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Neue Studien
Nail psoriasis (NP) is not an uncommon psoriasis variant whose symptoms have a negative impact on patients' quality of life. Treating NP can be a great challenge for the dermatologist, especially when it is presented as isolated subtype or when it is not associated with psoriatic arthritis (PsA). The available treatments, topical or systemic therapies, have limited efficacy and can be associated with adverse effects (AEs). Topical roflumilast is an FDA-approved treatment for skin plaque-psoriasis in patients aged 6 and above, but there is limited evidence for treating NP. We present outcomes of nail psoriasis not associated with PsA treated with roflumilast 0.3% cream in 7 patients.Methods
A single center, retrospective case series analysis was conducted in a Canadian nail clinic in adult patients with NP refractory to treatment between January 2023 and December 2024. Clinical characteristics (matrix and/or nail bed alterations) were included to calculate the Nail Psoriasis Severity Index (NAPSI) score. Improvement degree was based on NAPSI score reduction. All patients were treated with roflumilast 0.3% cream daily for at least 16 weeks.Results
The case series included 7 patients with NP not associated with PsA. The mean baseline NAPSI score was 19, which decreased to 6.8 after 16 weeks of topical treatment. Roflumilast 0.3% cream was used both as monotherapy and/or in combination with topical steroids or acitretin. Interestingly, all patients reported quality of life improvements, and complete lesion clearance was achieved in almost all patients.Conclusions
Topical roflumilast showed promising results to treat topically NP. In this case series topical roflumilast was effective, well-tolerated and not associated with AEs.Weiterlesen
- 301 Aufrufe
Biologics effectively improve psoriatic skin lesions, but their impact on itch relief remains unclear.Objective
To evaluate itch improvement in severe psoriasis patients treated with ustekinumab or guselkumab.Methods
This retrospective study analyzed patients with severe psoriasis who completed initial efficacy evaluations after treatment with either biologic. Itch severity was assessed using numerical rating scale (NRS), visual analog scale, and verbal rating scale. NRS improvement was evaluated after three injections.Results
Among 108 patients (74 on ustekinumab, 34 on guselkumab), 77 (71.3%) had moderate-to-severe itch (NRS ≥4) at baseline. Of these, 63 (81.8%) achieved an NRS improvement of ≥4 points. Ustekinumab showed greater itch relief compared to guselkumab in NRS (p=0.033). On the other hand, guselkumab showed more reduction for psoriatic skin lesions than ustekinumab in the Psoriasis Area and Severity Index (p=0.040). In the moderate-to-severe itch group, patients with large plaques experienced significantly greater improvement in NRS than those with small plaques (p=0.012).Conclusion
While guselkumab is generally preferred for psoriatic skin lesions, ustekinumab may provide superior itch relief.Weiterlesen
- 308 Aufrufe
This study aimed to evaluate the required test characteristics that a psoriatic arthritis (PsA) biomarker test would need to achieve to be considered cost-effective.Methods
We adapted an existing Markov model to compare a hypothetical biomarker with current practice. The model followed a patient cohort aged 45 years with moderate psoriasis (PsO) in which PsA was prevalent but unrecognized over a 40-year time horizon. Patients were assumed to be routinely seen at a dermatology clinic. In the current practice arm, patients with PsA were clinically detected. In the biomarker arm, a hypothetical test was assumed to be administered at baseline. Patients who screened positive would accept a combination of conventional disease-modifying antirheumatic drugs and targeted treatment to slow disease progression. Progression was modeled as linear changes in Health Assessment Questionnaire (HAQ) scores. We varied the sensitivity, specificity, and biomarker price based on current development progress. Scenario analyses considered alternative patient cohorts with mild and severe PsO separately.Results
The base case showed that a biomarker test with 70 percent sensitivity, 80 percent specificity, and a price of US$500 would be cost-effective (incremental cost-effectiveness ratio US$47,566 per quality-adjusted life-year [QALY]). Three-way analyses showed that a test with 80 percent specificity could be cost-effective at a US$50,000 per QALY threshold with a sensitivity as low as 66 percent at US$500. Only a near-perfect test would be cost-effective at a US$1,000 price point. Results were sensitive to HAQ progression under treatment, therapy costs, and the patient population.Conclusion
This study supports the continued product development of candidate PsA biomarkers.Weiterlesen
