Chronic Plaque Psoriasis Patients Research Articles

Efficacy and safety of weekend cyclosporine treatment as maintenance therapy for preventing frequent disease exacerbations in moderate to severe chronic plaque psoriasis patients - A retrospective cohort study.

Background Psoriasis is a chronic, inflammatory, systemic disease with predominant manifestations in the skin and joints impairing patient's quality of life. A proportion of patients have frequent severe disease exacerbations requiring repeated systemic treatments. There is a scarcity of literature evaluating the role of systemic maintenance therapy in psoriasis patients in preventing such frequent disease flares. Objective To evaluate the efficacy and safety of weekend cyclosporine treatment (WCT) as maintenance therapy in moderate to severe chronic plaque psoriasis patients for the prevention of frequent disease exacerbations. Methods In this retrospective cohort study, 22 psoriasis patients with a history of frequent disease exacerbations (≥ 3 in the last 1 year) who were administered WCT (group A) were compared with the same number of matched patients (age and gender) not on WCT or any systemic maintenance therapy (group B). Results Four patients (18.2%) in group A had disease exacerbations which was significantly lower (p = 0.00, Fisher's exact test) as compared to 21 patients (95.5%) in group B during the study period. Also, patients in group A had significantly lower number of overall exacerbations [mean ± SD: 0.23 ± 0.53 vs 2.95 ± 1.43) p = 0.00, Mann-Whitney U test] as compared to group B. Four (9.1%) patients in group A encountered adverse effects (acneiform eruptions - two, mild gingival hyperplasia - one, myalgia - one) as compared to three (acneiform eruptions - two, headache - one) in group B (p = 1.00). Conclusion WCT significantly reduced the number of disease exacerbations and is a safe and effective mode of maintenance therapy in such subset of psoriasis patients.

EVALUATION OF EFFICACY AND SAFETY OF ORAL VITAMIN D3 AND VITAMIN E AS AN ADD-ON-THERAPY TO METHOTREXATE IN PATIENTS OF MODERATE CHRONIC PLAQUE PSORIASIS

Objective: This study was conducted with the aim to evaluate the efficacy and safety of oral Vitamin D3 and Vitamin E as an add-on-therapy to methotrexate (MTX) in patients of moderate chronic plaque psoriasis. Methods: In this prospective, open-labeled, randomized, and comparative clinical study, a total of 120 patients of age 20–60 years with moderate chronic plaque psoriasis attending the dermatology outpatient department were randomly allocated into three groups of 40 each, i.e., Group M, Group D, and Group E. Group M received MTX (7.5 mg) tablet orally weekly, Group D received MTX (7.5 mg) and Vitamin D3 (60,000 IU) sachet orally weekly, and Group E received MTX (7.5 mg) weekly and Vitamin E (400 mg) daily. Efficacy assessment was done through the following primary parameters-psoriasis area and severity index (PASI) score, dermatology life quality index (DLQI), and psoriasis disability index (PDI), and secondary parameters such as Vitamin D deficiency and insufficiency among the study participants and improvement of serum 25(OH)D concentration. Adverse events were monitored. Results: PASI and DLQI were calculated at the time of recruitment (baseline), 1 month, 2 months, 3 months, and 4 months, and PDI and serum Vitamin D were calculated at baseline and 4 months. On intergroup comparison of PASI score and PDI, statistically significant results were seen at 4 months. DLQI showed significant results at 2, 3, and 4 months. Significant results were found in Group D which signifies improvement in serum Vitamin D levels. Mild side effects were seen at the end of 4 months. Conclusion: The present study suggested that Vitamin D as an add-on therapy was found to cause a significant reduction in psoriatic lesions. It could be a promising drug in patients with psoriasis to improve the psoriatic lesions, when combined can reduce the dose of MTX, thereby minimizing the side effects.

Interleukin Levels and Non-Alcoholic Fatty Liver Disease in Chronic Plaque Psoriasis: An Analytical Case Control Study.

