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Neue Studien
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Mental illness stigma is widely examined in healthcare, yet less is known about its intersections with the stigma of chronic physical conditions in shaping distinct forms of disadvantage. Here, we investigate whether patients with concurrent mental and physical health conditions are perceived and treated differently by prospective medical doctors.Methods
Using a mixed-methods design, preclinical medical students (N = 463) evaluated clinical vignettes describing patients with single (i.e., mental or physical chronic disease) and multiple health conditions (i.e., concurrent mental and physical conditions). We assessed emotional reactions, attributions of disease aetiology, caregiving attitudes and meta-beliefs about patients' disclosure behaviour. Participants were also asked to report as accurately as possible on symptoms presented by each patient in the vignette.Results
Findings revealed that stigmatized conditions were associated with higher levels of caregiving discomfort, greater disease disclosure reticence and lower levels of symptom recall accuracy. Compared with patients with single conditions, those with concurrent mental and physical illnesses were less likely to receive care, were attributed a lesser tendency to conceal their conditions and had their symptoms recalled less accurately.Conclusions
Results indicate that when mental and physical illnesses intersect, patients with multiple stigmatized conditions may be differentially perceived in the eyes of medical students and may become (in)visible targets of discrimination in a healthcare setting. We discuss implications for enhancing awareness of social determinants of health and disease for a more representative, responsive and inclusive healthcare curriculum and practice.Weiterlesen
- 37 Aufrufe
Selecting the most appropriate therapy for psoriasis remains challenging due to variability in disease severity and individual patient factors. Among non-biological treatments, methotrexate (MTX), apremilast (APRE), and narrowband UVB (NB-UVB) phototherapy are widely utilized.Objective
To compare, under real-world conditions, the clinical efficacy, quality of life, patient satisfaction, and immunomodulatory effects of APRE, MTX, and NB-UVB in moderate-to-severe plaque psoriasis over 16 weeks.Methods
This pilot prospective observational cohort study included 37 patients treated independently with APRE (n = 13), MTX (n = 15), or NB-UVB (n = 9). Clinical outcomes were assessed using PASI, BSA, PGA, DLQI scores, and the TSQM-9 questionnaire. Systemic and local inflammation were assessed by multiplex cytokine assays and RT-PCR in vivo and in vitro.Results
By Week 16, significant improvements were observed in PASI, DLQI, and PGA scores across all groups, with no statistically significant differences in efficacy between treatments. A trend toward a greater response was observed for both MTX and APRE. APRE treatment demonstrated a tendency for more pronounced modulation of pro-inflammatory cytokines compared to both MTX and NB-UVB. NB-UVB increased the anti-inflammatory IL-10. Combination therapy with NB-UVB and APRE further increased IL-10 levels and reduced IL-33 in HaCaT cells, suggesting synergistic immunomodulatory effects; however, the clinical relevance of these in vitro findings remains unproven and requires further investigation.Conclusion
APRE, MTX, and NB-UVB each improved clinical outcomes with comparable overall efficacy and good tolerability in this pilot cohort. Each therapeutic regime showed distinct immunomodulatory profiles with good tolerability. Personalized treatment strategies, including potential combinations, may optimize outcomes for patients with moderate-to-severe psoriasis.Weiterlesen
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To assess the real-world efficacy and safety of tildrakizumab in Chinese patients with psoriasis stratified by age, age of psoriasis onset and MetS status.Methods
This two-center retrospective cohort study evaluated tildrakizumab's efficacy and safety over 28 weeks in 80 Chinese adults with moderate-to-severe plaque psoriasis, with subgroup analyses by age and age of psoriasis onset and metabolic syndrome (MetS).Results
Mean PASI scores showed progressive improvement, declining from 9.3 ± 5.1 at baseline to 1.0 ± 1.4 at week 28 (p < 0.001). A high proportion of patients responded by week 16 (78.4% achieving PASI ≤ 3; 48.6% PASI ≤ 1), with further improvement at week 28 (88.6% and 62.0%, respectively). Dermatology Life Quality Index (DLQI) scores paralleled clinical gains, decreasing from 7.7 ± 4.6 to 0.9 ± 1.8 (p < 0.001), reflecting an 88.3% reduction in quality-of-life impairment. Geriatric patients showed superior PASI 100 responses (81.8% vs 38.6%, p < 0.001) while late-onset patients also represented higher PASI 90 responses (81.5% vs 55.8%, p = 0.027) at week 28. The MetS status did not affect therapeutic response (PASI 100 response: 52.6% vs 45.5%, p = 0.622) at week 28. Safety monitoring identified 4 (5.0%) treatment-emergent adverse events, with no treatment discontinuation for psoriasis exacerbation.Conclusion
