hospitalizations for a psoriasis flare tended to increase between 2005 and 2015. The availability of additional treatment options might have increased patient demand and/or broadened the indications in clinical practice. [ABSTRACT FROM AUTHOR]

Summary: Background: 'Not relevant' responses (NRRs) on the Dermatology Life Quality Index (DLQI) may occur in up to 40% of patients with psoriasis. As these responses are scored as the item of the questionnaire having no impact on the patients' lives at all, it is more difficult for these patients to fulfil the DLQI > 10 criterion required by clinical guidelines to become candidates for systemic treatment including biologics. Objectives: We propose a new scoring system for the DLQI that corrects for the bias in the NRR option and test its construct validity in a sample of patients with psoriasis. Methods: Data from 242 patients (104 of whom marked at least one NRR) from two earlier cross‐sectional surveys were reanalysed. For each patient, the DLQI score was calculated in two ways: (i) according to the original scoring and (ii) by applying a new scoring formula (DLQI‐R) that adjusts the total score for the number of NRRs. The construct validity of the DLQI‐R was tested against the Psoriasis Area and Severity Index (PASI) and EQ‐5D‐3L. Results: The mean DLQI and DLQI‐R scores were 9·99 ± 7·52 and 11·0 ± 8·02, respectively. The DLQI‐R allowed eight more patients (3·3%) to achieve the 'PASI > 10 and DLQI > 10' threshold. The results were robust when limiting the maximum number of NRRs allowed to two or three. Compared with the DLQI, DLQI‐R correlated slightly better with PASI (rs = 0·59 vs. 0·57) and EQ‐5D‐3L index scores (rs = −0·58 vs. −0·54). Conclusions: The DLQI‐R seems to be a valid scoring system for avoiding the bias in the NRR option and can help to improve patients' access to biologics. What's already known about this topic? 'Not relevant' responses on the Dermatology Life Quality Index (DLQI) may occur in up to 40% of patients with psoriasis.As these responses are scored as the item having no impact on patients' lives at all, it is more difficult for these patients to fulfil the DLQI > 10 criterion required by guidelines to become candidates for systemic treatment including biologics. What does this study add? This study proposes a new scoring system for the DLQI that corrects for the bias in the 'not relevant' response option.We demonstrated the new scoring system's construct validity in a sample of patients with psoriasis. What are the clinical implications of this work? The new scoring can help to improve patients' access to biologics. Linked Editorial:Finlay and Sampogna. Br J Dermatol 2018; 179:1021–1022. Respond to this article Plain language summary available online [ABSTRACT FROM AUTHOR]

Summary: Background: Narrowband ultraviolet B (NB‐UVB) treatment for psoriasis is considered expensive. However, existing data are based on estimates and do not consider indirect cost savings. Objectives: To define the actual costs of NB‐UVB incurred by the service provider, as well as treatment‐associated cost savings. Methods: We performed data linkage of (i) comprehensive treatment records and (ii) prescribing data for all NB‐UVB treatment episodes spanning 6 years in a population of 420 000. We minimized data fluctuation by compiling data from four independent treatment sites, and using drug prescriptions unrelated to psoriasis as a negative control. Results: National Health Service Tayside spent an average of £257 per NB‐UVB treatment course (mean 257 ± 63, range 150–286, across four independent treatment sites), contrasting sharply with the estimate of £1882 used by the U.K. National Institute for Health and Care Excellence. The cost of topical treatments averaged £128 per patient in the 12 months prior to NB‐UVB, accounting for 42% of the overall drug costs incurred by these patients. This was reduced by 40% to £53 per patient over the 12‐month period following NB‐UVB treatment, while psoriasis‐unrelated drug prescription remained unchanged, suggesting disease‐specific effects of NB‐UVB. The data were not due to site‐specific factors, as confirmed by highly similar results observed between treatment sites operated by distinct staff. Finally, we detail all staff hours directly and indirectly involved in treatment, allowing direct translation of cost into other healthcare systems. Conclusions: NB‐UVB is a low‐cost treatment; cost figures currently used in health technology appraisals are an overestimate based on the data presented here. Creating or extending access to NB‐UVB is likely to offer additional savings by delaying or avoiding costly third‐line treatments for many patients. What's already known about this topic? Narrowband ultraviolet B (NB‐UVB) is considered expensive.However, existing estimates of treatment costs are based largely on assumptions and do not consider treatment‐associated savings. What does this study add? We present the comprehensive direct and indirect actual costs incurred for NB‐UVB by a provider serving a population of 420 000 over 6 years.We identify significant savings achieved due to the reduced need of topical treatment.Our data necessitate a review of cost figures used in health technology appraisals. Linked Editorial:Tanew and Lim. Br J Dermatol 2018; 179:1019–1020. Respond to this article Plain language summary available online [ABSTRACT FROM AUTHOR]

