Onset Of Psoriasis Research Articles

Primary biliary cholangitis—cause or association with psoriasis: a case report

Primary biliary cholangitis is a chronic progressive cholestatic granulomatous and destructive inflammatory lesion of small intralobular and septal bile ducts that primarily affects women. The exact etiology of this disease has not yet been elucidated; however, it is believed to be the result of a combination of environmental triggers in genetically predisposed individuals. It can manifest itself simultaneously with, before, or after the onset of psoriasis and other skin autoimmune diseases. Standard treatment is ursodeoxycholic acid. A 65-year-old patient presenting with elevated hepatic laboratory findings that had persisted for several years and normal abdominal ultrasound was additionally diagnosed with primary biliary cholangitis after 2 years on a biological drug for psoriasis. She did not have other symptoms except elevated liver tests. The skin showed a strong response to biological therapy and treatment with ursodeoxycholic acid prompted lowering of liver enzymes. The skin was clear all throughout the treatment. This article emphasizes the importance of additional diagnostic workups in patients with psoriasis and elevated hepatic laboratory findings.

New-Onset and Exacerbation of Psoriasis following COVID-19 Vaccination: A Systematic Review of Case Reports and Case Series.

Although uncommon, several cases of new-onset and exacerbation of psoriasis have been reported after coronavirus disease 2019 (COVID-19) vaccination. This study aims to systematically review reports regarding new-onset and exacerbation of psoriasis to identify features related to that condition following COVID-19 vaccination. Three databases were utilised, namely, PubMed, Google Scholar, and EBSCOHost to search for literature published until June 2022. We used the following MeSH terms: "psoriasis," "exacerbation," "induced psoriasis," and "COVID-19 vaccination." The included literature must report the case/(s) of psoriasis exacerbation in previously-in-remission or induced psoriasis in individuals receiving any dose of COVID-19 vaccines regardless of the type. Among 33 selected studies, an overall mean age was 57.52 ± 15.92 years. Female (n = 40; 54.8%) was more frequently reported than male (n = 33; 45.2%). In terms of vaccine types, Pfizer is the most commonly reported (49 cases; 67.1%), followed by Astra-Zeneca (13 cases; 17.8%), Moderna (10 cases; 13.7%), and CoronaVac (1 case; 1.4%). The onset of psoriasis after receiving the COVID-19 Vaccines was varied, ranging from 1 to 90 days (Mean ± SD: 15.75 ± 18.22). Plaque psoriasis was most commonly reported, followed by pustular, guttate and other types of psoriasis. Reported cases were frequently treated with topical steroids and monoclonal antibodies monotherapy. Although the cases of new-onset and exacerbation of psoriasis after COVID-19 vaccination is quite scarce, the possibility of occurrence should be acknowledged and managed properly; and patients should be informed, particularly ones with history of psoriasis without discouraging patients to take vaccine.

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

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

GHRL Gene Polymorphisms in Early Onset Psoriasis: Molecular and In silico Analyses

Background: Psoriasis is an inflammatory skin disease. Ghrelin protein exhibits an anti-inflammatory effect by inhibiting the TNF-α/NF-κB pathway in psoriasis. The aim of this study was to investigate whether the GHRL gene rs27647 and rs34911341 polymorphisms are associated with susceptibility to generalized Early Onset Psoriasis (EOP). Material and Methods: The study group consisted of 80 EOP patients and 70 unrelated healthy controls. GHRL polymorphisms were determined using the polymerase chain reaction (PCR)-restriction fragment length polymorphism method. In addition, we determined other genes with which the GHRL gene interacts, and the effect on protein function and protein stability for rs34911341. We used web-based tools for all in silico analyses. Results: Our results have shown GHRL gene rs34911341 polymorphism GA genotype is associated with an increased risk of EOP (p=0.000). Also, there was a significant difference between the two groups with regard to the allele frequency of rs34911341 polymorphism (p=0.000). We have shown the prediction of Gene-gene interaction that GHRL is co-expressed with 18 genes, physical interaction with 16 genes and co-localization with 9 genes. We determined deleterious of rs34911341 in 7 tools and revealed that rs34911341 decreased protein stability significantly. Conclusion: The GHRL rs34911341 polymorphism genotype and allele frequencies of the EOP patients differ significantly from those of healthy controls. We obtained in silico analysis results that support molecular data for rs34 polymorphism in the GHRL gene. This may be responsible for explaining chronic inflammation in the pathogenesis of EOP.

The Intriguing Links between Psoriasis and Bullous Pemphigoid.

