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Neutrophile sind die häufigsten weißen Blutkörperchen im Blut und kommen als Erste zu Entzündungen oder Infektionen[1][4]. Sie können sogenannte Neutrophil Extracellular Traps (NETs) bilden[1][4]. NETs sind netzartige Strukturen aus DNA und Proteinen[1][3]. Sie fangen Keime ein und helfen, Infektionen zu bekämpfen[1][3]. Doch NETs können auch Probleme machen. Sie fördern Entzündungen und spielen eine Rolle bei Autoimmunerkrankungen wie Psoriasis sowie bei Thrombosen und Krebs[3][4]. So sind NETs wichtig, können aber auch Schaden anrichten. Originaltitel: Neutrophil Extracellular Traps (NETs) in Immunity and Diseases: Second Edition. Link zur Quelle

Background and objectivesContinuous biologic treatment is recommended for patients with psoriasis; however, treatment interruption in daily practice is inevitable. The impact of treatment interruption is difficult to study in a real-world setting. In Taiwan, biologics are reimbursed by the National Health Insurance for moderate-to-severe psoriasis for a 2-year course, followed by regulatory discontinuation. Thus, our study provides pragmatic data on the impact of the interruption of biologics treatment for non-medical reasons on therapy effectiveness.Patients and methodsThis single-center retrospective cohort study recruited patients who underwent two consecutive 2-year courses of biologics between 2012 to 2021.ResultsA total of 192 treatment courses from 61 patients were analyzed, with secukinumab and ustekinumab being the most frequently administered biologics. Among patients who continued with the same biologic across two consecutive courses, the time to achieve PASI 75 was shorter during the first course compared to the second, while overall maintenance effects remained similar. Switching to a different biologic usually produced superior results in the second course of treatment.ConclusionsAlthough the overall effectiveness after interruption and resumption of treatment with secukinumab or ustekinumab was comparable, the time to achieve PASI 75 was longer following an interruption. Continuous, uninterrupted treatment with a given biologic is therefore recommended whenever possible.Weiterlesen

No abstract supplied.Weiterlesen

Gluten-related disorders (GRDs) encompass a spectrum of clinical manifestations triggered by gluten ingestion in genetically susceptible individuals. These disorders include celiac disease (CD) and non-celiac gluten sensitivity (NCGS) and present with both intestinal and extraintestinal symptoms, including skin manifestations. Besides the well-known association between CD and dermatitis herpetiformis, considered as the cutaneous manifestation of CD, other dermatoses have been associated to GRDs. In this paper, we provide a concise overview of the clinical appearance, diagnosis and therapeutic management of GRDs, a tool which we hope will facilitate clinicians when faced with this challenging group of diseases.Weiterlesen

No abstract supplied.Weiterlesen

Tuberculosis (TB) continues to be a leading cause of death in many countries, and also remains a significant concern in Germany, particularly due to migration. The diagnosis of rare cutaneous tuberculosis is challenging as it manifests in various clinical forms that resemble more common dermatological conditions. Especially in paucibacillary forms, gold-standard diagnostic tests may yield negative results, complicating the identification of the disease. Therefore, a strong clinical suspicion based on the clinical presentation is essential for guiding further or repeated diagnostic evaluations. In this article, we present various forms of cutaneous tuberculosis, using excerpts from the image collection of the Department of Dermatology and Allergy at Biederstein, Technical University of Munich, to improve clinical recognition of cutaneous TB and raise awareness of this condition also as a potential differential diagnosis.Weiterlesen

No abstract supplied.Weiterlesen

Background and objectivesKnowledge on patient care gaps of prurigo nodularis (PN) is limited. This retrospective chart review (ADVANCE PN) investigated unmet medical needs and gaps in diagnostics, treatment, and management of patients with PN in routine care in Germany.Patients and methodsMedical records for adults newly diagnosed with PN between January 2012 and December 2022 from dermatologic clinics and office-based dermatologists were analyzed. Baseline demographics, treatment patterns, diagnostics, symptoms, patient-reported outcomes (PROs), and disease-specific scores are reported.ResultsRecords of 363 patients from 42 sites were analyzed. Median age (range) was 67 (19-95) years; most patients were female (61.7%), Caucasian (73.4%), and retired (57.3%). Overall, 209 (62.2%) patients had comorbidities (most common: hypertension [28.3%]). Clinically, most patients had nodules (81.1%) or papules (66.7%). PROs, disease-specific scores, and laboratory assessments were performed for 32 (8.8%), 12 (3.3%), and 71 (19.7%) patients, respectively. Topical corticosteroids (TCS) were the most common overall (90.9%) and first-line therapy (84.9%); for second-line therapy, 'no further treatment' was most commonly documented (58.6%).ConclusionsThe findings of ADVANCE PN indicate a high unmet need in the current state of medical care, evidenced by shortcomings in PRO assessment, PN documentation, and adherence to guidelines on PN.Weiterlesen

