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Background: The product of Physician Global Assessment and Body Surface Area (PGA × BSA) is a new outcome measure for psoriasis severity and response to therapy. The objective of this study was to evaluate PGA × BSA as an alternative to Psoriasis Area and Severity Index (PASI) for psoriasis assessments. Methods: The relationship between PASI and PGA × BSA was assessed in a post hoc analysis of pooled data from the PRISTINE (NCT00663052) and PRESTA (NCT00245960) trials in patients with moderate-to-severe psoriasis who received etanercept 50 mg/week. Data were analyzed using Spearman and intra-class correlation coefficients, effect sizes, scatterplots, Bland–Altman plots, and Kappa statistics. Results: Spearman correlations at baseline, week 12, and week 24 were strong for PGA × BSA versus PASI (r=0.78, 0.87, and 0.90, respectively; all P [ABSTRACT FROM AUTHOR]

Abstract: Background: Psoriasis is a chronic inflammatory skin disease, which requires long‐term, safe and effective treatment. Apremilast, a small‐molecule PDE4 inhibitor, has been introduced as psoriasis (and psoriatic arthritis) treatment in Europe in 2015. Objective: We analysed and report the efficacy and safety of apremilast in the first 51 patients with psoriasis that have undergone treatment with this novel small molecule in our outpatient clinic. Method: Our primary endpoint was the evaluation of clinical response to apremilast according to the percentage of Psoriasis Area Severity Index (PASI) reduction (ΔPASI) at 16 weeks after treatment initiation. Secondary endpoints were the evaluation at week 16 of (i) PASI; (ii) Dermatology Life Quality Index (DLQI); (iii) Physician Global Assessment (PGA); (iv) Psoriasis Scalp Severity Index (PSSI); and (v) the percentage of patients who achieved ΔPASI50, ΔPASI75, ΔPASI90 and ΔPASI100; (vi) adverse events (AE); (vii) reasons for drug discontinuation; and (viii) drug survival. Results: About 59.3% of the patients who remained on apremilast achieved at least ΔPASI75 at week 16, while 11.1% achieved combined 50% ≤ PASI < 75% and DLQI ≤ 5 (satisfactory response) adequate enough to maintain treatment. Five patients (18.5%) also achieved ΔPASI100. Patients discontinued apremilast (28%), mostly during the first 4 weeks due to adverse events (12%) with gastrointestinal symptoms being the most common, and later due to lack of efficacy (16%). A statistically significant improvement of PASI, DLQI, PGA and PSSI scores was observed after 4 and 16 weeks of treatment relative to pretreatment measurements. Conclusion: Apremilast is a safe and efficacious treatment for psoriasis patients as it produces ΔPASI75 and ΔPASI50 responses combined with DLQI ≤ 5 in 16 weeks in 70.4% of the patients. These results, from a real‐world setting, confirm the efficacy and safety of apremilast which has been demonstrated in large phase III clinical trials. [ABSTRACT FROM AUTHOR]

Abstract: The effects of tofacitinib in treating moderate‐to‐severe plaque psoriasis were unclear. We aimed to assess the effects of tofacitinib in treating moderate‐to‐severe plaque psoriasis. We searched PubMed, Cochrane Central Register of Controlled Trials and EMBASE for relevant randomized controlled trials (RCTs) and conducted a systematic review and meta‐analysis. Four RCTs with 2724 participants were included. Compared to placebo, tofacitinib significantly improved psoriasis {≥75% reduction in the Psoriasis Area and Severity Index score: 5 mg BID: risk difference (RD) 0.32 [95% confidence interval (CI) 0.28–0.35], 10 mg BID: RD 0.51 (95% CI 0.43–0.58); ≥90% reduction in the Psoriasis Area and Severity Index score: 5 mg BID: RD 0.19 (95% CI 0.17–0.22), 10 mg BID: RD 0.36 (95% CI 0.31–0.42); Physician's Global Assessment 0/1: 5 mg BID: RD 0.31 (95% CI 0.27–0.35), 10 mg BID: RD 0.48 (95% CI 0.44–0.53)} and participants’ life quality [Dermatology Life Quality Index 0/1: 5 mg BID: RD 0.24 (95% CI 0.20–0.2), 10 mg BID: RD 0.36 (95% CI 0.33–0.40)]. Tofacitinib was associated with an increase in minor adverse events [upper respiratory tract infection: 5 mg BID: RD 0.02 (95% CI 0.00–0.03), 10 mg BID: RD 0.02 (95% CI 0.00–0.04); hypercholesterolaemia: 5 mg BID: RD 0.02 (95% CI 0.01–0.04), 10 mg BID: RD 0.02 (95% CI 0.01–0.04)]. In conclusion, tofacitinib may be a treatment option for moderate‐to‐severe plaque psoriasis that is unresponsive to other therapies and patients who are intolerable to other therapies or prefer oral medications. [ABSTRACT FROM AUTHOR]

In vivo reflectance confocal microscopy (RCM) is a modern, non-invasive imaging technique, which allows for real-time examination of the upper layers of the skin at a resolution similar to that of classic microscopy. In addition, it has the advantage of real-time evaluation of blood flow and dynamic monitoring of cutaneous changes while preserving tissue integrity. The present study reported on the in vivo RCM technique as an objective method for the noninvasive assessment of psoriasis vulgaris that is potentially applicable in clinical studies and in monitoring the evolution of lesions under treatment. In psoriasis lesions, RCM virtual horizontal sections at the level of the dermo-epidermal junction featured numerous and prominent dermal papillae that were not surrounded by bright rings of basal cells. Micromorphological examination of the lesions using this technique revealed that mean values of the section area, the perimeter and the Feret's diameter of the dermal papillae were significantly higher in psoriatic lesions than in normal skin. An increased number of capillary vessels per lesional dermal papilla as compared to healthy skin was observed. Furthermore, micromorphological parameters of dermal capillaries were increased in psoriatic skin. These observations point to the utility of in vivo RCM as a promising technique for the non-invasive diagnosis of psoriasis vulgaris, for monitoring the evolution of lesions at a micromorphological level under various treatments and for gaining a better understanding of the pathophysiological processes that occur in the evolution of this disease. [ABSTRACT FROM AUTHOR]

