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Leveraging Pixel-wise Embeddings for Segmenting Psoriasis Lesion Areas

Abstract In the context of psoriasis lesion segmentation, traditional methods in image segmentation, including region-based approaches like Mask R-CNN, have shown notable success. However, the problem of segmenting irregular and intricate biological structures such as psoriasis lesions presents significant challenges that cannot be effectively captured by standard bounding box approximations. This paper explores the potential of transforming psoriasis lesion segmentation into pixel labeling tasks, which promise greater efficiency and integration with modern image-to-image networks widely used across various domains. We investigate the limitations of convolutional-based architectures in generating dense pixel embeddings capable of distinguishing individual lesions. Through both theoretical analysis and empirical evidence, we propose a novel approach that leverages semi-convolutional operations. These modifications, which introduce spatially guided pixel embeddings, offer substantial improvements over traditional methods and demonstrate their applicability to the segmentation of complex biological forms. By drawing connections to advanced techniques such as Hough voting and bilateral kernels steered by convolutional networks, we show that these methods significantly enhance the segmentation accuracy of psoriasis lesions, outperforming conventional region-based models like Mask R-CNN in terms of precision and adaptability to irregular shapes.
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  • 420 Aufrufe
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Association Between Alcohol Consumption and Psoriasis: Exploratory Analysis of Crowdsourced Web Search Data in Sweden.

The nature of the relationship between psoriasis and alcohol consumption has been the topic of discussion for many years. Some studies have found that a higher intake of alcohol may be associated with a more severe manifestation of the disease. At the same time, patients with psoriasis often demonstrate elevated levels of alcohol consumption. It has not yet been fully established whether alcohol abuse serves as a trigger for psoriasis or if patients with psoriasis are simultaneously more prone to alcohol abuse. The objective of this study was to employ Google Trends as a tool for crowdsourcing data on a national level to explore the relationship between psoriasis and the consumption of alcohol in Sweden. This study examines crowdsourced web search data related to psoriasis and other skin disease-related search terms (such as utslag [rash]) as well as search interest in different types of alcohol. The analysis covers a 5-year period from 2018 to 2023 in Sweden, focusing on search behavior and correlations across this period. The search behavior regarding psoriasis and alcohol-related search terms showed seasonal variations throughout the year. The relative search volume for psoriasis peaked in February, while alcohol-related searches, particularly Systembolaget and vodka, peaked in December and June. Our statistical analysis revealed relationships between the search interest regarding psoriasis and terms related to alcohol consumption, with disparities between different types of alcohol. The term "psoriasis" was negatively correlated with "Systembolaget" (r=-0.210), "vitt vin" (r=-0.224), and "vodka" (r=-0.220) (all P<.001), while the term "utslag" showed positive correlations with these same alcohol-related terms (r=0.278-0.347; P<.001). Crowdsourced data can offer valuable insights into population-level behavior. The observed negative correlations between psoriasis and alcohol-related searches suggest complex interactions, possibly reflecting reduced disease awareness or care during periods of higher alcohol consumption. The direction and strength of the correlations with psoriasis were not consistent across the different types of alcohol investigated in this study, which poses the question whether the relationship might be influenced by the type of beverage consumed. Further research is warranted to explore underlying mechanisms and validate these findings in clinical populations.Weiterlesen
  • 244 Aufrufe
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Efficacy of risankizumab across GRAPPA domains in psoriatic arthritis: a pooled analysis of patients from the phase 3 KEEPsAKE 1 and 2 studies.

