Signs Of Psoriasis Research Articles

The experience of pain and redness in patients with moderate to severe plaque psoriasis

Introduction: The Psoriasis Symptom Inventory is a patient-reported outcome instrument that assesses severity of psoriasis signs and symptoms. In early qualitative research, patients reported pain related to psoriasis skin lesions and redness of affected areas of skin as key symptoms. Methods: Individual concept elicitation interviews and cognitive interviews were conducted in adults with moderate to severe plaque psoriasis. Interviews were audio-recorded and transcribed. Concepts were identified, coded and grouped by similar content using Atlas.ti software. Results were evaluated using qualitative research methods. Results: Of 30 patients recruited, 20 patients participated in concept elicitation interviews and 10 participated in cognitive interviews. Concept codes for skin pain and descriptions of color comprised 11% and 15%, respectively, of all symptom-related expressions. Of 90 pain-related expressions, 22 were about pain related to unconscious scratching and 68 were about pain from the psoriasis lesions. Of 199 color-related expressions, 72 were about red or reddish lesion color. Patients with darker skin tones were found to interpret redness consistently. Discussion: These results provide further support to content validity of pain and redness concepts in the Psoriasis Symptom Inventory. Conclusions: Symptoms of skin pain and redness are highly relevant to patients with psoriasis.

TNF Inhibitors in Psoriasis: A Review.

Adalimumab, etanercept, and infliximab are tumor necrosis factor (TNF) inhibitors that are currently approved by the US Food and Drug Administration for the treatment of moderate to severe psoriasis. The availability of these biologic agents established a new benchmark in the treatment of psoriasis that requires systemic therapy to control psoriasis signs and symptoms. Although a number of other biologic agents and small molecules have been approved recently, TNF inhibitors remain a cornerstone of psoriasis therapy. Semin Cutan Med Surg 34(supp2):S37-S39 © 2015 published by Frontline Medical Communications.

Genetically modified animals as models of the pathological processes in psoriasis

Psoriasis is a chronic recurrent disorder that affects predominantly the skin and is autoimmune in nature. Experimental models help to study the development of psoriasis in controlled conditions and investigate particular aspects of the pathological process. Many mouse models were obtained to reproduce, to a certain extent, the psoriasis signs seen in humans. Genetically modified animals help to reveal the new genes whose mutations potentially underlie the disease and to search for new therapeutic targets. Moreover, the animal models are used to test new drugs and therapies. The review summarizes the published data on the laboratory animal models of the psoriatic process.

OP0073 Peripheral Blood Gene Expression Profiling of Psoriatic Arthritis Patients

BackgroundAlthough PsA is heterogeneous and shows signs of rheumatoid arthritis (RA) and psoriasis (PsO), genetic studies indicate that PsA is a distinct disease with a strong heritable component. PsA is...

Development of a patient-reported outcomes measure for psoriasis: The Psoriasis Symptoms, Signs, and Impact Questionnaire

Development of a patient-reported outcomes measure for psoriasis: The Psoriasis Symptoms, Signs, and Impact Questionnaire

Health-Related Quality of Life Worsens Disproportionately to Objective Signs of Psoriasis After Withdrawal of Adalimumab Therapy

IntroductionHealth-related quality of life (HRQoL) is an important part of the clinical assessment and management of psoriasis. Few studies have investigated the effects of withdrawing treatment on the relationship between HRQoL and objective clinical manifestations of psoriasis. This post hoc subanalysis of a clinical trial (REVEAL) examined the relationship of HRQoL [assessed with the Dermatology Life Quality Index (DLQI)] and objective disease activity [assessed with the Psoriasis Area and Severity Index (PASI)] among patients before and after they underwent protocol-mandated discontinuation of psoriasis therapy.MethodsAdult patients with moderate-to-severe plaque psoriasis who received adalimumab from baseline and had 75% or greater improvement in the PASI score at weeks 16 and 33 were re-randomized to adalimumab 40 mg or placebo every other week from weeks 33 to 52. DLQI and PASI scores were compared at baseline (week 0), early in treatment (week 4), directly before randomized withdrawal (week 33), and up to 19 weeks after treatment discontinuation (week 52; last observations carried forward). Correlations between DLQI total score and PASI score at week 4 and week 52 were modeled by linear regression.ResultsIn the patients (N = 240) who underwent protocol-mandated discontinuation of psoriasis treatment after achieving PASI 75 response, mean PASI scores at week 52 were lower (i.e., better) compared with week 4, yet mean DLQI scores were higher (i.e., worse). An approximately twofold disproportionately greater degree of worsening of DLQI score compared with the degree of worsening of PASI was observed while patients underwent discontinuation of therapy (week 52) compared with early in treatment (week 4). There was a significant interaction (P < 0.0001) between the PASI–DLQI correlation and study period (week 4 or 52).ConclusionDiscontinuing therapy in patients who initially responded to treatment, as seen in this analysis with adalimumab, disproportionately worsened patient-reported HRQoL relative to the worsening of PASI.Electronic supplementary materialThe online version of this article (doi:10.1007/s13555-014-0043-4) contains supplementary material, which is available to authorized users.