The coexistence of psoriasis with autoimmune bullous diseases (AIBDs), particularly bullous pemphigoid (BP), has been documented in case reports and series, as well as in epidemiological studies. The onset of psoriasis precedes that of BP in the majority of cases. Patients with concomitant BP and psoriasis are generally younger at the onset of BP and present with fewer erosions and blisters as compared with patients suffering from isolated BP. Intriguingly, it has been speculated that some BP cases with comorbid psoriasis can actually correspond to anti-laminin gamma-1 pemphigoid, a rare form that was recently recognized as a distinct entity and which can mimic BP and/or other subepidermal AIBDs. The pathomechanisms underlying the BP-psoriasis association have not yet been identified, although several hypotheses have been proposed. The most credited among such hypotheses involves the so-called "epitope spreading" phenomenon, with tissue injury secondary to a primary inflammatory process (i.e., psoriasis) leading to the exposure of sequestered antigens evoking a secondary autoimmune disease (i.e., bullous pemphigoid). This narrative review aims to give a brief overview of the association between psoriasis and BP, examining epidemiological, clinical, and immunopathological features, the pathomechanisms underlying this association, the treatments for psoriasis incriminated as potential triggers of BP, and the therapeutic management of patients with psoriasis and BP.

Clinical Feature, Lifestyle Behavior and Non-Communicable Diseases Comorbidities Among Psoriasis Patients in Shanghai: Gender Disparity Analysis Based on a Cross-Sectional Study.

Gender difference is prevalent in clinical feature, disease severity for noncommunicable diseases (NCD), but studies on gender disparity in clinical feature, disease severity and NCD comorbidity among psoriasis patients are limited. This cross-sectional study explores gender differences in clinical feature, lifestyle behavior and NCD comorbidity among psoriasis patients. Psoriasis patients were recruited through cluster survey method in two hospitals, and questionnaire interviews were applied to collect the demographic feature, lifestyle habits, clinical feature and NCD among patients. A total of 2102 psoriasis patients included 1332 males (63.4%), 70% were over 35 years old and approximately 50% of them were overweight or obesity. The median value for psoriasis initiation age and disease duration was 33 years old (34 for male and 32 for female) and 9 years (10 for male and 7 for female), respectively. The psoriasis recurrence was mainly in winter (73.4%) and autumn (34.2%) both for patients. The prevalence of tobacco smoking and alcohol drinking was 31.2% and 12.6%. Male patients had higher prevalence of tobacco smoking (odds ratio (OR) = 13.26, 95% confidence interval (CI): 9.54-18.44) and alcohol drinking (OR = 14.44, 95% CI: 7.90-26.40). The prevalence of diabetes, hypertension, hyperlipidemia, and metabolic syndrome were 13.2%, 28.5%, 23.4% and 21.5%, respectively. Male patients had higher prevalence of diabetes (OR = 1.53, 95% CI: 1.16-2.02), hypertension (OR = 1.87, 95% CI: 1.52-2.30), hyperlipidemia (OR = 2.34, 95% CI: 1.85-2.95) and metabolic syndrome (OR = 2.06, 95% CI: 1.63-2.62) than female patients. The proportions for 4 types of NCDs diagnosed after psoriasis onset were over 58%, which were also higher in males than females. Female patients had shorter disease duration and with less NCD, and male patients had more body weight issue, with fewer sleep time and higher prevalence of tobacco smoking and alcohol drinking and NCDs. We recommend that dermatologist should notice the gender disparity in psoriasis patients, which is helpful for the disease diagnosis and treatment.

Fundamental dimensions of personality and emotional intelligence in people with psoriasis (comparative study)

Research into the fundamental dimensions of personality and emotional intelligence in people with psoriasis is particularly current and important in conditions of high psychological morbidity among patients with skin diseases. The complexity of this topic lies in the large number of individual and contextual characteristics that influence the onset and progression of psoriasis. Emotional intelligence is a complex construct that takes center stage in the management of dermatology. Its role is particularly emphasized when we refer to the defense mechanisms of emotional conflict that can be activated through the perception, assimilation, understanding, and control of emotions.

Risks of malignancies among patients with psoriasis: A cohort study of 360 patients.