Psoriasis is a chronic, immune mediated inflammatory condition of the skin and imbalance in inflammatory mediators could result in insulin resistance, metabolic syndrome and facilitate the occurrence and progression of Non-alcoholic fatty liver disease (NAFLD). Primary objectives: To study the frequency of NAFLD in cases of chronic plaque psoriasis and controlsTo study the interleukin levels in cases of chronic plaque psoriasis and controls. Secondary objectives: To study the BMI, lipid profile, waist circumference, FBS (fasting blood sugar), PPBS (post prandial blood sugar) and serum insulin in cases and controlsTo study the association of age, duration of psoriasis, PASI (psoriasis area severity index), BSA (body surface area) involved, BMI (body mass index), lipid profile, obesity, waist circumference, FBS (fasting blood sugar), PPBS (post prandial blood sugar) and serum insulin levels with NAFLD in patients of chronic plaque psoriasisTo correlate serum levels of IL1-β, IL6 and TNF-α with NAFLD in patients of chronic plaque psoriasis. 50 clinically diagnosed cases of chronic plaque psoriasis with age ≥ 18years, diseases duration ≥ 6 months and 30 age and sex matched controls were recruited. PASI, BSA of cases was calculated and BMI, BP, WC of all subjects was measured. Serum lipid profile, FBS, PPBS, insulin level, IL1- β , IL6, TNF- α , high frequency B-mode ultrasound, LFT and fibroscan were done in all subjects. 28(56.0%) cases and 2(6.6%) controls had NAFLD with statistically significant difference. Significantly elevated WC, serum insulin, deranged lipid profile, fatty liver, transaminitis, fibroscan score, liver fibrosis, NAFLD and interleukins were found in cases vs controls. There was a significant association of NAFLD in psoriatic patients with increasing duration of psoriasis, BMI ≥23 Kg/m2, high WC, increasing BSA involved, deranged lipid profile, raised total cholesterol levels and increasing number of risk factors. Nonsignificant but positive association of NAFLD in cases was found with high levels of IL1 - β, IL - 6, TNF-α, FBS and increasing PASI. Significantly increased interleukin levels and their weak positive correlation with the severity of psoriasis (PASI, BSA) in patients of chronic plaque psoriasis explains the possible role of inflammation in the causation of psoriasis. Screening may be considered in psoriatic patients with increasing duration of psoriasis, high WC, high BSA involved, high BMI, obesity, dyslipidemia and insulin resistance. Small sample size. NONE.

Effectiveness and Safety of Secukinumab in Latin American Patients with Moderate to Severe Plaque Psoriasis: PURE Registry 12-Month Data.

The efficacy and safety of secukinumab in patients with psoriasis has been established in randomised clinical trials. However, data on effectiveness and safety of secukinumab in Latin American real-world settings are scarce. To evaluate the effectiveness and safety of secukinumab in real-world settings in patients with psoriasis in Latin America. PURE is an ongoing multinational, prospective, observational study in patients with moderate-to-severe chronic plaque psoriasis in Canada and Latin America assessing the real-world safety and effectiveness of secukinumab and other approved therapies. The study enrolled (1:1) patients treated with secukinumab versus other approved therapies (other Tx) per local standard of care from 81 community- and hospital-based speciality sites (21 in Latin America). Here, we report effectiveness and safety outcomes with secukinumab and other Tx for plaque psoriasis for up to 12months in a Latin American population. Overall, 187 patients were included in the analysis, 89 of whom initiated secukinumab treatment and 98 of whom received other Tx. At month12, 84.4%, 71.1% and 53.3% of patients treated with secukinumab achieved Psoriasis Area and Severity Index (PASI) 75/90/100, respectively, compared with 66.7%, 47.9% and 29.2% of patients who received other Tx. Investigator Global Assessment (IGA) 0/1 responders in secukinumab versus other Tx were 78.3% versus 36.7% at month3 and 81.8% versus 66.7% at month12, respectively. Overall, the proportion of patients achieving Dermatology Life Quality Index (DLQI) 0/1 improved from 6.9% at baseline to 76.5% at month12 in patients treated with secukinumab versus 5.6% at baseline to 54.5% at month12 in patients on other Tx. No unexpected adverse events were reported during the 12-month observation period. Secukinumab demonstrated real-world effectiveness and improved dermatology quality-of-life in chronic plaque psoriasis patients from Latin America. PURE: NCT02786186.

