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Psoriasis is a chronic immune-mediated inflammatory disorder affecting both adults and children worldwide, with an average prevalence of approximately 2%. Recent evidence suggests that several hematological inflammatory parameters and vitamin levels may serve as accessible biomarkers for disease activity and severity assessment.Methods
This single-center retrospective case-control study was conducted at Jordan University Hospital using electronic medical record data from January 2019 to December 2023. The study included 142 patients with psoriasis and 277 age- and sex-matched controls. Psoriasis severity was assessed using the Psoriasis Area and Severity Index (PASI). Hematological inflammatory indices-including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII)-as well as vitamin D and vitamin B12 levels were evaluated.Results
The mean age ± standard deviation was 43.76 ± 16.78 years, with no significant differences between psoriasis cases and controls. Females accounted for 54.93% of psoriasis cases compared with 54.41% of controls. The mean PASI score was 9.02 ± 9.00. Approximately 51.79% of psoriasis patients were vitamin D deficient, while 17.82% had vitamin B12 deficiency. No significant differences in psoriasis severity categories were observed across vitamin B12 or vitamin D levels (p = 0.808 and p = 0.184, respectively). The mean NLR, PLR, and SII were 2.21, 124.6, and 588,441.8, respectively. These inflammatory indices did not demonstrate statistically significant differences between psoriasis patients and controls (p > 0.05).Conclusion
No significant associations were observed between psoriasis severity and inflammatory hematological indices (NLR, PLR, SII) or vitamin deficiencies. These findings suggest limited standalone utility of these biomarkers for routine assessment of psoriasis severity in this retrospective cohort.Weiterlesen
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Psoriasis is a non-communicable inflammatory skin disease that affects approximately 2%-3% of the world's population. Given its high impact on quality of life and the fact that a subset of patients exhibits suboptimal or secondary loss of response to current treatments, identifying new therapeutic strategies is crucial. Proliferation-associated protein 2G4 (PA2G4) is a transcription factor that has been exclusively studied in cancer research, where it promotes cell growth and enhances tumourigenesis by inhibiting apoptosis. However, its role in inflammatory skin diseases remains largely unknown.Objectives
This study focused on the pathophysiological and immunological functions of PA2G4 in psoriasis and evaluated its potential as a therapeutic target.Methods
Bulk, single-cell, and spatial RNA sequencing combined with immunohistochemistry were used to assess PA2G4 expression in psoriatic skin compared with that in non-lesional controls. Functional studies were performed in primary human keratinocytes and reconstructed human epidermis (RHE) models using the CRISPR/Cas9-mediated knockout (KO) of PA2G4 and pharmacological inhibition of PA2G4 with the small-molecule WS6. The regulatory effects of PA2G4 on cellular processes, such as proliferation, differentiation, and survival, were investigated using RNA-seq, western blot analysis, scratch assays, and annexin V staining.Results
PA2G4 was highly abundant in psoriasis, and its expression was predominantly restricted to basal proliferating keratinocytes. Its gene expression is positively correlated with psoriasis severity, the degree of acanthosis, neutrophil infiltration, and genes which are upregulated in psoriasis. PA2G4 KO in primary human keratinocytes activated differentiation pathways while suppressing proliferation pathways, resulting in the downregulation of proliferation- and inflammation-related genes (e.g. MKI67, IL20, VEGFA, and HIF1A) and the upregulation of differentiation and cell adhesion markers (e.g. KRT6C, LCE2C, and DSG4). Functionally, the PA2G4 KO reduced keratinocyte proliferation in scratch assays, attenuated interleukin-22-induced acanthosis in RHE models, and promoted keratinocyte death. Pharmacological inhibition of PA2G4 using the small-molecule inhibitor WS6 similarly downregulated genes associated with proliferation and cell survival.Conclusions
PA2G4 could promote keratinocyte hyperproliferation and survival in psoriasis, thereby critically influencing epidermal homeostasis. Therefore, inhibition of PA2G4 may represent a new treatment option for psoriasis.Weiterlesen
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Psoriasis, a chronic inflammatory skin disease affecting 2-3% of the global population, is driven by dysregulated immune responses. Despite advancements in biologic therapies, treatment challenges persist due to high recurrence rates. This study aimed to identify immune-related hub genes and elucidate their clinical implications in psoriasis pathogenesis and therapy.Methods
