Clinical Course Of Psoriasis Research Articles

P27 The state of the skin microbiome in patients with psoriasis

Abstract In dermatological practice, in the pathogenesis of chronic dermatoses, much attention is paid to the state of the skin microbiome. According to research, the role of superantigens—protein substances—bacterial toxins of staphylococcal, streptococcal nature, as well as fungi of the genus Candida, takes place in the pathogenesis of psoriasis. The purpose of our research was to assess the state of the skin microbiome in patients with psoriasis. Research materials and methods We examined 94 patients with psoriasis aged 12–69 years who received inpatient treatment at the Dermatological Department of the Research Dermatology Centre of Clinic of the Ministry of Health of the Republic of Uzbekistan. Taking into account gender, 40 patients were male and 54 were female. Clinical, biochemical, microbiological and statistical studies were conducted in all patients. The control group consisted of 72 healthy individuals of the appropriate age. The results of the study Microbiological studies of the skin in patients with psoriasis have shown a high detectability of opportunistic microorganisms of the Micrococaccea family—staphylococcus spp., which amounted to 62.7% of cases. Taking into account the clinical course of dermatosis, frequent seeding of opportunistic microflora was noted in the progressive stage—72.8%, whereas in the stationary stage—27.1%, respectively. According to the species identification of staphylococci in the examined patients, Staphylococcus epidermidis was most often sown—S. epidermidis was most often sown—32.2% and Staphylococcus haemoliticus—27.1%, Staphylococcus aureus—23.7% of cases. Cases with increased colonization caused the development of the syndrome of colonization resistance of opportunistic microorganisms. Conclusion Thus, the results obtained indicate that the role of opportunistic microorganisms in the clinical course of psoriasis is of clinical importance, the degree of colonization plays an important role in the pathogenesis of psoriasis, causing the development of the syndrome of colonization resistance of opportunistic microorganisms on the skin of patients.

Effect of Serum Vitamin D Content on the Clinical Course of Psoriasis

Objectives: To evaluate the incidence of serum vitamin D insufficiency in patients with psoriasis and study the relationship between dietary intake of vitamin D and clinical characteristics. Materials and Methods: Totally eighty individuals were enrolled and were equally divided into two groups (40 patients in each group): Group A consisted of psoriasis patients, whereas Group B consisted of controls. By using the PASI scale, psoriasis plaques were identified and assessed. The predesign questionnaire was developed and was given to each participant to complete it. Age, gender, the length of the psoriasis, concurrent illnesses, and medications were among the collected data. A dermatologist examined all of the patients and gathered information about their demographics, health, and any other pertinent information. Blood samples were taken to measure the level of serum vitamin D using the immuno-enzyme method. All measurements were conducted during winter months to avoid the influence of sun exposure on synthesis of vitamin D3 and its derivative 25-hydroxycholecalciferol. SPSS (v 25.0) was used for analysis and the results were shown in the form of graph and table. Results: Statistically significant difference was found in 25(OH) D3 levels between psoriasis affected individuals and healthy individuals. Both groups have low level of 25-hydroxycholecalciferol. In our results there is negative correlation between 25(OH) D3 and PASI. There is also a negative correlation between 25(OH) D3 and duration of psoriasis. Practical implication: This study will help the clinical practitioner to advise the patients with psoriasis to use enough amounts of vitamin D3 that will help to normalize the vitamin D level in patients. It is believed that psoriasis can cause a progressive decrease in the level of vitamin D3 derivatives in the whole human body, including the skin. So vitamin D rich food must be eaten in high amount. Conclusion: It is found in this study that both the groups have low serum vitamin D3 level. Both the general public and persons with psoriasis should eat enough amounts of vitamin D3. Keywords: PASI, vitamin D3, Psoriasis, serum, antiproliferative,

A crossroads between dietary habits, alcohol consumption, and smoking in the clinical course of psoriasis: a narrative review.

