Systemic Treatment Of Psoriasis Research Articles

JAAD Game Changer: “Reduced risk of mortality associated with systemic psoriasis treatment in the Psoriasis Longitudinal Assessment and Registry: A nested case-control analysis”

JAAD Game Changer: “Reduced risk of mortality associated with systemic psoriasis treatment in the Psoriasis Longitudinal Assessment and Registry: A nested case-control analysis”

Supervivencia de la ciclosporina en el tratamiento de la dermatitis atópica moderada-grave: Registro Español de Dermatitis Atópica (BIOBADATOP)

BackgroundThe past 5 years have seen a proliferation of new treatments for atopic dermatitis (AD). We analyzed recent drug survival data for cyclosporine in this setting. Because the Spanish National Healthcare system requires patients with AD to be treated with cyclosporine before they can be prescribed other systemic treatments, drug survival for cyclosporine may be shorter than in other diseases. Material and methodMulticenter, observational, prospective cohort study using data from the Spanish Atopic Dermatitis Registry (BIOBADATOP). Data from the Spanish Registry of Systemic Treatments in Psoriasis (BIOBADADERM) were used to create a comparison cohort. ResultsWe analyzed data for 130 patients with AD treated with cyclosporine (median drug survival, 1 year). Median cyclosporine survival in the psoriasis comparison group (150 patients) was 0.37 years. Drug survival was significantly longer in AD than in psoriasis (P<.001). ConclusionDrug survival of cyclosporine in the BIOBADATOP registry is similar to that described in other series of patients with AD and longer than that observed in the BIOBADADERM psoriasis registry.

Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis.

Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis.

Clinical features, therapeutic choice and response by phototype in psoriasis: analysis of the French PsoBioTeq cohort.

Little is known about phototype and the response to systemic treatment in psoriasis. To assess the characteristics of psoriasis, the therapeutic choice and its efficacy according to phototype. We included patients from the PsoBioTeq cohort initiating a first biologic. Patients were classified according to their phototype. The evaluation included disease characteristics, choice of the initial biologic and therapeutic response at 12 months based on 90% improvement from baseline in Psoriasis Area and Severity Index (PASI 90) and Dermatology Life Quality Index (DLQI) 0/1. Of the 1400 patients included, 423 (30.2%), 904 (64.6%) and 73 (5.2%) were in the phototype I-II, III-IV and V-VI groups, respectively. The V-VI group had a higher initial DLQI, and more frequently initiated ustekinumab. Patients in the V-VI group maintained the initial biologic prescribed as did the other phototype groups, even though the proportion of patients reaching PASI 90 and DLQI 0/1 at 12 months was lower in this group than the other groups. Patient phototype seems associated with quality of life and choice of the initial biologic in psoriasis. The phototype V-VI group less frequently switched treatments than did the other groups when the response was not efficient.

Efficacy and safety of oral roflumilast for moderate-to-severe psoriasis-a randomized controlled trial (PSORRO).

Roflumilast is a targeted inhibitor of phosphodiesterase (PDE)-4 and has been approved for treatment of severe chronic obstructive pulmonary disease for more than a decade. Generic versions are available in the United States. PDE-4 is involved in the psoriasis pathogenesis, but the efficacy and safety of oral roflumilast in patients with psoriasis have not previously been studied. A company-independent, multicenter, randomized, double-blind, placebo-controlled trial (ClinicalTrials.govNCT04549870). Patients were randomized 1:1 to receive monotherapy with oral roflumilast 500μg once daily or placebo. At week 12, placebo patients were switched to open-label roflumilast through week 24. The primary endpoint was a 75% or greater reduction from baseline in the psoriasis area and severity index (PASI75) at week12. In all, 46 patients were randomized (roflumilast, n=23; placebo, n=23). At week 12, significantly more patients in the active arm achieved PASI75 (8 of 23 patients [35%]) vs. placebo (0 of 23 patients [0%], with a difference vs. placebo of 8 [35%] patients, 95% CI: 3 [13%]-13 [57%] patients) (p=0.014). At week 24, 15 (65%), 10 (44%), 5 (22%), and 2 (9%) of patients treated with roflumilast from week 0 had PASI50, PASI75, PASI90, and PASI100 responses (key secondary endpoints), respectively. The most prevalent, drug-related adverse events in both treatment groups were transient gastrointestinal symptoms, weight-loss, headache, and insomnia. A total of three patients (roflumilast n=2; placebo, n=1) discontinued therapy due to adverse events. Oral roflumilast was efficacious and safe in treating moderate-to-severe plaque psoriasis over 24 weeks. With generic versions available, this drug may represent an inexpensive and convenient alternative to established systemic psoriasis treatments. Financial support was received from Herlev and Gentofte Hospital, University of Copenhagen, and independent grants from private foundations in Denmark. No pharmaceutical company, including the market authorization holder of roflumilast, was involved in the study at any point.