Introduction: Tumor necrosis factor (TNF)-α inhibitors are widely used for the treatment of inflammatory diseases. One of the side effects of TNF-inhibitors is the development of a psoriatiform eruption, also known as paradoxical psoriasis. In this case report, we describe a patient with this side effect after treatment with adalimumab and etanercept. Case Report: A 45-year-old female was treated with adalimumab 40 mg once every 2 weeks for pustulosis palmoplantaris and psoriatic arthritis. After 2 injections, the patient developed a psoriatiform eruption on her body, which improved after discontinuation of adalimumab but worsened after treatment with etanercept 50 mg twice weekly. Eventually, the patient was treated with topical corticosteroids and ustekinumab 45 mg once every 3 months with a complete remission of the psoriatiform eruption. Discussion: Several case reports and reviews have been published in recent years which describe patients with a psoriatiform eruption after treatment with TNF-α inhibitors. The pathogenesis that causes this psoriatic eruption is unclear. In conclusion, we describe a patient with a psoriatiform eruption after treatment with adalimumab and etanercept. This patient had to discontinue the treatment and eventually had a complete response after treatment with topical corticosteroids and treatment with ustekinumab. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic, relapsing, immune-mediated disease that can have a profound negative impact on patients' quality of life. Five different types of psoriasis have been characterised according to their clinical features. A working group sanctioned by the Dermatology Society of South Africa engaged in discussions which resulted in the development of guidelines for the diagnosis and management of psoriasis in the South African context. Healthcare professionals can use these recommended guidelines to promote a strategic evidence-based approach when treating patients with psoriasis to ensure optimal treatment outcomes. Topical agents are the mainstay of treatment in mild psoriasis, and phototherapy and systemic agents should be considered if the treatment is ineffective or the severity of the psoriasis heightened. [ABSTRACT FROM AUTHOR]

Introduction: Psoriasis is a chronic, inflammatory papulosquamous disease clinically characterized by erythematous, sharply demarcated, indurated papules and rounded plaques covered by silvery, micaceous scales. Psoriasis is characterized by hyperproliferation and abnormal differentiation of epidermal keratinocytes, infiltration of mostly T lymphocytes and various endothelial vascular changes in the dermal layer, such as angiogenesis, dilatation and high endothelial venule (HEV) formation. Material and Methods: The study was conducted on 70 patients of psoriasis attending the outpatient department. Patients who fulfilled the selection criterion were alternately assigned into two groups, 35 patients in each group. The assessment of effectiveness was done with the help of PASI. Follow up of patients were done after 1st, 2nd, 4th and 6th week of initiation of treatment. Results: We observed 70 patients and both the group showed statistically significant reduction in the disease severity. Conclusion: The calcipotriol and mometasone furoate ointment were found to be equally effective in clearance of the disease. [ABSTRACT FROM AUTHOR]

The article discusses the High Court of Australia's ruling in the 2013 case Apotex Pty. Ltd. v. Sanofi-Aventis Australia Pty. Ltd. which deals with medical treatment patents, the disease psoriasis, and Australia's patent laws. A medical practitioner's ethical obligations to patients are assessed in relation to a requirement to maximize profits for shareholders in companies which hold medical patents. Australia's Patents Act 1990 (Cth) and Investor-State Dispute Settlement clauses are examined.

This aim of this study was to validate the Scalpdex, a quality of life questionnaire for adults with scalp dermatitis, in children with scalp psoriasis. The reliability, responsiveness and validity of the 3 scales (symptoms, functioning and emotions) of this 22-item questionnaire were analysed in a cohort of children with scalp psoriasis (age range 6-18 years). A total of 94 children completed the questionnaire once, and 53 children a second time, after treatment of their scalp psoriasis. The Children's Scalpdex in Psoriasis (CSP) demonstrated reliability with internal consistency (Cronbach's α, 0.69-0.91). The CSP scales proved sensitive to change in the expected direction for children whose scalp psoriasis improved. Moderate effect sizes were observed between both visits for all 3 scales of the CSP (Cohen's d, 0.44-0.58). In conclusion, the CSP is a reliable, responsive and valid questionnaire, which is the first to illustrate the specific influence of scalp psoriasis on quality of life in children. [ABSTRACT FROM AUTHOR]

Objectives Dithranol, one of the most successful topical agents for the treatment of psoriasis, has been shown to exert its therapeutic effect by inducing keratinocyte apoptosis. To gain further insights into dithranol-induced apoptotic events in vitro, a detailed investigation of its time- and dose-dependent effects has been performed through the evaluation of selected apoptotic markers, using a human keratinocyte cell line ( HaCaT) as a model. Methods The time- and dose-dependent effects of dithranol on a human keratinocyte cell line ( HaCaT) were investigated through the evaluation of a series of apoptotic markers; morphological changes (electron microscopy), phosphatidylserine externalisation (flow cytometry), and caspase-3/7 activation. Key findings The dithranol-induced apoptotic cascade was found to follow a well-defined dose and time-course, with the concentration and the period of exposure to the drug acting as the two major factors influencing the events and nature of cell death. The earliest apoptotic event detected was caspase activation (after 6 h), followed by the occurrence of phosphatidylserine externalisation (after 9 h) and subsequently the morphological characteristics associated with early and late stage apoptosis/necrosis (after 12 h). Conclusions This study has elucidated the dose- and time-response effects of dithranol-induced apoptosis in human keratinocytes in vitro. [ABSTRACT FROM AUTHOR]