The relationship between pruritus and the clinical signs of psoriasis in patients receiving tofacitinib

Objective: Tofacitinib is a novel, oral Janus kinase inhibitor being investigated for psoriasis. This study assessed the relationship between pruritus and clinical signs of psoriasis (assessed by Physician’s Global Assessment [PGA]) in patients with moderate-to-severe chronic plaque psoriasis receiving tofacitinib.Methods: In this 16-week (12-week treatment period, 4-week observation period), double-blind, placebo-controlled, phase IIb study (NCT00678210), 197 patients were randomized to tofacitinib 2, 5 or 15 mg BID, or placebo. Pruritus was patient assessed using the Itch Severity Score (ISS), a 0–10 (10 = worst itching) rating scale recorded daily from baseline to week 2 and at study visits. Mediation modeling was used to determine relationships between ISS (average score weeks 2–12), PGA (average score weeks 2–12) and treatment groups.Results: Mediation analysis showed that 70.2–80.5% (p < 0.001 versus placebo) of tofacitinib’s effect on pruritus was direct, and mostly independent of improvements in erythema, induration and scaling. ISS measurements had acceptable test–retest reliability. Correlation analyses with clinical outcomes supported the validity of the ISS as a pruritus measure.Conclusions: Tofacitinib has a direct, beneficial effect on patient-reported pruritus independent from improvements in clinician-reported psoriasis severity signs. The ISS demonstrated favorable psychometric characteristics, supporting its use as a pruritus assessment tool.

Developing a diagnostic checklist of traditional Chinese medicine symptoms and signs for psoriasis: a Delphi study

BackgroundPsoriasis is a chronic inflammatory skin disease with a genetic basis. Its ill-defined causes make it difficult to diagnose. This study aims to develop a diagnostic checklist for psoriasis classification in the context of traditional Chinese medicine.MethodsA Delphi study was conducted with three rounds by a panel of 16 dermatology experts to develop a checklist for traditional Chinese medicine symptoms and signs of psoriasis. Dermatology experts in psoriasis research, nine in Yunnan and seven in Beijing, were selected as the expert panel. The initial list of symptoms and signs in psoriasis was developed by reviewing the literature retrieved from Chinese and English journals. Experts rated each item of the list on a 5-point Likert scale. The list was revised and re-evaluated in the same manner for a total of 3 rounds before it was finalized.ResultsOne hundred and thirty items were extracted from the literature review. After three rounds of expert ratings, 96 items were retained with eight domains: color, type and shape of skin lesion, physical expression, tongue and coating, pulse, associated factors, and living environment. Intraclass correlation coefficient and Kappa statistics indicated an inter-rater agreement in the final checklist.ConclusionA checklist containing 96 items in 8 domains was developed for psoriasis diagnosis using traditional Chinese medicine symptoms and signs.

Psoriasis: exploring the associated clinical issues and how to support your patients

Although psoriasis is a common condition manifesting in the skin and joints, recent clinical evidence has shown health professionals that it is a systemic disease that is more than skin deep. The most recent guidelines from the National Institute for Health and Clinical Excellence (2012) on psoriasis offer a comprehensive evidence-base to psoriasis management. Aesthetic nurses have an important role with their clients who have psoriasis, in supporting them in coping with and treating psoriasis and having an awareness of how cosmetic treatments may affect psoriasis. This article aims to inform and update aesthetic nurses' knowledge of the psoriasis signs and symptoms, evidence-based treatment options and implications for cosmetic treatment.

