Diagnosis Of Psoriasis Research Articles

Patient perspective on psoriasis: Psychosocial burden of psoriasis and its management in Malaysia.

Psoriasis is a chronic erythematous inflammatory skin disorder. The major challenge with psoriasis is delayed diagnosis, resulting in delayed treatment initiation and reduced quality of life (QoL). This patient perspective study aimed to explore the emotional and psychosocial burdens faced by patients with psoriasis in Malaysia and their attitudes toward current psoriasis treatment. Adult patients with mild or moderate-to-severe plaque psoriasis, preferably with concomitant psoriatic arthritis, participated in a patient advisory board meeting along with a senior consultant dermatologist. Patients had to describe their initial symptoms, time of diagnosis, misdiagnosis, treatment initiation delays, treatment course, flare-ups, psychosocial impact, and QoL associated with psoriasis. The 11 participating patients had a mean age of 46 years with mean age of psoriasis diagnosis and an average year of suffering with psoriasis being 21.9 years and 24.5 years, respectively. The most common initial symptom of psoriasis was itching (62.5%), particularly of the scalp followed by itchiness and red patches on skin. Most patients (90%) reported initial misdiagnosis with other skin diseases by their primary care physicians (PCPs), which led to delayed treatment initiation. Most patients reported an emotional impact of psoriasis, including low self-esteem (18%), lack of confidence (27%), shock (18%), sadness (9%), and outrage (9%). Social discrimination/stigmatization in public places and at work (45%), and even from relatives (18%) was another reported challenge. However, 73% of patients were highly satisfied with the current treatment. Overall, the patients agreed that the lack of public awareness of psoriasis was responsible for the social stigma. The evidence obtained from this qualitative study indicated that psoriasis has a significant emotional and psychological impact on the patients affecting their QoL. Lack of awareness of the disease among PCPs, patients, and the public is a major challenge leading to poor treatment outcomes.

Evaluating the Relative Effectiveness of Methotrexate and Acitretin in Chronic Plaque Psoriasis Treatment

Background: Chronic plaque psoriasis is a prevalent autoimmune skin disorder characterized by persistent red, scaly plaques. Methotrexate and acitretin are established systemic therapies, but their comparative efficacy in treating chronic plaque psoriasis needs further research. Objective: To compare the efficacy of methotrexate and acitretin in chronic plaque psoriasis treatment. Study Design: Randomized Controlled Trial. Settings: This study was conducted at DHQ Hospital, Muzaffargarh Pakistan. Duration: December 2022 to May 2023. Methods: Total 155 patients diagnosed with Chronic Plaque Psoriasis, aged 18 to 55 years, are recruited from the OPD of hospital. Inclusion criteria comprise a confirmed diagnosis of chronic plaque psoriasis and no prior exposure to methotrexate or acitretin within the last six months. Patients with previous intolerance or allergic reactions to methotrexate or acitretin, presence of severe hepatic impairment or chronic liver disease and known pregnancy or lactating mothers were excluded. Participants were randomized into two groups using computer-generated random numbers. Group A receives methotrexate at a dose once a week for 12 weeks as a tablet at a dosage of 0.3-0.5 mg/kg and Group B is treated with Acitretin in which patients were given a capsule at a dosage of 0.4 mg/kg daily for duration of 12 weeks. Statistical analysis is performed using SPSS version 23. Results: The study involved 150 patients with a mean age of 52.33± 16.55. Gender distribution indicated that 47(31.33%) were male, and 103(68.66%) were female. The baseline PASI scores for the methotrexate and acitretin groups were 14.12±3.21 and 14.79±1.08, respectively. At the 3-month, the PASI scores were 7.92±2.07 for methotrexate and 8.14±1.03 for acitretin. The mean reduction in PASI scores was 54.12±9.22 for methotrexate and 47.31 ± 11.31 for Acitretin, with a significant difference favoring Methotrexate (p =0.031*). Of the total participants, 68.66% demonstrated efficacy, with 78.66% in the methotrexate group and 58.66% in the acitretin group, indicating a significant difference (p < 0.005*). Conversely, 31.33% showed no efficacy, with 21.33% in the methotrexate group and 41.33% in the acitretin group. Conclusion: In conclusion, the frequency of effectiveness was significantly higher with methotrexate (78.66% vs. 58.66%) p=<0.005) as compared to acitretin in treating chronic plaque psoriasis.

