Treatment Options For Psoriasis Research Articles

Reappraising the Use of Systemic Immunomodulators for Psoriasis and Eczema in the Military.

Psoriasis and atopic dermatitis are chronic, immune-mediated skin disorders that are disqualifying for entrance into the military. Both conditions can cause difficulty wearing body armor and other protective equipment when poorly controlled, limiting a service member's ability to train and deploy worldwide. In addition, these conditions may be exacerbated by military service because of increased exposure to austere environments, extreme temperatures, stress, skin injury, bug bites, and vaccinations Service members have limited treatment options because of restrictions on systemic medications that can be used while deployed. Newer systemic medications-in particular, biologics and oral immunomodulators-have evolved to be both extremely effective and safe. We review more recent treatment options for psoriasis and atopic dermatitis in the context of DoD's regulations guiding entry and retention of personnel with psoriasis and eczema and make recommendations regarding updating DoD policy for systemic treatment options. A literature search was performed using PubMed, Embase, and Ovid with the last search done in the fall of 2023 from all years to date. These articles were further screened based on inclusion and exclusion criteria. In total, 25 articles were included in this review. An Internet search was also performed on the DoD's regulations guiding entry and retention of personnel with psoriasis and eczema. In addition, we examined medical requirements for deployment to the U.S. Central Command and U.S. European Command. Currently, U.S. Central Command and U.S. European Command do not allow the use of medications with special storage and handling requirements on deployments. Newer biologics are safe and efficacious but require refrigeration, although other immunomodulators like deucravacitinib and apremilast are oral pills and do not have cold-storage requirements. However, the use of biologics in austere environments may be feasible because of increased intervals between dosing and the ability to store refrigerated medical supplies in most deployed environments. For military service members with psoriasis, risankizumab and deucravacitinib are excellent options given their favorable safety and efficacy profiles. Of the biologics available for atopic dermatitis, dupilumab is the safest and effective systemic medication available. The Janus kinase inhibitors have also demonstrated excellent efficacy in treating atopic dermatitis, but more safety data are needed because of potential adverse events to include heart-related events, blood clots, and cancers. Systemic treatments have evolved to become highly specific for both eczema and psoriasis. These newer biologics and immunomodulators may be compatible with use in the deployed setting, especially those that have long dosing intervals and proven efficacy and safety. Of the biologics, dupilumab and risankizumab offer the best efficacy, safety, and dosing intervals for atopic dermatitis and psoriasis, respectively. Deucravcitinib is a recently FDA-approved oral immunomodulator for psoriasis that has an excellent safety profile and efficacy. Allowing the use of these medications on deployments will enable more people with moderate to severe psoriasis and eczema to join and remain in the military while receiving effective treatment.

Efficacy of probiotic supplementation in the treatment of psoriasis-A systematic review and meta-analysis.

Many studies have emphasized the possible role of probiotics in psoriasis, probiotic supplementation might be helpful to treat psoriasis. This study systematically evaluated the efficacy of probiotic supplementation for the treatment of psoriasis. We searched some databases with keywords until November 10, 2023, including PubMed, Cochrane Library, Embase, and Web of Science. These keywords included probiotics, psoriasis RCT, and so on. After rigorous literature screening by two authors, five studies were identified. Eventually, the required data were independently extracted by another author. A total of five studies with 286 patients were included. The pooled results showed that the efficacy of probiotic supplementation was superior to placebo in the treatment of psoriasis. The Psoriasis Area and Severity Index (SMD = -1.40, 95% Cl = -2.63 to -0.17, p < 0.00001) and Dermatology Life Quality Index (SMD = -0.92, 95% Cl = -1.86 to 0.01, p < 0.00001). Score decreased after probiotic supplementation. The meta-analysis showed that probiotic supplementation could be a new treatment option for psoriasis.

Bimekizumab for the treatment of psoriasis.

