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Patients with cutaneous lymphomas (CL) are at an increased risk of developing secondary malignancies. This study aimed to assess the frequency of association between CL and Kaposi sarcoma (KS) and to identify factors that may promote the co-occurrence of these two diseases.Patients and methods
On January 25, 2024, we conducted a systematic search of four electronic medical databases to identify all published cases of KS associated with CL. The clinical course and outcomes of these patients were summarized. For critical appraisal, we applied the JBI Checklist for Case Reports. The study was registered in the PROSPERO database (CRD42022313204).Results
A total of 40 articles reporting on 45 patients were assessed for eligibility. We included 27 cases in the final analysis (26 cutaneous T-cell lymphomas, 1 cutaneous B-cell lymphoma). In 71% of cases, the diagnosis of CL preceded KS. Nearly half (48%) of the patients had erythrodermic mycosis fungoides or Sézary syndrome. KS lesions were predominantly limited to the skin, with complete remission achieved in 53% of cases.Conclusions
The association between KS and CL is rare, limiting our study due to the small sample size and potential reporting bias. Skin-targeted therapies, a restricted T-cell repertoire, and impaired T-cell responses in erythrodermic CTCL patients may contribute to the development of KS.Weiterlesen
- 159 Aufrufe
Psoriasis skin lesions are generally thought to occur before psoriatic arthritis (PsA) develops. However, PsA may be challenging to diagnose in the absence of psoriasis and might be underdiagnosed when occurring before psoriasis. We tested the hypothesis that PsA may commonly occur before psoriasis, but without psoriasis skin lesions, is diagnosed as another form of arthritis.Methods
A single-center retrospective chart review was performed to identify patients with qualifying diagnoses from January 1, 2023, until December 31, 2023. This study was performed using electronic health records at a large tertiary care medical center. Inclusion criteria were (1) the presence of inflammatory or non-inflammatory arthritic conditions, (2) prior to the diagnosis of psoriasis, atopic dermatitis, or rosacea. Diagnoses were screened using International Classification of Diseases, Tenth Revision (ICD-10) codes.Results
During 2023, we identified 2780 patients with rosacea, 1672 with psoriasis, and 5195 patients with atopic dermatitis, of whom 436 had preceding arthritis (239 with psoriasis [14.3%], 189 with rosacea [6.8%], and 126 with eczema [2.4%, p < 0.0001]).Conclusions
Arthritic symptoms are common in psoriatic patients before psoriasis develops, and psoriasis skin lesions do not necessarily precede psoriatic arthritis.Weiterlesen
- 181 Aufrufe
SB17 is a ustekinumab (UST) biosimilar targeting interleukin-12/23 for treating immune-mediated inflammatory diseases (IMIDs). The development of UST biosimilars like SB17 may help address the high cost of innovator biologics, offering affordable alternatives without compromising efficacy or safety.Areas covered
This review encompasses the totality of evidence supporting SB17's similarity to UST, its regulatory approval, and indication extrapolation. It also discusses SB17's lower immunogenicity relative to UST.Expert opinion
The approval of UST biosimilars represents a significant advancement in managing chronic IMIDs including psoriasis, plaque psoriasis, psoriatic arthritis, Crohn's disease, and ulcerative colitis, providing cost-effective, efficacious alternatives. A randomized double-blind 28-week study involving over 500 patients with moderate-to-severe chronic plaque psoriasis demonstrated SB17's equivalence to UST, with more than 80% of patients achieving over 90% improvement in psoriasis severity indices. Treatment-emergent adverse events were comparable between SB17 and UST. Despite their potential to transform clinical outcomes, economic burdens, and drug utilization patterns, the adoption of UST biosimilars faces challenges, including concerns about equivalence and regulatory inconsistencies. Addressing these issues through education, consistent regulatory frameworks, real-world data, and ongoing monitoring is crucial for their successful integration into clinical practice.Weiterlesen
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Psoriasis and psoriatic arthritis are chronic autoimmune inflammatory conditions frequently associated with a range of comorbidities, including oncological diseases. Managing these conditions in patients with a history of cancer requires careful consideration of treatment efficacy and safety. Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, has shown promise in the treatment of psoriasis and psoriatic arthritis. However, data on its use in oncological patients remain limited.Methods