A Comparative Study of Oral Methotrexate and Combination of Oral Methotrexate and Narrow Band Ultraviolet-B in Chronic Plaque Psoriasis

Background: Psoriasis is a chronic common skin condition which alters the skin appearance, causes an inflammation in the outerepidermis, and proliferates the skin epidermal layers. It is influenced by both genomic and other external factors like environmental factors.1The most common lesions are red, scaly, sharply demarcated plaques that appear primarily on extensor surfaces. Psoriasis exhibits a chronic relapsing nature and variable clinical features. The cutaneous lesions are typically thus distinct for clinical diagnosis. Material & Methods: Prospective hospital based observational study. The study was conducted in Department of Department of Dermatology, Narayana Medical College, Nellore, A.P. Patients of chronic plaque psoriasis not responding to any other therapeutic modality. Initially a detailed history regarding the age of onset, the duration of illness, past modalities of treatment, family history of the disease, seasonal variation, other triggering factors, occupation were taken. The patients were explained regarding the duration of treatment, the need for regular follow up of therapy, clinic and probable side effects that could be encountered during treatment. Results: Among all (n=50 including group A and B, 25 of each) participants, relapse of treatment in weeks observed between the range of 6-12, mean was 9 with the standard deviation of 1.6 in group A. For group B relapse of medical regimen in weeks observed between the range 8-12, Mean was 10.5 with the standard deviation of 1.9 which is nearly similar in group A. This results were statistically significant as p= 0.01 where p<0.05. Conclusion: From our study it,we concluded that Combination therapy of oral methotrexate and NBUVB is found to be most effective, feasible from the economic point of view as well as the side effects profile and patient compliance.

The study of epidemiological, clinical, histopathological and dermoscopic features of chronic plaque psoriasis

: Psoriaisis is a common papulosquamous condition seen by the dermatologists. It can involve the skin and nails. There are many sub types of Psoriasis with various clinical, histopathological and dermoscopic features. In this study we intend to study the epidemiological, clinical, histopathological and dermoscopic features of Chronic Plaque Psoriasis (CPP).: A total of 45 patients of CPP, above the age of 18 years who qualified the inclusion and exclusion criteria were included in the study. A proforma of epidemiological details was noted, clinical and dermoscopic examination of the lesions were done. The punch biopsy specimens of cutaneous lesions were subjected to histopathological examination and the findings noted. : Out of the 45 patients included in the study, 31 were males and 14 females with a ratio of 2.21:1. The commonest symptom at presentation was flaking of skin and the most common site of involvement was trunk. On dermoscopic examination, dotted vessels and white scales were seen in all the patients. Hyperkeratosis, Parakeratosis, Acanthosis, Munro’s microabscess, Hypogranulosis were the significant histopathological features.: Psoriasis is more common in young adults and shows a male preponderance. Presence of dotted vessels in a regular distribution on dermoscopy is classical of CPP. Hyperkeratosis, Hypogranulosis and Munro’s microabscess are notable features of histopathology of LP.

Characterization and comparison of efficacy and safety of calcipotriene and clobetasol in severe chronic plaque psoriasis patients

Calcipotriene and Clobetasol ointments efficiently treat psoriasis. The purpose of the study was to characterize and compare the efficacy and safety of Calcipotriene and Clobetasol in chronic plaque psoriasis patients. 70 patients with chronic plaque psoriasis were recruited and randomly divided into two groups of 35 each. One group received 0.005% Calcipotriene, and the other group received 0.05% clobetasol twice daily for 12 weeks. Efficacy evaluations comprise global improvement assessed by the clinician by using the Physician Global Assessment (PGA) score. Efficacy further included the 'Dermatological Sum Score' (DSS) and Psoriasis Area and Severity Index (PASI) score at each study visit. The safety evaluations included clinical assessment of cutaneous safety and assessment of cutaneous discomfort by the clinician as well as the subject. Calcipotriene and Clobetasol were significantly effective in reducing PASI and DSS. However, the two experimental groups have shown no statistically significant observations. The PGA score assessed clinically was 1.27 for calcitriene and 1.79 for Clobetasol (p>0.05). The cutaneous safety score was higher in the clobetasol group compared to the Calcipotriene group. 4% of cutaneous discomfort was reported with Clobetasol compared to 2% with Calcipotriene. Calcipotriene showed a better safety profile than Clobetasol.

