Psoriasis (Auckland, N.Z.)最新文献

Purpose: Psoriasis is a common chronic inflammatory skin disease. Acupoint injection is reported to be used for the treatment of psoriasis, however its mechanism is not yet clear. The study aimed to investigate the efficiency of combined treatment including acupoint injection in the treatment of psoriasis.

Patients and methods: Here, we compared the efficacy of multiple immune intervention therapy (MII, acupoint injection with BCG-PSN combined with thymosin enteric-coated tablets, levamisole, intramuscular injection with BCG-PSN) to NB-UVB and acitretin for psoriasis. One thousand two hundred patients with moderate-severe psoriasis vulgaris were randomly treated with MII, NB-UVB or acitretin. For another 53 patients treated with MII, the T cell subsets and TCR repertoire analysis were investigated with sequencing and flow cytometry.

Results: The effective rate in MII treated group was similar to acitretin-treated group in 3 months (P > 0.05), though lower than in subjected treated with NB-UVB (P < 0.05). MII treatments maintained a longer remission of both PASI25 and PASI75 in comparison to the treatment with either NB-UVB or acitretin in following 5-year follow-up. Moreover, the relapse rate was lower in MII treatment than in either NB-UVB (P < 0.0001) or acitretin treatment (P < 0.0001), accompanied with longer remission duration (MII vs both NB-UVB and acitretin, P < 0.0001). Meanwhile, MII treatments markedly increased Treg cells (P = 0.04), while decreasing the number of both Th1 (P < 0.001) and Th17 cell (P = 0.01), along with decreased secretion of IFN-γ (P = 0.03) and IL-17 (P = 0.02). Multivariable Cox regression analysis demonstrated that MII significantly reduced psoriasis relapse risk versus NB-UVB (58.7% reduction; HR = 0.413, 95% CI: 0.329-0.517, P < 0.001) and acitretin (65.3% reduction; HR = 0.347, 95% CI: 0.276-0.435, P<0.001).

Conclusion: Acupoint injection combined with BCG-PSN, thymosin enteric-coated tablets and levamisole treat psoriasis and prevent relapse of psoriasis, via modulation of Treg/Th1/Th17.

Background: Plaque-type psoriasis (PSO) is a chronic inflammatory systemic skin disease. Psoriatic arthritis (PsA) is a frequent component requiring early treatment to prevent joint damage. Guidelines recommend differentiated drug decisions for both conditions.

Objective and methods: Descriptive analysis of drug choices for patients with PSO with or without additional PsA of the German Psoriasis registry PsoBest from 2007 to 2022.

Results: The analysis comprises data of 17,310 patients with PSO: 18,6% with additional PsA (PSO+PsA), mean age 47.6 (± 14.8) years, 58.8% male, mean duration of PSO 16.4 years in patients without PsA (PSO-PsA; ± 14.3), 20.6 years in PSO+PsA (± 15.3, p < 0.001). PSO-PsA and PSO+PsA patients showed a marked burden of disease: PASI (15.7 (± 10.1) and 13.9 (± 10.6, p < 0.001)); DLQI (11.7 (± 7.2) and 12.3 (± 7.6; p < 0.001)). Before registry entry, 47.0% of patients received no systemic antipsoriatic treatment. Prior systemic medications were mainly non-biologics (40.4%), 12.6% were biologics, with a significantly higher rate in PSO+PsA patients (24.7% vs 9.8%). At registry baseline, the majority of the patients received non-biologic treatment (55.9%), with significantly higher rates for PSO-PsA patients (55.9% vs 34.8%). Biologics were used in 43.9% of all patients, with a significantly higher rate in PSO+PsA patients (65.9% vs 38.8%). Three hundred and three (9.4%) of PSO+PsA patients received treatments at baseline with approval for PSO, but not explicitly for PsA. Those patients had minor active joint involvement.

Conclusion: Early and effective treatment of PsA is crucial to prevent persistent damage of the joints. Although most patients received recommended systemic treatment for PSO+PsA, there is a small number of patients with prescriptions addressing mainly the inflammation of the skin and not explicitly PsA. To choose recommended medication for both entities we need to regard the entire systemic inflammation and interdisciplinary co-working should be implemented.