Summary Background An unmet need remains for safe and effective long-term treatments of psoriasis. Objectives To evaluate ustekinumab efficacy and safety for up to 3 years in the PHOENIX 1 trial. Methods Patients ( n = 766) with moderate-to-severe psoriasis were randomized to ustekinumab 45 mg or 90 mg at weeks 0 and 4, and then every 12 weeks, or placebo at weeks 0 and 4, with crossover to ustekinumab at week 12. Ustekinumab responders [≥ 75% improvement from baseline in the Psoriasis Area and Severity Index (PASI 75) at weeks 28 and 40] were re-randomized at week 40 to continue or withdraw from treatment until psoriasis recurrence. Partial responders (week 28: PASI 50-74; week 40: < PASI 75) switched to dosing every 8 weeks. Clinical efficacy was assessed by PASI, the Physician's Global Assessment (PGA), and the Dermatology Life Quality Index (DLQI) measures. Results Overall, 79·8% of the ustekinumab-treated patients remained in the study for 3 years. PASI 75 response rates (45 mg: 61·2%; 90 mg: 72·4%) at week 76 were maintained through year 3 (45 mg: 62·7%; 90 mg: 72·2%); PGA response was similarly durable. At year 3, 80·9% (45 mg) and 82·7% (90 mg) of week 40 responders continuing treatment every 12 weeks achieved a PASI 75 response, while 42·6% (45 mg) and 58·0% (90 mg) achieved a PASI 90 response. Among partial responders adjusted to dosing every 8 weeks, 50·9% (45 mg) and 52·0% (90 mg) had a PASI 75 response at year 3. DLQI responses paralleled the PASI responses. Through year 3, no dose response was observed in rates of adverse events (AEs), overall infections, serious AEs, or AEs leading to discontinuation; nor was there evidence of cumulative organ toxicity. Conclusions Continuous, stable, maintenance dosing with ustekinumab was generally well tolerated and sustained durable efficacy for up to 3 years of treatment. [ABSTRACT FROM AUTHOR]

Psoriasis is a genetically determined inflammatory and proliferative disease of the skin, presenting with sharply demarcated scaly plaques, especially on the extensor prominences and the scalp. Although it is a clinical diagnosis, biopsy can help to confirm the diagnosis. Treatment modalities include topical corticosteroids, tar preparations, vitamin D analogues, systemic retinoids, immunosuppressive drugs, phototherapy, and recently, biologicals. [ABSTRACT FROM AUTHOR]

Summary [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic, disabling disease in which adherence to treatment is often poor. The aim of this article is to highlight the problem of adherence to long-term treatment in psoriasis and the factors that contribute to it, and to discuss how adherence, and thus outcomes, can be improved. This article is based on a presentation given by the authors at a satellite symposium held during the 19th Congress of the European Academy of Dermatology and Venereology, 6-10 October, 2010, in Gothenburg, Sweden. Adherence to topical medication is a major problem in psoriasis. Not only are prescriptions not being filled by patients (primary adherence) but topical medications are not being used as recommended (secondary adherence). The issue is complex due to the many factors which affect adherence, including efficacy, ease of use and convenience of application, and the healthcare professional-patient relationship. Due to the nature of the disease, patients suffer poor self-image and feel stigmatized, particularly when psoriasis is present on a visible part of the body. Consequently, the negative impact of psoriasis on patient quality of life underlies many adherence issues. It is therefore important for treatment to address the psychological aspects as well as the physical symptoms of psoriasis. Improvements in several areas of disease management may lead to benefits in medication adherence and hence clinical benefit. Prescribing therapy in line with patient preference for treatment vehicle and improving the healthcare professional-patient relationship may be key factors. Nurses have an important role in educating patients and delivering long-term care. This individualized, personal, approach may help improve treatment adherence, outcomes, and the quality of life for patients with psoriasis. [ABSTRACT FROM AUTHOR]

This article describes topical therapies and treatment guidelines for psoriasis and is based on a presentation given by the authors at a satellite symposium held during the 19th Congress of the European Academy of Dermatology and Venereology, 6-10 October, 2010, in Gothenburg, Sweden. The highly variable nature of psoriasis and its individual presentation in patients can make it difficult to choose the most appropriate treatment. There are many treatment options, from topical treatment with emollients for very mild psoriasis, to systemic therapy with fumaric acid esters, methotrexate or biologics for severe disease. For the treatment of mild-to-moderate psoriasis, topical therapy is generally the most appropriate and a variety of options, both historical and recent, are available. Newer therapies offer greater convenience and fewer side-effects. Of the more recently available therapies, vitamin D analogues and topical corticosteroids are the two with the greatest proven efficacy in randomized clinical trials. A recent Cochrane review showed the highest efficacy overall with the fixed combination vitamin D analogue (calcipotriol) and corticosteroid (betamethasone dipropionate). Indeed, clinical trials have shown that two-compound calcipotriol/betamethasone dipropionate ointment has higher efficacy than calcipotriol or betamethasone dipropionate alone. With regard to safety, two-compound calcipotriol/betamethasone dipropionate was shown to be suitable for intermittent long-term treatment of mild-to-moderate psoriasis. The findings of the Cochrane review are reflected in the current treatment guidelines from the USA and Germany regarding the treatment of mild-to-moderate psoriasis. In both these guidelines, which will be discussed in this article, the recommended treatments for this patient group are vitamin D analogues and corticosteroids, particularly when used in combination. [ABSTRACT FROM AUTHOR]

This article describes a recent development in topical therapies for psoriasis and is based on a presentation given by the authors at a satellite symposium convened during the 19th Congress of the European Academy of Dermatology and Venereology, 6-10 October 2010, in Gothenburg, Sweden. Topical therapies are the mainstay of treatment for psoriasis; however, for optimal outcomes to be achieved, medications need to be used as prescribed. Patients with psoriasis often report low treatment adherence rates; the reasons for this are multifactorial, but can include specific aspects of the treatments themselves. For example, physical properties, ease of use and the vehicle in which the active ingredients are dissolved can all play a role in an individual patient's adherence to treatment. Of the available topical therapies, corticosteroids and vitamin D analogues are the treatment of choice, with combined efficacy that is superior to monotherapy with either agent. To permit simultaneous once-daily dosing, an ointment was formulated that allowed calcipotriol and betamethasone dipropionate to be delivered together; this two-compound ointment had an improved efficacy and tolerability profile vs. either compound alone. To provide an alternative for patients who may dislike ointments, but still want to benefit from the high efficacy of combination therapy, a two-compound (calcipotriol/betamethasone dipropionate) gel has recently been developed; data from phase 2 and phase 3 studies show that it is more effective than the comparators it was tested against, with fewer adverse events, and a rapid onset of action. In a series of one-to-one interviews recently conducted with 150 patients with psoriasis, gel and cream formulations were preferred for ease of use and cosmetic acceptability compared with ointment. The availability of this new gel thus increases patient choice. Ultimately, treatment should always be tailored to match individual patients' needs. [ABSTRACT FROM AUTHOR]

