Effective Treatment For Psoriasis Research Articles

The Effect of Szigetvár Medicinal Water on HaCaT Cells Exposed to Dithranol.

(1) Introduction: Topical dithranol is still commonly used today as an effective treatment for psoriasis. Dithranol treatment is often supplemented with balneotherapy, which has been shown to increase effectiveness and reduce side effects. The inorganic salts (sulfhide, selenium, zinc) are usually thought to be responsible for the effect. The antioxidant effect of the waters is thought to be behind the therapeutic effect, for which inorganic substances (sulfides, selenium, zinc) are thought to be responsible. The organic matter content of medicinal waters is also particularly important, as humic acids, which are often found in medicinal waters, have antioxidant effects. (2) Methods: In this short-term experiment, we aimed to test the possible protective effect of Szigetvár medicinal water and its organic matter isolate on HaCaT cells exposed to dithranol. Malondialdehyde levels were measured, and RT-qPCR was used to investigate the gene expression of selected cytokines relevant in the oxidative stress response (IL-6, IL-8, TNF-α, GM-CSF) and the expression of microRNA-21. (3) Results: Szigetvár medicinal water and the organic isolate prevented the increase in malondialdehyde levels caused by dithranol treatment. The cytokine gene expressions elevated by dithranol exposure were reduced by the treatment. (4) Conclusions: Szigetvár medicinal water and organic substances alone may have a protective effect on patients' healthy skin surfaces against dithranol damage. We also demonstrated that the organic compounds are also responsible for the protective effect.

Ionic Liquid-Mediated Transdermal Delivery of Organogel Containing Cyclosporine A for the Effective Treatment of Psoriasis.

The dermal delivery of peptide therapeutics that are of high molecular weight is a challenge. Cyclosporine A (CsA) is a cyclic undecapeptide with poor aqueous solubility and high molecular weight (1202 Da) indicated for psoriasis. The objective of the study was to evaluate the effect of ionic liquids mixed with the Pluronic F127 matrix in skin permeation of CsA and its efficacy in psoriasis treatment. Choline and geranic acid (CAGE) ionic liquids in a 1:2 molar ratio were mixed with Pluronic F127 (22.7%) and PEG 400 (45%) to prepare an organogel formulation. The CsA-loaded CAGE (CsA-CAGE) and CAGE-Pluronic F127 gels (CsA-CAGE-P gel) were characterized for physical and rheological characteristics. The skin transport studies showed that free CsA did not permeate across the excised porcine skin after 48 h. The amount of CsA permeated across the oleic acid (0.25% v/v) and palmitic acid (0.25% w/v) cotreated skin was found to be 244 ± 4 and 1236 ± 17 μg/cm2, respectively. The application of CsA-CAGE and CsA-CAGE-P gel enhanced CsA flux by 110- and 135-fold, respectively, compared with the control. The thermal analysis and biophysical studies changed the barrier property of the skin significantly (p < 0.05) after incubation with CAGE and CAGE-P gel. The pharmacokinetic studies in the rat model showed that topical application of CsA-CAGE-P gel provided 2.6- and 1.9-fold greater C max and AUC0-t, respectively, compared to the control group. In vitro-in vivo level A correlations were established with R 2 values of 0.991 and 0.992 for both linear and polynomial equations for the CsA-CAGE-P gel formulation using the Wagner-Nelson method. The topical application of CsA-CAGE-P gel (10 mg/kg) on an imiquimod-induced plaque psoriatic model reduced the area of the psoriasis and severity index (PASI) score significantly for erythema and scaling, reversing the changes to skin thickness, blood flow rate, and transepidermal water loss. Together, CAGE-Pluronic F127 organogel was developed as an effective topical formulation for the local and systemic delivery of CsA for the treatment of psoriasis.

Efficacy and Safety of Orally Administered East Asian Herbal Medicine Combined with Narrowband Ultraviolet B against Psoriasis: A Bayesian Network Meta-Analysis and Network Analysis.

