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Introduction: Genital involvement is observed in approximately 60% of patients with psoriasis, presenting clinicians with formidable challenges in treatment. While new biologic drugs have emerged as safe and effective options for managing psoriasis, their efficacy in challenging-to-treat areas remains inadequately explored. Intriguingly, studies have shown that interleukin (IL)-17 inhibitors exhibit effectiveness in addressing genital psoriasis. Objectives: We aimed to determine the effectiveness profile of bimekizumab in patients affected by moderate-to-severe plaque psoriasis with involvement of genitalia. Methods: Bimekizumab, a dual inhibitor of both IL-17A and IL-17F, was the focus of our 16-week study, demonstrating highly favorable outcomes for patients with genital psoriasis. The effectiveness of bimekizumab was evaluated in terms of improvement in Static Physician's Global Assessment of Genitalia (sPGA-G) and Psoriasis Area and Severity Index. Results: Sixty-five adult patients were enrolled. Remarkably, 98.4% of our participants achieved a clear sPGA-G score (s-PGA-g=0) within 16 weeks. Moreover, consistent improvements were observed in PASI scores, accompanied by a significant reduction in the mean Dermatology Life Quality Index (DLQI), signifying enhanced quality of life. Notably, none of the patients reported a severe impairment in their quality of life after 16 weeks of treatment. In our cohort of 65 patients, subgroup analyses unveiled that the effectiveness of bimekizumab remained unaffected by prior exposure to other biologics or by obesity. Conclusions: Our initial findings suggest that bimekizumab may serve as a valuable treatment option for genital psoriasis. Nevertheless, further research with larger sample sizes and longer-term follow-up is imperative to conclusively validate these results.

In recent years, with the increased usage of tumour necrosis factor (TNF) inhibitors, more side effects have been revealed. Paradoxical psoriasis, including psoriasis vulgaris, palmoplantar pustulosis, scalp psoriasis and their combinations, is a common adverse effect. However, erythrodermic psoriasis associated with alopecia due to anti-TNF-α is rarely reported in the literature. We report a 44-year-old woman who developed erythrodermic psoriasis associated with diffuse alopecia during her treatment with adalimumab for palmoplantar pustulosis. [ABSTRACT FROM AUTHOR]

IntroductionThe development of several effective biological drugs for moderate-to-severe plaque psoriasis has dramatically changed the lives of patients. Despite the wide use of interleukin (IL) inhibitors, limited data are available to date regarding long-term treatment persistence.MethodThis multicenter retrospective real-world study evaluated 5932 treatment courses across 5300 patients, all treated with interleukin inhibitors. Drug survival was expressed by using the Kaplan-Meier estimator for each biological drug at 6, 12, 24, 36 and 48 months. We also stratified by discontinuation associated with primary or secondary ineffectiveness.ResultsIn our study, the most prescribed drugs were secukinumab (1412), ixekizumab (1183), and risankizumab (977). After four years of follow-up, risankizumab emerged as the treatment with the highest drug survival overall, as 91.6% of patients were still on treatment. The overall probability of drug survival at four years was comparable for tildrakizumab (83.5%), ixekizumab (82.6%), guselkumab (82.4%) and brodalumab (81.8%). When evaluating only patients who discontinued the treatment because of ineffectiveness, once again risankizumab was the molecule with the highest drug survival at 4 years (93.4%), this time followed by ixekizumab (87%). Our study, in which all IL inhibitors were adequately represented, confirmed a slightly better treatment persistence for IL-23 inhibitors, consistent with other real-world studies.ConclusionOur experience showed that IL-23 inhibitors, and risankizumab in particular, had a higher probability of drug survival overall during a 4-year follow-up. Risankizumab and ixekizumab were less likely to be discontinued because of ineffectiveness after four years.

Introduction: Metformin has potential in treating patients with psoriasis, and this meta-analysis aims to explore the impact of metformin supplementation on treatment efficacy for psoriasis. Material and methods: The PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched, and we included randomized controlled trials (RCTs) assessing the effect of metformin on treatment efficacy for patients with psoriasis. Results: Three RCTs were included in the meta-analysis. Overall, compared with control intervention for psoriasis, metformin intervention resulted in significantly increased psoriasis area severity index (PASI) 75% reduction (odds ratio (OR) = 22.02; 95% confidence interval (CI): 2.12 to 228.49; p = 0.01), and erythema, scaling and induration (ESI) 75% reduction (OR = 9.12; 95% CI: 2.13 to 39.02; p = 0.003), and was associated with substantially decreased fasting plasma glucose (FPG, standard mean difference (SMD) = --0.59; 95% CI: -0.92 to -0.26; p = 0.0005), triglycerides (SMD = -0.92; 95% CI: -1.38 to -0.47; p < 0.0001), total cholesterol (SMD = -0.77; 95% CI: -1.22 to -0.32; p = 0.00008), and low-density lipoprotein (LDL, SMD = -0.67; 95% CI: -1.12 to --.23; p = 0.003). Conclusions: Metformin supplementation effectively improves treatment efficacy and metabolic syndrome in psoriasis patients. [ABSTRACT FROM AUTHOR]

Background • Despite there being advanced treatment options, psoriasis remains an incurable and recurring disease. Noteworthy scholars of Unani (Greco-Arab) medicine have proposed many drugs and formulations for psoriasis but the scientific evidence on the same is scarce. Hence, trial formulations were selected for the study. Primary Study Objectives • This study was designed to evaluate the efficacy and safety of two herbal Unani formulations, Ma΄jūn Mundī and Qairūtī Karnab, in the management of chronic plaque psoriasis (CPP). Methods/Design • This open-label, single-arm clinical trial was conducted on 33 participants, of whom 30 completed the 12-week treatment course. Setting • This study was conducted at the Central Research Institute of Unani Medicine (CRIUM), Hyderabad, Telangana, India, from 01 August 2018 to 25 May 2019. Participants • Participants of any gender aged 18 to 65 years with clinically diagnosed CPP and psoriasis area severity index (PASI) ≥ 10% were included in the trial. Interventions • The participants received 5 g of Ma΄jūn Mundī (a semisolid preparation) orally, twice daily with water, followed by the topical application of Qairūtī Karnab (a homogenous paste) to cover the lesions over 12 weeks. Outcome Measures • The primary outcome measure was the change in PASI determined pre- and post-trial in terms of mean and percentage reduction. Secondary outcome measures were changes in patient global assessment (PGA) on a 100 mm visual analog scale, investigator global assessment (IGA) on a 6-point scale, and subjective parameters including erythema, induration, scaling, and itchiness. Results • The analysis revealed a significant reduction in the PASI score, with 12 subjects (40%) achieving PASI 75 and 3 subjects (10%) achieving PASI 90. Significant improvements were also observed in secondary outcome measures with no adverse events. Conclusion • The findings of the study indicate that the trial formulations exhibit a notable anti-psoriatic effect without any adverse effects. The formulations are worthy of further evaluation as an alternative treatment for CPP [ABSTRACT FROM AUTHOR]