Psoriasis is a chronic autoimmune disease that affects 1-3% of the population. The pathomechanism of psoriasis development is complex, but genetic (non-modifiable) factors play a key role. However, the importance of environmental factors and lifestyle choices, such as the diet, alcohol consumption, and smoking, is increasing. The objective of this review was to analyse the influence of dietary habits, alcohol consumption, and smoking on the clinical course of psoriasis. Stress, a poor diet, alcohol abuse, and smoking can trigger psoriasis or cause its exacerbation. Therefore, in addition to the correct selection of therapy, it is extremely important to educate patients about the impact of these factors on the onset and progression of psoriasis. This literature review confirms that a holistic and multidisciplinary approach is required for patients with psoriasis, further emphasizing Hippocrates' thesis, "Let food be thy medicine, and medicine be thy food".

Changes in mononuclear cell subsets in capillary and venous blood of patients with psoriasis depending on the treatment

Topical glucocorticoids are conventionally used to treat psoriasis, but such treatment provides a short-term effect, and may cause various complications during long-term usage. A detailed study of the immunopathogenesis of psoriasis has made it possible to use bioengineered drugs that block the main cytokines. It has been shown that IL-36 plays an important regulatory role in pathogenesis of psoriasis. The aim of the study was to study therapeutic effect of patients with psoriasis using topical glucocorticoid hormone versus IL- 36 receptor antagonist (RAIL-36), with respect to clinical course of psoriasis and the subsets of mononuclear cells in venous and capillary blood taken close to the focus of inflammation. 16 patients with psoriasis (group 1a) received 0.1% mometasone cream for 14 days; 20 patients of group 1b received a gel containing 0.4% recombinant RAIL-36 for 14 days. Control group included 20 healthy adults. Treatment efficacy was assessed by PASI, DISHS and DLQI indices. 19 lymphocyte subsets and 3 monocyte subsets were assessed by four-color staining of whole capillary and venous blood with erythrocyte lysis using BD Biosciences (USA) technologies and reagents. It was shown that both drugs led to a decrease in the severity of the disease at the end of treatment. However, 2 weeks after the end of treatment in group 1a, the disease indexes nearly returned to the initial values. Meanwhile, the reduced index levels persisted 2 weeks later in group 1b. Significant deviations (more pronounced in capillary blood) were revealed for the levels of several leukocyte subsets in the psoriasis patients compared with healthy persons. As a result of treatment, we have revealed some changes in the levels of leukocyte subsets common to the two groups, and special differences for the two treatment options, that were more pronounced in capillary blood samples. Both medical preparations used are suitable for treatment of psoriasis.

Changes in the clinical course of psoriasis post-COVID-19: a clinical case series

During COVID-19 pandemic, researchers and clinicians worldwide have noted changes in the course of chronic disorders of various organs and systems, which are likely to be related to systemic effects of the pathogen. Specific heterogeneous skin lesions have been identified in SARS-CoV-2 infection, including those in the patients without any history of skin disorders and exacerbation of chronic dermatoses and/or changes in their clinical manifestation. Post-COVID-19 manifestation and exacerbation of psoriasis have been also described in the literature.
 We retrospectively analyzed medical files of 22 in-patients with exacerbation of psoriasis after mild or moderate SARS-CoV-2 infection in the Department of Dermatovenereology from April 2020 to April 2021. There were 7 male patients aged 42 to 74 (meanSD 57.714.1) years and 15 female patients aged 40 to 78 (59.210.3) years. The duration of psoriasis ranged from 1 to 15 (8.74.7) years. Their mean PASI before the coronavirus infection had been 10.25.2. In the majority of the patients the psoriasis exacerbation after COVID-19 was associated with a significant increase of PASI to 18.594.82 (n=12, p 0.05), 32.221.71 (n=5, p 0.01), and to 596 (n=2, p 0.01). In 3 patients, in addition to the increase of the rash area (PASI 10 to 17, mean 13.42.63), psoriatic arthritis was newly diagnosed after COVID-19.
 We present a clinical case of a 33-year old male patient with a 15-year history of psoriasis, dramatic worsening of his benign psoriasis vulgaris with its transformation to the Zumbusch type of generalized pustular psoriasis after SARS-CoV-2 infection and rapid clinical improvement after the initiation of treatment with an interleukin-17A inhibitor secukinumab.
 This clinical case series may contribute to the knowledge on the new coronavirus infection and its effects on the course of psoriasis.

An Analysis of IL-10, IL-17A, IL-17RA, IL-23A and IL-23R Expression and Their Correlation with Clinical Course in Patients with Psoriasis.