This retrospective observational study evaluated the efficacy and safety of Apremilast in 79 patients with a history of cancer who were treated for psoriasis and/or psoriatic arthritis over a period of approximately five years. Clinical outcomes were assessed using the Psoriasis Area Severity Index (PASI), Dermatology Life Quality Index (DLQI), and Visual Analog Scale for pain (PAIN VAS) to monitor disease severity, quality of life, and articular involvement, respectively. Regular oncological assessments were conducted concurrently with Apremilast therapy to ensure patient safety and identify potential interactions.Results
Over the five-year treatment period, significant improvements were observed in PASI, DLQI, and PAIN VAS scores, indicating effective management of both dermatological and articular symptoms. Patients reported enhanced quality of life and reduced pain levels, reflecting the therapeutic benefits of Apremilast. Oncological evaluations revealed no significant adverse interactions between Apremilast and the patients' cancer history or treatments, underscoring the drug's safety profile in this population.Conclusion
This study highlights the efficacy and safety of Apremilast as a treatment option for psoriasis and psoriatic arthritis in oncological patients. The findings support its role in improving disease outcomes and quality of life, emphasizing the importance of personalized treatment strategies in managing complex cases involving a history of cancer. Further research is warranted to validate these results in larger patient cohorts.Weiterlesen
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Nail psoriasis (NP) is not an uncommon psoriasis variant whose symptoms have a negative impact on patients' quality of life. Treating NP can be a great challenge for the dermatologist, especially when it is presented as isolated subtype or when it is not associated with psoriatic arthritis (PsA). The available treatments, topical or systemic therapies, have limited efficacy and can be associated with adverse effects (AEs). Topical roflumilast is an FDA-approved treatment for skin plaque-psoriasis in patients aged 6 and above, but there is limited evidence for treating NP. We present outcomes of nail psoriasis not associated with PsA treated with roflumilast 0.3% cream in 7 patients.Methods
A single center, retrospective case series analysis was conducted in a Canadian nail clinic in adult patients with NP refractory to treatment between January 2023 and December 2024. Clinical characteristics (matrix and/or nail bed alterations) were included to calculate the Nail Psoriasis Severity Index (NAPSI) score. Improvement degree was based on NAPSI score reduction. All patients were treated with roflumilast 0.3% cream daily for at least 16 weeks.Results
The case series included 7 patients with NP not associated with PsA. The mean baseline NAPSI score was 19, which decreased to 6.8 after 16 weeks of topical treatment. Roflumilast 0.3% cream was used both as monotherapy and/or in combination with topical steroids or acitretin. Interestingly, all patients reported quality of life improvements, and complete lesion clearance was achieved in almost all patients.Conclusions
Topical roflumilast showed promising results to treat topically NP. In this case series topical roflumilast was effective, well-tolerated and not associated with AEs.Weiterlesen
- 241 Aufrufe
Biologics effectively improve psoriatic skin lesions, but their impact on itch relief remains unclear.Objective
To evaluate itch improvement in severe psoriasis patients treated with ustekinumab or guselkumab.Methods
This retrospective study analyzed patients with severe psoriasis who completed initial efficacy evaluations after treatment with either biologic. Itch severity was assessed using numerical rating scale (NRS), visual analog scale, and verbal rating scale. NRS improvement was evaluated after three injections.Results
Among 108 patients (74 on ustekinumab, 34 on guselkumab), 77 (71.3%) had moderate-to-severe itch (NRS ≥4) at baseline. Of these, 63 (81.8%) achieved an NRS improvement of ≥4 points. Ustekinumab showed greater itch relief compared to guselkumab in NRS (p=0.033). On the other hand, guselkumab showed more reduction for psoriatic skin lesions than ustekinumab in the Psoriasis Area and Severity Index (p=0.040). In the moderate-to-severe itch group, patients with large plaques experienced significantly greater improvement in NRS than those with small plaques (p=0.012).Conclusion
While guselkumab is generally preferred for psoriatic skin lesions, ustekinumab may provide superior itch relief.Weiterlesen
- 256 Aufrufe
This study aimed to evaluate the required test characteristics that a psoriatic arthritis (PsA) biomarker test would need to achieve to be considered cost-effective.Methods