Adherence to treatment is an indicator of treatment success. Long-term data on adherence to biologic treatment in psoriasis are lacking. To compare the tumour necrosis factor (TNF)-α inhibitors regarding drug survival rate and safety in patients with psoriasis. This study is based on data from the Danish nationwide database DERMBIO covering patients with psoriasis treated with a biologic agent. All patients who received anti-TNF-α treatment in academic referral centres were included. Baseline data, adverse events, time on treatment and reason for stopping treatment were recorded. Hazard ratios (HRs) for factors determining drug survival were calculated by logistic regression. In total, 882 treatment series with etanercept ( n = 311), adalimumab ( n = 427) or infliximab ( n = 144) were administered to 747 patients. Significant predictors of drug survival were: sex, the anti-TNF-α agent and the previous response to an anti-TNF-α agent. In the group of anti-TNF-α-naïve patients the longest drug survival was observed for infliximab, followed by adalimumab [HR vs. infliximab 3·70, 95% confidence interval (CI) 1·99-6·89] and etanercept (HR vs. infliximab 3·18, 95% CI 1·72-5·86). The 4-year drug survival is in the range of 40% for etanercept or adalimumab vs. 70% for infliximab. There was no difference in number of adverse events. The overall efficacy of anti-TNF-α drugs diminishes with time, as envisaged by the progressive loss of patient adherence to treatment. The major reasons for stopping treatment were loss of efficacy, followed by adverse events. Infliximab had the best patient retention ability, with 70% of patients still being on the drug after 4 years of treatment. [ABSTRACT FROM AUTHOR]

Methotrexate and fumarates are effective systemic therapies for moderate to severe psoriasis according to the European S3 guidelines. We conducted a randomized controlled trial comparing the effectiveness and the adverse events of methotrexate and fumarates. Sixty patients with moderate to severe psoriasis vulgaris were randomly assigned to treatment for 16 weeks with either methotrexate (30 patients; 15 mg per week) or fumarates (30 patients; 30 mg, followed by 120 mg according to a standard progressive dosage regimen) and were followed up for 4 weeks. The primary endpoint with respect to the efficacy was the difference in mean change from baseline in Psoriasis Area and Severity Index (PASI) after 12 weeks of treatment. The study was powered to detect a difference of five points. Analyses were by intention to treat. Six patients were excluded because five were not eligible and one withdrew consent. Two patients in the methotrexate group and one in the fumarate group dropped out during the 12 weeks of treatment because of nonappearance at the outpatient clinic. In total, 25 patients in the methotrexate group and 26 in the fumarate group were evaluated in the primary analysis. After 12 weeks of treatment, the mean ± SD PASI decreased from 14·5 ± 3·0 at baseline to 6·7 ± 4·5 in the 25 patients treated with methotrexate, whereas it decreased from 18·1 ± 7·0 to 10·5 ± 6·7 in the 26 patients treated with fumarates. After adjustment for baseline values, the absolute difference (fumarates minus methotrexate) in the mean values at 12 weeks was 1·4 (95% confidence interval −2·0 to 4·7; P = 0·417). In this randomized trial methotrexate and fumarates were found to be equally effective in the treatment of patients with moderate to severe psoriasis. No serious or irreversible adverse events were observed in any of the patients. [ABSTRACT FROM AUTHOR]

Patients with psoriasis are believed to be at an increased risk of cardiovascular (CV) morbidity, and the effect of biological agents on CV safety is not fully understood. To evaluate the effect of ustekinumab on CV events using detailed analyses of pooled data from the phase II/III clinical studies of its use in moderate to severe psoriasis. The incidence of major adverse CV events [MACE: myocardial infarction (MI), stroke or CV death] is reported. Meta-analyses using risk difference and odds ratio estimates are presented based on data collected during the placebo-controlled period of ustekinumab trials. The cumulative numbers of events and rates of MIs and strokes over time were compared with those expected in the psoriasis and/or general populations. During the placebo-controlled period (12/20 weeks), five MACE were reported in 1582 ustekinumab-treated patients [0·3%; 95% confidence interval (CI) 0·1-0·7%] compared with no events in 732 placebo-treated patients (0·0%; 95% CI 0·0-0·5%). MACE rates were stable over time during both the controlled and uncontrolled study periods, with 19 of 3117 ustekinumab-treated patients (0·6%) experiencing 21 events for a combined event rate per 100 patient-years of follow-up of 0·44 (95% CI 0·27-0·67) through up to 3 years. Standardized incidence ratios for comparison of ustekinumab clinical data with external data sources ranged from 0·34 to 0·52, suggesting no increased risk of MI or stroke in ustekinumab-treated patients compared with the general U.S. and psoriasis populations. The totality of available clinical data suggests neither a detrimental nor a beneficial effect of ustekinumab on serious CV events. Additional data are needed to define the net effect of ustekinumab on CV events. [ABSTRACT FROM AUTHOR]

Psoriasis is a dermatosis in which a multiplicity of ethio-pathogenic factors are involved, in a complex way. In the second part of this article the so called biological agents and non-traditional drugs, used for the treatment of this entity, will be reviewed. [ABSTRACT FROM AUTHOR]

A part of the book "Monthly Prescribing Reference" for February 2011 is presented. It offers an overview of pharmacological treatments for dermatological disorders including acne, psoriasis and skin infections. The drugs include Aczone from Allergan, Neoral from Novartis and Abreva from GlaxoSmithKline. Information on pharmacologic class, generic name, adverse reactions, and required doses for children and adults are also offered.