Tildrakizumab demonstrated sustained efficacy in real-world management of moderate-to-severe psoriasis and supported broad applicability across diverse psoriasis subtypes.Weiterlesen
- 36 Aufrufe
Psoriasis is a chronic, immune-mediated skin disease that significantly affects patients' quality of life. Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, has emerged as a promising treatment for moderate to severe psoriasis, offering an alternative to biologics with a favorable safety profile. This study analyzes global research trends, key contributors, and emerging focus areas concerning apremilast in the treatment of psoriasis.Patients and methods
Publications related to apremilast and psoriasis from 2008 to 2024 were retrieved from the Web of Science Core Collection (WoSCC). Bibliometric and visual analyses were performed using tools such as VOSviewer, CiteSpace, and R 4.3.3.Results
A total of 437 publications on apremilast and psoriasis were identified. The United States led with 158 publications, followed by Japan with 39 and Italy with 33. Celgene Corporation was the most productive institution, contributing 96 articles. The top journals include Journal of Dermatology, Journal of the European Academy of Dermatology and Venereology, and Journal of the American Academy of Dermatology. Key researchers, such as Shinichi Imafuku and Bruce Strober, were identified as leading contributors. Burst analysis revealed that since 2020, keywords like "monotherapy", "nail psoriasis", and "pathogenesis" have gained prominence, indicating emerging research areas.Conclusion
This bibliometric analysis demonstrates that research on Apremilast for psoriasis has evolved from clinical trials focused on efficacy and safety to broader applications in real-world settings, including nail psoriasis and pathogenesis. Future research is likely to concentrate on long-term outcomes, optimizing treatment regimens, and addressing unmet needs in psoriasis management, particularly among specific patient subgroups.Weiterlesen
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Individuals with psoriatic arthritis (PsA) and plaque-type psoriasis and nail involvement have more severe disease and worse quality of life than those without. Bimekizumab is a monoclonal IgG1 antibody that selectively inhibits interleukin (IL)-17F in addition to IL-17A. Here, we assess 52-week efficacy and safety of bimekizumab in individuals with PsA who had baseline plaque-type psoriasis (≥ 3% body surface area) and nail involvement (modified Nail Psoriasis Severity Index [mNAPSI] > 0).Methods
We conducted a post hoc analysis of BE OPTIMAL (NCT03895203; biologic disease-modifying antirheumatic drug [biologic]-naïve patients) and BE COMPLETE/BE VITAL open-label extension (NCT03896581/NCT04009499; patients with prior inadequate response/intolerance to tumour necrosis factor inhibitors [TNFi-IR]). Participants were randomised to subcutaneously administered bimekizumab 160 mg every 4 weeks (Q4W), placebo or reference arm (adalimumab 40 mg Q2W; BE OPTIMAL only). At week 16, placebo-randomised participants switched to bimekizumab (PBO/BKZ). Participants who completed BE COMPLETE week 16 could enter BE VITAL. Efficacy and safety data are reported by study to week 52. Efficacy outcomes included American College of Rheumatology ≥ 50% improvement (ACR50), Psoriasis Area and Severity Index 100% improvement (PASI100) and nail psoriasis resolution (mNAPSI = 0).Results
Overall, 263 (placebo n = 88; bimekizumab n = 133; reference [adalimumab] n = 42) biologic-naïve and 159 (placebo n = 54; bimekizumab n = 105) TNFi-IR participants had baseline plaque-type psoriasis and nail involvement. In bimekizumab-randomised participants with baseline plaque-type psoriasis and nail involvement, improvements in the proportion of participants achieving efficacy responses across disease domains were sustained from week 16 to week 52, including ACR50 (65.4% biologic-naïve; 61.0% TNFi-IR), PASI100 (60.9%; 63.8%), and mNAPSI = 0 (68.4%; 70.5%). PBO/BKZ switchers demonstrated improvements from week 16 to week 52 after receiving 36 weeks of bimekizumab treatment, for ACR50 (63.6% biologic-naïve; 51.9% TNFi-IR), PASI100 (64.8%; 57.4%), and mNAPSI = 0 (73.9%; 63.0%). To week 52, exposure-adjusted incidence rates/100 patient years for ≥ 1 treatment-emergent adverse event in all bimekizumab-treated (≥ 1 dose) participants with baseline plaque-type psoriasis and nail involvement were 181.1 (biologic-naïve) and 99.2 (TNFi-IR).Conclusions
Bimekizumab treatment resulted in consistent, sustained efficacy to 52 weeks in biologic-naïve and TNFi-IR individuals with PsA and baseline plaque-type psoriasis and nail involvement. Bimekizumab was well tolerated, with a safety profile consistent with previous reports. Graphical abstract available for this article.Trial registration