To assess the efficacy of long-term treatment with risankizumab across the updated Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) domains and key related conditions of psoriatic arthritis (PsA). This post hoc analysis primarily used data from the phase 3 KEEPsAKE 1 trial of adult patients with PsA, with data from KEEPsAKE 2 pooled for prespecified outcomes. Outcomes measuring risankizumab efficacy across key GRAPPA-recognised domains of PsA (peripheral arthritis, enthesitis, dactylitis, skin and nail psoriasis, axial disease) and PsA-related conditions such as inflammatory bowel disease (IBD) and uveitis were assessed over 100 weeks of treatment (~2 years). Statistical approaches included non-responder imputation (as-observed with imputation) for categorical variables and mixed-effect model for repeated measures for continuous variables including as-observed measurements at all visits. PsA-related conditions were evaluated via adverse events through 100 weeks. Overall, in KEEPsAKE 1 and KEEPsAKE 2, 412/483 (85.3%) and 181/224 (80.8%) of patients randomised to risankizumab completed treatment to week 100. Risankizumab demonstrated efficacy across all GRAPPA-defined domains through 100 weeks, including swollen and tender joint counts, enthesitis, dactylitis, skin and nail outcomes, and axial disease. In KEEPsAKE 1, 42.4% of patients had achieved a Disease Activity in Psoriatic Arthritis measurement of low disease activity and 62.9% had reached a minimal clinically important difference in pain at week 100. Rates of new onset or flare of IBD and uveitis were low. Treatment with risankizumab provides durable improvement in the signs and symptoms of PsA across all GRAPPA disease domains and related conditions.Weiterlesen
  • 440 Aufrufe
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Trifolirhizin improves the hyperproliferation and excessive inflammatory response in human HaCaT keratinocytes and ameliorates skin lesions in psoriasis-like mouse models.

Keratinocyte hyperproliferation and excessive inflammatory responses are associated with psoriasis pathogenesis. Trifolirhizin has anti-inflammatory and anti-proliferation effects. The purpose of the study was to investigate the role of trifolirhizin in psoriasis-like skin lesions and its molecular mechanism. Imiquimod-induced psoriasis-like mouse models were treated with trifolirhizin. Skin lesions and inflammatory factors were assessed. In vitro, human HaCaT keratinocytes were stimulated by a mixture of interleukin (IL)-1α, IL-17, IL-22, tumor necrosis factor (TNF)-α, and oncostatin M (M5) to establish a psoriatic keratinocyte model. Cell viability and cycle were assessed via CCK-8 assay and flow cytometry. Inflammatory factors, autophagy levels, and AMPK-mTOR pathway activation were detected by western blot. Trifolirhizin dose-dependently inhibited epidermal layer erythema, scaling, and thickening and reduced epidermal thickness and IL-12 level in an imiquimod-induced psoriasis-like mouse model. Trifolirhizin also inhibited cell viability, PCNA expression, and excessive synthesis and secretion of IL-8 and IL-12 in HaCaT keratinocytes induced by M5. Furthermore, the inhibition of autophagy and AMPK-mTOR pathway could be reversed by trifolirhizin in M5-induced HaCaT keratinocytes and skin lesions from imiquimod-mediated psoriasis-like mouse model. The improvement effects of trifolirhizin could be inhibited by the autophagy inhibitor chloroquine. Trifolirhizin up-regulated autophagy through the AMPK-mTOR pathway, improved the hyperproliferation and excessive inflammatory responses of keratinocytes, thus alleviating psoriatic skin lesions. Trifolirhizin may have therapeutic potential in improving the progression of psoriasis.Weiterlesen
  • 420 Aufrufe
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Long-term Safety and Efficacy of Ixekizumab in Patients With Moderate to Severe Psoriasis – a Systematic Review of Randomised Controlled Trials

Abstract Background This systematic review evaluates the efficacy, safety, and tolerability of ixekizumab (IXE), an anti-IL 17A monoclonal antibody, in treating moderate to severe psoriasis. Methods A comprehensive search of PubMed and Scopus using the terms ‘ixekizumab’ and ‘psoriasis’ was conducted. This study was registered in PROSPERO (CRD42024539975) and followed the PRISMA guidelines for reporting systematic reviews. Inclusion criteria encompassed randomised clinical trials assessing the efficacy and safety/tolerability of ixekizumab for moderate-to-severe psoriasis, published from inception until April 2024. Case reports, conference papers, and observational studies were excluded. A total of 5 studies (6 randomised controlled trials) with 4705 participants met the selection criteria out of 1172 search results. The risk of bias was assessed among the selected studies using the RoBViS tool. Results The standardised dosing regimen of ixekizumab demonstrated superior efficacy compared to placebo in improving Psoriasis Area and Severity Index (PASI) from baseline and Static Physician Global Assessment (sPGA) across most of the included studies. No significant difference in efficacy was observed when comparing ixekizumab with ustekinumab in a survey conducted by Reich et al. Most adverse events were mild, although some serious ones were reported. Conclusion Ixekizumab, a monoclonal antibody approved for treating moderate to severe psoriasis, exhibits a superior safety profile comparable to other biologics used in psoriasis. However, its widespread usage in psoriasis is still relatively less than conventional non-selective immunomodulatory agents.
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  • 417 Aufrufe
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Relative sensitivity and preference of indicators in pharmaceutical trials of psoriasis and psoriatic arthritis.

