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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

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

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

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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

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BackgroundThe pathogenesis of nummular eczema (NE) remains unclear, and no targeted therapy has been approved. Apremilast is a small molecule inhibitor targeting phosphodiesterase-4.Patients and methodsA phase IIb randomized, double-blind, placebo-controlled study evaluating the effects of apremilast or placebo in patients with NE. Patients received apremilast (30 mg BID) or placebo until week 16 followed by an open label phase in which all patients were treated with apremilast until week 32. The primary endpoint was the number of patients achieving an improvement in Physician's Global Assessment (PGA) by two or more points or an absolute PGA of 0 or 1 at week 16. Secondary endpoints included changes in skin physiology, life quality, or dermato-pathology.Results33 patients were enrolled, of whom 31 were randomized to apremilast (n = 15) or placebo (n = 16). 1/15 (6.7%) patients in the apremilast group and 4/16 (25.0%) in the placebo group reached the primary endpoint (p = 0.369). There was no difference between placebo and apremilast with regard to all secondary endpoints at week 16 and week 32. The safety profile was in accordance with the known safety profile of apremilast.ConclusionPhosphodiesterase-4 inhibition by apremilast showed no beneficial effects for the treatment of NE.Weiterlesen

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No abstract supplied.Weiterlesen

BackgroundThere are only limited histomorphological data on the response of psoriatic skin lesions to topical dithranol. In vivo reflectance confocal microscopy (RCM) in psoriatic skin is highly correlated with histopathological findings and allows non-invasive monitoring of treatment effects on a cellular level.Patients and methodsProspective, single-center pilot study at a university-based clinic of dermatology between January 1st and August 30th, 2016. Psoriatic lesions of 20 patients receiving dithranol treatment were assessed by RCM at baseline, day 4 and 8 of treatment.ResultsRCM measurements of psoriatic lesions receiving dithranol treatment revealed epidermal histomorphological changes with a strong median reduction of baseline hyperkeratosis by 45.0% (p < 0.001), acanthosis by 38.2% (p < 0.001), and epidermal thickness by 66.5% (p < 0.001) from baseline until day 8. Moreover, semiquantitative measurements of parakeratosis also showed a significant reduction until day 8 (p < 0.001). Correspondingly, RCM revealed dermal histomorphological changes with a decrease in diameter of dermal papillae by 32.1% (p < 0.001), decrease in diameter of papillary vessels by 16.9% (p = 0.002) and a strong semiquantitative reduction of the inflammatory infiltrate (p < 0.001).ConclusionsResults from our pilot study indicate that topical dithranol treatment of psoriatic lesions may induce a rapid and marked reduction of pathologic epidermal and dermal RCM features.Weiterlesen

Abstract Psoriasis is a chronic skin condition characterized by the rapid growth of skin cells, leading to the formation of thick, scaly patches. Detecting these lesions accurately is crucial for early diagnosis and effective treatment. However, the variability in lesion size, shape, and appearance across different skin types presents significant challenges for automated detection systems. Traditional methods often struggle with these variations, leading to reduced accuracy and efficiency. In recent years, convolutional neural networks (CNNs) have emerged as a powerful tool for medical image analysis, particularly in the detection of skin conditions. This paper introduces a novel approach for psoriasis lesion detection using convolutional neural networks (CNNs). The challenge of accurately identifying lesions across various skin types and lesion sizes is addressed by leveraging a scale-aware strategy. In this method, a CNN first estimates the scale distribution of psoriasis lesions within an image by predicting a scale histogram. This histogram serves as a guide for image scaling operations, ensuring that lesions are brought to a uniform scale for subsequent detection. By applying zoom-in and zoom-out transformations based on the predicted scale histogram, the model reduces computational overhead while maintaining high detection accuracy. The proposed approach demonstrates improved efficiency and accuracy in identifying psoriasis lesions, as compared to traditional multi-scale testing techniques, with reduced computational demands. Extensive qualitative and quantitative evaluations on various skin datasets show that the scale-aware strategy significantly enhances lesion detection performance, making it a promising tool for automated psoriasis diagnosis. Weiterlesen