004 Does methotrexate affect treatment persistence or effectiveness of adalimumab for psoriasis? A trial emulation cohort study

Abstract It is unclear whether concomitant methotrexate enhances the effectiveness and/or persistence of adalimumab in treating psoriasis. The OPTIMAP study (Optimizing Adalimumab Treatment in Psoriasis with Concomitant Methotrexate), a randomized controlled trial testing adalimumab against adalimumab + methotrexate, could not adequately answer this question due to under-recruitment. The aim of the current study is to replicate key aspects of the OPTIMAP trial design in a cohort study to provide a more precise estimate for the effect of concomitant methotrexate on adalimumab persistence and effectiveness. We conducted a cohort study using the British Association of Dermatologists Biologics and Immunomodulators Register, a national pharmacovigilance registry for people on systemic treatments for psoriasis, between 2007 and 2021. We included participants ≥ 18 years old who had at least one record of a Psoriasis Area and Severity Index (PASI) ≥ 8 and were naïve to adalimumab. We used the same exclusion criteria as in the OPTIMAP study. Participants received either adalimumab (Humira®) in the comparison arm or adalimumab (Humira) in addition to methotrexate and folic acid, with dosage as determined by the clinician in the intervention arm from initiation at cohort entry, and were censored if they deviated from the treatment strategy. The primary outcome is in the difference in the survival function for adalimumab at 1 year. The secondary outcome was the difference in the proportion of patients achieving a 75% reduction in PASI (PASI 75) at 1 year. We used inverse probability treatment weighting to correct for known differences in participant characteristics precomparison. Missing outcomes were accounted for using inverse probability of censoring weighting. We fitted a flexible parametric survival model and a generalized linear model with an identity link for the primary and secondary outcomes, respectively. There were 219 and 1376 participants in the intervention and comparison arms, respectively. Drug survival for the monotherapy arm at 1 year was 77.5% [95% confidence interval (CI) 75.3–79.8], and for the intervention arm, it was 75.3% (95% CI 66.9–84.7), with a difference of −2.3% (95% CI −11.4 to 6.9). The risk difference for PASI 75 at 1 year was −10.7% (95% CI −29.3 to 8.0), with a PASI 75 rate of 43.5% for the intervention arm (95% CI 25.4–61.9) and 54.2% for the comparison arm (95% CI 49.6–58.7). We did not find any significant difference for the persistence and effectiveness of adalimumab in people with psoriasis on methotrexate vs. those who were not on methotrexate in this study. This result is in keeping with the reported first-year outcomes of OPTIMAP. Clinicians and patients should consider alternative strategies to improve treatment outcomes in people with severe psoriasis.

Psoriatic Arthritis: Development, Detection and Prevention: A Scoping Review.

