Chronic Plaque-type Psoriasis Research Articles

A Case of Psoriasis and Pemphigus Foliaceous in a 55-year-old Filipino

Pemphigus foliaceous is a rare autoimmune blistering disease, while psoriasis is a common immune-mediated inflammatory skin disease. The coexistence of psoriasis and pemphigus foliaceous has rarely been reported. We report a case of a 55-year-old Filipino female with an 8-year history of chronic plaque-type psoriasis biopsy-proven. After 5 years, she developed generalized flaccid bullae and crusted erosions over the face, trunk, and extremities, with no mucous membrane involvement. Skin punch biopsy, direct immunofluorescence, and enzyme-linked immunosorbent assay were consistent with pemphigus foliaceous. The combination of topical corticosteroids and oral methotrexate was selected as the therapeutic approach, leading to a notable improvement in the patient’s condition. This case report underscores the significance of identifying the simultaneous presence of psoriasis alongside autoimmune blistering diseases like pemphigus foliaceous. Examining predisposing and triggering factors, performing re-biopsy, and further work-up as the disease evolves may yield more profound insights. Nonetheless, effectively managing this condition poses a significant challenge.

Identification of immunological patterns characterizing immune-related psoriasis reactions in oncological patients in therapy with anti-PD-1 checkpoint inhibitors.

Immunotherapy with biologics targeting programmed cell death protein-1 (PD-1) is highly effective in the treatment of various malignancies. Nevertheless, it is frequently responsible for unexpected cutaneous manifestations, including psoriasis-like dermatitis. The pathogenesis of anti-PD-1-induced psoriasis has yet to be clarified, even though it is plausible that some innate and adaptive immunity processes are in common with canonical psoriasis. The genetic predisposition to psoriasis of patients could also be a contributing factor. Here, we investigated the immunological and genetic profiles of two patients with metastatic melanoma and one patient affected by lung cancer, who developed severe psoriasis after receiving anti-PD-1 nivolumab therapy. The immune patterns of the three patients were compared with those detectable in classical, chronic plaque-type psoriasis or paradoxical psoriasis induced by anti-TNF-α therapy, mostly sustained by adaptive and innate immunity processes, respectively. Therefore, immunohistochemistry and mRNA analyses of innate and adaptive immunity molecules were conducted on skin biopsy of patients. Genetic analysis of polymorphisms predisposing to psoriasis was carried out by NGS technology. We found that anti-PD-1-induced psoriasis showed immunological features similar to chronic psoriasis, characterized by the presence of cellular players of adaptive immunity, with abundant CD3+, CD8+ T cells and CD11c+ dendritic cells infiltrating skin lesions, and producing IL-23, IL-6, TNF-α, IFN-γ and IL-17. On the contrary, a lower number of innate immunity cells (BDCA2+ plasmacytoid dendritic cells, CD15+ neutrophils, CD117+ mast cells) and reduced IFN-α/β, lymphotoxin (LT)-α/β, were observed in anti-PD-1-induced psoriasis lesions, as compared with anti-TNF-α-induced paradoxical psoriasis. Importantly, the disintegrin and metalloprotease domain containing thrombospondin type 1 motif-like 5 (ADAMTSL5) psoriasis autoantigen was significantly upregulated in psoriasis lesions of anti-PD-1-treated patients, at levels comparable with chronic plaque-type psoriasis. Finally, NGS analysis revealed that all patients carried several allelic variants in psoriasis susceptibility genes, such as HLA-C, ERAP1 and other genes of the major psoriasis susceptibility PSORS1 locus. Our study showed that adaptive immunity predominates over innate immunity in anti-PD-1-induced psoriasis lesions, consistently with the local ADAMTSL5 overexpression. The presence of numerous SNPs in psoriasis susceptibility genes of the three patients also suggested their strong predisposition to the disease.

How should we do in the selection and follow-up of systemic conventional treatments in psoriasis?