Multiple microarray datasets from psoriasis patients (GSE30999, GSE106992, GSE14905, GSE78097, and GSE117468) were obtained to identify immune-key genes by differential gene analysis and Weighted Gene Co-expression Network Analysis (WGCNA). Subsequently, immune-related hub genes were identified using the Least Absolute Shrinkage and Selection Operator (LASSO) algorithm and Protein-Protein Interaction (PPI) networks, with further validation through Gene Set Enrichment Analysis (GSEA) and Receiver Operating Characteristic (ROC) curves to assess exploratory within-sample discrimination. Pearson correlation analysis evaluated the relationship between hub genes, skin lesion severity, and treatment outcomes. The study also conducted immune infiltration by using the Cell-type Identification by Estimating Relative Subsets Of RNA Transcripts (CIBERSORT) algorithm and identified potential therapeutic targets by the Drug-Gene Interaction Database (DGIdb).Results
Thirty-one immune-related key genes were identified, and six hub genes (CLEC7A, CXCL1, IRF1, S100A12, S100A8, S100A9) were validated as central players in immune signaling pathways. These genes exhibited within-sample discrimination (AUC > 0.9) and correlated with disease severity and biological therapy efficacy. Immune infiltration analysis revealed increased activated memory CD4+ T cells and M1 macrophages in lesional skin, which was strongly associated with hub gene expression. Additionally, drug-gene interaction analysis identified potential therapeutic agents targeting these genes.Conclusion
This study identified six immune-related hub genes that were closely linked to the severity of psoriasis, the effectiveness of biological treatments, and infiltrated activated memory CD4+ T cells and M1 macrophages. Our findings elucidate a novel immune-related hub gene network in psoriasis and provide potential targets for the development and application of biologics.Weiterlesen
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Evidence-based recommendations for the treatment of patients with psoriatic disease (PsO) and a prior history of malignancy are limited. This study aimed to compare the incidence of newly diagnosed neoplasms among patients with PsO and a previous malignancy receiving treatment with conventional systemic therapies, apremilast, or biologic agents.Patients and methods
Retrospective observational study using TriNetX. PsO patients (ICD10:L40) with a previous diagnosis of cancer (ICD10:C00-D49) less than 5 years prior to systemic therapy initiation were selected. Outcomes evaluated included new documentation of neoplasms and all-cause mortality.Results
Patients under biologic therapy had a significantly lower new neoplasm documentation rate and all-cause mortality compared to classical agents (HR 0.857 and HR 0.705, respectively) and apremilast (HR 0.782 and HR 0.803, respectively) at 3 years follow-up. Only TNFi exhibited a significantly lower new neoplasm rate (HR 0.867, p < 0.0001) compared to classical agents; however, all biologic agents significantly decreased mortality. IL-23i was the only biologic therapy to significantly lower cancer recurrence risk (RR 0.878) compared to TNFi, with no differences in all-cause mortality.Conclusions
Biologic therapy for PsO may represent a safe treatment option in patients with a history of malignancy, compared with conventional systemic therapies or apremilast. Among biologic agents, IL-23 inhibitors appear to be associated with the most favorable safety profile.Weiterlesen
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There is very limited data regarding atlantoaxial instability (AAI) in patients with psoriatic arthritis (axPsA). In this study, we aimed to contribute to the existing literature on this topic.Methods
Adult patients were included in this single-center study who were classified as PsA by the 'CASPAR' criteria and evaluated as having axial involvement according to the 'Calin' criteria. Those with inflammatory or non-inflammatory diseases that could affect the spine were excluded. Electronic patient files were reviewed retrospectively. Lateral neutral/full extension/full flexion and open-mouth anteroposterior cervical radiographs were evaluated by three rheumatologists blinded to the patients. Patients were compared in two groups as AAI-positive and AAI-negative.Results
A total of 100 patients with a mean age of 48.8 years and a mean PsA duration of 7.4 years, 57% of whom were female, were included in the study. A total of 20 AAI lesions were detected in 18% patients; subaxial subluxation was detected in eight, anterior atlantoaxial subluxation (AAS) in seven, posterior AAS in three, lateral AAS in one, and vertical subluxation in one case. In the group with AAI, the presence of psoriasis (Ps) (p = 0.037), scalp psoriasis (p < 0.001), and the use of targeted therapy for Ps and PsA (p < 0.001, p < 0.001) were significantly higher than in the AAI-negative group.Conclusion
Given that Ps and PsA patients on targeted therapy may reflect cases with higher disease activity and inadequate response to conventional treatments, it may be appropriate to consider closer monitoring for AAI in these patients. Key Points • Atlantoaxial instability is present in approximately one-fifth of patients with axial psoriatic arthritis. • The most common instability lesion is subaxial subluxation, accounting for 40% of all lesions. • The presence of psoriasis, scalp psoriasis, and the use of targeted therapies for psoriatic arthritis or psoriasis are significantly more frequent in the group with atlantoaxial instability. These factors may be useful for cervical spine monitoring in patients with axial psoriatic arthritis. • The use of targeted therapies for psoriatic arthritis or psoriasis may indirectly indicate an association between high disease activity and atlantoaxial instability.Weiterlesen