Psoriatic arthritis is a heterogenous chronic inflammatory disease that develops over time in some patients with psoriasis. The course of the disease is variable, with a broad clinical spectrum. The management of PsA has changed tremendously over the last decade, thanks to earlier diagnosis, a multidisciplinary approach and progress in pharmacological therapies. Therefore, screening for risk factors and the early signs of arthritis is highly important and recommended. Currently, research is focused on finding soluble biomarkers and developing imaging techniques that can improve the prediction of psoriatic arthritis. Among imaging modalities, ultrasonography seems to be the most accurate in detecting subclinical inflammation. Early intervention is based on the assumption that it is possible to prevent or delay psoriatic arthritis if systemic treatment for psoriasis can be administered early enough. This review article provides an overview of the current perspectives and evidence regarding the diagnosis, management and prevention of psoriatic arthritis.

Systemic treatment of psoriasis in special population.

Psoriasis is a common skin disorder affecting approximately 1% of the general population. The treatment of psoriasis depends on the body surface area involvement, quality of life impairment and associated co-morbidities. Special population comprising of pregnant women, lactating mothers, elderly individuals and children, is more vulnerable. They are not included in drug trials; rendering the data for use of systemic treatment scant and is mainly based on anecdotal evidence. In this narrative review, we discuss systemic treatment options in this special population. Though couples planning a family are not considered a special population, they form a subset that require special therapeutic consideration and have also been included in this review.

Systematic review: andrographolide as a potential Anti-inflammatory treatment for psoriasis

A chronic inflammatory skin condition called psoriasis affects 1-3% of people worldwide. It will lead to other psychological, endocrine, and cardiovascular issues. It mainly affects the elbows, knees, scalp, back, umbilicus, and lumbar regions and is distinguished by well-defined crimson plaques and thick silvery white scales. Topical corticosteroid cream has been the main therapy in treating inflammatory skin in psoriasis vulgaris until now. Nowadays, andrographolide is an active compound of Andrographis paniculate, or the name in Indonesia is Sambiloto, which has been reported as a potential anti-inflammatory. Therefore, this study aimed to systematically review the published efficacy of andrographolide as an anti-inflammatory in an in vivo study and synthesize the available data. This study was a literature review searched using PubMed/ Medline, Science Direct, and Cochrane up to September 2022. The following search terms were used: (andrographolide or Andrographis paniculate) AND (anti-inflammatory) AND (animal study or in vivo). The bias in the research using the Newcastle-Ottawa quality assessment score was rated as low risk, of some concern, or high risk. A total of six in vivo studies were included in our analysis. Methotrexate and biologic agents are used for the systemic treatment of psoriasis. Topical corticosteroid therapy remains the first line of topical therapy but has some side effects. Specific reporting of andrographolide as a potential anti-inflammatory in other inflammatory diseases is necessary to support the possible treatment for psoriasis. There still needs to be further studies regarding the use of andrographolide as a topical psoriasis treatment.

Impact of comorbidities in elderly and frail patients and response to biological therapy in psoriasis.

Impact of comorbidities in elderly and frail patients and response to biological therapy in psoriasis.

ASSESSMENT OF INFECTION RISK IN OLDER PATIENTS WITH PSORIASIS ON SYSTEMIC THERAPY

Systemic treatment for psoriasis can be effective but have more risk of infection especially in old age groups. The aim of this study is to assess the infection risk in older patients with psoriasis on systemic therapy. A total of 639 patients were included in the study those were taking systemic therapy for psoriasis for last 6 months. They were divided into two groups. Group A with younger patients whereas the Group B had the older patients. Data was gathered and analyzed. Both groups were compared with respect to the incidence of infection. The results showed that that the group B had significantly high frequency of infection compared to the Group A. In conclusion, the assessment of infection risk in older patients with psoriasis who are receiving systemic therapies is crucial to ensure that patients receive the most appropriate and effective treatment while minimizing the risk of infections and other adverse events.

The Effect of Biological Treatment on Stress Parameters Determined in Saliva in Patients with Severe Psoriasis.