Psoriasis is a chronic, immune-mediated inflammatory skin disease with many complications and a poor prognosis that imposes a significant burden on individuals and society. Narrowband ultraviolet B (NB-UVB) represents a cost-effective non-drug therapeutic intervention for psoriasis. East Asian herbal medicine (EAHM) is currently being investigated for its potential as a safe and effective psoriasis treatment. Consequently, it has the potential to be employed as a combination therapy with NB-UVB. The objective was to ascertain the efficacy and safety of the EAHM with NB-UVB combination therapy and to identify important drugs for further research. In this study, randomized controlled trials (RCTs) were retrieved from ten databases in Korea, China, and Japan. All statistical analyses were conducted using R software version 4.3.0. The primary outcomes were the Psoriasis Area and Severity Index (PASI) and the incidence rate of adverse events (AEs), while the secondary outcomes were hematologic markers and the Dermatology Life Quality Index (DLQI), which reflect the immune-mediated inflammatory pathology of psoriasis. The analysis of 40 RCTs, including 3521 participants, demonstrated that EAHM with NB-UVB combination therapy exhibited a statistically significant superiority over NB-UVB monotherapy with respect to primary and secondary outcomes. The Bayesian network meta-analysis revealed that Investigator Presciption 3 and Ziyin Liangxue Decoction exhibited a consistent relative advantage with respect to each PASI-based efficacy metric. The network analysis estimated the potential influence ranking for all individual herbs according to PageRank centrality. The findings of this study suggest that EAHMs co-administered with NB-UVB may provide additional efficacy and safety-related benefits for patients with psoriasis. However, the quality of evidence is still low, and further high-quality trials are needed to reach more definitive conclusions.

Inhibitory Effect of Evodiamine on Psoriasis Lesions and Itching in Mice.

This study seeks to investigate the effect of evodiamine on psoriasis and psoriatic pruritus. Imiquimod-induced psoriasiform dermatitis in mice was used as a model, and evodiamine was topically applied for seven days. The mice were observed daily for skin damage on the back, clinical score and their scratching behavior was recorded. Blood samples were collected on the final day of the experiment, and the serum levels of pruritus-associated inflammatory cytokines tumor necrosis factor (TNF) -α, interleukin (IL) -23, and IL-17A were measured using enzyme-linked immunosorbent assay. Histopathological changes were observed in Hematoxylin and Eosin-stained skin specimens. The expression levels of transient receptor potential vanilloid (TRPV) 1, TRPV3, TRPV4, and the pruritus-related mediators Substance P (SP), nerve growth factor (NGF), and calcitonin gene-related peptide (CGRP) in the skin lesions were analyzed using Western blot and qRT-PCR. The effect of evodiamine on the exploratory behavior, motor, and coordination abilities of mice was assessed using open field, suspension, and Rota-Rod experiments. Molecular docking was utilized to verify the binding of evodiamine to the residues of TRPV1, TRPV3, and TRPV4. Evodiamine reduced pruritus and inhibited inflammation by decreasing the levels of inflammatory mediators TNF-α, IL-23, and IL-17A in the serum of Imiquimod-induced mice and attenuated the mRNA and protein expression levels of SP, NGF, CGRP, TRPV1, TRPV3, and TRPV4 in the skin. Evodiamine is an effective treatment for psoriasis and pruritus, due to its ability to inhibit immune inflammation and pruritic mediators.

O04 Delineation of psoriasis from uninvolved skin using an artificial neural network as a means of targeting phototherapy to psoriatic lesions