Numerous indicators have been proposed to evaluate the efficacy for randomized clinical trials (RCTs) of psoriasis (Pso) and psoriatic arthritis (PsA), but their comparability and correlation remain unknown. We aim to evaluate the preference and relative sensitivity of the most widely used indicators that report response rate, and to offer guidance for the primary endpoint selection for Pso and PsA trials. We conducted a systematic search, including five databases and four registries, to identify all pharmacological intervention-controlled RCTs. A Bayesian hierarchical linear mixed model was employed to assess relative discriminations and provide a ranking of these indicators. This model, considered the gold standard for sparse and heterogeneous data, was applied to estimate differences between control and intervention groups and assess the preference and relative sensitivity of outcome indicators in Pso and PsA. Altogether, 386 RCTs met our inclusion criteria. We included 9 and 8 commonly used response rate indicators for Pso and PsA trials, respectively, all of which were treated as primary endpoints. We found evidence of significant differences among indicators. PASI 50, PASI 75 and IGA 0,1 proved to be robust indicators for assessing pharmacological efficacy in the majority of RCTs of Pso. Conversely, PASI 125, DIQI 0,1 and NRS-4 were not preferred under different circumstances. Furthermore, PASI 50, PASI 75 and PASI 90 appeared to be highly effective in almost all categories of pharmacological RCTs of PsA. However, due to their extreme sensitivity, it was advisable to use ACR 20 to prevent an overestimation of the therapeutic benefits of interventions. ACR 50, ACR 70 and MDA were less sensitive, but they were supposed to be more cautious in evaluating disease changing. The choice of indicators was slightly influenced by disease severity, intervention type and administration method. The notable efficacy discrimination ability of indicators underscores the importance of flexibility and comprehensiveness in selecting primary outcome(s). Our findings provide practical implications for optimizing indicator selection in future trial design, ensuring better alignment with trial objectives and disease characteristics. PROSPERO number: CRD42022337725.Weiterlesen
  • 407 Aufrufe
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Toward Harmonized Recommendations for Psoriatic Arthritis: A Comparative Viewpoint on Global Guidelines.

Objective
Psoriatic arthritis (PsA) guidelines aim to provide consistent, evidence-based recommendations. Multiple regional guidelines exist, often based on similar evidence but with different methodologies and contexts. Our aim was to compare recent PsA treatment guidelines from the American College of Rheumatology, Group for Research and Assessment of Psoriasis and Psoriatic Arthritis, European Alliance of Associations for Rheumatology, and Pan American League of Associations for Rheumatology, identifying similarities, differences, and opportunities for global harmonization with regional adaptation.Methods
Narrative comparative review of guideline documents published between 2018 and 2024 by major rheumatology societies was performed. Data on methodology, panel composition, treatment domains, pharmacologic recommendations, and update strategies were extracted and synthesized.Results
Guidelines share core principles, including domain-based approaches, treat-to-target strategies, and the use of conventional synthetic disease-modifying antirheumatic drugs and biologics. Differences arise from methodological frameworks (eg, GRADE [Grading of Recommendations Assessment, Development, and Evaluation], domain-based, adolopment), stakeholder composition, and explicit consideration of regional drug access.Conclusion
A hybrid framework combining global core recommendations with modular regional adaptations may optimize resource use, improve guideline sustainability, and maintain local relevance. Living systematic reviews and artificial intelligence could support more timely updates.Weiterlesen
  • 278 Aufrufe
Redaktion

The Skin-Brain Axis in Psoriasis and Depression: Roles of Inflammation, Hormones, Neuroendocrine Pathways, Neuropeptides, and the Microbiome.

Psoriasis, a common chronic inflammatory skin disease affecting approximately 2-3% of the global population, frequently co-occurs with depression. This highly prevalent comorbidity significantly impairs patients' quality of life. Despite the substantial physical and mental health burden imposed by psoriatic depression, the underlying pathophysiological mechanisms connecting psoriasis and depression remain poorly understood. In this review, we explored several pathological processes that may contribute to psoriasis-associated depression, including immune cells dysregulations, hormones imbalances, hypothalamic-pituitary-adrenal (HPA) axis dysfunctions, neuropeptides expression abnormalities, and gut dysbiosis. The primary purpose of this review was to present a comprehensive overview of the pathogenic mechanisms linking psoriasis and depression. These insights may guide trans-disciplinary interventions aimed at both skin and mood symptoms.Weiterlesen
  • 299 Aufrufe
Redaktion

Successful guselkumab treatment for a psoriasis patient experiencing an adrenal crisis: a case report.