We adapted an existing Markov model to compare a hypothetical biomarker with current practice. The model followed a patient cohort aged 45 years with moderate psoriasis (PsO) in which PsA was prevalent but unrecognized over a 40-year time horizon. Patients were assumed to be routinely seen at a dermatology clinic. In the current practice arm, patients with PsA were clinically detected. In the biomarker arm, a hypothetical test was assumed to be administered at baseline. Patients who screened positive would accept a combination of conventional disease-modifying antirheumatic drugs and targeted treatment to slow disease progression. Progression was modeled as linear changes in Health Assessment Questionnaire (HAQ) scores. We varied the sensitivity, specificity, and biomarker price based on current development progress. Scenario analyses considered alternative patient cohorts with mild and severe PsO separately.Results
The base case showed that a biomarker test with 70 percent sensitivity, 80 percent specificity, and a price of US$500 would be cost-effective (incremental cost-effectiveness ratio US$47,566 per quality-adjusted life-year [QALY]). Three-way analyses showed that a test with 80 percent specificity could be cost-effective at a US$50,000 per QALY threshold with a sensitivity as low as 66 percent at US$500. Only a near-perfect test would be cost-effective at a US$1,000 price point. Results were sensitive to HAQ progression under treatment, therapy costs, and the patient population.Conclusion
This study supports the continued product development of candidate PsA biomarkers.Weiterlesen
- 712 Aufrufe
The management of moderate-to-severe psoriasis in patients with concurrent or previous malignancy presents a unique clinical challenge. Despite the transformative impact of biologic therapies on psoriasis treatment, the exclusion of patients with malignancy from clinical trials has led to a paucity of data regarding the safety and efficacy of systemic and biologic agents in this subgroup. Clinicians are thus often compelled to rely on registry data, real-world evidence, and expert opinion when navigating these complex cases.Objectives
To investigate prescribing practices among psoriasis experts for systemic and biologic therapies in patients with severe psoriasis and concomitant malignancy. The study aimed to elucidate trends in decision-making, perceptions of treatment risks, and adherence to multidisciplinary approaches.Methods
An electronic survey was disseminated to 141 members of the International Psoriasis Council (IPC) between December 2023 and June 2024. The self-administered questionnaire examined respondents' demographics, guideline familiarity, and preferences for systemic and biologic therapies across five malignancy types (breast cancer, melanoma, prostate cancer, lymphoma, and metastatic renal cell carcinoma) at varying remission intervals. Data were analysed descriptively.Results
Fifty-seven IPC councillors completed the survey (40%). Anti-IL-17 agents were the most commonly selected therapies across all malignancy scenarios for patients in remission, reflecting growing confidence in their safety profiles. For active malignancies, apremilast was the most frequently chosen agent, particularly for breast cancer (61%), melanoma (56%), and metastatic renal cell carcinoma (49%). Tumour necrosis factor-alpha (TNF-α) inhibitors and fumaric acid esters were the least frequently selected treatments for active malignancies. The majority of respondents (70%) believed current guidelines lacked clarity on treating psoriasis in the context of malignancy. Nearly half (49%) reported always consulting oncology teams before initiating systemic therapy for patients with recent malignancy diagnoses, underscoring the importance of a multidisciplinary approach.Conclusions
This study highlights significant variability in prescribing practices and a strong preference for biologics such as anti-IL-17 agents and apremilast. The findings underscore the urgent need for malignancy-specific guidelines informed by robust long-term safety data to support optimal decision-making and improve patient outcomes.Weiterlesen
- 132 Aufrufe
Mucosal lichen planus (LP) is a chronic inflammatory disease. The patient's journey can be arduous as diagnosis and therapy are challenging.Patients and methods
In this cross-sectional study, a wide range of characteristics of the patient's journey were assessed and evaluated from a total of 72 patients with mucosal LP who were treated in the dermatology departments of six German university medical centers between 02/2022 and 07/2023.Results
On average, 18.1 months elapsed between the onset of symptoms and diagnosis. Until the correct diagnosis was made, an average of 3.1 different physicians of the same or different specialties were consulted. 28.1% of patients also had cutaneous involvement. Therapeutically, 68% of patients received at least one systemic drug. Both topical (90%, 65/72) and systemic (oral, 50% of patients, 36/72; intravenous, 33%, 24/72) glucocorticoids were most frequently used. Systemic agents were most often discontinued due to ineffectiveness (46%, 50/110). Satisfaction with treatment was highest for intravenous and topical glucocorticoids (moderate to high satisfaction: 59% and 36%, respectively), and lowest for retinoids with 8%.Conclusions