Nail Psoriasis

Nail psoriasis is common, occurring in up to half of patients with psoriasis and in 90% of patients with psoriatic arthritis. Left untreated, it may progress to debilitating nail disease, which leads to significant functional impairment. The most common clinical signs of nail psoriasis are nail plate pitting and onycholysis. Other classical signs include oil drop discoloration, subungual hyperkeratosis, and splinter hemorrhages. The modified Nail Psoriasis Severity Index (mNAPSI) can be used to grade the severity of nail psoriasis, while the Nail Psoriasis Quality of Life Scale (NPQ10) is a questionnaire that evaluates the impact of nail psoriasis on the patient's functional status and quality of life. Treatment of nail psoriasis should be individualized according to the patient's preferences, severity of nail changes, and presence of skin and/or joint involvement. Both topical and intralesional therapies are safe and effective treatment modalities for nail disease, but are limited by poor adherence and pain, respectively. Systemic therapy such as oral retinoids may be considered for widespread nail disease causing significant morbidity. Among biologic agents, tumor necrosis factor-α inhibitors and T-cell-targeted therapies such as ustekinumab may be useful for refractory severe nail psoriasis.

Sleep quality and other patient‐reported outcomes improve after patients with psoriasis with suboptimal response to other systemic therapies are switched to adalimumab: results from PROGRESS, an open‐label Phase IIIB trial

Psoriasis is associated with poor health-related quality of life, including sleep impairment. To assess the extent of sleep impairment, the effect of adalimumab on sleep and other patient-reported outcomes, and correlations between changes in these outcomes and sleep quality in patients with psoriasis. Patients in the 16-week, open-label, Phase IIIb PROGRESS trial had chronic plaque psoriasis and suboptimal response to prior therapy (etanercept, methotrexate or narrowband ultraviolet B phototherapy). Adalimumab was self-injected subcutaneously (80 mg at week 0, then 40 mg every other week from week 1). The focus for this analysis was the Medical Outcomes Study Sleep Scale. Other patient-reported outcomes included the Dermatology Life Quality Index (DLQI), Psoriasis Area and Severity Index (PASI), Physician's Global Assessment, a visual analogue scale for psoriasis/psoriatic arthritis (PsA) pain, and the Work Productivity and Activity Index Questionnaire-Specific Health Problems. Patients with psoriasis had impaired sleep at baseline. The degree of sleep impairment was significantly associated with the extent of work productivity for all sleep measures and, for some sleep measures, was associated with DLQI impairment, clinical severity measured by PASI, the presence of PsA, and depression. Adalimumab treatment significantly improved sleep quality by 15% from baseline, as well as DLQI score, pain and work productivity. The improvement in sleep was partially explained (R(2 ) = 0·16, P < 0·001) by improvements in the objectively measured psoriasis signs in PASI. Adalimumab treatment improved sleep outcomes and other patient-reported outcomes including health-related quality of life, work productivity, daily activity and disease-related pain.

The effects of clobetasol propionate spray, 0.05% versus vehicle spray on the signs of plaque psoriasis on the body and scalp

The effects of clobetasol propionate spray, 0.05% versus vehicle spray on the signs of plaque psoriasis on the body and scalp

„Stiefkind“ Nagelpsoriasis

Approximately 50% of all patients with psoriasis develop characteristic nail changes as a clinical correlate of psoriatic inflammation of the nail matrix and/or nail bed. The most frequent signs of nail psoriasis are pitting and distal onycholysis. The most commonly used score to assess the severity of nail involvement at present is the Nail Psoriasis Severity Index (NAPSI). Although more than half of affected patients experience a significant physical and mental impairment, this index does not include patient-reported symptoms. There is a striking association between nail psoriasis and a higher risk of psoriatic arthritis with a prevalence of nail involvement among patients with psoriatic arthritis as high as 70%. A possible explanation is the close anatomical link between the nail apparatus and the distal interphalangeal joint; enthesitis of the latter is carried by fibers to the nail and becomes clinically visible as nail psoriasis. Nail involvement is not adequately reflected in current concepts of disease management. There is limited evidence for the efficacy of topical therapies in nail psoriasis. A number of large studies document an improvement of nail psoriasis in response to biologics and, more recently, also to methotrexate.

