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Langerhans cells (LCs) play a crucial role in sensing and processing stimuli from the skin and the external environment. They are implicated in various skin disorders, acting either as pro-inflammatory agents or as regulatory elements. However, the exact function of LCs in the pathogenesis of psoriasis remains unclear. Psoriasis is characterized by a significant Th17/Treg immune imbalance. To elucidate the independent effect of Treg dysfunction on psoriatic inflammation, we established a Treg-inhibited psoriasis group using the Foxp3 inhibitor CMD178, in conjunction with LC depletion models to investigate the LC-Th17/Treg regulatory axis METHODS: Psoriasis models were established through the topical application of IMQ. Female C57BL/6 N mice were divided into three groups: control, IMQ-induced psoriasis, and Treg-depleted psoriasis. LCswere depleted using diphtheria toxin in Langerin-DTR mice, while Tregs were inhibited by CMD178. Inflammation was assessed through measurements of ear thickness, histopathology, apoptosis, and cytokine production. Additionally, RT-qPCR was utilized to detect the expression of S100A7, S100A8, and MMP2. Flow cytometry was employed to analyze the functional status of lymphocytes and T cell phenotypes.Results
IMQ-induced psoriasis-like lesions exhibit activated LCs, an increase in Th17 cells, a decrease in Tregs, elevated levels of IL-17A and IL-22, and reduced levels of TGF-β and PD-L1. Depletion of LCs alleviated the lesions and restored the Th17/Treg balance, whereas depletion of Tregs exacerbated the inflammation.Conclusion
LCs play a central regulatory role in the psoriatic skin environment by influencing the Th17/Treg.Weiterlesen
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While dietary factors are known to be associated with the development and progression of psoriasis, their effect on treatment efficacy remains unclear. Therefore, this study aimed to elucidate the influence of tea consumption, sugar drinks, and high-fat foods on the treatment response in psoriasis.Patients and methods
We undertook a prospective cohort study comprising 559 patients with psoriasis from Shanghai Skin Disease Hospital between 2022 and 2024. Data on demographics, lifestyle (including tea, sugary drinks, and high-fat food consumption), and disease severity (PASI, BSA, PGA) were collected via structured questionnaires at baseline, week 4, and week 8. The primary endpoints were the proportions of patients achieving PASI 50 responses at week 8. Multivariable logistic regression was used to estimate odds ratios with 95% confidence intervals, adjusting for age, sex, BMI, smoking, alcohol, and treatment regimen. Data were analyzed using SAS 9.4 software.Results
In the psoriasis cohort (mean age 48.5 years; 73.2% male), 37.1% and 68.7% of patients consumed sugar drinks and high-fat foods ≥2 times/week, respectively. Frequent sugar drinks consumption (≥4 times/week) was independently associated with significantly reduced odds of achieving PASI 50 (adjusted OR=0.24, 95% CI: 0.08-0.75) and PASI 75 (adjusted OR=0.27, 95% CI: 0.07-1.00) at week 8. Moderate intake of high-fat foods (2-3 times/week) showed an inverse, borderline significant association with PASI 50 at week 4 (adjusted OR=0.68, 95% CI: 0.45-1.00). Tea consumption showed a non-significant association with treatment response (e.g, week 8 PASI 50 adjusted OR=1.44, 95% CI: 0.88-2.35), warranting further investigation in larger cohorts.Conclusion
This study demonstrates that high consumption of sugar drinks and high-fat foods is associated with suboptimal treatment response in psoriasis. Tea consumption was not significantly associated with treatment outcomes, although further investigation with larger cohorts may be warranted. These findings highlight the importance of integrating dietary assessment and counseling into comprehensive psoriasis management.Weiterlesen
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Emerging evidence suggests the involvement of the renin-angiotensin system (RAS) in the pathogenesis and progression of autoimmune dermatological diseases. In a small exploratory study, we investigated angiotensin-converting enzyme (ACE) activity in blood obtained from male probands with psoriasis vulgaris (n = 4) and atopic dermatitis (AD, n = 5).Methods
The degradation capacity of dabsylated synthetic bradykinin (DBK) with and without inhibition was determined using a thin-layer chromatography (TLC)-based neuropeptide reporter assay.Results
