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Psoriasis (Auckland, N.Z.)最新文献

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Hepatitis B reactivation in psoriasis patients treated with anti-TNF agents: prevention and management. 抗肿瘤坏死因子治疗的银屑病患者乙型肝炎再激活:预防和管理。
Pub Date : 2017-04-15 eCollection Date: 2017-01-01 DOI: 10.2147/PTT.S108209
Maria Vittoria Cannizzaro, Chiara Franceschini, Maria Esposito, Luca Bianchi, Alessandro Giunta

The risk of hepatitis B virus (HBV) reactivation (HBVr) in chronic HBV carriers, in occult HBV patients or in acute HBV patients affected by psoriasis and treated with anti-tumor necrosis factor (TNF)-α agents is a clinical practice issue to face with, particularly if the treatment has a long-term maintenance finality. The aims of this review are to examine the current knowledge on HBVr incidence in chronic HBV carriers and potential occult carriers undergoing therapy with biologics for the treatment of psoriasis and psoriatic arthritis; analyze the prophylactic measure to prevent HBV reactivation and define how to manage HBVr in patients treated with biologics. We searched through PubMed, Google Scholar and Scopus databases and evaluated all published manuscripts concerning HBVr in psoriatic patients, both plaque-type and psoriatic arthritis, in treatment with any indicated anti-TNF-α. Although anti-TNFs are considered moderate immunosuppressive drugs, the incidence of HBVr in psoriatic patients is lower compared to patients affected by other immune-mediated diseases treated with TNF inhibitors. HBV prophylaxis should be probably reserved to anti-HBs+/anti-HBc+ patients with a viral load <2000 IU/mL and alterations in serum liver enzymes, in order to prevent HBVr.

慢性HBV携带者、隐匿性HBV患者或银屑病急性HBV患者接受抗肿瘤坏死因子(TNF)-α药物治疗时乙型肝炎病毒(HBV)再激活(HBVr)的风险是临床实践中需要面对的问题,特别是如果治疗具有长期维持性。本综述的目的是检查目前对慢性HBV携带者和潜在隐性HBV携带者接受生物制剂治疗银屑病和银屑病关节炎的HBVr发病率的了解;分析预防HBV再活化的预防措施,明确生物制剂治疗患者HBVr的管理方法。我们检索了PubMed、Google Scholar和Scopus数据库,并评估了所有已发表的关于银屑病患者HBVr的手稿,包括斑块型和银屑病关节炎,以及任何指示的抗tnf -α治疗。虽然抗TNF被认为是中度免疫抑制药物,但银屑病患者中HBVr的发生率低于接受TNF抑制剂治疗的其他免疫介导性疾病患者。HBV预防应该保留给有病毒载量的抗hbs +/抗hbc +患者
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引用次数: 16
Monitoring treatment response in psoriasis: current perspectives on the clinical utility of reflectance confocal microscopy. 监测银屑病的治疗反应:反射共聚焦显微镜的临床应用现状。
Pub Date : 2017-02-20 eCollection Date: 2017-01-01 DOI: 10.2147/PTT.S107514
Marina Agozzino, Cecilia Noal, Francesco Lacarrubba, Marco Ardigò

Reflectance confocal microscopy (RCM) evaluation of inflammatory skin diseases represents a relatively new technique that, during the past 5 years, has attracted increasing interest, with consequent progressive increment of publications in literature. The success of RCM is directly related to the high need for noninvasive techniques able to both reduce the number of skin biopsies and support clinical diagnosis and patient management. RCM helps to visualize microscopic descriptors of plaque psoriasis (PP) with good reproducibility between observers and a high grade of correspondence with histopathology. Several clinical tests are used for the therapeutic management of PP, but they are limited by subjective interpretation. Skin biopsy presents objective interpretation, but the procedure is invasive and not repeatable. RCM has been used not only for the evaluation of skin cancer or inflammatory skin diseases, but also for monitoring the efficacy of different treatments in PP. In this review, we present some examples of RCM applications in therapeutic psoriasis follow-up.