Identification and verification of three autophagy-related genes as potential biomarkers for the diagnosis of psoriasis

Psoriasis vulgaris is the most common form of the four clinical types. However, early diagnosis of psoriasis vulgaris is difficult due to the lack of effective biomarkers. The aim of this study was to screen potential biomarkers for the diagnosis of psoriasis. In our study, we downloaded the original data from GSE30999 and GSE41664, and the autophagy-related genes list from human autophagy database to identify differentially expressed autophagy-related genes (DERAGs) by R software. Then Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were performed for DERAGs. DERAGs were validated by the other four databases (GSE13355, GSE14905, GSE6710, and GSE55201) to screen biomarkers with high diagnostic value for the early diagnosis of psoriasis vulgaris. Finally, DERAGs were verified in our clinical blood samples by ELISA. A total of 12 DERAGs were identified between 123 paired non-lesional and lesional skin samples from patients with psoriasis vulgaris. GO and KEGG enrichment analysis indicated the TORC2 complex was more enriched and the NOD-like receptor signaling pathway was mostly enriched. Three autophagy-related genes (BIRC5, NAMPT and BCL2) were identified through bioinformatics analysis and verified by ELISA in clinical blood samples. And these genes showed high diagnostic value for the early diagnosis of psoriasis vulgaris. We identified three autophagy-related genes (BIRC5, NAMPT and BCL2) with high diagnostic value for the early diagnosis of psoriasis vulgaris through bioinformatics analysis and clinical samples. Therefore, we proposed that BIRC5, NAMPT and BCL2 may be as potential biomarkers for the early diagnosis of psoriasis vulgaris. In addition, BIRC5, NAMPT and BCL2 may affect the development of psoriasis by regulating autophagy.

Mutations in PGRN gene associated with the risk of psoriasis in Pakistan: a case control study

BackgroundPsoriasis is a chronic, autoimmune, papulosquamous skin disorder, characterized by the formation of drop-like papules and silvery-white plaques surrounded by reddened or inflamed skin, existing predominantly on the scalp, knees and elbows. The characteristic inflammation and hyperproliferation of keratinocytes in psoriasis is regulated by progranulin (PGRN), which suppresses the expression and release of inflammatory cytokines, such as TNF-α.MethodologyIn this study mutation analysis of the PGRN gene was performed by extracting the genomic DNA from blood samples of 171 diagnosed psoriasis patients and controls through standard salting-out method, followed by amplification and sequencing of the targeted region of exon 5–7 of PGRN gene.ResultsThree single nucleotide polymorphisms, rs25646, rs850713 and a novel point mutation 805A/G were identified in the PGRN gene with significant association with the disease. The variant alleles of the polymorphisms were significantly distributed among cases and controls, and statistical analysis suggested that the mutant genotypes conferred a higher risk of psoriasis development and progression. Multi-SNP haplotype analysis indicated that the CAA (OR = 8.085, 95% CI = 5.16–12.66) and the CAG (OR = 3.204, 95% CI = 1.97–5.21) haplotypes were significantly associated with psoriasis pathogenesis.ConclusionsThese findings demonstrate that polymorphisms in PGRN might act as potential molecular targets for early diagnosis of psoriasis in susceptible individuals.

Association between red blood cell distribution width and psoriasis among the US adults.