Background: Pustular psoriasis (PP) is a systemic inflammatory disease that rarely occurs in children but adversely affects their quality of life.

Objective: This study aimed to evaluate the clinical characteristics, treatment, prognosis, and epidemiology of PP in pediatrics.

Methods: A single center retrospective study on 41 children diagnosed with PP was conducted in a university-affiliated referral hospital between January 2010 and May 2022. The demographics, clinical characteristics, treatment, and prognosis were evaluated in the descriptive analysis. To further investigate the effect of different acitretin-based treatments on the prognosis, 38 patients were included in the subgroup analysis. Patients who received acitretin alone were designated as the Acitretin group, while those who received acitretin combined with intravenous immunoglobulin, ciclosporin, or steroids (or any combination of these agents) were identified as the Combination group.

Results: A total of 41 patients were enrolled in the descriptive analysis. Of these, 65.8% (27/41) were male, and the mean age of onset was 3.2 ± 3.2 years. Among the patients, 63.4% (26/41) presented with pustules, and over half experienced fever and elevated C-reactive protein (CRP) levels. In the subgroup analysis, the CRP level was significantly higher in the Combination group (59.69 ± 43.74 versus 26.35 ± 19.67 mg/dL, P = 0.006), indicating that patients had more severe inflammatory conditions. Nevertheless, there was no significant difference in the remission rate between the Acitretin group and the Combination group.

Conclusion: Pediatric PP is a disease that often occurs in the pre-school period and predominantly affects males. It is characterized by typical skin lesions and systemic inflammatory reactions. Common comorbidities include nutritional disorders such as malnutrition and anemia. Combination treatment based on acitretin is recommended for children with PP and severe inflammation.

Psoriasis, a chronic inflammatory disease affecting approximately 3% of the global population, presents complex challenges that extend beyond its physical manifestations. This comprehensive review examines the multidimensional impact of psoriasis on patients' lives, encompassing physical, psychological, and social aspects. We analyze current therapeutic approaches, from traditional systemic treatments to cutting-edge biological therapies and emerging oral medications, evaluating their efficacy, limitations, and accessibility. The review explores how disease severity correlates with quality of life measures and psychological burden, noting the high prevalence of depression (20%), anxiety (21%), and suicidal ideation (0.77%) among affected individuals. However, emerging evidence suggests that clinical severity, as measured by PASI or BSA, does not always correlate with the psychoemotional burden experienced by patients, highlighting the need for a more comprehensive assessment of disease impact. We discuss the evolution of treatment strategies, highlighting recent developments in targeted therapies, including JAK inhibitors, particularly selective TYK2 inhibitors, and PDE4 inhibitors, which offer promising alternatives to traditional treatments. Additionally, we examine the role of various assessment tools and quality of life measures in evaluating treatment outcomes. The analysis emphasizes the need for a holistic approach to patient care that integrates medical interventions with psychological support, addressing both the visible and invisible burdens of the disease. This review underscores the importance of personalized treatment strategies that consider not only clinical efficacy but also patient preferences, accessibility, and long-term safety profiles.

Background: Psoriasis significantly impacts patients' mental health and social relationships, often leading to feelings of stigmatization and shame due to the visibility of skin lesions. This study aimed to identify factors influencing the quality of life in patients with psoriasis.

Methods: A cross-sectional study was conducted from November 2018 to December 2020, involving 100 patients treated for psoriasis. The research utilized the WHO Quality of Life Questionnaire (WHOQoL-Bref), the Psoriasis Area and Severity Index (PASI), the Acceptance of Illness Scale (AIS), the Hospital Anxiety and Depression Scale (HADS), and the Mini Nutritional Assessment (MNA). The analysis included demographic, clinical, and psychological variables to evaluate their impact on quality of life.