反射共聚焦显微镜(RCM)对炎症性皮肤病的评估是一项相对较新的技术,在过去的5年里,它引起了越来越多的兴趣,随之而来的是文献发表的逐渐增加。RCM的成功与对非侵入性技术的高度需求直接相关,这些技术既能减少皮肤活检的数量,又能支持临床诊断和患者管理。RCM有助于可视化斑块银屑病(PP)的显微描述,在观察者之间具有良好的再现性和与组织病理学的高度对应。几种临床试验用于PP的治疗管理,但它们受到主观解释的限制。皮肤活检是客观的解释,但过程是侵入性的,不可重复。RCM不仅用于评估皮肤癌或炎症性皮肤病,还用于监测PP不同治疗方法的疗效。在本文中,我们介绍了RCM在治疗性银屑病随访中的应用。
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引用次数: 8
Local effects of adipose tissue in psoriasis and psoriatic arthritis. 脂肪组织在银屑病和银屑病关节炎中的局部作用。
Pub Date : 2017-02-03 eCollection Date: 2017-01-01 DOI: 10.2147/PTT.S122959
Ilja L Kruglikov, Uwe Wollina

The structure and physiological state of the local white adipose tissue (WAT) located underneath the lesional psoriatic skin and inside of the joints affected by psoriatic arthritis play an important role in the pathophysiology of these diseases. WAT pads associated with inflammatory sites in psoriasis and psoriatic arthritis are, correspondingly, dermal WAT and articular adipose tissue; these pads demonstrate inflammatory phenotypes in both diseases. Such local WAT inflammation could be the primary effect in the pathophysiology of psoriasis leading to the modification of the local expression of adipokines, a change in the structure of the basement membrane and the release of keratinocytes with consequent epidermal hyperproliferation during psoriasis. Similar articular adipose tissue inflammation can lead to the induction of structural modifications and synovial inflammation in the joints of patients with psoriatic arthritis.

银屑病皮损下和银屑病关节炎关节内局部白色脂肪组织(WAT)的结构和生理状态在银屑病的病理生理中起重要作用。与银屑病和银屑病关节炎炎症部位相关的WAT垫相应地是真皮WAT和关节脂肪组织;这些垫在两种疾病中都表现出炎症表型。这种局部WAT炎症可能是银屑病病理生理的主要作用,导致银屑病期间局部脂肪因子表达的改变,基底膜结构的改变和角化细胞的释放,从而导致表皮增生。类似的关节脂肪组织炎症可导致银屑病关节炎患者关节结构改变和滑膜炎症的诱导。
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引用次数: 15
The metabolomics of psoriatic disease. 银屑病代谢组学。
Pub Date : 2017-01-01 Epub Date: 2017-01-31 DOI: 10.2147/PTT.S118348
Di Yan, Ladan Afifi, Caleb Jeon, Megha Trivedi, Hsin Wen Chang, Kristina Lee, Wilson Liao

Metabolomics is an emerging new "omics" field involving the systematic analysis of the metabolites in a biologic system. These metabolites provide a molecular snapshot of cellular activity and are thus important for understanding the functional changes in metabolic pathways that drive disease. Recently, metabolomics has been used to study the local and systemic metabolic changes in psoriasis and its cardiometabolic comorbidities. Such studies have revealed novel insights into disease pathogenesis and suggest new biochemical signatures that may be used as a marker of psoriatic disease. This review will discuss common strategies in metabolomics analysis, current findings in the metabolomics of psoriasis, and emerging trends in psoriatic metabolomics.