Abstract Introduction and aims Narrowband ultraviolet B therapy (NB-UVB) is an effective treatment for psoriasis. Currently, NB-UVB is delivered in whole-body cabinets to all of the patient’s skin, thus increasing the risk of normal skin sunburning and the potential risk of skin cancer development. This limits the NB-UVB doses that can be used and requires patients attend sessions three times weekly for up to 10 weeks in order to complete treatment. An artificial intelligence (AI)-mediated, targeted NB-UVB approach would avoid these risks and allow use of higher NB-UVB doses for the areas of the skin affected by psoriasis. We sought to train an artificial neural network on digital images of psoriasis, and subsequently test this trained model in order to assess its accuracy at distinguishing psoriasis from unaffected skin. Methods Overall, 104 digital images of psoriasis from 14 patients with this skin condition, who attended the dermatology department at University Hospital Southampton NHS Foundation Trust, were used to train a conditional generative adversarial network– ‘pix2pix’. Areas of psoriasis were delineated within the images prior to the images being augmented by randomly cropping, rotating and altering colour intensity, thereby increasing the total number to 23 111 images to train and test the neural network. Results The trained neural network was able to identify psoriasis in unseen digital images with 96.73% accuracy at the pixel level across the dataset. The output of the neural network (i.e. a computer-generated image of psoriasis) acted as a signal source for a digital micromirror device (DMD) that was able to shape visible light and project this light over the original image of psoriasis, while avoiding the uninvolved skin. Conclusions It is possible to differentiate psoriasis from unaffected skin within digital images using an artificial neural network. We demonstrated that AI-mediated targeted phototherapy using a DMD is feasible.

O05 Single-cell transcriptomic signature of paradoxical eczema in patients with psoriasis treated with biologics

Abstract Introduction and aims Biologics targeting the tumour necrosis factor (TNF) and the interleukin (IL)-17/23 axis are highly effective treatments for psoriasis but can result in cutaneous adverse events. The pathogenesis of paradoxical eczema, an atopic dermatitis (AD) phenotype occurring after biologic initiation in people with psoriasis, is unknown. This study explored the systemic disease signature of paradoxical eczema. Methods We used single-cell RNA-Seq on peripheral blood mononuclear cells (PBMCs) from three patients with psoriasis with paradoxical eczema, and three matched, biologic-treated controls who had psoriasis. Differential gene expression, gene network expression and cell–cell interaction (using MultiNicheNet) analyses allowed comparison of cases and controls. We assessed overlap between paradoxical eczema and AD using six AD transcriptome datasets. Results Overall, 32 827 PBMCs (14 521 from cases, 18 306 from controls) were included and categorized into 27 clusters. Between cases and controls, there were 727 differentially expressed genes (DEGs) (log fold-change &amp;gt; 0.25, adjusted P &amp;lt; 0.05). A total of 94 of the top 100 DEGs were from monocytes. Significant DEG networks (P &amp;lt; 0.05) mostly mapped to T-cell and monocyte clusters, with commonly enriched pathways in cases including interferon (IFN)-γ, IFN-α, TNF, IL-2/signal transducer and activator of transcription 5 and T-cell differentiation pathways. Cell–cell interaction analysis revealed that the most prioritized interactions in controls, based on differential expression data and known ligand-receptor interactions, included immune regulatory interactions (including ligands such as transforming growth factor β1 and lymphocyte-activation gene 3). In cases, functions of prioritized interactions included chemotaxis, leucocyte activation, T-cell priming and IFN-γ signalling. There was significant enrichment of concordance in the direction of effect of DEGs (65%, P = 5.39 × 10−6) and enriched pathways (85%, P = 3.62 × 10−13) between AD and paradoxical eczema. Conclusions Patients with paradoxical eczema have reduced immune regulatory mechanisms and evidence of monocyte and T-cell activation systemically, with increased production IFN-γ, IFN-α and TNF. There is a significant overlap with the AD transcriptome.

Improved Quality of Life in Patients with Psoriasis Receiving Apremilast: Real-World Data from the Netherlands.