Psoriasis is a systemic, chronic, immunologically-mediated disease affecting approximately 2%-4% of the worldwide population. It is well known that psoriasis is associated with several comorbidities such as metabolic syndrome, cardiovascular disease, and malignancy. Although meta-analyses and large prospective cohort studies have shown an increased risk of malignancies in patients with psoriasis worldwide, an association between psoriasis and malignancy onset has not yet been established in Japan. We retrospectively analyzed 360 patients with psoriasis at our hospital to evaluate the incidence and types of malignancies in these patients. The incidence rate of malignancy was 14.4% (52/360). Colorectal cancer was the most commonly associated malignancy (20.9%), followed by skin cancer (16.4%), gastric cancer (10.4%), and lung cancer (10.4%). The calculated age- and sex-standardized incidence ratio of malignancies was 1.235 (95% CI 0.952-1.601) which indicated that the malignancy rate was higher in patients with psoriasis than in the general population, although the difference was not statistically significant. Furthermore, the multivariate analysis revealed increased risk of malignancy in males (HR=3.15; 95% CI 1.381-7.187; p < 0.001), psoriasis onset at older age (HR=1.08; 95% CI 1.058-1.111; p < 0.01), and psoriatic erythroderma (HR=4.44; 95% CI 1.354-14.581; p < 0.05). We also observed that treatment with biological agents tends to reduce the risk of developing malignancy; however, no statistical significance was found. These results suggest that periodic screening for malignancy should be recommended in patients with psoriasis having these risk factors and in those with poorly controlled psoriatic inflammation.

Clinical characteristics, management, and quality of life of psoriasis patients with coexistent lupus erythematosus: Data from the Malaysian Psoriasis Registry.

To describe the clinical characteristics, management and quality of life of psoriasis patients with and without coexistent lupus erythematosus (LE). This retrospective cross-sectional study uses data from the Malaysian Psoriasis Registry (MPR) from January 2007 to December 2018. Of 21 735 psoriasis patients, 34 (0.16%) had coexistent LE. The male to female ratio among psoriasis patients with coexistent LE was 1:5.8 versus 1.3:1 in patients with psoriasis but without LE. Nearly 70% presented with LE preceding psoriasis. Psoriasis patients with LE had an earlier age of psoriasis onset (27.56 ± 11.51 versus 33.31 ± 16.94 years, P=0.006), a higher rate of psoriatic arthropathy (26.5% versus 13.0%, P=0.02), and a significantly greater impairment of quality of life (Dermatology Quality of Life Index >10; 57.6% versus 40.3%, P=0.04) compared with psoriasis patients without LE. The majority (87.5%) had systemic LE. The incidences of lupus nephritis (72.7% versus 40%) and hematological abnormalities (50% versus 20%) were higher among patients with LE preceding psoriasis compared with those with psoriasis preceding LE. Antinuclear antibody and double-stranded DNA were positive in 59.4% and 28.1% of psoriasis patients with LE, respectively. Hydroxychloroquine triggered the onset of psoriasis in 7 (24.1%) patients. Patients with LE were more likely to receive systemic treatment for psoriasis compared with those without LE (30.3% versus 14.2%, P=0.008). Psoriasis patients with coexistent LE were uncommon, displayed a female preponderance, were more likely to have joint involvement, and had greater quality of life impairment than those without LE. LE preceded psoriasis in most of these patients, and systemic LE was the most common subtype.

The Association of HLA Alleles and Haplotypes with Age of Disease Onset in Pakistani Psoriatic Patients

Introduction: The human leukocyte antigen (HLA) region on chromosome 6p21 is well known to carry the most important genetic factors in susceptibility to psoriasis. Different HLA alleles and haplotypes have been reported to be associated with psoriasis in different populations. Psoriasis has a variable age of onset and, based on this, it can be classified into two types; type I with age of onset before 40 years of age and type II with age of onset after 40 years of age. The objective of this study was to determine the association of HLA class I and class II alleles and haplotypes with disease and stratification using age of onset in Pakistani psoriatic patients. Methods: A group of 603 individuals (326 cases and 277 controls) were analyzed for HLA class I and II alleles and haplotype association by sequence specific PCR. The association was further analyzed according to the age of onset of the patients. Results: We found that HLA alleles B*57 and Cw*06:02, DQB1*03:03:02 are strongly associated with early onset psoriasis, while alleles B*15, DRB1*13:02 and DQB1*03:03:02 are associated with late-onset psoriasis. Cw*06:02 allele was not associated with late-onset psoriasis patients. Allele DQB1*03:03:02 had the highest odds ratio in all patients. We found a novel association specifically with late-onset psoriasis samples with the haplotype HLA-A*11; B*15; Cw*04; DRB1*15; DQB1*05 (Pc = 3.60 × 10⁻⁷). We also found strong association with previously reported extended haplotype EH-57.1: HLA-B*57; Cw*06:02; DRB1*07:01; DQB1*03:03:02 in all our patients (Pc = 8.34 × 10⁻⁰⁷). Conclusion: Our results show that different HLA class I and II alleles and haplotypes are associated with psoriasis at different age of onset. In this study, we have reported novel alleles and haplotype association with late-onset psoriasis. Our data confirm the previous strong associations with HLA alleles and haplotypes and also reports novel alleles and haplotype association in Pakistani psoriasis patients.