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Objectives: Despite extensive research, there is currently no specific biomarker that reliably and universally indicates treatment response in psoriasis. Multiple studies have evaluated systemic inflammation markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and systemic immune response index (SIRI) in psoriasis patients. However, there are limited studies investigating changes in these markers with biologic therapy. The goal of this study was to investigate the impact of biologic therapy on parameters including NLR, PLR, MLR, SII, and SIRI in patients with psoriasis. Methods: In this cohort study, we retrospectively evaluated 108 psoriasis patients who were on biological treatment, including interleukin (IL)17, IL23, and IL12/23 inhibitors, for a minimum of 12 weeks. We analyzed Psoriasis Area Severity Index (PASI) scores, complete blood count parameters, and C-reactive protein (CRP) levels both before and after 12 weeks of treatment. Results: The NLR, PLR, MLR, SII, SIRI, and CRP values all demonstrated a significant decrease, regardless of the specific type of biologic agent (p=0.001, 0.007, 0.011, <0.001, <0.001 and <0.001, respectively). Furthermore, we observed a statistically significant but low correlation between the reduction in PASI scores and PLR, SII, and SIRI values (p=0.036, r=0.202; p=0.042, r=0.196; p=0.023, r=0.219, respectively). Conclusion: The NLR, MLR, especially PLR, SII, and SIRI might be used as simple, convenient, and inexpensive laboratory markers to monitor the degree of inflammation and response to treatment after biologic therapy in daily practice. [ABSTRACT FROM AUTHOR]

Genital psoriasis affects 3-33% of patients with psoriasis during the course of the disease, usually leading to a severe reduction in the patient’s quality of life. This study aims to retrospectively assess the effectiveness of interleukin (IL)-23 and IL-17 inhibitors in a real-life population affected by moderate-to-severe plaque psoriasis with genital involvement coming from our dermatology department. A total of 86 patients with a diagnosis of moderate-tosevere plaque psoriasis with severe genital involvement were enrolled. Patient characteristics, psoriasis area and severity index (PASI), and static physician global assessment of genitalia (sPGAG) at each visit were recorded. During the treatment, the mean PASI decreased from 12.8 to 0.63 at week 52; a PGA of 0/1 was reached by 97.40% at week 52 and by 100% of patients (37/37) at week 104. No significant differences between IL-23 and IL-17 inhibitors were observed; indeed, the bio-naïve group of patients demonstrated a superior response compared to the group of bioexperienced patients.Our findings confirmed that IL-23 and IL-17 inhibitors are safe and effective therapeutic options for the treatment of genital psoriasis. [ABSTRACT FROM AUTHOR]

Introduction • Psoriasis is a chronic inflammatory dermatological condition characterized by welldemarcated erythematous scaly plaques. It affects the immune system of the body causing inflammation and hyper-proliferation of the skin, where a key role is played by immune dysfunction and psychological stress. Psoriasis is a relapsing and remitting disease which shows its affections primarily for skin. This makes it more difficult to treat as there often is a mental maintaining cause associated in the background. Homoeopathy is an ideal system of medicine for the treatment of such diseases which show affections for both physical and mental sphere. Whilst treating such diseases, the homoeopathic physician often faces challenges when the most indicated remedy stops acting after an initial amelioration. This demands the usage of an intercurrent remedy which removes the obstacles in the path of cure and brings about recovery in the patient. Case Summary • A 28-year-old female presented with thick, coppery red eruptions on ear pinnae, scalp, extensor surface of left hand, back and ankles laterally. Based on the totality of symptoms, she was prescribed Staphysagria 1M which initially provided relief to the patient. The case was stood still for several months during which both placebo and Staphysagria 10M were prescribed. Still there was no progress whatsoever, the case was retaken, but the totality and the remedy were same. This was a clear call for prescribing an anti-miasmatic remedy to remove the miasmatic block. The patient was prescribed Psorinum 1M as an intercurrent anti-miasmatic remedy with remarkable physically and mental recovery. Staphysagria 10 M was repeated which later removed all the lesions and restored the patient mentally too. [ABSTRACT FROM AUTHOR]

Objective: To evaluated the health-utility values and risk factors for cumulative life course impairment (CLCI) using Patient Acceptable Symptom State (PASS) and European Quality of Life 5 Dimensions (EQ-5D). Materials and Methods: This cross-sectional investigation enrolled patients with psoriasis. Patients were asked PASS questions about their overall self-perceived health state, adaptation, and expectations for current, future, and lifelong conditions. The patients also completed EQ-5D. Results: The mean age of 139 enrolled patients was 45.8 ± 14.4 years, and 57.6% were women. Most cases had chronic plaque psoriasis 121 (87.1%). For current PASS, satisfaction was significantly associated with older age, being married, and lower disease severity. The mean health-utility value and visual analog scale of the 139 patients were 0.89 ± 0.12 and 77.0 ± 17.4, respectively. Patients would not accept their disease if they had moderate to extreme problems in usual activities and depression/anxiety for the future and lifelong. Univariate analysis revealed that depression and usual activities were significantly associated with satisfaction for current PASS, future PASS, and lifelong PASS. Conclusion: Disease severity, age, marital status, problems with usual activities, and depression/anxiety were significantly related to CLCI. These findings may allow physicians to identify psychosocial and psychological aspects of psoriatic patients at high risk for developing CLCI. Early and adequate treatment, good coping strategies, and good social support can prevent a negative impact on CLCI and major life-changing decisions. [ABSTRACT FROM AUTHOR]

Purpose: The current study was carried-out to examine the effectiveness of low-level laser therapy versus bioptron on psoriasis. Subjects and Methods: 60 patients of both sexes with psoriasis contributed in this study and they were aged from 30 to 60 years. They were randomized into two groups of the same number (A and B). Group (A) were given low level laser therapy (LLLT) and medical care, while group (B) were given bioptron light therapy (BLT) and the same medical care that received in group (A). The variables included Psoriasis Area Severity Index (PASI) and Dermoscopic finding were measured pre and post intervention program on psoriatic patients in both groups. Both groups were given treatment program 3 sessions a week for 8 weeks. Results: following 8 consecutive weeks, both groups showed statistically significant improvement in all outcome measures, however there was a significant difference between them post treatment, favoring group (A). Conclusion: Low level laser therapy and bioptron were beneficial treatment modalities in psoriatic patients and LLLT may be more effective in treating psoriasis. [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]