We observed a significantly reduced capacity for cleavage of DBK in psoriasis patients compared with that in AD patients and controls. In patient samples, the variation in the measured values was generally greater than that in healthy controls. We could not confirm the increased ACE activity in the circulation in psoriasis patients reported by others, likely because of different study designs and detection methods. We did not include samples of female patients and focused on younger men to avoid hormonal effects and minimize age-related factors.Conclusion
This preliminary study of the hypothesis-generating nature lacks power, but it certainly adds a question to the current view of the role of ACE in psoriasis. Treatments targeting specific components of the RAS could ameliorate inflammatory responses; thus, research in this area is becoming increasingly important.Weiterlesen
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Xiegan-Liangxue-Jiedu decoction (XLJD) is an ethnopharmacological empirical prescription inherited from Gu's Surgery, a national intangible cultural heritage of Chinese ethnomedicine. Developed based on the classic TCM theory of Liver governing emotion, XLJD has been clinically used for centuries to treat psoriasis (PsO) via the principle of the TCM principle of "treating PsO from the Liver perspective", and has shown favorable efficacy in alleviating psychiatric comorbidities in psoriasis (PCP) by soothing the Liver and relieving emotional discomfort.Aim of the study
To determine the therapeutic efficacy of XLJD and its potential mechanisms of action in PCP mice, and to reveal the modern pharmacological mechanism of the TCM theory of Liver governing emotion in the treatment of PCP.Materials and methods
Mass spectrometry were used to elucidate XLJD's phytochemical profile and blood-absorbed components. The murine PCP model was established by exposure to CUMS and imiquimod. The efficacy of treating PsO was evaluated using PASI, HE staining, lymphocyte proliferation levels, cytokine levels, etc. Mental disorders were evaluated using the open field, elevated plus maze, and tail suspension tests. RNA-seq was performed to detect transcriptional changes in skin tissues, while lipidomics was applied to analyze serum lipids. Key genes and protein were validated using qPCR and Western-blotting, respectively. Acid sphingomyelinase (ASM) and M1/M2 microglia in the hippocampus were determined via immunofluorescence staining.Results
Among the 142 compounds identified in XLJD, 21 were detected in the blood. XLJD significantly alleviated the severity of PsO-related indicators in PCP mice while ameliorating behavioral abnormalities and mitigating HPA axis hyperactivity. XLJD downregulated the transcription of genes involved in lipid metabolism and ameliorated abnormal sphingolipid (SP) metabolism. It inhibited lesions mediated by sphingosine-1-phosphate signaling in lesioned skin. In the hippocampus, XLJD reduced the proportion of M1 microglia and exerted potential neuroprotective effects by inhibiting ASM expression and activity.Conclusions
Based on the TCM theory of Liver governing emotion, XLJD alleviated PsO severity and improved associated mental dysfunctions concomitantly in PCP mice by regulating SP metabolism. This study verifies the scientific connotation of the ethnopharmacological principle of treating PsO from the Liver perspective and provides a new ethnopharmacological strategy for the clinical management of PCP.Weiterlesen
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Hyperkeratotic psoriasis is a rare variant that includes forms such as elephantiasis, considered the rarest. It is characterized by thick, persistent plaques, resembling elephant skin, located mainly on the extremities and buttocks. Early detection and appropriate treatment, including systemic therapies, are essential for its management.Clinical case
A 58-year-old male patient presented in 2018 with dermatosis on his forehead, right elbow, and the backs of both hands. He was initially diagnosed with seborrheic dermatitis and chronic lichen simplex and received multiple topical therapies without improvement. In 2024, he developed new, disseminated lesions on his elbows, hands, and both legs, characterized by hyperkeratotic plaques and excoriations. A biopsy confirmed the diagnosis of elephantiasis variant hyperkeratotic psoriasis. Treatment with ustekinumab was initiated, resulting in significant improvement of the lesions.Conclusions
Elephantine psoriasis is a rare and difficult-to-treat variant, with few reported cases, which hinders the standardization of its management. Biologic therapies represent an effective alternative for improving prognosis, reducing complications, and preventing progression to other associated pathologies. Disseminating these cases is essential to expanding knowledge of this variant and optimizing available therapeutic options, for the benefit of patients.Weiterlesen