Psoriasis is a chronic inflammatory condition that can significantly impact the quality of life (QoL), regardless of the level of skin involvement. Apremilast is indicated for the treatment of moderate to severe psoriasis. Real-world data regarding the impact of apremilast on patient-reported outcomes in clinical practice in the Netherlands is lacking. The prospective, multicenter observational Apremilast in Real-Life Psoriasis Treatment (APRIL) study enrolled patients ≥ 18years old with moderate to severe plaque psoriasis receiving apremilast in clinical practice in the Netherlands. Patients were followed-up for 12 months, with assessments scheduled at 6 and 12 months. The primary outcome was Dermatology Life Quality Index (DLQI) response (score ≤ 5 or ≥ 5-point improvement from baseline) at 6 months. Secondary patient-reported outcomes included EQ-5D and skin-specific parameters; exploratory outcomes were Patient Benefit Index (PBI) and Work Productivity and Activity Impairment (WPAI). Of the 155 patients enrolled (February 2016-June 2019), 153 received apremilast; 69 (45%) and 39 (26%) continued treatment at 6 and 12months, respectively. Psoriasis in special areas was common (scalp, 65%; nail, 51%; palmoplantar, 27%). Most patients (92%) had received prior systemic antipsoriatic therapies. Of the 151 patients with a baseline DLQI value, 56 (37%) achieved DLQI response at 6months. Mean (standard deviation) PBI scores were 3.5 (1.2) and 3.8 (1.1) at 6 and 12months, respectively. Improvements in DLQI, EQ-5D, and WPAI scores and disease signs and symptoms, including itch and special areas, were observed at 6 and 12months. Adverse events were consistent with the known safety profile. In the Netherlands, patients with moderate to severe psoriasis receiving apremilast for up to 12months reported improved disease-related QoL, skin involvement, and patient-reported outcomes. These data add to the growing body of evidence demonstrating apremilast is an effective treatment for psoriasis, itch, and special areas (scalp and palms). ClinicalTrials.gov, NCT02652494.

Quality by design driven systematic development of nanoemulgel of clobetasol-17-propionate for effective treatment of psoriasis

Nanoemulgels require two step formulation, the first one being formulation of nanoemulsion followed by the incorporation of nanoemulsion within a gel matrix. The current investigation aimed to formulate a Clobetasol-17-propionate (CP-17) nanoemulgel using QbD approach as anti-psoriatic for plaque type psoriasis. CP-17 was selected as a therapeutic agent to incorporate into the nanoemulsion system and then optimized CP-17 loaded nanoemulsion was incorporated into gelling agent (Carbopol 940) for topical use. Central Composite Design (CCD) was used. The independent factors used were amount of Smix (X1) and amount of gelling agent (X2). The dependent factors were in vitro drug release (Y1), droplet size (Y2) and encapsulation efficiency (Y3). The droplet size, rheological evaluation, PDI, in vitro release, ex vivo permeation and, retention and, in vivo studies were carried out. The nanoemulgel formulated was found to have droplet size within the range of 37.16 ± 21.16 nm. The ex vivo permeability was 44.68 ± 1.21 % and the skin retention was 40.86 ± 0.61 % after 7 h, both of which were greater than the marketed formulation. The CP-17 nanoemulgel showed 1.3-fold higher flux (498.66 ± 14.40 μg/cm2 h) than marketed formulation (383.9 ± 8.59 μg/cm2 h). The apparent permeability coefficient (APC) found to be 1.6 × 10−4 μg/min and 1.27 × 10−4 μg/min, respectively. The in vivo evaluation showed a reduction in PASI scores for erythema, thickness and scaling. The nanoemulgel produces sustained effect of CP-17 on the site of application as localized effect is required. The inflamed stratum corneum will demand hydration as well as targeted therapy, which the CP-17 nanoemulgel successfully provides.

Development of an Effective Psoriasis Treatment by Combining Tacrolimus-Encapsulated Liposomes and Iontophoresis.

Psoriasis is a chronic T-cell-mediated autoimmune skin disease. Tacrolimus (FK506) is commonly used treatment for psoriasis. However, since the molecular weight of FK506 is more than 500 Da, its skin penetration is limited, so that there is a need to improve the penetrability of FK506 to allow for more effective treatment. To this end, we employed iontophoresis (ItP), which is a physical, intradermal drug delivery technology that relies on the use of weak electric current. Previous findings suggest that activation of cell signaling by the weak electric current applied during ItP may affect the expression of inflammatory cytokines, leading to aggravation of psoriasis. In this study, we analyzed the effect of ItP on the expression of various inflammatory cytokines in the skin, and subsequently examined the therapeutic effect of ItP using negatively-charged liposomes encapsulating FK506 (FK-Lipo) in a rat psoriasis model induced by imiquimod. We found that ItP (0.34 mA/cm2, 1 h) did not affect mRNA levels of inflammatory cytokines or epidermis thickness, indicating that ItP is a safe technology for psoriasis treatment. ItP of FK-Lipo suppressed the expression of inflammatory cytokines induced by imiquimod treatment to a greater extent than skin treated with FK506 ointment for 1 h. Furthermore, epidermis thickening was significantly suppressed only by ItP of FK-Lipo. Taken together, results of this study demonstrate the successful development of an efficient treatment for psoriasis by combining FK-Lipo and ItP, without disease aggravation associated with the weak electric current.