This document is a letter to the editor discussing a case study of a 32-year-old female patient with psoriasis and multiple sclerosis who developed both generalized and patch granuloma annulare after treatment with fingolimod. Granuloma annulare is an inflammatory cutaneous disorder that can present in various forms and has been associated with diabetes, hyperlipidemia, malignancy, infections, and certain medications. The patient in this case had a family history of psoriasis and was treated with topical medications before starting fingolimod. The authors suggest that T lymphocytes may play a role in the development of fingolimod-induced granuloma annulare, and this case contributes to the literature on this rare topic. [Extracted from the article]

IntroductionBimekizumab is a monoclonal antibody that targets Interleukin-17 A and F, approved for the treatment of moderate-to-severe plaque psoriasis. While bimekizumab has been evaluated in several phase-III clinical trials, real-world evidence is still very limited.MethodThis multicenter retrospective study included patients affected by plaque psoriasis treated with bimekizumab from May 1, 2022 to April 30, 2023, at 19 Italian referral hospitals. Patients affected by moderate-to-severe plaque psoriasis eligible for systemic treatments were included. The effectiveness of bimekizumab was evaluated in terms of reduction in psoriasis area and severity index (PASI) compared with baseline at weeks 4 and 16. The main outcomes were the percentages of patients achieving an improvement of at least 75% (PASI75), 90% (PASI90) and 100% (PASI100) in PASI score.ResultsThe study included 237 patients who received at least one injection of bimekizumab. One hundred and seventy-one patients and 114 reached four and 16 weeks of follow-up, respectively. Complete skin clearance was achieved by 43.3% and 75.4% of patients at weeks 4 and 16, respectively. At week 16, 86.8% of patients reported no impact on their quality of life. At week 16, there were no significant differences between bio-naïve and bio-experienced patients in terms of PASI75, PASI90 and PASI100. The most commonly reported adverse events (AEs) were oral candidiasis (10.1%). No severe AEs or AEs leading to discontinuation were observed throughout the study.ConclusionOur experience supports the effectiveness and tolerability of bimekizumab in a real-world setting with similar results compared with phase-III clinical trials.

Aim: Psoriasis is a disease characterized by chronic inflammation of the skin and small joints that causes serious deterioration in quality of life. Inflammation, angiogenesis and fibrosis plays a significant role in the disease pathogenesis. Fibroblast growth factor 2 (FGF2) is a vigorous mitogenic agent and a molecule associated with pathways that are effective in the pathogenesis of psoriasis. The purpose of this study is to determine the level of patients with FGF2 in the serum of psoriasis and to determine the change in the level of this molecule according to the severity of the disease. Materials and Methods: 96 patients with psoriasis and 100 healthful were included in this study. The level of FGF2 was measured by ELISA method from serum samples obtained from blood samples taken from those included in the study. The results were compared with the healthful control group. Patients with psoriasis were grouped as mild, moderate, severe and very severe. FGF2 levels were compared in patients grouped according to disease severity. Results: Serum FGF2 levels were found to be higher in psoriasis patients compared to the healthful control group (p<0.0001). When psoriasis patients were checked against the healthy control group according to the severity of the disease, serum FGF2 levels were found to increase in the moderate, severe and very severe patient groups (p<0.001). Conclusion: Elevated serum FGF2 level in psoriasis patients was revealed for the first time. As the severity of the disease increases, the increase in the serum FGF2 level shows that this molecule may be effective in the pathogenesis of psoriasis and may be the target molecule in treatment. [ABSTRACT FROM AUTHOR]

Psoriasis is an autoimmune skin disease characterized by hyperproliferation of keratinocytes. Topical delivery of drugs is mostly favored for the treatment of mild psoriatic conditions. But permeation of drugs across psoriatic skin is too complex. Niosomes are the non-ionic surfactant vesicles, reported to enhance dermal drug delivery. In the present work, cyclosporine niosomes were, formulated, optimized, and evaluated in-vitro to boost the dermal penetration of cyclosporine for the better management of psoriasis. Niosomes were developed using the thin film hydration method. Formulated niosomes were characterized and optimized for their percent encapsulation efficiency, size, and polydispersity index using Box-Behnken design. Optimized formulation was developed using cholesterol and span 60 (1:2.2), 30 minutes of hydration time, and 30 mg of cyclosporine. Niosomes' size, polydispersity index, and percent encapsulation efficiency were in the scale of 180.5 ± 11.16 nm, 0.156, and 93.2% ± 2.5%, respectively. The ex-vivo studies were carried out using excised goat skin. In the ex-vivo permeation experiments, though the percent drug permeated was low but the quantity of drug permeated across the skin from the niosomes was significantly greater than from suspension. Skin deposition studies revealed deeper and more significant accumulation of cyclosporine niosomes than the free cyclosporine in the epidermis. The in-vivo experiments were carried out using imiquimod induced psoriatic mice, where both the histopathology and psoriasis area severity index displayed significant recovery in the skin condition of mice treated with niosomes of cyclosporine, in comparison with the dispersion of the drug. The results indicate that the non-ionic surfactant vesicles of cyclosporine can be employed for the enhanced management of psoriasis and reduction of side effects linked with the systemic delivery of cyclosporine. [ABSTRACT FROM AUTHOR]

The aim of this investigation was to develop and analyze a tacrolimus and thymoquinone co-loaded nanostructured lipid carriers (TAC-THQ-NLCs)-based nanogel as a new combinatorial approach for the treatment of psoriasis. The NLCs were formulated by an emulsification-solvent-evaporation technique using glyceryl monostearate, Capryol 90 (oil), and a mixture of Tween 80 and Span 20 as a solid lipid, liquid lipid, and surfactant, respectively. Their combination was optimized using a three-factor and three-level Box–Behnken design (33-BBD). The optimized TAC-THQ-NLCs were observed to be smooth and spherical with a particle size of 144.95 ± 2.80 nm, a polydispersity index of 0.160 ± 0.021, a zeta potential of −29.47 ± 1.9 mV, and an entrapment efficiency of >70% for both drugs. DSC and PXRD studies demonstrated the amorphous state of TAC and THQ in the lipid matrix of the NLCs. An FTIR analysis demonstrated the excellent compatibility of the drugs with the excipients without interactions. The TAC-THQ-NLC-based nanogel (abbreviated as TAC-THQ-NG) exhibited a good texture profile and good spreadability. The in vitro release study demonstrated a sustained drug release for 24 h from the TAC-THQ-NG that followed the Korsmeyer–Peppas kinetic model with a Fickian diffusion mechanism. Moreover, the TAC-THQ-NG revealed significantly higher dose-dependent toxicity against an HaCaT cell line compared to a TAC-THQ suspension gel (abbreviated as TAC-THQ-SG). Furthermore, the developed formulations demonstrated antioxidant activity comparable to free THQ. Confocal microscopy revealed improved permeation depth of the dye-loaded nanogel in the skin compared to the suspension gel. Based on these findings, it was concluded that TAC-THQ-NG is a promising combinatorial treatment approach for psoriasis. [ABSTRACT FROM AUTHOR]