Summary: Background: Understanding genetic variations is important in predicting treatment response and forms the basis for identifying new pharmacogenetic and pharmacogenomic targets for psoriasis treatment. There are limited data on the efficacy of secukinumab in relation to genetic markers. Objectives: To evaluate the efficacy and safety of secukinumab 300 mg in HLA‐Cw6‐positive (Cw6‐POS) and HLA‐Cw6‐negative (Cw6‐NEG) patients with moderate‐to‐severe chronic plaque‐type psoriasis. Methods: SUPREME was a 24‐week, phase IIIb study with an extension period up to 72 weeks. Primary end point was Psoriasis Area Severity Index (PASI) 90 response rate after 16 weeks. Results: In total, 434 patients were recruited: 185 (42·6%) were Cw6‐POS and 246 (56·7%) were Cw6‐NEG (three not assessed). Mean ± SD age was 45·2 ± 13·2 years (Cw6‐POS 42·7 ± 13·1; Cw6‐NEG 47·2 ± 12·9). The baseline PASI score was comparable between the cohorts [Cw6‐POS 20·7 ± 8·99; Cw6‐NEG 21·5 ± 9·99 (P = 0·777)]. At week 16, PASI 90 was achieved in 80·4% of Cw6‐POS and 79·7% of Cw6‐NEG patients (difference 0·76; 95% confidence interval −7·04 to 8·23). No differences in absolute PASI at week 16 (Cw6‐POS 1·36 ± 3·58; Cw6‐NEG 1·18 ± 2·29) were observed. The overall safety profile of secukinumab was consistent with that previously reported. No statistically significant difference was detected in the rate of treatment‐emergent adverse events [Cw6‐POS 42·7%; Cw6‐NEG 49·6% (P = 0·295)]. A high PASI 90 response was achieved with secukinumab with a fast reduction in absolute PASI. Conclusions: Determination of HLA‐Cw6 status for secukinumab therapy is unnecessary, as it is highly effective regardless of HLA‐Cw6 status. What's already known about this topic? HLA‐Cw6 is associated with the phenotypic features of psoriasis and positive response to ustekinumab and is present in approximately 40–80% of cases.Secukinumab is a fully human monoclonal antibody neutralizing interleukin‐17A and it has demonstrated a rapid onset of action and sustained responses with a favourable safety profile in moderate‐to‐severe psoriasis, psoriatic arthritis and ankylosing spondylitis. What does this study add? Although HLA‐Cw6‐positive and HLA‐Cw6‐negative patients have distinct clinical features, the present study showed that secukinumab achieved similar clinical responses in both cohorts after 24 weeks of treatment.There was no difference in efficacy regarding HLA‐Cw6 status. Respond to this article Plain language summary available online [ABSTRACT FROM AUTHOR]