Abstract: The oxidative cleavage of the known anti-psoriasis drug 1 to give 2 has been reported previously. Due to the importance of accessing medium-sized ring containing systems via oxidative cleavage, this reaction has been revisited revealing additional information about the structure of 2. Alternative reaction products were identified when the reaction was carried out in the presence of water. The conversion of 1 to 2 has also been carried out using ruthenium tetroxide. A detailed variable temperature NMR and computational study of the restricted rotation of the N-aryl ring in 2 is presented. [ABSTRACT FROM AUTHOR]

The article presents abstracts on medical topics which include the use of adapalene-benzoyl peroxide in treating acne, the assessment of the recovery time for the collagen products Dermicol-P35 27G and 30G and the use of Calcitriol ointment as an optimizing psoriasis therapy.

Nail involvement in psoriasis is common and can be distressing. It can be treated with a range of treatment options, including topical medications, intralesional corticosteroids, phototherapy, radiation therapy, systemic therapies and biological agents. However, evidence for their efficacy in this setting is generally limited and additional research is needed. [ABSTRACT FROM AUTHOR]

The article offers information on biologic therapies. These refer to new therapies that involve the use of biologic interventions for blocking the molecular steps in psoriasis' pathogenesis and are classified into two types, one targeting tumor necrosis factor-α and interleukin-IL 12/23. Several products are featured, including he Sterlara monoclonal antibody from Jannsen-Cliag Ltd. and Enbrel TNF-inhibitor from Wyeth Pharmaceuticals.

Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing inservices. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent in print and are also available online. Monographs can be customized to meet the needs of a facility. Subscribers to The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.LX.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service or The F.LX., call The Formulary at 800-322-4349. The April 2010 monograph topics are on liraglutide, dalfampridine, collagenase clostridium histolyticum for injection, roflumilast, and belimulnab. The DUE is on liraglutide. [ABSTRACT FROM AUTHOR]

The article offers information on new drugs approved for marketing by the U.S. Food and Drug Administration (FDA) as of March 2010. A human monoclonal antibody called ustekinumab is indicated for the treatment of moderate or severe plaque psoriasis in adult patients. Among the adverse events linked with the antiarthritic agent tocilizumab are headache and hypertension. The mechanism of action of the antibiotic telavancin hydrochloride is also discussed.

The article discusses the case of a psoriasis patient who became pregnant while undergoing treatment with ustekinumab. Topics discussed include the discontinuation of ustekinumab treatment during the patient's first pregnancy, the re-start of ustekinumab after pregnancy which resulted to the remission of psoriasis and impetigo herpetiformis, and unintended second pregnancy following the third injection of ustekinumab.

Introduction: A study was conducted to explore the epidemiology of childhood psoriasis in general practitioners (GPs) and dermatological practice in the region of our academic medical centre. The treatments used by GPs and dermatologists in juvenile psoriasis were investigated. Methods: A questionnaire was sent to 229 GPs and 73 dermatologists. Questions were addressed about the prevalence of childhood psoriasis and treatments used in this disease. Results: Seventy-three questionnaires were completed. The response rate was 17.0% for GPs and 46.6% for dermatologists. Almost one-third of all GPs have seen one or more patients with juvenile psoriasis under the age of 11 in their own patient population, in contrast to more than 80% of the dermatologists. Extrapolating the results implied an estimated prevalence of childhood psoriasis of 0.17% in the overall Dutch population. Topical corticosteroids were used by 46.2% of GPs and by 91.2% of dermatologists. Vitamin D analogues were prescribed by GPs and dermatologists in 15.4% and 73.5% of cases, respectively. Systemic medication for juvenile psoriasis was only used by 20.6% of dermatologists. Conclusions: Calculated for the Dutch population, there should be approximately 27 500 children with psoriasis in The Netherlands. Topical corticosteroids were the first-choice treatment for both GPs and dermatologists, whereas vitamin D analogues were used as a second-choice topical therapy. Systemic medication was only sparsely prescribed by dermatologists. [ABSTRACT FROM AUTHOR]

Background. Severe plaque psoriasis in childhood has a significant morbidity and can warrant the use of systemic agents, although there are no published clinical trials in this group. Objectives. We report a series of 13 children with severe plaque psoriasis treated with low-dose once-weekly methotrexate. Methods. We reviewed the notes of all 13 children treated with low-dose methotrexate at Birmingham Children’s Hospital. Results. Of the 13 patients reviewed, 11 responded with clearance of psoriasis, leaving small residual plaques. Five patients are currently maintained on methotrexate. Three patients needed two courses of methotrexate and one needed three courses, with treatment-free intervals of between 9 and 22 months. One patient stopped treatment due to rises in the results of liver function tests (LFTs) at 6 weeks, and one patient stopped the second course of methotrexate after two doses because of slightly raised baseline LFT results. There were no other adverse events. Conclusions. We propose that when carefully monitored, methotrexate can be a safe and efficacious treatment option for severe psoriasis in children as well as in adults. Obesity may be a relative contraindication, as associated nonalcoholic fatty liver disease is likely to increase hepatotoxicity. [ABSTRACT FROM AUTHOR]

Ustekinumab is a novel investigational human monoclonal antibody (mAb) that is pending approval for the treatment of plaque psoriasis. As a chronic inflammatory skin disorder, psoriasis can be effectively treated with biologic agents, which target immune pathways. Current approved biologic agents for psoriasis include agents that inhibit tumor necrosis factor (TNF)-alpha (eg, etanercept, infliximab, adalimumab) or T-ceil activation (eg, alefacept, efalizumab), Ustekinumab works through the inhibition of interleukin (IL)42 and IL-23, Subcutaneous administration of ustekinumab has demonstrated efficacy in both phase 2 and 3 trials, with larger proportions of ustekinumab-treated patients (>50%) achieving 75% reduction in Psoriasis Area and Severity Index (PASI) scores compared with placebo-treated patients. Ustekinumab-treated patients also experienced greater improvements in health-related quality of life. Ustekinumab is generally well tolerated; the most commonly reported adverse events include cough, arthralgia, injection-site reaction, and headache. INSET: I Formulary considerations. [ABSTRACT FROM AUTHOR]