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Psoriasis is a chronic, inflammatory disease affecting up to 5% of the population. It significantly impacts patients' quality of life. In Africa, data on disease severity remain limited. The aim of this study was to evaluate the prevalence of severe psoriasis among Tunisian patients and to identify factors associated with disease severity and impairment of quality of life.Methods
A cross-sectional study was conducted using data from the Tunisian National Psoriasis registry (PsoTreg) (ClinicalTrials.gov ID: NCT05258838). A total of 1100 patients with psoriasis were included between July 12, 2022, and November 15, 2024. Disease severity and quality-of-life impairment were assessed using the Simplified Psoriasis Index (SPI). Demographic, clinical, and lifestyle data were analyzed to identify factors associated with disease severity and quality-of-life impairment.Results
Moderate-to-severe psoriasis affected 31.9% of patients, with 38.3% experiencing quality-of-life impairment. Multivariate analysis confirmed male gender (odds ratio [OR]: 2.057), psoriatic arthritis (OR: 1.693), and substance use (alcohol OR: 2.759; smoking OR: 1.609) as independent severity predictors. There were gender-specific patterns, with smoking significantly associated with severity in men and obesity with quality-of-life impairment in women.Conclusions
This study, the first multicenter psoriasis registry in North Africa, highlighted the prevalence of moderate-to-severe psoriasis (31.9%). It emphasized a high proportion of patients with quality-of-life impairment (38.3%). Psoriasis severity was associated with smoking in men and obesity in women. These findings suggest a need for gender-tailored lifestyle interventions prioritizing mental health screening in the management of psoriasis patients.Weiterlesen
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In childhood, moderate-to-severe psoriasis often requires systemic treatments such as acitretin, methotrexate, or cyclosporine. This study aimed to explore the feasibility of discontinuing systemic therapy in pediatric patients who achieve remission when receiving these treatments and to identify predictors of sustained remission.Methods
The ACMe cohort study was a retrospective, multicenter, international, real-world study involving children and adolescents with moderate-to-severe psoriasis treated with acitretin, methotrexate, or cyclosporine. Patients who achieved remission and stopped their systemic treatment were monitored for up to 6 months to evaluate the need for further systemic treatment.Results
Of the 433 patients analyzed, 79 (18.2%) discontinued systemic treatment due to remission. Of these, 70 (88.6%) remained off systemic treatment for at least 6 months. Factors predictive of discontinuation due to remission included younger age (9.0 ± 3.5 vs. 10.5 ± 4.1 years, p < 0.001); lower baseline psoriasis severity (PGA: 3.0 ± 0.7 vs. 3.3 ± 0.8; and PASI: 9.3 ± 4.8 vs. 11.1 ± 6.8, p < 0.04); and the presence of non-palmoplantar forms of psoriasis (palmoplantar psoriasis: 5 (6.3%) vs. 58 (16.4%), p = 0.02). No factors were identified that predicted sustained remission at 6 months.Conclusions
These promising results suggest that systemic treatment discontinuation during clinical remission is feasible for pediatric patients with moderate-to-severe psoriasis and is associated with a low risk of early relapse. Prospective studies with long-term follow-up are needed to confirm the durability of remission and to better define criteria for selecting candidates for treatment discontinuation.Weiterlesen
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Switching biologics for psoriasis is common; however, data on switching to alternative treatments after failure of IL-23 inhibitors are limited.Methods
A retrospective analysis was conducted to extract efficacy and drug survival data from the BIOREP registry from January 2015 to June 2025. The analysis included all patients with psoriasis who were switched from an IL-23 inhibitor to an IL-17 inhibitor during this period and had at least one follow-up visit recorded.Results