BE OPTIMAL: NCT03895203; BE COMPLETE: NCT03896581; BE VITAL: NCT04009499 (ClinicalTrials.gov).Weiterlesen
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Psoriasis is an erythema papulosquamous dermatosis that cannot be cured at present. Pithecellobium clypearia Benth. belonging to the Leguminosae family and is clinically used as a treatment for gastroenteritis, acute tonsillitis, acute pharyngitis, and upper respiratory tract infections. Our previous studies have found that P. clypearia can improve imiquimod (IMQ)-induced psoriasis in mice and have revealed some differential metabolites and pathways using metabolomics methods. However, the underlying molecular mechanisms remain obscure. The purpose of this study is to investigate the therapeutic mechanism of the anti-psoriatic effects of P. clypearia using transcriptomics technology.Methods
The psoriasis model was induced in male Balb/c mice by applying IMQ on their backs. To identify the differentially expressed genes (DEGs) among groups, RNA sequencing was employed. DEGs were analyzed using Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, and protein-protein interaction (PPI) network analysis. Furthermore, quantitative real-time PCR (qPCR) was employed for validation of these results.Results
A total of 26 DEGs were identified, with several enriched pathways, including the MAPK signaling pathway, unfolded proteins response, hedgehog signaling pathways, NADH dehydrogenase activity, oxidative phosphorylation. Additionally, PPI network analysis revealed that gene Hspa1a was connected with Hspa1b, Bcl2 and GzmA, and Asns was related to Trib3, Slc7a5 and Chac1, and mt-Nd4l was correlated with mt-Nd5 and mt-Nd6. The RNA-seq results were concordant with the qPCR results.Conclusions
P. clypearia may ameliorate inflammation in psoriasis mice by modulating genes such as Hspa1a, Hspa1b, mt-Nd4l, mt-Nd5, mt-Nd6, Bcl2, Asns, Trib3, and associated pathways related to energy metabolism, cell growth, and apoptosis. Our study explored the underlying molecular mechanisms at the transcriptome level and provided a theoretical basis for further investigation into the efficacy of P. clypearia.Weiterlesen
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Psoriasis is a chronic inflammatory skin disease often accompanied by various comorbidities, but its relationship with frailty remains understudied. The Frailty Index (FI), calculated based on 49 health deficits across multiple systems (e.g., cognition, function, comorbidities, laboratory values) was used as a continuous measure.Objectives
We investigated the association between psoriasis and the Frailty Index (FI), providing evidence to support the implementation of frailty screening and potential interventions in patients with psoriasis.Design and setting
This cross-sectional study used data from the 2003-2006 U.S. National Health and Nutrition Examination Survey (NHANES) including 6532 participants.Measurements
We analyzed the psoriasis-FI relationship using weighted nested regression, supplemented by subgroup analyses and restricted cubic spline regression to test for nonlinear relationships.Results
The FI was significantly higher in patients with psoriasis (n = 162) than in those without (n = 6370; P < 0.001). Weighted nested regression analysis showed a significant positive association between FI and psoriasis (OR 2.22; 95% CI 1.14-4.35; P = 0.02). The association was stronger for male patients, those with normal body mass index, hypertension, and diabetes. Nonlinear relationships were observed between FI and psoriasis.Conclusions
The present study validates the association between psoriasis and frailty using a nationally representative sample and provides empirical support for integrating frailty evaluations into psoriasis care. Our findings are consistent with the hypothesis that chronic inflammatory pathways may underlie the association between psoriasis and frailty.Weiterlesen
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Psoriasis can result in reduced quality of life, work productivity loss, and a significant restriction in non-professional activities. This study investigates the effects of long-term treatment with adalimumab regarding work ability, non-professional activities, and health-related quality of life in a large real-word population in Germany.Patients and methods
Single-arm, multicenter non-interventional study to document routine care data for up to 5 years in adult patients with psoriasis after initiation of adalimumab.Results
Baseline data was collected for 4,793 (62.1 % male) patients with a mean (± SD) age of 47.5 ± 13.11 years. The number of days with restrictions in non-professional activities was much higher than in professional activities. Under adalimumab, the psoriasis-related number of days unfit for work and number of days with restrictions in non-professional activities significantly decreased. Correlation analyses showed that psoriatic arthritis, disease severity (PASI > 10), and impairment of quality of life (DLQI > 10) are associated with restrictions in non-professional activities. Health-related quality of life improved over the observed time but remained reduced in patients with restrictions in non-professional activities.Conclusions