Seroprevalence of Helicobacter Pylori in Plaque Psoriasis at Tertiary Care Hospital

Background: Psoriasis is a common, chronic inflammatory skin disorder whose aetiology is largely unknown. Several microorganisms, including Helicobacter pylori, have been identified as triggering factors for the disease. Aims: To determine the frequency of seroprevalence of Helicobacter pylori in chronic plaque psoriasis and to determine any relationship between sero-positivity to H. pylori and severity of chronic plaque psoriasis. Study design: Cross-sectional study Place and duration of study: Department of Dermatology, Pakistan Emirates Military Hospital, Rawalpindi from 1st September 2020 to 31st March 2021. Methods: Eighty three patients of chronic plaque psoriasis were enrolled. Psoriasis Area Severity Index was calculated in each patient to determine the severity of psoriasis. Seroprevalence was confirmed by IgG anti H. pylori antibody in sera detected by enzyme linked immunosorbent assay. Results: Mean age was 46.67±15.32 years. Majority of the patients, 46(55.42%) were between 46 to 70 years of age. Sixty three (75.90%) were males and 20(24.10%) were females. Sixty four (77.11%) of the patients showed sero-positivity to underlying helicobacter pylori infection. Frequency of seroprevalence of Helicobacter pylori increased with severity of plaque psoriasis (p=0.0001). Conclusion: Chronic plaque psoriasis is associated with high frequency of H. pylori infection and statistically significant correlation was found between severity of psoriasis and underlying H. pylori infection. Keywords: Psoriasis, Chronic plaque psoriasis, H. pylori, Infection, Frequency, Association

Hemorrhagic dot score as a follow up marker in psoriasis on treatment: A prospective observational study.

Psoriasis assessment tools in use presently lack reproducibility and are cumbersome to use. An easily reproducible, objective tool with ability to maintain visual records for follow up is hence desirable. We conducted a study with the aim to assess dermoscopic changes in psoriasis while on treatment by recording the number of hemorrhagic dots (Hemorrhagic Dot Score-HDS) in a representative plaque and comparing it to the PASI score. A longitudinal prospective study was conducted between October 2018 to March 2020 in a dermatology centre of a tertiary hospital on cases of chronic plaque psoriasis on treatment over 6months, assessed at baseline and thereafter monthly for 6 months. Hundred consenting patients of chronic plaque psoriasis were assessed, clinically, PASI and dermoscopically. HDS and other dermoscopic features were noted at every visit. ANOVA and F test of testing of equality of Variance; effect size in terms of Cohen were used to report the strength of an apparent relationship. Percentage improvement in the mean PASI scores and HDS and percentage improvement of mean was found significant in each month on follow up. Systemic therapy as compared to topical therapy showed higher effect size of 6.1 and 1.7, respectively. Hemorrhagic dot score can be used as an objective, definite assessment tool correlating with clinical severity of psoriasis with more accuracy which shows changes early following institution of therapy.

Evaluation of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Chronic Plaque Psoriasis.

Psoriasis is a common inflammatory dermatological condition and affects 2-3% population worldwide. Psoriasis area and severity index (PASI) and body surface area (BSA) are two commonly used scales used to measure disease severity in psoriasis patients. However, these scales are plagued by weaknesses as inter-observer variation and insufficient evaluation of micro-vascular inflammation. Thus, it is necessary to have an objective and simple measure of the severity of inflammation. The ratio of neutrophils-to-lymphocytes (NLR) and platelets-to-lymphocytes (PLR) are simple and inexpensive markers of systemic inflammatory response that can be measured as part of a complete blood count and are already used in the setting of inflammatory diseases. The utility of the NLR and PLR in psoriasis however, remains relatively unexplored. The present study was undertaken to assess if NLR, PLR and C-reactive protein were altered in chronic plaque psoriasis patients as compared to controls and also to determine correlation of NLR and PLR values with disease severity as measured by PASI. This case control study consisted of equal numbers (45 each) chronic plaque psoriasis patients and control subjects. The subjects were evaluated by way of history taking, clinical and blood examination. Thereafter, the results were tabulated and examined statistically. Our study results indicate that psoriasis patients tended to have a higher neutrophil count, lymphocyte count, NLR and C-reactive protein in comparison the control subjects (P < 0.05). We concluded that such easily available and low cost indices of systemic inflammation are raised in psoriasis patients and are positively correlated with the severity of involvement. They can thus not only be used to monitor the effect of systemic drugs in psoriasis.