ObjectivesThrough this meta-analysis, we aim to provide an overview and statistical synthesis of the prevalence of MetS and its components in psoriatic arthritis (PsA) compared to the general populations, patients with cutaneous psoriasis (PsO), and patients with other inflammatory arthropathies.MethodA search was conducted in Ovid Medline, Web of Science, and Scopus up to February 2024. Original articles investigating the prevalence of MetS in PsA in adults compared to one or more comparison populations were included. Bias risk was assessed by means of a funnel plot. The data was analyzed by means of a random effects model and presented in forest plots.ResultsOf 1526 articles in the original search, 20 relevant were identified. Meta-analyses showed an increased prevalence of MetS in PsA compared to the general population, rheumatoid arthritis (RA), and ankylosing spondylitis (AS) (LogOR 0.93, 0.63, and 1.04, respectively). Meta-analysis showed no difference in the prevalence of MetS in PsA compared to PsO (LogOR 0.15, I2 0.63). Meta-analysis of the prevalence of the different components of MetS in PsA compared to RA showed an increased prevalence of central obesity, hypertriglyceridemia, impaired glucose tolerance, and diabetes mellitus.ConclusionsPsA was associated with an increased risk of MetS compared to the risk in the general population, in RA and in AS, respectively. This emphasizes the importance of screening for and taking necessary measures to prevent MetS in patients with PsA. Key Points • Patients with PsA have an increased risk of MetS compared to the general population as well as patients with RA or AS. • According to this meta-analysis, the risk of MetS is the same in patients with PsA as in patients with PsO.Weiterlesen

Psoriasis and psoriatic arthritis are chronic autoimmune diseases characterized by dysregulated immune responses, particularly involving Th17 cells. Immune checkpoint molecules such as programmed death-1 (PD-1) and its ligands (PD-L1/PD-L2) are critical for maintaining immune tolerance. Disruptions in these pathways contribute to psoriatic disease pathogenesis. Notably, immune checkpoint inhibitors used in cancer therapy have been linked to the development of psoriasis or its exacerbation. This highlights the complex role of checkpoint pathways in psoriatic diseases. Thus, immune checkpoint agonists could be a therapeutic strategy aimed at restoring immune balance without widespread immunosuppression. Preclinical studies demonstrate that PD-1 agonists can mitigate inflammation by enhancing inhibitory signaling. Additionally, early-phase clinical trials in autoimmune diseases such as rheumatoid arthritis and ulcerative colitis suggest potential benefits of PD-1 modulation in psoriasis. This review explores immune checkpoint agonists in psoriatic disease as a promising alternative to conventional immunosuppressants by selectively suppressing pathogenic T-cell activity.Weiterlesen

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No abstract supplied.Weiterlesen

BackgroundGenetic susceptibility to psoriasis involves multiple loci, including TYK2 (Tyrosine Kinase 2), which is associated with various autoimmune diseases. However, its specific role and mechanisms in psoriasis remain unclear. This study aimed to identify psoriasis-associated proteins using Summary-based Mendelian Randomization (SMR) and to explore their regulatory mechanisms.MethodsSMR analysis integrating pQTL data was conducted to identify proteins linked to psoriasis, revealing ICAM1 (Intercellular Adhesion Molecule 1) as a potential pathogenic factor. A key SNP, rs34536443 (P1104A), located in TYK2, was found to regulate ICAM1. To assess its function, THP-1 cells carrying the TYK2-P1104A mutation were generated, and ICAM1 and cytokine expression were analyzed following LPS stimulation. The effect of the TYK2 inhibitor Deucravacitinib was tested in an imiquimod (IMQ)-induced psoriasis mouse model.ResultsSMR identified ICAM1 as a causal protein for psoriasis, regulated by the TYK2 SNP rs34536443. In TYK2-P1104A mutant THP-1 cells, LPS-induced ICAM1 expression was significantly reduced, with ICAM5 unaffected. The mutation also suppressed IL-1β, TNF-α, IL-6, and IL-18 expression, suggesting anti-inflammatory effects. Single-cell RNA-seq revealed enrichment of TYK2, ICAM1, and ICAM5 in dendritic cells and monocytes. In vivo, Deucravacitinib significantly downregulated ICAM1 in the IMQ-induced psoriasis model, with minimal effect on ICAM5.ConclusionThis study identifies ICAM1 as a key mediator in psoriasis via SMR analysis and implicates the TYK2 SNP rs34536443 in its regulation. The TYK2-P1104A variant attenuates ICAM1 and cytokine expression, and Deucravacitinib downregulates ICAM1 in vivo. These findings provide mechanistic insights into the TYK2-ICAM1 axis and support the therapeutic potential of TYK2 inhibitors for psoriasis.Weiterlesen