Psoriatic disease is a chronic inflammatory disease with a serious impact on the health of affected individuals. The mechanisms of the disease involve local but also systemic inflammatory changes. Apremilast is a selective oral phosphodiesterase 4 (PDE4) inhibitor, which regulates many inflammatory mediators involved in the pathogenesis of psoriatic disease, such as tumor necrosis factor (TNF alfa), interleukin 10 (IL-10) or interleukin 23 (IL-23), some of the most important interleukins in psoriasis. Although there is currently a wide range of therapeutic options, starting from topical therapies and going to diseasemodifying antirheumatic drugs (DMARDs), apremilast finds its indications both in common cases of moderate-severe psoriatic disease, but more importantly, in special cases of patients with psoriatic disease who are not eligible or have not responded to other therapies. [ABSTRACT FROM AUTHOR]

Psoriasis is a common immune-mediated, chronic inflammatory disease, causing adverse effects on patients' quality of life and disease burden. In psychodermatology, psoriasis is included both in the group of dermatological diseases, in which the psychophysiological background plays a key role, and in dermatoses being a potential source of emotional disturbances or being a trigger for the development of secondary mental disorders. A comprehensive view of the patient with psoriasis, not only from the point of view of skin disease, but also as a result of a wide impact of stress, including low self-esteem and inappropriate social perception may have a key influence on improvement of quality of life of these patients. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic inflammatory dermatosis with periods of exacerbation and remission. Prevalence of psoriasis is estimated at 1-3% of the population of Europe and the United States of America. The disease process may affect the skin, nails and joints. Perception of psoriasis as not only a skin disease, but a systemic inflammatory disease that affects the functioning of the entire body has changed over the years. Patients suffering from psoriasis more often than the general population suffer from many comorbidities. Little data is available on the comorbidity of psoriasis and pancreatic diseases. The relationship between the coexistence of psoriasis and chronic pancreatitis seems to the most interesting and worth further studies. [ABSTRACT FROM AUTHOR]

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

Objective: As with every chronic disease, YouTube is increasingly heavily accessed to get information for psoriasis. It contains quality videos containing medical information; however, some content is of low quality, unscientific, misleading, and potentially harmful. We aimed to conduct this study to reveal this situation, understand the rate of non-physician practice, and develop solutions. Material and Methods: Between May 1-31, 2022, we searched the YouTube search engine by typing “psoriasis treatment” in Turkish. The number of views of the video, the number of subscribers, time of publication, duration of the video, gender and occupation of the presenter, type of YouTube channel on which the video was posted, were recorded. In the analysis of analytical statistics, the Quade test was used to eliminate the severity of the difference in the number of views and the extreme difference of skewness. Levene’s test was used for homogeneity analysis. Results: The majority of the videos consisted of education-information about psoriasis treatment methods (41.6%) and specific treatment recommendations (35%). 46.2% of the video narrators were physicians (21.7% dermatologist, 24.5% non-dermatologist) 25.8% were non-physicians, and herbalists (15.4%) were the leading ones. The rate of evidence-based treatment recommendations was 24.5%, while the rate of non-evidence-based treatments was 65.7%. Conclusion: We have identified videos created by herbalists who recommend supplements containing plant extracts, which are not based on substantial evidence. There should be more videos on YouTube about psoriasis and its treatment by dermatologists who are experts in the subject. [ABSTRACT FROM AUTHOR]

Dimethyl fumarate (DMF) was recently approved by the European Medicines Agency for systemic treatment of moderateto-severe chronic plaque psoriasis. Appropriate management of DMF treatment is required to achieve optimal clinical benefits. 7 dermatology experts gathered online for 3 meetings to identify consensus on the use of DMF in patient selection, drug dosage/titration, side effects management, and follow-up, with the aim to provide guidance on the use of DMF for psoriasis in clinical dermatological practice based on literature data and expert opinion. 20 statements were discussed and voted on using a facilitator-mediated modified Delphi methodology. Strong consensus was reached for all statements (agreement level of 100%). DMF treatment is characterized by dosage flexibility, sustained efficacy, high rates of drug survival, and low potential for drug-drug interactions. It can be used in a broad range of patients, including the elderly or those with comorbidities. Side effects (mainly gastrointestinal disorders, flushing, and lymphopenia) are frequently reported but are generally mild and transient and can be minimized by dosage adjustments and a slow titration schedule. Hematologic monitoring throughout the treatment course is required to reduce the risk of lymphopenia. This consensus document provides clinical dermatologists with answers on the optimal use of DMF to treat psoriasis. [ABSTRACT FROM AUTHOR]

Abstract Objectives Psoriasis‐related pruritus is a frequent and underestimated symptom with a strong impact on quality of life, psychological condition and sleep. Our main objective was to document, in real‐life clinical practice, the perception of pruritus and the efficacy of a 4‐week topical treatment with a fixed‐dose combination of calcipotriol/betamethasone dipropionate (Cal/BD) foam on psoriasis‐related moderate‐to‐severe pruritus. Methods This was an exploratory prospective observational study in psoriasis patients with a pruritus visual analogic scale (VAS) score ≥ 3/10 cm. The primary endpoint was the proportion of responder patients defined as the self‐assessed improvement from baseline of pruritus of at least 2 VAS score points 48 h after the first topical administration. The quality of sleep was assessed on VAS and the quality of life was assessed using the Dermatology Life Quality Index (DLQI) on Day 28. Results A total of 81 patients were included by 34 dermatologists and 40 self‐questionnaires were evaluable for efficacy on Day 28. At inclusion, pruritus was self‐assessed as severe by 60.8% of patients, whereas physicians reported severe pruritus in 16.9% of patients. A proportion of 91.4% (95% confidence interval: 82–100) of patients were responders to pruritus relief 48 h after the first Cal/BD application. Relevant improvements in quality of sleep after 24 h (+2.9 ± 3.0) and in quality of life after 28 days (−9.0 ± 6.8) were reported. Conclusion This exploratory study provides further evidence that pruritus is an underestimated symptom, and it confirms the usefulness of the fixed‐dose combination of Cal/DB foam in relieving moderate‐to‐severe pruritus and improving the quality of life and sleep in patients with plaque psoriasis.