The association between red blood cell distribution width (RDW) and psoriasis among the US adults is still unknown. We aimed to assess whether RDW is associated with psoriasis in the US adults. We conducted a cross-sectional study consisting of 14,089 participants from National Health and Nutrition Examination Survey (NHANES) 2009-2014. Psoriasis status were assessed by self-reported questionnaire. We evaluated the association between RDW and risk of psoriasis using multivariate regression models. Subgroup and interaction analysis were performed. The higher RDW level was associated with an increased risk of psoriasis (OR = 1.10 [95% CI, 1.01, 1.19]; p = 0.025) after adjusting for confounders in female. However, there is no significant association between RDW and risk of psoriasis among male (OR = 0.99 [95% CI, 0.87, 1.15]; p = 0.992). Subgroup and interaction analysis found that the strongest positive association mainly exists in female participants with BMD greater than 29.9 kg/m2 (OR = 1.20 [95% CI, 1.09, 1.32], Pint = 0.004). In conclusion, we found that increased RDW levels were associated with an increased risk of psoriasis in females, which could provide clinicians with auxiliary data for the early diagnosis of psoriasis.

Pediatric psoriasis: Understanding pathological conditions and advances in treatment.

Psoriasis is a long-lasting skin disease that primarily affects the skin, nails, and joints and is characterized by inflammation. Genetic factors contribute to its development and environmental triggers can worsen symptoms. Pathologically, psoriasis is characterized by uncontrolled keratinocyte proliferation and abnormal differentiation, and histological features include acanthosis with inflammatory cell infiltration and neovascularization. Psoriasis often starts in childhood, with about one-third of cases beginning during this time. Its prevalence steadily increases from the ages of 1 to 18 years in a linear fashion. Young people with psoriasis often require treatment throughout their childhood and adolescence, and into adulthood. However, prolonged treatment may increase the risk of complications and adverse events, so it is important to adopt an effective treatment approach that minimizes this risk. In addition, psoriasis is often associated with various comorbidities that may place a great burden on the physical and mental health of the children beyond those due to psoriasis itself. To ensure good long-term health outcomes, individuals with psoriasis should undergo regular screening. Treatment should be provided not only for skin lesions, but also for any comorbidities; however, currently there is not enough evidence on the treatment of pediatric psoriasis and no globally agreed-on guidelines exist for treating psoriasis in children. This article describes the etiology, clinical symptoms, and disease burden of pediatric psoriasis, the pathological conditions and diagnosis of plaque psoriasis, psoriatic arthritis, and generalized pustular psoriasis, and the available treatments for these conditions in Japan.

Identification of ADAM23 as a Potential Signature for Psoriasis Using Integrative Machine-Learning and Experimental Verification.

Psoriasis is a common chronic, recurrent, and inflammatory skin disease. Identifying novel and potential biomarkers is valuable in the treatment and diagnosis of psoriasis. The goal of this study was to identify novel key biomarkers of psoriasis and analyze the potential underlying mechanisms. Psoriasis-related datasets were downloaded from the Gene Expression Omnibus database to screen differential genes in the datasets. Functional and pathway enrichment analyses were performed on the differentially expressed genes (DEGs). Candidate biomarkers for psoriasis were identified from the GSE30999 and GSE6710 datasets using four machine learning algorithms, namely, random forest (RF), least absolute shrinkage and selection operator (LASSO) logistic regression, weighted gene co-expression network analysis (WGCNA), and support vector machine recursive feature elimination (SVM-RFE), and were validated using the GSE41662 dataset. Next, we used CIBERSORT and single-cell RNA analysis to explore the relationship between ADAM23 and immune cells. Finally, we validated the expression of the identified biomarkers expressions in human and mouse experiments. A total of 709 overlapping DEGs were identified, including 426 upregulated and 283 downregulated genes. Enhanced by enrichment analysis, the differentially expressed genes (DEGs) were spatially arranged in relation to immune cell involvement, immune-activating processes, and inflammatory signals. Based on the enrichment analysis, the DEGs were mapped to immune cell involvement, immune-activating processes, and inflammatory signals. Four machine learning strategies and single-cell RNA sequencing analysis showed that ADAM23, a disintegrin and metalloprotease, may be a unique, critical biomarker with high diagnostic accuracy for psoriasis. Based on CIBERSORT analysis, ADAM23 was found to be associated with a variety of immune cells, such as macrophages and mast cells, and it was upregulated in the macrophages of psoriatic lesions in patients and mice. ADAM23 may be a potential biomarker in the diagnosis of psoriasis and may contribute to the pathogenesis by regulating immunological activity in psoriatic lesions.