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Lifestyle factors have the potential to enhance well-being and quality of life (QoL). This study aimed to identify lifestyle patterns among UK-based adults with psoriasis and examine associations with QoL.Methods
This was a cross-sectional analysis of the 'Asking People with Psoriasis about Lifestyle and Eating' (APPLE) study (n=353). QoL, Body Mass Index (BMI), and physical activity were assessed using the Dermatology Life Quality Index (DLQI), self-reported weight and height, and the International Physical Activity Questionnaire.Results
Participant demography was: 82% female; mean (SD) age of 41 (13) years; and BMI of 27 (7) kg/m2. When fully adjusted for age, sex, smoking, and alcohol use, compared to individuals in the highest BMI tertile (35 (5) kg/m2), those in the lowest tertile (21 (2) kg/m2) reported a 71% reduced likelihood of QoL impairments (Odds Ratio (OR) = 0.29; 95% CI 0.14-0.59, adjusted P<0.01). Dairy-free, gluten-free, and pescatarian diets were more frequently adopted in individuals reporting healthy BMIs (≈24 kg/m2, adjusted P<0.05). Higher levels of physical activity (2932 (1509) Metabolic Equivalent of Task Minutes per week), and adequate sleep duration (7 (0) hours/day) were associated with lower odds of QoL impairments, although attenuated by multiple testing. Participants affected by embarrassment or self-consciousness related to their psoriasis engaged in less vigorous-intensity and walking activities compared to those who were less affected (adjusted P<0.05).Conclusions
Assessing weight status and physical activity in individuals reporting high DLQI scores may help identify modifiable behaviours contributing to poorer QoL and thereby shape interventions.Weiterlesen
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This study analyzed the mechanisms of action of Andrographis paniculata (AP), a medicinal plant with diverse pharmacological properties, on psoriasis.Materials and methods
The active components of AP and their corresponding targets were identified. These targets were subsequently intersected with differentially expressed genes (DEGs) and immune-related genes associated with psoriasis. The resulting gene set was subjected to functional enrichment analysis and immune infiltration analysis. The scRNA-seq data were analyzed to delineate the single-cell landscape in psoriasis and cell type-specific expression of genes of interest. Further, the molecular docking and experimental verification were performed for validation.Results
Active components of AP and their targets were predicted. Cross-referencing these targets with psoriasis DEGs revealed 2 feature genes (AR and ITGAL), both exhibiting strong diagnostic potential. The two genes were associated with differentially enriched pathways and immune cell infiltration. Further, scRNA-seq analysis identified 10 cell subclusters. Notably, AR was expressed in reticular fibroblasts of healthy controls, while ITGAL was expressed in T cells of psoriasis samples. Molecular docking confirmed a stable binding interaction between Dehydroandrographolide and AR. In vitro validation using an M5 cytokine-induced keratinocyte model demonstrated that Dehydroandrographolide exerted potent anti-inflammatory and antiproliferative effects. Furthermore, it significantly modulated the protein expression levels of both genes.Discussion
Combining in-silico and in-vitro analyses, this study identified AR and ITGAL as potential key mediators and validated the efficacy of the active component of AP, Dehydroandrographolide, against psoriasis.Conclusion
Collectively, the study demonstrated that AP had the potential anti-psoriasis effects.Weiterlesen
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Psoriasis is a chronic, immune-mediated skin disorder that causes physical, psychological, and social burdens. There is a growing need to better characterize the distinct clinical features and specific treatment needs of elderly patients with psoriasis, which remains an important area for further research to optimize care in this population.Objective
To investigate the clinical characteristics, comorbidities, and treatment preferences of elderly patients with psoriasis vulgaris.Methods
Patients with psoriasis vulgaris were included in this retrospective study. Data on demographics, disease characteristics, including age at diagnosis, body surface area (BSA), Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), comorbidities, and treatment needs were collected. Patients at the visit over 60 years of age were defined as elderly patients. Patients who were diagnosed before 40 years of age were defined as early-onset psoriasis (EOP), and patients who were diagnosed over 40 years of age were defined as late-onset psoriasis (LOP). Continuous variables were compared using t-tests or Mann-Whitney U-tests, categorical variables using Chi-square or Fisher's exact tests. Spearman correlation was used for association analysis. Statistical significance was set at P<0.05.Results