Effect of lockdown due to COVID-19 on health and lifestyle of psoriasis patients: A web-based survey

Background:Chronic skin diseases like psoriasis affect a patient’s physical, psychological, and social functioning as well as well-being, and the lockdown acted as a cofactor in further worsening the quality of life in psoriasis patients.Objective:The objective of the study is to assess the effect of lockdown on the health, lifestyle, and mental well-being of psoriasis patients.Methods:A cross-sectional study was done using an online questionnaire shared through messenger applications to the patients of chronic plaque psoriasis who registered in the psoriasis clinic between August 2020 and December 2020. Data regarding demographics, psoriasis, lifestyle changes, mental status, financial loss, and problems faced during lockdown were collected.Results:Our study included 181 completed questionnaires. The mean age was 37.7 (SD 13.9) years, and 124 (68.5%) were males. Sixty-five (35.9%) patients reported worsening of their psoriasis during the lockdown. Ordinal regression analysis revealed male sex had a higher proportion of worsening of psoriasis (OR 2.56, 95% CI 1.29–5.08, P < 0.007). Duration of illness <6 months (OR 0.14, 95% CI 0.02–0.98, P < 0.04) and feeling relaxed (OR 0.14, 95% CI 0.03–0.56, P < 0.005) were negatively associated with disease worsening.Conclusion:The findings of our study reveal the impact of coronavirus disease 2019 (COVID-19) lockdown on the life of people with psoriasis. A substantial number of patients had a flare of psoriasis during the lockdown. A shorter duration of illness and relaxed mental status was negatively associated with disease worsening. Individuals with financial loss felt anxious or depressed.

A Cross-Sectional Study to Assess Sub-clinical Atherosclerosis in Patients of Psoriasis Independent of Metabolic Syndrome.

A sustained inflammatory state of psoriasis causes comorbidities such as psoriatic arthritis, metabolic syndrome (MetS), and cardiovascular disease. To note the duration and severity of psoriasis, assess prevalence of MetS, and correlate these with indicators of sub-clinical atherosclerosis. Thirty-two patients of chronic plaque psoriasis were enrolled in the study. Their demographic particulars, clinical details, results of investigations to assess MetS, and indicators of sub-clinical atherosclerosis, namely, carotid intimal media thickness (CIMT) measured using B-mode USG and epicardial fat thickness (EFT) using 2-D ECHO, were recorded. The study participants were predominantly male (2.5:1); their mean age was 40.45 ± 12.42 years, the median disease duration (DD) was 2 years, and the mean psoriatic area severity index (PASI) score was 8.62 ± 7.49. Mild disease (PASI <5) was present in 12 participants (37.5%), and shorter DD (<5 years) was present in 16 (50%) participants. MetS, detected in 11 (37.5%) study participants, was not significantly associated with CIMT, EFT, DD, and PASI. CIMT and EFT too did not correlate significantly with DD, PASI, or measures of MetS. Neither did there exist any significant correlation between CIMT and EFT. Sub-clinical atherosclerosis in our study participants was not significantly associated with either measures of MetS or duration/severity of psoriasis.

