Overview how IL-17 inhibitors target the inflammatory disease pathway

Summarize the clinical trial data for IL-17 inhibitors for psoriasis and psoriatic arthritis

Illustrate how to individualize care with IL-17 inhibitors for the management of psoriasis and psoriatic arthritis

Managing Psoriasis and Psoriatic Arthritis with IL-17 Inhibitors: What do we Know Today? Online CME Activity

Discuss current management advancement in dermatology from rashes through tumors

Compare strategies to manage dermatologic conditions from laser treatment through systemic therapies

Identify appropriate treatment options for dermatologic conditions based on patient and disease characteristics

Recognize the nuances of managing dermatologic conditions in skin of color

Underline strategies to optimize management in patients with dermatologic conditions

2023 Virtual Grand Rounds  Session 3: March 8, 2023 - WCM: Your Questions Answered

Illustrate strategies to manage dermatologic conditions effectively in clinical practice

Discuss the treatment of psoriasis and related disorders with evolving therapies

Describe the modalities for diagnosing and managing skin cancer

Describe strategies to prepare and administer fillers and botulinum

2023 Virtual Grand Rounds  Session 1: February 1, 2023 - WCH23 Your Questions Answered

Overview of key data for emerging topical therapies to manage plaque psoriasis

Describe how to individualize care with emerging topical therapies to optimize patient outcomes

Compare between the various topical therapies for the management of plaque psoriasis


Plaque Psoriasis: Itching for New Topical Options Online CME Activity

Overview IL-17 inhibitors for the management of moderate-to-severe psoriasis

Describe how to prevent and manage side effects associated with IL-17 inhibitors

Discuss strategies to individualize care for patients with moderate-to-severe psoriasis 

Matching the Right Patient with the Right Therapy: The Role of IL-17 Inhibitors for Psoriasis Online CME Activity

Psoriasis

<div class="body js-expandable clearfix js-listicle-body css-listicle-body-2655060646"><div class="body-description"><div id="utm_campaign"><div class="body js-expandable clearfix js-listicle-body css-listicle-body-2655327632"><div class="body-description"><div class="body js-expandable clearfix js-listicle-body css-listicle-body-2655486016"><div class="body-description"><div class="body js-expandable clearfix js-listicle-body css-listicle-body-2655432920"><div class="body-description"><p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(90, 88, 88);font-family:&quot;Source Sans Pro&quot;, sans-serif;font-size:18px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:100;letter-spacing:normal;margin-left:auto;margin-right:auto;margin-top:0px;max-width:980px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">WEDNESDAY, April 19, 2023 (HealthDay News) -- A child with psoriasis can have a negative effect on the mother's quality of life, according to a study published online March 31 in the Journal of Cosmetic Dermatology.<p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(90, 88, 88);font-family:&quot;Source Sans Pro&quot;, sans-serif;font-size:18px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:100;letter-spacing:normal;margin-left:auto;margin-right:auto;margin-top:0px;max-width:980px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">EmadEldin Abd Elmoneim Elgamal, M.D., from Al-Azhar University in Damietta, Egypt, and colleagues examined the effects of childhood psoriasis on mothers' quality of life. Participants included 100 mothers of children with psoriasis (pustular psoriasis, scalp and flexural psoriasis, solitary plaque psoriasis, palmoplantar psoriasis, and psoriasis vulgaris [4, 4, 4, 12, and 76 percent, respectively]). Mothers' quality of life was assessed using the Family Dermatology Life Quality Index (FDLQI).<p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(90, 88, 88);font-family:&quot;Source Sans Pro&quot;, sans-serif;font-size:18px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:100;letter-spacing:normal;margin-left:auto;margin-right:auto;margin-top:0px;max-width:980px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">The researchers found that mothers' FDLQI scores varied from 3 to 25, with a mean of 13. There was a substantial direct link observed between a mother's FDLQI score and their child's Psoriasis Area Severity Index score and age (r = 0.615 and 0.399, respectively), but no link was seen with the duration of psoriasis. The highest FDLQI scores were seen for scalp and flexural psoriasis and pustular psoriasis.<p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(90, 88, 88);font-family:&quot;Source Sans Pro&quot;, sans-serif;font-size:18px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:100;letter-spacing:normal;margin-left:auto;margin-right:auto;margin-top:0px;max-width:980px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">"Childhood psoriasis may be a highly time-consuming and financially burdensome issue for relatives, leading to substantial emotional distress," the authors write. "So, psychological support strategies must be offered to both the pediatric patients, and to the family members."<p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(90, 88, 88);font-family:&quot;Source Sans Pro&quot;, sans-serif;font-size:18px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:100;letter-spacing:normal;margin-left:auto;margin-right:auto;margin-top:0px;max-width:980px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;"><a class="rm-stats-tracked" style="color:rgb(50, 170, 236);overflow-wrap:break-word;text-decoration:none;" target="_blank" rel="noopener noreferrer" href="https://onlinelibrary.wiley.com/doi/10.1111/jocd.15737">Abstract/Full Text</a><a target="_blank" rel="noopener noreferrer" href="https://consumer.healthday.com/u/physiciansbriefingstaff"><img style="max-width:150px;" src="https://assets.rbl.ms/23636171/origin.png" alt="HealthDay"></a></div></div></div></div></div></div></div></div></div>

Positive association seen between mothers' Family Dermatology Life Quality Index scores and children's Psoriasis Area Severity Index scores

Child With Psoriasis Negatively Impacts Mom's Quality of Life

<div class="body js-expandable clearfix js-listicle-body css-listicle-body-2655060646"><div class="body-description"><div id="utm_campaign"><div class="body js-expandable clearfix js-listicle-body css-listicle-body-2655327632"><div class="body-description"><div class="body js-expandable clearfix js-listicle-body css-listicle-body-2655486016"><div class="body-description"><div class="body js-expandable clearfix js-listicle-body css-listicle-body-2655432920"><div class="body-description"><p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(90, 88, 88);font-family:&quot;Source Sans Pro&quot;, sans-serif;font-size:18px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:100;letter-spacing:normal;margin-left:auto;margin-right:auto;margin-top:0px;max-width:980px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">THURSDAY, April 20, 2023 (HealthDay News) -- There is good agreement between psoriasis severity assessed clinically and by photographs, according to a study recently published in JAAD International.<p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(90, 88, 88);font-family:&quot;Source Sans Pro&quot;, sans-serif;font-size:18px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:100;letter-spacing:normal;margin-left:auto;margin-right:auto;margin-top:0px;max-width:980px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">Zarqa Ali, M.D., Ph.D., from Copenhagen University Hospital Bispebjerg in Denmark, and colleagues examined the extent to which smartphone photographs together with a self-reported body region (BR) score can be used to evaluate psoriasis severity. Severity of psoriasis was assessed using the Psoriasis Area and Severity Index (PASI) and the Physician's Global Assessment (PGA) in the clinic. On the same day, patients took a photograph of a representative lesion from four BRs (head/neck, upper limbs, trunk, and lower limbs); a questionnaire about BR score was completed. Five dermatologists rated the photographs.<p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(90, 88, 88);font-family:&quot;Source Sans Pro&quot;, sans-serif;font-size:18px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:100;letter-spacing:normal;margin-left:auto;margin-right:auto;margin-top:0px;max-width:980px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">Thirty-two patients were included: 6, 69, and 25 percent had almost clear, mild, and moderate psoriasis, respectively. The researchers found that 59 percent had perfect agreement between the self-reported and doctors' BR score; near perfect agreement was 92 percent. The intraclass correlation coefficient was 0.78 between clinical and photographic PASI. For PGA, perfect agreement was 53 percent.<p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(90, 88, 88);font-family:&quot;Source Sans Pro&quot;, sans-serif;font-size:18px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:100;letter-spacing:normal;margin-left:auto;margin-right:auto;margin-top:0px;max-width:980px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">"There is a good agreement between severity of psoriasis assessed on photographs taken by the patient with a smartphone of a target lesion in combination with self-reported extent of skin involvement and the clinical assessment of psoriasis," the authors write. "Future studies should investigate the validation of photographic assessment in the entire range of psoriasis severity and across all skin types and ethnicities."<p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(90, 88, 88);font-family:&quot;Source Sans Pro&quot;, sans-serif;font-size:18px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:100;letter-spacing:normal;margin-left:auto;margin-right:auto;margin-top:0px;max-width:980px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">Several authors were employed by Studies&amp;Me, which funded the study.<p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(90, 88, 88);font-family:&quot;Source Sans Pro&quot;, sans-serif;font-size:18px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:100;letter-spacing:normal;margin-left:auto;margin-right:auto;margin-top:0px;max-width:980px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;"><a class="rm-stats-tracked" style="color:rgb(50, 170, 236);overflow-wrap:break-word;text-decoration:none;" target="_blank" rel="noopener noreferrer" href="https://www.jaadinternational.org/article/S2666-3287(23)00031-7/fulltext">Abstract/Full Text (subscription or payment may be required)</a><a target="_blank" rel="noopener noreferrer" href="https://consumer.healthday.com/u/physiciansbriefingstaff"><img style="max-width:150px;" src="https://assets.rbl.ms/23636171/origin.png" alt="HealthDay"></a></div></div></div></div></div></div></div></div></div>

Intraclass correlation coefficient 0.78 between clinical and photographic Psoriasis Area and Severity Index

Good Agreement Found for Clinical, Photograph Assessment of Psoriasis

Mild psoriasis aligns well with the patient-reported outcome of patient acceptable symptom state (PASS), according to a study published in the April issue of the
 
 Journal of Dermatology
 
 .




 Qiaolin Wang, from Central South University in Changsha, China, and colleagues examined the association of PASS with the Psoriasis Area and Severity Index (PASI) and body surface area (BSA) affected by lesions among 198 patients with psoriasis. PASS was assessed by a binary question relating to the patient's feeling that they have about their symptoms.




 The researchers found that most patients with mild psoriasis considered their symptom state acceptable (71.4 percent and 76.3 percent based on the PASI and BSA, respectively). The likelihood of reporting an acceptable symptom state was lower in association with female sex and for patients with exposed skin involved (adjusted odds ratios, 0.47 and 0.38, respectively). The threshold for differentiating psoriasis patients in PASS was 3.85 and 2.85 percent for the PASI and BSA, respectively (area under the curve, 0.67, sensitivity, 0.67, and specificity, 0.60 for PASI; area under the curve, 0.66, sensitivity, 0.79, and specificity, 0.54 for BSA).




 "This study accentuated the importance of patient-reported measures, which should be taken into consideration in treatment decision-making processes," the authors write. "We found that patients with mild psoriasis had a high proportion of acceptable status, while female sex and exposed skin involved were factors for less acceptability."




 <a class="rm-stats-tracked" href="https://onlinelibrary.wiley.com/doi/10.1111/1346-8138.16299" target="_blank">
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Both Psoriasis Area and Severity Index and body surface area have limited capability for differentiating acceptable symptom state

Mild Psoriasis Aligns With Patient-Reported Outcome of PASS

Health concepts can be categorized into five domains across patient-reported outcome measures (PROMS) assessing health-related quality of life for psoriasis, according to research published online Jan. 10 in
 
 JAAD International
 
 .




 Haya A. Homsi, M.D., M.P.H., from the Cleveland Clinic, and colleagues identified and described the content captured by existing psoriasis PROMs. Thirteen psoriasis-specific, two dermatology-specific, and one generic PROM were assessed, with a total of 284 PROM items.




 The researchers found that each item had an average of 2.28 health concepts; across all PROMs, there were 295 unique health concepts. The health concepts could be categorized into 25 subdomains, with five general domains: physical well-being, psychological well-being, social well-being, treatment, and vitality. Social and psychological well-being were the most frequently captured domains (40.5 and 32.4 percent, respectively). For each PROM, there were differences seen in the relative domains included. None of the PROMs captured all five domains, and some had a relative emphasis on one domain, with Psoriasis Quality of Life Questionnaire-12 and Psoriasis Index Quality of Life emphasizing psychological well-being and Psodisk emphasizing physical well-being.




 "PROMs provide valuable information to understand the lived experience of psoriasis, which can be used to better individualize management in clinical practice," the authors write. "This analysis provides a framework to guide clinicians and researchers for selecting which PROM is most relevant to their specific needs."




 <a class="rm-stats-tracked" href="https://www.jaadinternational.org/article/S2666-3287(23)00002-0/fulltext" target="_blank">
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Most frequently captured domains are social well-being and psychological well-being; no PROM captured all five domains

Health Concepts From PROMs Can Be Classified Into Five Domains for Psoriasis

Short-term air pollutant exposures are associated with psoriasis, according to a study published online Dec. 22 in
 
 Frontiers in Public Health
 
 .