Summary: Background: Adherence to topical psoriasis treatments is low, which leads to unsatisfactory treatment results. Smartphone applications (apps) for patient support exist but their potential to improve adherence has not been systematically evaluated. Objectives: To evaluate whether a study‐specific app improves adherence and reduces psoriasis symptoms compared with standard treatment. Methods: We conducted a randomized controlled trial (RCT, clinicaltrials.gov registration: NCT02858713). Patients received once‐daily medication [calcipotriol/betamethasone dipropionate (Cal/BD) cutaneous foam] and were randomized to no app (n = 66) or app intervention (n = 68) groups. In total, 122 patients (91%) completed the 22‐week follow‐up. The primary outcome was adherence, which was defined as medication applied ≥ 80% of days during the treatment period and assessed by a chip integrated into the medication dispenser. Secondary outcomes were psoriasis severity measured by the Lattice System Physician's Global Assessment (LS‐PGA) and quality of life, measured using the Dermatology Life Quality Index (DLQI) at all visits. Results: Intention‐to‐treat analyses using regression was performed. More patients in the intervention group were adherent to Cal/BD cutaneous foam than those in the nonintervention group at week 4 (65% vs. 38%, P = 0·004). The intervention group showed a greater LS‐PGA reduction than the nonintervention group at week 4 (mean 1·86 vs. 1·46, P = 0·047). A similar effect was seen at weeks 8 and 26, although it did not reach statistical significance. Conclusions: This RCT demonstrates that the app improved short‐term adherence to Cal/BD cutaneous foam treatment and psoriasis severity. What's already known about this topic? Psoriasis affects 2–4% of the Western adult population, has detrimental socioeconomic effects and negatively affects quality of life.Topical corticosteroid/calcipotriol combinations are recommended first‐line treatments for mild‐to‐moderate psoriasis, but poor adherence to topical treatments result in low efficacy.Several smartphone applications (apps) are available to patients with psoriasis, but the adherence‐improving potential of this technology has not been evaluated in a randomized controlled setting. What does this study add? This randomized controlled trial investigates the effects of a supporting app on adherence to a once‐daily topical calcipotriol/betamethasone dipropionate cutaneous foam preparation over a 28‐day period.The app provided daily reminders and informed patients whether they had applied their treatment. Information on adherence was obtained with a chip attached to the dispenser that synchronized to the app.The app significantly improved adherence rates and reduced psoriasis severity in the short term. Linked Comment:Howland and Dellavalle. Br J Dermatol 2018; 179:1025–1026. Respond to this article Plain language summary available online [ABSTRACT FROM AUTHOR]

Background/Objectives: Biological agents provide a relatively safe and promising long‐term therapeutic option for patients with moderate to severe psoriasis in whom conventional treatment has failed. However, these agents are not effective in all patients. We aimed to examine the association of baseline patients' characteristics with the short‐term efficacy and the long‐term survival of biological therapies in patients with moderate to severe psoriasis. Methods: We performed a retrospective observational study of all patients who received biological treatment for psoriasis at the Royal Melbourne Hospital (N = 146). We extracted data on the patients' characteristics and medical history. The outcomes we measured included a 75% reduction in psoriasis area and severity index (PASI) score at 12 and 24 weeks, the total duration of drug survival and dermatology life quality index (DLQI) scores. We used regression modelling to assess the association between each baseline patient's characteristic and outcome measures. Results: An increase in baseline body mass index was associated with a reduced likelihood of achieving PASI75 at 12 and 24 weeks (P = 0.014) and also correlated with reduced long‐term therapeutic survival (P = 0.03). High rates of treatment termination were noted in patients with greater baseline DLQI (P = 0.038). Conclusion: Greater body mass index at the initiation of biological treatment for psoriasis may contribute to its decreased short‐term efficacy. Similarly, a high body mass index or DLQI at baseline was associated with a relatively short duration of biological treatment retention. [ABSTRACT FROM AUTHOR]

