bluuebunny/crossref_metadata_2025 huggingface dataset:
The Direct Correlation between Total Body Surface Area Involvement and PASI Scores in Judging Psoriasis Severity
Authors: Chinn Steven , Zeichner Joshua A.
Published: April 2018

The Psoriasis Area and Severity Index (PASI) is a psoriasis severity measurement tool used by clinicians, which evaluates different regions of the body and rates the corresponding psoriatic lesions based on their level of erythema, induration and scaliness. It is a highly quantitative method that has been used by some insurance companies to establish minimum requirements for approval of the biologic therapeutics alefacept (Amevive), efalizumab (Raptiva) or etanercept (Enbrel) for psoriasis. A large insurance company proposed a minimum PASI score of 10 to justify reimbursement for biologic therapies. However, calculating the PASI score was burdensome. We hypothesized that the method of calculating percentage of body surface area (BSA) affected would be easier and more time-efficient, and thus could serve as a suitable proxy for the PASI score.

We analyzed the BSA percentages and corresponding PASI scores in 96 patients whose psoriasis was prospectively graded in clinical trials. We hypothesized that BSAs of 10% to 15% correlated to a PASI of 10, the threshold score for the insurance company to authorize the use of the biologics. Our results show that with a minimum BSA involvement of 13%, only two out of 15 patients had PASI scores less than 10, and both of those patients had PASI scores greater than 9. Like the PASI score, BSA is an imperfect tool for the assessment of psoriasis severity, but it is much easier to use than the PASI score.
Safety and Efficacy of 16 Weeks of 30 mg/Week Intramuscular Alefacept in the Treatment of Chronic Plaque Psoriasis
Authors: Gosnell Amy L. , Kaur Mandeep , Carroll Christie , Pearce Daniel J. , Boles Ann F , Camacho Fabian , Fleischer Alan B. , Feldman Steven R.
Published: April 2018

Background

The biological agent alefacept (Amevive) induces sustained clinical improvement in patients with chronic plaque-type psoriasis.1 Multiple or extended courses of therapy are associated with higher response rates and an increased duration of results.2,3

Objective

To obtain pilot information on the safety and efficacy of a 16-week course of intramuscular alefacept in doses of 30 mg per week.

Methods

All subjects in this open-label, single-center study received a starting dose of 15 mg intramuscular (IM) alefacept, followed by 30 mg per week for 15 weeks. Outcomes were assessed every two weeks throughout the 16-week drug administration phase and every four weeks during the 12-week follow-up phase using the Psoriasis Area and Severity Index (PASI), the Physician Global Assessment (PGA), Subject's Global Assessment (SGA), pruritus visual analog scale (VAS), measurement of CD4 counts and adverse event reporting.

Results

Of the 19 enrolled subjects, 17 completed treatment and 16 completed 12-week follow-up. PASI, PGA, SGA, and VAS scores improved from baseline to week 16 with 59% of subjects achieving a 50% reduction in PASI (PASI 50), and 18% achieving a 75% reduction (PASI 75). Clinical improvement occurred during the treatment phase and continued into follow-up. CD4 counts decreased significantly from week 2 to week 16, but a linear trend was not seen. No adverse events occurred that required discontinuation of treatment. One subject had a CD4 count < 250 cells/μL for 4 consecutive weeks, leading to the discontinuation of treatment in accordance with the protocol.

Conclusion

A16-week extended course of higher dose (30 mg) IM alefacept was well-tolerated and may offer additional therapeutic benefit to some patients. However, the higher dose and extended course did not dramatically improve efficacy seen with lower doses in previous trials.
TNF-α Blocker-Induced Psoriasiform Dermatitis
Authors: Hayashi Genki , Becker Emily , Berger Tim , Koo John
Published: April 2018

Background

The anti-TNF-α agents adalimumab, infliximab and etanercept are indicated for a variety of autoimmune diseases such as rheumatoid arthritis (RA), Crohn's disease (CD), ankylosing spondylitis (AS), psoriatic arthritis (PsA) and psoriasis (Pso). In some patients treated for nonpsoriatic conditions such as rheumatoid arthritis and Crohn's disease, these agents have been associated with the appearance of psoriasis (either its emergence or exacerbation)—a term previously coined TNF-α antagonist induced psoriasis.

Objective

This article reviews published data demonstrating this phenomenon.

Methods

Studies with English abstracts between 2000–2008, identified in MEDLINE and PUBMED with keywords anti-TNF, psoriasis, TNF-α antagonist and induced, were retrospectively reviewed.

Results

An association between use of anti-TNF agents and the appearance of psoriasis was seen in a total of 219 patients from 38 reports.