Prolonged glucocorticoid therapy may lead to adrenal insufficiency (AI) or even adrenal crisis (AC) due to suppression of the hypothalamic-pituitary-adrenal (HPA) axis. This case report describes a male patient with psoriasis who had received long-term irregular glucocorticoid therapy for psoriasis management. Following an upper respiratory tract infection, the patient developed generalized skin lesions accompanied by systemic symptoms including abdominal pain, vomiting, fatigue, fever, and lethargy. After multiple misdiagnoses, the patient was ultimately diagnosed with psoriasis complicated by AC. The patient was subjected to guselkumab combined with glucocorticoid therapy for the treatment of psoriasis and AC. After 6 months, complete resolution of skin lesions was achieved, and adrenal function returned to normal. Dermatologists should be aware of the potential for AI when prescribing glucocorticoids (topical or systemic) to treat psoriasis. Guselkumab represents a viable therapeutic option for psoriasis patients with concurrent AI/AC.Weiterlesen
  • 276 Aufrufe
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Clinical efficacy of 308 nm excimer laser irradiation combined with 0.1% tacrolimus ointment in the treatment of plaque-type psoriasis.

Plaque psoriasis is an immune-mediated chronic recurrent skin disease. In recent years, 308 nm excimer laser (308 nm EL) and topical tacrolimus have been widely used to treat psoriasis. The purpose of this study was to evaluate the efficacy of 308 nm EL irradiation combined with 0.1% tacrolimus ointment in the treatment of plaque psoriasis. This study was a retrospective observational study involving 100 patients with plaque psoriasis, divided into two groups: the control group (50 cases) was treated with 0.1% tacrolimus ointment; the observation group (50 cases) was treated with 308 nm EL and 0.1% tacrolimus ointment. After eight weeks of treatment, the psoriasis area and severity index (PASI) of the two groups were compared, and the occurrence of adverse reactions during treatment was recorded. Before treatment, there was no significant difference in PASI scores between the two groups (p > 0.05). However, the PASI scores of the two groups were significantly lower after treatment than before treatment, and the PASI scores of the observation group after treatment were lower than those of the control group (p < 0.05). No serious adverse reactions occurred in either group. 308 nm EL irradiation combined with 0.1% tacrolimus ointment could be considered a safe and effective method for the treatment of plaque psoriasis, which can significantly reduce the PASI score and is more effective than the use of 0.1% tacrolimus ointment alone, and it is expected to be popularized in the clinic.Weiterlesen
  • 865 Aufrufe
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Characterising Alternative Diagnoses to Psoriatic Arthritis in a Rheumatology-Dermatology Combined Clinic.

Psoriatic arthritis (PsA) is a chronic inflammatory arthritis involving axial and peripheral joints and tendons that affects a subset of patients with psoriasis (PsO). PsA can be a debilitating disease and warrants prompt rheumatologic evaluation and management. The diagnosis of PsA can be challenging for the practising dermatologist as there is often an overlap in the symptoms of PsA and non-inflammatory musculoskeletal conditions such as osteoarthritis, tendonitis and myofascial pain. The primary aim of the study is to examine psoriasis patients seen at our tertiary institution's combined rheum-derm clinic for a concern for PsA, specifically examining the revised diagnosis and the joint symptom similarities to psoriatic arthritis. We performed a retrospective chart review of patients referred to the rheumatology-dermatology clinic (RDC) at our institution between November 2019 and March 2022. Our review included 242 patients, of which 34 (14%) were psoriasis patients specifically referred due to suspicion for PsA. Each patient underwent a comprehensive rheumatic evaluation, including history, physical examination, laboratory tests and imaging as needed. Fourteen (41.2%) of the 34 patients referred for suspected PsA were diagnosed with non-inflammatory musculoskeletal conditions, primarily mechanical joint pain. Stiffness and/or swelling were significantly more common among patients with confirmed PsA. These findings underscore the importance of thorough evaluation of musculoskeletal symptoms, particularly stiffness and swelling, in patients with psoriasis. Improving education on distinguishing non-inflammatory musculoskeletal conditions may enhance diagnostic accuracy and optimise referral practices.Weiterlesen
  • 339 Aufrufe
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Causal Effect of Plasma Fatty Acid Profiles on Psoriasis Risk: Genetic Evidence from a Mendelian Randomization Study.