 Ting Wang, from the School of Public Health at Anhui Medical University in Hefei, China, and colleagues examined the short-term effects of air pollutants on outpatients with psoriasis in China between 2015 and 2019. Patients of different ages and genders were included in the stratified analyses.




 The researchers found that an increase of 10 μg/m
 
 3
 
 of nitrogen dioxide was associated with a 2.1 percent increase in outpatients with psoriasis, while a decrease of 10 μg/m
 
 3
 
 of ozone was associated with a 0.8 percent increase in outpatients with psoriasis. Male patients were more sensitive to a change in meteorological factors, while female patients and outpatients with psoriasis aged 17 years or younger were more sensitive to a change in air pollutants.




 "In conclusion, short-term air pollutant exposures were correlated with the occurrence of psoriasis in outpatients. Females, and outpatients with psoriasis aged 0 to 17 years old, were more sensitive to the changes in air pollutants," the authors write. "This finding suggests that patients and people at high risk of psoriasis should reduce their time outdoors and improve the quality of their protective gear when the air quality is poor."




 <a class="rm-stats-tracked" href="https://www.frontiersin.org/articles/10.3389/fpubh.2022.1071263/full" target="_blank">
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Females, children more sensitive to changes in air pollutants

Air Pollution Tied to Psoriasis Occurrence

Air pollution from wildfires is associated with modestly increased rates of clinic visits for psoriasis among adults starting five weeks after the fire, according to a research letter published online Jan. 13 in
 
 JAMA Network Open
 
 .




 Raj P. Fadadu, from the University of California in San Francisco, and colleagues examined whether clinic visits and online search interest in psoriasis were associated with wildfire air pollution. Data were obtained for outpatient dermatology visits for psoriasis at an academic medical center in San Francisco from Oct. 1, 2018, to Feb. 10, 2019 (including the California Camp Fire, which occurred 175 miles away from San Francisco); Oct. 1, 2015, to Feb. 10, 2016 (no fires); and Oct. 1, 2016, to Feb. 10, 2017 (no fires). In addition, weekly online search interest data were collected (search value index [SVI]) from Google Trends for the term "psoriasis" in 2018 in San Francisco.




 A total of 986 clinic visits were analyzed (914 for adults). The researchers found that for adults, the earliest statistically significant increase in visits to the psoriasis clinic occurred at the five-week lag and peaked at the eight-week and nine-week lags (adjusted rate ratios, 1.32, 1.45, and 1.45, respectively). For pediatric patients, no significant results were seen. From Oct. 4, 2018, to Jan. 30, 2019, the mean weekly SVI for psoriasis increased starting at five weeks after the fire and peaking at eight weeks.




 "Understanding environmental triggers is important for appropriately counseling patients regarding the risk of pollution-induced psoriasis flares as wildfires increase," the authors write.




 <a class="rm-stats-tracked" href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2800402" target="_blank">
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Air pollution from wildfire linked to modestly increased rates of clinic visits for psoriasis among adults starting five weeks after fire

Rates of Clinic Visits for Psoriasis Increased for Adults After Wildfires

The incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection does not differ for patients with psoriasis receiving biologics or nonbiologic systemics versus other treatments, according to a study published online Dec. 22 in the
 
 Journal of Dermatological Treatment
 
 .




 K.V. Kwee, M.D., from Bravis Hospital in Roosendaal, Netherlands, and colleagues examined the prevalence of SARS-CoV-2 infection in psoriasis patients and compared infection rates for different psoriasis treatment groups in a cross-sectional study. A questionnaire was administered to 551 patients included between April 12, 2021, and Oct. 31, 2021. Participants also underwent a blood test to screen for antibodies to SARS-CoV-2 N-antigen.




 The researchers found that based on questionnaire data combined with serologic data, 59 patients (10.7 percent) had experienced a SARS-CoV-2 infection. The risk for SARS-CoV-2 infection did not seem to be increased for biologic or nonbiologic systemic therapy users versus patients using other treatment in analyses corrected for confounders. Only four hospitalizations were reported, and there were no reports of admissions to the intensive care unit. In all treatment groups, the rough mortality rate was 0.32 percent.




 "Our results do not contradict current recommendations to continue biologics and systemic antipsoriatic drugs during the COVID-19 pandemic," the authors write.




 Several authors disclosed financial ties to pharmaceutical companies, including Novartis, which funded the PsoCovid study.




 <a class="rm-stats-tracked" href="https://www.tandfonline.com/doi/full/10.1080/09546634.2022.2161297?src=" target="_blank">
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Incidence of SARS-CoV-2 infection no higher with biologics, nonbiologic systemics versus other treatments

Is Risk for SARS-CoV-2 Infection Increased With Biologics in Psoriasis?

About 10 percent of patients with psoriasis have a high risk for advanced liver fibrosis, according to a systematic review and meta-analysis published online Dec. 15 in
 
 Frontiers in Medicine
 
 .




 Tanat Yongpisarn, from Mahidol University in Bangkok, and colleagues examined the prevalence of psoriasis patients who have a high or low risk for advanced liver fibrosis and examined risk factors for liver fibrosis using data from observational studies identified from a systematic literature review.




 The researchers found that the pooled prevalence was 9.66 percent for patients with psoriasis at high risk for advanced liver fibrosis, while the pooled prevalence was 77.79 percent for patients at low risk for advanced liver fibrosis. The prevalence of advanced liver fibrosis was lower in studies that recruited methotrexate-naive patients versus methotrexate-user cohorts (4.44 versus 12.25 percent). For age older than 50 years, body mass index &gt;30 kg/m², diabetes mellitus, hypertension, dyslipidemia, and metabolic syndrome, the pooled odds ratios were 2.20, 3.67, 6.23, 2.82, 3.08, and 5.98, respectively.




 "In this systematic review and meta-analysis, we discover that 9.66 percent of people with psoriasis are at high risk of having advanced liver fibrosis, necessitating further investigation and management. While 77.79 percent of the population is considered low risk, the remaining 22.21 percent requires further testing," the authors write. "We hope to inform practitioners and future researchers about the high prevalence of advanced liver fibrosis in psoriasis patients, as well as the critical need for liver fibrosis screening."




 <a class="rm-stats-tracked" href="https://www.frontiersin.org/articles/10.3389/fmed.2022.1068157/full" target="_blank">
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Increased odds ratios seen for advanced liver fibrosis with age older than 50 years, BMI &gt;30, diabetes, hypertension, dyslipidemia, metabolic syndrome

~10 Percent of Psoriasis Patients Have High Risk for Liver Fibrosis

Current depression is associated with systemic inflammation, specifically increased neutrophils in patients with psoriasis, especially women, according to a study published online Dec. 21 in the
 
 Journal of Investigative Dermatology
 
 .




 Georgia Lada, M.D., from the University of Manchester in the United Kingdom, and colleagues used data from the U.K. Biobank for middle- to older-aged adults to examine the correlations of current and lifetime depression with neutrophil count, neutrophil-to-lymphocyte ratio (NLR), and high-sensitivity C-reactive protein (CRP) in psoriasis. The analysis included 5,485 psoriasis patients; 4,796 had lifetime depression data.




 The researchers found that compared with patients on topicals or untreated patients, those on systemic treatment exhibited higher CRP, NLR, and neutrophil counts, suggesting higher systemic disease activity. No association was seen for CRP or NLR with current or lifetime depression, although there was a trend toward lifetime depression effect on CRP. When body mass index was omitted from models, CRP-depression associations were significant. Sex modified the effect of the association between neutrophils and the Patient Health Questionnaire (PHQ-2), which was used to assess current depression. For women, the association of PHQ-2 scores with neutrophil count was greater and significant, even after accounting for lifetime depression. In both sexes, lifetime depression was associated with higher neutrophil counts.




 "The observed associations and their independence of lifestyle factors, comorbidities, and treatment-based psoriasis severity are suggestive of underlying immunological relationships with mood, particularly among women," the authors write. "It is important to elucidate further these associations in psoriasis through large prospective studies including multiple inflammatory markers."




 <a class="rm-stats-tracked" href="https://www.jidonline.org/article/S0022-202X(22)02894-9/fulltext" target="_blank">
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Correlation of PHQ-2 scores with neutrophil count greater and significant only for women

Current Depression Linked to Systemic Inflammation in Psoriasis

The rates of relapse are high following withdrawal of ustekinumab from psoriasis patients who responded to treatment, according to a study published in the January issue of the
 
 Journal of the American Academy of Dermatology
 
 .




 Hsein-Yi Chiu, M.D., Ph.D., from the National Taiwan University Hospital Hsin-Chu Branch, and colleagues examined predictors of relapse after ustekinumab withdrawal in patients with psoriasis. A total of 500 patients with psoriasis who received ustekinumab (669 treatment episodes) between 2011 and 2018 were screened; 202 patients with 304 treatment episodes who responded to therapy and were withdrawn from ustekinumab were included.




 The researchers found that after withdrawal from ustekinumab therapy, the cumulative probabilities of being relapse-free at six, 12, 18, 24, and 36 months were 49.3, 12.6, 5.3, 4.7, and 1.6 percent, respectively. After adjustments, significant predictors of time to relapse following discontinuation of ustekinumab included biologic-naive status, maximum improvement in the Psoriasis Area and Severity Index during ustekinumab treatment, time to achieve a 50 percent improvement in baseline Psoriasis Area and Severity Index score after initiation of ustekinumab, family history of psoriasis, chronic kidney disease, and immunosuppressant use while not taking ustekinumab.




 "Although a subset of patients with distinct characteristics relapsed more slowly after discontinuation of ustekinumab treatment, current evidence supports continuous treatment with biologics," the authors write.




 Several authors disclosed financial ties to pharmaceutical companies, including Janssen, which manufactures ustekinumab.




 <a class="rm-stats-tracked" href="https://www.jaad.org/article/S0190-9622(19)30142-2/fulltext" target="_blank">
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Cumulative probability of being relapse-free at 24 months after withdrawal was 4.7 percent

Rate of Relapse High After Ustekinumab Withdrawal in Psoriasis

Restless leg syndrome (RLS) is more common in psoriasis patients and is associated with more severe psoriasis, according to a study published online Dec. 5 in the
 
 International Journal of Dermatology
 
 .




 Berna Solak, M.D., from Sakarya University in Adapazar%u0131, Turkey, and colleagues conducted a cross-sectional study to examine whether psoriasis is associated with RLS. The study included 70 psoriasis patients and 70 controls without any skin disorder.




 The researchers found that the frequency of RLS was 18.6 and 5.7 percent in patients with psoriasis and controls, respectively. Body mass index (BMI), Dermatology Life Quality Index (DLQI), International RLS Rating Scale (IRLSRS), hemoglobin, ferritin, C-reactive protein (CRP), and uric acid levels were significantly higher in psoriasis patients than controls. The Psoriasis Area and Severity Index (PASI), DLQI, Pittsburgh Sleep Quality Index, IRLSRS scores, CRP levels, and BMI were significantly higher in psoriasis patients with RLS compared with psoriasis patients without RLS, and hemoglobin level was significantly lower. The only independent associate of RLS presence in psoriasis patients was PASI score.




 "The association of psoriasis and RLS might be owing to increased systemic inflammation frequently seen in psoriasis patients," the authors write.




 <a class="rm-stats-tracked" href="https://onlinelibrary.wiley.com/doi/10.1111/ijd.16532" target="_blank">
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Presence of RLS associated with significantly more severe psoriasis and more severe systemic inflammation

Restless Leg Syndrome More Common in Psoriasis Patients

A value-based outcome set (VOS) has been developed for psoriasis, according to an article published online Dec. 7 in the
 
 Journal of the European Academy of Dermatology and Venereology
 
 .




 Niels Timo Hilhorst, M.D., from Ghent University in Belgium, and colleagues developed an actionable VOS for psoriasis for daily practice in a mixed-method approach consisting of four phases. A systematic review was conducted to review all patient-relevant outcomes defined in the literature. The 23 outcomes identified were presented to patients using a modified nominal group technique (NGT). These outcomes were then ranked according to importance by patients from a specialized psoriasis clinic. To assess which instruments were available and suitable for assessing the outcomes, a review of the literature was performed.




 The researchers note that after the NGT, two of the 23 outcomes were omitted. One hundred twenty patients participated in the ranking exercise. Symptom control, treatment efficacy, confidence in care, and control of disease were the outcomes scored as most important; comorbidity control, productivity, and cost of care were the least important. The ranking of the outcomes differed significantly. To measure the outcomes in this VOS, 12 instruments, which are reported by both patient and provider, were selected. For the patient part, the median completion time was 30 minutes.




 "This first proposal of a VOS gives health care professionals insights on what might matter to their patients and shows how they could start measuring the value they create in daily clinical practice, with the resource setting they apply," the authors write.