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The management of moderate-to-severe psoriasis in patients with concurrent or previous malignancy presents a unique clinical challenge. Despite the transformative impact of biologic therapies on psoriasis treatment, the exclusion of patients with malignancy from clinical trials has led to a paucity of data regarding the safety and efficacy of systemic and biologic agents in this subgroup. Clinicians are thus often compelled to rely on registry data, real-world evidence, and expert opinion when navigating these complex cases.Objectives
To investigate prescribing practices among psoriasis experts for systemic and biologic therapies in patients with severe psoriasis and concomitant malignancy. The study aimed to elucidate trends in decision-making, perceptions of treatment risks, and adherence to multidisciplinary approaches.Methods
An electronic survey was disseminated to 141 members of the International Psoriasis Council (IPC) between December 2023 and June 2024. The self-administered questionnaire examined respondents' demographics, guideline familiarity, and preferences for systemic and biologic therapies across five malignancy types (breast cancer, melanoma, prostate cancer, lymphoma, and metastatic renal cell carcinoma) at varying remission intervals. Data were analysed descriptively.Results
Fifty-seven IPC councillors completed the survey (40%). Anti-IL-17 agents were the most commonly selected therapies across all malignancy scenarios for patients in remission, reflecting growing confidence in their safety profiles. For active malignancies, apremilast was the most frequently chosen agent, particularly for breast cancer (61%), melanoma (56%), and metastatic renal cell carcinoma (49%). Tumour necrosis factor-alpha (TNF-α) inhibitors and fumaric acid esters were the least frequently selected treatments for active malignancies. The majority of respondents (70%) believed current guidelines lacked clarity on treating psoriasis in the context of malignancy. Nearly half (49%) reported always consulting oncology teams before initiating systemic therapy for patients with recent malignancy diagnoses, underscoring the importance of a multidisciplinary approach.Conclusions
This study highlights significant variability in prescribing practices and a strong preference for biologics such as anti-IL-17 agents and apremilast. The findings underscore the urgent need for malignancy-specific guidelines informed by robust long-term safety data to support optimal decision-making and improve patient outcomes.Weiterlesen
- 185 Aufrufe
Mucosal lichen planus (LP) is a chronic inflammatory disease. The patient's journey can be arduous as diagnosis and therapy are challenging.Patients and methods
In this cross-sectional study, a wide range of characteristics of the patient's journey were assessed and evaluated from a total of 72 patients with mucosal LP who were treated in the dermatology departments of six German university medical centers between 02/2022 and 07/2023.Results
On average, 18.1 months elapsed between the onset of symptoms and diagnosis. Until the correct diagnosis was made, an average of 3.1 different physicians of the same or different specialties were consulted. 28.1% of patients also had cutaneous involvement. Therapeutically, 68% of patients received at least one systemic drug. Both topical (90%, 65/72) and systemic (oral, 50% of patients, 36/72; intravenous, 33%, 24/72) glucocorticoids were most frequently used. Systemic agents were most often discontinued due to ineffectiveness (46%, 50/110). Satisfaction with treatment was highest for intravenous and topical glucocorticoids (moderate to high satisfaction: 59% and 36%, respectively), and lowest for retinoids with 8%.Conclusions
This study indicates that there might be a lack of diagnostic awareness among physicians and the unmet need for effective systemic treatment options.Weiterlesen
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Psoriasis vulgaris is a common chronic inflammatory skin disease, associated with multiple cardiovascular comorbidities, which can ultimately lead to increased mortality. Dermatological rehabilitation programs represent an additional therapeutic option in patients with psoriasis besides the classical outpatient or inpatient management. This study aimed to investigate the impact of dermatological rehabilitation on cardiovascular risk factors, cardiorespiratory fitness and quality of life at the Clinic of Dermatology, Bad Bentheim, Germany.Patients and methods
This prospective study included 105 patients (age > 18 years) with known psoriasis and/or psoriasis (pustulosa) palmoplantaris committing to a 3-week long rehabilitation program. Various patient reported outcomes including dermatological life and quality index, patient global assessment, physical activity, pruritus and smoking and alcohol consumption history were captured. Body mass index (BMI) and physical fitness were also assessed. Study parameters were collected by telephone at baseline, at discharge, and at 3 and 6 months.Results