Erythrodermic psoriasis (EP) is a severe, often refractory, variant of psoriasis. Due to the high morbidity and mortality rate associated with EP and other causes of erythroderma, they are often classified as dermatologic emergencies. EP is usually a therapeutic challenge, where topical and conventional systemic therapies have yielded a less than satisfactory result in several patients. Furthermore, there are a limited number of studies evaluating other therapeutic modalities, such as biologic agents, with no clear treatment guidelines. In this case report, we present a patient who was diagnosed as a case of EP and showed an impressive response to risankizumab.

Axial symptoms (i.e., back pain) are common in the general population. At the same time 25–70% of patients with psoriatic arthritis (PsA) exhibit signs of inflammatory axial involvement (axial PsA). The presence of unexplained chronic (duration ≥ 3 months) back pain in a patient with psoriasis or PsA should trigger evaluation of the presence of axial involvement. Evaluation of axial involvement normally involves imaging of the axial skeleton (sacroiliac joints and/or spine) in addition to clinical and laboratory evaluation. Symptomatic patients with confirmed axial PsA are treated with a combination of non-pharmacologic and pharmacologic methods including the use of non-steroidal anti-inflammatory drugs, tumour necrosis factor, interleukin 17, and Janus kinase inhibitors. Interleukin 23 blockade might also be effective in the axial domain of PsA; a dedicated clinical study is ongoing at present. Safety considerations, patient preference, as well as the presence of other disease manifestations (especially of extra-musculoskeletal manifestations—clinically relevant psoriasis, acute anterior uveitis, inflammatory bowel disease), define the choice of a specific drug or drug class. [ABSTRACT FROM AUTHOR]

Introduction: Psoriasis is an immune-mediated, chronic, inflammatory, systemic disease that primarily affects the skin and joints. Despite advances in the comprehension of the disease, there is still a lack of biomarkers available for clinical use. Objective: To evaluate neutrophil-lymphocyte ratio (NLR) as a marker of systemic inflammatory status in patients with moderate to severe plaque psoriasis vulgaris, compared with controls. Methods: Observational case-control study, conducted in a public hospital unit, focused on skin disease. A total of 165 patients with psoriasis and 187 healthy subjects seen between August and December 2020 were studied. Results: The group of cases showed a greater median of NLR compared with controls (medium = 1.96, p = 0.032). When stratified by age, the median NLR was higher in individuals between 31 and 60 years, with statistical significance. No differences were identified in gender, presence of arthritis or comorbidities. Study limitations: Observational, retrospective, single-center study based on medical records review. Conclusion: NLR was higher in individuals with psoriasis when compared with controls. It is simple, inexpensive and available in all levels of care, based on an elementary laboratory test that is already part of the routine care of patients with psoriasis. Its use in evaluating systemic inflammation could contribute to better management of psoriatic disease. [ABSTRACT FROM AUTHOR]

Background: The rate of seroconversion after COVID-19 vaccination in patients with moderate to severe psoriasis requiring systemic treatment is poorly understood. Objectives: The aim of this prospective single-center cohort study performed between May 2020 and October 2021 was to determine the rate of seroconversion after COVID-19 vaccination in patients under active systemic treatment for moderate to severe psoriasis. Methods: Inclusion criteria were systemic treatment for moderate to severe psoriasis, known COVID-19 vaccination status, and repetitive anti-SARS-CoV-2-S IgG serum quantification. The primary outcome was the rate of anti-SARSCoV-2-S IgG seroconversion after complete COVID-19 vaccination. Results: 77 patients with a median age of 55.9 years undergoing systemic treatment for moderate to severe psoriasis were included. The majority of patients received interleukin- (n=50, 64.9%) or tumor necrosis factor (TNF)-a inhibitors (n=16, 20.8%) as systemic treatment for psoriasis; nine patients (11.7%) were treated with methotrexate (MTX) monotherapy, and one patient each received dimethyl fumarate (1.3%), respectively apremilast (1.3%). All included patients completed COVID-19 vaccination with two doses over the course of the study. Serum testing revealed that 74 patients (96.1%) showed an anti-SARSCoV-2-S IgG seroconversion. While all patients on IL-17A, -12 or -12/23 inhibitors (n=50) achieved seroconversion, three of 16 patients (18.8%) receiving MTX and/or a TNF-a inhibitor as main anti-psoriatic treatment did not. At follow-up, none of the patients had developed symptomatic COVID-19 or died from COVID-19. Conclusions: Anti-SARS-CoV-2-S IgG seroconversion rates following COVID-19 vaccination in psoriasis patients under systemic treatment were high. An impaired serological response, however, was observed in patients receiving MTX and/or TNF-a inhibitors, in particular infliximab. [ABSTRACT FROM AUTHOR]