Psoriasis is a common chronic inflammatory skin disease that significantly affects patients'quality of life. There is no cure for psoriasis, and available treatments are not completely effective. We have previously found that hydroxytyrosol (HT) has anti-psoriatic effects in vitro. In the present study, we aimed to investigate the therapeutic effects of HT on psoriasis in vivo and to explore the underlying mechanisms. We explored the effects and molecular mechanisms of HT on imiquimod (IMQ)-induced psoriasis-like dermatitis in mice and an M5-induced in vitro cell model using real-time PCR, western blotting, hematoxylin-eosin staining, immunohistochemistry, and enzyme-linked immunosorbent assay. HT (10 mg/kg/d or 50 mg/kg/d, by gavage) ameliorated IMQ-induced clinical manifestations in mice. Moreover, HT ameliorated the histopathological changes and decreased the spleen index and levels of pro-inflammatory cytokines, such as interleukin (IL)-17 A, IL-23, and IL-22, in mouse serum or skin. Mechanistically, HT application inhibited the activation of ERK and NF-кB signaling in the skin samples. Consistently, in vitro analysis showed that HT significantly inhibited inflammation via ERK and NF-κB signaling in a cellular model of psoriasis. Our results indicate that HT alleviates IMQ-induced psoriasis-like dermatitis by inhibiting the ERK and NF-κB signaling pathways, suggesting that HT has a promising therapeutic application in psoriasis treatment.Weiterlesen

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Background/purposeWhile biologics and small-molecule inhibitors are first-line systemic treatments for psoriasis, phototherapy remains an alternative for patients unable to access these treatments because of medical or financial constraints. Narrow-band ultraviolet B (NB-UVB) is effective for localized psoriasis but less so for extensive disease. To address this limitation, bathwater delivery of psoralen plus ultraviolet A (bath-PUVA) was introduced in 2004. This study evaluates the efficacy, safety, and patient characteristics associated with bath-PUVA therapy in a large cohort.MethodsThis retrospective analysis included 229 patients (180 males, 49 females) treated with bath-PUVA from 2004 to September 2021. Baseline characteristics and treatment outcomes were assessed using the psoriasis area and severity index (PASI). Statistical analyses examined relationships between treatment outcomes and factors, including baseline PASI, body mass index (BMI), and smoking status.ResultsThe mean baseline PASI score was 24.9. Bath-PUVA achieved PASI 75 in 80.4% of patients, PASI 90 in 44.1%, and PASI 100 in 2.6%, with efficacy comparable to biologics. Patients achieving PASI 90 had significantly higher baseline PASI scores (p = 0.005), while the number of irradiations required did not differ (p = 0.692). Higher baseline PASI scores correlated with elevated BMI (p = 0.002), but BMI did not influence improvement rates (p = 0.094). Smokers had significantly higher baseline PASI scores (p = 0.004) compared with non-smokers, yet smoking status did not affect improvement rates (p = 0.862).ConclusionBath-PUVA demonstrates efficacy comparable with biologics for psoriasis, regardless of BMI or smoking status. This analysis supports its use as an effective and accessible treatment option for patients with extensive disease.Weiterlesen

