The Journal of dermatology最新文献

Generalized pustular psoriasis is a rare but severe form of psoriasis, accounting for 7.5% of all psoriasis cases. We investigated whether the disease burden and quality of life of patients with generalized pustular psoriasis were lower than those of patients with psoriasis vulgaris in Japan. Patients registered in the Western Japan Psoriasis Registry, a prospective cohort of patients with psoriasis treated at 31 facilities specializing in psoriasis medicine, were surveyed using the SF-36v2 and other patient-reported outcomes. We enrolled patients with generalized pustular psoriasis (n = 97) and psoriasis vulgaris (n = 1065). The generalized pustular psoriasis group had fewer males, were younger at onset, had fewer smokers and habitual drinkers, and were more frequently treated with biologics than patients with psoriasis vulgaris. Questions on disease burden revealed that patients with generalized pustular psoriasis experienced sores, blisters, skin pain, and systemic symptoms more frequently than patients with psoriasis vulgaris. A higher proportion of patients with generalized pustular psoriasis had joint pain and fatigue than those with psoriasis vulgaris, although patient satisfaction with treatment did not differ significantly between the two groups. The Short Form-36 evaluation revealed that patients with generalized pustular psoriasis had significantly lower physical component summary scores than patients with psoriasis vulgaris. These findings indicate that patients with generalized pustular psoriasis have a higher burden and more impaired quality of life than patients with psoriasis vulgaris.

Palmoplantar pustulosis (PPP) is a chronic, debilitating skin disease of the palms and/or soles. We report the efficacy and safety of risankizumab (RZB), an interleukin 23 p19 inhibitor, from the JumPPP study (a phase 3, multicenter, randomized, placebo-controlled, double-blind study to evaluate RZB in adult Japanese sUbjects with Moderate-to-severe PalmoPlantar Pustulosis; NCT04451720). Patients were randomized 1:1 to receive RZB (150 mg) or placebo at weeks 0 and 4; all patients received RZB from week 16 to week 52 (patients initially randomized to RZB) or week 56 (patients initially randomized to placebo). The primary end point was a Palmoplantar Pustulosis Area and Severity Index (PPPASI) change from baseline; secondary end points were ≥50%/≥75% improvement in PPPASI (PPPASI 50/75) at week 16. Efficacy and safety were evaluated to 68 and 76 weeks, respectively. In total, 119 patients (RZB, n = 61; placebo, n = 58) were enrolled. Greater improvement with RZB versus placebo was demonstrated by the significant difference in PPPASI change from baseline at week 16 (least squares mean treatment difference, -3.48; p < 0.05). At week 16, a greater proportion of patients receiving RZB vs placebo achieved PPPASI 50 (41.0% vs 24.1%; nominal p < 0.05) but not PPPASI 75 (13.1% vs 15.5%; nominal p = 0.74). Improvements generally continued through to week 68. The safety profile was generally consistent with previous studies of RZB in psoriasis. RZB demonstrated efficacy over placebo at week 16 in Japanese patients with PPP, with improvements sustained through to week 68, and was well tolerated with no unexpected safety findings.

During the COVID-19 pandemic, the daily life of many patients with dermatological immune-mediated inflammatory diseases (DIMIDs), such as atopic dermatitis (AD), psoriasis, and vitiligo, was impacted by social restrictions caused by (fear of) morbidity, mortality associated with COVID-19, and vaccine hesitancy. This prospective observational, multicenter, multidisciplinary cohort study explored the impact of COVID-19 disease and vaccination on DIMIDs, specifically AD, psoriasis, and vitiligo. Data from patients with DIMIDs were collected as part of the Target2B! study (between February 2021 and October 2022). We analyzed the differences in baseline characteristics, risk of developing COVID-19, proportion of DIMIDs in patients reaching seroconversion upon vaccination per DIMID, and self-reported increase in DIMID activity by multivariable logistic regression and sensitivity analyses. A total of 424 patients with DIMID were included. COVID-19 disease commonly occurred in patients with vitiligo (51.1%), AD (42.0%), and psoriasis (34.3%) (p = 0.038). COVID-19 was not associated with the use of immunosuppressive therapy. Three patients (two with AD and one with vitiligo) were hospitalized due to COVID-19. Nearly all patients with DIMIDs exhibited effective seroconversion after regular vaccination regimens (vitiligo 100%, psoriasis 97.9%, AD 96.5%). Increased DIMID activity after COVID-19 (6.6%) or severe acute respiratory syndrome-related coronavirus (SARS-CoV-2) vaccination (12.26%) was reported in a minority of patients, with baseline progressive disease (disease activity 3 months preceding baseline survey) being the only associated risk factor (COVID-19: odds ratio [OR], 4.27 [p = 0.02]; vaccination OR, 3.45 [p = 0.002]). In conclusion, no alarming signs were shown in this study regarding (severe) COVID-19 in patients with AD, psoriasis, or vitiligo. Vaccination against COVID-19 is advised in patients with DIMIDs. Moreover, patients with DIMIDs can safely continue their immunosuppressant therapy, since this does not increase the risk of COVID-19, while vaccination-induced humoral responses are adequate. In only a minority of patients, increased DIMID activity after COVID-19 or SARS-CoV-2 vaccination occurred.

Granulocyte and monocyte adsorptive apheresis (GMA) selectively removes activated granulocytes and monocytes from the peripheral blood. In 2012, GMA was approved in Japan as a treatment for generalized pustular psoriasis and localized pustular psoriasis or palmoplantar pustulosis (PPP). Limited evidence from case reports and monocentric studies suggested that GMA is an effective treatment for skin and joint symptoms of PPP with pustulotic arthro-osteitis (PAO). The present, prospective, observational study was performed at three dermatology departments in Japan to evaluate the efficacy and safety of GMA in patients with PPP with PAO. Between April 2017 and December 2020, two male and 12 female patients with PPP and PAO were enrolled. Their mean age, mean duration of skin manifestations, and mean duration of PAO symptoms was 52.8 years, 51.2 months, and 44.9 months, respectively. GMA was applied weekly over five sessions. The skin and joint symptoms were assessed at baseline, post-GMA, and at the 3-month follow-up. A total of 12 patients completed five GMA sessions, and two patients discontinued the treatment because of adverse events. Thus, 12 patients were finally assessed post-GMA, and 10 patients were assessed at the 3-month follow-up. The assessment of GMA efficacy demonstrated that the skin symptoms had remarkably improved and improved in 33.3% (4/12) and 70% (7/10) of the patients post-GMA and at the 3-month follow-up, respectively. Furthermore, the joint symptoms had remarkably improved in 66.7% (8/12) and 60% (6/10) of the patients post-GMA and at the 3-month follow-up, respectively. These results suggest that GMA is effective in treating the skin and joint symptoms of PPP with PAO.