代谢组学是一个新兴的 "全息 "领域,涉及对生物系统中代谢物的系统分析。这些代谢物提供了细胞活动的分子快照,因此对于了解驱动疾病的代谢途径的功能变化非常重要。最近,代谢组学被用于研究银屑病及其心脏代谢合并症的局部和全身代谢变化。这些研究揭示了疾病发病机制的新见解,并提出了可用作银屑病标志物的新生化特征。本综述将讨论代谢组学分析的常见策略、银屑病代谢组学的最新发现以及银屑病代谢组学的新趋势。
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引用次数: 0
Excimer laser for the treatment of psoriasis: safety, efficacy, and patient acceptability. 准分子激光治疗牛皮癣:安全性、有效性和患者可接受性。
Pub Date : 2016-12-12 eCollection Date: 2016-01-01 DOI: 10.2147/PTT.S105047
Michael Abrouk, Ethan Levin, Merrick Brodsky, Jessica R Gandy, Mio Nakamura, Tian Hao Zhu, Benjamin Farahnik, John Koo, Tina Bhutani

Introduction: The 308 nm excimer laser is a widely used device throughout the field of dermatology for many diseases including psoriasis. Although the laser has demonstrated clinical efficacy, there is a lack of literature outlining the safety, efficacy, and patient acceptability of the excimer laser.

Methods: A literature search on PubMed was used with combinations of the terms "excimer", "excimer laser", "308 nm", "psoriasis", "protocol", "safety", "efficacy", acceptability", "side effects", and "dose". The search results were included if they contained information pertaining to excimer laser and psoriasis treatment and description of the safety, efficacy, and patient acceptability of the treatment.

Results: The 308 nm excimer laser is generally safe and well tolerated with minimal side effects including erythema, blistering, and pigmentary changes. It has a range of efficacies depending on the protocol used with several different treatment protocols, including the induration protocol, the minimal erythema dose protocol, and the newer minimal blistering dose protocol.

Conclusion: Although the excimer laser is not a first-line treatment, it remains an excellent treatment option for psoriasis patients and has been demonstrated to be an effective treatment with little to no side effects.

308 nm准分子激光器是一种广泛应用于包括牛皮癣在内的许多皮肤病领域的设备。虽然激光已经证明了临床疗效,但缺乏文献概述准分子激光的安全性,有效性和患者可接受性。方法:结合准分子、准分子激光、308 nm、牛皮癣、方案、安全性、有效性、可接受性、副作用、剂量等关键词,在PubMed检索文献。如果搜索结果包含与准分子激光和牛皮癣治疗有关的信息,以及对治疗的安全性、有效性和患者可接受性的描述,则纳入搜索结果。结果:308 nm准分子激光通常是安全的,耐受性良好,副作用很小,包括红斑、水泡和色素改变。根据不同的治疗方案,包括硬化方案、最小红斑剂量方案和较新的最小起泡剂量方案,它具有一系列的疗效。结论:准分子激光虽然不是银屑病的一线治疗方法,但它仍然是银屑病患者的一个很好的治疗选择,并且已被证明是一种有效的治疗方法,几乎没有副作用。
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引用次数: 13
Tacrolimus for the management of psoriasis: clinical utility and place in therapy. 他克莫司治疗牛皮癣:临床应用和治疗的位置。
Pub Date : 2016-12-07 eCollection Date: 2016-01-01 DOI: 10.2147/PTT.S101233
Nina Malecic, Helen Young

Psoriasis affects 1%-3% of the population in the United Kingdom and can convey significant detriment to the physical and mental health of sufferers. Plaques of psoriasis typically affect the extensor skin surfaces and scalp. Less frequently inverse psoriasis can affect more sensitive skin such as the face, genitals, and intertriginous areas. Psoriasis is incurable, but there are a range of treatment modalities that can be used to manage the condition. Treatment options include topical preparations, phototherapy, systemic therapy, and biological agents. Tacrolimus is a macrolide calcineurin inhibitor licensed for immunosuppression in transplant patients and topical administration in atopic dermatitis. Tacrolimus administered orally and in topical form has been shown to produce successful outcomes in patients with psoriasis. Topical tacrolimus is particularly effective for inverse psoriasis, which is likely to be due to the reduced level of induration seen in these psoriatic lesions, which allows greater skin penetrance, compared with hyperkeratotic plaques of psoriasis on the body. It is also notable that the areas affected by inverse psoriasis are more susceptible to adverse effects of topical corticosteroid therapy, and thus a topical preparation without the risk of skin atrophy, telangiectasia, and striae could be a valuable addition to current topical treatment options. Oral tacrolimus has shown efficacy in the treatment of severe, refractory psoriasis. Compared to ciclosporin, systemic tacrolimus may be more suited to a patient population with increased cardiovascular risk. This review will draw together the current literature on topical and oral tacrolimus for the treatment of psoriasis. Efficacy and safety have been evaluated by case reports and randomized controlled trials and comparisons have been made between tacrolimus therapy and standard treatment.