Efficacy and Safety of Apremilast versus Methotrexate in the Treatment of Chronic Plaque Psoriasis

Introduction: Psoriasis is a common, chronic, inflammatory and proliferative disease of the skin, also affecting nail and joints. Although there are a range of treatment options available, none have proved to wane the symptoms fully and also they reappear in course of time. Aim: To explore the safety and efficacy of Apremilast and Methotrexate on chronic plaque psoriasis patients. Methods: A randomized open clinical trial was done among fifty clinically diagnosed chronic plaque psoriasis patients in the Department of Dermatology and Venereology at Combined Military Hospital (CMH), Dhaka from 1st July 2017 to 30th June 2018. Patients were divided randomly into two equal treatment groups, 25 for Methotrexate and 25 for Apremilast. Involvement of body surface by plaque psoriasis, erythema, scaling and induration were recorded in a 3 points scale before treatment and 8 weeks after starting the treatment and finally at 12th week. Results: Reduction of psoriasis at 1st follow up in Methotrexate and Apremilast groups were 29.9±9.0 and 31.9±11.6 respectively and at 2nd follow up were 85.9±7.3 and 28.48±39.3 respectively. Significantly higher improvements were observed in Methotrexate group than Apremilast group both at 1st and 2nd follow up (p=0.001). Conclusion: Methotrexate is a better therapeutic option than Apremilast in the treatment of chronic plaque psoriasis. JAFMC Bangladesh. Vol 15, No 1 (June) 2020: 39-41

Safety and efficacy of methotrexate (0.3 mg/kg/week) versus a combination of methotrexate (0.15 mg/kg/week) with cyclosporine (2.5 mg/kg/day) in chronic plaque psoriasis: A randomised non-blinded controlled trial.

Psoriasis is a chronic, inflammatory, relapsing and remitting disease with no cure till date. There is a paucity of trials using a combination of methotrexate (MTX) and cyclosporine (CsA) in chronic plaque psoriasis, due to fear of added toxicity, although they are time tested treatment options for monotherapy. The study aimed to compare the efficacy and adverse effect profile of the standard recommended dose of MTX (i.e. 0.3mg/kg/week) versus a combination of reduced doses of MTX and CsA (i.e. MTX 0.15 mg/kg/week with CsA 2.5mg/kg/day) in patients with chronic plaque psoriasis. Study design was a non-blinded randomised controlled trial. Patients of chronic plaque psoriasis with PASI more than 10 were randomised in 1: 1 allocation to receive either 0.3 mg/kg/week of intramuscular MTX injection or a combination of 0.15 mg/kg/week of intramuscular MTX injection and 2.5 mg/kg/day of CsA rounded off to the nearest 25 mg. Patients were followed up at every 2 weeks for 12 weeks. The doses were kept fixed throughout the study period. A total of 66 patients received MTX monotherapy, whereas 67 patients received the combination. At baseline, both groups were comparable in their BSA (P = 0.105, Student t-test) and PASI (P = 0.277, Student t-test), which reduced significantly at 12 weeks in both groups (P < 0.001, paired t-test). The achievement of PASI-75 (P = 0.005), PASI-90 (P < 0.001) and PASI-100 (P = 0.001) was more in the combination group (Chi square test). Intention to treat analysis using Chi square test also showed better outcomes for PASI-75 (P = 0.027), PASI-90 (P < 0.001) and PASI-100 (P = 0.001) in the combination group. Combination group also had earlier onset of action (P = 0.001, Chi square test). There was no significant difference between the groups in terms of laboratory and clinical adverse events. Non-blinded, no comparison with CsA monotherapy arm, no follow up beyond 12 weeks. The combination of reduced doses of MTX and CsA is more efficacious with earlier onset of action and similar adverse effects as with MTX monotherapy.

Characteristic of chronic plaque psoriasis patients treated with biologics in Italy during the COVID-19 Pandemic: Risk analysis from the PSO-BIO-COVID observational study