Background: Various diagnostic tools are used to assess cutaneous psoriasis, but most of it were subjective. Sympathetic skin response (SSR), skin PH and temperature objectively measure the skin barrier functions that could aid clinicians to evaluate accurately and predict skin disease incidence even before the onset of clinical symptoms. Aim and Objectives: The study's objective was to assess the utility of cutaneous parameters (skin temperature and pH) and SSRs influencing psoriatic patients' diagnosis management and treatment compared to controls. Materials and Methods: A total of 40 healthy participants and 40 psoriasis patients aged 18 to 65 years were recruited for this study. SSR, skin temperature and pH were assessed. The psoriasis disability index (PDI) was recorded from all the patients. Data analysis was carried out using SPSS version 20.0. Results: The results shows significantly increased skin temperature, prolonged SSR latency (bilaterally) and decreased SSR amplitude (bilaterally) among patients affected with psoriasis compared to control subjects. There is a positive correlation between SSR latency with PDI and a negative correlation between SSR amplitude and PDI in psoriasis patients. Conclusion: SSR reveals sympathetic sudomotor dysfunction and increased skin temperature in psoriasis. Furthermore, there is a link between increased SSR latency and PDI, which shows that local nervous system impairment significantly contributes to the inflammatory process in psoriasis. Thus, SSR can be used as a complementary tool for the early identification and assessment of epidermal barrier integrity in psoriasis patients, along with the clinician's standard protocols. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic, non-infectious, inflammatory immune-mediated skin disease. It progresses with periods of exacerbation and remission. Genetic, epigenetic, and environmental factors all play a role in the development of psoriasis. Psoriasis is a common dermatosis affecting both adults and children. The pediatric population has the same clinical subtypes of psoriasis as adults, while lesions may differ in distribution and morphology. Children are more likely to report skin pruritus and burning. The diagnosis of psoriasis is mainly based on clinical features. Psoriasis patients are predisposed to developing cardiovascular disease, metabolic syndrome, and its components, type 2 diabetes, and inflammatory bowel disease. Psoriasis can hurt the quality of life, school life, and peer interactions of children and adolescents. Treatment of children with psoriasis — should be individualized and selected according to the severity of the skin lesions and age. Topical medications are used to treat the mild form, while general conventional and biological treatment is used for the moderate and severe cases. This paper reviews the current state of knowledge on the clinical features, therapeutic management, and impact on the quality of life of psoriasis in the pediatric population. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic, mild and common inflammatory skin condition. Still an ideal treatment for psoriasis, effective, safe, convenient, and economical is not available. In this scenario, the search for suitable alternative treatments with minimal side effects is necessary. Plants can be effective and alternative in this regard. Therefore, this article discusses the leaves of the plants Thespesia populnea (Malvaceae) that are traditionally used in the treatment of psoriasis. The present study aimed to assess anti-psoriatic activity. The dried leaves of the plants were subjected to soxhlation with 95% ethanol and phytochemical studies were performed. The anti-psoriatic activity was evaluated by the Mouse-Tail model. It is a relatively sensitive and reproducible morphometric method that allows quantitative evaluation of the effects of anti-psoriatics through epidermal differentiation. Extracts were applied topically at a dose of 500mg/kg over 14 days and at the end, the animals were sacrificed, longitudinal histological sections were made of the tail skin and the degree of orthokeratosis was determined. It was significantly (P <0.05) increased by the ethanolic extract of Thespesia populnea (52.86±2.86) compared to the control (17.30±4.09). In relative epidermal thickness, the ethanolic extract of Thespesia populnea (92.68±8.8) showed a significant difference (P <0.05) compared to the control (100±10.7). The data obtained suggest that the selected plant has anti-psoriatic activity and confirms its traditional use in the treatment of psoriasis. [ABSTRACT FROM AUTHOR]

Psoriasis is a persistent and mysterious autoimmune skin condition that affects 2-3% of the world's population. Currently, topical therapies, light therapy, and systemic drugs are the three main forms of treatment used to lessen inflammation and skin irritation/itching. However, all these treatments are only used to manage the disease each time it surfaces. Therefore, the main target of this work is to search for a safer and more effective remedy for psoriasis from the reservoir of phytochemicals present in Carica papaya via in silico studies due to its anti-psoriatic and anti-inflammatory properties. Reported phytochemicals isolated from Carica papaya were subjected to computational simulations using the PyRx docking tool and were docked against Janus Kinase 1 (JAK1) and Tumor necrosis factor ff (TNFff) target receptors. The results obtained were visualized using PyMol, and Biovia 2019. Analysis of the results identified both Chlorogenic acid and Coumaroylquinic-acid with docking scores (-8.6 kcal/mol and -7.9 kcal/mol) respectively as potential inhibitors for the JAK1 receptor. The identified compounds also possessed excellent ADMET, drug-likeness, bioactivity, and activity spectra for substances (PASS) prediction properties. Their binding mode and the molecular interactions with the targets also affirmed their potency. In comparison with the standards (Methotrexate and Cyclosporine), Chlorogenic acid and Coumaroylquinic-acid have better ADMET properties, binding affinities, drug-likeness, PASS properties, bioactivities, oral bioavailability, binding mechanism, and interactions with the active site of the target receptor and are hereby recommended for further analysis towards the development of a new therapeutic agent for psoriasis treatment and management. [ABSTRACT FROM AUTHOR]

Psoriasis, due to its unique pathological manifestations and the limited success of existing therapeutic modalities, demands dedicated domain research. Our group has developed nanotherapeutics consisting of bioactives such as Thymoquinone (TQ) and Fulvic acid (FA), which have been successfully incorporated into a Nanoemulsion gel (NEG), taking kalonji oil as oil phase. The composition is aimed at ameliorating psoriasis with better therapeutic outcomes. TQ is a natural bio-active that has been linked to anti-psoriatic actions. FA has anti-inflammatory actions due to its free radical and oxidant-scavenging activity. Our previous publication reports the formulation development of the NEG, where we overcame the pharmaco-technical limitations of combining the above two natural bioactives. In vitro evaluation of the optimized NEG was carried out, which showed an enhanced dissolution rate and skin permeation of TQ. This work furthers the pharmaceutical progression of dual-targeted synergistic NEG to treat psoriasis. A suitable animal model, BALB/c mice, has been used to conduct the in vivo studies, which revealed the effective anti-psoriatic action of TQ. Molecular docking studies corroborated the results and revealed a good binding affinity for both the targets of TNF-α (Tumor necrosis factor) and IL-6 (Interlukin-6). Tissue uptake by Confocal laser scanning microscopy (CLSM), a skin interaction study of the gel formulation, and an antioxidant free radical scavenging assay (1-1 Diphenyl-2-picrylhydrazyl DPPH) were also carried out. It was concluded that the NEG may be effective in treating psoriasis with minimal side effects. [ABSTRACT FROM AUTHOR]

IntroductionBrodalumab is a monoclonal antibody that targets the subunit A of the interleukin-17A receptor (IL17RA), inhibiting the signaling of various isoforms of the IL-17 family. It has been approved for the treatment of moderate-to-severe plaque psoriasis after being evaluated in three Phase-3 trials. However, long-term data on brodalumab in a real-life setting are still limited.MethodsThe aim of this study was to evaluate the long-term effectiveness and safety of brodalumab in psoriasis. We also assessed the drug survival of brodalumab in a 3 years timespan. We conducted a retrospective multicenter study on 606 patients followed up at 14 Italian dermatology units, all treated with brodalumab according to Italian guidelines. Patients’ demographics and disease characteristics were retrieved from electronic databases. At baseline and weeks 12, 24, 52, 104 and 156, we evaluated the psoriasis area and severity index (PASI) score and investigated for adverse events. The proportions of patients reaching 75, 90 and 100% (PASI 75, PASI 90 and PASI 100, respectively) improvement in PASI, compared with baseline, were also recorded.ResultsAt week 12, 63.53% of the patients reached PASI 90 and 49.17% PASI 100. After 3 years of treatment, 65.22% of patients maintained a complete skin clearance, and 91.30% had an absolute PASI of 2 or less. Patients naïve to biological therapies had better clinical responses at weeks 12, 24 and 52. However, after 2 years of treatment, no significant differences were observed. Body mass index did not interfere with the effectiveness of brodalumab throughout the study. No new safety findings were recorded. After 36 months, 85.64% of our patients were still on treatment with brodalumab.ConclusionOur data confirm the effectiveness and the safety of brodalumab in the largest real-life cohort to date, up to 156 weeks.