There is an increasing need for appropriate effective treatment and long-term disease control in patients with psoriasis because of the decreased quality of life, increased physicosocial deficits and associated co-morbidities. Systemic conventional treatments that are the first step in the management of moderate-to-severe plaque psoriasis include methotrexate (MTX), acitretin, cyclosporine and fumarates. MTX is considered the gold standard in the treatment of moderate-to-severe chronic plaque type psoriasis. It is also used to treat pustular psoriasis, erythrodermic psoriasis and psoriatic arthritis. Acitretin monotherapy is less effective than other conventional systemic treatments for plaque psoriasis, while superior to generalized, palmoplantar pustular, and hyperkeratotic variants. Cyclosporine is preferred in the presence of unstable acute clinical conditions (erythrodermic or generalized pustular psoriasis) and also in induction phase of rotational and sequential therapy for severe resistant psoriasis, due to its rapid effect. Dimethyl fumarate, which has similar efficacy to MTX, is an appropriate option in the induction and long-term systemic treatment for adult patients with moderate to severe plaque psoriasis without psoriatic arthritis. Although they are often overshadowed by biologics at the stage of preference by most physicians and patients today, they are classical and inexpensive agents with known long-term results. When the appropriate patient profile and psoriasis type are selected at the right time and necessary laboratory and clinical follow-ups are made, each of them is an effective treatment with reliable and satisfactory results. In this article, important points (recommendations according to patient characteristics, psoriasis type and comorbidities) to be considered in clinical practice when using the conventional anti-psoriatic agents in the treatment of psoriasis are overviewed.

Serum Adiponectin Levels as an Independent Marker of Severity of Psoriasis: A Cross-Sectional Analysis.

Adiponectin is an adipokine, having anti-inflammatory properties, the levels of which are reduced in metabolic syndrome. In psoriasis, it plays a preventive role by inhibiting the differentiation and proliferation of keratinocytes and decreasing the levels of the signature cytokine, IL-17. To find a correlation between serum adiponectin levels and the severity of psoriasis and to compare these levels amongst patients with parameters of metabolic syndrome vs those without it. This was a cross-sectional observational study consisting of 60 cases of chronic plaque type psoriasis and 20 controls. Mild, moderate and severe disease was defined based on Psoriasis Area Severity Index (PASI). Serum samples were analyzed for fasting serum adiponectin levels. The mean serum adiponectin level among cases (16.07 ± 8.55μg/ml) was significantly lower than controls (21.65 ± 8.07μg/ml, P = .012). It was not only lower among cases with MetS (14.28 ± 7.95μg/ml), but also in patients without MetS (17.35 ± 8.83μg/ml). Serum adiponectin levels were negatively correlated to age, Body Mass Index (BMI), PASI, disease duration and Erythrocyte Sedimentation Rate(ESR). However, only the negative correlation with PASI (P = .000), duration (P = .005) and ESR (P = .010), was statistically significant. Serum adiponectin is decreased in psoriasis, independent of metabolic syndrome and is negatively correlated with disease severity and duration. Analysis on a larger sample size and response to treatment could not be assessed.

Efficacy of a Thai Herbal Remedy in Patients with Mild Chronic Plaque Psoriasis: An Observer-Blinded Randomized, Standard Treatment-Controlled Trial