Background and objectives: In psoriatic patients, stress is the most common aggravating factor. Despite the use of quality-of-life assessment questionnaires, diagnosing stress in psoriatic patients is not a flawless procedure. This study aimed to assess the usefulness of potential stress biomarkers in saliva for monitoring the treatment of psoriasis. Materials and methods: A total of 104 adult patients with severe psoriasis were included and randomly treated via biological treatment or symptomatic therapy: 84 received biological treatment, with 20 formed a control group receiving symptomatic therapy. The administered biological treatment was adalimumab, whilst in controls calcipotriol/betamethasone dipropionate topical gel and emollients were used. Patients were monitored monthly with a dermatological examination and the dispensing of a biological drug. During each of the four visits, the severity of the disease was assessed (PASI, BSA, and DLQI), and a sample of the patient's saliva was taken. In all the participants, the saliva concentrations of immunoglobulin A (sIgA), α-amylase (sAA), and chromogranin A (CgA) were measured. Results: The majority of patients in both the study and control groups achieved clinical improvement, though favoring the group receiving biological treatment. The concentration of sIgA in the saliva was constantly increasing in the study group during subsequent visits (Fr = 27.26; p < 0.001). Meanwhile, there were no statistically significant changes in the control group during the same follow-up period (Fr = 6.66; p = 0.084). Levels of sAA underwent statistically significant changes in both groups (Fr = 58.02; p < 0.001-study group and Fr = 13.74; p = 0.003-control group). In the study group, a steady, statistically significant increase in sAA was observed from the first to the third visit. In the study group, a downward trend in CgA concentration was observed. In the control group, no significant differences in the level of CgA were obtained. Conclusions: sIgA, sAA, and CgA are potential markers of the severity of psoriasis and the associated stress reaction. Based on the presented observations, only sIgA and CgA seem to be valuable biomarkers for monitoring the effectiveness of the systemic treatment of psoriasis.

COVID-19 vaccination in psoriasis patients receiving systemic treatment: A prospective single-center study.

The rate of seroconversion after COVID-19 vaccination in patients with moderate to severe psoriasis requiring systemic treatment is poorly understood. The aim of this prospective single-center cohort study performed between May 2020 and October 2021 was to determine the rate of seroconversion after COVID-19 vaccination in patients under active systemic treatment for moderate to severe psoriasis. Inclusion criteria were systemic treatment for moderate to severe psoriasis, known COVID-19 vaccination status, and repetitive anti-SARS-CoV-2-S IgG serum quantification. The primary outcome was the rate of anti-SARS-CoV-2-S IgG seroconversion after complete COVID-19 vaccination. 77 patients with a median age of 55.9 years undergoing systemic treatment for moderate to severe psoriasis were included. The majority of patients received interleukin- (n=50, 64.9%) or tumor necrosis factor (TNF)-α inhibitors (n=16, 20.8%) as systemic treatment for psoriasis; nine patients (11.7%) were treated with methotrexate (MTX) monotherapy, and one patient each received dimethyl fumarate (1.3%), respectively apremilast (1.3%). All included patients completed COVID-19 vaccination with two doses over the course of the study. Serum testing revealed that 74 patients (96.1%) showed an anti-SARS-CoV-2-S IgG seroconversion. While all patients on IL-17A, -12 or -12/23 inhibitors (n=50) achieved seroconversion, three of 16 patients (18.8%) receiving MTX and/or a TNF-α inhibitor as main anti-psoriatic treatment did not. At follow-up, none of the patients had developed symptomatic COVID-19 or died from COVID-19. Anti-SARS-CoV-2-S IgG seroconversion rates following COVID-19 vaccination in psoriasis patients under systemic treatment were high. An impaired serological response, however, was observed in patients receiving MTX and/or TNF-α inhibitors, in particular infliximab.

