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Psoriasis and obesity often occur together, with up to 50% of patients with psoriasis being classified as obese. This increases systemic inflammation, cardiovascular risk, and disease severity while reducing the efficacy of biologic treatments. Despite this overlap, dermatology lacks obesity-specific guidance. This review evaluates lifestyle, pharmacological (glucagon-like peptide 1 receptor agonists [GLP-1 RAs] and tirzepatide) and surgical strategies, as well as clinic-level algorithms, to inform dermatological practice.Methods
We performed a narrative synthesis of epidemiology, randomized trials, real-world studies, and guideline recommendations. Our focus was on the pathophysiology and the efficacy of GLP-1 RAs and tirzepatide, providing a practical algorithm pathway for triage, pharmacotherapy escalation, and referral criteria to a multidisciplinary unit.Results
Although there are no psoriasis-specific guidelines for obesity treatment, the strong link between the two conditions and the poorer therapeutic response observed in obese patients make addressing excess weight essential for people with psoriasis. The proposed algorithms emphasize universal lifestyle counseling and dermatology-led management for patients with a BMI (body mass index) < 35 kg/m2 and without major metabolic complications. GLP-1 RAs are considered the first-line treatment, given the available scientific evidence about their efficacy in terms of weight loss and management of comorbidities, as well as their safety profile. If weight loss with these drugs is insufficient, the next proposed treatment step is tirzepatide. Bariatric surgery, including bypass procedures, should be reserved for patients with a BMI ≥ 40 kg/m2, or with a BMI ≥ 35 kg/m2 when earlier measures have failed and/or comorbidities are not adequately controlled.Conclusion
Dermatologists should integrate obesity assessment and patient-centered interventions into psoriasis care. A structured, multidisciplinary approach could meaningfully enhance dermatological, metabolic, and cardiovascular outcomes in patients with psoriasis and obesity.Weiterlesen
- 22 Aufrufe
Although adalimumab has shown strong efficacy and safety in clinical trials, real-world evidence in Australian patients with moderate-to-severe chronic plaque psoriasis is limited. This study assessed adalimumab efficacy and drug survival in routine clinical practice, comparing outcomes with the Phase 3 REVEAL trial and its open-label extension.Methods
Data were extracted from the Australasian Psoriasis Registry for adults meeting Pharmaceutical Benefits Scheme criteria to be prescribed adalimumab for chronic plaque psoriasis. Baseline demographics, Psoriasis Area and Severity Index (PASI) scores and treatment history between June 2006 and March 2022 were analysed. Drug survival was evaluated using Kaplan-Meier and Cox regression.Results
A total of 306 patients were included; 59.8% had prior biologic exposure compared to 12.8% in REVEAL. The mean baseline PASI was 24.1 and at 3 months, 63.5% achieved PASI75 while 33.6% achieved PASI90. PASI90 responses remained stable through 3 years and exceeded REVEAL extension rates beyond 18 months. Median drug survival was 27.9 months; survival was 97.7%, 78.6%, 63.7% and 51.0% at 3, 9, 15 and 27 months, respectively. Male sex and achieving PASI ≤ 2 predicted longer drug survival.Conclusions
In Australian real-world practice, adalimumab demonstrated sustained effectiveness and drug survival in patients with chronic plaque psoriasis comparable to RCTs, despite higher baseline disease severity and greater prior biologic exposure.Weiterlesen
- 29 Aufrufe
Psoriasis is a chronic inflammatory skin disease, and noninvasive diagnostic tools are essential for accurate diagnosis and treatment monitoring. Multiphoton microscopy (MPM) enables real-time, noninvasive skin imaging with submicron resolution. This study evaluated the diagnostic accuracy of MPM in psoriasis and its potential application in therapeutic monitoring.Patients and methods
This prospective observational study enrolled 34 patients with psoriasis. It comprised three parts: (1) analysis of imaging features of lesional and nonlesional skin using multiphoton microscopy (MPM; Transcend Vivoscope); (2) evaluation of the diagnostic performance of MPM parameters compared with reflectance confocal microscopy (RCM); and (3) prospective monitoring of 24 patients treated with Benvitimod (Tapinarof) cream for 8 weeks (T0/T1/T2).Results