Dermatologic Adverse Events in Acute Lymphocytic Leukemia Patients Treated with Bispecific T-Cell Engager Blinatumomab

Blinatumomab is a novel FDA-approved bi-specific T-cell engager (BiTE) that significantly improves survival (vs standard chemotherapy) in adults with relapsed or refractory Philadelphia chromosome positive or negative B-cell precursor ALL (B-ALL) and is associated with high rates of clearing persistent measurable residual disease. Though the best known adverse effects associated with blinatumomab include cytokine release syndrome and neurologic toxicity, dermatologic adverse events (DAE) have also been reported in 16% of patients in clinical trials (FDA, 2018). In this study, we aimed to assess the incidence of DAEs in B-ALL patients treated with blinatumomab and characterize their associated clinical and histopathologic features. We conducted a retrospective analysis of B-ALL patients treated with blinatumomab monotherapy at Memorial Sloan Kettering Cancer Center from 1/1/2012 - 10/1/2021 (N=45). Seven patients experienced a total of nine DAEs (15.6%). Median number of blinatumomab cycles at time of DAE onset was one (range cycles 1-3). Median time to DAE onset following blinatumomab induction was 40 days (range 5-115 days). The most common DAEs were rashes (N=4); types included eczema, folliculitis, papular dermatitis, and panniculitis. Other DAEs (N=5) included new onset psoriasis, seborrheic dermatitis, acne, facial erythema, and nail dystrophy. All DAEs were grade 1, many DAEs did not require treatment, and no DAEs warranted interruption or discontinuation of blinatumomab. Four of the 7 patients with DAEs developed CRS at any point during blinatumomab therapy (ASTCT consensus grade 1, N=3; grade 2, N=1). Six of 7 patients with DAE achieved undetectable minimal residual disease (MRD) in the course of blinatumomab therapy or maintained MRD negativity. This is the most comprehensive study to report incidence and clinico-morphologic patterns of DAEs associated with blinatumomab monotherapy. Blinatumomab DAEs may be more common in patients who experience CRS; this finding may support that DAEs are the result of increased circulating cytokines secondary to effective immune activation by blinatumomab. DAEs are mild and we recommend that patients with severe rash during blinatumomab infusion are carefully evaluated for other etiologies of rash.

Study of single nucleotide polymorphisms and serum level of E-cadherin and their relation to psoriasis severity

Backgroundpsoriasis is a persistent autoimmune-mediated systemic inflammatory illness that affects the skin and several organ systems. A family of calcium-dependent cell adhesion molecules called cadherins (CDH) works through homophilic contacts to keep cells attached to one another. In comparison to normal skin, several investigations found that the expression of E-cadherin was downregulated in the granular and basal layers of psoriasis lesional skin. ObjectivesThis study aimed to relate the serum level of E-cadherin and its genes (rs17715799 and rs13689) SNPs with the severity of psoriasis. MethodsIn the current study, 120 participants were divided into two groups: 60 patients with plaque psoriasis were in group I, and 60 healthy controls were in group II. The serum level of E-cadherin protein was measured using an enzyme linked immunosorbent assay (ELISA), and SNPs in the E-cadherin gene (rs17715799 and rs13689) were identified using real-time polymerase chain reaction (RT-PCR) technology. ResultsIn our study group I had a considerably higher serum level of the protein E-cadherin. It was confirmed that the E cadherin (rs13689) genotype frequency distribution revealed a significant difference between the two studied groups. The frequency of the CC genotype was higher in group I. While there was no significant variation in the genotype frequency distribution of E-cadherin (rs17715799) between the two study groups under the dominant, over-dominant, and recessive modes of inheritance (p 0.204) conclusion: patients with psoriasis had considerably higher serum levels of E-cadherin. The E-cadherin gene rs13689 polymorphism affects the chance of developing psoriasis. However, the E-cadherin gene rs17715799 polymorphism has no impact on the onset of psoriasis. As a result, the E-cadherin gene rs13689 but not rs17715799 might be considered as a marker for the risk of developing psoriasis.

Incidence and prevalence of psoriasis in multiethnic Johor Bahru, Malaysia: a population-based cohort study using electronic health data routinely captured in the Teleprimary Care (TPC®) clinical information system from 2010 to 2020: Classification: Epidemiology.