The article discusses the impact of biologic agents used in treating plaque psoriasis. It refers to psoriasis refers as a chronic inflammatory skin disorder that is characterized by thickened, erythematous and scaling plaques. The etiology, the use of the Psoriasis Area and Severity Index (PASI) in determining the severity of psoriasis and various treatment approaches are detailed. The agents tackled include etanercept, a soluble tumor necrosis factor (TNF)α receptor, and the monoclonal antibodies infliximab and adalimumab.

At any point in time, psoriasis affects 2-3% of the world's population and has one of the biggest impacts on quality of life of any dermatological disorder. Treatment is extremely costly and prevention of disease progression in severity and extent is crucial. Psoriasis treatment should include skin hydration (regular use of moisturizers and emollients), careful, gentle skin cleansing, and identification and avoidance of Koebner phenomenon triggers (excoriation, maceration) and infectious foci (Streptococcus pyogenes). Moisturizers have been shown to significantly improve skin conditions and quality of life for psoriasis patients. They are a valuable first-line treatment, as dry skin is common and adds to the irritability of the diseased skin. Most patients respond well to topical treatment with topical corticosteroids, emollients, coal tar, anthralin (dithranol) or calcipotriol. Emollients are the most prescribed products, providing transient relief from irritation and some possessing antiinflammatory properties. Moisturizers and emollients should be used in the following cases: minimal psoriasis, napkin psoriasis, psoriasis of the folds, psoriatic skin damaged by previous local treatments, and in pregnancy or women of childbearing age. [ABSTRACT FROM AUTHOR]

Background Goeckerman's therapy (GT) of psoriasis is based on daily application of pharmacy grade coal tar on affected skin with subsequent exposure to UV light. Pentraxin 3 (PTX3) is a newly identified acute phase reactant with non redundant functions in innate immunity. PTX3 has been shown to be a reliable prognostic marker in patients with various inflammatory disorders including rheumatoid arthritis, vasculitis, and psoriasis. Methods The aim of this study was to evaluate the influence of Goeckerman's therapy of psoriasis on levels of two pentraxins: long pentraxin PTX3 and C reactive protein in 49 patients with chronic plaque psoriasis. CRP was assessed by immunonephelometry on IMMAGE 800 (Beckman, USA). PTX3 was detected using sandwich ELISA detection set (Alexis Biochemicals, Switzerland). Results The serum levels of both parameters (expressed as average ± 1 SD) were significantly diminished after GT. The level of PTX3 dropped from 1.92 ± 0.72 ng/ml before GT to 1.66 ± 0.58 ng/ml after GT ( P= 0.0396) and the level of CRP fell from 4.64 ± 3.93 mg/l to 1.66 ± 0.58 mg/l ( P < 0.0001).Comparing to healthy controls, the serum levels of both parameters before GT were significantly higher than those found in healthy blood donors and remained significantly increased after GT. Conclusion Increased serum concentrations of pentraxin 3 and CRP are alleviated by GT in patients with psoriasis. [ABSTRACT FROM AUTHOR]

Background This study investigates four measures of disease severity in patients with psoriasis, both before and after therapy. Methods Data records were analyzed from 33 patients with moderate-to-severe chronic plaque psoriasis who were treated with efalizumab, 1 mg/kg/week subcutaneously, for 12 weeks. Four measures of disease severity were used: body surface area (BSA), psoriasis area and severity index (PASI), psoriasis log-based area and severity index (PLASI) and self-administered PASI (SAPASI). Results At the end of the 12-week therapy, the mean percent improvement shown by each measure varied considerably, ranging from 48.6% (PASI) to 70.6% (SAPASI). PASI and PLASI were the most comparable (67.3% and 66.5%). These differences were smaller when a dermatologist's opinion about the improvement was taken into account, for example “very good improvement” ranged from mean percent improvement of 63.8% (BSA) to 83.8% (PASI). The correlation between all measures revealed a high level of significance ( P≤ 10−5). Conclusions Comparing the slopes and intercepts of the regression lines revealed PLASI as the most reliable measure for the severity and therapeutic improvement in patients with moderate-to-severe chronic plaque psoriasis. PLASI proved to be a marginally more accurate than PASI, and much more accurate than SAPASI and BSA. The superiority of PLASI may be a result of the logarithmic scale of the affected skin surface. [ABSTRACT FROM AUTHOR]

Background: Psoriasis and atopic eczema are reportedly as common among women as among men and are not known to differ in severity between sexes. Research has shown that men get more treatment with ultraviolet (UV) light for longer periods than women. This fact, together with ongoing efforts to improve patient satisfaction with care and treatment at our department, prompted us to gather information from our patients. Objective: The aim of this study was to explore patients' views of dermatological care and treatment methods. Method: A questionnaire-based survey was carried out, complemented with qualitative interviews. Results: The main findings fall under three areas of clinical relevance: information to patients must be individually designed with a gender perspective; men and women have different attitudes towards greasing which must be kept in mind in clinical practice; and women often appear to be under-prescribed UV treatment. Conclusion: The information from our study can form a basis for new therapeutic strategies, taking a gender perspective into account. [ABSTRACT FROM AUTHOR]