Summary: This review provides a summary of key findings from 27 systematic reviews of 51 articles first published or indexed during 2015, focusing on the treatment of psoriasis and on precision medicine in psoriasis. The evidence supports weight‐loss interventions by dieting and exercise for improvement in disease severity in overweight and obese patients with psoriasis. No significant increased risk of serious infections was reported for the biologic therapies adalimumab, etanercept and ustekinumab compared with appropriate comparators. Evidence could not provide reliable estimates of rare adverse events, emphasizing the need for large prospective registries. Polymorphisms in the tumour necrosis factor (TNF)‐α gene may confer improved responses to TNF inhibitor (TNFI) therapy, but the studies to date lack power to detect a true association. From the limited available evidence, multidisciplinary management is both more effective and more satisfactory for patients with psoriasis and psoriatic arthritis than conventional consultations. This summary of reviews provides a succinct guide for clinicians and patients wishing to remain up to date with high‐quality evidence for the treatment of psoriasis. [ABSTRACT FROM AUTHOR]

Abstract: The links between psoriasis and stress are complex. This article proposes a review of the literature on the relationship between stress and psoriasis. In 31–88% of cases, patients report stress as being a trigger for their psoriasis. There was also a reported higher incidence of psoriasis in subjects who had a stressful event the previous year, suggesting that stress may have a role in triggering the disease in predisposed individuals. Stress is also a consequence of psoriasis outbreaks. Understanding the role of stress makes it appropriate to target stress when proposing treatment to patients with psoriasis. Several controlled studies have demonstrated that relaxation, hypnosis, biofeedback, and behavioral and cognitive stress management therapies have been effective in people with psoriasis. [ABSTRACT FROM AUTHOR]

Introduction: Psoriasis is a non-contagious but chronic skin disease that does not usually affect the client's wellbeing, but, due to the changes regarding the aspect of their skin, other members of society tend to avoid and sometimes marginalize a person that exhibits clear visual symptoms. This can cause the patient issues like anxiety, stress and depression. In this paper, we outline and detail a case study with the treatment of a patient diagnosed with psoriasis and the effects of the IEMT model treatment. In addition, the IEMT primary concepts and techniques are described and further references and training resources are provided. Objectives: The current paper aims at providing evidence for the IEMT model, both as possible and efficient, but also a non-intrusive, complementary method for treating patients diagnosed with psoriasis skin eruption. Methods: The Integral Eye Movement Therapy process was specifically designed by the Association for IEMT Practitioners for their psoriasis research project. Results: The client participating in this case study presented improvement after two weeks of the single IEMT based treatment session and after three months the client's psoriasis-induced eruptions completely disappeared. Moreover, after two years and a half, his psoriasis-induced eruptions also did not reappear. Conclusions: Although further research is needed, following this case study, we can clearly see the Integral Eye Movement Therapy (IEMT) model shows to be a promising approach in treating stress-related psoriasis. [ABSTRACT FROM AUTHOR]

Psoriasis used to be known as a skin disorder; however, it can now be considered as a systemic disease with the involvement of multiple organs. Neurological and psychiatric disorders are some of the associated problems that can be observed in patients with psoriasis. Stroke, multiple sclerosis, seizure, migraine, restless leg syndrome, Parkinson's disease, Guillain-Barré syndrome, and myasthenia gravis are the reported neurological diseases, while depression, bipolar mood disorder, anxiety, psychosis, cognitive impairment, personality disorders, sexual disorders, sleep disturbance, and eating disorders are the recognized psychiatric presentations in patients with psoriasis. Herein, the neurological and psychiatric disorders of psoriasis are described. [ABSTRACT FROM AUTHOR]