Results: The multivariate linear regression model revealed that significant independent predictors of quality of life included age (p=0.001), duration of disease (p=0.004), and nutritional status (p=0.002). In the physical domain, factors such as phototherapy (r=2.46) and anxiety levels assessed by the HADS anxiety subscale (r=-0.23) were particularly relevant. In the psychological domain, the presence of psoriatic arthritis (r=1.978), hand and foot psoriasis (r=2.34), and scores on the HADS anxiety (r=-0.212) and depression subscales (r=-0.226) were significant. Male gender (r=1.632) and depressive symptoms (r=-0.352) impacted the social domain. In the environmental domain, predictors included erythrodermic psoriasis (r=1.98), hand and foot psoriasis (r=2.312), phototherapy (r=1.877), PASI score (r=-0.04), and depression as measured by HADS (r=-0.228).

Conclusion: The primary predictors of quality of life in patients with psoriasis are the type of psoriasis, the presence of anxiety and depressive disorders, and treatment with phototherapy. However, the study's single-center design and relatively small sample size may limit the generalizability of the findings. Further multi-center studies are needed to confirm these results and broaden their applicability.

Psoriasis and atopic dermatitis (AD), once viewed as mutually exclusive diseases, are increasingly recognized to co-occur in complex inflammatory phenotypes. We present a 17-year-old male with multimorbid atopic conditions, including persistent atopic dermatitis, allergic rhinitis, and asthma, who developed new-onset psoriasis in the absence of previous biologic therapy. Initially misdiagnosed as exacerbated AD, he received ineffective treatment for one year. Treatment with secukinumab yielded limited improvement in psoriatic symptoms and eczematous lesions. AD and psoriasis significantly improved after adding dupilumab for 12 weeks; there were no documented side effects and a durable remission lasting 78 weeks. This case report underscores the importance of vigilance in patients with long-standing AD for newly emerging psoriasis and cautions against attributing all new rashes solely to chronic AD history. This case highlights the potential benefit of dual biologic therapy in managing concurrent type 2 inflammatory diseases and psoriasis, suggesting that a comprehensive immune-modulatory approach may be advantageous for patients with these coexisting conditions.

This narrative review examines critical considerations for biologic treatment in psoriasis patients, with a focus on infection risks, providing current recommendations and practical considerations for prevention, including vaccination, screening, and management strategies. Since type I (Th1) inflammation and type III (Th17) inflammation protect against intracellular and extracellular infections, respectively, it is logical that biologic treatments blocking these pathways may be associated with an increased risk of infection. It has been proven that TNF inhibitors are associated with an increased risk of latent tuberculosis (LTBI) and hepatitis B virus reactivation. However, not all biologics exert the same immunosuppressive effect, as IL-17 and IL-23 inhibitors may be associated with a lower risk of infection. In general, pre-treatment screening for reactivable infectious diseases is advised for all patients initiating biologic therapy. Vaccination schedules for patients with psoriasis under biologic treatment should mirror those of the general population, including annual influenza and COVID-19 vaccines. Live-attenuated vaccines are generally advised against in patients undergoing biologic treatment. However, some live-attenuated vaccines may be safely administered under specific circumstances with IL-17 or IL-23 inhibitors. Current guidelines and recommendations on this topic were initially designed for TNF inhibitors and later extrapolated to other classes of biologic agents. Thus, they should be revised to better align with the specific pathogenic mechanisms of drugs and clinical evidence, emphasizing individualized treatment approaches.

Introduction: Psoriasis is a chronic inflammatory skin disease significantly impairing quality of life. The introduction of biologic therapies, such as bimekizumab-a monoclonal antibody targeting IL-17A and IL-17F-has revolutionized treatment outcomes. This study investigates the effectiveness of bimekizumab in a real-world setting, focusing on the predictors of Early Super Response (ESR), defined as achieving PASI 100 by week 4, and evaluates the safety profile over a 48-week follow-up period.

Methods: A retrospective study was conducted on 109 psoriasis patients treated with bimekizumab at two Italian dermatology centers. Of these, 61 patients completed a 48-weeks follow-up. Baseline clinical and demographic data, PASI scores at multiple time points, and adverse events were collected. ESR predictors were analyzed using univariate and multivariate logistic regression models. Safety was assessed using Cox proportional hazards models to find predictive factors associated with the risk of adverse events (AEs).