A total of 102 patients were switched from an IL-23 inhibitor to an IL-17 inhibitor, with 92 (90.2%) of these switches occurring due to insufficient efficacy. In these 92 patients, PASI-75 was achieved in 82.6% after 3 months and in 73.5% after 12 months. Absolute PASI ≤ 1 was achieved by 66.3% of patients after 3 months and 52.9% after 12 months. Patients treated with bimekizumab had the highest probability of meeting both efficacy parameters, particularly an absolute PASI ≤ 1 after 3 months. The overall survival probability was 79.5% after 12 months and 68.1% after 24 months.Conclusion
For patients with an inadequate response to IL-23 inhibitors, switching to IL-17 inhibitors offers adequate efficacy in reaching current therapeutic goals during the first year of treatment.Weiterlesen
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Psoriasis represents a prevalent long-term inflammatory skin condition marked by the dysregulation of immune responses. T cells are integral to the pathogenesis of psoriasis. This study conducted a comprehensive analysis to recognize biomarkers associated with T cell infiltration in psoriasis and to elucidate their underlying molecular mechanisms.Results
Three biomarkers (AKR1B10, C10orf99, and CKS2) demonstrated high sensitivity and specificity in receiver operating characteristic (ROC) curve, and the reliability of the developed nomogram diagnostic model was observed. In addition, gene set enrichment analysis (GSEA) revealed notable enrichment of the biomarkers in the NOD-like receptor signaling pathway and focal adhesion. Immune infiltration analysis indicated elevated levels of activated B cells and CD8 T cells in psoriasis samples, with the biomarkers showing meaningful correlations with the majority of immune cell infiltration statuses. Importantly, preliminary reverse transcription quantitative PCR (RT-qPCR) validation showed increased expression of AKR1B10, C10orf99, and CKS2 in psoriasis tissues, confirmed higher expression of AKR1B10, C10orf99, and CKS2 in psoriasis patients.Conclusion
AKR1B10, C10orf99, and CKS2 may serve as candidate molecules for future mechanistic studies and provide potential diagnostic biomarkers for further investigation of psoriasis-related immune regulation.Weiterlesen
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Pediatric psoriasis may result in significant cumulative life course impairment, and there is comparatively less evidence available than for adult psoriasis.Objective
The aim of this study is to provide an update on the management of pediatric psoriasis, integrating recent immunogenetic and therapeutic advances. It highlights challenges, including clinical heterogeneity, complex differential diagnosis, and limited treatment options, especially in Brazil.Methods
A narrative review was conducted, including studies published in English, Portuguese, and Spanish between 2009 and 2025, retrieved from the United States National Library of Medicine (PubMed), Cochrane Library, and Scientific Electronic Library Online (SciELO). The following descriptors were used: "psoriasis", "child health", "pediatrics", "therapeutics", "comorbidity", and "T-lymphocyte antigen differentiation".Results
Pediatric psoriasis most commonly presents as chronic plaque. Differential diagnoses are broad and include atopic dermatitis and autoimmune diseases. Data about comorbidities, particularly cardiovascular risk, are controversial. Although severe cases are less frequent, they are associated with a substantial impact on quality of life. Conventional therapies include topical corticosteroids, phototherapy, and non-targeted systemic agents such as acitretin, methotrexate, and cyclosporine. Biologic therapies have been approved for pediatric use and demonstrate safety profiles and superior efficacy compared to conventional treatments.Study limitations
Scarcity of pediatric psoriasis guidelines.Conclusions
Despite advances in understanding adult psoriasis, evidence in pediatric populations remains limited, especially in Brazil. Expanding knowledge in pediatric psoriasis is essential to improve diagnosis, optimize treatment strategies, and increase access to innovative therapies, thereby reducing inflammatory burden and cumulative life course impairment.Weiterlesen
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The IL-23/Th17 axis is the cornerstone of psoriasis pathogenesis, but molecular heterogeneity across different ethnicities remains poorly defined.Objective
To comprehensively define the immunological and pathogenic transcriptomic profiles of a Taiwanese psoriasis cohort.Methods
Lesional skin (LS) and non-lesional skin (NL) biopsies from 11 patients with chronic plaque psoriasis and normal skin (N) from 9 healthy controls were analyzed via bulk RNA-sequencing. Differential gene expression (DEG), pathway enrichment (GSEA), and clinical correlations (PASI score) were performed. Serum levels of cytokines were validated via ELISA from all 50 psoriasis patients and 9 healthy controls.Results
