Moderate Psoriasis Vulgaris Research Articles

Imaging Approach in the Diagnostics and Evaluation of the Psoriasis Plaque: A Preliminary Study and Literature Review.

(1) Background: the aim of the study was to demonstrate its usefulness in the field of imaging evaluation of plaque morphology in psoriasis vulgaris, with an emphasis on the use of confocal microscopy and other advanced skin-imaging techniques. (2) Methods: we conducted a prospective study over two years (July 2022-April 2024), on patients diagnosed with moderate or severe psoriasis vulgaris, treated in the dermatology department of our institution. We selected 30 patients, of whom 15 became eligible according to the inclusion and the exclusion criteria. A total of 60 psoriasis plaques were analyzed by dermatoscopy using a Delta 30 dermatoscope and Vidix 4.0 videodermoscope (VD), by cutaneous ultrasound (US) using a high-resolution 20 MHz linear probe, and by confocal microscopy, along with histopathological analysis. (3) Results: the study included fifteen patients with vulgar psoriasis, diagnosed histopathologically, of whom six were women and nine were men, with an average age of 55. Between two and six plaques per patient were selected and a total of sixty psoriasis plaques were analyzed by non-invasive imaging techniques. Twelve lesions were analyzed with ex vivo fluorescence confocal microscopy (FCM), compared to histology. US showed that the hyperechoic band and the lack of damage to the subcutaneous tissue were the most common criteria. The epidermis and dermis were found to be thicker in the area of psoriasis plaques compared to healthy skin. Dermatoscopy showed that the specific aspect of psoriasis plaques localized on the limbs and trunk was a lesion with an erythematous background, with dotted vessels with regular distribution on the surface and covered by white scales with diffuse distribution. The presence of bushy vessels with medium condensation was the most frequently identified pattern on VD. Good correlations were identified between the histological criteria and those obtained through confocal microscopy. (4) Conclusions: the assessment and monitoring of patients with psoriasis vulgaris can be conducted in a more complete and all-encompassing manner by incorporating dermatoscopy, ultrasonography, and confocal microscopy in clinical practice.

Study on the Impact of Depression on the Quality of Life of Patients With Psoriasis

Introduction: Psoriasis is a chronic condition with a strong impact on the daily life of patients, especially on relationship life. This paper aims to clarify the impact of depression on the quality of life of patients with moderate psoriasis. Methods: A cross-sectional study was conducted on 16 participants with psoriasis from April to May 2023. Patients with psoriasis vulgaris completed self-administered questionnaires which include demographic characteristics, Hamilton Depression Rating Scale (HAM-D) and Dermatological Life Quality Index (DLQI). Data were collected both physically, during periodic checks and online by email. Only 16 patients met the eligibility criteria for study entry. All patients included in the study had moderate psoriasis vulgaris. Exclusion criteria for participation in the study was: current use of psychotropic medications. severe comorbidities or chronic medical conditions and visual, auditory, linguistic, or cognitive impairments. Results: After completed the Hamilton Depression Rating Scale (HAM-D) half of them 8 (50%) had a score lower than 8 (minimal depression) and the other half 8 (50%) between 8-16 (mild depression). 14 (87.5%) of the participants had a DLQI score of more than 10, indicating severe impairment in their quality of life. The results obtained showed a positive correlation between Dermatological Life Quality Index (DLQI) andHamilton Depression Rating Scale (HAM-D). Conclusions: Depressive manifestations significantly influence the quality of life of psoriasis patients analyzed. A multidisciplinary approach in treating the patient with psoriasis is indispensable because it is not only necessary to manage a disease or a "case", but also to manage a patient.

Effects of secukinumab combined with tretinoin on metabolism, liver enzymes, and inflammatory factors in patients with moderate to severe psoriasis vulgaris.