No abstract supplied.Weiterlesen

No abstract supplied.Weiterlesen

Secukinumab, a fully human monoclonal antibody that antagonizes interleukin-17A (IL-17A), has proven efficacious in the management of moderate to severe plaque psoriasis. Secukinumab has established itself as an effective treatment for plaque psoriasis, offering rapid and sustained symptom improvement. However, more research is warranted to assess its efficacy and safety in elderly patients, where clinical data is currently lacking. We describe an 84-year-old female presented with stable angina pectoris needed to be hospice cared. She had more than 30 years history of plaque psoriasis. The patient underwent treatment with secukinumab for two weeks. The skin lesions had been decreased rapidly and this greatly improved quality life of this patient. We report the clinical use of secukinumab in the treatment of elderly psoriasis and biologicals may be a new strategy for hospice care of patients with psoriasis.Weiterlesen

No abstract supplied.Weiterlesen

Moderate to severe psoriasis has been reported as an independent risk factor for IgA nephropathy (IgAN). IgAN is characterized by episodic microscopic hematuria, which can progress to end-stage renal disease (ESRD). Managing therapeutic interventions for psoriasis patients requiring dialysis due to ESRD presents significant challenges. We present a case of severe plaque psoriasis in a patient concurrently diagnosed with IgAN who is dependent on hemodialysis. Over the past two months, his condition has worsened without any identifiable triggers. Physical examination revealed generalized scaly plaques on the scalp, trunk, and extremities, resulting in a Psoriasis Area Severity Index (PASI) score of 19.2. Laboratory tests confirmed end-stage renal insufficiency, with no other abnormalities detected. Consequently, the patient was prescribed subcutaneous secukinumab following a standard regimen. He achieved complete resolution of symptoms after eight weeks of treatment and experienced no recurrence during a one-year follow-up. His kidney-related parameters remained stable during secukinumab therapy. To summarize, this case report discusses a patient with severe psoriasis who also has concurrent IgAN and ESRD, successfully treated with secukinumab. It reinforces the rapid efficacy and enduring safety of secukinumab in managing psoriasis in hemodialysis-dependent patients with IgAN comorbidity. Zeno Fratton et al has reported that an interleukin (IL)-17A/F inhibitor effectively treats moderate-to-severe psoriasis in patients with chronic kidney disease (CKD). However, further studies are necessary to develop evidence-based guidelines for biologic selection within this vulnerable population.Weiterlesen

BackgroundThe IL-17A inhibitors target aberrant immune responses in psoriasis but also impacts the host's defense against infections. The effects of this treatment on skin microorganisms and microbiome-encoded metabolic pathways remain unclear.ObjectivesThis was an exploratory clinical study designed to investigate whether Psoriasis is associated with skin microbiota, as well as a longitudinal cohort study aimed at revealing the effects of IL-17A inhibitor treatment on skin microbiota in Psoriasis.MethodsIn this study, we recruited 26 patients with moderate to severe psoriasis and 15 healthy controls. We collected skin microbiome samples from both greasy and dry skin regions. All samples were analyzed using 16S rDNA gene sequencing to determine the microbial profiles.ResultsCompared with healthy controls, the composition and function of skin microbiome in psoriasis patients are heterogeneous. Treatment with IL-17A inhibitors significantly increases the alpha diversity of the skin microbiota in psoriasis patients, indicating potential restoration of microbial community richness and evenness. However, this treatment does not entirely alter the taxonomic composition of the skin microbiota; rather, it shifts the relative abundance of specific microbial species, indicating that certain core microbial features remain relatively stable. Moreover, IL-17A inhibitors help adjust the functional profile of the skin microbiome in psoriasis patients, bringing it closer to that of healthy individuals.ConclusionsPsoriasis patients exhibit significant heterogeneity in both the composition and functionality of their skin microbiota. Although IL-17A inhibitor treatment fails to fundamentally alter its taxonomic composition, this therapy effectively enhances microbial community stability by increasing alpha diversity and modulating the relative abundance of various taxa. Additionally, it adjusts the functional profile of the skin microbiota towards a healthier state, thereby contributing to the restoration of microecological balance.Weiterlesen