Summary: Background: Biologics are being used increasingly to treat moderate‐to‐severe psoriasis. Efficacy may differ in patients with previous exposure to biologics. Objectives: To investigate the impact of previous biologic exposure on the efficacy and safety of brodalumab and ustekinumab in patients with moderate‐to‐severe plaque psoriasis. Methods: Two placebo‐ and ustekinumab‐controlled phase III clinical trials. There was an initial 12‐week induction phase where patients were treated with brodalumab [210 mg or 140 mg every 2 weeks (Q2W)], ustekinumab or placebo. Efficacy end points included ≥ 75% improvement in Psoriasis Area and Severity Index (PASI 75) and static Physician's Global Assessment (score of 0 or 1) vs. placebo, PASI 100 vs. ustekinumab, Dermatology Life Quality Index and Psoriasis Symptom Inventory. Adverse events were monitored throughout. Results: In total, 493 patients [334 (27%) brodalumab 210 mg Q2W and 159 (26%) ustekinumab] had received prior biologics; 150 (12%) and 62 (10%), respectively, reported previously failed treatment with a biologic. Brodalumab efficacy in patients with or without previous exposure to biologics was statistically equivalent: 40·9% and 39·5% of biologic‐naive and ‐experienced patients achieved PASI 100 at week 12, compared with 21·1% and 17·0% with ustekinumab (both P < 0·001). In patients where prior biologics had been successful or failed, 41·7% and 32·0% achieved PASI 100, compared with 21·1% and 11·3% with ustekinumab. Tolerability was similar, and did not appear to be influenced by previous treatment with biologics. Conclusions: The efficacy of brodalumab 210 mg Q2W was similar regardless of prior biological therapy (P = 0·31, 0·32 and 0·64 for PASI 75, 90 and 100, respectively). Almost twice as many patients achieved PASI 100 or complete clearance with brodalumab at week 12 compared with ustekinumab; the differences were most noticeable where previous biologics had failed. Both treatments were well tolerated. [ABSTRACT FROM AUTHOR]

Psoriasis is a widespread chronic disease affecting 2–4% of the population in Western countries. Its mild-to-moderate form, representing approximately 80% of the total cases, is treated by topical application, with corticosteroid being the standard treatment. However, in case of psoriasis, no single treatment works for every patient and optimizing topical therapy is a key aspect. A possible alternative is represented by cyclosporine, an immunosuppressant cyclic peptide administered orally in the treatment of the severe form. Its topical application could avoid the problems related to systemic immunosuppression, but the unfavourable physico-chemical properties (MW: 1202 Da; LogP ≈ 3) hinder its permeation across the stratum corneum. The aim of the paper was the preparation, characterization and ex-vivo evaluation of cyclosporine loaded microemulsions using oleic acid as oil phase, either Tween ® 80 or a soluble derivative of vitamin E (TPGS) as surfactants and either Transcutol ® , propylene glycol or 1,3 propanediol as co-surfactants. The issue of formulation viscosity was also addressed 1) by evaluating the thickening of Tween ® 80-based microemulsions by direct addition of different rheological modifiers, 2) by building pseudo-ternary phase diagrams using TPGS, to identify the water/oil/surfactants proportions resulting in viscous self-gelifying systems. Nine formulations (five Tween ® 80-based and four TPGS-based) were selected, characterized in terms of droplets size (low viscosity systems) or rheological properties (high viscosity systems), loaded with 6 mg/g cyclosporine and applied ex-vivo on porcine skin for 22 h. A relevant skin accumulation was obtained either with a low-viscosity Tween ® 80-based microemulsion (9.78 ± 3.86 µg/cm 2 ), or with a high viscosity TPGS-based microemulsion (18.3 ± 5.69 µg/cm 2 ), with an increase of about 3 and 6 times respectively for comparison with a control cyclosporine solution in propylene glycol. The role of water content, surfactant, co-surfactant and viscosity was also addressed and discussed. The kinetic of skin uptake from the best performing formulation was finally evaluated, highlighting a relatively quick skin uptake and the achievement, after 2 h of contact, of potentially therapeutic cyclosporine skin concentrations. [ABSTRACT FROM AUTHOR]