牛皮癣影响了英国1%-3%的人口,并可能对患者的身心健康造成严重损害。银屑病斑块通常影响伸肌皮肤表面和头皮。不太常见的逆型牛皮癣可影响更敏感的皮肤,如面部、生殖器和三节间区。牛皮癣是无法治愈的,但是有一系列的治疗方法可以用来控制病情。治疗方案包括局部制剂、光疗、全身治疗和生物制剂。他克莫司是一种大环内酯类钙调磷酸酶抑制剂,被许可用于移植患者的免疫抑制和局部治疗特应性皮炎。口服和局部形式的他克莫司已被证明对牛皮癣患者产生成功的结果。局部他克莫司对逆型银屑病特别有效,这可能是由于在这些银屑病病变中看到的硬结水平降低,与体内银屑病的角化过度斑块相比,这允许更大的皮肤外显性。值得注意的是,受逆型银屑病影响的区域更容易受到外用皮质类固醇治疗的不良影响,因此,一种没有皮肤萎缩、毛细血管扩张和条纹风险的外用制剂可能是当前外用治疗方案的一个有价值的补充。口服他克莫司对治疗严重难治性银屑病有疗效。与环孢素相比,全身性他克莫司可能更适合心血管风险增加的患者群体。本综述将汇集目前关于局部和口服他克莫司治疗牛皮癣的文献。通过病例报告和随机对照试验对疗效和安全性进行了评估,并对他克莫司治疗和标准治疗进行了比较。
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引用次数: 41
Psoriasis in children. 儿童牛皮癣。
Pub Date : 2016-10-20 eCollection Date: 2016-01-01 DOI: 10.2147/PTT.S87650
Roxanne Pinson, Bahman Sotoodian, Loretta Fiorillo

The clinical presentation, disease associations, and diverse treatment modalities in overcoming the challenges of managing pediatric psoriasis have been extensively summarized in this article. An extensive literature review revealed the differences in presentation of psoriasis during infancy, childhood, and adolescence. We also summarized the latest topical, systemic, and biological modalities in treating recalcitrant psoriasis. The association of psoriasis with juvenile arthritis and obesity and the significant influence of the disease on the children's quality of life were explored. The clinical presentation of psoriasis can evolve during the child's lifespan. While many treatment modalities already exist for treating pediatric psoriasis, some of the new biologics that are approved for adult patients have not been investigated in the pediatric population and no algorithm exists for their use in this population. Large clinical studies in the future will enhance our understanding with regards to their safety and potential implications in pediatric populations.

本文对小儿牛皮癣的临床表现、疾病关联以及克服治疗挑战的多种治疗方式进行了广泛的总结。一项广泛的文献综述揭示了牛皮癣在婴儿期、儿童期和青春期表现的差异。我们还总结了治疗顽固性银屑病的最新局部、全身和生物方法。探讨银屑病与青少年关节炎和肥胖的关系及其对儿童生活质量的显著影响。牛皮癣的临床表现可以在儿童的一生中发展。虽然已有许多治疗小儿牛皮癣的方法,但一些批准用于成人患者的新生物制剂尚未在儿科人群中进行研究,也没有适用于该人群的算法。未来的大型临床研究将增强我们对其安全性和对儿科人群潜在影响的理解。
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引用次数: 34
Herpes zoster in psoriasis patients undergoing treatment with biological agents: prevalence, impact, and management challenges. 接受生物制剂治疗的银屑病患者的带状疱疹:患病率、影响和管理挑战。
IF 5.2 Q1 DERMATOLOGY Pub Date : 2016-10-18 eCollection Date: 2016-01-01 DOI: 10.2147/PTT.S102202
Lara El Hayderi, Fany Colson, Bita Dezfoulian, Arjen F Nikkels