A multidisciplinary dermatology-gastroenterology-rheumatology (DER.RE.GA) unit for the care of patients with immune-mediated inflammatory diseases: analysis of the first 5 years from the dermatologist’s perspective

Immune-mediated inflammatory diseases (IMIDs) constitute a heterogenous group of chronic and highly disabling conditions. The clinical challenges they often pose led to formation of numerous dermo-rheumatological interdisciplinary units around the world, which are reported to benefit their patients in various ways. The present paper describes our experience with a multidisciplinary dermatology-rheumatology-gastroenterology unit DERREGA at the IRCCS Foundation Policlinico San Matteo of Pavia over a period of 5 years of its activity (2017–2022). A digital database was created, containing the medical records of 146 patients referred to the dermatology unit only by rheumatologists or gastroenterologists belonging to the multidisciplinary unit DERREGA. Then, aspects such as demographics, initial basis of referral and final diagnosis among the patients were analyzed retrospectively. Patients were classified as either gastroenterological or rheumatological, and then categorized according to the specific basis of referral. Most of the gastroenterological patients (97%) were affected by inflammatory bowel diseases (IBDs). Rheumatological patients were divided in three subgroups, including patients referred with vasculitis, arthropathies (undifferentiated arthritis, psoriatic arthritis and other arthritis) and other rheumatological diseases. Then, final diagnoses were evaluated in each group. Almost a third of IBD patients received a diagnosis of paradoxical psoriasis. Dermatological examination allowed diagnosis of minimal psoriasis based on Caspar criteria in over 70% of the patients admitted with undifferentiated arthritis. A multidisciplinary approach is suggested to provide more effective management of IMIDs and, specifically, from a dermatological perspective, allows for the diagnosis of minimal manifestations of psoriasis in patients with a provisional diagnosis of undifferentiated arthritis.

Diagnostic clinical decision support based on deep learning and knowledge-based systems for psoriasis: From diagnosis to treatment options

Psoriasis is an acute immuno-dermatological disease, affecting people of all ages, which significantly decreases quality of life. While the standard approach to identification and diagnosis of psoriasis is based on dermatologist decisions, various Deep Learning (DL) methods have been utilized to create Computer-Aided Diagnosis (CAD) systems to detect and classify psoriasis cases. In response to the knowledge gap of an existing practical and functional DL-based solution to psoriasis diagnosis, this study proposed an ensemble Convolutional Neural Network (CNN) model using Residual Network 50 Version 2 (ResNet50V2), ResNet101V2, and ResNet152V2 networks to create a CAD system for detecting and classifying psoriatic images. This ensemble model determines whether an input image is psoriatic using a binary classification procedure in the initial stage and classifies the psoriatic images into seven variants utilizing a multi-class classification. Furthermore, a treatment suggestion system was embedded within the diagnostic algorithm to suggest the best treatment options for psoriasis variants using a Multi-Criteria Decision Making (MCDM) method with the aim of reducing the disease symptoms in patients. A web-based Decision and Diagnostic Support System (D&DSS) is constructed to determine whether an input image is psoriatic, classify the psoriatic images into different variants, and accordingly recommend the best treatment options based on the observed disease symptoms in a patient. Nevertheless, the functionality and reliability of the proposed D&DSS are validated with high accuracy rates in both diagnostic and identification stages of the approach, which ratifies the practicality of this proposition.

Predicting Psoriatic Arthritis in Psoriasis Patients - A Swiss Registry Study.