Being one of the most common dermatological inflammatory disorders, psoriasis is a frequent subject of research. It is considered to be a T cell-dependent immune disease whose pathogenesis is influenced by cytokines, such as IL-10, IL-17A, IL-17RA, IL-23A and IL-23R. The present study examines whether the expression of selected genes is correlated with the clinical course of psoriasis, assessed by the PASI, BSA and DLQI scales. Skin biopsies and blood from 60 patients with psoriasis and 24 healthy controls were obtained for RNA isolation. These were subjected to RT-PCR for IL-10, IL-17A, IL-17RA, IL-23A and IL-23R genes. The results were presented as an RQ value. IL-17A and IL-23R expression levels were higher in psoriatic skin compared to controls, while IL-10 expression was lower. A positive correlation was also found between RQ for IL-23A and PASI index. Psoriatic skin is characterised by elevated expression of IL-17A and IL-23R and decreased expression of IL-10. This indicates that the selected cytokines may be one of the factors involved in the pathogenesis and pathomechanism of psoriasis, but more studies need to be made before we can elucidate the exact reason for the unbalance in cytokine expression levels.

Pustular psoriasis and arthropathy in a patient with HIV infection. Clinical case

The article presents a clinical case of pustular psoriasis and arthropathy in a patient with HIV infection. The diagnosis of psoriasis was confirmed by morphological examination. Signs of arthropathy were confirmed by X-Ray: presence of oligoarthritis of the distal interphalangeal joints of the fingers and feet was seen. Dactylitis severity ― 23 points, the Ritchie index ― 2, DLQI ― 28. The clinical course of psoriasis and its treatment in HIV-infected patients was considered after taking into account the data from literature and the patients current condition and observation. The above observation of a combination of several clinical forms of psoriasis (vulgar, pustular and arthropathy) in patients with HIV infection is an illustration of the features of the course and comorbidity of chronic dermatosis and AIDS, due to the influence of the infectious process, immunosuppression and ART. The development of pustular form and arthropathy creates the additional challenge of prescribing basic systemic treatment for severe and complicated psoriasis in an HIV-infected patient due to the presence of contraindications due to comorbidity. The glucocorticosteriod selected by the committee was effective on the skin and joint pathological processes, without having any negative impact on the course and treatment of the HIV infection. Such cases require further study and development of methods for the treatment of patients with comorbidity and their inclusion in an additional section in the clinical recommendations for the diagnosis and treatment of psoriasis.

Treatment of psoriasis with biologics in the early COVID-19 pandemic: A study examining patient attitudes toward the treatment and disease course.

BackgroundSince March 2020, the coronavirus disease 2019 (COVID‐19) pandemic has been ongoing all around the world with a wide range of clinical course including asymptomatic cases to severe and fatal respiratory tract disease. Patients on immunosuppressive treatments were predicted to be more susceptible to COVID‐19.AimsIt was aimed to assess treatment continuity, the course of psoriasis and the course and clinical features of COVID‐19 in patients treated with biological agents for psoriasis at the early initial period of COVID‐19 pandemic.Patients/MethodsPatients treated with biological agents for psoriasis at our institute were contacted by phone between 1 and 10 July 2020 and fulfilled a questionnaire about their continuity to psoriasis treatments, clinical course of psoriasis, and any suspicion/diagnosis of COVID‐19.ResultsA total of 106 patients, 41 females and 65 males, were enrolled. Mean age of the patients was 46.1 ± 12.1 years (range: 19–77). Median duration of psoriasis was 18 years (min–max: 1 month–51 years). Twenty‐four patients (22.6%) were using tumor necrosis alpha inhibitors (ETA:1, IFX:19, ADA:4), whereas 82 patients (77.4%) were using interleukin (IL) 12/23 or IL‐17 inhibitors (UST:48, SECU:30, IXE:4). Seventy‐six patients (71.7%) continued the treatment, whereas 30 patients (28.3%) interrupted the treatment voluntarily. Twenty out of 30 patients (66.6%) who interrupted the treatment had an exacerbation of psoriasis. None of the patients were diagnosed with COVID‐19 in the study period.ConclusionPatients with psoriasis who received biological therapy continued their treatment at a high rate during the early period of the COVID‐19 pandemic. No COVID‐19 diagnosis was made among patients whether they continued or discontinued treatment. Recurrence and exacerbation of psoriasis in a significant proportion of patients who interrupted treatment and absence of COVID‐19 diagnosis in each group support the importance and safety of continuity of biological treatments for psoriasis in COVID‐19 era.