Psoriasis is a T cell-mediated polygenic chronic inflammatory disease. Interleukin (IL)-17A plays a major role in psoriasis pathogenesis. Secukinumab is a high-affinity human monoclonal antibody against IL-17A. This article explored efficacy and safety of secukinumab plus tretinoin in moderate to severe psoriasis (MSP) vulgaris, and assessed metabolism, liver function, and inflammation. A total of 135 patients diagnosed with moderate or severe psoriasis vulgaris were enrolled and randomized into three groups at a 1 : 1 : 1 ratio, receiving treatment with rretinoin, secukinumab, or combination therapy for a duration of 16 weeks. Psoriasis area and severity index (PASI) scores, serum T lymphocyte subsets, glucose, lipid, and uric acid (UA) metabolism, liver enzymes, and inflammatory factors (IFs) were measured. Following the therapy, subjects had decreased PASI scores, increased serum CD3+, CD4+, and CD4+/CD8+, decreased serum CD8+, and decreased serum UA and IL-2, IL-6, IL-23, interferon-γ (IFN-γ), and tumor necrosis factor (TNF)-α (p < 0.05). Total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, apolipoproteins A1, B, fasting blood glucose, alanine transaminase, aspartate transaminase, and alkaline phosphatase had no obvious differences among the subjects (p > 0.05). As against the Tretinoin and the Secukinumab groups, the PASI score was visiblysmaller, the changes in serum T lymphocyte subsets were more obvious, and serum UA and IFs were lower in the Combination group following the therapy (p < 0.05). Secukinumab combined with tretinoin is more effective in MSP vulgaris, which can visibly reduce inflammatory response without affecting glucose and lipid metabolism and liver function.

The CDX2 G allele and the FoKI F allele of the VDR gene are more prevalent and related to changes in vitamin D levels in patients with psoriasis vulgaris: A pilot study.

Psoriasis is a chronic, non-contagious autoimmune condition marked by dry, itchy,erythematous and scaly plaques. From modest, localized plaques to total body coverage, the severity of psoriasis varies. Plaque, guttate, inverted, pustular, and erythrodermic psoriasis are the five primary kinds. About 90% of cases are of plaque psoriasis, commonly known as psoriasis vulgaris. Study aims to determine the impact of an rs2228570 (FokI) variant and an rs11568820 (CDX2) variant on serum vitamin D levels (SVD) in patients with psoriasis, and the correlation between the two variants and disease severity. A case-control study consisting of 95 psoriasis vulgaris patients and 84 healthy controls. The clinical investigation, molecular genetics analysis, and biochemical analysis were done for both groups. SVD levels were significantly decreased in psoriasis patients group. FokI genotypes analysis, we found no significant variance between groups. CDX2 G/G genotype is more prevalent in patients than controls. Moderate psoriasis vulgaris patients with CDX2 G/G genotypes have higher SVD levels than CDX2 G/A, and CDX2 A/A p=0.003. The study found a difference in vitamin D levels between patients and healthy subjects, as well as a difference in vitamin D levels with different FoKI and CDX2 genotypes.

The Efficacy of Topical Formulation Containing Ciplukan (Physalis angulata Linn.) in Modulating Interleukin-17 and Interferon Gamma Expression in Mice (Mus musculus) Psoriasis Model.

Interleukin 17 (IL-17) and interferon gamma (IFN-γ) play a role in the pathogenesis of psoriasis vulgaris (PV). Topical corticosteroids are still utilised as first-line therapy for mild to moderate PV. However, long-term use of corticosteroid is associated with various side effects. Physalis angulata Linn. (Ciplukan) possesses anti-inflammatory properties that could serve as a potential alternative topical therapy for PV. To assess the efficacy of topical ciplukan as an anti-inflammatory agent targeting the expression of IL-17 and IFN-γ. Psoriasis was induced using imiquimod cream, therefore divided into five groups. Group I, the psoriasis control group, received only imiquimod cream. Groups C1 and C2 received imiquimod cream followed by a mixture of Ciplukan and vaseline in a 1:2 and 1:4 ratio, respectively. Group M, the standard therapy group, received imiquimod cream, followed by mometasone furoate cream. Lastly, group V, the vehicle group, received imiquimod cream followed by vaseline album. Expression of IL-17 and IFN-γ in mice's skin tissue was analysed using reverse transcription polymerase chain reaction (RT-PCR) after seven days of treatment. The mean expression of IL-17 in Group C1 (22.60) was significantly lower (p = 0.012) than in the psoriasis control group (23.60), and there was no significant difference (p = 0.613) in Group M (22.41). The mean expression of IFN-γ in Group C1 (26.97) and Group C2 (27.03) was also significantly lower (p = 0.026 and p = 0.026, respectively) than Group I (28.80), and there was no significant difference (p = 0.180 and p = 0.093, respectively) than Group M (26.03). Expression of IL-17 and IFN-γ in the ciplukan group is lower than in the psoriasis control group, and there is no significant difference compared to the standard therapy group.