Long-term treatment with adalimumab had a favorable impact on clinical outcomes, employment-related aspects, practice of non-professional activities, and health-related quality of life in psoriasis patients.Weiterlesen
- 52 Aufrufe
Preventive tuberculosis (TB) therapy before initiating MTX or IL-17/IL-23/IL-12/23p40 inhibitors for latent tuberculosis infection (LTBI) is supported by indirect evidence of TB reactivations with TNF inhibitors. However, direct evidence for MTX or IL-17/IL-23/IL-12/23p40 inhibitors is limited. To better evaluate the risk of TB reactivation, data on LTBI patients exposed to these medications without preventive TB therapy are necessary. This study was conducted as part of the update of the European and German psoriasis guidelines aimed to assess current LTBI screening and preventive treatment practices.Patients and methods
An online survey was distributed via German, European and international dermatological societies, yielding 326 complete responses.Results
LTBI screening was performed by 45% of respondents before MTX initiation and 95% before IL-17/IL-23/IL-12/23p40 inhibitors. Preventive TB therapy was initiated "always" or "almost always" in 38% of MTX cases and "never" or "almost never" in 31%. For IL-17/IL-23/IL-12/23p40 inhibitors, preventive TB therapy was used in 66% of cases "always" or "almost always," 16% case-by-case and 9% "never" or "almost never."Conclusions
LTBI screening and preventive TB therapy for MTX lack standardization. While screening is common for IL-17/IL-23/IL-12/23p40 inhibitors, a significant proportion of LTBI patients receive these treatments without preventive TB therapy.Weiterlesen
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Sacroiliac joint (SIJ) pain accounts for a large portion of low back pain within the population. Management for this SIJ pain consists of many non-invasive treatments including physical therapy, nerve ablation, intra-articular SIJ injections, bracing, and manipulative therapy. Pain that proves to be resistant to these modalities has previously been considered for surgical stabilization through a transiliac approach, which involves placement of screws.Aims
To describe the anterior extrusion of a SIJ implant following arthrodesis, which is a unique complication of a minimally invasive SIJ fusion via the posterior approach.Materials and methods
A 52 year old female with a past medical history of psoriatic arthritis and alanto-axial instability presented with a year-long history of bilateral lower back and right-sided posterior thigh and buttock pain. Evaluation included lumbar MRI and pelvic CT. Based on these findings, she underwent minimally invasive posterior SIJ fusion using the LinQ allograft. Her symptoms and response to treatment were documented throughout her clinic follow-ups.Results
Imaging revealed degenerative SIJ changes. She subsequently underwent several rounds of SIJ steroid injections. Due to continued pain, she opted to have a minimally invasive SIJ fusion via the posterior approach, first on the right side and then on the left side. After several months of persistent, reaggravated SIJ pain, a repeat pelvic CT showed anterior extrusion of the right SIJ allograft.Discussion
More recently, multiple minimally invasive techniques for SIJ fusions have been developed, one of them being posterior insertion of an orthobiologic implant. Minimally invasive SIJ fusion has been shown to provide pain relief and decrease disability. Posterior implant insertion to partially fuse the SIJ carries minimal risk of complications, one of which is posterior dislodgment of the implant. However, anterior extrusion of the implant has not, to our knowledge, been described or reported.Weiterlesen
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Psoriasis can result in reduced quality of life, work productivity loss, and a significant restriction in non-professional activities. This study investigates the effects of long-term treatment with adalimumab regarding work ability, non-professional activities, and health-related quality of life in a large real-word population in Germany.Patients and methods
Single-arm, multicenter non-interventional study to document routine care data for up to 5 years in adult patients with psoriasis after initiation of adalimumab.Results
Baseline data was collected for 4,793 (62.1 % male) patients with a mean (± SD) age of 47.5 ± 13.11 years. The number of days with restrictions in non-professional activities was much higher than in professional activities. Under adalimumab, the psoriasis-related number of days unfit for work and number of days with restrictions in non-professional activities significantly decreased. Correlation analyses showed that psoriatic arthritis, disease severity (PASI > 10), and impairment of quality of life (DLQI > 10) are associated with restrictions in non-professional activities. Health-related quality of life improved over the observed time but remained reduced in patients with restrictions in non-professional activities.Conclusions