This study indicates that there might be a lack of diagnostic awareness among physicians and the unmet need for effective systemic treatment options.Weiterlesen
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Psoriasis vulgaris is a common chronic inflammatory skin disease, associated with multiple cardiovascular comorbidities, which can ultimately lead to increased mortality. Dermatological rehabilitation programs represent an additional therapeutic option in patients with psoriasis besides the classical outpatient or inpatient management. This study aimed to investigate the impact of dermatological rehabilitation on cardiovascular risk factors, cardiorespiratory fitness and quality of life at the Clinic of Dermatology, Bad Bentheim, Germany.Patients and methods
This prospective study included 105 patients (age > 18 years) with known psoriasis and/or psoriasis (pustulosa) palmoplantaris committing to a 3-week long rehabilitation program. Various patient reported outcomes including dermatological life and quality index, patient global assessment, physical activity, pruritus and smoking and alcohol consumption history were captured. Body mass index (BMI) and physical fitness were also assessed. Study parameters were collected by telephone at baseline, at discharge, and at 3 and 6 months.Results
Significant improvements in cardiorespiratory fitness (p < 0.001), BMI (p < 0.001), quality of life (p < 0.001), patients subjective estimation of disease severity (p < 0.001) and psoriasis area and severity index (p < 0.001) were shown.Conclusions
The findings emphasize the importance of a rehabilitation program for patients with psoriasis due to its positive and sustained effects on cardiovascular risk factors.Weiterlesen
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Up to 30% of psoriasis (PsO) is clinically associated with psoriatic arthritis (PsA). A large proportion of new onset of PsA is diagnosed at a later stage, despite the necessity of early effective treatment to prevent structural damage. This study aimed to identify the routine screening practices used for PsA in patients with PsO.Patients and methods
This non-interventional, prospective, epidemiological, cross-sectional study conducted in Germany focuses on screening activity and treatment selection of dermatological practices in suspected PsA. Descriptive statistics and patient characteristics were analyzed for different center types.Results
One hundred ninety-five patients from 34 office-based physicians, five non-university hospitals, and nine university hospitals were included. Questionnaires or imaging techniques were not routinely used (< 45%). Especially, ultrasounds (≤ 5%) and MRIs (< 6.3%) were rarely performed. Between 30% and 75% of suspected PsA could be confirmed. Referral to rheumatologists and/or appropriate therapy initiation were the most frequent consequences.Conclusions
Results of this study reflect the status of PsA screening activity by dermatologists. Imaging techniques, particularly ultrasound or MRIs to detect early forms of PsA, were inadequately used, which may have contributed to continued underdiagnoses. Collaboration between dermatologists and rheumatologists should be reviewed with a view to improving effective PsA screening.Weiterlesen
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De-escalation strategies of biologics in psoriasis treatment are widespread in clinical practice. Dose spacing consists of de-escalating the time range between biological drug injections.Patients and methods
Major objectives were: to describe trends in mean PASI, PASI 100, 90, and ≤ 1 from baseline to 12 months after dose spacing, provide drug survival analysis of dose-spaced regimens, and concurrently describe phenotypic characteristics related to the selection of patient candidates for therapeutic dose spacing. A pre-post analysis was made between mean PASI at dose spacing and baseline, and after 3, 6, 9, and 12 months following dose spacing.Results
Of 1,144 patients treated with IL-23 or IL-17 inhibitors, 61 patients underwent dose spacing. They presented with lower mean baseline Body Mass Index (BMI) (p = 0.011) and PASI (Psoriasis Area Severity Index) (p = 0.044) and were more frequently bio-experienced (p = 0.033). 12 months after dose spacing 42.9%, 85.7%, and 92.9% of observed patients achieved PASI 100, 90, and ≤1. There were no significant differences in mean PASI between dose spacing and subsequent time points. The dose spacing survival was 70% at 1 year.Conclusions
Therapeutic modulation, such as dose spacing, is an effective strategy for most psoriasis patients, resulting in a clear or almost clear skin response that is maintained over time.Weiterlesen
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