Psoriatic arthritis (PsA) is a prevalent comorbidity among patients with psoriasis, heavily contributing to their burden of disease, usually diagnosed several years after the diagnosis of psoriasis. To investigate the predictability of psoriatic arthritis in patients with psoriasis and to identify important predictors. Data from the Swiss Dermatology Network on Targeted Therapies (SDNTT) involving patients treated for psoriasis were utilized. A combination of gradient-boosted decision trees and mixed models was used to classify patients based on their diagnosis of PsA or its absence. The variables with the highest predictive power were identified. Time to PsA diagnosis was visualized with the Kaplan-Meier method and the relationship between severity of psoriasis and PsA was explored through quantile regression. A diagnosis of psoriatic arthritis was registered at baseline of 407 (29.5%) treatment series. 516 patients had no registration of PsA, 257 patients had PsA at inclusion, and 91 patients were diagnosed with PsA after inclusion. The model's AUROCs was up to 73.7%, and variables with the highest discriminatory power were age, PASI, physical well-being, and severity of nail psoriasis. Among patients who developed PsA after inclusion, significantly more first treatment series were classified in the PsA-group, compared to those with no PsA registration. PASI was significantly correlated with the median burden/severity of PsA (P = .01). Distinguishing between patients with and without PsA based on clinical characteristics is feasible and even predicting future diagnoses of PsA is possible. Patients at higher risk can be identified using important predictors of PsA.

Comorbidity Burden and Treatment Patterns of Psoriasis in Vietnam: Real-World Data from the EXPAND Study.

Psoriasis is a multi-faceted, immune-mediated inflammatory disease associated with a wide range of comorbidities. Real-world data on treatment patterns, comorbidities, and economic burden in patients with psoriasis are needed for comprehensive patient care in Vietnam. A retrospective chart review study was conducted using secondary data extracted from patients' medical records of two hospitals in Vietnam, with the aim of identifying adult patients with a confirmed diagnosis of psoriasis. The index date was defined as the date of first diagnosis between 1 January 2020 and 31 October 2021. Sociodemographic factors, disease characteristics, comorbidities, medication usage, drug survival, and medication costs were analyzed. A total of 661 patients were identified (mean ± standard deviation [SD] age 43.5 ± 14.8years). The most prevalent comorbidity was dyslipidemia (49.6% of patients), followed by hypertension (23.4%), and psoriatic arthritis (10.4%). In total, 44% of patients received biologic therapies. Overall, 66.7% and 54.3% of patients receiving biologic and non-biologic therapies, respectively, had ≥ 1 comorbidity. Only 23.2% of patients with psoriasis-related comorbidities stopped therapy with biologics. Biologics had a longer retention time (17.0months) than non-biologics (6.0months) in patients with comorbidities. Patients with comorbidities had significantly higher total annual healthcare costs than those without comorbidities (in US dollars: USD901 vs. USD304; p < 0.001), mainly due to the relatively higher costs associated with the use of biologics. Patients with psoriasis in Vietnam experience a high disease and economic burden due to comorbidities. Evidence from this real-world study supports the need for routine monitoring of and an appropriate treatment course for psoriasis-related comorbidities.

INNOVATIVE APPROACH TO THE TREATMENT OF PSORIASIS USING NANOTECHNOLOGIES

Psoriasis is a chronic immune-mediated genetic disease with systemic and cutaneous manifestations that can significantly impair patients' quality of life. 2-3% of the world population suffers from psoriasis, and this imposes a significant economic burden on patients. Aetiology is mainly related to genes and environmental factors. The pathophysiology of psoriasis is characterized by T cells and dendritic cells, antimicrobial peptides, genetic predisposition, lipoprotein-2, galactosin-3, fractalkine, vaspin, human neutrophil peptides, etc. in the progression of psoriasis. For patients with psoriasis, conventional treatments include corticosteroids, vitamin D3 analogs, calcineurin inhibitors, methotrexate, cyclosporine, acitretin, phototherapy, and biological agents, etc. Today, there are various standard topical therapeutic approaches that can help control the condition for months to years, however, complete recovery from psoriasis with these treatments has not been reported. Therefore, researchers around the world are mainly considering the possibility of using various nanotechnological therapies for complete recovery. New drug delivery carriers, in particular nanocarriers, can overcome certain disadvantages of conventional treatment methods, such as: dose minimization, frequency of administration, and dose-dependent side effects. Nanodermatology is a new multidisciplinary science that is gaining more and more recognition in the treatment of psoriasis. The use of nanotechnology makes it possible to select drugs to achieve dermal targeting, increase efficiency and minimize unwanted effects. Currently, these nanocarriers are becoming increasingly popular as delivery vehicles for psoriasis drugs due to their non-toxicity, natural degradability, excellent biocompatibility and biodegradability, they do not cause harmful inflammatory reactions and are easily excreted from the body. Reports of nanocarrier delivery for the treatment of psoriasis have shown improved efficacy and reduced toxicity compared to standard pharmacotherapy. To better clarify the application of nanotechnology in the treatment of psoriasis, various drugs based on nanocarriers will be summarized. This review provides a concise overview of the pathophysiology, epidemiology, clinical diagnosis, and classical pharmacotherapy of psoriasis. The review also summarizes various nanotechnological treatments for the effective treatment of psoriasis.