Formulation and Evaluation of Gel Containing Nigella sativa Seed Extract Loaded Transferosomes for Effective Treatment of Psoriasis

Background: Psoriasis vulgaris is an autoimmune associated skin disease causing plaques or scales formation where the skin cells form quicker than in their typical life cycle. The phenolic phytoconstituents reported in Nigella sativa are effective for the treatment of skin disorders. Transfersomes is an emerging nanoencapsulation drug delivery approach which can squeeze themselves due to its elastic nature as an intact vesicle across narrow pores. It improves the potency of topical formulations with higher permeation efficiencies compared to other vesicular drug delivery systems. Objective: This research work focused to prepare Nigella sativa or black seed extract loaded transfersomes as nanoformulation and further incorporating them in the gel system to give improved therapeutic efficacy due to their self-regulating and self-optimizing capabilities. Methods: The phenolic content of Nigella sativa or black seed was extracted in ethanol and the solvent was removed using a vacuum with suitable storage conditions at 22ºC. Transfersomes of ethanol extract were prepared by thin layer hydration method and further incorporated into gel formulations. The ant-psoriasis activity of prepared gel formulation was performed with histopathology study in the Imiquimod induced albino rat model. Results: A nanoformulation prepared with 0.85 mg lecithin and 0.10 mg tween 80 has the highest entrapment efficiency. The entrapment efficiency, vesicle size, polydispersity index and zeta potential of optimized transferosomes batch were found to be 69.3 ± 2.6%, 178 ± 11 nm, 1.1 ± 0.2, -29.4 mV, respectively. Anti-psoriatic activity of N. sativa seed extract loaded transfersomes showed a more significant reduction in thickness of the epidermis and less elongation of rete ridges with capillary loop dilation as compared to conventional gel formulation. Conclusion: We concluded that the Nigella sativa seed ethanolic extract loaded transfersomes gel formulation showed significant ant-psoriasis activity in an albino rat model.

Excimer Laser System: The Revolutionary Way to Treat Psoriasis.

Psoriasis is a chronic, autoinflammatory skin disease that affects approximately 100 million people worldwide. It is a systemic disease characterized by scaly, red patches on the skin and can also affect the joints. Psoriasis can significantly affect a person's physical and mental health. The prevalence rate of psoriasis may vary depending on the specific population studied and the diagnostic criteria used. Phototherapy is a safe and effective treatment for psoriasis that involves exposing the affected skin to specific wavelengths of light. It can be used alone or with other treatments for severe psoriasis. However, clinicians must choose the right light source for each type of psoriasis and monitor the patient closely during treatment to avoid adverse events. The 308 nm excimer laser is a widely used device in dermatology for treating several skin conditions, including psoriasis. Although the excimer laser can treat various dermatologic diseases, this study will focus only on its effectiveness in treating psoriasis. This study will review the use of an excimer laser, its protocol, and its side effects.

1% Tapinarof cream for the treatment of psoriasis: a network meta-analysis of randomized placebo- and calcipotriol- controlled trials.