Emerging evidence indicates that omega-3 fatty acids from fish oil may serve as beneficial dietary supplements for psoriasis management. Clinical observations demonstrate a significant association between psoriasis improvement and increased docosahexaenoic acid (DHA) levels. However, the causal relationship between fatty acids and psoriasis risk requires further investigation. Using summary-level genome-wide association study (GWAS) data, we applied univariable (UVMR), reverse, and multivariable (MVMR) Mendelian randomization analyses to assess causal effects of multiple fatty acids-including polyunsaturated (PUFA), saturated (SFA), monounsaturated (MUFA), omega-3/6 fatty acids, DHA, eicosapentaenoate (EPA) and docosapentaenoate (DPA)-on psoriasis risk. The analysis revealed that higher circulating levels of omega-3 fatty acids were significantly associated with a reduced risk of psoriasis development (UVMR: OR = 0.900, p = 0.022; MVMR: OR = 0.862, p = 0.007). Sensitivity analyses supported the robustness of this causal relationship, with consistent effects across multiple MR methods. Notably, DHA (UVMR: OR = 0.788, p = 0.006; MVMR: OR = 0.856, p = 0.021) drove this inverse association, while EPA and DPA showed marginal contributions. This study provides valuable insights for targeted nutritional strategies to prevent and manage psoriasis, but further validation is needed.Weiterlesen
  • 292 Aufrufe
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Composite Outcome Measures for Psoriatic Arthritis: Project Updates 2024.

J Rheumatol 2025; doi: 10.3899/jrheum.2025-0268 The affiliation for Tommy Kok Annfeldt should be Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark. This correction applies only to the August 5 First Release. The correct affiliation appears in the print and online issues. doi: 10.3899/jrheum.2025-0268.C1.Weiterlesen
  • 327 Aufrufe
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Generalized Pustular Psoriasis

Pustular psoriasis is a rare and severe variant of psoriasis characterized by the eruption of sterile pustules, which may present in distinct clinical patterns. The pathologic features of psoriasis, including keratinocyte hyperproliferation, neutrophilic infiltration, and immune dysregulation, are markedly accentuated. Generalized pustular psoriasis (GPP) displays clinical heterogeneity in age of onset, severity, and disease course. Several overlapping phenotypes are recognized. A variable relationship exists between GPP and plaque psoriasis. Some individuals experience plaque psoriasis before or after GPP episodes, while others exhibit GPP as the sole phenotype without any history of plaque involvement (see Image. Pustular Psoriasis).Weiterlesen
  • 388 Aufrufe
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Beyond Skin Clearance: Personalized Strategies for DLQI Improvement in Psoriasis -Insights From a Shanghai Prospective Cohort.

Introduction
Psoriasis is a chronic immune-mediated disease that significantly impacts patients clinically and psychologically. Physician-assessed severity measures, including Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA), and Physician Global Assessment (PGA), often fail to capture patient-reported outcomes, particularly when clinical improvement and perceived quality-of-life gains are misaligned.Purpose
To clarify the association between clinical improvements and Dermatology Life Quality Index (DLQI) outcomes, identify predictors of substantial DLQI improvement (≥90% reduction), and explore reasons for suboptimal DLQI responses in patients achieving skin clearance.Methods
In this 12-week prospective study, 551 psoriasis patients were enrolled at Shanghai Skin Diseases Hospital. Data on demographics, clinical severity (PASI, BSA, and PGA), DLQI scores, and treatment modalities were collected. Logistic regression analyses were employed to assess the dose-response relationships between improvements in clinical parameters and DLQI reduction, and to identify factors of suboptimal DLQI improvement among patients achieving significant skin clearance.Results
Median DLQI improved significantly (8.0 to 3.0) at week 12, with 24.1% of patients achieving ≥90% DLQI reduction. Strong dose-response associations existed between clinical severity improvements (PASI, BSA, PGA) and DLQI gains. PASI75 responders were significantly more likely to achieve substantial DLQI improvement (OR = 2.48, 95% CI: 1.51-4.07). However, only 33.3% of PASI75 achievers reached ≥90% DLQI improvement. Early clinical response (as early as week 4) strongly predicted superior DLQI outcomes. Female sex, older age, lower baseline DLQI scores, and shorter disease duration were associated with achieving high skin clearance but suboptimal DLQI improvement.Conclusion
Early clinical response effectively predicts substantial DLQI improvement, whereas demographic and disease-related factors help identify patients at risk for suboptimal quality-of-life gains despite significant skin clearance. These insights support personalized therapeutic strategies aimed at improving patient satisfaction beyond skin clearance alone.Weiterlesen
  • 336 Aufrufe
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Exosome mediated delivery of Epigallocatechin 3 gallate as a novel approach to alleviate psoriasis symptoms through cytokine and apoptotic pathway modulation.

