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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
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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
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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
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Palmoplantar pustulosis (PPP) is a chronic and refractory inflammatory skin disorder with unclear pathogenesis.Patients and methods
Ten PPP patients treated with upadacitinib were monitored to assess efficacy and safety. Immunofluorescence and immunohistochemistry were employed to evaluate Th1, Th2, and Th17 cell expressions, along with their associated cytokines in lesions on palms or soles from 16 PPP patients, 10 chronic eczema (CE) patients, 10 psoriasis vulgaris (PV) patients, and 7 healthy controls (HC).Results
In PPP patients receiving upadacitinib, the shortest time to achieve PPPASI75 and PPPASI90 was 4 weeks and 8 weeks, respectively. The rates of patients achieving PPPASI90 at week 16, week 24, and week 52 was 70 %, 100 %, and100 %, respectively. Th1 cells and IFN-γ levels in PPP were comparable to CE and PV, and higher than HC. Th2 cells, IL-4, and IL-13 levels in PPP were similar to CE, and greater than HC and PV. Th17 cells, IL-17, and IL-36γ levels in PPP were comparable to PV, and more abundant than HC and CE.Conclusions
Upadacitinib is a safe and effective option for PPP patients, which may be attributed to the complex Th1, Th2, and Th17 inflammatory responses associated with PPP.Weiterlesen
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Psoriasis is a chronic autoimmune skin condition that significantly impacts an individual's quality of life, resulting in physical discomfort, psychological distress, and compromised social well-being. However, there is limited understanding regarding the challenges faced by patients in Malaysia. This study examines the lived experiences of patients with psoriasis in Malaysia, focusing on the emotional, social, financial, and treatment-related challenges they face, as well as the coping mechanisms they employ.Methods
A qualitative, phenomenological approach was employed among members of the Psoriasis Association Malaysia. Purposive sampling was used to recruit adult participants who were capable of participating in the online interview. Data collection involved the use of Google Forms, which included the Malay version of the Dermatology Life Quality Index questionnaire, supplementing the qualitative findings. This was followed by semi-structured online interviews conducted via video conferencing. Thematic analysis was conducted using NVivo version 14, and descriptive analysis was performed using SPSS version 28.Result
This study involved 30 respondents with a mean age of 44 years diagnosed with psoriasis. The mean (SD) for the duration of illness is 21.3 (11.8) years. About 70% respondents reported that psoriasis had a moderate to very high impact on their quality of life. Thematic analysis has identified six major themes, including physical devastation, emotional burden, disruption in social functioning, treatment hurdles and advancements, financial barriers, and behavioral adaptation.Conclusion
Psoriasis imposes complex challenges that extend beyond physical symptoms, affecting emotional well-being, social interactions, financial stability, and treatment struggles. In response to the various challenges that arose, respondents developed behavioral adaptations to achieve a better quality of life. Framed within the biopsychosocial model, the findings emphasize the need for a holistic, patient-centred approach to psoriasis care that integrates medical treatment with psychological support and social interventions to improve overall quality of life.Weiterlesen
- 138 Aufrufe
Psoriasis affects approximately 2% of the global population, with the IL-17A-STAT3 pathway mediating abnormal keratinocyte proliferation and inflammatory amplification. Solanum lyratum (Bai Ying) has long been used for skin disorders, and its steroidal alkaloids have anti-inflammatory potential, though the mechanisms remain unclear.Objective
To elucidate the molecular basis and cytological efficacy of S. lyratum steroidal alkaloids in exerting anti-psoriatic effects via the IL-17A/STAT3 axis.Methods
HPLC-MS-QTOF, network pharmacology, molecular simulation, and a HaCaT cell model with STAT3-siRNA assays were employed.Results
Eighteen components were identified; steroidal alkaloids showed high affinity for STAT3 and IL17RA. S. lyratum (5-40 μg/mL) enhanced cell viability, inhibited p-STAT3 (IC50 = 14.30 μg/mL), and attenuated inflammatory responses and keratinocyte proliferation.Conclusion
S. lyratum steroidal alkaloids exert dual-targeted blocking effects on the IL-17A/STAT3 axis, supporting it as a potential therapeutic candidate for psoriasis.Weiterlesen
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Treatment of moderate to severe psoriasis typically requires the use of multiple systemic therapies over a patient's lifetime. The efficacy and safety of systemic treatments are typically evaluated in clinical trials; however, patient registries are increasingly used to monitor long-term outcomes of systemic therapies for psoriasis in real-world settings. Psoriasis registries also generate important real-world evidence about psoriasis treatment that may facilitate a greater understanding of outcomes outside of a controlled clinical trial setting. This study thus characterises the design and measures used in real-world studies of psoriasis treatment from patient registries and assesses its use in informing clinical guidelines and reimbursement decisions.Methods and analysis
A systematic literature review was conducted to identify real-world observational studies that used psoriasis registry data. PubMed and Embase were searched for English-language studies published between January 2018 and January 2023. To assess how real-world studies, clinical guidelines, and reimbursement and coverage reports have informed practice, treatment, and reimbursement guidelines, a narrative review of recommendations was conducted. All results were screened by two independent reviewers (LP and TAS) using prespecified inclusion and exclusion criteria. Outcomes of interest were extracted into Excel, with all conflicts resolved through discussion/consensus. Tables displayed outcomes and research topics first by year, then by registry.Prospero registration number