43 Machine learning-based differential diagnosis of psoriasis and atopic dermatitis using clinical data and medical images

43 Machine learning-based differential diagnosis of psoriasis and atopic dermatitis using clinical data and medical images

The ATTRACT study: screening for the early identification of axial psoriatic arthritis in a cohort of Italian psoriatic patients.

There is growing interest in the early identification of patients with axial PsA (axPsA). We aimed to evaluate whether a dermatology-based screening strategy could help to identify axPsA patients. The dermatologist-centred screening (DCS) questionnaire was administrated by dermatologists to consecutive patients fulfilling the inclusion criteria [(i) age ≥18 years and (ii) clinical diagnosis of psoriasis made by a dermatologist] to identify patients eligible (affirmative answers 1-3c of the DCS) for rheumatological evaluation. Clinical, laboratory, genetic and imaging data were collected from all referred patients. Among the 365 patients screened, 265 fulfilled the inclusion criteria and 124/265 (46.8%) were eligible for rheumatological referral. Diagnosis of axPsA, with or without peripheral PsA (pPsA), was made in 36/124 (29.0%) patients; pPsA without axial involvement was found in 21/124 (16.9%) patients. Back pain at screening was recorded in 174 (66%) patients, with 158 (60%) reporting a back pain duration longer than 3 months and 140 (53%) reporting back pain onset before the age of 45 years. Active inflammatory and/or structural post-inflammatory changes in the sacroiliac joints and/or spine were observed in all axPsA patients. Patients with PsA showed a numerically longer duration of back pain and higher CRP levels in comparison with patients with psoriasis without PsA. The DCS tool proved to be a valuable screening strategy for detecting and characterizing patients with axPsA in a real-life cohort of psoriasis patients in a dermatological setting and helped to identify a substantial number of patients affected by undiagnosed pPsA.

A Prospective Open-Label Study of the Antifungal Activity of External Forms of Activated Zinc Pyrithione in the Treatment of Malassezia- Associated Skin Diseases

Background: There are insufficient data on the antifungal activity of active zinc pyrithione, which is widely used in practice. Considering the reported role of Malassezia spp. in the pathogenesis of several dermatologic diseases, it is of scientific and practical importance to investigate this issue. Aim: To evaluate the antifungal activity of external forms of activated zinc pyrithione in the treatment of psoriasis, seborrheic dermatitis, and pityriasis versicolor. Method: An open-label prospective study was conducted between March and July 2022. Patients with psoriasis, seborrheic dermatitis, and pityriasis versicolor were treated with external forms of activated zinc pyrithione for 21 days. Skin scales and circular prints from lesion foci, as well as from skin areas without clinical manifestations before and after therapy were studied. A quantitative assessment of skin colonization by micromycetes of Malassezia was performed using microscopic and cultural methods of examination. Clinical efficacy and drug safety of the therapy was assessed using the Dermatological Symptom Scale Index, by recording adverse events at weeks 0, 1, 2, and 3. Results: 64 patients aged 18 to 65 years with diagnoses of psoriasis, seborrheic dermatitis, and pityriasis versicolor were included. 60 patients completed the study, 4 were excluded due to failure to adhere to the schedule. In patients with seborrheic dermatitis and pityriasis versicolor in the lesion foci after therapy, a significant decrease was observed in the colonization level according to the results of microscopic and cultural studies. In psoriasis patients, a significant decrease in the colonization level was obtained only based on the results of microscopic examination. In all groups, significant differences in comparison to the initial level were observed at the 1st week of treatment. There was no adverse events observed. Conclusion: Activated zinc pyrithione in the form of cream and aerosol showed moderate antifungal activity against micromycetes of the genus Malassezia.