ABSTRACT Background: The susceptibility of patients with chronic plaque psoriasis and the risks or benefits related to the use of biological therapies for COVID-19 are unknown. Few data about prevalence, clinical course and outcomes of COVID-19 among psoriatic patients were reported. The aims of this study were 1) to assess the prevalence and severity of COVID-19 in psoriatic patients treated with biologic agents during the first phase of the emergency (22 February to 22 April 2020) in Italy, and 2) to report the clinical outcomes of patients who have been exposed to individuals with confirmed SARS-CoV-2 infection. Methods: Patients with moderate-to-severe chronic plaque psoriasis, aged ≥18 years and undergoing treatment with biologic agents as of 22 February 2020, were eligible to be included in PSO-BIO-COVID study. Demographic and clinical characteristics of patients using any biologic for psoriasis treatment between 22 February and 22 April 2020 were registered. Results: A total of 12,807 psoriatic patients were included in the PSO-BIO-COVID study. In this cohort 26 patients (0.2%) had a swab confirmation of SARS-CoV-2 infection. Eleven patients required hospitalization and two died. Conclusion: The incidence of COVID-19 observed in our cohort of psoriatic patients (0.2%) is similar to that seen in the general population (0.31%) in Italy. However, the course of the disease was mild in most patients. Biological therapies may likely lessen ‘cytokine storm’ of COVID-19, which sometimes lead to multiple organ failure, ARDS, and death.

Comparative study of PUVA and NB-UVB in the management of chronic plaque psoriasis

Background: There are independent studies on PUVA and NB-UVB therapy for the treatment of psoriasis, but studies comparing both PUVA and NB-UVB are scarce. Aim: The aim of this study was to compare the efficacy and safety of PUVA and NB-UVB therapy in chronic plaque psoriasis. Materials and Methods: Fifty patients of chronic plaque psoriasis of more than 20% of body surface area and of more than 2 years duration with Psoriasis Area Severity Index (PASI) score of more than 10, aged above 12 years, were subjects in the study. PASI score was recorded. Patients were randomly allocated to one of the two groups, each consisting of 25 patients and administered therapy as per protocol: Group A: PUVA—psoralens + UVA or Group B: NB-UVB phototherapy. Therapeutic response of patients was followed up every week and PASI score was calculated at 0, 2, 4, 6, 8, 10, and 12 weeks. Observations: Commonest age group afflicted in both the groups was 31–40 years. There was significant improvement (P-value <0.0001) from baseline to 12th week in patients subjected to PUVA as well as NB-UVB therapy. In the PUVA group, minimum and maximum duration of treatment for PASI 75 was 5 and 11 weeks, respectively, whereas in the NB-UVB group it was 6 and 12 weeks, respectively. In the PUVA group, minimum and maximum number of exposures for PASI 75 was 10 and 22, respectively, and in the NB-UVB group it was 18 and 36, respectively. Conclusion: PUVA and NB-UVB are both effective therapies. However, NB-UVB is considered as good, effective, and safer treatment for plaque psoriasis with no or minimal long-term carcinogenic risk, and it can be safely used in children, pregnant women, and in patients with hepatic and renal insufficiency. However, more number of exposures and less energy (joules) are required in NB-UVB to achieve therapeutic target. Limitations: The number of cases in the study is less.

Direct detection of free vitamin D as a tool to assess risk conditions associated with chronic plaque psoriasis.

SummaryIntroductionPsoriasis is a major public health problem that results in high social and health costs. New approaches and methods are required to identify any conditions related to the disease and comorbidity development. The vitamin D deficiency is associated to psoriasis and could play an important role in its pathogenesis. However, the serum level of vitamin D is currently measured as total vitamin D, which is affected by wide variability. Therefore, the determination of the free form could be more significant, since it is independent of confounding factors. A cross-sectional study was performed to assess the association between chronic plaque psoriasis and serum level of free vitamin D, detected by a direct analytical method.MethodsThe levels of bioavailable vitamin D, total vitamin D and other metabolic parameters whose homeostasis is regulated by vitamin D were evaluated in 72 psoriasis patients and in 48 healthy controls. A direct immunoassay method was used to measure serum free vitamin D level. Analysis of covariance was performed to calculate estimated marginal means (EMM) and 95% confidence interval (CI), after adjustment for age, sex and BMI, within the two groups.ResultsPatients showed an EMM of 5.526 ± 0.271pg/ml, 95% CI 4.989-6.063; while controls an EMM of 6.776 ± 0.271 pg/ml, 95% CI 6.115-7.437.ConclusionsChronic plaque psoriasis patients exhibited a serum level of free vitamin D lower than controls. The direct immunoassay method could represent a useful tool to assess vitamin D status and identify a risk condition associated with the onset of the pathology.