Background: Psoriasis is a chronic non-infectious inflammatory skin disease caused by genetic and environmental predispositions. There is a Thai herbal remedy for psoriasis recorded in Wat Pho’s marble inscriptions, consisting of Dictyophora indusiate Fisch, Psilocybe cubensis (Earle) Sing, and sesame oil. Objective: To compare the efficacy and safety of a Thai herbal remedy as an alternative treatment to the standard treatment of 0.1% triamcinolone lotion in patients with mild chronic plaque psoriasis. Materials and Methods: A randomized, split-body controlled design was conducted in 30 mild chronic plaque-type psoriasis patients with symmetrically distributed psoriasis rashes. Each patient was randomized to apply a Thai herbal remedy on a rash on one side of the body and 0.1% triamcinolone lotion on the other side, using the same dosage of twice daily for eight weeks. Efficacy was assessed at week 1, 2, 4, and 8 by the Targeted Area Score (TAS). The Self-Assessment Score (SAS) at week 8 was compared to the baseline. Safety was assessed through the interviews at each visit. Product satisfaction was evaluated by the visual analog scale (VAS). Results: The TAS and SAS for erythema, desquamation, and induration decreased in both treatment groups, with no significant difference. However, product satisfaction in color (p=0.012), odor (p=0.013), and absorption (p=0.003) were significantly higher in the 0.1% triamcinolone lotion group. Conclusion: The present study showed that the Thai herbal remedy was safe and efficacious in treating chronic plaque-type psoriasis, therefore, can be used as an alternative treatment. Keywords: Thai herbal remedy; Psoriasis; Dictyophora indusiate Fisch; Psilocybe cubensis (Earle) Sing; Sesame oil

396 The potential role of periostin in psoriasis

Chronic plaque-type psoriasis is an inflammatory skin disease, where alterations can be found at the dermal-epidermal junction (DEJ) of the non-lesional (NL) skin and signs of systemic inflammation can also be detected. Periostin is also located at the DEJ, besides periostin is known to play a role in inflammatory and wound healing processes. Thus, we aimed to investigate the potential role of periostin in the pathogenesis of psoriasis. Serum and skin samples were collected from untreated and systemically treated (ST) psoriatic patients (PS) and from healthy (H) volunteers.

Real-world effectiveness of anti-interleukin-23 antibodies in chronic plaque-type psoriasis of patients from the Austrian Psoriasis Registry (PsoRA)

With the introduction of the latest class of biologic drugs targeting interleukin (IL)-23p19, three new, highly effective drugs can be used for the treatment of chronic plaque psoriasis. However, poorer skin improvement as well as higher rates of serious adverse events have been reported for patients under real-world conditions (outside clinical trials). This accounts especially for patients who have already been treated with biologic drugs. We therefore aimed to determine effectiveness and safety of IL-23p19 inhibitors in real-world patients by analysing data from the Psoriasis Registry Austria (PsoRA) in this observational, retrospective, multicentre cohort study. Data for 197 patients (52.3% biologic-non-naïve), who were treated with anti-IL-23p19 antibodies (127 guselkumab, 55 risankizumab and 15 tildrakizumab) for at least 3 months, were eligible for analysis. In general, biologic-non-naïve patients displayed a less favourable response to anti-IL-23 treatment as compared to biologic-naïve patients. However, after correction for previous biologic exposure, few differences in PASI improvement were detected among biologic-naïve and -non-naïve patients treated with different IL-23p19 inhibitors. This indicates that treatment effectiveness is not related to the class of the previously administered therapy in biologic-non-naïve patients. Therefore, IL-23p19 inhibitors represent a promising treatment alternative for patients who have not responded to previous biologics. However, as with other biologic agents (including IL-17 inhibitors), we did not observe an entirely satisfactory treatment response (i.e. PASI < 3 and/or PASI 75) to anti-IL-23 treatment in one out of four to five patients. Adverse events (mainly non-severe infections) were observed in 23 (11.7%) patients with no major differences regarding the administered IL-23 inhibitor or previous biologic exposure.

Interleukin-17E, inducible nitric oxide synthase and arginase1 as new biomarkers in the identification of neutrophilic dermatoses.