Psoriasis is a chronic skin disorder with significant individual and societal impacts. Current therapies often lack efficacy, are costly, or cause side effects, necessitating new treatments. This study explores regenerative therapies-exosomes, mesenchymal stem cells (MSCs), epigallocatechin-3-gallate nanoparticles (EGN), and EGN-loaded exosomes (EGN-Exo)-in regulating psoriasis-related markers (IL-6, IL-4, Bcl-2, Bax, NF-κB, CDC25B). An imiquimod-induced psoriasis model in Wistar rats was used, with six groups: negative control, positive control, and treatments (MSCs, exosomes, EGN, EGN-Exo). After seven days, ELISA revealed EGN-Exo most effectively reduced pro-inflammatory IL-6 and pro-apoptotic Bax while increasing anti-inflammatory IL-4 and anti-apoptotic Bcl-2. EGN-Exo also significantly lowered NF-κB and CDC25B, demonstrating superior anti-inflammatory effects. Apoptosis profiling showed EGN-Exo reduced late apoptotic cells, highlighting cytoprotective abilities. EGN had a moderate effect, while MSCs and exosomes showed modest improvements. Histopathological and immunohistochemical analyses confirmed EGN-Exo's efficacy, notably reducing TGF-β expression. These findings suggest EGN-Exo combines EGCG's antioxidant and anti-inflammatory properties with exosomes' targeted delivery, offering a promising advanced therapy for psoriasis.Weiterlesen
  • 364 Aufrufe
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Risk of Serious Infection With Adalimumab in Hidradenitis Suppurativa Compared With Psoriasis.

Previous research suggests that patients with hidradenitis suppurativa (HS) may face a higher risk of serious infections compared with those with psoriasis. However, these studies are subject to limitations that could constrain their reliability. To compare the risk of hospitalization from noncutaneous infections, infection profiles, and the length of stay (LOS) of adult patients with HS and psoriasis treated with adalimumab. This retrospective cohort study was conducted using deidentified claims data from the MarketScan database. All adult patients with HS or psoriasis who initiated adalimumab therapy between January 2017 and December 2020 were included. Data were analyzed from October 2023 to March 2024. New users of adalimumab diagnosed with psoriasis or HS, identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes and adalimumab prescriptions. The primary outcome was hospitalization from noncutaneous infections in a time-to-event analysis using inverse probability weighting to account for confounders in the Cox regression models. Secondary outcomes included the infection types compared using incidence rate ratios and LOS analyzed with multivariable Poisson regression. Of 10 349 included patients, 5641 (54.5%) were female, and the mean (SD) age was 44.8 (12.8) years. The cohort included 1650 patients with HS and 8699 with psoriasis. The HS cohort was younger (mean [SD] age, 36.2 [11.5] years vs 46.5 [12.4] years) and predominantly female (1271 [77.0%] vs 4370 [50.2%]), with higher rates of obesity, Crohn disease, anxiety, and depression. The weighted Cox analysis indicated an increased risk of serious infection in patients with HS (hazard ratio, 1.53; 95% CI, 1.34-1.86). This group also had a higher likelihood of sepsis and genitourinary infections (sepsis: incidence rate ratio, 2.07; 95% CI, 1.35-3.12; genitourinary infections: incidence rate ratio, 2.22; 95% CI, 1.22-3.86) and greater odds of prolonged LOS (odds ratio, 1.28; 95% CI, 1.13-1.45) compared with the psoriasis cohort. In this cohort study, among adults treated with adalimumab, those with moderate to severe HS had an elevated risk of infection and different infection profiles compared with those with psoriasis. Future research should focus on the impacts of disease severity and treatment regimens on infection risk and develop targeted prevention strategies.Weiterlesen
  • 340 Aufrufe
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Impact of psoriasis on THA and TKA outcomes: A systematic review.