Conclusion

There is an association between use of anti-TNF agents and appearance of psoriasis, but the specific nature of the relationship is unknown. Recent studies help to delineate patient characteristics common among the group, as well as theorize proposed mechanisms for the emergence of psoriasis. At this time, however, further investigation into this multi-factorial condition is needed.
A Practical Approach to the Use of Infliximab
Authors: Pancir Darcy , Lebwohl Mark
Published: April 2018

Infliximab is one of the most effective treatments available for severe psoriasis. It has been used successfully to treat severe plaque psoriasis, pustular psoriasis and erythrodermic psoriasis, and is one of the most rapidly effective treatments available. Relative contraindications include severe infliximab hypersensitivity, severe heart failure and significant infections including tuberculosis, malignancies and demyelinating diseases. Baseline screening must include testing for tuberculosis (TB) and most advise routine chemistry screen and complete blood count (CBC). The drug is administered by intravenous (IV) infusion. The development of infusion reactions may necessitate treatment with acetaminophen, diphenhydramine and epinephrine. Pre-treatment with acetaminophen and diphenhydramine can prevent infusion reactions.

Follow-up monitoring should include screening for tuberculosis, chemistry screens with liver function tests, CBC and monitoring for infection or malignancy. Side effects include reactivation of tuberculosis, exacerbation of heart failure, reactivation of hepatitis B, hepatotoxicity, exacerbation of demyelinating diseases, the development of lupus-like syndromes and infusion reactions.
Calcitriol 3 μg/g Ointment: A New Topical Treatment for Psoriasis
Authors: Zeichner Joshua , Bowes Mark P.
Published: April 2018

Vitamin D receptor modulators have been used extensively for years in the treatment of psoriasis. These agents have demonstrated comparable efficacy to mid-potency corticosteroids and have a good safety profile. Vitamin D receptor modulators are useful as single agents and when used in combination, rotational or sequential therapy with other psoriasis treatments. Calcitriol ointment (1α,25-dihydroxyvitamin D3), the naturally occurring, endogenous, biologically active metabolite of vitamin D3, has recently been approved in the United States as the only Vitamin D3 ointment (Vectical™) available for the topical treatment of psoriasis. Two randomized, double-blind, placebo-controlled clinical trials demonstrated the application of calcitriol 3 μg/g ointment twice daily for eight weeks produced significantly greater improvement than did vehicle ointment on physician-rated and patient-rated scores of global psoriasis severity and improvement in psoriasis symptoms from baseline. Long-term clinical trials have demonstrated that twice-daily calcitriol was safe and well-tolerated for one year or longer and that calcium homeostasis was not significantly affected by continuous treatment up to 52 weeks.

A direct comparison of calcitriol and calcipotriol [calcipotriene (Dovonex®)] in patients with chronic plaque psoriasis found that the two agents produced generally similar improvements in psoriasis severity but that calcitriol was associated with fewer cutaneous adverse events. A second comparative study that examined calcitriol and calcipotriene for the treatment of psoriasis in sensitive areas found that calcitriol produced significantly less perilesional edema, erythema and stinging/burning than did calcipotriene. Several clinical trials also support calcitriol as part of combination therapy. Topical calcitriol ointment is a new, safe, effective and well-tolerated treatment that offers considerable flexibility in psoriasis care.
Can Adalimumab Make a Smooth and Easy Transition from Cyclosporine a Reality? A Case Series of Successful Transitions
Authors: Gattu Shilpa , Wu Jashin J. , Koo John Y.M.
Published: April 2018

Background

Cyclosporine, a calcineurin inhibitor of T cells, is an effective treatment option for generalized psoriasis. However, its duration of use is limited to one to two years due to its risk of organ toxicity, while its discontinuation raises concern for relapse. Initiating cyclosporine is often met with reluctance in the absence of a safe, long-term agent with which to transition patients after treatment with cyclosporine. Adalimumab, a tumor necrosis factor inhibitor recently approved for the treatment of psoriasis, may provide a safe alternative for long-term therapy. An experience of using sequential therapy with these two treatments to help prevent relapse in patients transitioning from cyclosporine to adalimumab is described.

Methods

A series of five representative patients is presented. Patients were informed of the off-label nature of concomitant use of cyclosporine and adalimumab for the treatment of psoriasis.

Results

Five patients with severe generalized psoriasis, ages 17, 21, 22, 31, and 41, were treated with cyclosporine for one to two years prior to beginning treatment with adalimumab. Cyclosporine was tapered over a period of 6, 12, 12, 8 and 11 weeks respectively and eventually discontinued. There was no decrease in Psoriasis Area and Severity Index (PASI) scores from the time of initiating adalimumab to discontinuation of cyclosporine. Serum labs and blood pressure readings remained normal for all five patients during this period and no adverse events were noted.