MPM detected psoriasis characteristics (including hyperkeratosis, parakeratosis, an absent stratum granulosum, enlarged nucleus diameter, and absent bright rimming) with comparable diagnostic efficiency to RCM (AUC = 0.838, p < 0.001 vs. 0.824, p < 0.001). Psoriatic lesions showed significant perinuclear fluorescence accumulation compared to healthy skin (p < 0.001). All imaging features improved significantly after 8 weeks of treatment (p < 0.001). PASI/TLS scores showed correlations with the epidermal thickness (r = 0.403/0.492, p < 0.001), nuclear diameter (r = 0.4/0.375, p < 0.001), and fluorescence intensity (r = -0.419/-0.492, p < 0.001).Conclusions
MPM is a novel and non-invasive imaging technique for psoriasis evaluation and treatment monitoring.Weiterlesen
- 50 Aufrufe
This prospective multicenter cohort study was conducted to identify and compare clinical factors associated with the effectiveness of commonly used biologics in Chinese patients with moderate-to-severe psoriasis.Subjects
Patients from the SPEECH registry initiating treatment with ixekizumab, secukinumab, guselkumab, or ustekinumab were included.Treatment
Guideline-recommended dosing; 3-month follow-up.Methods
The primary endpoint was PASI90 response at 3 months. Multivariable logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for clinical predictors of treatment response.Results
A total of 717 patients were included in the analysis. In guselkumab-treated patients, obesity (aOR 0.22, 95% CI 0.06-0.78) and prior biologic exposure (aOR 0.22, 95% CI 0.06-0.75) were independently associated with reduced PASI90 response. Psoriatic arthritis predicted poorer response to ustekinumab (aOR 0.16, 95% CI 0.03-0.78). For secukinumab, male sex reduced the likelihood of PASI90 (aOR 0.47, 95% CI 0.23-0.96), whereas family history of psoriasis improved outcomes (aOR 2.20, 95% CI 1.10-4.42). In ixekizumab-treated patients, obesity (aOR 0.38, 95% CI 0.18-0.80) was a negative predictor, while family history (aOR 2.79, 95% CI 1.22-6.38) enhanced treatment response.Conclusions
Predictors of biologic effectiveness differ by agent, supporting personalized treatment based on patient characteristics.Weiterlesen
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Psoriasis is a chronic inflammatory skin disease, and noninvasive diagnostic tools are essential for accurate diagnosis and treatment monitoring. Multiphoton microscopy (MPM) enables real-time, noninvasive skin imaging with submicron resolution. This study evaluated the diagnostic accuracy of MPM in psoriasis and its potential application in therapeutic monitoring.Patients and methods
This prospective observational study enrolled 34 patients with psoriasis. It comprised three parts: (1) analysis of imaging features of lesional and nonlesional skin using multiphoton microscopy (MPM; Transcend Vivoscope); (2) evaluation of the diagnostic performance of MPM parameters compared with reflectance confocal microscopy (RCM); and (3) prospective monitoring of 24 patients treated with Benvitimod (Tapinarof) cream for 8 weeks (T0/T1/T2).Results
MPM detected psoriasis characteristics (including hyperkeratosis, parakeratosis, an absent stratum granulosum, enlarged nucleus diameter, and absent bright rimming) with comparable diagnostic efficiency to RCM (AUC = 0.838, p < 0.001 vs. 0.824, p < 0.001). Psoriatic lesions showed significant perinuclear fluorescence accumulation compared to healthy skin (p < 0.001). All imaging features improved significantly after 8 weeks of treatment (p < 0.001). PASI/TLS scores showed correlations with the epidermal thickness (r = 0.403/0.492, p < 0.001), nuclear diameter (r = 0.4/0.375, p < 0.001), and fluorescence intensity (r = -0.419/-0.492, p < 0.001).Conclusions
MPM is a novel and non-invasive imaging technique for psoriasis evaluation and treatment monitoring.Weiterlesen
- 42 Aufrufe
This study aims to evaluate the clinical impacts of topical and/or oral administration of compounds rich in omega-3 fatty acids from various sources, such as oils and foods, on psoriatic lesions.Design
A systematic review was carried out.Data sources
Searches were conducted in six databases (PubMed, Cochrane, VHL, Scopus, Embase, and Web of Science) using descriptors related to fatty acids and psoriasis.Study selection
Inclusion criteria were studies published in the last 10 years (2013-2023) that involved patients with psoriasis and provided quantitative clinical outcome data, such as psoriasis severity scale.Data extraction