Tapinarof is an aromatic hydrocarbon receptor inhibitor for the treatment of adult psoriasis, and with the completion of Phase III clinical trials for this drug, it is important to understand its place among the medications used in the treatment of psoriasis for clinical application. Networks were constructed for 1% tapinarof cream with positive control (calcipotriol) and negative control (placebo). Network meta-analysis was performed using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PISMA) 2015. Relevant randomized clinical trials were searched from PubMed, Cochrane Library, and National Knowledge Infrastructure (CNKI) as of February 2023. Data were analyzed using the gemtc package in R software (RStudio) to evaluate the efficacy and safety of 1% tapinarof cream in the treatment of psoriasis in adults. A totalof 2408 patients wereenrolled in8 clinicalstudiesof1% tapinarof cream, and 6874 patients wereenrolled in 14 clinial studies of calciptriol.1% tapinarof cream was superior to placebo [OR: 8.3 (5.5, 13.0), 8.3 (5.9, 13.0), 7.3 (5.1, 11.0)] and calcipotriol in the treatment of psoriasis at 4, 8, and 12weeks, and the incidence of adverse events was higher than that with placebo [OR: 3.3 (2.6, 4.3)] and calcipotriol, with no serious systemic adverse events. 1% tapinarof cream is a safe and effective treatment for psoriasis.

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.

The Psoriasis Disability Index in Romanian Psoriasis Patients during COVID-19 Pandemic: Contribution of Clinical and Psychological Variables.

Psoriasis is one of the most frequent chronic inflammatory skin diseases and has a negative impact on the interpersonal relationship and psychosocial well-being. The aims of this study were to examine the effects of intensity of pruritus on quality of life and depression, to investigate the relationship between anger, self-esteem, and depression, and to compare patients with early and late onset of psoriasis. As our study was carried out during the COVID-19 pandemic, we aimed also to investigate the safety concerns and anxiety related to COVID-19 in psoriasis patients. This cross-sectional study included 137 patients diagnosed with plaque psoriasis. The patients were classified as early-onset (age < 30 years) and late-onset psoriasis (age ≥ 30 years). Duration of disease, pruritus scores, and socio-demographic characteristics were recorded. Measures included the State-Trait Anger Expression Inventory (STAXI), Rosenberg Self-Esteem Scale, Beck Depression Inventory (BDI-II), Psoriasis Disability Index (PDI), and Fear and anxiety in relationship with COVID-19 Scale were used for determining anger, anger expression style, self-esteem, depression, anxiety, and quality of life. The psoriasis patients had a lower score for self-esteem than the normative data from the Romanian general population. The average scores for state anger and trait anger are similar to the normative data from the Romanian general population, but the scores for anger-in and anger-out are higher. Patients with early onset had higher depression scores and lower quality of life. Self-esteem correlates negatively with depression, anger, severity of disability due to psoriasis, number of affected areas, and duration of disease. Lower level of self-esteem led to increased anger. Reduced self-esteem, increased anger levels, and depression are present in psoriasis patients. The effective treatment of psoriasis must, therefore, consist of a multidisciplinary approach, in which the personalized treatment of the skin condition is as important as the adjuvant therapies that reduce the patients' stress level.

Effect of Narrow-Band Ultraviolet B Therapy of Psoriasis Vulgaris on Skin Directional Reflectance, Skin Density and Epidermal Thickness

Psoriasis is an inflammatory dermatosis manifested by the appearance of brown-red papules on the body, covered with silver scales. One of the most common and effective treatments for psoriasis is narrow-band UVB phototherapy. Narrow-band UVB has a wavelength of 311 nm, which results in shallow skin penetration, is absorbed only by the epidermis and the superficial layers of the dermis. The aim of the study was to assess the effect of narrow-band UVB 311 nm phototherapy on skin covered with psoriatic scales and without psoriatic lesions in patients with psoriasis vulgaris on the total directional hemispherical reflectance (DHR) of the skin, skin density and epidermis thickness. For this purpose, a 410 Solar DHR reflectometer and high-frequency ultrasonography DUB SkinScanner were used. A total of 48 volunteers were enrolled. There was a difference in the reflectance of skin without psoriatic scales and psoriatic skin. Depending on the wavelength range, the skin was characterized by different reflectance values. During the course of phototherapy, the reflectance values decreased, both in the psoriatic skin and skin without psoriatic scales. After the phototherapy, the epidermis thickness and SLEB layer decreased and skin density increased in the area with psoriatic plaque. The density of the skin without psoriasis after a series of 20 irradiations increased, while the thickness of the epidermis did not change.