CRD42023402431.Weiterlesen
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To assess the incidence and risk factors for arrhythmias in patients with psoriatic arthritis (PsA).Methods
We performed a cohort analysis of patients followed prospectively from 1994 to 2024. Participants were evaluated using standard protocols at 6-to-12-month intervals. The following events were assessed: (1) atrial tachyarrhythmia (including atrial fibrillation and supraventricular tachycardia); (2) ventricular tachyarrhythmia and (3) bradycardia/pacemaker. The cumulative incidence rate (CIR) of each arrhythmia was calculated. Cox proportional hazards models (reported as the current level HR (measured just prior to the event) and the adjusted mean HR) were fitted to assess the association between selected measures of PsA disease activity and the age of occurrence of arrhythmia events. Each model was adjusted for sex, PsA duration, cardiovascular risk factors and medications.Results
A total of 1670 patients with PsA were analysed (80 atrial tachyarrhythmias, 17 bradyarrhythmias/pacemakers and 11 ventricular tachyarrhythmias). By age 70, the CIRs were 7.82%, 0.67% and 0.45% for atrial, ventricular and bradycardia, respectively. In multivariable analysis, remission/low versus high disease activity state was associated with lower risk of atrial tachyarrhythmia (current HR 0.49, 95% CI 0.26 to 0.92; adjusted mean HR 0.46, 95% CI 0.23 to 0.91). Similarly, a higher three-item Visual Analogue Scale (3-VAS) was associated with a higher risk of atrial tachyarrhythmia (current level HR 1.18, 95% CI 1.04 to 1.33; adjusted mean HR 1.22, 95% CI 1.04 to 1.44).Conclusions
Higher PsA disease activity is associated with higher atrial tachyarrhythmia risk. These findings reinforce the importance of controlling inflammation in PsA to optimise cardiac health.Weiterlesen
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Psoriasis is a chronic inflammatory disease associated with multiple systemic comorbidities and reduced quality of life. Risankizumab, an interleukin (IL)-23 inhibitor, has demonstrated efficacy in achieving rapid and sustained skin clearance in moderate-to-severe psoriasis. However, its impact on chronic subclinical inflammation is less understood. Conventional clinical assessments like Psoriasis Area and Severity Index (PASI), Investigator's Global Assessment (IGA), and Body Surface Area (BSA) focus on evaluating visible symptoms and are limited in capturing underlying disease activity. Optical coherence tomography (OCT), a non-invasive imaging modality, offers real-time assessment of structural and vascular changes, providing valuable insights beyond the skin surface.Methods
This sub-analysis of a prospective, single-center exploratory study included 22 patients with moderate-to-severe psoriasis treated with risankizumab. Clinical assessments (PASI, IGA, BSA) were conducted at baseline and weeks 2, 4, 16, 28, 40, and 52. OCT imaging performed at baseline and weeks 4, 16, and 52 evaluated epidermal thickness and vascular parameters (e.g., vessel density and diameter) in lesional and perilesional skin.Results
By week 16, mean (95% confidence interval [CI]) PASI score decreased from 16.3 (11.6-21.1) at baseline to 3.5 (1.8-5.2), and BSA involvement from 24.7% (16.1-33.3) to 5.2% (1.9-8.4) (both p < 0.001). By week 52, 86.7%, 73.3%, and 40.0% of patients achieved PASI 75, 90, and 100, respectively, and 93.3% achieved IGA 0/1. OCT showed lesional reductions in epidermal thickness (- 37.4%), vessel density (- 26.6% Δ area under the curve [AUC]), and vessel diameter (- 59.5% ΔAUC) over the 52-week period. Notably, vascular changes also occurred in uninvolved perilesional skin.Conclusion
Risankizumab improved both clinical and OCT parameters over 52 weeks, emphasizing the importance of long-term therapy with benefits extending beyond visible improvement. OCT emerged as a valuable tool for assessing deep (vascular) treatment response, thereby supporting a more comprehensive understanding of therapeutic outcomes in psoriasis.Weiterlesen
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The German national psoriasis registry PsoBest collects long-term data on the effectiveness, safety, and tolerability of systemic treatments for psoriatic disease. Here, we describe patient characteristics and the safety and effectiveness of apremilast for the treatment of psoriatic disease in Germany based on data from PsoBest.Methods
This was a descriptive analysis of observational data collected from PsoBest using cross-sectional (baseline characteristics) and longitudinal (outcomes, safety) designs. PsoBest recruits patients with moderate to severe plaque psoriasis or psoriatic arthritis who initiate a new systemic psoriasis treatment. Adverse events (AEs) and sociodemographic descriptors were reported for patients exposed to apremilast during the study period (safety cohort). Clinical and patient-reported outcomes were collected 3, 6, and 12 months after the initiation of apremilast monotherapy (outcomes cohort).Results
From January 15, 2015 to June 30, 2020, 595 registry patients were exposed to apremilast; 417 were treated with apremilast monotherapy. Patients taking apremilast had a higher mean age and higher proportions of comorbidities such as cardiovascular or metabolic disease compared with those taking other nonbiologic systemic or biologic drugs. The most common nonserious AEs were drug ineffectiveness (14.1%), diarrhea (9.4%), nausea (7.1%), and headache (6.1%). The highest incidence rates of nonserious and serious AEs of special interest were for infections and infestations per system organ class (8.03/100 patient-years) and malignant or unspecified tumors (2.50/100 patient-years), respectively. Improvements in Dermatology Life Quality Index, patient-defined treatment benefits (Patient Benefit Index), body surface area, and Psoriasis Area and Severity Index were observed after 3, 6, and 12 months of apremilast treatment.Conclusions
Patients in routine care treated with apremilast in the German PsoBest registry experienced treatment benefits and improved skin, psoriasis severity, and quality of life. Safety was consistent with the established safety profile. Apremilast is safe and effective for treating moderate to severe psoriatic disease.Weiterlesen
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