Psoriasis is a chronic inflammatory skin condition characterized by Th17 T cell-mediated inflammation. An emerging treatment option for psoriasis is bimekizumab, a humanized monoclonal antibody targeting cytokines IL-17A and IL-17F. Phase I trials evaluating bimekizumab reported strong safety, tolerability, and clinical efficacy with most common treatment emergent adverse events being mild to moderate in nature. Phase II trials evaluated dosing intervals, revealing that higher dosages or more frequent administration of bimekizumab resulted in minimal increases in adverse events. Phase III trials and open label extension studies demonstrated a rapid, sustained clinical response when compared with placebo and active comparators. Bimekizumab shows strong efficacy in the treatment of psoriasis and has potential in the treatment of other Th17-mediated pathologies.

Topical Treatment for the Management of Mild-to-Moderate Psoriasis: A Critical Appraisal of the Current Literature.

Several comprehensive and updated guidelines are available on the management of psoriasis with systemic treatments. However, there is a lack of updates in recommendations and guidelines on topical treatments, particularly regarding the latest evidence and developments in treatment formulations. Consequently, a comprehensive literature review on this topic, considering the continuous evolution of knowledge and evaluation of the relevance of the available literature evidence, represents a current need to improve the topical management of psoriasis. This study critically appraises the available literature on all topical treatments of psoriasis from the past 20 years to address some relevant issues, such as the vehicle associated with the highest effectiveness, the best vehicle for improving patient adherence, and the best strategy in terms of efficacy and safety for long-term treatment. The greater effectiveness of the foam formulation was demonstrated for calcipotriene/betamethasone dipropionate (Cal/BD) administration compared with the gel and ointment. Without a direct comparison, matching-adjusted indirect comparison analyses support the superiority of the foam versus the cream overall. In addition, the reduced treatment period required by the Cal/BD foam (4 weeks) may favor this formulation over cream (8 weeks). The literature evidence, supported by a broad clinical experience, reported high rates of acceptability and adherence for the foam vehicle. A growing consensus is shared among dermatologists sustaining the proactive approach as the best option for the long-term topical treatment of psoriasis in adults. The Cal/BD foam is the only treatment for which the approved label allows biweekly maintenance use (proactive management), thus representing the first option for long-term topical treatment.

Non-psoriatic uses of calcipotriol: a concise updated review.

Calcipotriol (calcipotriene) is a synthetic vitamin D3 derivative that is a standard treatment option for psoriasis. It is generally well tolerated with minimal side effects. Due to its ability to reduce keratinocyte proliferation and induce keratinocyte differentiation as well as its immunomodulatory effects, calcipotriol has been used to treat a variety of skin disorders such as atopic dermatitis, actinic keratoses, lichen planus, seborrheic keratoses, and vitiligo [1]. We surveyed the literature examining the use of calcipotriol for non-psoriatic dermatologic disease.

P97 Risankizumab real-world effectiveness in UK clinical practice: results from the BADBIR registry