Data dynamics of angiogenesis visualization instrumental methods in patients with psoriasis during methotrexate therapy: Clinical and prognostic value of dermatoscopy and ultrasound dopplerography

BACKGROUND: Pathological angiogenesis is one of the important pathogenetic links of psoriasis. At the same time, the prognostic significance of instrumental methods for studying the severity of angiogenesis in psoriatic plaques remains poorly understood.&#x0D; AIM: Clinical assessment of the correlation between the dynamics of angiogenesis parameters (morphometric parameters of vascular glomeruli and Doppler blood flow in the skin and nail bed) and indicators of the methotrexate clinical efficacy during 12 months of therapy.&#x0D; MATERIALS AND METHODS: The work is based on the clinical data analysis of 82 patients with moderate and severe psoriasis vulgaris in the acute stage, who were prescribed methotrexate after initial examination. Patients underwent Doppler ultrasound examination of the skin in psoriatic plaques area and digital dermatoscopy to study the characteristics of vascular angiogenesis loci before treatment and at 1, 3 and 12 months of methotrexate therapy.&#x0D; RESULTS: As a result of comparative correlation analysis of dermatoscopy and ultrasonographic Dopplerography indicators dynamics and psoriasis clinical index values during the treatment of patients with methotrexate, moderate and strong correlations were established between the values of the average diameter of the vascular glomerulus and the degree of increased blood flow in psoriatic plaque area after 1 month of methotrexate treatment and the values of PASI at 3, 6 and 12 months from the start of treatment (r=0.540.76, p=0.0020.005), as well as between the mean vascular glomerulus diameter values and the degree of skin blood flow increase after 3 months and PASI and BSI indices after 6 and 12 months (r=0.360.74, p=0.0010.036). Disappearance of Doppler signals in psoriatic plaques skin and decrease in vascular glomeruli average diameter after 1 month from the start of therapy in 1.76 [1.38; 2.30] and 1.30 [1.38; 2.30] times increase the probability of achieving clinical improvement after three months of methotrexate treatment. The correlation coefficient between the degree of NAPSI reduction after 6 and 12 months of treatment and the dynamics of Doppler blood flow in the nail bed and resistance index of arterial vessels in the nail bed after three months from the start of treatment varied from 0.53 to 0.73.&#x0D; CONCLUSIONS: The dynamics of instrumental methods indicators for studying pathological angiogenesis correlates with the probability of achieving clinical improvement in psoriasis symptoms during systemic methotrexate therapy.

Randomized study of the efficacy of monoclonal antibodies in patients with refractory psoriasis

BACKGROUND: The main vector of psoriasis therapy is suppression of proliferative activity of keratinocytes, normalization of their differentiation, neutralization of immune inflammation in the dermis and normalization of cytokine balance.&#x0D; AIM: of the study was to study the efficacy and tolerability of an IL-17A inhibitor (secukinumab) as monotherapy and in combination with methotrexate in patients with moderate and severe psoriasis vulgaris.&#x0D; MATERIALS AND METHODS: The severity of psoriasis was assessed by the Psoriasis Prevalence and Severity Index (Psoriasis Area and Severity Index, PASI). To assess the damage to the nail plates of the hands and feet in psoriasis, the NAPSI index (Nail Psoriasis Severity Index) was used. In order to assess the quality of life of patients with psoriasis, a Russian-language version of the dermatological quality of life index (DQLI) was used. Patients' quality of life was assessed before the prescribed therapy and at 12 weeks of treatment. Assessment of the severity of itching and its impact on the daily life of patients was carried out according to the Prurindex questionnaire.&#x0D; RESULTS: All patients were divided into two groups by a randomized method. The first group included 25 patients who received therapy with secukinumab in the age category of 55 (3067) years. The second group included 25 patients aged 56 (3469) years of moderate and severe psoriasis who were treated with secukinumab after initiation (300 mg) 150 mg subcutaneously in combination with methotrexate 15 mg intramuscularly for 24 weeks. Thus, in the first group PASI 90 was achieved after 24 weeks ― in 69%, PASI 100 ― in 31% patients; in the second group ― PASI 90 ― in 68%, PASI 100 ― in 32% patients respectively. In both groups, it was possible to maintain clinical remission (PASI 90) in 87.3% of patients throughout the year. During therapy in patients of both groups, there was a decrease in DLQI values from 25.63.7 to 3.53.1 (p 0.01) in the first group and from 23.33.7 up to 3.12.6 in the second group.&#x0D; CONCLUSIONS: Treatment of patients with moderate and severe psoriasis vulgaris with secukinumab has shown its high efficacy and safety. Moreover, it was estimated that the combination of secukinumab and methotrexate is comparable in effectiveness to secukinumab monotherapy. It has been established that the use of secukinumab as monotherapy and in combination with methotrexate significantly improves the quality of life of patients with moderate and severe psoriasis vulgaris.