Long-term Outcomes and Prognosis in New-Onset Psoriasis

Psoriasis is a heterogeneous disease. Improved understanding of prognosis and long-term outcomes in new-onset psoriasis may improve care. To describe the clinical course of psoriasis and identify possible indicators of long-term outcomes. The Stockholm Psoriasis Cohort was a noninterventional inception cohort study enrolling patients between 2001 and 2005. The present study was conducted from January 15, 2019, to February 5, 2021. At enrollment and 10 years, patients were examined by dermatologists and rheumatologists. Data from examinations were complemented by questionnaires, medical records, and registers. A total of 721 patients with recent-onset psoriasis (<12 months duration), 15 years or older were recruited using advertising and referrals from a broad range of health care settings. Disease severity and psoriatic arthritis (PsA). Recursive partitioning and regression models were implemented to identify probable indicators of long-term outcomes. A total of 721 patients (median [interquartile range] age, 39 [27-55] years; 405 [56%] women), including 542 (75%) with plaque-onset and 174 (24%) with guttate-onset psoriasis, were enrolled. The median follow-up was 9.6 years (interquartile range, 8.8-10.4 years). The cumulative incidence of severe psoriasis at 12 years from enrollment was 21%. Among 509 patients examined clinically after 10 years, 77 of 389 patients (20%) with plaque onset and 56 of 116 (48%) with guttate onset had minimal disease activity without treatment, and 120 of 509 (24%) had PsA. Recursive partitioning identified strata with distinct risks for severe skin disease and PsA: the cumulative incidence of severe disease in patients with plaque phenotype, above-median disease activity, and scalp lesions was 52% (95% CI, 41%-64%), compared with 11% (95% CI, 8%-14%) in patients with below-median disease activity at inclusion; and 48 of 82 patients (59%) with peripheral enthesitis had PsA after 10 years compared with 37 of 304 patients (12%) without initial joint pain (P < .001). Smoking (hazard ratio, 1.70; 95% CI, 1.10-2.63) and activating genes in the interleukin-23 (IL-23) pathway (odds ratio, 1.55; 95% CI, 1.14-2.11) were also significantly associated with a severe disease course. Systemic therapy at or before enrollment was associated with a lower risk for severe disease at 10 years compared with later initiation of systemic therapy (odds ratio, 0.24; 95% CI, 0.06-0.90). The findings of this cohort study suggest that combinations of clinical characteristics at onset and activating genes in the IL-23 pathway are significantly associated with the clinical course of psoriasis, whereas joint pain and peripheral enthesitis may indicate the probability of PsA. Patients within those categories merit specialist referral and closer follow-up. The possibility of modifying the disease course with early systemic intervention should be tested.

Features of clinical course of psoriasis in children depending on haplotypes of the VDR gene and vitamin D level