Background The Goeckerman regimen (GR) involves the dermal application of a crude coal tar (polycyclic aromatic hydrocarbon, PAH) and exposure to ultraviolet (UV) radiation. Both PAH and UV radiation exhibit immunosuppressive activity. This study describes the changes in the serum levels of the pro-inflammatory cytokine interleukin-12 (IL-12) and the anti-inflammatory cytokine IL-10 in patients with psoriasis ( n = 55) treated with GR. Methods The serum levels of IL-12 and IL-10 were compared before and after GR. In addition, the IL-12 and IL-10 levels in psoriatic patients were compared with those in a control group of healthy blood donors ( n = 47). The Psoriasis Area and Severity Index (PASI) was used to evaluate the efficacy of GR. Results When compared with the control group, both IL-12 and IL-10 were significantly higher in psoriatic patients in all cases ( P < 0.001). When compared before and after GR, the IL-12 and IL-10 levels ( P < 0.01) and PASI value ( P < 0.001) were significantly lower after GR. The decrease in the serum level of IL-12 and IL-10 after GR was related to the entry value before GR (IL-12, r = 0.60, P < 0.001; IL-10, r = 0.36, P < 0.01). There was a significant correlation between the IL-10 level before GR and the PASI value after GR ( r = –0.39; P < 0.01). Conclusions The results indicate a strong pro-inflammatory effect of IL-12 in the immunopathogenesis of psoriasis, and confirm the immunosuppressive and anti-inflammatory effect of GR. IL-10 seems to be a promising individual marker for a positive effect of GR therapy. [ABSTRACT FROM AUTHOR]

Background In 2003, the Dutch psoriasis guidelines were among the first evidence-based medicine guidelines in dermatology. Although pivotal, the implementation of dermatological guidelines has not been assessed. Objectives To evaluate various aspects that affect implementation of clinical guidelines such as knowledge, attitudes and practices among dermatologists. Methods A cross-sectional anonymous postal survey was conducted among all Dutch dermatologists. In addition to questions about knowledge and practices, 24 items assessed guidelines attitudes. Factor analysis was applied to merge these items into attitudinal scales and multiple linear regression was used to identify predictors for these scales. Results Of the 353 dermatologists, 161 (46%) completed the questionnaire. Almost all respondents were aware of the guidelines and 60% reported to have a decent knowledge of their content. Factor analysis retained 22 items divided into three scales: usefulness and content, barriers, and reliability. Apart from some disagreement on the user-friendliness and communication facilitating properties, the dermatologists’ attitudes were generally positive. A larger volume of patients with psoriasis was associated with more frequent use of the guidelines [adjusted odds ratio (OR) = 2·42; 95% confidence interval (CI) 1·02–5·72]. Good familiarity predicted a more positive attitude towards the guidelines’ usefulness and content ( P < 0·001), perceived barriers ( P < 0·001), and more frequent use in practice (adjusted OR = 8·38; 95% CI 3·08–22·81). Conclusions Dutch dermatologists seem to know and appreciate their psoriasis guidelines and use them more often when they have a larger psoriasis population. Enhancing the familiarity of the guidelines among users may result in a more positive attitude towards them and a higher frequency of use. [ABSTRACT FROM AUTHOR]

The histologic and immunologic findings on psoriasis have led to the development of biologic therapies for its treatment. Biologic therapies are classified according to their structure as recombinant human proteins, monoclonal antibodies, and fusion proteins. Currently there are five biological drugs approved by the Food and Drug Administration for the treatment of psoriasis; however research studies are being performed to implement a few others. It is important to be familiarized with biological drugs, understand their mechanisms of action, and their adverse effects in order to be able to provide patients the most adequate therapeutical alternative. Advances in biotechnology provide new strategies that act on the immune system. The clinical experience using biological therapies in dermatology is relatively limited and there is a need to define which patients are candidates to receive these drugs. The combination of biologic treatments with traditional drugs needs further research since this could enhance their benefits, limit their toxicity, and reduce costs. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and safety of a 308 nm excimer laser for the treatment of psoriasis vulgaris patients. Method: Forty subjects with psoriasis vulgaris (26 macular type, and 14 chronic plaque type) were treated by a 308 nm excimer laser. The initial dose was based on multiples of a predetermined minimal erythema dose, while the subsequent doses were adjusted on the response to the intervention, which was twice per week for a total of 15 treatments. The therapeutic efficacy and safety were then evaluated. Results: Of the 40 patients who received and completed the entire 15 times of laser radiation, (1) the Psoriasis Area and Severity Index score was improved by 90.19±10.12% and 77.34±17.04% in macular type and chronic plaque type, respectively ( P<0.05) and (2) the average treatment sessions were 13.7 times. The average cumulative doses for all patients were 6.86±2.48 J/cm2, in which it was 5.64±1.86 J/cm2 for macular type and 9.13±1.80 J/cm2 for chronic plaque type, respectively ( P<0.05). Conclusion: Our clinical data suggest that treatment of psoriasis vulgaris by a 308 nm excimer laser is effective and safe, and it is more efficacious in macular type than in chronic plaque type. [ABSTRACT FROM AUTHOR]

The article cites a study that describes the basic characteristics of psoriatic disease, a dermatologic disorder that affects residents in the U.S. It discusses the need for appropriate management for early and aggressive intervention of this condition. It highlights the principles that maximizes treatment outcomes by giving tumor necrosis factor-alpha antagonist therapy.

This article presents a case vignette that includes a therapeutic recommendation. A 52-year-old man who had psoriasis for 30 years seeks further treatment. His psoriasis is not responsive to topical therapy, is worse in the winter and improves in sunlight. His psoriasis covers 20 percent of his body and is only partially responsive to narrow-band ultraviolet B (UVB) therapy. His dermatologist recommends oral psoralen and ultraviolet A (PUVA) therapy. The pathology and mechanisms of psoriasis are discussed. Clinical trials on the use of PUVA therapy are presented. Therapy choices are listed with the notation that optimal therapy for a patient will vary over the years of the disease. Different phototherapies are presented along with potential adverse reactions.