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In dieser Studie wird untersucht, wie wirksam, sicher und verträglich **TAK-279** (auch bekannt als Zasocitinib) bei Erwachsenen mit mittelschwerer bis schwerer Plaque-Psoriasis ist. Die Teilnehmenden werden zufällig einer von drei Gruppen zugeordnet: Sie erhalten entweder TAK-279, das bereits zugelassene Medikament Apremilast (Otezla) oder ein Placebo. Ziel ist es, herauszufinden, ob TAK-279 die Hautsymptome (wie Rötung, Schuppung und Verdickung) besser reduziert als die Vergleichsmedikamente und wie gut es insgesamt vertragen wird. Die wichtigsten Messgrößen sind, wie viele Patient:innen nach 16 Wochen eine fast oder ganz erscheinungsfreie Haut erreichen und wie stark sich der Schweregrad der Psoriasis verbessert. **TAK-279** ist ein sogenannter **TYK2-Inhibitor** (Tyrosin-Kinase-2-Hemmer). Das bedeutet, dass die Substanz gezielt einen bestimmten Signalweg im Immunsystem blockiert, der bei der Entstehung von Entzündungen und Autoimmunerkrankungen wie Psoriasis eine Rolle spielt. Im Unterschied zu vielen bisherigen Therapien handelt es sich bei TAK-279 um eine Tablette, die täglich eingenommen wird. In früheren Studien zeigte sich, dass TAK-279 bei vielen Patient:innen zu einer deutlichen Besserung der Haut führte, ohne dass schwere Nebenwirkungen wie bei anderen Immunmodulatoren auftraten. Häufige Nebenwirkungen waren milde Beschwerden wie Durchfall oder Hautausschläge. Originaltitel: A Phase 3, Randomized, Multicenter, Double-Blind, Placebo- and Active Comparator-Controlled Study to Evaluate the Efficacy, Safety, and Tolerability of TAK-279 in Subjects with Moderate-to-Severe Plaque Psoriasis Erkrankung: mittelschwere bis schwere Plaque-Psoriasis Phase: III Firma: Takeda Development Center Americas Inc. Art der Verabreichung: Tablette https://euclinicaltrials.eu/search-for-clinical-trials/?lang=en&EUCT=2023-505841-22-00

In dieser Studie wird untersucht, wie wirksam, sicher und verträglich die Substanz TAK-279 bei Erwachsenen mit mittelschwerer bis schwerer Plaque-Psoriasis ist. Die Teilnehmer erhalten entweder TAK-279, ein Placebo oder Apremilast (ein bereits zugelassenes Medikament) und werden über einen Zeitraum von bis zu 69 Wochen behandelt. Ziel ist es herauszufinden, ob TAK-279 die Hautveränderungen (Plaques) besser reduziert als Placebo oder der aktive Vergleichspartner. TAK-279 ist ein sogenannter TYK2-Inhibitor – das heißt, er blockiert gezielt ein Enzym (Tyrosin-Kinase 2), das eine Rolle bei Entzündungsprozessen im Körper spielt. Durch diese Blockade sollen entzündliche Reaktionen unterdrückt werden, die für die Schuppenflechte typisch sind. Im Unterschied zu vielen anderen Therapien handelt es sich um eine Tablette zur oralen Einnahme – also keine Spritze oder äußerliche Anwendung. Die wichtigsten Ziele der Studie sind: Wie viele Patienten erreichen nach 16 Wochen eine fast oder komplett erscheinungsfreie Haut? Und wie viele schaffen eine Verbesserung um mindestens 75 % im sogenannten PASI-Wert (ein Maß für den Schweregrad der Psoriasis)? Auch weitere Verbesserungen wie PASI-90 und PASI-100 sowie Veränderungen an Nägeln und Kopfhaut werden betrachtet. Originaltitel: A Phase 3, Randomized, Multicenter, Double-Blind, Placebo- and Active Comparator-Controlled Study With a Randomized Withdrawal and Retreatment Period to Evaluate the Efficacy, Safety, and Tolerability of TAK-279 in Subjects With Moderate-to-Severe Plaque Psoriasis Erkrankung: mittelschwere bis schwere Plaque-Psoriasis Phase: III Firma: Takeda Development Center Americas Inc. Art der Verabreichung: Tablette (oral) https://euclinicaltrials.eu/search-for-clinical-trials/?lang=en&EUCT=2023-505842-24-00