Results: At week 4, 28.4% of patients achieved PASI 100. Baseline PASI (OR: 0.93, p = 0.029), absence of nail involvement (OR: 0.12, p = 0.003), and fewer biologic failures (OR: 0.14, p = 0.038) were independently associated with ESR status. Safety analysis revealed that 15.6% of patients experienced adverse events, with asthma/allergic rhinitis significantly associated with a higher risk (HR: 6.43, p = 0.012). Candidiasis (7.3%) and eczema (4.6%) were the most common adverse events.

Conclusion: Bimekizumab demonstrated significant effectiveness and an acceptable safety profile in a real-world setting. Baseline PASI, nail involvement, and prior biologic failures influenced early treatment response. Identifying predictors of ESR and adverse events can guide personalized therapeutic approaches, optimizing outcomes for psoriasis patients.

Introduction: Psoriasis is a chronic, relapsing inflammatory skin disorder that causes a detrimental physical and psychological impact on people living with the disease. However, little is known about its current prevalence, clinical variants, and quality of life among patients in Uganda.

Objective: The purpose of this study was to determine the prevalence of psoriasis, clinical variants, and quality of life (QoL) among patients attending Skin Clinic, Mbarara Regional Referral Hospital (MRRH), in western Uganda.

Methods: A cross-sectional study design and consecutive sampling were used. It was conducted between January and March 2023 at the skin clinic, MRRH, with a sample size of 384. The patients were thoroughly examined to assess clinical variants, and Quality of Life was evaluated using the Dermatology Life Quality Index (DLQI). Data obtained was entered using Excel version 20 and analyzed using STATA version 12.0 and GraphPad Prism 9.00. Descriptive statistics and comparison analysis (students t-test and ANOVA) were done.

Results: The overall prevalence of psoriasis was 3.91%. Majority of cases (86.67%) had chronic plaque psoriasis, 60% had a severe disease, and 60% were between 4 and 40 years. Most affected sites were arms (60%) and back (60%) and shins (53.33%), and the least affected were nails and dorsal feet (6.67%). Psoriasis moderately reduces QoL, with an overall mean DLQI score of 8.95 ± 1.35. There was no significant difference between QoL and age or gender.

Conclusion: Prevalence of psoriasis at MRRH in western Uganda is 3.91%. Chronic plaque psoriasis was the most common variant (86.67%), and the disease moderately affects the quality of life.

Purpose: The Brazilian Unified Health System is an interesting model for international healthcare innovation analysis. Covering over 200 million people, this system stands out as one of the largest purchasers of healthcare technologies worldwide. Our goal in this study was to evaluate how targeted therapies reduce the duration of sick leave for psoriasis patients.

Patients and methods: We conducted a retrospective cohort study within the Brazilian National Institute of Social Security. The primary outcome was the return to work (cessation of sick leave) of patients with psoriasis. Factors such as age, sex, and access to targeted therapies were evaluated using a Cox proportional hazards model.

Results: Over the 25-year period from 1998 to 2023, 32,512 benefits were granted for psoriasis, totalling an expenditure of $577,478,002.15. Public access to psoriatic arthritis (PsA)-targeted therapies decreased the average minimum wage granted to psoriasis patients on sick leave by 22%, and public access to psoriasis-targeted therapies reduced the average wage by 7%. The availability of these therapies was associated with earlier cessation of sick leave in our proportional hazards model (targeted therapies for PsA: hazard ratio (HR) = 1.90, 95% confidence interval (CI) = 1.82-2.00; targeted therapies for psoriasis: HR = 1.63, 95% CI = 1.54-1.70).

Conclusion: This study highlights a remarkable reduction in costs and sick leave duration due to the implementation of therapies for psoriatic disease by the Brazilian Unified Health System, which underscores the importance of considering detailed indirect cost data when evaluating new health technologies for large populations.