SummaryBackgroundNeutrophilic dermatoses (ND) are a heterogeneous group of diseases, but can often have a relatively similar histological appearance.AimTo identify a combination of biomarkers allowing a better differentiation of ND types.MethodsBiopsies were obtained from normal human skin (NS; n = 4), chronic plaque‐type psoriasis (PsO; n = 7), paradoxical psoriasis (PP; n = 8), generalized pustular psoriasis (GPP; n = 9), subcorneal pustular dermatosis of Sneddon–Wilkinson (SPD; n = 3), acute generalized exanthematous pustulosis (AGEP; n = 3), hidradenitis suppurativa (HS; n = 7), Sweet syndrome (SS; n = 8) and pyoderma gangrenosum (PG; n = 8). Samples were analysed by immunofluorescence using three biomarkers, interleukin (IL)‐17E, inducible nitric oxide synthase (iNOS) and arginase1, each one in combination with two cell markers, myeloperoxidase (MPO) and CD68, which allow the identification of neutrophils and macrophages, respectively.ResultsWe found that SS is characterized by high expression of IL‐17E and iNOS in the epidermis, while PG exhibits low expression. The density of the neutrophil infiltrate helps to differentiate PP (high‐density infiltrate) from PsO (low‐density infiltrate). High expression of arginase1 in the granular layer of the epidermis is a hallmark of SPD. Finally, mature neutrophils and proinflammatory macrophages are readily detectable in PP, SPD and PG, whereas immature neutrophils and anti‐inflammatory macrophages are more frequent in GPP, AGEP, HS and SS.ConclusionsThe analysis of ND by immunofluorescence using IL‐17E, iNOS and arginase1 in combination with MPO and CD68 allows for characterization of differential expression patterns in the epidermis as well as the determination of the polarization status of the dermal neutrophils and macrophages. The appropriate markers may help in the differentiation of ND in clinical practice.

Phase I Study to Assess Safety of Laser-Assisted Topical Administration of an Anti-TNF Biologic in Patients With Chronic Plaque-Type Psoriasis.

Ablative fractional laser treatment facilitates epidermal drug delivery, which might be an interesting option to increase the topical efficacy of biological drugs in a variety of dermatological diseases. This work aims at investigating safety and tolerability of this new treatment approach in patients with plaque-type psoriasis. Eight patients with plaque-type psoriasis were enrolled in this study. All patients received (i) ablative fractional laser microporation (AFL) of a psoriatic lesion with an Er:YAG laser + etanercept (ETA; Enbrel® solution for injection) (AFL-ETA), (ii) ETA alone on another lesion, and, if feasible, (iii) AFL alone on an additional lesion. Overall, all treatment arms showed a favorable safety profile. AFL-ETA improved the lesion-specific TPSS score by 1.75 vs. baseline, whereas ETA or AFL alone showed a TPSS score improvement of 0.75 points, a difference that was not statistically significant and might be attributable to differences in baseline scores. Topical administration of ETA to psoriatic plaques via AFL-generated micropores was generally well-tolerated. No special precautions seem necessary in future studies. Clinical benefit will need assessment in sufficiently powered follow-up studies.

Nanobody cytokine blockers in psoriasis

In The Lancet, Kim Papp and colleagues 1 Papp KA Weinberg M Morris A Reich K IL17A/F nanobody sonelokimab in patients with plaque psoriasis: a multicentre, randomised, placebo-controlled, phase 2b study. Lancet. 2021; 397: 1564-1575 Summary Full Text Full Text PDF PubMed Scopus (23) Google Scholar report the efficacy of nanobodies, a novel molecular technology, in patients with moderate to severe chronic plaque-type psoriasis. The nanobody examined in this study, sonelokimab, is a camelid-derived (ie, from the Camelidae family of mammals, such as llamas, camels, and alpacas), single-domain, heavy-chain-only antibody. It is postulated that these nanobodies allow for greater stability and less complex production issues than traditional canonical monoclonal antibodies. Sonelokimab is specific to human interleukin (IL)-17A and IL-17F, which are known to play a pathogenic role in psoriasis and psoriatic arthritis. Nanobodies such as caplacizumab have been approved for thrombotic thrombocytopenic purpura, and other nanobodies are currently in development for various autoimmune and CNS disorders, infectious diseases, and cancers. 2 Jovčevska I Muyldermans S The therapeutic potential of nanobodies. BioDrugs. 2020; 34: 11-26 Crossref PubMed Scopus (218) Google Scholar IL17A/F nanobody sonelokimab in patients with plaque psoriasis: a multicentre, randomised, placebo-controlled, phase 2b studyTreatment with sonelokimab doses of 120 mg or less showed significant clinical benefit over placebo, with rapid onset of treatment effect, durable improvements, and an acceptable safety profile. Full-Text PDF