A Novel Methacryloyl Chitosan Hydrogel Microneedles Patch with Sustainable Drug Release Property for Effective Treatment of Psoriasis.

Psoriasis is a chronic and recurrent skin disease that often requires long-term treatment, and topical transdermal drug delivery can reduce systemic side effects. However, it is still a challenge in efficient transdermal drug delivery for psoriasis treatment due to low penetration efficiency of most drugs and the abnormal skin conditions of psoriasis patients. Here, a safe and effective methacryloyl chitosan hydrogel microneedles (CSMA hMNs) patch is developed and served as a sustained drug release platform for the treatment of psoriasis. By systematically optimizing the CSMA preparation, CSMA hMNs with excellent morphological characteristics and strong mechanical properties (0.7 Nneedle-1 ) are prepared with a concentration of only 3% (w/v) CSMA. As a proof-of-concept, methotrexate (MTX) and nicotinamide (NIC) are loaded into CSMA hMNs patch, which can produce a sustained drug release of 80% within 24h in vitro. In vivo experiments demonstrated that the CSMA hMNs patch can effectively inhibit the skin thickening and spleen enlargement of psoriatic mice and has a good biosafety profile at sufficient therapeutic doses. This study provides a new idea for the preparation of hMN systems using modified CS or other biocompatible materials and offers an effective therapeutic option for psoriasis treatment. This article is protected by copyright. All rights reserved.

The psoriasis area and severity index is an independent risk factor for cardiovascular events: A prospective register study.

Patients treated with systemics for moderate-to-severe psoriasis have increased risk of cardiovascular disease (CVD). However, to the best of our knowledge, there are no data on the association between clinical disease activity and future cardiovascular events in this population. Such data could help identify patients at increased CVD risk and inform the potential for CVD prevention with effective psoriasis treatment. To estimate the association between the Psoriasis Area and Severity Index (PASI) and cardiovascular events defined as hospitalization for CVD and cardiovascular death. We linked prospectively collected data on PASI and CVD risk factors to population-based administrative data on hospitalizations and causes of death. We estimated the association between PASI and cardiovascular events using Cox proportional hazard models with PASI and Framingham 10-year cardiovascular risk as time-varying covariates. A total of 767 patients with 6264 PASI scores were included. After adjusting for 10-year cardiovascular risk and prior CVD, a one-point increase in PASI was associated with a hazard ratio of 1.04 (95% CI: 1.01-1.07) for cardiovascular events. The findings were robust in sensitivity analyses. PASI is an independent marker for future cardiovascular events in patients with moderate-to-severe psoriasis.

Elucidating the NB-UVB mechanism by comparing transcriptome alteration on the edge and center of psoriatic plaques

Narrow band-ultraviolet B (NB-UVB) is an effective treatment for psoriasis. We aim to generate a potential mechanism of NB-UVB through comparing the transcriptomic profile before and after NB-UVB treatment between the peripheral edge of lesional skin (PE skin) and the center of lesional skin (CE skin) on the basis of molecular mechanisms of these two areas display different downstream functions. More than one-fourth of the NB-UVB-altered genes were found to be plaque-specific. Some of them were psoriasis signature genes that were downregulated by NB-UVB in, both, PE and CE skin (core alteration), such as IL36G, DEFB4A/B, S100A15, KRT16, and KRT6A. After NB-UVB treatment, the activity score of upstream cytokines, such as interferons, interleukin (IL)-6, IL-17, and IL-22 in pathogenesis decreased. In addition, NB-UVB could restore normal keratinization by upregulating LORICRIN and KRT2, particularly in the CE skin. Finally, we illustrated that NB-UVB is capable of suppressing molecules from the initiation to maintenance phase of plaque formation, thereby normalizing psoriatic plaques. This finding supports the usefulness of NB-UVB treatment in clinical practice and may help in the development of new treatment approaches in which NB-UVB treatment is included for patients with psoriasis or other inflammatory skin diseases.