Long-term treatment with adalimumab had a favorable impact on clinical outcomes, employment-related aspects, practice of non-professional activities, and health-related quality of life in psoriasis patients.Weiterlesen
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Accumulating evidence supports the association between altered salivary microbiota and inflammatory diseases. The existing literature on the salivary microbiota in patients with psoriasis is limited. However, differences in the prevalence of Candida species and abundance of several bacterial taxa in saliva have been found between patients and controls. This study aimed to investigate the differences in the composition and functional potential of salivary microbiota in patients with psoriasis compared to their cohabiting partners and healthy controls.Patients and methods
Samples from 115 of 123 individuals qualified for statistical analysis: patients with psoriasis who did not receive systemic anti-psoriatic treatment (n=47); cohabiting partners (n=21); and age-, sex-, and BMI-matched healthy controls (n=47). One saliva sample was collected from each participant and analysed by shotgun metagenomic sequencing.Results
A difference in the α-diversity of bacterial species was observed exclusively between patients and controls, with a lower diversity in patients (p=0.041). Variation in bacterial composition (β-diversity) was influenced by smoking (p=0.001) and diet (p=0.025) but not by group status. Using a linear regression model adjusted for smoking and diet, we identified four bacterial classes and five species that were significantly different between the patient, partner, and control groups. One Kyoto Encyclopedia of Genes and Genomes module differed significantly between patients with psoriasis and their partners. No differences in Candida species or abundance were found among the three groups.Conclusion
Comparison of salivary microbiota at the levels of bacterial diversity, composition, and predicted function indicated that psoriasis cases are characterised by dysbiosis.Weiterlesen
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Background
Psoriasis is a chronic skin disease mediated by Th1 and Th17 immune responses and is classified as a systemic inflammatory disorder. Notably, psoriasis is an independent risk factor for myocardial infarction, stroke, and cardiovascular mortality, particularly in severe disease. However, the cellular mechanisms linking psoriasis to cardiovascular disease risk have not yet been identified. To address this gap, we investigated systemic markers of inflammasome signaling and innate immune activation in patients with psoriasis. Methods
Whole blood was collected from 43 patients, including active psoriasis (mild-to-moderate disease) without clinical manifestations of atherosclerosis, inactive psoriasis (minimal disease activity), patients receiving anti-TNF-α therapy, and 19 BMI-matched healthy controls. Multiparametric spectral flow cytometry was performed to profile inflammasome signaling, and mass spectrometry-based proteomics was used to obtain unbiased phenotyping of circulating immune cells. Results
Classical monocytes from patients with active psoriasis exhibited heightened NLRP3 protein expression and caspase-1 activity upon brief physiological stimulation, responses absent in inactive psoriasis and healthy controls. Mechanistically, active psoriasis demonstrated elevated plasma ATP and increased monocyte expression of P2X7R, a potent NLRP3 activator. TNF-α was identified as a key cytokine, selectively upregulating both P2X7R and NLRP3. Baseline proteomics revealed enriched pathways for monocyte extravasation and cell adhesion, suggesting a pro-thrombotic state. Stimulation increased proteins linked to ROS and mitochondrial stress. Monocytes from active psoriasis exhibited increased baseline activation and, upon stimulation, enhanced monocyte-platelet aggregation, both of which were attenuated by inhibition of mitochondrial ROS. Importantly, anti-TNF therapy normalized ATP levels, P2X7R expression, inflammasome responsiveness, monocyte activation, and monocyte-platelet interactions, supporting the restoration of systemic immune homeostasis. Conclusions
In patients with mild-to-moderate psoriasis, we demonstrate persistent systemic stress, resulting in inflammasome hyperreactivity and increased monocyte-platelet aggregation in response to minor perturbations in cellular homeostasis. Notably, TNF-α blockade restores these effects, providing mechanistic insight into how anti-TNF therapy reduces systemic inflammation and cardiovascular risk. What is already known about this topic?