Effectiveness and tolerability of calcipotriol/betamethasone aerosol foam in patients with psoriasis vulgaris in real‐life setting: A prospective, noninterventional, multicenter observational study in Austria

AbstractBackgroundFor the topical treatment of plaque psoriasis, vitamin D analogues and corticosteroids are used as a fixed combination, which is available in different galenic preparations.ObjectivesThe aim of this study was to investigate the effectiveness and tolerability of calcipotriol/betamethasone (Cal/BD) cutaneous foam in a real‐world setting.MethodsOverall, 107 adult patients with at least mild plaque psoriasis as measured by the Investigator Global Assessment (IGA) were included and treated for 4 weeks. Affected body surface area (BSA), plaque locations, and Psoriasis Area and Severity Index (PASI) were documented at baseline, after 4 weeks and at the end of the study. Pruritus, overall patient satisfaction, tolerability and convenience of use, as well as quality of life (DLQI) were also evaluated.ResultsIn total, 96% of the patients suffered from mild to moderate psoriasis vulgaris. Of all patients included, 76% had previously received topical therapy. Under treatment with Cal/BD aerosol foam, the mean IGA score was reduced from 2.49 to 1.28 points (p &lt; 0.001). The mean PASI score was reduced from 7.01 to 3.58 (p &lt; 0.001). BSA was improved from 9.92% to 4.19% (p &lt; 0.001) and the DLQI from 7.81 to 2.43 points (p &lt; 0.001). Over 88% (84/95 patients) were very satisfied or satisfied with Cal/BD aerosol foam. The treatment was described as soothing (63/89), cooling (70/89), and itch relieving (53/84). Lack of efficacy was documented as an adverse event (AE) in four of 107 patients. No other AEs were observed.ConclusionsThe treatment of psoriasis vulgaris with Cal/BD aerosol foam was demonstrated to be effective, well tolerated and associated with high patient satisfaction.

Clinical significance of plasma markers of angiogenesis in patients with psoriasis

BACKGROUND: Currently, many researchers attach great importance in psoriasis pathogenesis to hyperproduction of vascular endothelial growth factor (VEGF) and endothelin-1, which leads to increased angiogenesis in dermis and mediates processes of immune inflammation. At the same time, possibility of using these angiogenesis biomarkers as additional indicators of immune inflammation activity and disease activity has been poorly studied.&#x0D; AIMS: the purpose of the study was to assess the relationship between serum concentrations of VEGF and endothelin-1, structural changes in the capillary bed according to videodermatoscopy, and severity and prevalence of skin lesions in patients with psoriasis, duration of disease, presence of nail lesions, synovitis, enthesitis and spondylitis, as well as concomitant diseases of the cardiovascular system.&#x0D; MATERIALS AND METHODS: The work is based on examination data analysis of 132 patients with moderate and severe psoriasis vulgaris for the period 20202022. Patients were determined the levels of VEGF and endothelin-1 in blood plasma and underwent digital dermatoscopy to study the characteristics of angiogenesis vascular loci (vascular glomeruli) in the papillary dermis. All psoriasis patients with symptoms of musculoskeletal system lesions were examined by a rheumatologist, which was supplemented by ultrasonography of the joints.&#x0D; RESULTS: According to the results of enzyme immunoassay, it was found that the examined patients had an increased concentration of VEGF and endothelin-1 in blood plasma compared to the control group (respectively 19.5 [4.7; 48.1] pg/ml and 274.5 [146; 439] pg/ml versus 5.2 [0.5; 9.8] pg/ml and 96.5 [32; 188] pg/ml, p=0.004 and p=0.002). It was found that an increase in plasma concentrations of VEGF and endothelin-1 correlates with an increase in density of vascular glomeruli (respectively r=0.65 and r=0.74) and the average diameter of the glomerulus (respectively r=0.58 and r=0.56). A more pronounced increase in plasma concentrations of VEGF and endothelin-1 in patients with psoriasis was noted in patients with psoriatic arthritis and in the presence of synovitis. VEGF levels were higher in patients with severe psoriasis and in patients with nail lesions. Correlation analysis showed the strongest relationship between VEGF concentration and DAS28, DLQI, PASI and NAPSI values, as well as endothelin-1 concentration and PASI, BSA and DLQI values.&#x0D; CONCLUSIONS: The work showed that the plasma concentration of VEGF and endothelin-1 characterizes the degree of angiogenesis expression in the psoriasis pathogenesis, reflects morphology changes in capillaries of the affected skin, and can also be used as a marker of severe psoriasis and an increased risk of developing damage to the nails and synovial membranes of the joints.