Psoriasis is an autoimmune inflammatory condition that often intersects with orthopaedic care due to its connection to psoriatic arthritis. However, not all psoriasis patients develop psoriatic arthritis. Psoriasis patients may undergo hip or knee arthroplasties for reasons unrelated to psoriasis. This condition, marked by inflamed, scaly skin caused by an overactive immune system, may pose challenges for orthopaedic surgeries. This systematic review evaluated outcomes for psoriasis patients after total hip arthroplasty (THA) or total knee arthroplasty (TKA), focusing on postsurgical impact to inform additional considerations for patients. Following PRISMA guidelines, a systematic search was conducted in Medline, Embase, Web of Science, and Cochrane (up to October 2024). Studies involving patients with psoriasis undergoing THA or TKA were analyzed for postoperative outcomes. 359 studies were screened, 7 met inclusion criteria. Two studies focused on THA, three on TKA, and two examined both procedures. Patients with psoriasis undergoing THA showed increased risk of infections compared to non-psoriasis patients. For TKA, results were mixed in whether psoriasis led to higher infection rates. Psoriasis did not lead to increased revisions in both THA and TKA. Additionally, two studies found no significant differences in wound complications in TKA patients. This systematic review underscores the importance of considering post-surgical complications in psoriasis patients undergoing either a THA or TKA. However, lack of research makes it difficult to generalize findings. Psoriasis is an important factor to consider for surgical outcomes, but further research is needed to clarify risks and optimize care for patients.Weiterlesen
  • 333 Aufrufe
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Psychosocial Burden of Visible Psoriasis Vulgaris Lesions: A Case-Control Study on Social Appearance Anxiety and Psychological Well-Being

Abstract Background: Psoriasis vulgaris, particularly when manifesting in highly visible regions such as the face and hands, can profoundly impair self-perception and social functioning. Despite a growing interest in psychodermatology, the specific impact of visible psoriatic lesions on social appearance anxiety remains insufficiently explored.
Objective:
To assess the severity of social appearance anxiety in patients with visible psoriasis vulgaris lesions compared to healthy controls, and to examine its associations with general anxiety, depression, perceived disease severity, and dermatology-related quality of life. Methods:
A cross-sectional case-control study was conducted involving 178 patients diagnosed with psoriasis vulgaris exhibiting visible skin lesions and 196 age- and sex-matched healthy controls. All participants completed the Social Appearance Anxiety Scale (SAAS) and the Hospital Anxiety and Depression Scale (HADS). Patients additionally completed the Dermatology Life Quality Index (DLQI) and a Visual Analog Scale (VAS) to evaluate subjective disease severity. Statistical analyses included group comparisons and Pearson correlations between psychological and clinical parameters. Results:
SAAS scores were significantly elevated in the patient group (mean = 60.32 ± 8.10) compared to controls (mean = 22.15 ± 9.05; p < 0.001), indicating a large effect size. In psoriasis patients, social appearance anxiety showed a moderate positive correlation with perceived disease severity (r = 0.293, p < 0.01), while correlations with DLQI and depression scores were not statistically significant. General anxiety levels (HADS-A) demonstrated a moderate correlation with SAAS (r = 0.484, p < 0.01). Conclusion:
Visible lesions in psoriasis vulgaris contribute substantially to social appearance anxiety, independent of general psychopathology. These findings underscore the psychological vulnerability of patients with visible psoriatic involvement and highlight the need for integrated psychosocial interventions as part of comprehensive dermatological care.Weiterlesen
  • 339 Aufrufe
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JNK/c-Jun cascade activation enhances malignant proliferation of psoriatic keratinocytes by regulating ROS levels and mitochondrial membrane potential.