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Twelve instruments were selected to measure outcomes in the value-based outcome set, which were reported by patients and providers

Value-Based Outcome Set Developed for Psoriasis

For adults with moderate-to-severe plaque psoriasis, mirikizumab is efficacious and safe over 52 weeks, according to a study published in the December issue of the
 
 British Journal of Dermatology
 
 .




 Andrew Blauvelt, M.D., from the Oregon Medical Research Center in Portland, and colleagues examined the efficacy and safety of mirikizumab in adults with moderate-to-severe plaque psoriasis through 52 weeks. A total of 530 patients were randomly assigned to subcutaneous mirikizumab 250 mg or placebo every four weeks (Q4W) in a 4:1 ratio through week 16. Responders were randomly reassigned to mirikizumab 250 mg Q8W, mirikizumab 125 mg Q8W, or placebo Q8W through 52 weeks.




 The researchers found that all primary and key secondary end points were met. Static Physician's Global Assessment score of 0 or 1 (sPGA[0,1]) responses were significantly greater with mirikizumab than placebo (69.3 versus 6.5 percent) at week 16. A ≥90 percent improvement in the Psoriasis Area and Severity Index (PASI 90) response occurred in significantly more patients receiving mirikizumab versus placebo (64.3 versus 6.5 percent). In addition, significantly more patients receiving mirikizumab than those receiving placebo achieved PASI 75 and PASI 100 (82.5 and 32.4 versus 9.3 and 0.9 percent, respectively). At week 52, PASI 90, PASI 100, and sPGA(0,1), respectively, occurred in 19, 10, and 18 percent of those receiving mirikizumab 250 mg Q4W/placebo Q8W; 86, 59, and 86 percent of those receiving mirikizumab 250 mg Q4W/125 mg Q8W; and 86, 60, and 82 percent of those receiving mirikizumab 250 mg Q4W/250 mg Q8W.




 "Following an induction dose of 250 mg every four weeks, maintenance doses of 125 mg or 250 mg every eight weeks from week 16 to week 52 were comparable in maintaining efficacy," the authors write.




 Several authors disclosed financial ties to pharmaceutical companies, including Eli Lilly, which is developing mirikizumab and supported the study.




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Following induction dose, maintenance dose of 125 or 250 mg every eight weeks from weeks 16 to 52 was comparably safe and efficacious

Is Mirikizumab Efficacious, Safe for Plaque Psoriasis?

Guselkumab is more likely to be associated with achieving super-response among patients who are younger, less obese, and have less severe psoriasis, according to a study published in the December issue of the Journal of the European Academy of Dermatology and Venereology.
 
 
 Kristian Reich, M.D., from the University Medical Center Hamburg-Eppendorf in Germany, and colleagues describe the baseline characteristics of patients with moderate-to-severe psoriasis achieving super-response (Psoriasis Area and Severity Index [PASI] 100 response at weeks 20 and 28) after initiating guselkumab treatment using pooled data from the VOYAGE 1 and VOYAGE 2 studies. Factors that were potentially predictive of super-response status were identified.
 
 
 The post-hoc analysis included 664 patients: 271 achieved super-response and 393 had a non-super-response. The researchers found that significant predictors of super-response status included patient age at study entry, baseline body weight (≤90 versus &gt;90 kg), PASI, and the Investigator's Global Assessment score. Compared with those with non-super-response, more patients with super-response achieved an early response (week 2 PASI 75: 5.5 versus 1.8 percent; week 8 PASI 100: 22.5 versus 3.3 percent). Patients with versus without super-response had slightly greater median serum guselkumab concentrations through week 28.
 
 
 "Guselkumab-treated patients with super-response have distinguishable baseline demographic and disease characteristics," the authors write. "These results may allow clinicians to predict which patients at their baseline might achieve super-response, which may be beneficial in drug selection, managing patient expectations of treatment response, and improving patient-physician communication."
 
 
 Several authors disclosed financial ties to pharmaceutical companies, including Janssen, which manufactures guselkumab and partially funded the study.

Patient age, baseline body weight, disease severity measured by PASI, Investigator's Global Assessment predict response to guselkumab

What Factors Predict Super-Response to Guselkumab in Psoriasis?

A machine learning-based tool (Mind.Px) that predicts patient response to biologic classes used for psoriasis alters physician behavior and improves patient outcomes, according to a research letter published online Nov. 16 in SKIN.
 
 
 Bruce E. Strober, M.D., Ph.D., from the Yale University School of Medicine in New Haven, Connecticut, and colleagues examined the clinical utility of Mind.Px among 112 psoriasis patients who were biologic-naive or switching their biologic. A dermal biomarker patch was applied to lesional skin at baseline; Mind.Px test results were provided to physicians prior to selection of biologics. For each patient, the choice of biologic was recorded, and in the case of physician nonconcordance with Mind.Px, a questionnaire was completed. The data were compared to those obtained previously for 180 patients whose Mind.Px results were not provided to physicians at any point during treatment.
 
 
 The researchers found that when given access to Mind.Px, physician behavior was significantly altered, with concordance between the Mind.Px-informed and Mind.Px-uninformed groups of 84.4 and 53.8 percent, respectively. Clinical outcomes were improved for patients whose physicians were provided with Mind.Px test results. This cohort reached a 75 percent or greater reduction in Psoriasis Area and Severity Index scores from baseline sooner than those who were not provided with test results.
 
 
 "While this interim [analysis] demonstrates statistically significant changes in physician behavior and improved patient outcomes from this behavior change, the cohort of patients who have currently completed the study is limited," the authors write.
 
 
 Several authors disclosed financial ties to pharmaceutical and biotechnology companies, including Mindera Health, which manufactures Mind.Px and funded the study.
 
 
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Machine learning-based tool that predicts response to biologics significantly altered physician prescribing and improved patient outcomes

Can a Machine Learning Tool Be Used to Improve Psoriasis Patient Outcomes?

Isolated nail psoriasis (NP) is not significantly associated with an increased risk for metabolic syndrome, according to a letter to the editor recently published in the
 
 Journal of the European Academy of Dermatology &amp; Venereology
 
 .




 Rhiannon C. Miller and Shari R. Lipner, M.D., Ph.D., both from Weill Cornell Medicine in New York City, examined the risk for metabolic syndrome in patients with isolated NP. The analysis included 156 patients with a diagnosis code for isolated NP (2010 through 2021) and matched controls.




 The researchers found no difference between NP patients and controls for average body mass index and systolic blood pressure, for either closest to diagnosis or highest value recorded. The groups were also similar in the prevalence of metabolic syndrome components (hypertension, hypertriglyceridemia, low high-density lipoprotein, elevated hemoglobin A1c) or related medical conditions, including hypercholesterolemia, obesity, and type 2 diabetes. All cholesterol values were similar. For hemoglobin A1c, NP patients had greater closest recorded value, but not highest recorded value.




 "Isolated NP patients can be counselled that they are not at significantly higher risk for metabolic syndrome, which may help decrease patient anxiety and health care costs associated with additional monitoring," the authors write.




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Both metabolic syndrome components and related medical conditions seen at similar rates between patients with, without isolated nail psoriasis

Isolated Nail Psoriasis Does Not Increase Risk for Metabolic Syndrome

Vitamin D supplementation does not reduce the risk for asthma exacerbation in children overall, but does reduce the risk in those with low serum 25-hydroxyvitamin D (25[OH]D) concentrations, according to a review recently published in Nutrients.
 
 
 Qinyuan Li, M.D., from the Chongqing Key Laboratory of Pediatrics in China, and colleagues conducted a systematic review and meta-analysis to examine the effects of vitamin D supplementation in children with allergic diseases. Data were included from 32 randomized controlled trials (RCTs) comparing vitamin D supplementation with placebo among 2,347 children.
 
 
 The researchers found that compared with placebo, vitamin D supplementation did not reduce the risk for asthma exacerbations overall (risk ratio, 0.84; 95 percent confidence interval, 0.65 to 1.08; P = 0.18), but there was a reduction observed in the risk for asthma exacerbation for children with baseline serum 25(OH)D &lt;10 ng/mL (risk ratio, 0.48; 95 percent confidence interval, 0.28 to 0.83; P = 0.009). A significant reduction was seen in the Scoring Atopic Dermatitis or the Eczema Area and Severity Index scores in children with atopic dermatitis with vitamin D versus placebo (standardized mean difference, −0.5; 95 percent confidence interval, −0.87 to −0.12; P = 0.009). For children with allergic rhinitis, vitamin D supplementation reduced the symptom-medication score compared with placebo (mean, 43.7 versus 57.8).
 
 
 "Large-scale and well-designed RCTs are needed to confirm these conclusions and investigate the optimum regimen of vitamin D and the patients who would benefit most from vitamin D supplementation," the authors write.
 
 
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Supplements reduce risk among children with low serum 25(OH)D and have beneficial effects in children with atopic dermatitis, allergic rhinitis

Vitamin D Supplements Do Not Reduce Asthma Exacerbations Overall

For adults with mild-to-moderate psoriasis, continued apremilast treatment results in sustained clinical improvements, according to a research letter published online Oct. 27 in the
 
 Journal of the American Academy of Dermatology
 
 .




 Linda Stein Gold, M.D., from the Henry Ford Health System in West Bloomfield, Michigan, and colleagues present data on the efficacy and safety of apremilast during a 16-week extension phase following a trial in which patients were randomly assigned in a 1:1 ratio to apremilast or placebo for 16 weeks. Overall, 437 patients completed the extension phase, 221 of whom continued apremilast treatment.




 There were 66 discontinuations (13.1 percent). The researchers found that the primary end point was met, with 21.6 and 4.1 percent of apremilast- and placebo-treated patients, respectively, achieving static Physician's Global Assessment (sPGA) scores of 0 or 1 (clear or almost clear) and at least a 2-point reduction from baseline at week 16. At week 32, sPGA response was maintained by 30.2 and 34.3 percent, respectively, of patients continuing apremilast and patients initially randomly assigned to placebo and initiating apremilast using data as observed, and 24.9 and 29.3 percent, respectively, using nonresponder imputation.




 "These findings demonstrate that continued apremilast treatment results in sustained clinical improvements in overall disease severity, scalp psoriasis, itch, and quality of life for patients with mild-to-moderate psoriasis," the authors write.




 Several authors disclosed financial ties to pharmaceutical companies, including Amgen, which manufactures apremilast and funded the study.




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Static Physician's Global Assessment response maintained for those continuing apremilast, receiving apremilast after placebo

Improvements Sustained With Continuing Apremilast in Psoriasis

Among individuals with end-stage renal disease (ESRD), psoriasis is not associated with an increased risk for myocardial infarction (MI), according to a study recently published in the
 
 American Journal of the Medical Sciences
 
 .




 Naomi Siddiquee, from the Medical College of Georgia at Augusta University, and colleagues used the United States Renal Data System to identify 1.06 million patients with ESRD starting dialysis between 2004 and 2015.




 The researchers report that in the whole cohort, 0.6 percent of individuals had psoriasis and 17.1 percent had MI. However, among the 6,823 patients with psoriasis, 24 percent developed an MI. In unadjusted models, psoriasis was associated with an increased risk for MI (odds ratio, 1.34; 95 percent confidence interval, 1.26 to 1.42), but when controlling for demographics, dialysis modality, access type, and comorbidities, psoriasis was not associated with MI (odds ratio, 0.95; 95 percent confidence interval, 0.89 to 1.01).




 "Contrary to prior research in the general population, in the ESRD population, psoriasis was not associated with an increased risk of MI after controlling for various demographic and clinical parameters," the authors write. "These data emphasize the importance of an integrated approach since comorbidities may influence the choice of therapy for psoriasis and outcomes."




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Confounding variables, particularly comorbidities, impact association

Psoriasis Not Tied to Myocardial Infarction in Patients With ESRD

For patients with moderate-to-severe psoriasis, apremilast appears to have a neutral association with aortic vascular inflammation, generally beneficial associations with certain cardiometabolic biomarkers, and associations with reductions in visceral and subcutaneous fat, according to a study published online Sept. 21 in
 
 JAMA Dermatology
 
 .




 Joel M. Gelfand, M.D., from the University of Pennsylvania Perelman School of Medicine in Philadelphia, and colleagues examined the association between apremilast and aortic vascular inflammation in a single-arm, open-label nonrandomized trial. Seventy patients with moderate-to-severe psoriasis were enrolled; 60 completed assessments at week 16 and 39 at week 52.




 The researchers found that compared with baseline, there was no change in aortic vascular inflammation at week 16 or 52. Potentially beneficial decreases in interleukin 1b, valine, leucine, isoleucine, fetuin A, and branched-chain amino acids were seen at week 16. Compared with baseline, at week 52, potentially beneficial decreases were seen in ferritin, β-hydroxybutyrate, acetone, and ketone bodies, and there was an increase observed in apolipoprotein A-1; a reduction was seen in cholesterol efflux. An approximately 5 to 6 percent decrease in subcutaneous and visceral adiposity was seen at week 16 and was maintained at week 52.