There are no population-based epidemiological data on psoriasis in Southeast Asia, including Malaysia. To determine the incidence and prevalence of psoriasis over 11 years in multiethnic Johor Bahru, Malaysia. A population-based cohort study was made using the Teleprimary Care database between January 2010 and December 2020. Cases of psoriasis, identified by ICD-10 diagnostic codes, were validated by dermatologists. Annual prevalence and incidence were estimated and stratified by age, sex and ethnicity. We identified 3932 people with dermatologist-confirmed psoriasis, including 1830 incident cases, among 1 164 724 Malaysians, yielding an 11-year prevalence of 0·34% [95% confidence interval (CI) 0·33-0·35] and incidence of 34·2 per 100 000 person-years (95% CI 32·6-35·8). Rates were higher in Indian patients; the prevalences were 0·54% (0·50-0·58) in Indian, 0·38% (0·36-0·40) in Chinese and 0·29% (0·28-0·30) in Malay patients, and the respective incidences per 100 000 person-years were 52·5 (47·3-57·7), 38·0 (34·1-41·8) and 30·0 (28·2-31·8). Rates were higher in males; the prevalence was 0·39% (0·37-0·41) in males and 0·29% (0·27-0·30) in females, and the respective incidences per 100 000 person-years were 40·7 (38·2-43·2) and 28·3 (26·4-30·3). Between 2010 and 2020, annual psoriasis prevalence and incidence increased steadily from 0·27% to 0·51% and from 27·8 to 60·9 per 100 000 person-years, respectively. Annual rates were consistently higher in male and Indian patients. Overall, psoriasis was significantly more common in males than females [odds ratio (OR) 1·37, 95% CI 1·29-1·46] and in Indian and Chinese patients vs. Malay (OR 1·85, 1·71-2·01 and OR 1·30, 1·20-1·41, respectively). Prevalence increased with age, with the highest rates in the groups aged 50-59 and 60-69 years at 0·67% and 0·66%, respectively. A modest bimodal trend in age of psoriasis onset was observed, with first and second peaks at 20-29 and 50-59 years. Disease onset was significantly earlier in females than males [mean (SD) 36·8 (17·3) vs. 42·0 (17·2) years, P < 0·001] and in Malay vs. Indian and Chinese patients [mean (SD): Malay 36·4 (17·5), Indian 40·8 (15·2), Chinese 47·4 (16·9) years, P < 0·001]. We found that psoriasis incidence and prevalence are increasing and varied by age, sex and ethnicity. Our findings should help inform healthcare planning and management for patients with psoriasis in Malaysia. What is already known about this topic? The incidence and prevalence of psoriasis are generally lower in Asian populations and children. There is a lack of agreement on sex-specific differences in psoriasis incidence and prevalence. There has been no population-based study on the incidence and prevalence of psoriasis in Southeast Asia, including Malaysia. There is no information on differences in psoriasis prevalence and incidence by sex, age and ethnicity in Malaysia. What does this study add? Psoriasis incidence and prevalence are increasing in the multiethnic population of Johor Bahru, Malaysia. Incidence and prevalence rates were higher in male than female patients and were consistently highest among Indian patients, followed by Chinese and Malay. A modest bimodality in the age of psoriasis onset was observed among the groups aged 20-29 and 50-59 years. Psoriasis onset was significantly later in male than female patients and in Chinese vs. Indian and Malay patients.

Efficacy and safety of PUVA and UVB-311 nm in psoriasis: single-center retrospective study