Abstract Risankizumab is an anti-interleukin (IL)-23 monoclonal antibody approved for the treatment of psoriasis and psoriatic arthritis (PsA) in the UK. IL-23 is a key regulatory cytokine that is essential for the activation of pathogenic T helper 17 cells that stimulate inflammation in psoriasis and PsA. The efficacy and safety profile of risankizumab has been demonstrated in multiple clinical studies [Gordon KB, Strober B, Lebwohl M et al. Efficacy and safety of risankizumab in moderate-to-severe plaque psoriasis (UltIMMa-1 and UltIMMa-2): results from two double-blind, randomised, placebo-controlled and ustekinumab-controlled phase 3 trials. Lancet 2018; 392:650–61]; however, the real-world effectiveness of risankizumab in UK clinical practice is not well characterized. Using BADBIR data up to 1 September 2022, we report drug survival up to 24 months in biologic-naïve and biologic-experienced patients treated with risankizumab for psoriasis. Drug survival was estimated by the Kaplan–Meier method in patients with ≥ 6 months of follow-up, with censoring at the last observation or end of the study period. Treatment effectiveness was assessed by best absolute Psoriasis Area and Severity Index (aPASI) or Dermatology Life Quality Index (DLQI) at a mean (SD) of 12 (2) months in an available case analysis. In total, 569 patients received risankizumab of whom 117 (20.6%) were biologic naïve at the start of risankizumab. In biologic-experienced patients, 166/452 patients (36.7%) received risankizumab as second-line, 123 (27.2%) as a third-line, 77 (17.0%) as a fourth-line and 86 (19.0%) as a fifth-line or higher agent. The median observed follow-up was 1.1 years [interquartile range (IQR) 0.6–1.6] for biologic-naïve patients and 1.5 years (IQR 0.9–2.2) for biologic-experienced patients. Many characteristics, including patient age, sex and disease duration, were similar between groups. Overall, 92 (16.2%) patients had a diagnosis of PsA [n = 9/117 (biologic naïve) vs. n = 83/452 (biologic experienced)]. Unadjusted risankizumab drug survival at 12 months was 91% (95% confidence interval 81–96) for biologic-naïve patients and 91% (95% CI 87–93) for biologic-experienced patients. In total, there were 53/419 (12.6%) discontinuations, attributed to ineffectiveness (n = 22; 5.2%), adverse events (n = 13; 3.1%) and other reasons (n = 18; 4.3%). Of the 69 biologic-naïve patients who discontinued, four (6%) discontinued owing to ineffectiveness, one discontinued (1%) owing to adverse events and four (6%) discontinued for other reasons. Of the 350 biologic-experienced patients that discontinued, 18 (5.1%) discontinued owing to ineffectiveness, 12 (3.4%) discontinued owing to adverse events and 14 (4.0%) discontinued for other reasons. Overall, at 12 months, 71 of 104 (68.3%) patients achieved aPASI ≤ 2 (16 of 19 biologic-naïve patients vs. 55 of 85 biologic-experienced patients) and 34 of 49 (69.4%) achieved DLQI 0/1 (nine of 15 biologic-naïve patients vs. 25/34 biologic-experienced patients). Using real-world data from BADBIR, these results demonstrate that risankizumab is an effective treatment option for psoriasis that maintains a high treatment response for at least 12 months. Funding sources: AbbVie Ltd.

Drug survival of methotrexate and predictor factors for discontinuation in psoriasis.

Methotrexate (MTX) is a systemic therapy largely used for moderate-severe psoriasis. There is a lack of data on its use in daily practice and particularly on its long-term effectiveness and survival in psoriasis. We performed a single-centered, retrospective, observational study to evaluate the drug survival of MTX in patients with psoriasis, treated in monotherapy with MTX between March 2015 and March 2022. Clinical and demographic characteristics were extracted from files of the patients. The drug survival was analyzed using Kaplan-Meier survival curves, considering separately overall discontinuation, discontinuation due to MTX ineffectiveness, and discontinuation due to adverse events. Multivariable Cox regression analyses were carried out including clinically meaningful variables. A total of 199 patients were included; 148 (74.4%) suspended MTX during the observation period. The reasons for discontinuation were adverse events (39.2%), ineffectiveness (38.5%), remission of psoriasis (12.2%), and other reasons (10.1%). Average duration of therapy was 10.1 months. Patients who remained on therapy after 1, 2, and 5 years of treatment were respectively 46.9, 35.6, and 29.3%. Positive predictive factors for therapy continuation were increasing age and the use of >15 mg of MTX for a period >3 months; the only negative predictive factor was the clinical variant of palmoplantar pustular. MTX is a valuable, cost-effective option for long-term treatment of psoriasis although drug survival is not comparable with that of biological treatments. Studies are needed to better understand the best dosing regimen to use, with the aim of achieving the best clinical outcomes and the lowest rate of side effects with this drug.