Management of Pediatric Psoriasis: A U.S. Survey Based on Visits from the National Ambulatory Medical Care Survey (NAMCS).

Approximately one-third of psoriasis cases present in the first two decades of life. Many psoriasis treatments are approved by the U.S. Food and Drug Administration (FDA) for adults, including topical agents, systemic non-biologic agents, and systemic biologic agents. Only a handful of psoriasis treatments are FDA approved for children. Given the constantly evolving landscape of pediatric psoriasis management, our aim is to characterize how children with psoriasis are treated in the U.S. Data from the 2003-2016 and 2018 National Ambulatory Medical Care Survey (NAMCS) were used to evaluate patient demographics and treatment patterns for visits of children with psoriasis. Visits were stratified by those with a diagnosis of psoriasis and those for children with a diagnosis of psoriasis. Separate analyses for visits of children with a diagnosis of psoriasis were performed, including for sex, race, ethnicity, age, specialty of provider seen, and medications prescribed. Pediatric psoriasis visits accounted for 3.3% of visits with psoriasis from 2003 to 2016 and in 2018; about one-third of those visits were to primary care providers. Children with psoriasis were prescribed a variety of topical and systemic medications, of which the most frequently prescribed treatments were topical tacrolimus, followed by topical clobetasol and topical betamethasone dipropionate or betamethasone valerate. Etanercept was the only biologic prescribed to children. At least 59% of the visits for children with a diagnosis of psoriasis included a topical prescription while at least 5.3% of the visits included a systemic prescription. Use of off-label treatments was common for pediatric psoriasis. Most children with psoriasis were treated with topicals, of which tacrolimus, an unapproved treatment, was the most common. The frequent use of tacrolimus could indicate an avoidance of corticosteroids in children.

Prevalence and Clinical Predictors of Psoriatic Arthritis in Saudi Patients With Psoriasis: A Single-Center Retrospective Cohort Study.

Background Among psoriatic patients, psoriatic arthritis is the most common and most impactful comorbidity. In most cases, it occurs after the onset of psoriasis. Detecting and treating it early is crucial for rheumatologists and dermatologists. Objectives The study aimed to determine the prevalence of psoriatic arthritis among recognized cases of psoriasis, as well as to determine the clinical features of psoriasis that are linked to a greater prevalence of psoriatic arthritis at King Abdulaziz Medical City (KAMC), Riyadh. Methods A retrospective cohort study of 487 psoriatic patients diagnosed between 2015 and 2023 was conducted at KAMC, Riyadh. The study included subjects aged 18 years or older with a psoriasis diagnosis documented by a dermatologist and a psoriatic arthritis diagnosis documented by a rheumatologist based on the Classification Criteria for Psoriatic Arthritis (CASPAR). Patients younger than 18 years, diagnosed with psoriatic arthritis concurrently with psoriasis, or within 90 days of psoriasis diagnosis, or who lack a documented diagnosis of psoriasis by a dermatologist were excluded. The study evaluated demographic data and medical variables concerning psoriasis (age at onset, type of psoriasis, site of psoriasis, and nail dystrophy) and psoriatic arthritis. SPSS Statistics version 25 (IBM Corp., Armonk, NY) was used to conduct statistical analysis. The p-value of 0.05 was used to evaluate statistical significance. Results Overall, 487 patients had psoriasis in this study. Of these, 49 (10%) were diagnosed with psoriatic arthritis. The mean ± standard deviation of the age of the psoriasis group was 41.7 ± 15.6 years, with 264 (54.2%) females and 223 (44.8%) males. The clinical features of psoriasis that were linked to a greater frequency of psoriatic arthritis in our study included female gender (71.4%), plaque psoriasis (95.9%), psoriatic lesions involving the extremities (75%), scalp (42.9%), and trunk (36.7%), nail dystrophy (28.6%), as well as the involvement of three or more sites (40.8%) at the time of their initial diagnosis of psoriasis. Conclusion Our study indicated that 10% of Saudi patients with psoriasis had psoriatic arthritis. Moreover, the present study shows that patients with greater psoriatic lesions at initial presentation are more likely to develop psoriatic arthritis.