Effect of phototherapy on psychoemotional state in psoriasis: assessment of depression, anxiety and quality of life

BACKGROUND: Psoriasis is a widespread chronic genetically determined inflammatory dermatosis that affects approximately 125 million people worldwide. In the vast majority of cases, the first rashes appear in people younger than 35 years old who are just starting to build a career and start a family. Localization of psoriatic rashes on visible areas of the skin and stigmatization in society, regular exacerbations and multiple courses of expensive and insufficiently effective treatment negatively affect the quality of life and emotional state of patients up to the development of depressive and anxiety disorders, and even suicide attempts. An imbalance of mental status leads to the progression of psoriasis, which further aggravates the course of the skin process. This necessitates a personalized approach to the choice of a therapy method, taking into account high efficiency and maximum comfort for patients, which will improve their psychoemotional state.&#x0D; AIM: to study the effect of phototherapy (PUVA and UVB-311 nm) on the mental status of psoriasis patients&#x0D; MATERIALS AND METHODS: A prospective study was conducted on the basis of FGKU Central Polyclinic and V.A. Rakhmanovs clinic of skin and venereal diseases of Sechenov University with the participation of 228 patients with moderate-to-severe psoriasis who received UVB-311 nm (n=116) and PUVA therapy (n=112), including psoriasis vulgaris (n=193), guttate psoriasis (n=14), exudative psoriasis (n=21). Before and after treatment, patients were assessed for the severity of psoriasis (PASI), quality of life (DQLI), as well as the presence of depression and anxiety disorders (panic disorder, social phobia) using PHQ-9 and GAD-7 questionnaire tests. The initial radiation dose was 1 J/cm2 at PUVA and 0.10.2 J/cm2 at UVB-311 nm with a gradual increase in the dose every 12 sessions by 0.5 J/cm2 and 0.1 J/cm2, respectively. As photosensitizers ammifurin and oxoralen were used. The treatment was carried out according to the method of four-time irradiation per week using the UV-7001K cabin (Waldmann, Germany).&#x0D; RESULTS: Among 228 patients there were 108 women and 120 men aged 438.2 years. The UVB-311 nm group included 102 patients with moderate psoriasis vulgaris and 14 guttate psoriasis, the second group (PUVA) included patients with severe recalcitrant psoriasis vulgaris (n=91) and exudative psoriasis (n=21). In the first group, the course of therapy consisted of 282 procedures of UVB-311 nm. Before treatment, minimal depression was observed in 19 (16%) patients, mild depression in 87 (75%), moderate depression in 10 (9%). A high level of anxiety was observed in 94 (81%), the average level in 22 (19%) patients. At the end of the course of UVB, PASI 90 was achieved in 94% (n=109) of patients, PASI 100 in 88% (n=102); at the same time, on average, anxiety decreased by 80%, depressive symptoms decreased by 73%, quality of life increased by 92%. In the second group, the PUVA course consisted of 253 irradiation sessions. Before starting therapy, minimal depression was observed in 12 (11%) cases, mild depression in 73 (65%), moderate depression in 27 (24%). A high level of anxiety was characteristic of 100% of patients. As a result of therapy, PASI 90 was achieved in 95.5% (n=107) of cases, PASI 100 in 90% (n=101). The average severity of anxiety, depression, and quality of life improved by 88%, 83%, and 96% respectively.&#x0D; CONCLUSION: PUVA and UVB-311 nm have demonstrated high efficacy and safety in moderate-to -severe psoriasis, contributing to the rapid cleansing of the skin from rashes and improving the psycho-emotional state, which not only significantly improves the quality, but also increases the life expectancy of patients.&#x0D; .

TaqI polymorphism T/t genotypes at the vitamin D receptor gene (VDR) are associated with increased serum vitamin D levels in mild and moderate psoriasis vulgaris: A pilot study.