Body mass index and severity of psoriasis: a cross-sectional study

Background: The relationship between body mass index (BMI) and the severity of psoriasis is of debate. We investigated the relationship between BMI and psoriasis area and severity index (PASI) in Northern Iran. Method: In this prospective, observational descriptive study, 190 patients with chronic plaque-type psoriasis were included from January 2015 to 2017. None of the patients used systemic therapy for psoriasis during the last month. Results: There was a slight female predominance in our study (n=116; 61.1%). The mean age of our patients was 28.88 ± 18.17 (mean ± standard deviation) years. We found a positive correlation between BMI and PASI in the groups of psoriatic patients who had normal weight or were overweight (r = 0.369, P=0.006 and r=0.287, P=0.019, respectively). In the final logistic regression model, it was shown that in cases with BMI<18.5, the mean PASI score was lower in comparison with those with normal BMI (OR = 0.074, CI: 0.009, 0.636). Conclusion: A relationship between BMI and PASI was only seen in psoriatic patients who had normal weight or were overweight. To reduce the effect of factors such as systemic treatments, it is suggested to evaluate the relationship between BMI and PASI score as soon as the diagnosis of psoriasis is confirmed.

Comparing the topical preparations of Indigo naturalis from Chinese and Iranian origin in the treatment of plaque-type psoriasis: A preliminary randomized double-blind pilot study

IntroductionPsoriasis is an inflammatory and proliferative disease. Indigo naturalis is a blue herbal pigment extracted from Indigofera tinctoria and other plants. The purpose of this study was to compare Iranian ointment made of Indigofera tinctoria with Chinese ointment made of Indigo naturalis from China, and topical betamethasone on the severity of chronic plaque-type psoriasis. MethodsIn this preliminary randomized double-blind pilot study, patients with localized chronic plaque-type psoriasis were divided into three groups to receive either topical Iranian herbal ointment, Chinese herbal ointment, or betamethasone ointment twice a day for 8 weeks. ResultsAt the end of the 8th week of treatment, the mean PASI score in the three groups was 5.8 ± 3.13, 6.32 ± 2.85, 3.04 ± 2.23 for the Chinese, Iranian and betamethasone ointments respectively; and the mean PASI score change from baseline was statistically significant only in the topical betamethasone group (p = 0.0082). ConclusionThe Iranian herbal ointment used for psoriasis for 8 weeks caused a lower clinical response in comparison with topical betamethasone or the Chinese herbal ointment in the studied patients.

Idiosyncratic Reaction to Single 7.5 mg Dose of Methotrexate

Methotrexate (MTX) is one of the most common systemic immunosuppressive agents prescribed in dermatology. MTX toxicity targets skin, gastrointestinal mucosa, kidney, liver, and bone marrow. Toxic effects of MTX presenting as hepatic, renal, pulmonary, and bone marrow disorders occur less frequently than the minor effects but may be life-threatening. Characteristic signs and symptoms of acute MTX toxicity are based on extent and severity of organ involvement. Here, we report a 55-year-old married male, known case of chronic plaque-type psoriasis presenting with reaction to single dose of tablet MTX 7.5 mg as advised by the dermatologist for his disease. On history and clinical examination, diagnosis of idiosyncratic reaction to single dose of tablet MTX 7.5 mg was made.