Impact of the first wave of the COVID-19 pandemic on the treatment of psoriasis with systemic therapies in France: Results from the PSOBIOTEQ cohort

BackgroundThe nature of the COVID-19 pandemic led to concerns among patients and physicians about the potential impact of immunosuppressive treatments for chronic diseases such as psoriasis on the risk of severe COVID-19. ObjectivesTo describe treatment modifications and determine the incidence of COVID-19 infection among psoriasis patients during the first wave of the pandemic, and identify the factors associated with these events. MethodsData from PSOBIOTEQ cohort relating to the first COVID-19 wave in France (March to June, 2020), as well as a patient-centred COVID-19 questionnaire, were used to evaluate the impact of lockdown on changes (discontinuations, delays or reductions) in systemic therapies, and to determine the incidence of COVID-19 cases among these patients. Logistic regression models were used to assess associated factors. ResultsAmong the 1751 respondents (89.3%), 282 patients (16.9%) changed their systemic treatment for psoriasis, with 46.0% of these changes being initiated by the patients themselves. Patients were more likely to experience psoriasis flare-ups during the first wave if they changed their treatment during this period (58.7% vs 14.4%; P < 0.0001). Changes to systemic therapies were less frequent among patients with cardiovascular diseases (P < 0.001), and those aged ≥ 65 years (P = 0.02). Overall, 45 patients (2.9%) reported having COVID-19, and eight (17.8%) required hospitalization. Risk factors for COVID-19 infection were close contact with a positive case (P < 0.001) and living in a region with a high incidence of COVID-19 (P < 0.001). Factors associated with a lower risk of COVID-19 were avoiding seeing a physician (P = 0.002), systematically wearing a mask during outings (P = 0.011) and being a current smoker (P = 0.046). ConclusionsDiscontinuation of systemic psoriasis treatments during the first COVID-19 wave (16.9%) – mainly decided by patients themselves (46.0%) – was associated with a higher incidence of disease flares (58.7% vs 14.4%). This observation and factors associated with a higher risk of COVID-19 highlight the need to maintain and adapt patient–physician communication during health crises according to patient profiles, with the aim of avoiding unnecessary treatment discontinuations and ensuring that patients are informed about the risk of infection and the importance of complying with hygiene rules.

Illustrating Emerging Good Practices for Quantitative Benefit-Risk Assessment: A Hypothetical Case Study of Systemic Biologic Treatments for Plaque Psoriasis

ObjectivesQuantitative benefit-risk assessment (qBRA) is a structured process to evaluate the benefit-risk balance of treatment options to support decision making. The ISPOR qBRA Task Force was recently established to provide recommendations for the design, conduct, and reporting of qBRA. This report presents a hypothetical case study illustrating how to apply the Task Force’s recommendations toward a qBRA to inform the benefit-risk assessment of brodalumab at the time of initial marketing approval. The qBRA evaluated 2 dosing regimens of brodalumab (210 mg or 140 mg twice weekly) compared with weight-based dosing of ustekinumab and placebo. MethodsWe followed the 5 steps recommended by the Task Force. Attributes included treatment response (≥75% improvement in Psoriasis Area and Severity Index), suicidal ideation and behavior, and infections. Performance data were drawn from pivotal clinical trials of brodalumab. The qBRA used multicriteria decision analysis and preference weights from a hypothetical discrete choice experiment. Sensitivity analyses examined the robustness of benefit-risk ranking to uncertainty in clinical effect and preference estimates, consideration of a subgroup (nail psoriasis), and the maintenance phase of treatment (52 weeks instead of 12). ResultsResults from this hypothetical qBRA suggest that brodalumab 210 mg had a more favorable benefit-risk profile compared with ustekinumab and placebo. Ranking of brodalumab compared with ustekinumab was dependent on brodalumab’s dose. Sensitivity analyses demonstrated robustness of benefit-risk ranking to uncertainty in clinical effect and preference estimates, as well as choice of attributes and length of follow-up. ConclusionThis case study demonstrates how to implement the ISPOR Task Force’s good practice recommendations on qBRA.