Several types of polymorphisms in vitamin D receptor (VDR) have been found in psoriasis. This study looked at the role of the TaqI polymorphism in the VDR gene as a factor in changing plasma 25-hydroxyvitamin D [25(OH)D] levels in psoriasis patients and to see if it had any relationship with disease severity. Clinical examination, serum 25(OH)D level measurement, molecular studies and TaqI genotyping by PCR and RFLP were performed for the two groups. The T/t genotypes of TaqI polymorphism genotypes were most common in patients, while the t/t genotypes were more abundant in healthy subjects. The T allele was high in the patient group in comparison with the normal subjects, but there were no significant differences (p= 0.421). Patients with T/t TaqI genotypes had higher levels of 25(OH)D than those with T/T and t/t (p= 0.004). Moderate psoriatic patients with the T/t genotype had relatively high 25(OH)D levels compared with moderate patients with the T/t and t/t genotypes (p= 0.001). The increase in 25(OH)D titers in moderate patients is greater than that in mild and severe patients. T/t genotypes are associated with increased 25(OH)D levels in moderate and mild patients.

Evaluation of safety and efficacy of topical 4% nicotinamide in treatment of psoriasis; among a representative sample of Egyptians (an analytical observational study).

To assess and evaluate the efficacy and safety of nicotinamide 4% topical formulation for the treatment of mild to moderate psoriasis. This study was conducted on 60 patients aged 18-65 years, with mild to moderate psoriasis vulgaris. Nicotinamide 4% in a cold cream base was used twice daily for 12 weeks. Nicotinamide 4% topical treatment shows satisfactory results, more in males than in females. Some patients report disturbing irritation (burning, itching, and redness) upon the usage of topical nicotinamide treatment and were advised to wash out the treated area after 1h of cream application, which solved the issue. No other adverse effects of treatment were reported by patients during the study period. Unicentral base, a limited amount of sample size, and 12 weeks duration of therapy and follow-up period, which may not be sufficient to demonstrate the complete therapeutic properties and side effects of using nicotinamide as a long-term treatment for psoriasis. This study reveals statistically reliable evidence of the positive impact of topical 4% nicotinamide preparation used alone on the treatment of psoriasis with minimal side effects. Thus, we can conclude that topical nicotinamide preparation may be a good adjuvant to the current treatment regimens used alone or alternate currently used topical therapeutical regimens if used in combination.

095 Therapeutic conduct in multiple bio-experienced psoriatic patient

Psoriasis is a chronic inflammatory disease, immune - mediated, with multisystemic implications and genetic predisposition, characterized by the development of erythematous, scaling plaques on the skin. The current therapy with biologic agents induces long term remissions in patients with moderate or severe psoriasis vulgaris, who are not responding to the conventional systemic therapy. Risankizumab is a humanised immunoglobulin G1 monoclonal antibody selective to the interleukin (IL)-23. We are presenting the case of a 71-year-old male patient, smoker, known with generalized psoriasis vulgaris, multiple bio-experienced who was referred to our Clinic for the occurrence of an eruption constituted by well-defined erythematous-squamous plaques and placards, pruritic, disseminated at the level of the whole body, occured in the context of discontinuation of biologic treatment for a period of 5 months due to the pandemic.

Orta şiddette ve şiddetli psoriasis hastalarında ustekinumab tedavisi sonrası inflamatuar belirteçlerde azalma

Purpose: Psoriasis is a chronic, inflammatory, and systemic disease. The disease activity is usually measured by Psoriasis Area and Severity Index (PASI), however, further objective laboratory tools are needed. Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and mean platelet volume (MPV) are objectively calculated markers that increase in inflammation. This study aimed to investigate the utility of these markers for follow-up of systemic inflammation and response to treatment. Material and methods: A total of 25 patients who had moderate or severe psoriasis vulgaris, who received ustekinumab treatment were retrospectively evaluated in the study. In patients, pre-treatment PASI, complete blood count parameters, serum CRP levels and NLR, PLR and MPV values in the follow up when they achieved PASI 75 and/or more improvement were recorded. Patients with an additional inflammatory disease or accompanying infection were excluded from the study. Results: While a statistically significant decline was recorded in NLR and PLR (p<0.05), no significant change was observed in MPV and CRP after the therapy success where patients achieved an improvement greater than or equal to PASI 75. Conclusion: We conclude that the correlation with the response to treatment and NLR and PLR levels show that these markers may be beneficial for assessment of disease severity either in combination with current scores or alone. These markers are cost effective predictors that can easily be measured in routine practice.

Phase 3 Trial Demonstrates that MC2-01 Cream has Improved Treatment Efficacy Compared to Calcipotriene Plus Betamethasone Dipropionate Topical Suspension in Patients with Mild to Moderate Psoriasis Vulgaris

Abstract not available.