Conclusion

Patients may be smoothly transitioned from cyclosporine to adalimumab through sequential therapy to minimize risk of recurrence of psoriasis. The short duration of three months or less in young healthy individuals may allow safe concomitant use of these two drugs. Whether sequential therapy of cyclosporine and long-term treatment with adalimumab will be successful and safe must be validated by large controlled studies.
Clinical Review a Practical Approach to the Use of Etanercept
Authors: Wolinsky Claire , Kwon Audrey , Lebwohl Mark
Published: April 2018

This clinical review outlines a practical approach to the use of etanercept in the treatment of psoriasis. Etanercept is FDA-approved for treatment of adult patients with chronic moderate-to-severe plaque psoriasis and psoriatic arthritis in addition to several other rheumatologic conditions. It is a recombinant fusion protein consisting of tumor necrosis factor-alpha (TNF-α) receptor components covalently linked to the Fc portion of IgG. Etanercept binds and inactivates TNF-α. The most common side effect associated with its use is mild to moderate injection-site reactions that usually do not require discontinuation of treatment. There is also likely some increased risk of infection and malignancy associated with this agent that one should consider when prescribing this medication.
Clinical Application of National Psoriasis Foundation Findings for Management of Psoriasis in Patients with Coexisting Hepatitis C Infection
Authors: Rhee Libby , Hadi Ahmed , Hasty Robert
Published: April 2018

Treating psoriasis in patients with concomitant hepatitis C infection presents an intricate challenge. Interferon (IFN) therapy, a mainstay of therapy for hepatitis C virus infection, often exacerbates psoriasis. Moreover, many psoriatic therapies are contraindicated in chronic liver infections due to their potential hepatotoxicity and immunosuppressive effects. The National Psoriasis Foundation (NPF) recently issued a consensus statement regarding the treatment of psoriasis in patients infected with hepatitis C virus (HCV) with the aim of standardizing treatment options and optimally managing psoriasis while minimizing adverse risks for the patients. A patient case is presented here for which the evidence-based treatment guidelines are applied and discussed. By managing psoriasis in patients with coexisting hepatitis C infection in a step-wise manner based on the currently recommended treatments, potential negative complications such as exacerbation of liver disease and dangerous psoriatic flares may be minimized.
Prevention of Tuberculosis Infections in Patients Considered for Anti-TNF-α Therapy: Practical Application of National Psoriasis Foundation Consensus Statement
Authors: Huo Ran , Sikaria Swati , Berman Brian
Published: April 2018

Tumor necrosis factor inhibitors have been linked to increased Mycobacterium tuberculosis infections. In order to standardize treatment and minimize risks to patients, the National Psoriasis Foundation (NPF) issued a consensus statement on patient management regarding this issue, including advice on when to use the FDA-approved QuantiFERON® TB Gold screening test. The evidence-based guidelines developed in the Psoriasis Foundation statement are summarized in a practical clinical algorithm, which we have applied to the management of a patient with severe psoriasis. Proper utilization of this algorithm clarifies the risks and benefits balance of using these biologics. In general, the tumor necrosis factor-alpha (TNF-α) inhibitors possess impressive rates of efficacy in the treatment of psoriasis and relatively fewer adverse effects when compared with other systemic immunosuppressants.
Golimumab: A User's Guide to a New Biologic Treatment
Authors: Michelon Melissa A. , Wang Andrew
Published: April 2018

Background

Golimumab is a new tumor necrosis factor (TNF) antagonist recently approved by the Food and Drug Administration for controlling the signs and symptoms of rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis, although it is not currently approved for use in psoriasis.

Objective

To give readers a review of current literature and clinical trials of golimumab and serve as a guide to this new biologic therapy.

Methods

A Medline search was performed using the following terms: golimumab, anti-TNF, psoriasis, and psoriatic arthritis. Product inserts were obtained from fda.gov/Drugs.

Results

In a phase III clinical trial comprising patients with psoriatic arthritis, patients receiving golimumab showed significant improvement in the signs and symptoms of disease. Significant changes in the Psoriasis Area and Severity Index were also observed in patients with at least 3% body surface area treated with golimumab. Other assessments included the Nail Psoriasis Severity Index, Physician's Global Assessment of psoriatic nail disease, and the psoriatic arthritis modified Maastricht Ankylosing Spondylitis Enthesitis Score, all of which showed notable improvement in golimumab-treated patients compared with placebo. Golimumab was usually well tolerated in phase III trials, but adverse events generally occurred more often in patients receiving golimumab compared with placebo. Long-term safety studies are ongoing.