 "Seeing a drop in visceral fat during apremilast treatment suggests that, over the longer term, psoriasis patients who take apremilast may be on a trajectory toward better cardiovascular health," Gelfand said in a statement.




 Several authors disclosed financial ties to biopharmaceutical companies, including Celgene, which was the initial funding sponsor, and Amgen, which subsequently sponsored the study; Amgen manufactures apremilast.




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5 to 6 percent decrease seen in subcutaneous and visceral adiposity at week 16 of treatment, which was maintained at 52 weeks

Apremilast May Offer Cardiometabolic Benefit in Psoriasis Patients

Tapinarof cream 1 percent once daily is safe, well tolerated, and durably effective for adults with mild-to-severe psoriasis, according to a study published in the October issue of the
 
 Journal of the American Academy of Dermatology
 
 .




 Bruce Strober, M.D., Ph.D., from Yale University in New Haven, Connecticut, and colleagues assessed long-term safety, efficacy, remittive effect, durability of response, and tolerability of once-daily tapinarof 1 percent cream among adults with mild-to-severe plaque psoriasis. The analysis included 763 patients who completed a 12-week trial and subsequently enrolled for 40-week open-label treatment and four-week follow-up.




 The researchers found that 40.9 percent of patients achieved complete disease clearance (Physician Global Assessment [PGA] score, 0), and 58.2 percent entering with PGA ≥2 achieved PGA of 0 or 1. For patients achieving a PGA of 0, the mean duration of off-therapy remittive effect was 130.1 days. No new safety signals were seen, and the most common adverse events included folliculitis (22.7 percent), contact dermatitis (5.5 percent), and upper respiratory tract infection (4.7 percent).




 "Tapinarof may represent a novel nonsteroidal topical therapy that addresses limitations of current therapies," the authors write.




 Several authors disclosed financial ties to pharmaceutical companies, including Dermavant, which manufactures tapinarof and funded the study.




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For up to one year, 40.9 percent of patients achieved complete disease clearance with a four-month remittive effect; no new safety signals seen

Is Long-Term Tapinarof Cream Safe, Effective for Psoriasis?

Inflammatory bowel disease (IBD) appears to have a causal impact on psoriasis, especially psoriatic arthritis (PsA), and total psoriasis and PsA are associated with Crohn disease (CD), according to a study recently published in the
 
 Frontiers of Immunology
 
 .




 Yajia Li, from Central South University in Changsha, China, and colleagues used a mendelian randomization (MR) approach to examine whether there is a causal relationship between IBD and psoriasis. A two-sample MR was conducted with the genetic instruments identified for IBD and its main subtypes, CD and ulcerative colitis (UC), using data from a genome-wide association study (GWAS) with 25,042 IBD cases and 34,915 controls. Summarized psoriasis data were obtained from GWAS studies with 4,510 psoriasis cases and 212,242 controls.




 The researchers found that genetic predisposition to IBD was associated with increased psoriasis risk (odds ratio, 1.1271). A significant association was seen for PsA with total IBD (odds ratio, 1.1202). Causal relationships were also observed for CD-psoriasis and CD-PsA (odds ratios, 1.1552 and 1.1407, respectively). A genetic predisposition to psoriasis was not associated with total IBD; however, psoriasis was associated with CD (odds ratio, 1.2224) but not UC. There was a borderline association observed for genetic predisposition to PsA with IBD (odds ratio, 1.0716), and a suggestive association was observed with CD (odds ratio, 1.0667).




 "Understanding that specific types of psoriasis and IBD constitute mutual risk factors facilitates early diagnosis enabling more efficient targeting of therapy," the authors write.




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Genetic predisposition to psoriasis not linked to total IBD, but is associated with Crohn disease

Inflammatory Bowel Disease, Psoriasis May Be Causally Related

Treatment with roflumilast cream results in better clinical status at eight weeks versus vehicle cream among patients with chronic plaque psoriasis, according to a study published in the Sept. 20 issue of the
 
 Journal of the American Medical Association
 
 .




 Mark G. Lebwohl, M.D., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues examined the efficacy of roflumilast cream, 0.3 percent, applied once daily for eight weeks in two multicenter trials involving patients with plaque psoriasis (DERMIS-1, 439 patients; DERMIS-2, 442 patients). Patients were randomly assigned to receive roflumilast cream or vehicle cream (trial 1, 286 and 153 patients, respectively; trial 2, 290 and 152 patients, respectively).




 The researchers found that the mean Investigator Global Assessment (IGA) scores were all 2.9 for roflumilast and vehicle in both trials 1 and 2. Significantly greater percentages of roflumilast- versus vehicle-treated patients had IGA success at week 8 in both trials (trial 1: 42.4 versus 6.1 percent; trial 2: 37.5 versus 6.9 percent). Significant differences were seen favoring roflumilast in eight and nine of nine secondary end points in trials 1 and 2, respectively, including intertriginous IGA success, 75 percent reduction in the Psoriasis Area and Severity Index score, and Worst Itch Numeric Rating Scale score of 4 or higher at baseline achieving 4-point reduction.




 "Further research is needed to assess efficacy compared with other active treatments and to assess longer-term efficacy and safety," the authors write.




 Several authors disclosed financial ties to biopharmaceutical companies, including Arcutis Biotherapeutics, which manufactures roflumilast and funded the study.




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Two multicenter trials show significantly greater percentage of patients treated with roflumilast versus vehicle had IGA success at week 8

Roflumilast Yields Better Results for Chronic Plaque Psoriasis

Psoriatic arthritis (PsA) screening is acceptable to patients with psoriasis whether they are diagnosed with PsA or not, according to a research letter published online Aug. 17 in the
 
 British Journal of Dermatology
 
 .




 Christine A. Silverthorne, from the University of the West of England in Bristol, and colleagues sought to understand the experience of screening from the perspective of 21 participants with psoriasis. Screening included an examination of skin, joints, hands, feet, scalp, physical tests (e.g., touching toes), height and weight measurement, blood tests, X-rays, magnetic resonance imaging scans, and questionnaires.




 The researchers identified three main themes. First, screening was perceived as well-conducted and, overall, a positive and reassuring experience. Participants reported appreciating the thoroughness of the examination and the time to talk with specialists. Secondly, screening provided participants a sense of control over their health. Among those screening positive for PsA, they valued the help they were given in treating their condition, while those screening negative gained an awareness of symptoms for which to watch out. Lastly, participants suggested improvements to the screening process, including using case studies, signposting to support groups, and providing information. They also indicated barriers to screening, which included location, parking, and time of appointments.




 "This qualitative study indicates that screening is acceptable and a potentially valuable method to increase the early detection of PsA in patients with psoriasis and improve their clinical outcomes," the authors write.




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Participants report feeling empowered by comprehensive screening

Psoriasis Patients Find Psoriatic Arthritis Screening Worthwhile

There seems to be a causal effect between inflammatory bowel disease and psoriasis and psoriatic arthritis, according to a study published online Sept. 14 in
 
 JAMA Dermatology
 
 .




 Dennis Freuer, Ph.D., from the University of Augsburg in Germany, and colleagues examined the association between inflammatory bowel disease and psoriasis or psoriatic arthritis in a bidirectional two-sample mendelian randomization study using summary statistics from genome-wide association studies, which included up to 463,372 European individuals. Total and direct effects were derived, and causal estimates were verified using a validation inflammatory bowel disease sample, a series of mendelian randomization methods, and sensitivity analyses.




 The European samples included 12,882 inflammatory bowel disease cases and 5,621 psoriasis cases. The researchers found that the risks for psoriasis and psoriatic arthritis were increased with genetically predicted inflammatory bowel disease (pooled odds ratios, 1.10 and 1.10, respectively). Crohn disease subentity was associated with psoriasis and psoriatic arthritis (odds ratios, 1.16 and 1.13, respectively), while ulcerative colitis was not. No notable associations were identified in the reverse directions.




 "The results of the study are critical because raising awareness among clinicians and primary care physicians about the potential risk of psoriasis in patients with inflammatory bowel disease will contribute to systematic diagnosis and interdisciplinary and early personalized treatment of patients," the authors write.




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Crohn disease, but not ulcerative colitis, associated with psoriasis and psoriatic arthritis

Causal Effect ID'd for IBD With Psoriasis, Psoriatic Arthritis

Psoriasis diagnoses in primary care may be delayed by up to five years, according to an observational study published online Aug. 30 in the
 
 British Journal of General Practice
 
 .




 Maha Abo-Tabik, from the University of Manchester in the United Kingdom, and colleagues used electronic health records to identify potential missed opportunities for an earlier diagnosis of psoriasis. Incident cases of psoriasis were matched (1:6) with controls.




 The researchers found that people with psoriasis were up to eight times more likely to be diagnosed with pityriasis rosea at six months before the index date compared with controls. Additionally, cases were twice as likely to be diagnosed with eczema or tinea corporis one year before diagnosis. Certain clinical features suggestive of psoriasis, including dry skin, rash, skin texture changes, and itching, were more likely to be reported by cases than controls up to five years before the index date. Rash was the most frequently reported clinical feature. Compared with controls, cases were prescribed topical corticosteroids or topical antifungals twice as often in the year before diagnosis.




 "The findings from this study suggest the diagnosis of psoriasis may be missed or delayed by up to five years for some individuals hence leading to a potentially detrimental delay in establishing an appropriate treatment regimen," a coauthor said in a statement.




 Two authors disclosed financial ties to the pharmaceutical industry.




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Medical records of psoriasis patients show reports of symptoms suggestive of psoriasis five years before diagnosis

Diagnosis of Psoriasis May Be Delayed in Primary Care

For adults with moderate-to-severe psoriasis, gradient-boosted decision trees perform better than logistic regression for predicting specific biologic therapy leading to a treatment duration of at least three years without discontinuation, according to a study published online Aug. 17 in
 
 JAMA Dermatology
 
 .




 Mia-Louise Nielsen, from the University of Copenhagen in Denmark, and colleagues conducted a population-based study involving adult patients treated for moderate-to-severe psoriasis with biologics to identify the optimal biologic therapy. A total of 2,034 patients with a total of 3,452 treatment series were included in the study, assuming a success criterion of three years of sustained treatment.




 The researchers found that gradient-boosted decision trees and logistic regression could predict a specific cytokine target associated with successful treatment (accuracies, 63.6 and 59.2 percent, respectively) and had top 2 accuracies of 95.9 and 93.9 percent, respectively. Gradient boost and logistic regression had accuracies of 48.5 and 44.4 percent when predicting specific drugs resulting in success, top 2 accuracies of 77.6 and 75.9 percent, and top 3 accuracies of 89.9 and 89.0 percent, respectively.




 "These findings could potentially be useful for clinicians in future treatment decision processes for choosing of appropriate biologic therapy for patients with psoriasis," the authors write.




 Several authors disclosed financial ties to the pharmaceutical industry.




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Gradient-boosted decision trees perform better than logistic regression for predicting biologic therapy leading to treatment duration of at least three years

Gradient-Boosted Decision Trees Predict Treatment Success for Psoriasis

For patients with end-stage renal disease (ESRD), those with concomitant psoriasis are younger and more often have cancer, diabetes mellitus, and coronary artery disease, according to a study published online July 26 in the
 
 Journal of Clinical Medicine
 
 .




 Johannes Wild, M.D., from the University Medical Center Mainz in Germany, and colleagues examined the impact of concomitant psoriasis on the in-hospital outcomes of patients hospitalized with ESRD. A total of 360,980 hospitalizations of patients treated for ESRD in German hospitals were identified from 2010 to 2020; 0.3 percent of these patients also suffered from psoriasis.




 The researchers found that within the time period, the annual number of all ESRD patients increased, but slight decreases were seen in the number of patients with ESRD and psoriasis. Patients with ESRD and psoriasis were younger (66 versus 71 years), more often obese (17.5 versus 8.2 percent), and more often had cancer (4.9 versus 3.3 percent), diabetes mellitus (42.7 versus 38.5 percent), and coronary artery disease (31.1 versus 28.0 percent). For patients with ESRD, psoriasis was not associated with in-hospital case fatality in multivariate regression models.




 "Taken together, our study results should be considered hypothesis-generating, and large prospective observational studies are needed to further explore the impact of psoriasis on different stages of acute and chronic kidney disease," the authors write.




 Several authors disclosed financial ties to the pharmaceutical industry.