Analysis identified 4,694 DEGs in LS vs. N. We confirmed robust Th17 upregulation (IL-17A/C, IL-23A). Unanticipatedly, a profound dual immune dysregulation was identified, involving significant upregulation of Type 2 (Th2) signatures (IL-4R, CCL17, TSLP). The IL-36 family was the most highly activated cytokine axis (IL-36G log2FCH=5.5). Barrier function genes (KRT77, GJB4) were significantly downregulated. Correlation analysis identified IL-36RN and the combination of AREG/CDSN (r ≈ -0.9, p=0.002) as potential severity biomarkers.Limitations
The small sample size and focus on a single ethnic group. Transcriptomic findings represent associations rather than mechanistic evidence of pathogenesis.Conclusion
Taiwanese psoriasis is characterized by a dual Th17/Type 2 endotype and extreme IL-36 activation. This molecular landscape underscores the need for stratified therapeutic strategies in Taiwanese populations.Weiterlesen
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To compare Sámi and non-Sámi patients with psoriatic arthritis (PsA) and evaluate potential differences in treatment and joint damage.Method
A total of 424 adult PsA patients meeting the ClASsification for Psoriatic ARthritis (CASPAR) criteria were recruited from the Norwegian Arthritis Registry and hospitals in northern Norway. A questionnaire from the SAMINOR (a study in regions with Sámi and Norwegian populations) was used to identify Sámi and non-Sámi patients. Demographic and clinical characteristics, joint damage, and disease-modifying anti-rheumatic drug treatment data were compared between the groups. Binary logistic regression was used to adjust for age and gender differences.Results
Sixty Sámi and 364 non-Sámi patients were identified, and the groups were comparable in demographic characteristics and disease activity measurements. Sámi patients experienced more joint damage than non-Sámi patients (42% vs 26%, p = 0.010), and the highest rate was observed among Sámi men (p = 0.005). Sámi patients also had a higher prevalence of arthritis and axial involvement (92% vs 76%, p = 0.007 vs 32% vs 20%, p = 0.033). In addition, Sámi men showed significant underutilization of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) (83% vs 92%, p = 0.031), particularly methotrexate (68% vs 90%, p = 0.002).Conclusion
Sámi PsA patients show higher rates of axial involvement, arthritis, and joint damage than their non-Sámi peers. Furthermore, Sámi patients demonstrate underutilization of csDMARDs. These findings underscore the importance of implementing culturally adapted healthcare strategies to improve treatment outcomes for Sámi patients with PsA.Weiterlesen
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Generalized pustular psoriasis (GPP) is a rare and severe inflammatory disease characterized by widespread pustular eruptions and systemic inflammation.Objective
To evaluate the clinical characteristics and disease burden of patients with GPP in Taiwan using a national claims database.Methods
Patients with GPP and no prior diagnosis of psoriasis vulgaris (PV) who experienced an incident flare between January 1, 2017, and September 30, 2020, were identified from Taiwan's National Health Insurance Database. Clinical characteristics, comorbidities, and treatment patterns were described. Recurrent flare frequency, healthcare resource utilization (HCRU) and costs were compared with those of a propensity score-matched PV cohort at a ratio of up to 1:4. Outpatient-managed flares were classified as moderate, whereas hospitalized flares were classified as severe.Results
A total of 245 patients with GPP were included (mean age 51.3 years; 49.8% male). During follow-up, 1,156 moderate-to-severe flares were identified. Compared with matched patients with PV, patients with GPP had a higher recurrent flare rate (rate ratio 1.14; 95% CI 1.06-1.23). Patients with GPP also had greater HCRU, including more outpatient visits (incidence rate ratio [IRR] 1.03 [95% CI 1.01-1.05]), emergency room visits (IRR 1.33, 95% CI 1.19-1.49), and hospital admissions (IRR 1.69 [1.50-1.91]). Median monthly healthcare costs were approximately twice as high among patients with GPP as among matched patients with PV.Conclusion
Patients with GPP experienced recurrent flares, greater healthcare utilization, and higher healthcare costs than matched patients with PV, underscoring the substantial real-world clinical and economic burden of GPP.Weiterlesen
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