The sign of psoriasis in mesenchymal stem cells of the skin

Psoriasis is a chronic inflammatory and immune-mediated skin disease, characterized by epidermal hyperproliferation, abnormal keratinocyte differentiation and angiogenesis, whose skin lesions are promoted by exogenous and endogenous factors. The cutaneous and systemic over-expression of several pro-inflammatory cytokines, observed in the initiation, maintenance and recurrence of skin lesions, is known to be caused also by reactive oxygen species (ROS). For this reason it has been postulated that ROS production and compromised function of antioxidant system may be involved in the pathogenesis of psoriasis. Some typical features of psoriasis, like growth rate, expression of VEGF and iNOS as well as the production of VEGF and nitric oxide (NO) and some antioxidant responses, have already been extensively evaluated in differentiated cells of psoriatic skin, but no indications are still available about, the mesenchymal stem, that may be isolated from skin (S-MSCs).

Chronic vulvitis in pre-pubertal girls

Pre-pubertal girls with inflammatory chronic vulval disease excluding lichen sclerosus are often described as having 'non-specific vulvovaginitis'. The aim of this retrospective case series was to determine the aetiology of chronic vulvovaginitis in pre-pubertal (Tanner Stage 1) girls, with particular reference to candidiasis. A chart review recorded and compared the characteristics of 38 girls and 68 post-menarchal adolescents and pre-menopausal women with chronic vulvitis. Nineteen (50%) of the pre-pubertal children had been previously diagnosed with candidiasis and 21 (55%) had been treated unsuccessfully with topical antifungal agents. Candida albicans was isolated in two (5%) of the children and 37 (54%) of the adults (P < 0.001). A positive Candida culture was causally associated with chronic vulvovaginitis in 50% of the adults but in none of the children (P < 0.001). In 28 (74%) of the children and 28 (41%) of the adults, no pathogens were isolated on microbiological testing. General skin examination of the girls revealed signs of psoriasis in 27 (71%) and atopic dermatitis in nine (24%). Symptoms were controlled with topical anti-inflammatory treatment and environmental modification, including cessation of topical antifungals. Pre-pubertal girls with chronic vulvitis are likely to have either psoriasis or atopic dermatitis. Chronic vulvovaginal candidiasis is not seen in Tanner Stage 1 girls.

The prevalence of psoriatic arthritis in people with psoriasis

To determine the prevalence of psoriatic arthritis (PsA) using the ClASsification criteria for Psoriatic ARthritis (CASPAR) for classification. People with psoriasis were identified from the computerized morbidity indices of 2 large UK general practices, total population 22,500. Questionnaires were mailed to all 633 patients thus identified. Of the respondents, a 50% sample was assessed clinically and a proportion had blood samples and radiographs taken. Patients labeled as having psoriasis were also cross-referenced with a local secondary care morbidity index for PsA and rheumatoid arthritis. Figures for the prevalence of PsA were estimated from these data. One hundred sixty-eight questionnaires were returned (response rate 27%) and 93 people (55% of questionnaire respondents) were examined. Of these 93 people, 12 (4 of whom were cross-referenced to the hospital database) were thought to have PsA clinically, all fulfilling the CASPAR criteria for PsA. Six of the 93 examined patients did not have psoriasis or a family history of psoriasis and had no historical features or clinical signs of psoriasis on interview and examination. Extrapolating from the data of those people actually examined, the estimated (corrected) prevalence was 13.8% (95% confidence interval 7.1-24.1%). The estimated prevalence of PsA in this population, using the CASPAR criteria, was 13.8%. Misclassification of psoriasis and arthritis, and response bias, indicate that this is probably an overestimate.