Topical drugs containing corticosteroids are recommended first-line treatment for patients with mild-moderate psoriasis. However, the optimal recommended dosage of topical drugs has not been well established. To investigate the effect of topical drug application quantity and treatment duration on psoriasis treatment outcome. We conducted a post-hoc analysis of two randomized controlled trials investigating 214 patients with psoriasis using topical drugs containing corticosteroids and/or calcipotriol for up to 48 weeks. We measured the amount of topical drugs used during the study period and calculated the mean amount of applied drugs per 1% affected body surface area (BSA) divided by number of days in the study period. Improvement in severity of psoriasis was measured by Lattice-System Physician's Global Assessment (LS-PGA) (where affected BSA was divided into seven categories) from baseline to last study visit. Descriptive results were reported as counts with proportions, and as means with normality-based confidence intervals (CI). Associations were analyzed using linear regressions. Most study participants had a duration of psoriasis greater than 20 years, moderate psoriasis, and no history of using systemic psoriasis treatment. They had applied a mean of 1.0 g per 1% BSA per day (95% CI 0.9; 1.2). Daily use of topical drugs for four-weeks reduced severity of psoriasis. However, extended daily use for up to 48 weeks provided further reduction in disease severity (coefficient --0.30 (95% CI -0.51, -0.09)) and -0.73 (95% CI -1.09; -0.38) (P= 0.028). Greater amount of applied topical drugs reduced severity of psoriasis in a linear manner. Every increase of 1 g of topical drugs applied per 1% BSA per day reduced LS-PGA by 0.43 (95% CI 0.24; 0.61). Finally, patients who had never used systemic drugs experienced a greater reduction in psoriasis when applying the same mean amount of topical drugs (coefficient -0.7 (95% CI -1.1, -0.4) compared to those who had a history of taking systemic treatment (-0.3 (95% CI -0.5; -0.1), P=0.026). A mean application amount of at least 1.0 g of topical drugs per 1% BSA per day seems safe and effective and can be used daily until clearance.Weiterlesen

We developed and validated a novel analytical methodology for the precise quantification of deucravacitinib, an oral TYK2 inhibitor for treating moderate-to-severe plaque psoriasis in adults. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was employed in this method for sensitive detection of the compound in rat plasma. Analytical separation was performed utilizing an ACE C18 column (4.6 × 100 mm, 5-μm particle size) with a carefully optimized mobile phase composition of methanol and 2-mM ammonium formate (90:10, v/v), maintained at a consistent flow rate of 0.9 mL/min. Detection was executed in positive ionization mode, targeting multiple reaction monitoring (MRM) transitions of m/z 426.8 → 358.4 for the analyte and m/z 394.1 → 363.2 for the internal standard. The validation of the analytical method encompassed an assessment of selectivity, linearity, accuracy, precision, recovery, and stability. This method demonstrated stability, specificity, and no matrix effect at three concentration levels (1.606, 267.600, 507.780 ng/mL). The method's lower limit of quantification (LLOQ) is 0.556 ng/mL. The calibration curve demonstrates linearity from the LLOQ up to 668.132 ng/mL, exhibiting a high correlation coefficient (r2 = 0.9976). The intraday and interday precisions were less than 6.62% and 5.95%, respectively, with accuracies ranging from 90.68% to 103.80%. The recovery of deucravacitinib ranged from 95.34% to 103.80% and remained stable under different conditions. After successful validation, the method was used for pharmacokinetic profiling of deucravacitinib in rats following oral administration.Weiterlesen

No abstract supplied.Weiterlesen

Down syndrome (DS), also known as trisomy 21, is a genetic condition linked to a higher prevalence of skin disorders, including psoriasis, which affects up to 8% of individuals. DS patients with psoriasis present unique management considerations, including a theoretical increased risk of infectious complications with immunosuppressive therapies. This report includes two cases and a systematic review summarizing available evidence on psoriasis characteristics and treatment outcomes in individuals with DS. We report two DS patients with psoriasis demonstrating variable therapeutic responses: one controlled with acitretin and another requiring secukinumab after multiple treatment failures. To contextualize these findings, we conducted a systematic review following PRISMA guidelines, identifying 10 studies comprising 37 DS patients with psoriasis. Methotrexate was the most frequently failed therapy. Biologics targeting IL-17 and IL-23 pathways achieved the highest rates of complete resolution. These findings reflect Th1/Th17-driven inflammation in DS and highlight the need for individualized, pathway-specific management strategies.Weiterlesen