Background The clinical usefulness of cyclosporine in patients with psoriasis has generally been established; however, modification of the dosage on the basis of therapeutic drug monitoring is needed to prevent potential adverse reactions. The area under the drug concentration–time curve from 0 to 4 h after treatment (AUC0−4), used to assess the pharmacokinetics of cyclosporine microemulsion, correlates with clinical symptoms and adverse reactions. Methods In order to evaluate the blood collection times after oral treatment that are most relevant to pharmacokinetics, we examined the pharmacokinetics of cyclosporine up to 4 h after treatment in 24 patients with psoriasis vulgaris who received an oral dose of 3.0 mg/kg of cyclosporine microemulsion (Neoral®) daily in two divided doses. Results Our results showed that the blood concentration of cyclosporine 2 h after treatment ( C2) correlated with AUC0−4 ( r = 0.89, P < 0.001). Conclusions C2 should be monitored in patients treated with cyclosporine microemulsion instead of the blood trough level immediately before treatment, which has conventionally been used to monitor cyclosporine concentrations in blood. [ABSTRACT FROM AUTHOR]

Abstract: Spa (thermal) tourism is gaining increasing importance in health tourism. Turkey has numerous thermal sources that have been used to cure a number of common diseases. Among these thermal sources, Kangal Fish Spring has a unique nature with its doctor fish known to cure psoriasis. To date, a number of studies analyzed Kangal Fish Spring as a thermal source with its water and fish characteristics but no research to the authors’ knowledge has been conducted to analyze the spring''s demand and destination characteristics. In Turkey, research about thermal health centers and their visitors, is fairly limited from a tourism experience point of view. The current paper reports a case study of psoriasis treatment by doctor fish in Kangal Fish Spring as part of health tourism in Turkey. The paper describes Kangal Fish Spring as a health tourism destination and investigates socio-economic and visitor characteristics of the people visiting Kangal Fish Spring. As part of the study, 104 visitors to the destination were surveyed and visitor perceptions about the destination and visitor characteristics were reported. The paper concludes with a discussion about the future of the destination and health tourism in Turkey. [Copyright &y& Elsevier]

Background: No controlled data is available till date comparing topical tazarotene and clobetasol in Indian psoriatic patients. Objective: The aim was to compare the clinical efficacy of 12 weeks of once-daily tazarotene 0.1% cream with that of once-daily clobetasol propionate 0.05% cream in the treatment of patients with chronic plaque psoriasis. Methods: About 36 patients with bilaterally symmetrical lesions were enrolled in this double-blind randomized controlled study. A left-right randomized study was conducted. Results: Clobetasol cream was better than tazarotene cream in reducing the erythema throughout the treatment period with statistically significant differences favoring clobetasol at weeks 2, 4, 6 and 8 (P<0.05). Tazarotene was better in reducing the induration at weeks 2 (P<0.05), 4, 10 and 12. Clobetasol cream was better in reducing the scaling throughout the treatment period with statistically significant differences favoring clobetasol over the entire treatment period. Treatment success rate was 100% with clobetasol and 88% with tazarotene at the end of week 12 with clobetasol achieving 100% success rate at the end of week 6. Treatment with tazarotene resulted in uniform reduction of plaque elevation and was not associated with the development of hot spots. Conclusion: Topical tazarotene 0.1% cream is less effective than topical clobetasol propionate 0.05% cream in the treatment of plaque psoriasis. It has more effect on induration than on erythema and scaling of psoriatic lesions. [ABSTRACT FROM AUTHOR]

Children with psoriasis often have involvement of the face and intertriginous areas. While corticosteroids have been the mainstay of treatment for plaque-type psoriasis, the face and intertriginous areas are more sensitive to local effects of topical steroid use such as cutaneous atrophy. Topical tacrolimus has shown promise in adult patients as an alternative antiinflammatory without the cutaneous side effects of steroids. Eleven patients between 6 and 15 years of age with facial or inverse psoriasis were evaluated in a 6-month, single-center, open-label trial. Clinical evaluations were made at baseline and days 30, 90, and 180. Severity was assessed using the physician's global assessment of improvement relative to baseline, a 6-point rating scale for signs of disease (erythema, infiltration, desquamation), and an overall severity score. Within the first 30 days of treatment, every patient had cleared or achieved excellent improvement with the use of tacrolimus ointment. Statistically significant improvement was achieved in each sign of disease and the overall severity score. The only adverse event reported in 6 months of observation was significant pruritus in one patient. We therefore conclude that tacrolimus ointment is an effective treatment for psoriasis on the face or intertriginous areas in children. [ABSTRACT FROM AUTHOR]

Background Most patients with psoriasis have limited disease which can be managed effectively in primary care. There is a marked variation in the frequency of referrals between practices reflecting, in part, inadequate training of general practitioners (GPs) in the management of psoriasis. Objectives To assess the effectiveness of guidelines and training sessions on the management of psoriasis in reducing inappropriate referrals from primary care. Methods Patients aged 18 years or over with psoriasis were eligible for the cluster-randomized, randomized controlled trial if they were referred by their GP between 9 September 2002 and 31 December 2003 to one of four hospital dermatology departments in Greater Manchester, North-West England. All GPs from 165 health centres were invited to a lecture by a local dermatologist on the diagnosis and management of psoriasis. Health centres in the intervention arm received guidelines on the management of psoriasis in primary care, developed by local dermatologists, supplemented by the offer of a practice-based nurse-led training session; those in the control arm received neither guidelines nor training sessions. Results Eighty-two health centres were randomized to the intervention arm and 83 to the control arm. Outcome data were available for 188 of the 196 eligible patients referred during the study period. Patients in the intervention arm were significantly more likely to be appropriately referred in comparison with patients in the control arm [difference = 19·1%; odds ratio (OR) 2·47; 95% confidence interval (CI) 1·31–4·68; intracluster correlation coefficient (ICC) = 0]. Only 25 (30%) health centres in the intervention arm took up the offer of training sessions. There was no significant difference in outcome between health centres in the intervention arm that received a training session and those that did not (OR 1·28, 95% CI 0·50–3·29, ICC = 0). Conclusions Dissemination of guidelines on the management of psoriasis in primary care can significantly enhance the appropriateness of referral of patients to secondary care. [ABSTRACT FROM AUTHOR]