Summary: Background: Very few studies have assessed the efficacy of excimer in the treatment of palmoplantar psoriasis (PPP), and none has compared the excimer with calcipotriol‐clobetasol propionate combination. Purpose: To compare the effectiveness and safety of excimer lamp vs topical ointment containing calcipotriol (0.005% w/w) and clobetasol propionate (0.05% w/w) combination in PPP. Methods: This right‐left randomization trial included 36 patients with PPP, who received treatment with excimer lamp (twice weekly) on one side and calcipotriol‐clobetasol combination (once daily) on another side for 12 weeks, followed by 8 weeks of follow‐up. Recruitment and response assessment was done by 2 experienced dermatologists (SD and TN) using modified palmoplantar pustular psoriasis area and severity index score (mPPPASI, originally devised for palmoplantar pustulosis, suitably modified to assess response in PPP). Primary outcome measure was percentage improvement in mPPPASI at 12 weeks, which was classified as minimal (≤25%), mild (>25%‐50%), moderate (>50%‐75%), and marked (>75%). Secondary outcome measures were the proportion of patients achieving >75% reduction in mPPPASI and the time taken to achieve it. Results: Of 36 recruited patients, 33 completed treatment and 21 adhered to 8‐weeks follow‐up. The mean mPPPASI on the excimer‐treated sides reduced significantly from 7.75 ± 4.62 to 4.01 ± 4.07 (P < .001) at 12th week (end of the treatment) and 2.66 ± 3.97 at 20th week (at 8 weeks follow‐up). The mean mPPPASI on the calcipotriol‐clobetasol combination treated sides reduced significantly from 7.36 ± 4.46 to 3.55 ± 3.77 (P < .001) and 2.70 ± 3.97 at 12th week and 20th week, respectively. The reduction was significant for both treatment and the difference between the two was not statistically significant. Minimal, mild, moderate, and marked improvement was seen in 5/33 (15.2%) and 1/33 (3.0%), 6/33 (18.2%) and 8/33 (24.2%), 12/33 (36.4%) and 13/33 (39.4%), and 8/33 (24.2%) and 8/33 (24.2%) sides in the excimer and calcipotriol‐clobetasol combination, respectively. A total of 8 patients in each group achieved mPPPASI 75 at 12 weeks. The mPPPASI 75 was achieved at 2, 4, and 8 weeks in 1, 2, and 8 patients, respectively, using either modalities. The adverse effects (most commonly hyperpigmentation) were noted more frequently on the excimer‐treated sides; however, they were well tolerated. Conclusion: Both excimer lamp and calcipotriol‐clobetasol propionate combination are equally effective in the treatment of PPP. [ABSTRACT FROM AUTHOR]

Aryl hydrocarbon receptor (AhR) is a transcription factor expressed in all skin cells type. It responds to exogenous and endogenous chemicals by inducing/repressing the expression of several genes with toxic or protective effects in a wide range of species and tissues. In healthy skin, AhR signalling contributes to keratinocytes differentiation, skin barrier function, skin pigmentation, and mediates oxidative stress. In the last years, some studies have shown that AhR seems to be involved in the pathogenesis of some skin diseases, even if the currently available data are contradictory. Indeed, while the blocking the AhR signalling activity could prevent or treat skin cancer, the AhR activation seems to be advantageous for the treatment of inflammatory skin diseases. Therefore, for its multifaceted role in skin diseases, AhR seems to be an attractive therapeutic target. Indeed, recently some molecules have been identified for the prevention of skin cancer and the treatment of inflammatory skin diseases. [ABSTRACT FROM AUTHOR]