Pequeñas moléculas: nuevos horizontes terapéuticos en la psoriasis

Psoriasis is a chronic immune-mediated skin disease frequently associated with different comorbidities, among which psoriatic arthritis stands out, with a high impact on the quality of life of patients. We have an important therapeutic arsenal that includes topical agents, phototherapy and systemic drugs. In recent years, biological therapy has brought about a true revolution in the treatment of moderate to severe psoriasis, due to its great efficacy and safety. However, it has some limitations such as its exclusively parenteral administration, its high cost and the lack of efficacy and tolerance in some cases. Therefore, based on a better knowledge of the pathophysiology of psoriasis, new therapeutic options have emerged: the small molecules. They represent an enrichment for the clinician in the therapeutic management of psoriasis. Some of those have approved indication and others under investigation. The objective of this review is to analyze the efficacy and safety data of these molecules that include phosphodiesterase inhibitors (apremilast), Janus kinase inhibitors (tofacitinib, baricitinib), selective tyrosine kinase 2 inhibitors (deucravacitinib), agonists G protein-associated A3 adenosine receptor (piclidenoson), orphan T-gamma receptor inverse agonists (vimirogant), and sphingosine-1-phosphate receptor antagonists (ponesimod). In addition, new molecular targets are discussed. In short, the frontline of new systemic treatment for psoriasis.

Trends in Systemic Psoriasis Treatment: Is Psoriasis Still Being Undertreated?

Trends in Systemic Psoriasis Treatment: Is Psoriasis Still Being Undertreated?

The Use of IL-17 and IL-23 Inhibitors in Swedish Clinical Practice: A Register-Based Analysis

Background: Interleukin (IL) inhibitors have made completely cleared skin achievable for many patients with moderate to severe psoriasis in clinical trial settings. Few observational studies assess treatment response in accordance with treatment goals in guidelines. Objectives: The aim of the study was to analyze the treatment response of IL-17/IL-23 inhibitors in clinical practice and the proportions of patients that reach the treatment target of the Psoriasis Area and Severity Index (PASI) < 3 and the Dermatology Life Quality Index (DLQI) ≤5. Methods: A longitudinal, observational study based on the Swedish National Registry for Systemic Treatment of Psoriasis, PsoReg. Patients using IL-17/IL-23 inhibitors with assessments of PASI, DLQI, and EQ-5D before (maximum 6 months) and after (3–12 months) initiation of IL-17/IL-23 were included. Results: In total, 333 patients using IL-17/IL-23 inhibitors were included. Eighty percent (n = 266) received IL-17 inhibitors, and 20% (n = 67) received IL-23 inhibitors. Sixty-six percent of patients reached both PASI <3 and DLQI ≤5, 23% reached one target, and 11% reached none. The mean (SD) PASI, DLQI, and EQ-5D improvements were 6.75 (6.99), 7.14 (7.97), and 0.126 (0.296), respectively. There was no statistically significant difference in outcomes between IL-17 and IL-23 inhibitor treatment groups. Conclusions: IL-17/IL-23 inhibitors are effective in clinical practice, but there is still an unmet therapeutic need in moderate to severe psoriasis.

Economic Burden of Comorbidities in Patients with Psoriasis in the USA.

This study assessed the comorbidity burden, healthcare resource utilization (HCRU), and costs associated with patients with moderate to severe psoriasis (PsO) compared with a matched cohort of the general population without PsO in the USA. Comorbidity-related HCRU (incidence rate ratios [IRRs]) and direct medical cost burden (per patient per month [PPPM] 2020 USD) in patients with moderate to severe PsO in the USA, previously apremilast- and biologic-naive, but currently treated, versus the general population were assessed through a retrospective cohort study using IBM (now Merative) MarketScan Commercial and Medicare Claims data (1 January 2006 to 31 December 2019). Comorbidities included cardiovascular, mental health, pulmonary, diabetes, hyperlipidemia, hypertension, peripheral vascular, liver, obesity, and other autoimmune disorders. There are increased all-cause HCRU and costs in patients with PsO compared with the general population. These differences (PsO-general population) in HCRU and costs (IRR visits; PPPM) are associated with specific comorbidities, including mental health (1.08; $372), chronic pulmonary disease (1.07; $135), diabetes (1.10; $159), hyperlipidemia (1.13; $203), hypertension (1.13; $305), liver disease (1.21; $360), and obesity (1.12; $145, all P < 0.01). Patients with PsO experience a higher economic burden of comorbidities than the general population despite using currently available systemic treatments for PsO.

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.