Резюме. Мета: провести зіставлення епідеміологічних, клінічних особ­ливостей перебігу псоріазу у дітей залежно від виявлених гаплотипів за геном VDR та рівнем вітаміну D. Об’єкт і методи дослідження. Обстежено 56 дітей із псоріазом, 23 хлопці та 33 дівчинки віком 4–17 років, середній вік — 12,30±0,45 року. Діагноз «псоріаз» встановлювали на підставі клінічних даних та загальноприйнятих діагностичних критеріїв. Оцінку тяжкості перебігу та розповсюдженості патологічного процесу проводили за індексами PASI, PGA, BSA. Матеріалом для генотипування слугував букальний епітелій дітей. Визначення поліморфних варіантів за геном VDR проводили із застосуванням методу полімеразної ланцюгової реакції та подальшим аналізом поліморфізму довжин рестрикційних фрагментів. Підрахунок показників здійснювали за допомогою пакета STATISTICA. Результати. У дітей із псоріазом встановили 5 гаплотипів за геном VDR: ТТСС, ТТАС, ТСАА, ТСАС, ССАА. У групі ТТСС за кількістю превалювали хлопці, в інших — дівчата. Вік початку захворювання у групі ССАА був найменшим (5,6±1,69 року), тривалість захворювання — одна з найдовших (6,00±0,67 року). У разі гаплотипу ТСАА виявлена найменша тривалість загострення псоріазу (4,2±1,11 тиж), яка поступово зменшувалася з роками, наявний зворотний значний кореляційний зв’язок із тривалістю захворювання, r=–0,56. Найнижчим індекс тяжкості псоріазу за PGA був при гаплотипі ТСАС (2,70±0,19), найвищим — при гаплотипах ТТАС (3,50±0,34) та ТТСС (3,31±0,22). Індекси PASI та BSA найвищими були при гаплотипі ССАА. Середній рівень вітаміну D у сироватці крові дітей із псоріазом був у межах недостатнього, лише у групі з гаплотипом ССАА — в межах оптимального та був найвищим (32,17±4,22 нг/мл). Виявлені зворотні значні, сильні та дуже сильні кореляційні зв’язки між рівнем вітаміну D у сироватці крові дітей із псоріазом і тривалістю патологічного процесу при гаплотипах ТТСС, ТТАС та ТСАА, інтенсивністю проявів та розповсюдженістю патологічного процесу при гаплотипах ССАА, ТСАА і ТСАС. Висновки. У дітей із псоріазом залежно від гаплотипів за геном VDR — ТТСС, ТТАС, ТСАА, ТСАС, ССАА — формуються епідеміологічні та клінічні особливості перебігу псоріазу. Встановлено, що у дітей із псоріазом гаплотип ТСАА зумовлює початок захворювання в більш ранньому віці (5–6 років) та збільшення тривалості загострення патологічного процесу з віком. При гаплотипах ССАА і ТТАС, навпаки, загострення псоріазу з віком коротшає. Зниження рівня вітаміну D у сироватці крові дітей із псоріазом з гаплотипами ТТСС, ТТАС та ТСАА призводить до збільшення тривалості загострення захворювання, а з гаплотипами ТСАА, ТСАС, ССАА — до збільшення інтенсивності шкірних проявів псоріазу.

Features of clinical course of psoriasis in children depending on haplotypes of the VDR gene and vitamin D level

Features of clinical course of psoriasis in children depending on haplotypes of the VDR gene and vitamin D level

The role of xenobiotics in triggering psoriasis.

Psoriasis is a common inflammatory skin disease affecting approximately 2% of the world population. A complex interplay of genetic predisposition and risk factors contributes to the risk of its onset. Several xenobiotics have been implicated in the pathogenesis of psoriasis. Drugs are among the most investigated trigger factors; strong association with disease induction or exacerbation has been reported for β-blockers, lithium, NSAIDs and ACE inhibitors, all of which are commonly used in the management of various comorbidities in psoriasis patients. Furthermore, inhibitors of TNF have a well-documented potential for triggering new-onset psoriasis when used for other indications (e.g. Crohn's disease or rheumatoid arthritis), while post-marketing data have revealed the same association for ustekinumab. Several other drugs have been connected with psoriasis, but the evidence is less compelling. Smoking and alcohol have been reported to increase the risk for occurrence of psoriasis, but can also affect unfavorably the course of the disease and its response to treatment. Furthermore, exposure to secondhand smoke, especially in childhood, also mediates the risk. Emerging data now suggest that air pollution also has a detrimental effect on skin disease, including psoriasis, but this association needs further investigation. Understanding of the toxic effect of xenobiotics on the initiation and clinical course of psoriasis can contribute to its better control, as it can help with the avoidance of triggering factors and, in some cases, influence the success of pharmacological treatment. It, therefore, has an important place in the comprehensive management of psoriasis.

SKIN MICROBIAL LANDSCAPE AND IMMUNE-ENDOCRINE PARAMETERS IN PATIENTS WITH PSORIASIS BY USING NARROWBAND UVB PHOTOTHERAPY

The aim: The study of skin microbial landscape and immune-endocrine parameters as well as improvement of treatment efficiency in patients with different clinical course of psoriasis by using narrowband UVB phototherapy. Materials and methods: We examined 89 patients with psoriasis (51 men and 38 women) aged 18-60. The comparison group consisted of 43 psoriasis patients comparable by age, sex and clinical course with those from the main group (46 patients). Cytokine levels IL-4, IL-8, IL-10, TNFα, thyroid peroxidase (TPO) and thyroglobulin (Tg) autoantibodies and microbial flora of skin were determined in patients with psoriasis. Results: The study finds that conventional therapy does not have sufficient corrective impact on immune-endocrine disorders and the use of narrow-band light therapy has shown that it has a focused corrective impact on cytokine production and modulating effect on the level of TPO and Tg autoantibodies and the state of skin automicroflora of lesions in patients suffering from psoriasis. Conclusions: Using UVB (311 nm) therapy in patients with psoriasis allows improving efficiency of treatment and limiting clinical signs in the form of achieving remission and significant improvement in patients' health without any negative dynamic changes.