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Psoriasis is a complex and chronic disease, and, in most cases, therapies are required during all patients' lifetime. The efficacy and safety profiles of biological therapies are well established, but their effectiveness is still open to discussion. We performed a systematic review to summarize how the effectiveness of biological therapies for psoriasis is measured in real-world studies and to understand whether drug survival, a recent alternative outcome to clinical ones, is a recurrent and valid outcome of effectiveness. In March 2017, we searched for quantitative epidemiological data of psoriasis treatments using PubMed/Medline and EMBASE, and we included 65 publications. The retrospective study design (37%) was most frequent, followed by prospective registries (29%), prospective studies (19%), and retrospective administrative databases/claims. Drug survival was reported in over 60% of prospective registries and retrospective studies, and less frequently in prospective studies. A general consensus emerged in the definition of drug survival as the time patients remain under treatment with a specific therapy, and in its interpretation as an overall marker of treatment success and treatment adherence, as it represents simultaneously information on drug efficacy, drug safety, and patient satisfaction. In conclusion, notwithstanding some limitations, drug survival is a useful measurement of biological therapy effectiveness for psoriasis in daily practice. Its major advantage is that it can be computed also in already collected databases without any specific clinical information on psoriasis. This outcome, combined with evidence on clinical markers of effectiveness, can contribute to better understanding the performance of this expensive class of drugs. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic, inflammatory, lifelong disease with a high prevalence (afflicting approximately 1-5% of the population worldwide) and is associated with significant morbidity. The introduction of biologic therapies has improved the management of this disease. Multiple biologic medicines that block cytokine signaling, including tumor necrosis factor (TNF) antagonists (adalimumab, etanercept, and infliximab) and inhibitors of interleukin (IL)-17 (brodalumab, ixekizumab, and secukinumab), IL-23 (guselkumab), or IL-12/23 (ustekinumab), are approved for the treatment of psoriasis. Despite the clinical benefits associated with use of biologics in psoriasis, many patients are not treated with biologic therapy, and access to treatment may be limited for various reasons, such as high treatment costs. Patents for many biologics have expired or will soon expire, and biosimilar versions of these agents are available or in development. A biosimilar is a biological product that is highly similar to an approved biologic (i.e., originator or reference) product, and has no clinically meaningful differences in safety, purity, or potency when compared with the reference product. Biosimilars may offer less expensive treatment options for patients with psoriasis; they also may increase access to and address problems with underutilization of biologic therapy. Biosimilar development and approval follows a well-regulated process in many countries, with guidelines developed by the European Medicines Agency, US Food and Drug Administration, and World Health Organization. Currently, several anti-TNF biosimilars are available for use in patients with psoriasis, and other monoclonal antibodies are in development. This review provides dermatologists and those who treat and/or manage psoriasis with a working knowledge of the scientific principles of biosimilar development and approval. It also examines real-world experience with biosimilars available for or used in dermatology that will enable physicians to make informed treatment decisions for their patients with psoriasis.Funding: Pfizer Inc. [ABSTRACT FROM AUTHOR]

Summary: Background: The appearance and lifelong, chronic nature of psoriasis result in considerable burden to patients, such as sleep impairment, depressive symptoms, negative self‐esteem and reduced work productivity. Objectives: To examine direct and indirect (mediated) effects of secukinumab vs. ustekinumab on quality of life, work productivity and activity impairment based on psoriasis severity and symptoms. Methods: Analyses were based on data from the CLEAR study. Structural equation modelling examined the effects of secukinumab vs. ustekinumab on the Dermatology Life Quality Index (DLQI) and on the Work Productivity and Activity Impairment (WPAI) questionnaire using Psoriasis Area and Severity Index (PASI) severity and symptoms (pain, itching and scaling) as potential mediators. Analyses were conducted primarily for patients achieving a PASI 90 response (90% or greater reduction in PASI from baseline) at week 16 (repeated at week 52) and for PASI 50, 75 and 100. Results: Results at weeks 16 and 52 showed that the effect of treatment on change in DLQI score was mediated by the PASI 90 response and by improvements in itching, pain, and scaling. Achieving any PASI response as early as week 16 directly resulted in significantly better WPAI scores. At week 52, both PASI response and improvement in scaling directly resulted in significantly better WPAI scores. Pain, itching and scaling were correlated (r = 0·51–0·68); improvement in any of these had a significant effect (directly or indirectly) on WPAI. All results favoured secukinumab over ustekinumab. Conclusions: The results underscore the important role of both PASI response and reduction in symptoms on improvements in health‐related quality of life and work and daily activity in favour of secukinumab vs. ustekinumab. [ABSTRACT FROM AUTHOR]