IntroductionPsoriasis is a chronic immune-mediated skin condition that has a substantial impact on patients' quality of life. The Saudi Arabia Psoriasis Registry (PSORSA) was established to address long-term real-world data (RWD) on systemic and biologic therapies in the region. This observational cohort study provides a comprehensive analysis of baseline disease characteristics, comorbidities, and treatment efficacy among patients enrolled in PSORSA, with an emphasis on risankizumab.MethodsData were sourced from a governmental online database covering multiple healthcare centers. Patients eligible for biologics were followed at baseline and at weeks 16, 28, 40, and 52 to evaluate disease severity, quality of life, and adherence. Statistical analyses were conducted using Jamovi and R. Descriptive statistics were performed for categorical and continuous variables. p-Values < 0.05 were considered significant.ResultsThe study cohort included 313 patients. Plaque psoriasis was the most prevalent clinical type (93.9%). An analysis of treatment history revealed that 39.6% of patients had prior therapy exposure, and all patients received risankizumab as a biologic therapy. At baseline, the mean Psoriasis Area and Severity Index (PASI) score was 25.49. By week 52, it had decreased to 0.358, indicating complete clearance. PASI scores showed a steady and substantial reduction over time, with an 88% reduction at week 16, 96% at week 28, 97.5% at week 40, and 98.5% by week 52, demonstrating a strong and sustained treatment effect (p < 0.001). Additionally, risankizumab exhibited a favorable drug survival profile, with many patients maintaining treatment beyond 122 weeks.ConclusionThis study represents the first real-world assessment of risankizumab for moderate-to-severe psoriasis in Saudi Arabia. The findings demonstrate that risankizumab is an effective and well-tolerated treatment for moderate-to-severe psoriasis in this Saudi Arabian cohort. However, future studies should explore long-term safety outcomes and the comparative effectiveness of risankizumab and emerging biologics in diverse patient populations.Weiterlesen

Wer seine Schuppenflechte (Plaque-Psoriasis) mit Biologika behandelt, sollte die Therapie am besten ohne Pause fortführen. Im Alltag lassen sich Unterbrechungen aber nicht immer vermeiden[2]. Nach einer Pause kann es länger dauern, bis die Haut wieder so gut wird wie vorher. Die Wirkung von Secukinumab oder Ustekinumab bleibt nach Wiedereinstieg zwar ähnlich, aber der Zustand bessert sich langsamer[2]. Wer nach einer Therapiepause auf ein anderes Biologikum wechselt, erzielt oft sogar bessere Ergebnisse als zuvor[2]. Trotzdem empfehlen Fachleute, möglichst keine unbeabsichtigten Unterbrechungen zu machen, weil eine durchgehende Behandlung schneller und verlässlicher wirkt[2]. Wechsel zwischen verschiedenen Biologika sind keine Seltenheit: Hauptgrund dafür ist meist, dass das Mittel nicht mehr genug wirkt[4]. Adalimumab und Ustekinumab gehören oft zu den am meisten genutzten Präparaten[4]. Originaltitel: Optimizing biologics for chronic plaque psoriasis: insights on non‐medical interruptions of IL‐17, IL‐12/23, and IL‐23 inhibitors Link zur Quelle

Axiale Psoriasis-Arthritis (axPsA) und axiale Spondyloarthritis (axSpA) sind beides entzündliche Erkrankungen, bei denen Rücken und Gelenke weh tun können[1][2]. Bei axSpA ist meistens das Kreuz-Darmbein-Gelenk zuerst betroffen und viele Patienten haben das HLA-B27-Gen[1]. Bei axPsA gibt es häufiger nur Probleme an der Wirbelsäule, oft im Nacken, und das HLA-B27-Gen fehlt häufiger[1][2]. Die Diagnose ist schwierig, weil es keine klaren Kriterien gibt und die meisten Medikamente für axPsA von axSpA übernommen werden[1][3]. Experten glauben, dass axPsA eigentlich eine eigene Krankheit ist[4]. Originaltitel: Similarities and differences: disentangling the intersection between axial psoriatic arthritis and axial spondyloarthritis. Link zur Quelle