Genital psoriasis affects 33-63% patients with psoriasis during the course of disease, usually leading to a severe reduction of patient’s quality of life. This study aims to retrospectively asses the effectiveness of interleukin (IL)-23 and IL-17 inhibitors in a real-life population affected by moderate-to-severe plaque psoriasis with genital involvement coming from our dermatology department. A total of 86 patients with diagnosis of moderate-to-severe plaque psoriasis with severe genital involvement were enrolled. Patient characteristics, Psoriasis Area and Severity Index (PASI), and Static Physician Global Assessment of Genitalia (sPGA-G) at each visit were recorded. During the treatment, the mean PASI decreased from 12,8 at 0,63 at week 52; PGA of 0/1 was reached by 97,40% at week 52 and by 100% of patients (37/37) at week 104. No significant differences between the IL-23 and IL-17 inhibitors were observed; indeed the bio-naive group of patients demonstrated superior response compared to the group of patient bio-experienced. Our findings confirmed that IL-23 and IL-17 inhibitors as a safe and effective therapeutic option for the treatment of genital psoriasis.

Psoriasis is a common chronical inflammatory skin disease with a prevalence of 2%-4% worldwide. In contrast, porocarcinoma is a relatively rare cutaneous neoplasm and an associated localization of both lesions is rare. Here, we describe the first case of porocarcinoma in a patient with psoriasis. A 71-year-old Japanese man was referred to our clinic for evaluation of nodule within a keratotic plaque of 20-years history on his leg. Histopathological examination showed that the plaque revealed acanthosis with regular elongation of rete ridges, agranulosis and the presence of Munro micro-abscesses. In contrast, massive proliferation of atypical poroid cells and a few cuticular cells in the dermis were seen in the nodule. We speculated that it is likely the porocarcinoma was caused by the elevated risk of skin cancer due to chronic inflammatory process of psoriasis itself in our patient. [ABSTRACT FROM AUTHOR]

This article presents a case study of a 65-year-old female diagnosed with sudden-onset psoriasis, providing details about the client's condition, medical history, and treatment approach using aromatherapy. The client's psoriasis symptoms, the choice of essential oils, and the purpose of aromatherapy treatments aimed at improving skin integrity, promoting rest, and minimizing flare-ups are discussed, along with a comforting psoriasis blend recipe.

BackgroundThe rate of seroconversion after COVID-19 vaccination in patients with moderate to severe psoriasis requiring systemic treatment is poorly understood.ObjectivesThe aim of this prospective single-center cohort study performed between May 2020 and October 2021 was to determine the rate of seroconversion after COVID-19 vaccination in patients under active systemic treatment for moderate to severe psoriasis.MethodsInclusion criteria were systemic treatment for moderate to severe psoriasis, known COVID-19 vaccination status, and repetitive anti-SARS-CoV-2-S IgG serum quantification. The primary outcome was the rate of anti-SARS-CoV-2-S IgG seroconversion after complete COVID-19 vaccination.Results77 patients with a median age of 55.9 years undergoing systemic treatment for moderate to severe psoriasis were included. The majority of patients received interleukin- (n=50, 64.9%) or tumor necrosis factor (TNF)-α inhibitors (n=16, 20.8%) as systemic treatment for psoriasis; nine patients (11.7%) were treated with methotrexate (MTX) monotherapy, and one patient each received dimethyl fumarate (1.3%), respectively apremilast (1.3%). All included patients completed COVID-19 vaccination with two doses over the course of the study. Serum testing revealed that 74 patients (96.1%) showed an anti-SARS-CoV-2-S IgG seroconversion. While all patients on IL-17A, -12 or -12/23 inhibitors (n=50) achieved seroconversion, three of 16 patients (18.8%) receiving MTX and/or a TNF-α inhibitor as main anti-psoriatic treatment did not. At follow-up, none of the patients had developed symptomatic COVID-19 or died from COVID-19.ConclusionsAnti-SARS-CoV-2-S IgG seroconversion rates following COVID-19 vaccination in psoriasis patients under systemic treatment were high. An impaired serological response, however, was observed in patients receiving MTX and/or TNF-α inhibitors, in particular infliximab.

Background: Among various nail disorders encountered in dermatology outpatient department, nail psoriasis is not uncommon. Around 80%–90% of patients with psoriasis present with nail involvement at some point in their life. In 1%–5% of patients, alterations compatible with nail psoriasis may also occur in the absence of cutaneous lesions. There is limited literature on nail psoriasis especially in Indian patients. Objective: The present study was undertaken to evaluate clinical, histopathological, and dermoscopic features in nail psoriasis and its impact on quality of life. Materials and Methods: All clinically suspected cases of nail psoriasis were included in the study. Clinical parameters and dermoscopic findings were observed and noted. Nail biopsy was performed to confirm the findings. Impact on quality of life was evaluated by correlating Nail Psoriasis Severity Index (NAPSI) score and nail psoriasis quality of life scale (NPQ10) score. Results: Of 50 patients with clinically suspected nail psoriasis, skin involvement was seen in 45 (90%), and 5 (10%) had only nail involvement. The mean NAPSI score was 34.34 in our study. The most common clinical nail finding was pitting (38 [76%]) followed by onycholysis (31 [62%]). The most common dermoscopic finding was pitting (39 [76%]) followed by onycholysis (32 [64%]). Histopathologically, the most common finding was parakeratosis (41 [82%]) followed by focal hypergranulosis (40 [80%]). The majority of the patients (21 [42%]) had NPQ10 (modified) score between 10 and 20, and moderate positive correlation between NAPSI score and NPQ10 scale score was observed. Limitations: Small sample size and no control group. Conclusion: Nail psoriasis does impact the quality of life of patients especially in females who feel embarrassed in social gatherings and workplace. Nail biopsy, though painful and difficult to perform, is the most efficient method to diagnose nail psoriasis. [ABSTRACT FROM AUTHOR]