As TNF-α is a major factor in the immune defense against herpes zoster (HZ); an increased incidence and severity of HZ cases were suspected in patients undergoing treatment with TNF antagonists. Several studies and clinical experience provided evidence that the incidence of HZ increases by twofold to threefold in this patient category. The number of severe cases of HZ, with multisegmental, disseminated cutaneous, and/or systemic involvement, is also increased. Concerning psoriasis patients under biologicals, the clinician should be more alert for an eventual HZ event, in particular during the first year of biological treatment, and be aware of the possibility of more severe HZ cases. HZ may also undergo an age-shift toward younger patients. Rapid identification of risk factors for severe HZ, such as severe prodromal pains and/or the presence of satellite lesions, is recommended. The treatment recommendations of HZ in this patient group are identical to the recently published guidelines for the management of HZ. The live attenuated viral vaccine OKA/Merck strain anti-HZ vaccination is recommended before initiating biological treatment in psoriasis patients. The new adjuvanted anti-HZ vaccine will probably also benefit patients while on biological treatment.

由于TNF-α是抵抗带状疱疹(HZ)免疫防御的主要因素;在接受TNF拮抗剂治疗的患者中怀疑HZ病例的发生率和严重程度增加。几项研究和临床经验提供了证据,证明在这类患者中,HZ的发病率增加了两到三倍。伴有多节段、播散性皮肤和/或全身受累的重型HZ病例数量也有所增加。对于接受生物制剂治疗的银屑病患者,临床医生应该对最终的HZ事件更加警惕,特别是在生物治疗的第一年,并意识到可能出现更严重的HZ病例。HZ也可能经历向年轻患者的年龄转变。建议快速识别严重HZ的危险因素,如严重前驱疼痛和/或卫星病变的存在。HZ在该患者组中的治疗建议与最近发布的HZ管理指南相同。在银屑病患者开始生物治疗之前,建议接种OKA/Merck株抗HZ减毒活疫苗。新的佐剂抗HZ疫苗可能也会使正在接受生物治疗的患者受益。
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引用次数: 0
Pustular psoriasis: pathophysiology and current treatment perspectives. 脓疱型银屑病:病理生理学与当前治疗展望。
Pub Date : 2016-09-12 eCollection Date: 2016-01-01 DOI: 10.2147/PTT.S98954
Katie E Benjegerdes, Kimberly Hyde, Dario Kivelevitch, Bobbak Mansouri

Psoriasis vulgaris is a chronic inflammatory disease that classically affects skin and joints and is associated with numerous comorbidities. There are several clinical subtypes of psoriasis including the uncommon pustular variants, which are subdivided into generalized and localized forms. Generalized forms of pustular psoriasis include acute generalized pustular psoriasis, pustular psoriasis of pregnancy, and infantile and juvenile pustular psoriasis. Localized forms include acrodermatitis continua of Hallopeau and palmoplantar pustular psoriasis. These subtypes vary in their presentations, but all have similar histopathologic characteristics. The immunopathogenesis of each entity remains to be fully elucidated and some debate exists as to whether these inflammatory pustular dermatoses should be classified as entities distinct from psoriasis vulgaris. Due to the rarity of these conditions and the questionable link to the common, plaque-type psoriasis, numerous therapies have shown variable results and most entities remain difficult to treat. With increasing knowledge of the pathogenesis of these variants of pustular psoriasis, the development and use of biologic and other immunomodulatory therapies holds promise for the future of successfully treating pustular variants of psoriasis.