Novel Synergistic Approach: Tazarotene-Calcipotriol-Loaded-PVA/PVP-Nanofibers Incorporated in Hydrogel Film for Management and Treatment of Psoriasis.

Psoriasis is an autoimmune skin disease that generally affects 1%-3% of the total population globally. Effective treatment of psoriasis is limited because of numerous factors, such as ineffective drug delivery and efficacy following conventional pharmaceutical treatments. Nanofibers are widely being used as nanocarriers for effective treatment because of their multifunctional and distinctive properties, including a greater surface area, higher volume ratio, increased elasticity and improved stiffness and resistance to traction, favorable biodegradability, high permeability, and sufficient oxygen supply, which help maintain the moisture content of the skin and improve the bioavailability of the drugs. Similar to the extracellular matrix, nanofibers have a regeneration capacity, promoting cell growth, adhesion, and proliferation, and also have a more controlled release pattern compared with that of other conventional therapies at the psoriatic site. To ensure improved drug targeting and better antipsoriatic efficacy, this study formulated and evaluated a tazarotene (TZT)-calcipotriol (CPT)-loaded nanofiber and carbopol-based hydrogel film. The nanofiber was prepared using electrospinning with a polyvinyl alcohol/polyvinylpyrrolidone (PVA/PVP) K-90 polymeric blend that was later incorporated into a carbopol base to form hydrogel films. The prepared nanofibers were biochemically evaluated and in vitro and in vivo characterized. The mean diameters of the optimized formulation, i.e., TZT-loaded polyvinyl alcohol/polyvinylpyrrolidone nanofiber (TZT-PVA/PVP-NF) and TZT-CPT-loaded polyvinyl alcohol/polyvinylpyrrolidone nanofiber (TZT-CPT-PVA/PVP-NF) were 244.67 ± 58.11 and 252.31 ± 35.50 nm, respectively, as determined by scanning electron microscopy, and their tensile strength ranged from 14.02 ± 0.54 to 22.50 ± 0.03 MPa. X-ray diffraction revealed an increase in the amorphous nature of the nanofibers. The biodegradability studies of prepared nanofiber formulations, irrespective of their composition, showed that these completely biodegraded within 2 weeks of their application. The TZT-CPT-PVA/PVP-NF nanofibers exhibited 95.68% ± 0.03% drug release at the end of 72 h, indicating a controlled release pattern and following Higuchi release kinetics as a best-fit model. MTT assay, antioxidant and lipid profile tests, splenomegaly assessment, and weight fluctuation were all performed in the in vitro as well as in vivo studies. We found that the TZT-CPT-PVA/PVP-NF-based hydrogel film has high potential for antipsoriatic activity in imiquimod-induced Wistar rats in comparison with that of TT-PVA/PVP-NF nanofibers.

Real-Life Effectiveness of Tildrakizumab in Chronic Palmo Plantar Psoriasis: A Case Series of 7 Patients with 28 weeks of Follow Up

Palmo-plantar psoriasis (PPP) is highly debilitating and difficult to treat impairing quality of life of patients. Tildrakizumab is an anti-IL23p19 subunit monoclonal antibody approved for the treatment of moderate-severe chronic plaque psoriasis in adult candidates for systemic therapy. Objective of this study is to investigate the safety and efficacy of tildrakizumab in the management of palmo-plantar psoriasis. A total of 7 adults patients with moderate to severe PPP were retrospective analysed. Tildrakizumab 100 mg was administered at weeks 0, 4 and then every 12 weeks, by subcutaneous injection. Patients were visited at baseline, at week 16 and at week 28. Safety and efficacy were assessed at weeks 0, 16 and 28. Physician's Global Assessment (PGA) and Palmoplantar Pustular Psoriasis Area and Severity Index (PPPASI) clinical score were used to measure the efficacy. The mean PGA score was reduced from 3.6 at baseline to 1.7 after 16 weeks and 1.3 after 28 weeks. The mean PPPASI score was reduced from 19.2 at baseline to 9.2 after 16 weeks and 5.2 after 28 weeks. In conclusion tildrakizumab represents a safe and effective treatment for psoriasis even in difficult areas such as the palms and soles.