Topical Application of Ursolic Acid Cream Ameliorates Imiquimod-induced Plaque Psoriasis in BALB/c Mice

The valued studies of alternative psoriasis treatment options are in a much higher need among the Scientific Community. This study aimed to evaluate the anti-psoriatic activity of ursolic acid cream in imiquimod-induced psoriasis in BALB/c mice. The creams containing ursolic acid, a pentacyclic triterpenoid at percentages of 0.1 and 0.2% were formulated. The pH, spreadability, physical characteristics and acute dermal irritation of the cream were assessed. Animals were grouped into five each having 6 animals. Clobetasol, a topical corticosteroid, was used as the standard. One group was used as control and four groups were treated with the formulated imiquimod cream while receiving treatment. Parameters such as skin inflammation severity, ear thickness, plasma level of interleukins (IL)-17, histology of the back of the skin and spleen weight were evaluated. Erythema and scales were scored on a daily basis with the 0.1 and 0.2% ursolic acid cream significantly ameliorating psoriatic-like symptoms in a manner comparable to clobetasol. Imiquimod-induced epidermal hyperplasia and inflammation were inhibited by topical application of ursolic acid as shown by the results of histopathology. Spleens of the positive control group were larger in comparison with the rest of the groups. BALB/c mice treated with ursolic acid creams exhibited a decrease in the plasma levels of cytokines IL-17 when compared to the positive control group. The result of this study provided an insight that topical application of ursolic acid can be a potential treatment for psoriasis.

Topical application of imatinib mesylate ameliorated psoriasis-like skin lesions in imiquimod-induced murine model via angiogenesis inhibition.

Psoriasis is a chronic skin disorder characterized by a skin rash with scaly patches. Microvascular abnormalities are a characteristic feature of psoriasis and play a crucial role in the pathogenesis of psoriatic lesions. Angiogenic factors are upregulated in psoriatic skin lesions and are thought to induce angiogenesis. Platelet-derived growth factor (PDGF) induces vascular endothelial growth factor (VEGF), and PDGF is upregulated in keratinocytes in psoriatic skin lesions. The present study aimed to investigate the effect of topical imatinib mesylate (IMT) in inhibiting the activation of PDGF signalling in the pathogenesis of psoriasis. When topically applied to the skin of mice with imiquimod (IMQ)-induced psoriasis, IMT ameliorated skin symptoms similar to those of human psoriasis. Hyperproliferation of keratinocytes, hyperkeratosis, inflammatory cell infiltration and hypervascularity were histologically suppressed by topical IMT. The expression of angiogenic factors including fibroblast growth factor (FGF) and VEGF was decreased. The expression of FGF and VEGF in a PDGF-stimulated fibroblast cell line was inhibited by IMT. PDGF is required for the signalling pathway producing angiogenic factors in fibroblast. Thus, topically applied IMT inhibits PDGFR activation in fibroblast and suppresses the production of angiogenic factors, thereby mitigating the symptoms of psoriasis. The inhibitory effect of IMT on angiogenesis suggests that topical application IMT may be a viable treatment option for psoriasis.