Serum Concentration of 25-Hydroxy Vitamin D in Patients with Chronic Plaque Psoriasis: A case control study: Vitamin D and chronic plaque psoriasis

Objective: To determine 25-hydroxy vitamin D levels in patients of chronic plaque psoriasis and to assess any relationship between vitamin D deficiency and other disease parameters. Methods: This case-control study included 140 subjects (70 with chronic plaque psoriasis and 70 controls), and conducted in out-patient department of Dermatology Unit of The Indus Hospital, Karachi, Pakistan from 12th September 2018 to 18th November 2019. Body mass index (BMI) calculated and 25-hydroxy vitamin D (25-HVD) levels were checked in all subjects. Psoriasis Area and Severity Index (PASI) was calculated in psoriasis patients. Results: Serum concentration of 25-HVD in psoriasis patients is lower as compared to controls (17.1 ± 9.1 vs 18.3 ± 10.7) but it is not statistically significant (P=0.66). Similarly, age, gender and BMI were not statistically different between cases and controls. On comparative analysis, type I plaque psoriasis patients had more lower levels of 25-HVD (P=0.03), especially those who had disease for < 5 years (P=0.01). Stratified analysis revealed males of type I plaque psoriasis had significantly lower levels of 25-HVD as compared to males from type II group (P=0.003). Conclusion: 25-HVD levels were almost similar in both cases and controls. There was no significant 25-HVD deficiency found in chronic plaque psoriasis patients, neither any relation with age, gender, BMI or PASI. However, 25-HVD levels were much lower in males, type I cases and with shorter duration of disease.

To compare both, the 5-d itch scale scores and the DLQI scores in patients with chronic plaque psoriasis with pruritus

Background and Method: 80 patients of chronic plaque Psoriasis were evaluated under the study. Relevant history, clinical examination and necessary investigations along with PASI were done for all the patients. Severity of Pruritus was measured using the 5-D Itch scale. Quality of life of all chronic plaque psoriasis patients was evaluated by using Dermatology Life Quality Index (DLQI) structured questionnaire. It will be a prospective study in which patients will be selected randomly and the patients enrolled will be categorized under these. Result: There is a significantly positive (P0.05 hence non-significant where as that of PASI with 5-D Itch score and DLQI respectively was P

Sonographic Evaluation of Subclinical Enthesopathy in Patients of Chronic Plaque Psoriasis.

Background:Psoriasis is associated with spondyloarthropathy in 10%–30% of cases. Enthesitis is major feature of psoriatic arthritis. Ultrasonography can detect subclinical entheseal abnormalities in psoriasis patients.Objectives:To determine the prevalence of subclinical enthesopathy in psoriasis vulgaris using ultrasonography and evaluating its correlation with severity and duration of psoriasis.Materials and Methods:This study included 50 patients of psoriasis vulgaris and 50 healthy controls. Sonographic evaluation of six sites bilaterally (proximal plantar fascia, distal Achilles tendon, distal and proximal patellar ligaments, distal quadriceps, and brachial triceps tendons) were done in each subject. All Ultrasonographic findings were identified according to MASEI (Madrid sonography enthesitis index). Enthesopathy scores of patients and controls were compared and receiver operating characteristic curve was used to determine cut off value of MASEI, above which ultrasound enthesitis of clinical significance could be diagnosed.Results:31 (62%) psoriasis patients had subclinical enthesopathy of clinical significance as compared to only 5 (10%) of controls. Mean MASEI score between psoriasis cases and control was statistically different, 12.72 ± 7.55 (Mean ± SD) and (5.14 ± 4.69), respectively (P value 0.000001).The receiver operating characteristic curve established an ultrasound score of >11 as the best cut-off to differentiate between subject with enthesopathy of clinical significance from those with enthesopathy of unknown significance. No statistically significant correlation was found between the degree of enthesopathy (MASEI score) and duration and severity of the psoriasis.Conclusion:Ultrasonography can effectively screen subclinical entheseal abnormalities in psoriasis patients.