Role of CD 20+ T cells and related cytokines in mediating retinal microvascular changes and ocular complications in chronic-plaque type psoriasis

ObjectiveTo assess the role of CD3+ CD20+ CD4- CD8- double-negative (DN) or CD3+CD20+ CD4/CD8+ T cells and the related pro-inflammatory cytokines in the humor aqueous, in mediating retinal microvascular changes in patients with chronic plaque-type moderate to severe psoriasis.Design.A total of 76 patients (57.6 ± 11.7 years) with chronic plaque-type psoriasis were initially evaluated. Nineteen patients (19 eyes) and 19 healthy volunteers (19 eyes) were subjected to dermatological evaluation with Psoriasis Area Severity Index (PASI) and the Dermatology life quality index (DLQI). Retinal images were processed using an automatized software. On the same day, a venous sample was collected and analyzed using multiparametric flow cytometry. Three out of 6 patients who presented cataract, consented to perform surgery with humor aqueous collection. The samples were analyzed using a Multi-Analyte ELISA kit for the simultaneous quantification of IL1α, IL1β, IL2, IL4, IL6, IL8, IL10, IL12, IL17A, IFNγ, TNF-α, GMCSF. ResultsThe CD3+CD4+/CD8+CD20+CD56- T cells expression was greater in the psoriatic patients (+73.9%, P < 0.001) compared to controls, but not the DN T cells (-8.2%, P = 0.30). Ocular complications were diagnosed in 61.1% of patients, microvascular parameters including artero-venous ratio (P = 0.04), subfoveal choriocapillaris/Sattler’s layer, and choroidal thickness (CT, both P < 0.001) were significantly altered in psoriasis subgroup. The increased circulating levels of the CD3+CD4+/CD8+CD20+CD56- T cells were associated with thinning of subfoveal CT (P = 0.03) and Haller’s layer (P = 0.01). Instead, the DN T cells presented an inverse relationship with disease duration (P = 0.02), DLQI score (P = 0.02), and the use of biological therapy (P = 0.05). The related cytokine patterns possibly modified in this cellular context have been investigated. No significant differences were observed in cytokines levels between psoriasis and controls, the most significant difference was detected on IL-6, without reaching statistical significance (fold change of 1.4, P = 0.13). ConclusionOur findings demonstrated that CD20+ T cell subpopulation is highly represented in psoriasis regardless of the use of immunomodulatory therapies, and the diffuse microvascular alterations suggested possible endothelial damage as mainstream for the genesis of psoriatic-mediated complications as further supported by the comparable concentrations of cytokines, at least as humor aqueous content, with respect to healthy eyes.

Management of nail psoriasis with a single injection of abobotulinum toxin.

Nail psoriasis is challenging; as topical agents generally fail and systemic therapies are doubted especially when the involvement of the skin is rather localized. The response of chronic plaque-type psoriasis to botulinum toxin injections is reported in case series that is essentially explained through the modulation of neurogenic inflammation. Herein, we report the successful treatment results of two cases demonstrating different features of nail psoriasis treated by abobotulinum toxin.

A study to compare the efficacy and safety of narrow band-UVB alone as well as in combination with topical calcipotriol in patients with psoriasis vulgaris

Psoriasis is a complex disease that requires carefully designed therapy in order to achieve sustained remission. The disease can be effectively controlled by various therapeutic options, used alone or in combination. Phototherapy may be combined with topical or systemic agents to achieve higher clearance rates, longer disease free intervals and a lower carcinogenic risk. The combination of NB-UVB with calcipotriol increases the therapeutic efficacy of phototherapy as well as UVB reduces the irritation caused by calcipotriolThe chief purpose of this study was to compare the efficacy and safety of Narrow Band-UVB alone and in combination with topical calcipotriol in patients with psoriasis vulgaris.Patients with chronic plaque type psoriasis of 100 numbers involving less than 20% of body surface area were randomly allocated to any one of the following 2 groups. Group A- Narrow Band UVB phototherapy. &amp; Group B- Narrow Band UVB with topical calcipotriol ointmentIn group A (NB-UVB), the mean baseline PASI score was 12.1 and the mean PASI score at the end of 12 weeks was 2.54. There was 79% reduction in PASI score at the end of 12 weeks. 31 patients showed good response and 13 patients showed more than 70% clearance.When NB-UVB group was compared with NB-UVB and calcipotriol combination group, there was a significant difference (p&amp;#60;0.05) in PASI scores at 4 weeks, 8 weeks and 12 weeks.Further studies with additional numbers of patients are essential to compare the efficacy and safety of Narrow Band-UVB alone as well as in combination with topical calcipotriol in patients with psoriasis vulgaris

Indoor salt water baths followed by artificial ultraviolet B light for chronic plaque psoriasis.