Deucravacitinib and psoriasis: a sigh of relief

Introduction and pathophysiology Psoriasis is a chronic inflammatory skin condition linked to numerous other medical disorders, such as cardiometabolic syndrome, depression, and psoriatic arthritis1. Around 125 million individuals on the planet are affected by psoriasis. Genetic factors mostly cause psoriasis, while environmental variables can aggravate the condition2. Moderate-to-severe psoriasis is present in ~25% of affected patients3. Greater than 80% of cases of psoriasis fall within the most frequent subtype, plaque psoriasis. Erythematous scaly plaques, which typically develop on extensor surfaces like the knees and the elbows are the hallmark of this subtype. Gluteal fold, intertriginous areas, soles, palms, and nails may also be impacted. Furthermore, impacted regions are typically clearly defined and frequently symmetrical. A feed-forward mechanism of inflammation, notably the type 17 T-helper cell (TH17) pathway, leads to the development of plaque psoriasis2. Patients with more severe cases of psoriasis experience a stronger psychological impact as a result of the disease. Up to 20% of psoriasis sufferers are more prone to experience depression and have suicidal thoughts that progress to actual suicide4. Treatment options for psoriasis Primary treatment options for psoriasis include phototherapy and topical and systemic treatments which can be utilized singly or in combination. Phototherapy is initiated when the disease is extensive and resistant to other therapies. Two types of phototherapies are used: psoralen combined with ultraviolet A irradiation (PUVA) and UVB irradiation. However, they cost expensive and proper facilities are required. Despite toxicity-reducing strategies such as combination therapy, some individuals experience major adverse effects from traditional psoriasis medicines5. A phosphodiesterase 4 (PDE-4) inhibitor, Apremilast was approved by the Food and Drug Administration (FDA) in 2014 to treat plaque psoriasis6. Inhibition of PDE4 raises intracellular cyclic adenosine monophosphate (cAMP) concentrations. However, Apremilast’s precise therapeutic activity in people with psoriatic arthritis and psoriasis is not fully understood, nor are the mechanisms through which it works7. Apremilast over 16 weeks demonstrated a clinically significant improvement in patients suffering from plaque psoriasis, as determined by the PASI score, according to ESTEEM 1 and ESTEEM 2, two clinical trials8,9. Apremilast was the only oral drug available for plaque psoriasis until now. On September 9, 2022—FDA approved deucravacitinib, as a new and better oral treatment option for adults suffering from moderate to severe plaque psoriasis10,11. Sotyktu (deucravacitinib) Deucravacitinib is a tyrosine kinase 2 (TYK2) inhibitor that is selective and allosteric. It inhibits TYK2 by preferentially attaching to the pseudo kinase or unique regulatory domain instead of the enzyme’s active catalytic site12. The drug’s approval came after encouraging findings from the 2 clinical trials—POETYK PSO-1 and PSO-2, which found that Apremilast and placebo were less effective than deucravacitinib in treating 1684 adult patients with plaque psoriasis. In patients using deucravacitinib, oral ulcers, a rise in blood creatine phosphokinase, upper respiratory infections, pimples, and folliculitis were the most common side effects by the end of week 16 of these clinical studies. Deucravacitinib resulted in a rapid response and consistent trends in enhancements in many efficacy measurements as well as quality of life for those who have moderate to severe plaque psoriasis13. However, as per the manufacturer, Bristol Myers Squibb, combining Sotyktu (deucravacitinib) with other strong immunosuppressants is not advised. Conclusion For patients with psoriasis plaque who are not satisfied with conventional and topical therapies, the approval of deucravacitinib marks an exciting day, as it is the first oral medication authorized after a long time for plaque psoriasis. Given its track record of assisting patients in achieving smoother skin, as shown in the POETYK PSO clinical study, the drug deucravacitinib can change how psoriasis is managed and treated in a better way. Although the drug is contraindicated in pregnancy, information regarding the drug’s presence in human milk is lacking. Further research is required to comprehend better results in lactating women and widen the range as the drug has limitations in severe hepatic impairment10. Ethical approval Not applicable. Source of funding None. Author contributions MS.M. and F.A.: conceptualization. M.S.M., M.M.N.U., and S.T.A.: conducted the literature and drafting of the manuscript. M.A.S.: performed editing and supervision. All authors have read and agreed to the final version of the manuscript. Conflict of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) Not applicable. Guarantor All authors take responsibility for the work, access to data and decision to publish.

Preparation and Validation of Zebrafish Psoriasis Model to Investigate the Therapeutic Effects of Stem Cells.

