Clinical and Experimental Dermatology最新文献

Background: Psoriasis is a common autoimmune inflammatory disease. Vitamin B6 is crucial for the body's inflammatory response, yet the relationship between pyridoxal 5'-phosphate (PLP), 4-pyridoxic acid (4-PA), and vitamin B6 turnover (4-PA/PLP) in psoriasis remains unexplored.

Objective: To investigate the relationship of PLP, 4-PA and vitamin B6 catabolism with the risk of psoriasis.

Methods: This cross-sectional study analyzed 7,540 participants from the National Health and Nutrition Examination Survey. Vitamin B6 catabolism was assessed via the serum 4-PA to PLP ratio (4-PA/PLP). The primary outcome was psoriasis, evaluated using weighted univariate and multivariate logistic regression to determine odds ratios (OR) and 95% confidence intervals (CI). Subgroup analyses were performed by age, gender, body mass index (BMI), hypertension, dyslipidemia, and cardiovascular disease (CVD).

Results: Out of the participants, 208 had psoriasis. After adjusting for confounders, 4-PA levels in cutoff above group were positively associated with psoriasis (OR=1.51, 95% CI: 1.03-2.20). Additionally, 4-PA/PLP correlated with increased psoriasis risk (OR=1.82, 95% CI: 1.02-3.26). However, PLP levels did not show a significant association. The positive link between 4-PA/PLP and psoriasis was consistent in individuals with BMI ≥25 kg/m², hypertension, and those without dyslipidemia.

Conclusion: The results revealed significant association of 4-PA and 4-PA/PLP level with the presence of psoriasis. However, further extensive prospective studies are necessary to establish causality.

Background: Polymorphisms in thiopurine methyltransferase (TPMT) are a predominant cause of azathiopurine-induced leukopenia in the Western countries. The exact role of these polymorphisms in Indian population with dermatological disorders is uncertain.

Methods: We included consecutive patients on Azathioprine who were initiated for dermatological disorders from south India. Three TPMT polymorphisms (c.238 G > C, c.460 G > A, and c.719A > G) were assessed. A comparison of the proportion of adverse events to azathioprine, especially myelosuppression, was performed between those with wild-type genotype and those with TPMT polymorphisms.

Results: Of the 123 patients (61 males, mean age 46 years), 65% had autoimmune blistering disorder. Adverse event to azathioprine was noted in 25 (20.3%), of which 16 (13%) had myelosuppression, four (3.2%) each had hepatotoxicity and gastrointestinal intolerance. TPMT polymorphisms were detected amongst 13 (10.7%), of which five had experienced adverse events. The polymorphisms could explain 25% (4 out of 16) of the cases of leucopenia. The odds of developing leukopenia in TPMT polymorphism was not significant (3.63, 95% CI 0.96-13.60, p=0.055).

Conclusion: The tested TPMT polymorphisms could not predict the adverse events, particularly the haematological toxicity of azathioprine in dermatological use among the south Indian population.

Background: New interleukin (IL)-17A inhibitors seem to demonstrate smaller effects on tuberculosis (TB) reactivation than expected.

Objectives: To evaluate the risk of TB reactivation, to assess serial interferon (IFN)-γ levels, and to weigh up the risks and benefits of TB chemoprophylaxis in patients with psoriasis treated with IL-17A inhibitors.

Methods: This dual-centre study included patients with psoriasis who were treated with IL-17A inhibitors. The incidence of active TB, serial IFN-γ levels tested by IFN-γ release assays (IGRAs), adverse events (AEs) and effectiveness were evaluated through 1 year in patients with psoriasis treated with IL-17A inhibitors. According to the chemoprophylaxis treatment regimen, patients with latent TB infection (LTBI) were classified into three groups: a complete chemoprophylaxis dose regimen (CCP), an incomplete chemoprophylaxis (ICCP) or no chemoprophylaxis (NCP).

Results: In 220 IGRA-negative patients, 17 of 220 (7.3%) became IGRA positive after receiving a mean of 69.1 weeks of IL-17A inhibitor treatment. Only one case of new-onset TB was observed after 52 weeks of ixekizumab therapy. Significant changes in IFN-γ levels were observed in IGRA-negative patients. Similarly, IFN-γ levels [listed as the mean (SD)] significantly increased at 1 year compared with baseline among IGRA-positive patients in the NCP [105 (68.7) vs. 236 (80.8) pg mL-1, P < 0.01] and ICCP [75.3 (48.3) vs. 608 (249) pg mL-1, P < 0.001] groups, whereas the changes were not significant [125 (26.6) vs. 131 (21.7) pg mL-1, P = 0.70] in the CCP group.

Conclusions: During IL-17A inhibitor therapy, there is a need for increased awareness of annual screening and assessment of individual risk for early detection of TB infection. LTBI treatment is generally well tolerated and is effective in preventing increased IFN-γ responses in patients with psoriasis treated with IL-17A inhibitors.