Psoriasis and Pregnancy: Retrospective Evaluation of 47 Pregnancies in a Tertiary Center

Objective: To evaluate the impact of psoriasis on pregnancy outcomes.Study Design: Data of pregnant women with chronic plaque psoriasis who were followed up at Ha­cet­­tepe University Hospital between January 1, 2010 and December 31, 2017 were evaluated. Pregnant women with singleton pregnancies who had chronic plaque psoriasis were included in the study. Patients were divided into two groups based on the clinical course of psoriasis: group 1 (improvement/disease-stable), and group 2 (deterioration). Median maternal age, gravida, parity, gestational week at birth, birthweight, 5th minute APGAR score together with the rates of cesarean section, neonatal intensive care unit admission and pregnancy complications (spontaneous abortion, preterm delivery, fetal growth restriction and preeclampsia) were compared between the groups.Results: There were 29 (61.7%) patients in group 1 and 18 (38.3%) patients in group 2. Mean values for maternal age, gravida and parity were comparable between the groups (p values were 0.32, 0.09 and 0.17, respectively). Median values for gestational week at birth (39.2 vs 36.1, p =0.002), birthweight (3200 vs 2310, p =0.002) and 5th minute APGAR score (9 vs 7, p &lt;0.001) were statistically significantly lower in group 2. Cesarean section (33.3% vs 71.4%, p =0.02), neonatal intensive care unit admission (11.1% vs 64.3%, p &lt;0.001) and pregnancy complication rates (p =0.003) were statistically significantly higher in group 2. Frequencies of spontaneous abortion, preterm delivery, fetal growth restriction and preeclampsia were 6.9%, 10.3%, 3.4% and 3.4% in group 1, and 22.2%, 27.8%, 16.7% and 16.7% in group 2, respectively.Conclusion: Deterioration of psoriasis in pregnancy was associated with adverse obstetric outcome.

P4445Effects of interleukin 17A inhibition on myocardial deformation and vascular function in psoriasis:one year follow-up

Abstract Background Interleukin (IL)-17A activity is implicated in the clinical course of psoriasis. We investigated the effects of IL-17A inhibition on vascular and left ventricular (LV) function in psoriasis patients. Methods One hundred psoriasis patients received either an anti-IL-17A agent (secukinumab n=50), or cyclosporine treatment (n=50). At baseline and after 4 and 12 months of treatment, we measured (1) LV global longitudinal strain (GLS), strain rate (GLSR), strain rate at early diastole (GLSRE), twisting (LVtwist), (2) coronary flow reserve (CFR), (3) pulse wave velocity (PWV), (4) malondialdehyde (MDA) and protein carbonyl (PC) as markers of oxidative stress, (5) psoriasis severity and extent assessed by Psoriasis Area and Severity Index (PASI). Results Compared to treatment with cyclosporine, anti IL-17A treatment resulted in greater improvement in GLS (GLS: −16.7±3 at baseline vs −18.3±2.8 at 4 months vs −19±3 at 12 months post treatment with anti-IL-17 respectively, p=0.02, GLS: −16.8±2.9 at baseline vs −17.2±2.7 at 4 months vs −17.1±2.9 at 12 months post treatment with cyclosporine respectively, p=0.2), GLSR (−0.9±0.3 at baseline vs −1.08±0.3 at 4 months vs −1.11±0.2 at 12 months post treatment with anti-IL-17 respectively, p=0.02, −0.9±0.2 at baseline vs −0.95±0.2 at 4 months vs −0.96±0.2 at 12 months post treatment with cyclosporine respectively, p=0.5) GLSRE and LV twist (13.7±5.1 at baseline vs 18.1±6 at 4 months vs 17.8±5.6 at 12 months post treatment with anti-IL-17 respectively, p=0.001, 13±5.3 at baseline vs 13.8±5.6 at 4 months vs 15.5±5.3 at 12 months post treatment with cyclosporine respectively, p=0.6).Treatment with anti-IL-17A also resulted in greater improvement of CFR compared to cyclosporine treatment (2.6±0.3 at baseline vs 3±0.3 at 4 months vs 3.1±0.3 at 12 months post treatment with anti-IL-17 respectively, p=0.01, 2.7±0.4 at baseline vs 2.8±0.3 at 4 months vs 2.7±0.3 at 12 months post treatment with cyclosporine respectively, p=0.5) and PWV decreased after treatment with anti-IL-17 (10.2±1.8 at baseline vs 9.3±1.5 at 4 months vs 9.7±1.8 at 12 months post treatment with anti-IL-17 respectively, p=0.04, whereas higher values of PWV were observed after cyclosporine treatment (9.7±1.9 at baseline vs 10.8±1.7 at 4 months vs 11.2±2 at 12 months post treatment with cyclosporine respectively, p=0.02). PASI score was similarly improved after treatment with either anti-IL-17A or cyclosporine. Markers of oxidative stress were reduced after treatment with anti-IL-17A, in contrast to elevation of oxidative stress markers after treatment with cyclosporine. Changes of myocardial deformation markers and CFR after treatment with anti-IL-17A correlated with concomitant reduction of oxidative stress. Conclusions In psoriasis patients, inhibition of IL-17A results in a greater improvement of vascular and myocardial function compared with cyclosporine treatment.