Psoriasis is a chronic, inflammatory, autoimmune disease with systemic symptoms including seborrheic psoriasis, pustular lesions, plaque lesions, intestinal eruptions, and sometimes arthritis. Moreover, most of the psoriatic subjects report life challenges due to the condition, impacting social activities and daily tasks. Generally, psoriasis treatment options depend on the severity, coexisting conditions, and medical availability. Although psoriasis therapies reduce symptoms and appearance, still it is not curable. Hereupon, searching for optimal therapeutic options continues. Accordingly, stem cell therapy is considered an advanced psoriasis treatment. Subsequently, stem cell therapies' efficacy is uncertain yet. Therefore, further studies are needed. In this context, preclinical studies such as animal experiments are essential for evaluation of treatment modalities. Herein, zebrafish offer advantages in testing treatments and biomedical research applications compared to other vertebrate models. Further, zebrafish skin shares similarities with human skin, making it suitable for studying inflammatory disorders. Hence, the authors discuss the zebrafish psoriasis development method for evaluating the stem cell therapeutic influence.

Drug safety evaluation of tildrakizumab for psoriasis: a review of the current knowledge

ABSTRACT Introduction Psoriasis is a chronic inflammatory skin disease that may have an important negative impact on a patient’s quality of life. Biological agents deeply changed the management of its moderate-to-severe forms. Interleukin-23 inhibitors represent the latest biologics class approved for the treatment of moderate-to-severe psoriasis. In particular, tildrakizumab, the latest available anti-interleukin-23 on the Italian market, is a humanized monoclonal antibody specifically targeting the p19 subunit of IL-23. Areas covered The objective of this review is to evaluate the safety profile of tildrakizumab in moderate-to-severe psoriasis patients. A literature review included articles until July 2022. Expert opinion Our analysis showed tildrakizumab as a generally safe option for the treatment of psoriasis, with most of the reported adverse events being classified as mild or moderate, and rarely requiring treatment discontinuation. Furthermore, in line with other interleukin-23 inhibitor, no concerns have been raised for tildrakizumab in regard to inflammatory bowel diseases, which represent a significant comorbidity to investigate before starting other biologics (IL-17 inhibitors). However, more real-life long-term data are needed to confirm trial results to further confirm tildrakizumab as a generally safe treatment option for psoriasis.

151 Real life data of psoriasis patients treated with either ixekizumab or risankizumab

Biologics provide a variety of safe and effective treatment options for psoriasis. Crucial players in pathogenesis of psoriasis include cytokines, i.e. IL-17 and IL-23. The systemic drugs ixekizumab and Risankizumab are monoclonal antibodies targeting IL-17A and IL-23A, respectively. Multiple clinical trials evaluated safety and efficacy of these drugs, however real-life data and direct comparisons of clinical data from both drugs remain scarce. Here, we aim to assess the clinical response of 30 patients either treated with ixekizumab or risankizumab over 52 weeks.

Evaluation of oral and topical herbal formulations used in Unani medicine for treatment of psoriasis and its effect on inflammatory biomarkers – a randomized controlled clinical trial

Unani medicine, one of the complementary and alternative medicines which has mentioned the treatment options for Psoriasis, a chronic skin disease. The aim of the study was to evaluate the safety and efficacy of Unani herbal formulations in patients with psoriasis on systemic scientific parameters. This parallel group, randomized, single blind clinical trial compared Unani herbal formulations comprising of both an oral and a topical preparation with Betamethasone Valerate cream as a control. The total number of patients completing the trial was 26 in each group and treatment was given for 90 days with clinical follow-up after every 15 days. The Psoriasis Area and Severity Index (PASI) score and the inflammatory biomarkers were evaluated at the baseline and at the end of the study. There were no significant differences in general clinical characteristics ( P>0.05 ) of test and control groups and evidentally, the 95% CIs of two groups overlap for PASI score at baseline and at the end of treatment. There was improvement in the dominant features of psoriasis with decrease in PASI of patients from the baseline to the end of study in both groups. No adverse effects were observed and all the blood safety parameters remained within the normal range. The ESR and TNF-α values were found higher in psoriatic patients and there was reduction in TNF-α values in test group ( P= 0.08) with less reduction in control group ( P=0.10). The tests suggests that Unani herbal formulations can be safely and effectively used in the patients with psoriasis.