Risankizumab hilft vielen Menschen mit mittelschwerer bis schwerer Plaque-Psoriasis auch nach sechs Jahren noch gut. In einer großen Studie hatten am Ende 86 Prozent der Teilnehmenden fast keine Beschwerden mehr, bei 54 Prozent waren die Symptome ganz verschwunden. Die Lebensqualität verbesserte sich bei etwa drei Viertel der Teilnehmenden spürbar. Nebenwirkungen traten selten auf und waren ähnlich wie in früheren Studien. Das Mittel wird langfristig gut vertragen und wirkt dauerhaft[2]. Originaltitel: Long-Term Safety and Efficacy of Risankizumab to Treat Moderate-to-Severe Plaque Psoriasis: Final LIMMitless Phase 3, Open-Label Extension Trial Results. Link zur Quelle

Biologika helfen vielen Menschen mit schwerer Schuppenflechte sehr gut. Laut einer Studie bringt eine durchgehende Behandlung mit Biologika die besten Ergebnisse[1][2]. Wenn man die Behandlung aber aus nicht-medizinischen Gründen unterbricht, dauert es beim Wiedereinstieg meist länger, bis die Haut wieder deutlich besser wird. Wer auf ein anderes Biologikum umsteigt, hat nach einer Pause teilweise sogar bessere Ergebnisse. Trotzdem empfehlen Fachleute, Biologika möglichst ohne Unterbrechung weiterzunehmen, damit sie am besten wirken[1][2]. Originaltitel: Optimizing biologics for chronic plaque psoriasis: insights on non-medical interruptions of IL-17, IL-12/23, and IL-23 inhibitors. Link zur Quelle

In der Effisayil® REP-Studie wird untersucht, wie wirksam und sicher das Medikament Spesolimab ist, wenn es intravenös (i.v.) bei Erwachsenen mit generalisierter pustulöser Psoriasis (GPP) eingesetzt wird, die nach einer ersten erfolgreichen Behandlung mit Spesolimab erneut einen Krankheitsschub erleiden. Die Studie prüft außerdem, ob und wie die Immunantwort des Körpers auf das Medikament (Immunogenität) dessen Wirksamkeit, Sicherheit und den Abbau im Körper beeinflusst. Ziel ist es zu sehen, ob Patienten nach einem erneuten Schub wieder gut auf Spesolimab ansprechen – gemessen daran, dass nach einer Woche keine sichtbaren Eiterbläschen mehr vorhanden sind. Spesolimab ist ein sogenannter monoklonaler Antikörper. Das bedeutet: Es handelt sich um ein biotechnologisch hergestelltes Eiweißmolekül, das gezielt an einen bestimmten Rezeptor im Körper bindet – in diesem Fall an den Interleukin-36-Rezeptor. Dieser Rezeptor spielt eine zentrale Rolle bei Entzündungsprozessen der Haut. Bei GPP kommt es durch eine Überaktivierung dieses Signalwegs zu starken Entzündungen und zur Bildung von schmerzhaften Eiterbläschen am ganzen Körper sowie zu systemischen Beschwerden wie Fieber oder Erschöpfung. Durch Blockade des IL-36-Rezeptors kann Spesolimab diese Entzündung stoppen und so die Symptome rasch lindern. Originaltitel: Effisayil® REP: An open-label, multicenter, single-arm, post-marketing trial (in select countries) to evaluate efficacy and safety and the impact of immunogenicity on efficacy, safety, and pharmacokinetics of spesolimab i.v. in treatment of patients with Generalized Pustular Psoriasis (GPP) presenting with a recurrent flare following their initial GPP flare treatment with spesolimab i.v. Erkrankung: Generalisierte pustulöse Psoriasis (GPP) Phase: Phase III/IV Firma: Boehringer Ingelheim International GmbH / Boehringer Ingelheim Espana S.A. Art der Verabreichung: Intravenöse Injektion https://euclinicaltrials.eu/search-for-clinical-trials/?lang=en&EUCT=2022-502128-38-00

Neutrophil Extracellular Traps, kurz NETs, sind besondere Netzwerke aus DNA und Proteinen, die bestimmte weiße Blutkörperchen – die Neutrophilen – freisetzen. Diese Netze fangen Krankheitserreger wie Bakterien ein und helfen so dem Immunsystem, uns zu schützen[1][3]. Wenn es aber zu viele NETs gibt oder sie nicht richtig abgebaut werden, können sie auch Entzündungen auslösen und an Krankheiten wie Autoimmunerkrankungen oder Thrombosen beteiligt sein[3]. Forscher untersuchen NETs deshalb auch in Bezug auf Psoriasis, denn hier steht das Immunsystem ständig unter Strom. Originaltitel: Neutrophil Extracellular Traps (NETs) in Immunity and Diseases: Second Edition Link zur Quelle