BACKGROUND:Psoriasis is a widespread, genetically determined immunemediated dermatosis of a multifactorial nature, characterized by a recurrent course with frequent associative damage to other organs and systems, which significantly reduces the quality of patients lives. For many years, phototherapy (PUVA and UVB-311 nm) has had one of the leading places in the treatment of moderate and severe psoriasis according to the world dermatological communities. However, with the advent of genetically engineered biological drugs, the frequency of its administration has significantly decreased.&#x0D; AIM:to evaluate the efficacy and safety of PUVA and UVB-311 nm in the treatment of moderate and severe psoriasis.&#x0D; MATERIALS AND METHODS:A retrospective study was conducted on the basis of the Federal State Institution Central polyclinic with the participation of 920 patients with moderate and severe psoriasis who received phototherapy (PUVA and UVB-311 nm) in the period from 2005 to 2021. The initial radiation dose was 0.51 J/cm2at PUVA and 0.10.2 J/cm2at UVB-311 nm with a gradual increase in the dose every 12 sessions by 0.5 J/cm2and 0.1 J/cm2, respectively. 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 920 patients there were 478 (52%) men and 442 (48%) women (aged 21 to 68 years). The average age of psoriasis onset is 345.2 years. The duration of the disease averaged 10.58.2 years. Vulgar psoriasis was observed in 756 (82%) patients, teardrop-shaped ― in 36 (4%), exudative ― in 73 (8%), inverse ― in 55 (6%). 249 (27%) were diagnosed with psoriatic arthritis. On average, the first phototherapy sessions were prescribed 2.11.6 years after the onset of the disease. The choice of phototherapy method depended on the severity of the process. Thus, with moderate psoriasis, patients were prescribed UVB-311 nm (n=473). The course consisted of 2535 sessions of radiation with a cumulative dose of 35.35.9 J/cm2. Clinical remission was observed in 93% of patients, significant improvement ― in 7%. The achieved clinical remission was maintained for 361194 days. In total, during the studied period, 149 people received 27 courses of UVB-therapy, 132 ― 24 courses, 53 ― 19 courses, 69 ― 15 courses, 58 ― 11 courses, 12 ― 7 courses. Multiple infiltrated plaques and refractory course of severe psoriasis was an indication for PUVA therapy (n=447). The course consisted of 2030 irradiation sessions with a cumulative dose of 81.514.3 J/cm2. Clinical remission was observed in 98% of patients, a significant improvement in 2%. 14 people received 23 courses, 21 ― 20 courses, 12 ― 19 courses, 227 ― 15 courses, 104 ― 13 courses, 33 ― 10 courses, 27 ― 4 courses, 9 ― 2 courses of PUVA. The achieved clinical remission was maintained for 420275 days. 12 (1.3%) patients cancelled PUVA prematurely due to the inability to take a photosensitizer. In other cases, the observed side effects were minor and did not cause discontinuation of therapy.&#x0D; CONCLUSION:PUVA and UVB-311 nm have demonstrated high efficacy and safety in the treatment of moderate and severe psoriasis. At the same time, it is necessary to conduct further research to improve the methods of phototherapy for faster achievement of long-lasting clinical remission, which will allow phototherapy to regain its leading position in the treatment of psoriasis, increasing the doctors trust and patients compliance.

Extracellular nucleophosmin is upregulated in psoriasis and correlates with determinants of cardiovascular diseases

Abstract Introduction We previously showed that genotoxic stress induced an active extracellular release of nucleophosmin (NPM) in human cardiac mesenchymal progenitor cells, and that serum deprivation provokes NPM secretion from human endothelial cells, eliciting inflammation via nuclear factor kappa B (NF-kB) transcriptional activation. Purpose The aim of this study was to determine whether NPM was modulated in skin and plasma of psoriatic patients (Pso). Methods 29 Pso were compared to 29 control subjects (Ctrl) age- and sex-matched. All Pso had a severe psoriasis, defined as Psoriasis Area and Severity Index (PASI) &amp;gt;10 and one of the following: at least two systemic psoriasis treatments, psoriasis onset &amp;lt;40 years of age, disease duration &amp;gt;10 years. Exclusion criteria were: diabetes, cardiovascular events, psoriatic arthritis. Total RNA was extracted from plasma and miR-200c levels assayed by quantitative real-time PCR. NPM levels were assayed by ELISA. The clinical parameters were similar between the two groups except for Total Cholesterol (mg/dl) (Ctrl 193.3±6.2; Pso 213.2±6.9; P&amp;lt;0.05). Blood pressure measurement, wave reflection analysis and pulse wave velocity (PWV) were similar between groups, echocardiographic parameters were different for left ventricular (LV) mass index (g/m2) (Ctrl 84.2±5.2; Pso 102.5±4.7; P&amp;lt;0.05) and relative wall thickness (RWT) (Ctrl 0.4±0.0; Pso 0.48±0.0; P&amp;lt;0.01). Total RNA was extracted from biopsies of nonlesional (NLS) and lesional (LS) of 6 Pso and 6 healthy subject skin (HS) from which human fibroblasts (HFs) and primary Keratinocytes (KCs) were extracted. Results NPM was upregulated in LS (1.9+0.3 fold; p=0.05) vs NLS biopsies (2.9+0.1 fold; p&amp;lt;0.01) and was also increased at the transcriptional level in LS vs NLS (8.6+ 1.7fold; p&amp;lt;0.05). Both the innate stimuli, such as lipopolysaccharides and Poly I:C and adaptive stimuli, i.e. cytokine mix, were able to induce extracellular release of NPM in immortalized KCs and HFs. Interestingly, NPM interacts with Toll like receptor (TLR)4 and activates a NF-kB-dependent inflammatory pathway upregulating interleukin IL-6 and COX-2 gene expression. Circulating NPM was increased in the plasma of 29 Pso (1.1+0.1ng/ml; p&amp;lt;0.001) compared to 29 healthy controls (0.78+ 0.03ng/ml) and positively correlates with PASI (Rs=0.44; p=0.05) and with determinants of cardiovascular diseases (CVDs), i.e. PWV (Rs=0.5; p&amp;lt;0.008), PASis (Rs= 0.4; P&amp;lt;0.05) and LV mass (Rs=0.49; p&amp;lt;0.05). Further, NPM positively correlates with miR-200c circulating levels (Rs=0.29; p&amp;lt;0.05), that we previously showed to increase in Pso and to correlate with CVD progression. We found that circulating miR-200c physically associated with NPM, that most probably is responsible for its extracellular release and protection upon cytokine mix via a TLR4-mechanism. Conclusions NPM is increased in psoriasis both in skin and in plasma and could be a novel biologic target to counteract chronic inflammation associated with CVD risk. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Italian Ministry of Health and AFM Telethon 22522 grant to AM