Deucravacitinib for the Treatment of Psoriatic Disease.

Psoriasis is an immune-mediated disease, with the interleukin (IL)-23/IL-17 axis currently considered its main pathogenic pathway. Tyrosine kinase 2 (TYK2) is responsible for mediating immune signalling of IL-12, IL-23 and type I interferons, without interfering with other critical systemic functions as other JAK proteins do. This article aims to review the current knowledge on deucravacitinib, a new oral drug that selectively inhibits TYK2, granting it a low risk of off-target effects. After good efficacy and safety results in a phase II, placebo-controlled trial, two phase III, 52-week trials evaluated deucravacitinib 6 mg against placebo and apremilast—an active comparator. POETYK PSO-1 and PSO-2 involved 1688 patients with moderate-to-severe psoriasis. After 16 weeks, in both studies, over 50% of patients treated with deucravacitinib reached PASI75, which was significantly superior to placebo and apremilast. In POETYK PSO-1, these results improved until week 24 and were maintained through week 52, with over 65% of patients achieving PASI75 at this point. A reduction in signs and symptoms was also reported by patients, with greater impact on itch. Deucravacitinib was well tolerated and safe. There were no reports of serious infections, thromboembolic events, or laboratory abnormalities, which are a concern among other JAK inhibitors. Persistent efficacy and consistent safety profiles were reported for up to 2 years. Despite advances in the treatment of psoriasis, namely among biologic agents, an oral, effective and safe new drug can bring several advantages to prescribers and patients. Further investigation is required to understand where to place deucravacitinib among current psoriasis treatment options.

Vitamin D Signaling in Psoriasis: Pathogenesis and Therapy.

Psoriasis is a systemic, chronic, immune-mediated disease that affects approximately 2–3% of the world’s population. The etiology and pathophysiology of psoriasis are still unknown, but the activation of the adaptive immune system with the main role of T-cells is key in psoriasis pathogenesis. The modulation of the local neuroendocrine system with the downregulation of pro-inflammatory and the upregulation of anti-inflammatory messengers represent a promising adjuvant treatment in psoriasis therapies. Vitamin D receptors and vitamin D-mediated signaling pathways function in the skin and are essential in maintaining the skin homeostasis. The active forms of vitamin D act as powerful immunomodulators of clinical response in psoriatic patients and represent the effective and safe adjuvant treatments for psoriasis, even when high doses of vitamin D are administered. The phototherapy of psoriasis, especially UVB-based, changes the serum level of 25(OH)D, but the correlation of 25(OH)D changes and psoriasis improvement need more clinical trials, since contradictory data have been published. Vitamin D derivatives can improve the efficacy of psoriasis phototherapy without inducing adverse side effects. The anti-psoriatic treatment could include non-calcemic CYP11A1-derived vitamin D hydroxyderivatives that would act on the VDR or as inverse agonists on RORs or activate alternative nuclear receptors including AhR and LXRs. In conclusion, vitamin D signaling can play an important role in the natural history of psoriasis. Selective targeting of proper nuclear receptors could represent potential treatment options in psoriasis.