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Patients with end-stage renal disease and psoriasis are younger, more often obese, and more often have cancer, diabetes, CAD

Comorbidities Up Among Patients With ESRD, Concomitant Psoriasis

Evidence suggests a potential causal link for psoriasis and cardiovascular disease (CVD), according to a study published online June 29 in
 
 Frontiers in Immunology
 
 .




 Ning Gao, from The Second Affiliated Hospital of Zhejiang University School of Medicine in Hangzhou, China, and colleagues used Mendelian randomization (MR) to examine the potential causal relationship between psoriasis and CVD. Genetic instruments from the genome-wide association study of European descent for psoriasis were used to examine the association with CVD. The primary analysis included inverse variance-weighted (IVW) MR analyses.




 The researchers found that genetic susceptibility to psoriasis was associated with an increased risk for heart failure, atrial fibrillation, myocardial infarction, valvular heart disease, and large artery stroke using the fixed-effects IVW method, but no associations were seen for the other two subtypes of ischemic stroke (cardioembolic stroke and small vessel stroke). Weak evidence of horizontal diversity and heterogeneity was seen in a sensitivity analysis ensuring the stability of the results.




 "Our study provides evidence for a potential causal association between psoriasis and CVD," the authors write. "Combined with evidence from observational studies, early cardiovascular risk assessment and prevention in patients with psoriasis are of interest, which facilitate the introduction of individual-specific treatments as soon as possible."




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Increased risks noted for heart failure, atrial fibrillation, myocardial infarction, valvular heart disease, large artery stroke

Causal Link Suggested for Psoriasis, Cardiovascular Disease

Asian patients with psoriasis receive significantly less face-to-face time with a dermatologist than patients of other races and ethnicities, according to a research letter published online Aug. 3 in
 
 JAMA Dermatology
 
 .




 Kevin K. Wu, M.D., and April W. Armstrong, M.D., M.P.H., from the Keck School of Medicine at the University of Southern California in Los Angeles, conducted a cross-sectional study of data from the National Ambulatory Medical Care Survey from 2010 through 2016 and examined the association between patient race/ethnicity and time spent with the dermatologist for psoriasis treatment. A weighted estimate of 4,201,745 patient visits for psoriasis was identified.




 The researchers observed a significant difference in the age of patients by race (37.2, 44.7, 33.3, and 54.8 years for Asian, Hispanic, Black, and White patients, respectively) and for the complex topical regimen among the groups (11.8, 1.5, and 1.1 percent for Asian, Black, and White patients, respectively). The mean visit duration was 9.2, 15.7, 20.7, and 15.4 minutes with Asian, Hispanic or Latino, non-Hispanic Black, and non-Hispanic White patients, respectively. Compared with visits with White patients, visits with Asian patients had a 39.9 percent shorter mean duration, while compared with visits with non-Asian patients as a single group, visits with Asian patients were 40.6 percent shorter.




 "Dermatologists spend less time with Asian patients with psoriasis compared with patients of other races and ethnicities," the authors write. "Dermatologists need to allow sufficient time to develop strong physician-patient communication regardless of patient background."




 Armstrong disclosed financial ties to the pharmaceutical industry; she also is on the editorial board for
 
 JAMA Dermatology
 
 .




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Asian patients have visits of shorter mean duration compared with White patients, non-Asian patients as a single group

Dermatologist Visits Shorter for Asian Psoriasis Patients

For patients with moderate-to-severe plaque psoriasis, the oral, selective, tyrosine kinase 2 inhibitor deucravacitinib is effective and well tolerated, according to a study published online July 8 in the
 
 Journal of the American Academy of Dermatology
 
 
 .
 




 April W. Armstrong, M.D., M.P.H., from the Keck School of Medicine at the University of Southern California in Los Angeles, and colleagues compared the efficacy and safety of deucravacitinib versus placebo and apremilast in adults with moderate-to-severe plaque psoriasis. Participants were randomly assigned to receive deucravacitinib, placebo, or apremilast (332, 166, and 168 patients, respectively) in the 52-week phase 3 trial.




 The researchers found that for deucravacitinib versus placebo or apremilast, the response rates were significantly higher for ≥75 percent reduction from baseline in the Psoriasis Area and Severity Index (58.4 percent versus 12.7 and 35.1 percent, respectively) and for the static Physician's Global Assessment score of 0 or 1 (53.6 percent versus 7.2 and 32.1 percent, respectively) at week 16. Beyond week 16, efficacy improved and was maintained through 52 weeks. Similar adverse event rates were seen with deucravacitinib versus placebo and apremilast.




 "These data highlight the potential for deucravacitinib, a once-daily oral drug, to reduce disease activity and improve symptoms and quality of life among patients who require systemic therapy for psoriasis," the authors write.




 Several authors disclosed financial ties to pharmaceutical companies, including Bristol Myers Squibb, which manufactures deucravacitinib and funded the clinical trial.




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Response rates for deucravacitinib significantly higher versus placebo or apremilast for PASI 75, sPGA 0/1

Is Deucravacitinib Effective, Well Tolerated for Plaque Psoriasis?

Characteristics of Photoaggravated Atopic Dermatitis Described

Cutaneous T-cell-rich lymphoid infiltrates have been reported after Pfizer BioNTech COVID-19 vaccination, according to a research letter published online July 20 in
 
 JAMA Surgery
 
 .




 Madeline J. Hooper, from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues conducted a retrospective case series, including six cases of T-cell-rich cutaneous lymphoid infiltrates shortly after severe acute respiratory syndrome coronavirus 2 vaccination.




 The researchers identified three male and three female patients, with a median age of 47 years. One patient had multiple sclerosis and one had a history of psoriasis and transverse myelitis. All patients received the Pfizer/BioNTech vaccine. The median time from the first dose to development of lesions was 22 days. Vaccine-related constitutional symptoms were reported by two patients, while three reported lesional pruritus. Cutaneous eruptions were characterized by single or generalized papulonodules on the trunk and/or extremities (two and four patients, respectively). T-cell-predominant lymphoid infiltrates consistent with pityriasis lichenoides et varioliformis acuta, cutaneous T-cell lymphoid hyperplasia, and lymphomatoid papulosis type A were revealed in two patients each on histologic examination. The clinical course was indolent; after various therapies, resolution was reported. After an acute viral episode, four of the patients reported recrudescence.




 "Our observations should raise awareness about low-grade cutaneous lymphoid reactions after COVID-19 vaccination," the authors write.




 Two authors disclosed financial ties to Kyowa Kirin, and one received a grant from Elorac.




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Three types of infiltrates revealed on histologic examination including cutaneous T-cell lymphoid hyperplasia

T-Cell-Rich Lymphoid Infiltrates ID'd After Pfizer COVID-19 Shot

Smoking, but not alcohol consumption, is causally associated with psoriasis, according to a study published online June 28 in the
 
 British Journal of Dermatology
 
 .




 Jiahe Wei, from Hangzhou Medical College in China, and colleagues examined the causal associations of alcohol consumption and smoking with psoriasis using genome-wide association study (GWAS) summary-level data for alcohol consumption, smoking initiation, cigarettes per day, and smoking cessation from the Sequencing Consortium of Alcohol and Nicotine use consortium and for lifetime smoking from the U.K. Biobank. Summary statistics for psoriasis were obtained from a recent GWAS meta-analysis of eight cohorts and the FinnGen consortium. Bidirectional Mendelian randomization (MR) analyses were performed to assess causal direction.




 The researchers identified genetic correlations between smoking and psoriasis. A causal effect of smoking initiation, cigarettes per day, and lifetime smoking on psoriasis was revealed in MR (odds ratios [95 percent confidence intervals], 1.46 [1.32 to 1.60], 1.38 [1.13 to 1.67], and 1.96 [1.41 to 2.73], respectively). In addition, there was a suggestive causal effect of smoking cessation on psoriasis (odds ratio, 1.39; 95 percent confidence interval, 1.07 to 1.79). No causal relationship was identified between alcohol consumption and psoriasis.




 "Our study provides genetic evidence supporting the causal effects of smoking on psoriasis risk, suggesting that restricting smoking could be helpful in reducing the burden of psoriasis," the authors write.




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Causal effect found of smoking initiation, cigarettes per day, lifetime smoking on psoriasis; no causal link seen for alcohol consumption

Smoking Is Causally Associated With Psoriasis Risk

Four in 10 plaque psoriasis patients achieve complete disease clearance with tapinarof cream, 1 percent, according to a study published online June 26 in the
 
 Journal of the American Academy of Dermatology
 
 .




 Bruce Strober, M.D., Ph.D., from Yale University in New Haven, Connecticut, and colleagues assessed the long-term safety, efficacy, remittive effect, durability of response, and tolerability of tapinarof for the treatment of mild-to-severe plaque psoriasis. The analysis included 763 patients who completed the 12-week trial and were eligible for 40 weeks of open-label treatment and four weeks of follow-up.




 The researchers found that 40.9 percent of patients achieved complete disease clearance (Physician Global Assessment [PGA] of 0). More than half of participants (58.2 percent) entering with PGA ≥2 achieved PGA of 0 or 1. For patients achieving PGA of 0, mean duration of remittive effect off-therapy was 130.1 days. No new safety signals were seen. Folliculitis (22.7 percent), contact dermatitis (5.5 percent), and upper respiratory tract infection (4.7 percent) were the most frequent adverse events.




 "VTAMA [tapinarof] cream's demonstrated combination of efficacy, remittive effect, durability, and tolerability make it a strong addition to the psoriasis armamentarium," Philip M. Brown, M.D., J.D., chief medical officer of Dermavant Sciences, said in a statement.




 Several authors disclosed financial ties to pharmaceutical companies, including Dermavant, which manufactures tapinarof and funded the study.




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Complete disease clearance observed in 41 percent of patients with tapinarof cream 1 percent used once daily

Tapinarof Effective for Longer-Term Treatment of Plaque Psoriasis

Among biologics, the highest drug survival for effectiveness for psoriasis was seen for guselkumab, according to a study published online July 6 in
 
 JAMA Dermatology
 
 to coincide with the annual meeting of the British Association of Dermatologists, held from July 5 to 7 in Glasgow, Scotland.




 Zenas Z. N. Yiu, Ph.D., from the University of Manchester in the United Kingdom, and colleagues used data from the British Association of Dermatologists Biologics and Immunomodulators Register between November 2007 and August 2021 to examine drug survival associated with the effectiveness and safety of commonly used biologics for psoriasis. Data were included for 16,122 treatment courses: 41.0, 33.5, 16.6, 4.5, and 4.4 percent in which treatment with adalimumab, ustekinumab, secukinumab, guselkumab, and ixekizumab, respectively, was initiated.




 The researchers found that for measures of effectiveness for treatment, crude survival functions at one year were 0.81, 0.89, 0.86, 0.94, and 0.86 for adalimumab, ustekinumab, secukinumab, guselkumab, and ixekizumab, respectively. For the multivariable model for effectiveness, the adjusted survival curves showed that guselkumab had higher survival, while adalimumab had lower survival (adjusted hazard ratios, 0.13 and 2.37, respectively). Effect modifiers for survival in association with treatment effectiveness included psoriatic arthritis, previous biologic exposure, nail involvement, and ethnicity. For safety, the crude survival functions at one year were 0.91, 0.94, 0.94, 0.96, and 0.92 for adalimumab, ustekinumab, secukinumab, guselkumab, and ixekizumab, respectively. Similar adjusted survival curves for safety were seen for guselkumab, ustekinumab, and secukinumab, while lower survival was seen for adalimumab and ixekizumab.




 "This information on longer-term treatment effects, safety, and tolerability, along with other factors, such as background comorbidities and patient values, may help patients and their clinicians make an informed decision to initiate treatment with a particular biologic therapy," the authors write.




 The British Association of Dermatologists Biologic Register Ltd., a registered company within the British Association of Dermatologists, receives income from several pharmaceutical companies.




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Adjusted survival curves from the multivariable model for effectiveness showed higher drug survival for guselkumab

Study Compares Biologics for Long-Term Treatment of Psoriasis

The price of most biologics used to treat psoriasis is increasing rapidly, outpacing inflation, according to a research letter published online June 22 in the
 
 Journal of the American Academy of Dermatology.
 




 Deep Patel, M.D., from Mount Sinai in New York City, and colleagues explored the costs of biologics over time to examine whether changes are proportional to medical inflation rates in a retrospective claims analysis utilizing data from the International Business Machines MarketScan Commercial Database from Jan. 1, 2005, through Dec. 31, 2018.