Psoriasis in Northern Saudi Arabia: Clinical features and implications for quality of life.

Introduction:Psoriasis is a chronic non-contagious inflammatory skin disorder, which might impair patient’s social relationships, limit leisure activities, and lower self-esteem. Psoriasis patients might be stigmatized leading to psychological disorders such as anxiety and depression.Objectives:This study aimed to outline the clinical features of psoriasis and its effects on quality of life, and the feeling of stigmatization among psoriasis patients.Methods:This cross-sectional questionnaire-based study was conducted on 109 adult psoriasis patients in Arar City, Saudi Arabia. The study collected data on socio-demographic and clinical characteristics of psoriasis patients, self-reported psoriasis severity using the self-assessment Simplified Psoriasis Index (sa-SPI-s), patients’ quality of life using the dermatological life quality index (DLQI), and the feeling of stigmatization using the six-items stigmatization scale.Results:The mean age of psoriasis onset in studied patients was 20 (±7.65) years, females represented 58.72%, and 22% were unemployed. Joint and nail affection were reported in 46.79% and 51.38%, respectively. One third of patients had positive family history of psoriasis. Seasonal variation, life stressors, smoking and skin injuries were frequent provocative factors for psoriasis lesions. The average sa-SPI-s was 10.08 (±10.41), which was correlated with patients’ ages, disease duration, obesity, and pruritis. The average DLQI and six-items stigmatization scale for psoriasis patients were 8.95 (±5.77) and 7.61 (±4.5), respectively that were correlated with sa-SPI-s.Conclusion:The clinical manifestations and chronicity of psoriasis impaired patients’ quality of life and accompanied with social stigma due to skin disfigurement. These effects need to be addressed for better care of patients.

Comment on: Strong site-specific association of pharyngeal cultures with the onset of psoriatic arthritis and psoriasis, regardless of pathogen: reply.

Dear Editor, We thank Rubén Queiro-Silva for the letter and insightful comments [1] on our article: ‘Strong site-specific association of pharyngeal cultures with the onset of psoriatic arthritis and psoriasis, regardless of pathogen’ [2]. First, we would like to address the commenters’ questions regarding our methods. These are all addressed in the Methods section on follow-up in the published article. For additional clarity, we can confirm that each individual could contribute multiple exposed periods, so that the observation unit is the period following sampling. Thus, the study did not address the possibility of cumulative risk from multiple exposures in the same individual, which might indeed have resulted in an even stronger observed effect. Regarding other questions raised in the comment, we believe the text of the published paper speaks for itself: ‘When the same individual had multiple samples sent for culture from the same site within 30 days, they were treated as one exposure, using the date of the first sample as the index date, and they were considered positive if any sample was positive. In the case of multiple culture sites or different organisms being reported within 30 days, none were used in the analysis’. It should be noted that all these design decisions were intended to reduce the chance of spurious findings or associations.

Comment on: Strong site-specific association of pharyngeal cultures with the onset of psoriatic arthritis and psoriasis, regardless of pathogen.