Two independent reviewers carried out the initial screening of the titles and abstracts identified in the search. The quality of studies was evaluated using the Newcastle-Ottawa Scale, the Risk of Bias in Randomized Studies of Interventions, and the Joanna Briggs Institute critical appraisal checklist.Results
Out of 8570 articles identified, 9 met the inclusion criteria. The quality of randomized clinical trials and observational studies varied from low to high risk of bias, according to the respective parameters of each checklist.Conclusions
Most studies demonstrated that the topical and/or oral administration of omega-3 fatty acids from different sources significantly improved clinical parameters, as measured by severity scales and the Psoriasis Area and Severity Index (PASI).Weiterlesen
- 40 Aufrufe
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- 46 Aufrufe
Despite increased understanding of psoriasis pathogenesis, molecular classification of clinical phenotypes and disease severity is poorly defined. Knowledge gaps include whether molecular endotypes of psoriasis underlie distinct clinical phenotypes and the positive and negative molecular regulators of disease severity across tissue compartments.Methods
We performed comprehensive RNA sequencing of skin and blood (n = 718) from prospectively-recruited, deeply-phenotyped discovery and replication cohorts of 146 subjects with moderate-to-severe chronic plaque psoriasis initiating TNF-inhibitor (adalimumab) or IL-12/23-inhibitor (ustekinumab) therapy.Results
Here we show, using two complementary dimensionality reduction methods, that co-expressed gene modules and factors within skin and blood are significantly associated with psoriasis phenotypes and disease severity. We identify a 14-gene signature negatively associated with BMI in nonlesional skin and with disease severity in lesional skin. Genotype integration reveals that HLA-DQA1*01 and HLA-DRB1*15 genotypes are positively associated with baseline psoriasis severity. Using explainable machine learning models, we define two disease severity-associated gene modules in lesional skin - one positive, one negatively-associated - and a 9-gene signature in lesional skin predictive of disease severity. Disease severity signatures in blood are only seen following adalimumab exposure, suggesting greater systemic impact of adalimumab compared to ustekinumab, in line with its side effect profile. In contrast, a gene signature in blood linked to HLA-C*06:02 status is independent of disease severity or drug.Conclusions
These findings delineate gene-environmental and genetic effects on the psoriasis transcriptome linked to disease severity.Weiterlesen
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People with skin disease often experience stigmatization in health and body care settings, significantly impacting their quality of life. This parallel-group randomized controlled trial evaluated a face-to-face group seminar aimed at reducing stigma towards people with skin disease among health and body care professionals (HBCPs).Patients and methods
Cosmetologists, hairdressers, nurses, and physical therapists were randomized into an intervention (IG; n = 64) or control group (CG; n = 65). The IG received a seminar consisting of self-awareness exercises, education and a patient encounter; the CG followed a seminar on "health at work". Stereotype agreement, disease-related misconceptions, desire for social distance, and behavioral intentions were assessed at baseline (t0), post-intervention (t1), and 3 months follow-up (t2).Results
The intervention group showed significant reductions over time in disease-related misconceptions (t0-t1: 0.398, p < 0.001; t0-t2: 0.225, p < 0.001; ηp2 = 0.12) and in stereotype endorsement (t0-t1: 0.392, p < 0.001; t0-t2: 0.299, p = 0.002; ηp2 = 0.12). In both groups, the desire for social distance decreased immediately after the seminar (t0-t1Intervention: 0.186, p < 0.001; t0-t1Control: 0.135, p = 0.012) but returned to baseline at follow-up (t0-t2Intervention: 0.097, p = 0.35; t0-t2Control: 0.016, p = 1.00).Conclusions
The seminar improved skin disease-related stigmatizing beliefs and attitudes of HBCPs. Its integration into vocational training curricula or delivery in workshops to increase knowledge about skin diseases and to reduce prejudices in various professional groups is promising.Weiterlesen
- 53 Aufrufe