Significance of IL-17A-producing CD8+CD103+ skin resident memory T cells in psoriasis lesion and their possible relationship to clinical course

BackgroundA number of studies have shown the relationship between the pathogenesis of psoriasis and skin resident memory T (TRM) cells. ObjectiveTo investigate the cytokine profile of TRM cells from skin lesions of psoriasis and the relationship of skin TRM cells to the future clinical course of psoriasis. MethodsWe used stocked samples of T cells that were ex vivo expanded from skin biopsies of 10 patients with psoriasis vulgaris. A half of 4-mm punch biopsy specimens was subjected to expansion of skin-infiltrating T cells using IL-2 and anti-CD3/CD28 antibody-coated microbeads. More than 106 T cells per specimen were stocked at −80°C. Defrosted cells were subjected to flow cytometric analysis. Another half of skin biopsies were subjected to immmunofluorescence staining for CD103 and other markers. ResultsThe biopsied skin revealed CD8+CD103+ TRM cells were present in the epidermis of psoriasis and associated with acanthosis. Sorted CD103+ T cells were mostly CD8+ memory T cells expressing CD69 with a skin-homing potential. A part of CD8+CD103+ T cells produced interferon-γ, IL-17A or IL-22. Notably, CD8+CD103+ TRM cells more frequently produced IL-17A than did CD8+CD103− T cells. We retrospectively divided the 10 cases into the non-advanced therapy group, and the advanced therapy group in which systemic biologics or others were initiated within one year. The frequency of CD8+CD103+IL-17A+ TRM cells tended to be higher in the advanced therapy group. ConclusionThese results suggest that IL-17A-producing CD8+CD103+ TRM cells are associated with a progressive clinical course of psoriasis.

The role of intestinal microbiote disorders in the pathogenesis of psoriasis and eczema infectious

The purpose of the work was to study the quantitative and qualitative composition of microbiota of the colon in patients with psoriasis and eczema infectious and to analyze the impact of its violations on the severity of the clinical course of the diseases. There were examined in a complex way 34 patients with psoriasis and eczema in factious illness. The age of the subjectsrangedfrom 23 to 70 years, amongthem: women – 15 (44,1 %), men – 19 (55,9 %), the period of the disease ranged from 2 to 42 years. The control group consisted of 20 practically healthy persons. In order to diagnose concomitant dysbiotic changes in the large intestine, microbiological examination of feces was performed on the patients (according to the method of Epstein – Litvak and Vilshanskaya). A high incidence of various intestinal pathologies (dyspepsia, gastroesophageal reflux disease, irritable bowel syndrome, functional disorders by the hepatobiliary system, gallstone disease etc.) was detected. In the microbiological study of feces, concomitant dysbiosis of the colon was detected in 16 (72,7 %) patients. Disturbance of the microbiota of the colon of varying severity is more often diagnosed in patients with more severe clinical course of psoriasis and eczema of infectious, as well as with a longer duration of the disease. The obtained data suggest that the intestinal microbiota, in particular colon dysbiosis, should be considered an important pathogenetic factor that negatively influences the nature and severity of the psoriasis and infectious eczema and requires timely diagnosis and appropriate medical correction.