Revolutionalizing the age old conventional treatment of psoriasis: An animal based comparative study between methylprednisolone and different doses of a novel anti-oxidant humanin analogue (HNG)

Background and ObjectivePsoriasis is a chronic skin disease with 2–4% of prevalence worldwide conferring a major burden on health systems. It is assumed that the prevalence might increase due to climatic change and deterioration of protective ozone barrier. With the chances of increasing prevalence, newer and specific treatment options need to be explored.Skin is a constant target of oxidative stress owing to continuous exposure to ultraviolet radiations. Oxidative stress is considered to have a central role in dermatological diseases, including psoriasis. This study was designed to explore the role of Humanin analogue (S14-G HNG) as an important anti oxidant for psoriasis like condition in BALB/c mice as till date the commomly used drugs for this disease are corticosteroids which have a dissatisfactory adverse effect profile in terms of chronic use. MethodologyImiquimod 5% was used to induce Psoriasis like condition in mice, and the role of HNG was assessed through the histological examination, protein expressions and markers of oxidative stress. Two doses (low and high) of HNG were used and results were compared with an established drug methylprednisolone.Key Result.Significant improvement was seen on histology, PASI scoring, protein expression and oxidative stress by the use of intraperitoneal injections of S14-G HNG and the results were comparable to those obtained through peritoneal injections of methylprednisolone. ConclusionS14G-HNG can be considered as a suitable option for treatment of Psoriasis after clinical trials and it might prove to have lesser side effects as compared to other drugs employed for the treatment of psoriasis being an innate anti oxidant and anti apoptotic compound.

Unmet Needs in Psoriasis Patients.

Psoriasis can greatly impact patients' quality of life. The introduction of new treatments has improved treatment outcomes, but treatment gaps may still exist. Identify unmet treatment needs in patients with psoriasis. Participants aged 18 years or older, with an Amazon Mechanical Turk account, who reported diagnosis of psoriasis and correctly answered an attention check question were included. Results were analyzed using descriptive and inferential statistics. Of the 417 participants who met study inclusion criteria, 51.1% were female, and 39.3% were 31-40 years of age; 61.2% reported mild, 25.4% moderate, and 13.4% severe psoriasis. Most (74.8%) were currently under treatment; half (51.6%) were mostly or completely satisfied with treatment, while 24.5% were slightly or not at all satisfied. Respondents were most satisfied with topical (59.5%), followed by oral (46%), and injectable treatments (19.9%). Most (78.7%) slightly or strongly felt there should be more cost-effective options. Gaps in current psoriasis treatment options included more affordable topical and oral treatments that work faster and require less frequent use. The use of an English survey and Amazon Mechanical Turk precludes certain populations from this study. Participants were not asked to provide their current form of psoriasis treatment. Despite advances in psoriasis treatment, there remains a desire for more effective, faster, longer acting, and less costly, more accessible treatments. J Drugs Dermatol. 2022;21(8):839-844. doi:10.36849/JDD.6589.

Comparison of the Efficacy and Safety of Biologics (Secukinumab, Ustekinumab, and Guselkumab) for the Treatment of Moderate-to-Severe Psoriasis: Real-World Data from a Single Korean Center.

Biologics are important treatment options for psoriasis; however, direct comparison of their efficacy, safety, and drug survival is insufficient in clinical practice. This retrospective single-center study aimed to compare the efficacy, safety, and drug survival of three commonly used psoriasis biologics (secukinumab, ustekinumab, and guselkumab) and identify the factors affecting drug survival in actual clinics in Korea. We enrolled 111 patients with moderate to severe psoriasis and for at least 56 weeks of follow-up; among these, 27, 23, and 61 were administered secukinumab, ustekinumab, and guselkumab, respectively. All groups were comparable with respect to their baseline characteristics. Secukinumab showed a rapid response, and guselkumab was superior in terms of a long-term response and complete remission compared with other biologics, while ustekinumab showed a lower efficacy compared with other biologics. All three biologics had a favorable and similar safety profile; however, allergic reactions and latent tuberculosis were more common with secukinumab and ustekinumab, respectively. Guselkumab was the most sustained biologic, and the survival rates of secukinumab and ustekinumab were similar. Drug survival was remarkably shorter in female patients and those with hypertension. Introduction of new biologics emerged as a negative factor for drug survival in clinical settings.

A new possible treatment option for psoriasis

A new possible treatment option for psoriasis