A total of 375 patients were included, comprising 70 (18.67%) elderly and 305 (81.33%) non-elderly patients. The elderly group had a significantly higher proportion of LOP (87.14% vs 48.76%, P<0.05). A higher percentage of elderly patients had moderate-to-severe (27.14% vs 20.98%, P<0.05) and severe (1.43% vs 0.66%, P<0.05) disease. Comorbidities were more prevalent in the elderly, including cardiovascular disease (12.86% vs 3.93%, P<0.05) and diabetes (12.86% vs. 1.31%, P<0.05). Despite this, elderly patients reported lower DLQI scores (median 2.00 vs. 3.00, P<0.05). Regarding treatment needs, elderly patients were less likely to prioritize reducing treatment costs (10.00% vs 20.98%, P<0.05) and preventing disease recurrence (30.00% vs 44.26%, P<0.05) compared to non-elderly patients. Within the elderly cohort, EOP patients exhibited more severe disease (median BSA: 3.00 vs 2.00; median PASI: 3.30 vs 0.80, P<0.05), a higher rate of familial psoriasis (33.33% vs 4.92%, P<0.05), and a greater demand for reducing treatment costs (33.3% vs 6.56%, P<0.05) compared to LOP patients.Conclusion
Elderly patients with psoriasis present a distinct clinical profile characterized by a high prevalence of late-onset disease, a significant comorbidity burden, and differing treatment priorities focused less on cost and recurrence. Despite the increased clinical severity, their perceived quality-of-life impact is lower. Besides, they report higher dissatisfaction linked to unmet needs in itch relief, drug safety, and long-term control. Within the elderly cohort, early-onset patients had more severe disease, stronger familial predisposition, and greater cost-related concerns. The findings highlight the necessity for age-specific, multidimensional management strategies for this population.Weiterlesen
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Cutaneous lupus erythematosus (CLE), particularly discoid lupus erythematosus (DLE), is a chronic autoimmune condition driven in part by type I interferon signaling. No systemic therapies are specifically approved for CLE, and management is often extrapolated from systemic lupus erythematosus. Deucravacitinib, a selective oral tyrosine kinase 2 (TYK2) inhibitor targeting the Janus kinase (JAK)-signal transducer and activator of transcription (STAT) pathway, has shown efficacy in psoriasis and emerging promise in lupus.Case report
We describe a 29-year-old woman with biopsy-proven DLE refractory to prednisone and hydroxychloroquine who subsequently developed moderate-to-severe plaque psoriasis (Psoriasis Area and Severity Index [PASI] 16). Initial treatment with ixekizumab improved psoriasis but failed to control DLE, and psoriatic lesions later relapsed. Therapy was switched to deucravacitinib 6 mg daily. After 9 weeks, marked improvement of both conditions was observed (PASI 0.2) with progressive regression of DLE lesions. By week 27, complete clinical remission of psoriasis (PASI 0) and full resolution of DLE lesions were achieved, confirmed by reflectance confocal microscopy.Conclusion
This case highlights the potential of deucravacitinib as an effective therapeutic option for refractory DLE, particularly in patients with concomitant psoriasis, supporting TYK2 inhibition as a promising targeted strategy in cutaneous autoimmunity.Weiterlesen
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Psoriasis is a chronic inflammatory skin disease that significantly impacts patients' quality of life. Patients with skin of colour (SoC) often face unique barriers related to gaining access to care, diagnosis and treatment, which can contribute to health disparities. The aim of this study was to assess patient-reported experiences across the psoriasis care continuum in Canada, comparing white and non-white populations.Methods
A 15-min online survey was administered between 9 December and 19 December 2022 to patients ≥ 18 years with a confirmed psoriasis diagnosis. The survey included 33 questions covering demographics, medical history, psoriasis experience and access to information. Responses were analysed using t-tests at a 90% confidence level to identify significant differences based on ethnicity, treatment users, gender, psoriasis severity and region.Results
Of approximately 2500 invited participants, 103 met the eligibility criteria: 62 self-identified as white and 41 as non-white. A higher proportion of non-white patients reported severe psoriasis, delays in diagnosis and greater emotional and social burden during the pre-diagnosis stage. Non-white patients were more frequently diagnosed and treated by dermatologists and more commonly used non-topical therapies. Misdiagnosis, often as eczema or dermatitis, was more prevalent among non-white patients. Treatment initiation was more commonly delayed in non-white patients, with 71% reporting difficulty accessing effective therapy, compared to 31% of white patients. A greater proportion of non-white respondents sought additional support and education, especially for mental wellness and advocacy resources.Conclusion