The role of intestinal microbiote disorders in the pathogenesis of psoriasis and eczema infectious

The purpose of the work was to study the quantitative and qualitative composition of microbiota of the colon in patients with psoriasis and eczema infectious and to analyze the impact of its violations on the severity of the clinical course of the diseases. There were examined in a complex way 34 patients with psoriasis and eczema in factious illness. The age of the subjectsrangedfrom 23 to 70 years, amongthem: women – 15 (44,1 %), men – 19 (55,9 %), the period of the disease ranged from 2 to 42 years. The control group consisted of 20 practically healthy persons. In order to diagnose concomitant dysbiotic changes in the large intestine, microbiological examination of feces was performed on the patients (according to the method of Epstein – Litvak and Vilshanskaya). A high incidence of various intestinal pathologies (dyspepsia, gastroesophageal reflux disease, irritable bowel syndrome, functional disorders by the hepatobiliary system, gallstone disease etc.) was detected. In the microbiological study of feces, concomitant dysbiosis of the colon was detected in 16 (72,7 %) patients. Disturbance of the microbiota of the colon of varying severity is more often diagnosed in patients with more severe clinical course of psoriasis and eczema of infectious, as well as with a longer duration of the disease. The obtained data suggest that the intestinal microbiota, in particular colon dysbiosis, should be considered an important pathogenetic factor that negatively influences the nature and severity of the psoriasis and infectious eczema and requires timely diagnosis and appropriate medical correction.

PSORIASIS IN HIV-INFECTED PATIENTS: CLINICAL AND LABORATORY EVALUATION, APPROACHES TO THERAPY

Clinical and laboratory evaluation of the effectiveness of therapy of psoriasis vulgaris in 78 HIV-infected patients using the two treatment regimens is presented. Peculiarities of clinical course of psoriasis depending on the number of CD4+lymphocytes in the peripheral blood are shown. Histological and histochemical studies of biopsy samples from psoriatic skin lesions and apparently healthy skin in 15 people were performed. The dynamics before and after treatment of CD4+ and CD8+ lymphocytes in biopsies of skin and blood, their relationship with the index of severity of psoriasis (PASI) are presented. This study is of theoretical and practical interest in understanding the value and role of CD4+ and CD8+ lymphocytes in the formation of inflammatory reactions in the skin of patients with psoriasis as a possible option for treatment of psoriasis in HIV-infected patients.

Effect of psoriasis activity and topical treatment on plasma epidermal growth factor (EGF) and its soluble receptor (sEGFR)

Background: Pathogenesis of psoriasis involves epidermal growth factor (EGF) that participates in keratinocyte proliferation, angiogenesis and cell differentiation through binding to soluble epidermal growth factor receptor (sEGFR). It is synthesised by, among others, keratinocytes, especially within psoriatic skin.Objective: To evaluate EGF and sEGFR plasma concentrations during topical psoriatic treatment.Methods: Blood samples were collected from 51 patients with plaque psoriasis. EGF and sEGFR plasma concentrations were examined with immunoenzymatic method prior and 14 days after topical treatment. The outcomes were analyzed with respect to PASI.Results: Mean EGF concentration was higher in the plasma of psoriatic patients compared to the control group (p = .401) while mean sEGFR concentration was over twofold lower compared to the control group (p < .001). After the therapy, an insignificant decrease in EGF plasma concentration (p = .835) and a significant increase in sEGFR concentration (p = .017) compared to initial values were observed. The coefficient of EGF/sEGFR concentration calculated for each individual had similar values before and after the treatment (p = .009), both of which were significantly higher compared to control group (respectively p < .001, p < .008).Conclusion: Epidermal growth factor and its soluble receptor may be a useful markers in monitoring clinical course of psoriasis and the effectiveness of therapy.