Significant improvements in cardiorespiratory fitness (p < 0.001), BMI (p < 0.001), quality of life (p < 0.001), patients subjective estimation of disease severity (p < 0.001) and psoriasis area and severity index (p < 0.001) were shown.Conclusions
The findings emphasize the importance of a rehabilitation program for patients with psoriasis due to its positive and sustained effects on cardiovascular risk factors.Weiterlesen
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Up to 30% of psoriasis (PsO) is clinically associated with psoriatic arthritis (PsA). A large proportion of new onset of PsA is diagnosed at a later stage, despite the necessity of early effective treatment to prevent structural damage. This study aimed to identify the routine screening practices used for PsA in patients with PsO.Patients and methods
This non-interventional, prospective, epidemiological, cross-sectional study conducted in Germany focuses on screening activity and treatment selection of dermatological practices in suspected PsA. Descriptive statistics and patient characteristics were analyzed for different center types.Results
One hundred ninety-five patients from 34 office-based physicians, five non-university hospitals, and nine university hospitals were included. Questionnaires or imaging techniques were not routinely used (< 45%). Especially, ultrasounds (≤ 5%) and MRIs (< 6.3%) were rarely performed. Between 30% and 75% of suspected PsA could be confirmed. Referral to rheumatologists and/or appropriate therapy initiation were the most frequent consequences.Conclusions
Results of this study reflect the status of PsA screening activity by dermatologists. Imaging techniques, particularly ultrasound or MRIs to detect early forms of PsA, were inadequately used, which may have contributed to continued underdiagnoses. Collaboration between dermatologists and rheumatologists should be reviewed with a view to improving effective PsA screening.Weiterlesen
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De-escalation strategies of biologics in psoriasis treatment are widespread in clinical practice. Dose spacing consists of de-escalating the time range between biological drug injections.Patients and methods
Major objectives were: to describe trends in mean PASI, PASI 100, 90, and ≤ 1 from baseline to 12 months after dose spacing, provide drug survival analysis of dose-spaced regimens, and concurrently describe phenotypic characteristics related to the selection of patient candidates for therapeutic dose spacing. A pre-post analysis was made between mean PASI at dose spacing and baseline, and after 3, 6, 9, and 12 months following dose spacing.Results
Of 1,144 patients treated with IL-23 or IL-17 inhibitors, 61 patients underwent dose spacing. They presented with lower mean baseline Body Mass Index (BMI) (p = 0.011) and PASI (Psoriasis Area Severity Index) (p = 0.044) and were more frequently bio-experienced (p = 0.033). 12 months after dose spacing 42.9%, 85.7%, and 92.9% of observed patients achieved PASI 100, 90, and ≤1. There were no significant differences in mean PASI between dose spacing and subsequent time points. The dose spacing survival was 70% at 1 year.Conclusions
Therapeutic modulation, such as dose spacing, is an effective strategy for most psoriasis patients, resulting in a clear or almost clear skin response that is maintained over time.Weiterlesen
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Generalized pustular psoriasis (GPP) is a rare, chronic, potentially life-threatening skin disease. We aimed to establish criteria to accurately approximate GPP prevalence in Germany.Methods
A retrospective analysis of the WIG2 health claims database (1/1/2016-31/12/2020) was conducted. Patients aged ≥ 12 years continuously enrolled in their statutory health insurance with one inpatient or confirmed outpatient diagnosis code for GPP (International Classification of Diseases, 10th Revision [ICD-10] L40.1) were included. Scenarios with increasingly strict criteria were used to identify the GPP population.Results
From 2016-2020, 5,236 potential GPP cases were identified based on a recorded GPP diagnosis. The scenario of ≥ 1 GPP diagnosis yielded the highest prevalence (336-390 patients/million) followed by > 1 GPP diagnosis in ≥ 2 quarters (189-288 patients/million); scenarios resulting in the lowest prevalence were diagnosis in ≥ 2 quarters AND two independent diagnoses (17-28/million) and diagnosis in ≥ 2 quarters AND two independent diagnoses or diagnosis by a specialist AND potential flare (58-61 patients/million).Conclusions
This study suggests that diagnosis in ≥ 2 quarters by a specialist or two independent physicians may be the most clinically robust and reliable criteria for estimating GPP prevalence; therefore, 50-100 patients/million may represent a reasonable prevalence estimate range for Germany.Weiterlesen
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