 The researchers found that between 2005 and 2018, most biologics increased in cost per claim, including adalimumab ( 224.49 percent), etanercept ( 206.17 percent), infliximab ( 123.57 percent), and certolizumab ( 170.24 percent). From 2009 to 2018, there were increases observed for ustekinumab ( 127.91 percent) and golimumab ( 218.21 percent). A decrease was seen in the cost of secukinumab (−3.93 percent) from 2015 to 2018. The cost per claim for most biologics increased above that expected based on medical inflation alone, including for adalimumab ( 203.72 percent), etanercept ( 194.66 percent), infliximab ( 126.90 percent), certolizumab ( 164.06 percent), ustekinumab ( 105.17 percent), and golimumab ( 205.01 percent), while the change in the cost of secukinumab was below inflation (−3.87 percent).




 "Mean yearly increase in medical inflation-adjusted price showed ustekinumab outpacing other agents, which -- given the less frequent dosing of this agent -- may suggest that other sources of yearly cost variation beyond manufacturing costs and market trends may be impacting biologic pricing," the authors write. "New strategies to contain increase in cost above inflation are critical, such as biosimilar development to improve patient access to care."




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Apart from secukinumab, the mean cost of biologics increased by &gt;100 percent than inflation alone would explain

Rise in Cost of Biologics for Psoriasis Outpacing Medical Inflation

For patients with moderate-to-severe plaque psoriasis weighing ≥90 kg, secukinumab 300 mg every two weeks (Q2W) has improved and sustained efficacy compared with Q4W, according to a study published in the June issue of the
 
 British Journal of Dermatology.
 




 Matthias Augustin, M.D., Ph.D., from the University Medical Center Hamburg-Eppendorf in Germany, and colleagues examined the efficacy, safety, and tolerability of secukinumab 300 mg Q2W versus Q4W in patients with moderate-to-severe chronic plaque psoriasis weighing ≥90 kg. A total of 331 patients were randomly assigned to receive Q2W (165 patients) or Q4W (166 patients).




 At week 16, the researchers found significantly higher Psoriasis Area and Severity Index (PASI) 90 responses with Q2W versus Q4W (73.2 versus 55.5 percent; odds ratio estimate, 2.3). Higher efficacy responses were maintained in the Q2W arm at week 52 (versus Q4W) for PASI 75 (88.9 versus 74.8 percent), PASI 90 (76.4 versus 52.4 percent), PASI 100 (46.7 versus 27.3 percent), Investigator's Global Assessment 0/1 (75.9 versus 55.6 percent), and Dermatology Life Quality Index 0/1 (66.1 versus 48.8 percent). Higher efficacy responses were seen at week 32 for PASI 90 nonresponders at week 16 who uptitrated to Q2W versus those who remained on Q4W (16 weeks post-uptitration, PASI 90: 38.7 versus 16.5 percent). Comparable safety results were seen across treatment arms.




 "These results further support the use of an alternative treatment regimen for heavier patients with psoriasis (weighing ≥90 kg) with the aim of rapidly controlling their disease and achieving PASI 90 responses," the authors write.




 Several authors disclosed financial ties to biopharmaceutical companies, including Novartis, which manufactures secukinumab and funded the study.




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PASI 90 responses significantly higher for secukinumab 300 mg every two weeks versus every four weeks for patients weighing ≥90 kg

Should Secukinumab Dosing for Psoriasis Be Adjusted for Patient Weight?

The global prevalence of metabolic syndrome (MetS) is 32 percent among patients with psoriasis, according to a review published online June 6 in the
 
 Journal of the European Academy of Dermatology and Venereology.
 




 Liu Liu, from the Shanghai University of Traditional Chinese Medicine, and colleagues conducted a systematic review and meta-analysis to assess the prevalence of MetS among psoriasis patients. Five databases were searched from inception through September 2021.




 The researchers found that the global prevalence of MetS was 32 percent in patients with psoriasis, with prevalence of 32 and 9 percent in adults and in children and adolescents, respectively. The highest prevalence was seen in Latin America (47 percent), while North America had the lowest prevalence (26 percent). Compared with those with other psoriasis types, patients with psoriasis vulgaris or severe psoriasis had a higher prevalence of MetS (29 and 37 percent, respectively).




 "Although previous studies have demonstrated an increased risk of MetS among patients with psoriasis, to our knowledge, this study is the first to calculate the global prevalence of MetS in patients with psoriasis," the authors write. "Our findings suggest the need to identify and manage metabolic disorders in patients with psoriasis. Future studies should evaluate the pathogenesis of MetS in this patient population."




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Patients with psoriasis vulgaris or severe psoriasis had higher prevalence of MetS compared with other types

Prevalence of Metabolic Syndrome 32 Percent in Psoriasis Patients

Diagnostic delay is common for patients with psoriasis and is increased for men and with psoriasis in specific areas, according to a study recently published online in the
 
 British Journal of Dermatology.
 




 Mia-Louise Nielsen, from the University of Copenhagen in Denmark, and colleagues surveyed 2,142 dermatologist-verified patients with psoriasis during 2020 to examine diagnostic delay and identify predictors of diagnostic delay.




 The researchers found that 43.5 percent of patients had a diagnostic delay of less than a year, and 22.1, 17, 7, 6, and 4.3 percent waited one to two, two to five, five to 10, 10 to 20, and &gt;20 years, respectively, to see a dermatologist. For female and male patients with dermatologist-verified psoriasis, the mean diagnostic delay was 2.7 and 3.9 years, respectively. Patients who reported never having had an affected body surface area of ≥3 percent had a longer diagnostic delay than those with more extensive psoriasis. A significantly longer diagnostic delay was seen for patients with psoriasis in specific areas (head, face, hands, feet, and genitals) compared with those without psoriasis in specific areas. Individuals with a longer diagnostic delay had a higher current Dermatology Life Quality Index.




 "Early diagnosis is necessary for reducing the risk of irreversible structural damage, attenuating the deterioration of physical function and improving patients' quality of life," the authors write. "Early detection and appropriate treatment may also help reduce development of psoriasis-associated psychological conditions, including stress, anxiety and depression."




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Male patients have longer diagnostic delay than female patients; longer diagnostic delay seen for those with psoriasis in specific areas

Predictors of Diagnostic Delay in Psoriasis Identified

A diffuse reflectance spectroscopy (DRS) method can quantify skin barrier function and hemoglobin concentration, thereby improving severity evaluation in psoriasis vulgaris, according to a study published online May 6 in
 
 Scientific Reports.
 




 Noting that researchers utilize instruments that measure transepidermal water loss and skin capacitance to investigate skin barrier function and assess severity in psoriasis vulgaris, Chao%u2011Kai Hsu, M.D., Ph.D., from the National Cheng Kung University Hospital in Tainan, Taiwan, and colleagues used a custom-built DRS system, shown to be able to determine the skin water-protein binding status and the hemoglobin concentration, and performed cross-validation of DRS measurement results with readings derived from the Courage Khazaka Corneometer and Mexameter and Psoriasis Area and Severity Index (PASI) scores.




 The researchers found that the Mexameter erythema readings were a good representation of skin oxygenated hemoglobin but not deoxygenated hemoglobin. However, the dermatologists in this study were inclined to rate the "erythema" category with higher scores as the level of the skin deoxygenated hemoglobin was higher. Consequently, Mexameter-derived erythema readings may not be concordant with the PASI erythema scores. There were good correlations for the Corneometer-derived skin capacitance readings with the PASI "desquamation" and "thickness" scores; the PASI "desquamation" assessment was a dominating factor that contributed to the DRS-deduced water-protein binding status.




 "We conclude that the DRS method can provide quantitative evaluation of skin barrier function and hemoglobin concentrations and thus could be an additional valuable tool to the current skin capacitance/erythema measurement systems and the PASI scoring system," the authors write.




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Mexameter erythema readings are a good representation of skin oxygenated hemoglobin, but not deoxygenated hemoglobin

Diffuse Reflectance Spectroscopy Can Help Assess Psoriasis Severity

Psoriasis is associated with nonalcoholic fatty liver disease (NAFLD) in a U.S. outpatient population, according to a study published May 25 in
 
 JAMA Dermatology
 
 .




 Zhijie Ruan, M.Med., from the First Affiliated Hospital of Shantou University Medical College in China, and colleagues used data from 5,672 U.S. adults (aged 20 to 59 years) participating in the National Health and Nutrition Examination Survey (NHANES; 2003-2006 and 2009-2014 cycles). Associations between psoriasis and NAFLD were examined in this outpatient sample.




 The researchers found that those with psoriasis had a higher prevalence of NAFLD (32.7 versus 26.6 percent) compared with participants without psoriasis. Psoriasis was associated with NAFLD (odds ratio, 1.67) when adjusting for age, sex, race and ethnicity, educational level, family income, marital status, NHANES cycles, diabetes, metabolic syndrome, and smoking and alcohol drinking status. Psoriasis was associated with NAFLD among men (odds ratio, 2.16), among those aged 20 to 39 years (odds ratio, 2.48), and among those without diabetes (odds ratio, 1.70).




 "Because some antipsoriatic agents are potentially hepatotoxic, the association between psoriasis and NAFLD in U.S. adults found in this study may be worth considering in psoriasis management," the authors write.




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Authors say this association may be relevant to psoriasis management with some antipsoriatic agents

Psoriasis Tied to Higher Risk for Nonalcoholic Fatty Liver Disease

Patients with palmoplantar pustulosis (PPP) have an overlapping comorbidity profile with patients with psoriasis vulgaris, according to a study published online April 27 in
 
 JAMA Dermatology
 
 .




 Dong Hyo Kim, M.D., from the Seoul National University College of Medicine in South Korea, and colleagues conducted a nationwide population-based cross-sectional study involving Korean patients diagnosed with PPP, psoriasis vulgaris, or pompholyx who visited a dermatologist between Jan. 1, 2010, and Dec. 31, 2019, to examine the risks for comorbidities. The analyses included 37,399 patients with PPP, 332,279 with psoriasis vulgaris, and 365,415 with pompholyx.




 The researchers found that after adjustment for demographic covariates, patients with PPP had significantly higher risks for developing psoriasis vulgaris, psoriatic arthritis, ankylosing spondylitis, type 1 diabetes, type 2 diabetes, Graves disease, Crohn disease, and vitiligo compared with patients with pompholyx (adjusted odds ratios, 72.96, 8.06, 1.91, 1.33, 1.33, 1.25, 1.63, and 1.87, respectively). The risks for ankylosing spondylitis and Graves disease were significantly higher for patients with PPP versus those with psoriasis vulgaris (adjusted odds ratios, 1.37 and 1.40, respectively), while reduced risks were seen for psoriatic arthritis, systemic lupus erythematosus, Sjögren syndrome, systemic sclerosis, vitiligo, and alopecia areata (adjusted odds ratios, 0.54, 0.67, 0.70, 0.29, 0.53, and 0.88, respectively).




 "Further studies to explore the pathogenetic mechanisms of these comorbidities and elucidate their associations with PPP are warranted," the authors write.




 One author disclosed financial ties to the pharmaceutical industry.




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Patients with PPP have significantly higher risk for ankylosing spondylitis, Graves disease than those with psoriasis vulgaris

Comorbidities Explored in Palmoplantar Pustulosis

Candidate biomarkers for disease progression in psoriasis have been identified, according to a review published online April 28 in the
 
 British Journal of Dermatology
 
 .




 Ravi Ramessur, B.M.B.S., from King's College London, and colleagues conducted a systematic review of relevant articles published between 1990 and December 2021 to identify and catalogue candidate biomarkers of disease progression in psoriasis. Data were included from 181 studies, most of which examined genomic or proteomic biomarkers associated with disease severity or psoriatic arthritis (145 and 30, respectively).




 The researchers identified candidate genomic, proteomic, and metabolomic biomarkers with future potential utility for predicting disease severity, including
 
 LCE3D
 
 ,
 
 interleukin (IL)23R
 
 ,
 
 I
 
 
 L23A
 
 ,
 
 NFKBIL1
 
 loci, and
 
 HLA-C*06:02
 
 (genomic); IL-17A, immunoglobulin G aHDL, GlycA, I-FABP, and Kallikrein 8 (proteomic); and tyramine (metabolomic). Genomic (
 
 HLAC*06:02
 
 ,
 
 HLA-B*27
 
 ,
 
 HLA-B*38
 
 ,
 
 HLA-B*08
 
 , and variation at the
 
 IL23R
 
 and
 
 IL13
 
 loci), proteomic (IL-17A, CXCL10, Mac-2 binding protein, Integrin b5, MMP-3, and M-CSF), and metabolomic (tyramine and mucic acid) biomarkers were also identified for psoriatic arthritis. Variation in
 
 IL12B
 
 and
 
 IL23R
 
 loci were genomic biomarkers identified for type 2 diabetes mellitus in psoriasis.




 "From the diverse range of biomarker types and outcomes examined in the included studies, we identify candidate biomarkers (10 genomic, 10 proteomic, and two metabolomic) but note that none have sufficient evidence for clinical use without further validation," the authors write.




 Several authors disclosed financial ties to the pharmaceutical industry.