Disparities in psoriasis care are evident across the experience of patients with psoriasis. Among those who participated in the survey, a greater proportion of the non-white patients faced delayed diagnosis, misdiagnosis, and greater barriers to treatment access, often reflecting more severe disease and unmet informational needs. These findings highlight the importance of culturally competent care and inclusive research to ensure equitable outcomes for all patients with psoriasis. Enhanced representation in clinical trials and targeted health interventions are essential to address these disparities.Weiterlesen
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Pediatric psoriasis is a chronic inflammatory skin disease that affects both physical and psychosocial well-being. The impact of the disease extends beyond the patient, significantly affecting caregivers' emotional and functional quality of life.Objectives
This systematic review and meta-analysis aimed to evaluate the health-related quality of life (HrQOL) burden of pediatric psoriasis on children and their caregivers. The study also sought to identify clinical and child-related factors associated with increased impairment in HrQOL.Methods
A systematic search of MEDLINE and Embase databases was conducted according to PRISMA guidelines. Studies included children under 18 years of age with a diagnosis of psoriasis and/or their caregivers, reporting outcomes using validated HrQOL measures. Two reviewers independently screened studies, extracted data, and assessed quality using the Mixed Methods Appraisal Tool. Where appropriate, correlation coefficients were pooled using random-effects meta-analysis after Fisher's Z-transformation.Results
Twenty-one studies were included, encompassing 1038 children and 1161 caregivers. The most commonly used instruments were the Children's Dermatology Life Quality Index (CDLQI) and Family Dermatology Life Quality Index (FDLQI). Across studies, 84.8% of children and 96.1% of caregivers experienced some degree of HrQOL impairment. Meta-analysis revealed a moderate positive correlation between child disease severity (PASI scores) and caregiver HrQOL burden (r = 0.463), while no significant correlation was found with child age or disease duration. Amongst children, HrQOL was most affected in the domains of symptoms, leisure, and treatment-related concerns.Conclusions
Pediatric psoriasis exerts a substantial impact on both child and caregiver quality of life, with greater burden associated with more severe disease. These findings highlight the need for early intervention and psychosocial support targeting families. Clinicians should consider the broader family context when managing pediatric psoriasis and prioritize counseling during disease flares to mitigate emotional and functional strain.Weiterlesen
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Available evidence reveals markedly divergent metabolic signatures across biologics and small-molecule inhibitors, highlighting the need for further investigations.Objective
To address this knowledge gap, we performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies in patients with psoriasis or psoriatic arthritis (PsA) to quantify the short- and long-term effects of targeted therapies on lipid profiles.Evidence review
PubMed, Embase, and Cochrane databases were searched for RCTs and observational studies published through July 25, 2025. Eligible randomized RCTs were evaluated using the Cochrane Risk of Bias tool, while nonrandomized studies were assessed using the Methodological Index for Non-Randomized Studies. All lipid effect estimates were derived from within-group pre-to-post changes in patients with psoriasis or PsA.Findings
Thirty-six articles involving 21,477 patients with psoriasis and 3098 patients with PsA (total 24,575) across seven targets were analyzed. The long-term use of Janus kinase inhibitors (JAKi) significantly increases total cholesterol (TC; weighted mean difference [WMD] = 7.03; 95% confidence interval [CI] = 1.22, 12.84), triglyceride (TG; WMD = 19.98; 95% CI = 13.82, 26.14), high-density lipoprotein cholesterol (HDL-c; WMD = 6.87; 95% CI = 4.38, 9.36), and low-density lipoprotein cholesterol (LDL-c; WMD = 12.37; 95% CI = 7.24, 17.50) levels. Long-term tumor necrosis factor alpha inhibitors (TNFi) significantly lowers TC (WMD = -8.40; 95% CI = -15.21, -1.60), TG (WMD = -15.22; 95% CI = -21.92, -8.51), and LDL-c (WMD = -10.61; 95% CI = -16.77, -4.45) levels while raising HDL-c (WMD = 4.13; 95% CI = 1.23; 7.03) levels. Long-term interleukin-17 A inhibitors significantly increases TG (WMD = 7.31; 95% CI = 3.17, 11.46) levels, whereas IL-23p19 inhibitors yield the opposite effect (WMD = -32.08; 95% CI = -51.87, -12.30).Conclusions and relevance
Our data underscore the need for routine lipid monitoring during TNF-α- and JAK-targeted therapy in patients with psoriasis or PsA. Due to the limitations of our analysis, well-designed prospective trials with extended follow-up periods are warranted to validate and refine these observations.Weiterlesen
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