Artificial Intelligence Bringing Newer Paradigms in the Diagnosis, Treatment, and Management of Psoriasis

Artificial Intelligence Bringing Newer Paradigms in the Diagnosis, Treatment, and Management of Psoriasis

The journey of patients with skin diseases from the first consultation to the diagnosis in a representative sample of the European general population from the EADV burden of skin diseases study.

The journey of patients with skin diseases through healthcare has been scarcely investigated. To analyse the journey of people with skin diseases in the different healthcare environment in Europe. This multinational, cross-sectional, European study was conducted on a representative sample of the adult general population of 27 European countries. The prevalence of the most frequent skin diseases was determined. Information was collected on the patient journey from the first medical consultation to the diagnosis, and the reasons for not consulting a healthcare professional. On a total of 44,689 individuals, 30.3% reported to have consulted a dermatologist during the previous 2 years. Participants consulted mainly for mole control or skin cancer screening (22.3%), followed by chronic skin diseases (16.2%). The diagnoses of acne, atopic dermatitis, psoriasis and rosacea were made most frequently by a dermatologist, while fungal skin infections were diagnosed more often by a general practitioner (GP), and sexually transmitted diseases (STD) by other specialists. The diagnosis was not always definitive at the first consultation, in particular for STD. The percentage of people who did not consult a healthcare professional for their skin disease was particularly high for acne (36.4%), alopecia (44.7%) and fungal infection (30.0%). Moreover, 17.7% of respondents with psoriasis did not consult. A high percentage of participants with alopecia thought that the disease was not worrying, while patients with psoriasis often answered that they were able to manage the disease since they had already consulted a doctor. Many patients with acne (41.1%) and fungal infection (48.2%) thought that they were able to handle the disease by themselves. The analysis of the self-reported medical journey of patients with common skin diseases may allow to understand the unmet needs of patients, thus improving outcomes and reducing expenses.

Polymorphism of cytokine and C-reactive protein genes in patients with psoriasis in the Kemerovo region of Russia

Aim. To study the associations of polymorphisms of IL-1b (rs16944), IL-6 (rs1554606), IL-8 (rs2227306), IL-10 (rs1800896), TNFα (rs361525), CRP (rs1205) genes and their intergenic interactions with the risk of psoriasis development in Kemerovo region residents. Materials and Methods. We examined 170 patients (102 men and 78 women) a clinically established diagnosis of vulgar psoriasis. The average age of patients was 46.2+3.9 years, 165 people (97%) had progressive stage psoriasis. The control group (n=155) included 98 healthy men and 57 women matched by age. Genomic DNA isolated from peripheral blood leukocytes by phenol-chloroform extraction according to the standard protocol was used as material. Logistic regression analysis was performed to assess the role of intergenic interactions in the development of psoriasis. Conclusion. In patients of the Kemerovo region, vulgar psoriasis is associated with minor homozygous genotypes of polymorphic variants of TNFα (rs361525), IL-1b (rs16944), CRP (rs1205) genes. The minor homozygous TNFα (rs361525) genotype has a high odds ratio and is determinant in the development of this form of psoriasis among all genes studied. The major allele and IL-10 genotype (rs1800896) is a disease modifier and affects the clinical course, particularly the development of inflammatory plaques and papules on the lower and upper extremities of patients.