Indoor salt water baths followed by artificial ultraviolet B light for chronic plaque psoriasis.

Fatigue in patients with plaque-type psoriasis: lack of an association with plasma cytokines.

Fatigue is common in patients with psoriasis, and cytokines have been postulated to influence fatigue. This case-control study explored the plasma levels of selected cytokines in patients with psoriasis and compared them with fatigue and other clinical factors. Eighty-four patients with chronic plaque-type psoriasis and 84 age- and gender-matched healthy subjects were enrolled. Psoriasis severity was measured using the Psoriasis Area and Severity Index (PASI), and skin-related quality of life using the Dermatology Life Quality Index (DLQI). Fatigue was rated with the fatigue Visual Analogue Scale (fVAS). Plasma levels of interleukin (IL)-1β, IL-1Rα, IL-1RII, IL-6, and IL-10 were measured by electrochemiluminescence sandwich immunoassay and ELISA. IL-1Rα and IL-6 median concentrations were significantly higher in patients than healthy subjects: 203pg/mL (interquartile range: 150-274) versus 166pg/mL (128-212), p=0.008 for IL-Rα, and 0.82pg/mL (0.25-1.40) versus 0.50pg/mL (0.25-0.91), p=0.009 for IL-6. IL-1β, IL-1RII, and IL-10 concentrations did not differ between patients and healthy subjects. Higher levels of IL-1Rα and IL-6 were associated with increased body mass index (BMI), but not with disease activity. Cytokine concentrations were not associated with fatigue. These findings do not support an association between fatigue and blood concentrations of selected pro- and anti-inflammatory cytokines. The increased IL-1Rα and IL-6 levels associated with increased BMI are probably caused by release of adipokines from adipose tissue; of these, leptin, in particular, is known to be a strong inflammatory stimulator.

Interobserver variation of psoriasis area and severity index in a clinical setting

Background: Severity scoring systems are important parameters in assessing the severity of a disease aiding in categorization of disease and its prompt treatment. However, reliability of these scoring systems and inter-observer variation is a concern. In the recent years, there has been a lot of debate on reliability of Psoriasis Area and Severity Index (PASI) scoring as there is a wide range of difference in the scoring when assessed by each observer. We conducted this study to assess the inter-observer variation of PASI scoring observed in out-patient department of Dermatology at a tertiary care hospital. Methods: Total of 35 patients clinically presenting with chronic plaque type psoriasis, irrespective of disease duration and treatment taken were enrolled in the study. PASI scoring was assessed by 3 different observers (2st year, 3nd year postgraduate residents and clinical staff) independently on each patient and reliability was determined by intra-class coefficient. (ICC). Results: Our study showed an excellent reproducibility of PASI score when an inter-observer variation was performed. Most of the parameters showed an agreement of >0.9 (ICC) which was statistically significant (<0.001). However it was noted that “erythema” in head, upper limbs and lower limbs was in less agreement with ICC when compared to other parameters, yet excellent. Mean PASI score was 10.96, 10.78 and 10.47 among observer 1, 2 and 3 respectively. Conclusion: Our study concludes that PASI is a reproducible and reliable clinical tool with less inter-observer variation if done by trained qualified observers to assess the severity of chronic plaque type psoriasis although its application gets tedious and difficult in busy dermatology clinics. Limitation: A small sample size.

Painful erosions on psoriatic plaques: cutaneous clue to life-threatening methotrexate overdose

A 50-year-old man presented for evaluation of painful, bleeding lesions on his body of 3 days’ duration. His medical history was significant for chronic plaque-type psoriasis of 15 years’ duration....