Assessing Treatment of Pruritic Scalp

Pruritic scalp has not traditionally been specifically categorized as a separate dermatologic condition; but rather it has been included within the broad category of seborrheic dermatitis. This has severely limited testing and understand- ing of this entity. The objective of this study was to assess patient satisfaction with various topical and oral therapies for pruritic scalp. For this purpose, an open-label, five-week study, 12 patients with pruritic scalp were given five different therapies, each to be used for one week. The participants then completed a survey to assess their opinion on the different therapies. No one treatment was universally preferred. Lanacaine solution and steroid solution achieved slightly higher marks. In a few cases, oral antihistamines proved curative. In short, pruritic scalp is a distinct condition in which one experiences episodic itching of the head without any visible or pathological sign of psoriasis, head lice, or any other scalp disorder. The divergent responses in this study underlines that there are probably different factors and trigger points which elicit the condition. More studies on this entity are warranted.

Barrier Function, Epidermal Differentiation, and Human β-Defensin 2 Expression in Tinea Corporis

Barrier Function, Epidermal Differentiation, and Human β-Defensin 2 Expression in Tinea Corporis

A Randomized, Double-Blind Clinical Trial of a Probiotic Nutritional Intervention in the Treatment of Mild to Moderate Non-Scalp Psoriasis

Background The cellular immune system plays an important role in the pathogenesis of psoriasis. The digestive system (by virtue of the profile, number and species of bacteria present at any given time and nutritional factors) can influence the status of the immune system. Bacterial pathogens influence specific cytokine activity due to the activity of superantigens. Modulation of bacterial gut flora offers a potential target for psoriasis treatment. Methods Forty-two subjects with mild to moderate plaque-type psoriasis were enrolled in a 12-week, randomized, placebo-controlled trial of a lactobacillus nutritional supplement. The supplement or placebo was taken orally once daily for eight weeks. The primary outcome of this study was the change from baseline to week 12 (or end of treatment) in the composite score of the signs of psoriasis (erythema, scaling, plaque thickness) for target lesions. Other outcomes included Investigator's and Subject's Global Assessment of Response and change in pruritus score. Results Data were evaluable for 40 subjects (18 on the nutritional supplement and 22 on placebo). No significant improvement was found with the lactobacillus nutritional supplement compared to placebo-treated patients. Conclusion Patients commonly seek out alternative treatments for psoriasis. Nutritional supplementation is an intriguing way to manage the disease, offering the potential for a very safe treatment, however we found little to no benefit for lactobacillus nutritional supplement in this group of subjects with mild to moderate psoriasis.

Infliximab induction and maintenance therapy for moderate-to-severe psoriasis: a phase III, multicentre, double-blind trial

Tumour necrosis factor alpha (TNFalpha) is thought to play a part in the pathogenesis of psoriasis. We assessed the efficacy and safety of continuous treatment with infliximab, a monoclonal antibody that binds to and neutralises the activity of TNFalpha, in patients with psoriasis. In this phase III, multicentre, double-blind trial, 378 patients with moderate-to-severe plaque psoriasis were allocated in a 4:1 ratio to receive infusions of either infliximab 5 mg/kg or placebo at weeks 0, 2, and 6, then every 8 weeks to week 46. At week 24, placebo-treated patients crossed over to infliximab treatment. Skin and nail signs of psoriasis were assessed using the psoriasis area and severity index (PASI) and nail psoriasis severity index (NAPSI), respectively. The primary endpoint, analysed on an intention-to-treat-basis, was the proportion of patients achieving at least a 75% improvement in PASI from baseline to week 10. At week 10, 80% (242/301) of patients treated with infliximab achieved at least a 75% improvement from their baseline PASI (PASI 75) and 57% (172/301) achieved at least a 90% improvement (PASI 90), compared with 3% and 1% in the placebo group, respectively (p<0.0001). At week 24, PASI 75 (82% for infliximab vs 4% for placebo) and PASI 90 (58%vs 1%) were maintained (p<0.0001). At week 50, 61% achieved PASI 75 and 45% achieved PASI 90 in the infliximab group. Infliximab was generally well tolerated in most patients. Infliximab is effective in both an induction and maintenance regimen for the treatment of moderate-to-severe psoriasis, with a high percentage of patients achieving sustained PASI 75 and PASI 90 improvement through 1 year.