寻常型银屑病是一种慢性炎症性疾病,主要影响皮肤和关节,并伴有多种并发症。银屑病有多种临床亚型,包括不常见的脓疱型银屑病,又分为泛发性和局部性两种。泛发性脓疱型银屑病包括急性泛发性脓疱型银屑病、妊娠期脓疱型银屑病以及婴幼儿脓疱型银屑病。局部型脓疱型银屑病包括连续性哈洛波皮炎和掌跖脓疱型银屑病。这些亚型的表现各不相同,但都具有相似的组织病理学特征。每种亚型的免疫发病机制仍有待完全阐明,对于是否应将这些炎症性脓疱性皮肤病归类为有别于寻常型银屑病的亚型还存在一些争议。由于这些病症十分罕见,而且与常见的斑块型银屑病之间的联系值得商榷,因此许多疗法的效果不一,大多数病症仍然难以治疗。随着人们对这些脓疱型银屑病变体的发病机理认识的加深,生物疗法和其他免疫调节疗法的开发和使用为成功治疗脓疱型银屑病变体带来了希望。
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引用次数: 0
Psoriasis patients' experiences concerning medical adherence to treatment with topical corticosteroids. 银屑病患者对局部皮质类固醇治疗的依从性的经验。
Pub Date : 2016-08-23 eCollection Date: 2016-01-01 DOI: 10.2147/PTT.S109557
Mathias Tiedemann Svendsen, Klaus Ejner Andersen, Flemming Andersen, Jakob Hansen, Anton Pottegård, Helle Johannessen

Nonadherence to topical treatment of psoriasis is a common cause of treatment failure. This focus group study was conducted to obtain the patients' own experiences and explanations regarding medical adherence. The participants consisted of eight primary adherent patients with moderate psoriasis treated with corticosteroid or corticosteroid-calcipotriol combinations, purposefully sampled by age and sex at a dermatology outpatient clinic. Secondary medical adherence was supported by accessibility of the prescribing physician, the prescriber taking time to listen, having a more manageable disease, using a nonstaining product, and establishing routines around treatment at home. Secondary medical adherence was affected negatively by changes in daily routines, if the treatment influenced the patient's sexual life, having too little time in the consultation room, lack of confidence in the prescriber, diverging information from health care personnel, experiencing side effects, having fear of side effects, impractical formulations of topical products, and impatience regarding time before an effect of the treatment was observed. From this study, the recommendations for the prescribing doctor to improve medical adherence are, the doctor needs to take time to listen to the patient, prescribe a topical product that is easy to apply and less greasy, inform the patients about benefits from treatments, and explain the rationale behind the treatment plan.

不坚持局部治疗牛皮癣是治疗失败的常见原因。本焦点小组研究是为了获得患者自身的经验和对医疗依从性的解释。参与者包括8名接受皮质类固醇或皮质类固醇-钙化三醇联合治疗的中度牛皮癣患者,有目的地按年龄和性别在皮肤科门诊进行抽样。二级医疗依从性得到了以下方面的支持:开处方的医生的可及性、开处方的医生花时间倾听、疾病更易于控制、使用不染色的产品,以及在家中建立治疗常规。如果治疗影响了患者的性生活,在诊室呆的时间太少,对处方医生缺乏信心,与卫生保健人员的信息不一致,经历副作用,害怕副作用,局部产品的配方不切实际,以及在观察到治疗效果之前对时间缺乏耐心,则日常生活的变化会对二级医疗依从性产生负面影响。从这项研究中,对开处方的医生提高医疗依从性的建议是,医生需要花时间倾听病人的意见,开一种易于使用且不油腻的局部产品,告知病人治疗的好处,并解释治疗计划背后的理由。
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引用次数: 13
期刊
Psoriasis (Auckland, N.Z.)
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