Dear Editor, I have read with great interest the study by Thrastardottir et al. reporting a strong site-specific association between pharyngeal culture samples and an increased risk of PsA and psoriasis, regardless of the pathogen, thereby indicating that the site of infection, rather than the pathogen, is associated with increased risk for both conditions [1]. Data from this population-based cohort study are interesting as well as surprising, as they contradict classic observations on the relationship between streptococcal infections and psoriatic disease [2]. Thus, having a positive streptococcal pharyngeal culture was protective against psoriatic disease. Sensitivity analyses showed that when pharyngeal samples were compared with all other culture sites, an HR of 9.51 for PsA and 5.80 for psoriasis was seen during the first 50 days of follow-up, while the risk was significantly reduced after that period [1]. In any case, the study raises certain methodological concerns. For example, doubts remain as to whether the unit of observation was the individual or the culture sample. If it was the individual, what culture sample was taken into account? If it was the culture sample, was it taken into account which different cultures are from the same person? If it was not taken into account, how is the lack of independence of the observations justified?

New onset atopic dermatitis and psoriasis in the same patients under biologic treatments: The role of systemic treatments as a possible trigger.

Atopic dermatitis (AD) and psoriasis (PsO) are among the most common diseases in the daily clinical practice. Usually, AD and PsO are reported as two diseases that cannot coexist in the same patient because this requires the activation of opposing inflammatory pathways. Anyway, some reports highlight how AD and PsO may coexist in the same patient or develop consequently. In this short report we collected 12 patients that developed new AD or PsO. Among them, eight patients (n=8; 3M:5F) with a previous diagnosis of PsO, developed subsequently an AD with a mean time of onset of 71.5months. Out of eight patients, four patients where in treatment with ustekinumab, one with ixekizumab, two with adalimumab, and one with guselkumab. All new onset AD have been treated with topical medicaments, except one case that performed dupilumab. Contrariwise, four patients with a baseline AD developed a PsO with a mean time of onset of 25 months. Two AD patients were under dupilumab treatment, while the other two patients performed only topical treatments. All patients showed an improvement of the new onset PsO with topical treatment only. This report highlights how AD and PsO are not mutually exclusive diseases. The mechanisms by which AD patients develop PsO or psoriatic patients develop AD are still not very clear; some triggers can promote these processes, such as systemic therapies. Therefore, clinicians should carefully evaluate any changes in these patients, in order to reach a correct diagnosis and carry out a relative treatment.

The age at first cutaneous manifestation of psoriasis as a prognostic factor in the timing of psoriatic arthritis diagnosis

Background. Psoriatic arthritis is a chronic inflammatory disease of joints, spine and enthesis, which develops in 640% of patients with psoriasis and has a significant impact on the quality of life of patients.&#x0D; Aims. To determine the relationship between age of cutaneous manifestation of psoriasis and the timing of psoriatic arthritis diagnosis; to examine the possibility of prediction of timing of psoriatic arthritis diagnosis depending on age of cutaneous manifestation of psoriasis.&#x0D; Materials and methods. Data of patients aged 18 years and older with psoriatic arthritis included in the psoriasis patient register were analysed. Inclusion criteria were: patient age 18 years and older; established diagnosis of psoriasis and psoriatic arthritis. Exclusion criteria were: psoriatic arthritis diagnosed before or simultaneously with cutaneous manifestation of psoriasis; the age of the cutaneous manifestation of psoriasis older than 70 years. The sample included 771 patients.&#x0D; Spearman's correlation analysis was used to assess the correlation between age of cutaneous manifestation of psoriasis and period from skin psoriasis onset to psoriatic arthritis diagnosis.&#x0D; The possibility of prediction of the period till psoriatic arthritis was diagnosed depending on age at cutaneous manifestation of psoriasis was established by means of quantile regression analysis.&#x0D; Results. Mean age at cutaneous manifestation of psoriasis (SD) was 26.0 13.5 years. The period from the onset of skin psoriasis to the diagnosis of psoriatic arthritis averaged 13.7 10.3 years, its median [interquartile range] was 12 [619] years.&#x0D; According to Spearman's correlation analysis, a moderate (close to strong) negative correlation between varibles was revealed (Spearman's correlation coefficient = 0.490, p 0.0005).&#x0D; In accordance to quantile regression analysis, lines of 5, 25, 50, 75 and 95% quantiles were obtained and the dependence of the period till the diagnosis of psoriatic arthritis on the age of onset of skin psoriasis was demonstrated. Based on the quantile equation obtained, a prognostic table for the period from the onset of skin psoriasis to the diagnosis of psoriatic arthritis was compiled.&#x0D; Conclusions. Statistically significant inverse relationship between age of cutaneous manifestation of psoriasis and period till psoriatic arthritis diagnosis was established: older age at skin psoriasis onset is associated with shorter period till psoriatic arthritis diagnosis. Based on established relationship, presented as an equation, table and graphically, prediction of period till psoriatic arthritis diagnosis is possible. These results can be used in the clinical practice of dermatovenereologists.