Uncovering the mechanism of Jueyin granules in the treatment of psoriasis using network pharmacology

Ethnopharmacological relevanceOur clinical practice demonstrated that Jueyin granules (JYG) benefit patients with mild to moderate psoriasis vulgaris without apparent adverse effects. JYG have been shown to inhibit epidermal proliferation in an imiquimod (IMQ)-induced psoriasis-like mouse model, as well as keratinocyte proliferation. Moreover, JYG causes no acute or chronic toxicity in animal models. However, its related molecular mechanism has still not been elucidated. Aim of the studyTo assess the mechanism of JYG against psoriasis. Materials and methodsThis study combined network pharmacology analysis with experiments to investigate the mechanism of JYG against psoriasis. First, the molecular docking technology was used to construct the network of medicinal materials-core active plant ingredients-core targets and identify possible drug targets. Next, high-performance liquid chromatography (HPLC) was used for quality control of JYG. Finally, a mice model of psoriasis was used to further verify the effects of JYG. Results(1) Molecular docking analysis of network pharmacology revealed that the therapeutic effects of JYG on psoriasis might be achieved through Vitamin D Receptor (VDR) effects. (2) The concentrations of chlorogenic acid and paeoniflorin were determined using HPLC to establish quality control of JYG. (3) JYG ameliorated pathological characteristics that included in vivo reductions in erythema, scale, and infiltration scores of back and ear lesions in IMQ-induced psoriasis-like mice. Moreover, a reduced number of PCNA-positive and Ki67-positive cells were observed in the epidermis of JYG-treated lesions. JYG also reduced inflammation (interleukin (IL)-17, IL-23) in the peripheral blood of IMQ-induced psoriasis-like mice. As expected, JYG was found to upregulate VDR expression and downregulate p-STAT3 expression in the IMQ group, which may contribute to its mechanism against psoriasis. ConclusionOverall, this study clarifies the mechanism of JYG against psoriasis and provides evidence to support its clinical use.

Turmeric extract based therapy for psoriasis

Background: Psoriasis is a chronic inflammatory skin disease affects 3 % of world population on average. Psoriasis can have disfiguring and disabling impacts on patients with increased global burden of the disease. According to WHO, there is continuous need for establishing new modalities for treatment of psoriasis with emphasis on treatment safety concerns of the patients. Objectives: The aim of this study is to assess the efficacy and safety of turmeric extract based ointment in the treatment of mild to moderate psoriasis Methods: 10 patients with psoriasis vulgaris confirmed histopathologically were recruited at Dermatology Department outpatient clinic Zagazig University Hospitals. The diseased severity were assessed clinically using PASI score and the histopathologic severity was assessed before and after 4 weeks of twice daily application the turmeric extract based ointment.Results: Significant reduction in disease severity in all patients used treatment with PASI before PASI before treatment was 19.44 ± 10.7, and after was 10.5 ± 6.3 (P = 0.0007). There was 47% ± 12% improvement in disease severity, with 50% of patients already reached PASI 50 benchmark by 4th week of treatment. Conclusions: In this pilot study, the effectiveness and tolerability of turmeric extract based ointment in the treatment of moderate psoriasis vulgaris was evaluated and proved on both clinical and histopathological levels.

Evaluation of efficacy of infliximab in the long-term treatment of moderate and severe psoriasis vulgaris

Objective To evaluate the efficacy of long-term treatment with infliximab in patients with moderate to severe psoriasis vulgaris. Methods Patients with moderate to severe psoriasis vulgaris, who started infliximab therapy in Department of Dermatology, Peking University Third Hospital between March 2016 and May 2018, were followed up. The patients treated with infliximab for more than 54 weeks were enrolled into this study. The patients were treated with infliximab at a weight-based dosage of 5 mg/kg, and the total dosage used per session was 200, 300 and 400 mg for patients with the body weight of 40 - 59 kg, 60 - 79 kg, and > 80 kg respectively. The patients were treated at week 0, 2, 6, 14, 22, 30, 38, 46 and 54, and the psoriasis area and severity index (PASI) score was determined before each treatment. Mauchly′s test of sphericity, randomized block analysis of variance and Bonferroni method were used to analyze changes of PASI scores after 2-, 6-, 14-, 22-, 30-, 38-, 46- and 54-week treatment. Sequelae and adverse reactions were also recorded. Results Twelve patients received the treatment with infliximab, and 9 patients were treated for more than 54 weeks, whose clinical data were analyzed. Before the treatment, the PASI score (M[P25, P75]) of the 9 patients was 26.3 (23.4, 27.7) . There were significant differences in the PASI score among different time points (F = 7.12, P = 0.0004) , and the PASI score of the patients showed a generally decreasing trend over time. After 30-week treatment, the PASI score was 4 (2.5, 5.2) , and the PASI improvement rate was 86.38% ± 6.98%; of the 9 patients, 8 achieved PASI50, 7 achieved PASI75, and 2 achieved PASI90. After 54-week treatment, the PASI score was 8 (3.5, 8.9) , the PASI improvement rate was 64.23% ± 17.32%, and the number of patients achieving PASI50, PASI75 and PASI90 was 8, 4 and 1 respectively. Bonferroni method showed that the PASI score significantly increased at week 54 compared with that at week 30 (t = 3.269, P = 0.0048) , but significantly decreased at weeks 30 and 54 compared with that before the treatment (week 30: t = 18.49, P < 0.0001; week 54: t = 5.81, P = 0.0004) . Conclusion Infliximab is remarkably effective for moderate and severe psoriasis vulgaris in the 54- week treatment. Key words: Psoriasis; Biological agents; Treatment outcome; Infliximab; Long-term treatment