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Genomic, proteomic, and metabolomic biomarkers identified from systematic review of relevant studies

Candidate Biomarkers Identified for Psoriasis Progression

Women with psoriasis have a significantly increased risk for ectopic pregnancy (EP), which is highest for those with moderate-to-severe psoriasis, according to a study published in the June issue of
 
 JAAD International
 
 .




 Cæcilie Bachdal Johansen, M.D., from the University of Copenhagen in Denmark, and colleagues examined the association between psoriasis and adverse pregnancy outcomes (APOs) in a nationwide register-based case-control study involving data collected from 1973 to 2017. Cases were APOs, including spontaneous abortion, EP, intrauterine fetal death, and stillbirth; controls were singleton live births.




 The researchers included 42,041 APOs and 449,233 controls (8.56 and 91.44 percent, respectively). The only APO that was statistically significantly associated with psoriasis was EP (odds ratio, 1.34). Women with moderate-to-severe psoriasis had the highest odds ratio for EP (odds ratio, 2.77). Compared with those without psoriasis, women with moderate-to-severe psoriasis had a 2.48 percent higher absolute risk for EP (3.98 versus 1.50 percent).




 "As EP is the leading cause of maternal morbidity and mortality in the first trimester of pregnancy, our findings call for particular care for women of reproductive age with psoriasis, that is, informing sexually active patients to seek emergency gynecologic evaluation in case of lower abdominal pain, unplanned absence of menstruation, and concurrent light vaginal bleeding," the authors write.




 Several authors disclosed financial ties to the pharmaceutical industry, including UCB Pharma, which funded the study.




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Ectopic pregnancy is only adverse pregnancy outcome significantly associated with psoriasis

Risk for Ectopic Pregnancy Increased for Women With Psoriasis

For patients with moderate-to-severe plaque psoriasis, bimekizumab is well tolerated, according to a study published online May 11 in
 
 JAMA Dermatology
 
 .




 Kenneth B. Gordon, M.D., from the Medical College of Wisconsin in Milwaukee, and colleagues examined the two-year safety profile of bimekizumab in patients with moderate-to-severe plaque psoriasis using pooled safety data from a cohort of patients from four phase 2 randomized clinical trials and four phase 3 randomized clinical trials. Data were included for 1,789 patients (mean age, 45.2 years) with moderate-to-severe plaque psoriasis who were eligible for systemic psoriasis therapy and/or phototherapy, with total bimekizumab exposure of 3,109.7 person-years.




 The researchers found that treatment-emergent adverse events (TEAEs) occurred at an exposure-adjusted incidence rate (EAIR) of 202.4 per 100 person-years and did not increase with a longer duration of exposure to bimekizumab. Nasopharyngitis, oral candidiasis, and upper respiratory tract infections were the most frequently reported TEAEs (19.1, 12.6, and 8.9 per 100 person-years, respectively). Oral candidiasis events were mostly mild to moderate; three led to discontinuation of bimekizumab. Low EAIRs were seen for inflammatory bowel disease, adjudicated suicidal ideation and behavior, and adjudicated major adverse cardiac events (0.1, 0.0, and 0.5 per 100 person-years, respectively).




 "Overall, bimekizumab was well tolerated in patients with moderate-to-severe plaque psoriasis, and there was no increased risk of AEs with longer duration of exposure," the authors write.




 Several authors disclosed financial ties to biopharmaceutical companies, including UCB Pharma, which manufactures bimekizumab and funded the study.




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In pooled analyses of data from eight randomized clinical trials, no increased risk for TEAEs seen with increased duration of exposure

How Safe Is Bimekizumab for Moderate-to-Severe Plaque Psoriasis?

Patients with psoriasis have an increased incidence of any infection and of severe and rare infections compared with the general population, according to a study published online April 5 in the
 
 British Journal of Dermatology
 
 .




 Nikolai Loft, M.D., from Copenhagen University Hospital in Denmark, and colleagues examined the incidence and risk for severe and rare infections in Danish patients with psoriasis and the matched general population using data from the Danish National Patient Register between Jan. 1, 1997, and Dec. 31, 2018. Patients with psoriasis were matched for age and gender with general population controls in a 1:6 ratio (94,450 patients and 566,700 controls). Severe infections were those requiring treatment in a hospital setting, while rare infections included HIV, hepatitis B and C, and tuberculosis.




 The researchers found that compared with controls, patients with any psoriasis had higher incidence rates per 100,000 person-years of exposure: 3,104.9 and 2,381.1 for any infection; 3,080.6 and 2,364.4 for severe infections; and 42.9 and 31.8 for rare infections, respectively. The incidence rates for severe or rare infections were higher for patients with severe psoriasis (3,847.7) compared with patients with mild psoriasis and controls.




 "Factors that may explain the increased risk of infection include the altered immune environment in patients with psoriasis involving a network of leukocytes and pro-inflammatory cytokines in disease pathogenesis," the authors write. "Patients with severe psoriasis are defined by their eligibility for systemics, either conventional or biologic. Therefore, the increased risk may be a consequence of treatment and not the severity of psoriasis."




 Several authors disclosed financial ties to pharmaceutical companies, including Novartis Pharma, which funded the study.




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Incidence of any infection, severe and rare infections increased; risk higher for patients with severe versus mild psoriasis

Do Patients With Psoriasis Have a Higher Incidence of Infections?

Lifestyle factors are predictive of the risk for incident psoriasis, regardless of genetic risk, according to a study published online April 12 in the
 
 Journal of the American Academy of Dermatology
 
 .




 Minxue Shen, Ph.D., from Central South University in Changsha, China, and colleagues used data from the U.K. Biobank, which recruited 500,000 participants, to examine the gene-behavior interaction in association with incident psoriasis. Genetic risk was classified as low, intermediate, or high. Lifestyle, which included body mass index, smoking, physical activity, and diet, was also classified as ideal, intermediate, or poor. The risks for incident psoriasis associated with each lifestyle category were examined within each genetic risk group.




 The researchers found that the hazard ratio was up to 4.625 in association with poor lifestyle and high genetic risk compared with low genetic risk and ideal lifestyle. No interaction was seen between genetic risk and lifestyle. The population-attributable fractions were 32.2 and 13.0 percent for lifestyle and genetic risk, respectively.




 "We found that an unhealthy lifestyle and genetic susceptibility were associated with an increased risk of incident psoriasis," the authors write. "However, no interaction effects were observed between genetic risk and a healthy lifestyle; that is, an ideal lifestyle was associated with a lower psoriasis risk among participants in each genetic risk level."




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Lifestyle factors predict risk independent of genetic risk; relative impact of lifestyle factors greater than genetic risk

Lifestyle Factors Are Predictive of Incident Psoriasis

In research published online April 15 in
 
 Science Immunology,
 
 distinct classes of human inflammatory skin disease are defined at the molecular level.




 To examine the molecular dysregulation underlying inflammatory skin conditions, Yale Liu, M.D., from the Second Affiliated Hospital of Xi'an Jiaotong University in China, and colleagues single-cell-profiled CD45 immune cell transcriptomes from skin samples of 31 patients: seven with atopic dermatitis, eight with psoriasis vulgaris, two with lichen planus, one with bullous pemphigoid, six with clinical/histopathologically indeterminate rashes, and seven healthy controls.




 The researchers identified active proliferative expansion of the Treg and Trm components and universal T cell exhaustion in human rashes; antigen-presenting cells were attenuated. Skin-resident memory T cells demonstrated the greatest transcriptional dysregulation in both atopic dermatitis and psoriasis; recurrent abnormalities were also exhibited in the ILC and CD8 cytotoxic lymphocytes in atopic dermatitis. Transcript signatures differentiating these rash types accurately identified disease class in untrained validation data sets. With these gene signatures, clinicopathologically ambiguous rashes could be classified with skin disease diagnoses consistent with therapeutic response.




 "By placing transcriptomic features of individual rashes in the context of a large, existing dataset, we seek a standardized framework to link molecular features to disease prognosis and drug response based on contributions from clinical centers worldwide," the authors write.




 Two authors disclosed financial ties to the pharmaceutical industry.




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Molecular signatures for inflammatory skin diseases can help with classification of clinically indeterminate skin rashes

Inflammatory Skin Diseases Classified at Molecular Level

For pediatric patients with moderate-to-severe psoriasis, ixekizumab is associated with sustained improvements in skin condition, according to a study published online April 13 in
 
 JAMA Dermatology
 
 .




 Amy S. Paller, M.D., from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues conducted a trial involving pediatric patients (aged 6 to &lt;18 years) with moderate-to-severe psoriasis to examine the efficacy and safety of ixekizumab. Patients were randomly assigned to receive a weight-based dose of ixekizumab every four weeks or placebo (115 and 56 patients, respectively); after 12 weeks, 166 patients entered a 48-week, open-label ixekizumab maintenance period, followed by an extension period lasting through 108 weeks (139 patients completed the trial).




 The researchers found that primary and secondary end points were sustained through 108 weeks, with 91.7, 79.0, and 55.1 percent of patients achieving 75, 90, or 100 percent improvement in the Psoriasis Area and Severity Index, respectively, and 78.3 and 52.4 percent achieving static Physician's Global Assessment scores of 0 or 1 and 0, respectively. Most patients (78.5 percent) reported an improvement of 4 points or higher on the Itch Numeric Rating Scale. At week 108, 68.1, 90.0, 76.2, and 87.5 percent of patients who received ixekizumab reported clearance of nail psoriasis, palmoplantar psoriasis, scalp psoriasis, and genital psoriasis, respectively. No new safety findings were observed between weeks 48 and 108.




 "In pediatric patients who received ixekizumab, significant improvements in skin condition and itch were reported at week 12 and were sustained through week 108," the authors write.




 Several authors disclosed financial ties to pharmaceutical companies, including Eli Lilly, which manufactures ixekizumab and funded the study.




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Skin condition and itch significantly improved with ixekizumab through 108 weeks, with no new safety findings from 48 to 108 weeks

Does Pediatric Psoriasis Improve With Ixekizumab Treatment?

For patients with psoriasis (PsO) and psoriatic arthritis (PsA), interleukin 17 (IL-17) inhibitors are associated with higher treatment persistence than tumor necrosis factor (TNF) inhibitors, according to a study published online March 23 in
 
 JAMA Dermatology
 
 .




 Laura Pina Vegas, M.D., from the Université Paris Est Créteil in France, and colleagues examined the long-term persistence of different biologic classes to treat PsO and PsA using data for all adults with PsO and PsA who were new users of biologics from Jan. 1, 2015, to May 31, 2019. The analyses included 16,892 patients with PsO and 6,531 with PsA.




 The researchers found that 60.4 percent of the PsO patients started therapy with a TNF inhibitor; 23.6 percent started with an interleukin 12 and interleukin 23 (IL-12/23) inhibitor; and 16.0 percent started with an IL-17 inhibitor. Of the PsA patients, 76.2, 12.3, and 11.5 percent started treatment with a TNF inhibitor, IL-12/23 inhibitor, and IL-17 inhibitor, respectively. For PsO and PsA, the overall three-year persistence rates were 40.9 and 36.2 percent, respectively. For PsO and PsA, higher persistence was seen with the IL-17 inhibitor versus the TNF inhibitor (weighted hazard ratios, 0.78 and 0.70, respectively); for PsA, persistence was higher for the IL-17 inhibitor versus the IL-12/23 inhibitor (weighted hazard ratio, 0.69). For PsO, but not PsA, the IL-12/23 inhibitor was associated with higher persistence than the TNF inhibitor (weighted hazard ratio, 0.76).




 "Given the many biologic treatment options available in the modern therapeutic environment, our results may help physicians optimize first-line treatment pathways," the authors write.




 One author disclosed financial ties to the pharmaceutical industry.




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Treatment persistence high with IL-17 inhibitors versus TNF inhibitors for psoriasis, psoriatic arthritis patients

What Biologics Offer the Best Treatment Persistence for Psoriatic Disease?

There is a bidirectional association between nonalcoholic fatty liver disease (NAFLD) and psoriasis, especially for patients younger than 40 years, according to a study published online Feb. 16 in
 
 Frontiers in Immunology
 
 .




 Shuo-Yan Gau, from Chung Shan Medical University in Taichung, Taiwan, and colleagues retrieved data from Taiwan's National Health Insurance Research Database to examine the bidirectional association between NAFLD and psoriasis. Patients with new-onset NAFLD and psoriasis were enrolled in two cohorts; propensity score-matched controls with no NAFLD or psoriasis were included for each comparison cohort.