Objective: To examine data from studies supporting the clinical efficacy of medical approaches from India traditional systems of medicines like Ayurveda, Unani, Siddha, and Homeopathy for psoriasis using outcome indicators employed in clinical practice and research. Methods: Searches were conducted between December 2019 and September 2020 in databases PubMed, Scopus, Web of Science and Ovid Medline using search terms including traditional, complementary, psoriasis, Kushtha, Ayurveda, Siddha, Unani, Homeopathy and clinical. Controlled trials, case series and case reports published from India were included. Results: Data of 17 selected studies were extracted. Treatment efficacy in terms of improvement in Psoriasis Area and Severity Index (PASI) score or/and percentage reduction in score (PASI 50, PASI 75 and PASI 90) or/and patient-reported outcomes using instruments like Dermatology Life Quality Index and Psoriasis Disability Index were noted. All studies reported good improvement as per the study specific outcome. However, study characteristics, including study design, sample size, follow-up period, inclusion and exclusion criteria were heterogeneous, and the choice of outcome measures was not adequate to conclude the effectiveness of intervention. The use of some herbs as common ingredients in several formulations across different systems of medicines were noted in analyzing individual formulation. Conclusions: Future studies must incorporate a comprehensive study design with specific outcome measures like PASI, PASI 75, PASI 90, quality of life parameters, compliance to medications, adverse reactions, remission period, relapse rate and cost-effectiveness with long term follow-up. The currently available evidence on the roles of these herbs at molecular level in psoriasis is preliminary. [ABSTRACT FROM AUTHOR]

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]

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The aim of the work is to analyze the use of medicines containing retinoids for the treatment of psoriasis on the example of Ukraine, Poland and Kazakhstan. Materials and methods. The object of the study was antipsoriatic drugs, which are used for the treatment of psoriasis of local and systemic action, and are included in the official register of drugs of the studied countries. Regulatory documents of the State Expert Center of the Ministry of Health of Ukraine were involved in the analysis of the use of medicines for the treatment of psoriasis in Ukraine. The analysis of the availability of the considered medicines on pharmaceutical markets was carried out according to the data of the official websites of the State Register of Medicines (Ukraine), the Register of Medicines of Poland (Republic of Poland), data of the National Center for Expertise of Medicines and Medical Devices of the Republic of Kazakhstan (Republic of Kazakhstan). The following methods of logical and meaningful formulation of the problem, office marketing research, content analysis of publications in scientific and practically oriented medical and pharmaceutical publications, comparative analysis, tabular and graphic means of visual presentation of the obtained data were used in the work. The results. According to the results of the obtained data, an assortment of medicinal products containing retinoids of the studied countries, used for the treatment of psoriasis, was determined. The fate of domestic production in the countries was analyzed, the main active components from the group of retinoids used for the treatment of psoriasis in preparations of systemic and local action were updated. Conclusions. The role of retinoids in the treatment of psoriasis in Ukraine, Poland and Kazakhstan and the need to develop modern domestic medicines containing retinoids for the treatment of psoriasis have been determined. [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]

SDZ-ADL is a biosimilar of reference adalimumab. Here, the safety and effectiveness data of SDZ-ADL from the British Association of Dermatologists Biologic and Immuno-modulators Register (BADBIR) are reported. In the safety set, data of SDZ-ADL were compared with conventional systemics data. In the effectiveness set, the effectiveness and quality-of-life of patients treated with SDZ-ADL as a first-time biologic, or who switched from a previous biologic to SDZ-ADL, were assessed using the Psoriasis Activity Severity Index (PASI) and Dermatology Life Quality Index (DLQI), respectively. A total of 565 (incidence rate (IR) per 1000 person-years 29.1, 95% CI 26.8–31.6) serious infections and 48 (IR 2.5, 95% CI 1.8–3.3) myocardial infarction events were reported in the conventional systemics cohort compared with four (IR 31.5, 95% CI 8.6–80.7) and one (IR 7.9, 95% CI 0.2–43.9) in the biologic cohort, respectively. One patient (0.7% (1/136)) reported injection-site pain in the biologic cohort. At 12 months, PASI ≤ 2 was achieved in 84.6% (11/13) and 76.9% (10/13) and DLQI 0/1 was achieved in 70% (7/10) and 75% (3/4) of patients in the biologic-naïve and biologic-switch cohorts, respectively. After one year of therapy, 82.7% (110/133) patients remained on SDZ-ADL. SDZ-ADL was well-tolerated and effective in patients with psoriasis. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic inflammatory skin disease with hyperproliferation and aberrant differentiation of keratinocytes in association with the elevation of interleukin-17A (IL-17A) and IL-23 levels. In an animal model, psoriasis-like dermatitis was induced on the shaved dorsal skin of BALB/c mice by topical application of imiquimod (IMQ), a synthetic ligand of Toll-like receptor 7. Administration of bitter Pu'er tea significantly reduced psoriasis-like dermatitis in IMQ-treated mice, including a reduction in dorsal skin lesions, splenomegaly and the mRNA expression levels of IL-17A and IL-23. To examine putative antipsoriatic constituents, three major compounds in bitter Pu'er tea, strictinin, theacrine and epigallocatechin gallate (EGCG), were separately given as supplements to IMQ-treated mice. The results showed that all the three compounds attenuated the severity of psoriasis by reducing epidermal thickness. Only theacrine significantly attenuated splenomegaly. All the three compounds inhibited the expression of IL-23 mRNA in the skin as well as reduced the content of IL-17A+CD4+ T cells in the spleen, and strictinin was found to be relatively effective. It seemed that the antipsoriatic activity of bitter Pu'er tea was attributed to the additive effects of its multiple active compounds. [ABSTRACT FROM AUTHOR]

Topical administration of Tacrolimus (TAC) is efective in the treatment of psoriasis in human patients and in mouse models. Previously, we showed that, though promoting the proliferative expansion of CD4+Foxp3+ regulatory T cells (Tregs), TNFR2 was protective in mouse psoriasis model. We thus examined the role of TNFR2 signal in the efect of TAC in the treatment of mouse psoriasis. To this end, psoriasis was induced in WT, or TNFR1 KO, or TNFR2 KO mice, and the psoriatic mice were treated with or without IMQ. The results showed that TAC treatment potently inhibited the development of psoriasis in WT and TNFR1 KO mice, but not in TNFR2 KO mice. However, the treatment of TAC failed to induce the expansion of Tregs in psoriatic mice. In addition to playing a decisive role in the activation of Tregs, TNFR2 stimulates the generation and activation of myeloid-derived suppressor cells (MDSCs). This led us to found that the topical treatment with TAC markedly increased the number of MDSCs in the spleen of WT and TNFR1 KO mice, but not in TNFR2 KO mice. Consequently, TAC potently decreased serum levels of IL-17A, INF-γ, and TNF and their mRNA levels in the inflamed skin lesion. Therefore, our study for the first time found that the therapeutic efect of TAC in psoriasis is associated with the expansion of MDSCs in a TNFR2-dependent manner. [ABSTRACT FROM AUTHOR]