Efficacy, safety, and cost-effectiveness of all-trans retinoic acid/Clobetasol Propionate Compound Ointment in the treatment of mild to moderate psoriasis vulgaris: A randomized, single-blind, multicenter clinical trial.

To assess the efficacy, safety, and cost-effectiveness of all-trans retinoic acid/Clobetasol Propionate Compound Ointment and calcipotriol/betamethasone dipropionate ointment in the treatment of mild-to-moderate patients with psoriasis vulgaris. This was a randomized, single-blind, multicenter clinical trial. A total of 240 patients were randomized to receive twice-daily all-trans retinoic acid/Clobetasol Propionate Compound Ointment (treatment group) or once-daily calcipotriol/betamethasone dipropionate ointment (control group) for 4 weeks. The efficacy, safety, and cost-effectiveness were assessed at Weeks 2 and 4. After 4 weeks, both groups showed a significant clinical improvement compared to baseline (88.33% vs. 89.83%, respectively, p = .7112). But PASI 75 response in the treatment group was superior to the control group (44.12% vs. 28.57%, respectively, p = .0200), at Week 4. SSRI improvement rate in the treatment group was also superior to control group (67.11% vs. 59.43%, respectively, p = .0119) at Week 4. All-trans retinoic acid/Clobetasol Propionate Compound Ointment showed a significant clinical improvement in erythema, infiltration, and scales of skin lesions and PASI score compared to baseline. 1.67% of patients (treatment group) reported adverse reactions compared to 2.50% (control group) with no statistical significance. In addition, the cost-effectiveness assessment showed a higher cost-effectiveness of the treatment group compared to the control group in 4 weeks (199.25 vs. 801.51). All-trans retinoic acid/Clobetasol Propionate Compound Ointment was effective and safe in the treatment of psoriasis vulgaris with similar efficacy as calcipotriol/betamethasone dipropionate ointment and lower treatment costs.

Mutational analysis of epidermal and hyperproliferative type I keratins in mild and moderate psoriasis vulgaris patients: a possible role in the pathogenesis of psoriasis along with disease severity

BackgroundMutations in keratin proteins have been vastly associated with a wide array of genodermatoses; however, mutations of keratins in psoriasis have not been fully investigated. The main aim of the current research was to identify the mutation in K14, K10, K16, and K17 genes in two stages of psoriasis patients.MethodsNinety-six psoriatic skin biopsies were collected. mRNA transcript of K14, K10, K16, and K17 was prepared, amplified, and sequenced. Sanger sequences of all keratins were further validated for mutational analysis using Mutation Surveyor and Alamut Visual. Then, in silico analysis of protein stability and protein and gene expression of all keratins was performed and validated.ResultsOut of 44 mutations, about 75% of keratins are highly pathogenic and deleterious. Remaining 25% mutations are less pathogenic and tolerated in nature. In these 33 deleterious mutations were immensely found to decrease keratin protein stability. We also found a correlation between keratin and Psoriasis Area and Severity Index score which added that alteration in keratin gene in skin causes severity of psoriasis.ConclusionsWe strongly concluded that acanthosis and abnormal terminal differentiation was mainly due to the mutation in epidermal keratins. In turn, disease severity and relapsing of psoriasis are mainly due to the mutation of hyperproliferative keratins. These novel keratin mutations in psoriatic epidermis might be one of the causative factors for psoriasis.