 The researchers observed a significantly increased risk for developing psoriasis for patients with new-onset NAFLD (hazard ratio, 1.07), while for younger patients with NAFLD, the risk was increased 1.3-fold. For new-onset psoriasis patients, the risk for developing NAFLD in the future was increased 1.28-fold compared with those without psoriasis; the risk was higher for patients in younger psoriasis subgroups younger than age 40 years versus those in older subgroups (adjusted hazard ratio, 1.55).




 "Future studies should consider the mechanism influencing the pathogenesis and correlation between NAFLD and psoriasis and focus on the difference between different psoriasis severity subgroups and to what extent the severity difference would affect the bidirectional association," the authors write.




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Risk for developing psoriasis significantly increased for NAFLD patients, and risk for NAFLD significantly increased for psoriasis patients

Bidirectional Association Identified for NAFLD and Psoriasis

Among patients with plaque psoriasis, ixekizumab users have better persistence and adherence and a lower rate of discontinuation over 24 months than secukinumab users, according to a study published in the March 1 issue of the
 
 Journal of the American Academy of Dermatology
 
 .




 Andrew Blauvelt, M.D., from the Oregon Medical Research Center in Portland, and colleagues compared ixekizumab or secukinumab treatment patterns during a 24-month period among adult patients with plaque psoriasis. Participants had one or more claims for ixekizumab or secukinumab between March 1, 2016, and Oct. 31, 2019, and had 24 months of follow-up. The risks for nonpersistence, discontinuation, and switching and the odds of highly adherent treatment (proportion of days covered ≥80 percent) were estimated.




 Overall, 471 ixekizumab and 990 secukinumab users were included in the analysis. The researchers found that ixekizumab use was associated with a reduced risk for nonpersistence and discontinuation compared with secukinumab (hazard ratios, 0.80 and 0.83, respectively), while the odds of being highly adherent to treatment were increased (odds ratio, 1.42). There was no significant difference observed in the risk of switching.




 "These results add to prior findings that patients treated with ixekizumab were more likely to use the medication consistently and for a longer duration compared to secukinumab," the authors write. "These clinical data generated from real-world clinical settings could be beneficial to health care providers making treatment decisions for patients with psoriasis."




 Several authors were employed by IBM Watson Health and Eli Lilly and Company. The study was funded by Eli Lilly, the manufacturer of ixekizumab.




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During a 24-month period in a real-world setting, persistence and adherence higher with ixekizumab versus secukinumab for plaque psoriasis

What Are the Long-Term Treatment Patterns for Ixekizumab Versus Secukinumab?

Further study is warranted for the association of cardiac biomarkers with cardiovascular (CV) outcomes in patients with psoriatic disease (PsD), according to a study published online March 8 in
 
 Arthritis &amp; Rheumatology
 
 .




 Keith Colaço, from the Women's College Hospital in Toronto, and colleagues measured carotid total plaque area (TPA) in 358 participants with PsD at baseline. The association between cardiac troponin I (cTnI) and pro-brain-type natriuretic peptide (NT-proBNP), measured using automated clinical assays, and carotid atherosclerosis was assessed after adjustment for CV risk factors. Improvement in the prediction of CV events also was tested.




 The researchers found that cTnI and NT-proBNP were associated with TPA in univariate analyses. The association remained statistically significant for cTnI, but not for NT-proBNP, after adjustment for CV risk factors. Sixty-four of 1,000 PsD patients assessed for CV risk prediction had incident CV events. No improvement in predictive performance was seen when comparing a base model with the Framingham Risk Score (FRS) alone with expanded models with the FRS plus cardiac biomarkers.




 "cTnI may be as effective as established measures of carotid plaque burden for identifying subclinical atherosclerosis long before CV events occur," the authors write. "However, the lack of improvement in prediction metrics beyond the FRS does not support the routine use of these cardiac biomarkers for CV risk stratification in asymptomatic patients with PsD."




 Several authors disclosed financial ties to the pharmaceutical industry.




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No improvement seen in prediction of CV events using expanded model with cardiac biomarkers and Framingham Risk Score

Cardiac Biomarkers and CV Risk Examined in Psoriatic Disease

For patients with moderate-to-severe plaque psoriasis, self-injection of bimekizumab is safe and effective using a safety syringe or auto-injector, according to a study published in the February issue of the
 
 Journal of Drugs in Dermatology
 
 .




 Jerry Bagel, M.D., from the Psoriasis Treatment Center for Central New Jersey in East Windsor, and colleagues examined patients' ability to self-inject bimekizumab subcutaneously using a safety syringe or auto-injector. Patients with moderate-to-severe plaque psoriasis received bimekizumab injections every four or eight weeks and were then randomly assigned to safety syringe or auto-injector in a 1:1 ratio. Patients' ability to safely and effectively self-inject bimekizumab was examined at eight weeks and immediately after self-injection training (baseline).




 The researchers found that at week 8, all 125 and 86 evaluable patients from two substudies (DV0002 and DV0006, respectively) of the BE BRIGHT multicenter phase 3 study safely and effectively self-injected bimekizumab. At baseline, all 64 patients from DV0002 who used the safety syringe and 97.1 percent of the 68 who used the auto-injector and all 88 evaluable patients from DV0006 also self-injected bimekizumab safely and effectively. Across both devices, substudies, and timepoints, median visual analog scale scores for pain were low, and median preinjection and postinjection Self-Injection Assessment Questionnaire scores were high.




 "By providing both options, patients have the choice to use the device that best suits their preferences on the level of control over the self-injection process," the authors write.




 Several authors disclosed financial ties to pharmaceutical companies, including UCB Pharma, which manufactures bimekizumab; UCB Pharma funded the study.




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Both devices safe and effective, with low VAS pain scores and high preinjection and postinjection Self-Injection Assessment Questionnaire scores

Is Self-Injecting Bimekizumab Using Safety Syringe, Auto-Injector Safe?

A new nomogram may assess the risk for psoriatic arthritis (PsA) in patients with plaque psoriasis, according to a study published online Jan. 20 in the
 
 Frontiers of Immunology
 
 .




 Panpan Liu, from Central South University in Changsha, China, and colleagues recruited patients with plaque psoriasis or PsA and collected data on characteristics, skin lesions, and nail clinical manifestations. Features were selected and used to build a model to predict risk of PsA. Calibration, discrimination, and clinical utility of the model were evaluated. The model was validated externally in two separate cohorts.




 The researchers included age at onset, duration, nail involvement, erythematous lunula, onychorrhexis, oil drop, and subungual hyperkeratosis as predictors for the nomogram. The predictive model had a C-index of 0.759, indicating good calibration and discrimination. The prediction model had an area under the curve of 0.7578092. In the internal and external cohort validation, excellent performances were seen for the C-index (0.741, 0.844, and 0.845, respectively). The PsA nomogram had good effect in guiding clinical practice as indicated by the decision curve.




 "The assessment of the risk of PsA in plaque psoriasis patients can help physicians guide patients' lifestyles and make an individualized treatment plan," the authors write.




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Variables in the model include age at onset, duration, nail involvement, erythematous lunula, onychorrhexis, oil drop, subungual hyperkeratosis

Model May Predict PsA Risk in Patients With Plaque Psoriasis

Short-term exposure to air pollution seems to be associated with psoriasis flare, according to a study published online Feb. 16 in
 
 JAMA Dermatology
 
 .




 Francesco Bellinato, M.D., from the University of Verona in Italy, and colleagues examined whether short-term exposure to air pollution is associated with psoriasis flares in a study comprising case-crossover and cross-sectional designs. The case-crossover analysis included patients with at least one disease flare between two consecutive assessments within three to four months. The cross-sectional analysis included patients who received any systemic treatment for six months or longer. Data were included for 957 patients with chronic plaque psoriasis who had 4,398 follow-up visits; 369 were included in the case-crossover study.




 The researchers found that compared with the control visit, in the 60 days before the psoriasis flare, the concentrations of all pollutants were significantly higher. In the cross-sectional analysis, the risk for a Psoriasis Area and Severity Index increase of 5 or more points was increased in association with exposure to mean coarse particulate matter (2.5 to 10.0 µm in diameter) over 20 µg/m
 
 3
 
 or mean fine particulate matter (&lt;2.5 µm in diameter) over 15 µg/m
 
 3
 
 in the 60 days before assessment (adjusted odds ratios [95 percent confidence intervals], 1.55 [1.21 to 1.99] and 1.25 [1.0 to 1.57], respectively).




 "Further study is needed to examine whether these findings generalize to other populations and to better understand the mechanisms by which air pollution may affect psoriasis disease activity," the authors write.




 Several authors disclosed financial ties to the biopharmaceutical industry.




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Air pollution may trigger psoriasis flares in individuals with chronic plaque psoriasis

Short-Term Exposure to Air Pollution Linked to Psoriasis Flare

Sleep disturbance is highly prevalent among patients with psoriasis and is associated with pruritus, anxiety, and depression, according to a study published online Jan. 12 in the
 
 Journal of the European Academy of Dermatology and Venereology
 
 .




 Elvan Sahin, from the Universitätsmedizin Berlin, and colleagues examined sleep characteristics and factors associated with sleep disturbance in a cross-sectional study involving 334 psoriasis patients and 126 controls (response rates, 86 and 82 percent, respectively).




 The researchers found that 59 and 34 percent of patients and controls had sleep disturbance, respectively. Compared with controls, patients slept one hour less (median, six versus seven hours). Compared with patients with strong and very strong pruritus, those without pruritus had less impaired sleep. The strongest predictors of sleep impairment were anxiety and depression levels, followed by pruritus exacerbation at night, age, female sex, pruritus exacerbation in the morning, average pruritus intensity, diagnosed depression, and gastroesophageal reflux disease; together, these accounted for 32 to 37 percent of the global sleep quality variance. Significant mediators explaining the association between pruritus intensity and sleep impairment were anxiety and depression, accounting for 42 and 37 percent, respectively.




 "We reveal an alarmingly high prevalence of sleep disturbance in a population of patients with prevailingly well controlled psoriasis. Patients with psoriasis should be assessed for sleep impairment, pruritus, anxiety, and depression," the authors write. "Providing complementary psychotherapy aimed at reducing anxiety, depression and psychological distress may help to improve sleep in patients with psoriasis."




 The study was partially funded by Leo Pharma.




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Strongest predictors of sleep impairment include anxiety and depression levels, pruritus exacerbation at night, in morning

Sleep Disturbance Highly Prevalent in Psoriasis Patients

In U.S. studies of dermatologic clinical trials, reporting of race/ethnicity increased from 2010-2015 to 2015-2020, but inclusion of representative patient populations is still inadequate, according to a review published online Jan. 26 in
 
 JAMA Dermatology
 
 .




 Vivien Chen, from the University of Miami Miller School of Medicine, and colleagues conducted a systematic literature review to characterize the diversity of participants in dermatologic clinical trials conducted in the United States and published between 2015 and 2020 and compared findings for trials published from 2010 to 2015. The analyses included 392 randomized clinical trials.




 The researchers found that compared with the period of 2010 to 2015, the reporting rate for race and ethnicity increased in U.S. studies from 59.8 to 71.9 percent in 2015 to 2020. There was no change observed in the proportion of articles including at least 20 percent non-White representation, which was stable at 38.1 percent (37 of 97 trials in 2010 to 2015 and 53 of 139 trials in 2015 to 2020). The least diversity was seen among psoriasis studies, with 12.1 and 25.9 percent of studies reporting at least 20 percent non-White participants and at least 45 percent female participants, respectively.




 "While reporting of racial and ethnic data has become more transparent from the 2010-2015 period to the 2015-2020 period, inclusion of representative patient populations (particularly in psoriasis studies) has not statistically significantly changed," the authors write.




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However, proportion of reporting articles including at least 20 percent non-White representation unchanged at 38.1 percent

Reporting of Race, Ethnicity Has Improved in Dermatology Trials

Self-help based on compassion and mindfulness is acceptable to users and can reduce feelings of shame and improve quality of life for people living with psoriasis, according to a study published online Jan. 18 in the
 
 British Journal of Dermatology
 
 .




 Zina Muftin, from the University of Sheffield in the United Kingdom, and colleagues randomly assigned 130 participants with psoriasis to receive either compassion-based self-help (65 participants) or mindfulness-based self-help (65 participants) for four weeks.




 The researchers found that the interventions were acceptable, with more than 70 percent of study completers (30 percent attrition) reporting that the materials were helpful. There were modest but statistically significant reductions in shame, as well as improvements in quality of life, for both interventions.




 "In conclusion, the current study suggests that self-help interventions based on compassion-focused therapy have clinical relevance and are welcomed by a community psoriasis sample," the authors write. "The improvements were modest yet demonstrate potential for the benefit of brief self-help interventions. It is encouraging that despite the limitations of unguided self-help, the study has shown that self-help can reach a wide audience who do not have access to structured psychological support."




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Findings show modest, but significant, benefit from either compassion-based or mindfulness-based self-help

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