Psoriasis is a chronic immune-mediated skin disorder characterized by excessive keratinocyte proliferation, inflammation, and oxidative stress. This study investigates the role of the JNK/c-Jun cascade in psoriasis pathogenesis, focusing on its impact on keratinocyte proliferation and inflammatory responses. An in vitro psoriasis model was established using M5-stimulated HaCaT keratinocytes, while an in vivo model was created with imiquimod-treated Wistar rats. The results indicated that M5 stimulation significantly enhanced keratinocyte viability and proliferation, as demonstrated by increased optical density, EdU incorporation, and Ki-67 expression. M5 treatment also elevated pro-inflammatory cytokines TNF-α, IL-1β, and IL-6, while inducing oxidative stress through increased ROS production, lipid peroxidation, and mitochondrial membrane potential (MMP) disruption. Blocking the JNK/c-Jun cascade with the SP600125 inhibitor effectively reduced keratinocyte hyperproliferation, cytokine secretion, and oxidative stress, while restoring mitochondrial integrity. In addition, knockdown of Nrf2 suppressed M5-induced ROS generation, inflammatory signaling, and antioxidant enzyme activity. In psoriasis rats, JNK/c-Jun inhibition significantly alleviated skin tissue damage, reducing inflammatory cell infiltration, epidermal hyperkeratosis, and phosphorylation of key inflammatory markers. Correspondingly, serum pro-inflammatory cytokines were decreased, and oxidative stress indices improved. These findings suggest that the JNK/c-Jun cascade plays a central role in psoriasis pathogenesis by regulating keratinocyte proliferation, inflammation, and oxidative stress. Targeting this pathway presents a promising therapeutic strategy for psoriasis treatment. Further studies are warranted to explore upstream regulators and downstream effectors of the JNK/c-Jun signaling pathway.Weiterlesen
  • 345 Aufrufe
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Effects of Acute Time-Restricted Eating on Inflammation in Individuals With Psoriasis: Protocol for a Case-Control, Prospective Study.

Background
Psoriasis is a chronic inflammatory disease associated with multiple comorbidities, including metabolic syndrome and cardiovascular disease. Although specific dietary interventions, such as intermittent fasting and caloric restriction, have been shown to ameliorate inflammation and promote weight loss, the effect of these interventions independent of weight loss remains unclear. Time-restricted eating (TRE), a type of intermittent fasting, limits the daily eating window to a fixed number of hours. Recent studies suggest TRE may improve immune function in individuals with metabolic syndrome and cardiovascular risk factors. A crucial advantage of TRE over other investigated dietary restriction strategies is its reported high adherence rate, making it a more feasible intervention for long-term use. Therefore, exploring the effects of TRE on metabolic and immunological parameters in psoriasis is warranted.Objective
This study was designed to evaluate the effects of short-term, isocaloric TRE, independent of weight loss, on immune cell function and serum metabolite profiles of volunteers with mild-to-moderate psoriasis compared to healthy individuals.Methods
This case-control, prospective study was performed on 10 healthy male participants and 10 age-, BMI-, and sex-matched individuals with mild-to-moderate psoriasis. All individuals with psoriasis had stable disease and were being treated with topical therapies without any exposure to immunomodulatory biologics. This study was conducted at the National Institutes of Health Clinical Center. Immune profiles, glucose handling, energy expenditure, and participants' weights were assessed at baseline and after 3 days of TRE following a daily 6-hour eating window and 18-hour fast.Results
The trial commenced in June 2021 and was completed in February 2023. A total of 20 participants were enrolled-10 with mild-to-moderate psoriasis and 10 age-, BMI-, and sex-matched healthy individuals. As of the time of manuscript submission, data processing is ongoing. Multiomic datasets, including gene expression, surface and intracellular protein levels, and metabolite profiles, are being generated from peripheral blood mononuclear cells, CD4+-enriched T-cells, and serum samples. The integrated bioinformatics analyses will be reported once the data analysis is completed.Conclusions
This clinical protocol was designed to characterize the effects of short term (3-day) TRE on psoriasis, independent of weight loss, by comparing immune cell regulatory responses between healthy individuals and those with psoriasis. More specifically, we aim to map the molecular pathways activated by TRE and assess how they affect immune cell composition, activation, and metabolism. Additionally, components of the metabolic response to isocaloric TRE are being explored. Insights into how dietary interventions impact metabolism and the immune system will enhance our understanding of the pathogenesis of psoriasis and may reveal new therapeutic avenues for managing this inflammatory condition.Trial registration
ClinicalTrials.gov NCT04728165; https://clinicaltrials.gov/study/NCT04728165.Weiterlesen
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