Psoriasis is a systemic, immune-mediated skin disease that is associated with an increased risk of cardiovascular disease (CVD), particularly in severe disease. The NLRP3 inflammasome, an innate immune sensor, has been implicated in the pathogenesis of CVD. Anti-TNF therapy, which is effective in treating psoriasis, is proposed to reduce CVD risk, but the underlying mechanisms remain unclear. What does this study add?
Patients with mild-to-moderate psoriasis without clinical manifestations of atherosclerosis demonstrate elevated plasma ATP levels, increased monocyte P2X7 receptor expression, and enriched pathways for monocyte activation and extravasation, suggesting persistent systemic stress. Monocytes from these patients display ROS-dependent hyperactivation of the NLRP3 inflammasome and increased formation of monocyte-platelet aggregates in response to minor perturbations in cellular homeostasis. TNF-α was identified as a key cytokine, selectively upregulating both P2X7R and NLRP3. Anti-TNF therapy normalized these aberrant immune responses, suggesting a mechanism for its proposed cardioprotective effects. Novelty and significance
This study provides evidence that patients with mild to moderate psoriasis, without clinical manifestations of atherosclerosis, exhibit concurrent elevations in plasma ATP levels, monocyte P2X7 receptor expression, inflammasome responsiveness, and monocyte-platelet aggregates: features increasingly associated with CVD risk. These findings suggest that dysregulated purinergic signaling may contribute to systemic immune activation in psoriasis. Importantly, anti-TNF therapy was associated with normalization of these parameters, pointing toward a potential immunomodulatory mechanism by which such treatment may help reduce CVD risk. These observations highlight a novel intersection between inflammation, purinergic signaling, and monocyte-platelet activation, which may contribute to the increased CVD risk in psoriasis.Weiterlesen
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This study evaluated psoriasis treatment teaching in dermatology residency programs across Latin America (LATAM).Methods
A Spanish/Portuguese survey was distributed to directors of dermatology departments/training programs and their residents in several LATAM countries between November 29, 2022, and March 31, 2023.Results
A total of 108 individuals responded (59 directors and 49 residents) from eight countries: Argentina (2.8%), Brazil (41.7%), Chile (25.0%), Colombia (7.4%), Guatemala (1.9%), Mexico (1.9%), Paraguay (4.6%), and Peru (14.8%). Most directors reported that residents received training in complex medical dermatology (89.8%), immunodermatology (66.1%), and phototherapy (78%). Most residents reported familiarity with national guidelines (81.6%) and adherence to local guidelines (85.7%). In Brazil, 91% of programs had at least seven faculty members, 97% required national specialization exams, and 91% treated more than 31 psoriasis patients per week, compared with 48%, 36%, and 67% in other LATAM countries, respectively. Additionally, 47% of centers in Brazil reported that at least 26% of psoriasis patients received biological therapy, compared with only 8% in other LATAM countries.Conclusion
Dermatology residents in LATAM are trained in complex dermatology, immunodermatology, and phototherapy and national psoriasis guidelines. Variation exists in patient volume and biologics use. A focus on improving residents' psoriasis training throughout LATAM is needed.Weiterlesen
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