Psoriasis, psoriatic arthritis, and rheumatoid arthritis are prevalent conditions that often require a team of primary care and specialist healthcare professionals for the most optimum patient outcomes. Primary care providers can facilitate referrals to dermatology and rheumatology specialists by obtaining the needed screening workup for patients who need treatment with immunosuppressive therapies. This article reviews tuberculosis screening, hepatitis screening, and vaccinations to be administered before patients begin biologic medications. [ABSTRACT FROM AUTHOR]

Abstract: Psoriasis affects 0.5–2% of children. Severe forms required use of systemic treatments. Few studies are published on efficiency and tolerance of systemic treatments in children. We conducted a survey in France to better understand management of children with psoriasis. A survey on childhood psoriasis management was sent by e‐mail to GPs, pediatricians, and dermatologists. The survey included 384 physicians. Respectively 53.1%, 49.8%, and 83.3% of GPs, pediatricians, and dermatologists declare to have seen at least one child with psoriasis during the 3 previous months. Less than 5% of GPs and pediatricians used severity score versus 23.7% of dermatologists. If most of physicians declare to use local treatments, less than 5% of GPs and pediatricians used systemic treatments. 32.4% of dermatologists declared to use at least one systemic treatment, but only 2.9% to use the 4 systemic treatments available in France. This survey shows that only half of GPs and pediatricians see children with psoriasis, but most of dermatologists. However, the management of severe forms seems limited by the underuse of severity scores and systemic treatments. These results should stimulate dermatology societies to promote prospective studies and guidelines in young populations with psoriasis. [ABSTRACT FROM AUTHOR]

The recent advances in the understanding of psoriasis pathogenesis have clarified the pivotal role of interleukin (IL)-23. It is a heterodimeric cytokine consisting of two subunits, the unique p19 and the p40, which are shared with IL-12. The basic role of IL-23 in psoriasis is the activation and maintenance of the T-helper 17 pathway. New research findings indicate that IL-23 is more important than IL-12 in the pathogenesis of psoriasis. Based on that background, the selective targeting of the IL-23p19 subunit emerged as an attractive therapeutic option and led to the development of a new category of biologic agents. Three monoclonal antibodies that selectively inhibit the IL-23p19 subunit, guselkumab, tildrakizumab, and risankizumab, are in the pipeline for the treatment of moderate-to-severe psoriasis. In this article, we review the most recent efficacy and safety data regarding these IL-23p19 inhibitors. [ABSTRACT FROM AUTHOR]

Psoriasis is a genetically-regulated, T lymphocyte-mediated autoimmune skin disease that causes systemic damage, seriously affecting patient quality of life and survival. Psoriasis treatments, which aim to control the disease's development, are greatly limited because its etiology and pathogenesis have not yet been fully elucidated. A large number of studies have demonstrated that immunogenetic elements are the most important factors responsible for psoriasis susceptibility. This paper delineates the immunogenetic mechanisms of psoriasis and provides useful information with regards to performing drug repositioning for the treatment of psoriasis. [ABSTRACT FROM AUTHOR]

Lactoferrin is a glycoprotein widely present in mammalian secretions and possesses documented protective effects, including antimicrobial and anti-inflammatory properties. While its therapeutic use is being investigated for a myriad of diseases, there is increasing interest in its application for skin disease. Our objective was to systematically review the clinical evidence for the use and efficacy of lactoferrin for the treatment of dermatological conditions. Pubmed and Embase databases were searched for clinical studies evaluating lactoferrin for dermatological conditions. A total of six studies were reviewed. Of the current clinical trials, there is encouraging evidence to suggest that lactoferrin may be beneficial in acne, psoriasis, and diabetic ulcerations. Although the current evidence is promising, further research is necessary to establish lactoferrin as complementary therapy in the clinical setting. [ABSTRACT FROM AUTHOR]