Conclusion

Golimumab, one of the newest anti-TNF therapies, offers health care providers another effective treatment option for patients with psoriatic arthritis with a similar side effect profile and convenient dosing schedule relative to other available TNF antagonists.
OBSERVE-5, an Observational Post-Marketing Safety Surveillance Registry of Etanercept for the Treatment of Psoriasis: A Model for Studying New Psoriasis Therapies
Authors: Kimball Alexa B. , Pariser David , Yamauchi Paul S. , Menter Alan , Teller Craig F. , Shi Yifei , Creamer Kara , McCroskery Peter , Kricorian Gregory , Gelfand Joel M.
Published: April 2018

Background

OBSERVE-5 is collecting safety data from real-world use of etanercept in the treatment of psoriasis per a post-marketing commitment of the U.S. Food and Drug Administration.

Methods

This phase IV prospective, multicenter, 5-year observational registry was designed to enroll patients with plaque psoriasis for whom etanercept is indicated. Patients receive etanercept per standard medical care and can discontinue etanercept therapy at any time following receipt of the baseline dose. Visits occur at least twice yearly; follow-up will be up to 5 years.

Conclusions

Data from the OBSERVE-5 registry will complement safety data from clinical trials of etanercept.
Importance of CD109 and Transforming Growth Factor-β Signaling in Psoriasis
Authors: Litvinov Ivan V. , Bizet Albane , Binamer Yousef , Sasseville Denis , Philip Anie
Published: April 2018

Psoriasis is a chronic inflammatory skin disorder characterized by keratinocyte hyperproliferation, leukocyte infiltration, and alterations in cytokine production. Recent work documented that the inappropriately activated T helper cells 1 and 17 lymphocytes play a critical role in disease initiation and progression by elaborating an array of inflammatory cytokines that deregulate normal keratinocyte proliferation and differentiation. The key signal to suppress keratinocyte growth is the transforming growth factor (3 (TGF-β) protein, the expression of which is documented to be increased in psoriatic patients. Despite the observed upregulation in TGF-β signal, psoriatic keratinocytes continue to proliferate in response to other signals. Thus, there appears to be discordance between high levels of TGF-β at a lesion site and increased keratinocyte growth. Recently we identified CD109, a glycosyl-phosphatidylinositol (GPI)-anchored protein, as a novel regulator of the TGF-β signaling. CD109 is expressed on the keratinocyte cell surface and is released via an endogenous lipase into the extracellular milieu. Membrane-anchored CD109 has been documented to bind the TGF-β protein as well as interact with the TGF-β receptor and alter its stability and function. We describe here the paradoxical discordance between high TGF-β levels and the lack of proliferation inhibition in psoriatic skin. We also highlight the possible importance of CD109 as a critical TGF-β signaling modulator in psoriasis. Further understanding of CD109 and TGF-β signaling in psoriasis may lead to development of new, effective therapies.
A Practical Approach to the Use of Alefacept
Authors: Bashey Sameer , Tharp Michael
Published: April 2018

Alefacept is a recombinant, fully human immunoglobulin G1 fusion protein indicated for the treatment of moderate to severe psoriasis in patients who are also candidates for other biologics or phototherapy. Alefacept is considered by many authorities to be one of the safest biologic agents available to treat psoriasis. The drug, marketed and distributed as Amevive, is a leukocyte function antigen-3 fusion protein that selectively binds the CD2 receptor, consequently causing T-cell suppression with resulting clinical improvement of psoriasis. It is commonly administered as an intramuscular injection given weekly for a period of 12 weeks. This article serves as a practical outline for the major uses and indications of alefacept while also highlighting its unique mechanism of action and side effect profile.
Nail Psoriasis: A Review of Treatment
Authors: Kerensky Todd A. , Gottlieb Alice B.
Published: April 2018

Nail psoriasis is a common and disabling manifestation of cutaneous plaque-type psoriasis. Treatment of nail psoriasis is often unsuccessful and frequently requires prolonged and tedious treatment regimens to achieve or maintain remission. The clinician may choose from a variety of treatment modalities, including topical, intralesional, radiation, and systemic modes of therapy. The objective of this review is to summarize the available treatment options and assess their effectiveness for the treatment of nail psoriasis.
A Clinical Study Comparing the Efficacy of Halobetasol Propionate 0.05% Ointment Once Daily versus Twice Daily in Combination with Ammonium Lactate Lotion in the Treatment of Stable Plaque Psoriasis
Authors: Busse Zitelli Kristine , Bhutani Tina , Patel Tejas , Chiang Charles , Wu Jashin J. , Koo John
Published: April 2018

Objective

The aim of this study was to compare the efficacy of halobetasol propionate 0.05% ointment administered once daily with that of the ointment administered twice daily in combination with 12% ammonium lactate lotion for treatment of plaque psoriasis. A second objective was to investigate the benefits of maintenance therapy with ammonium lactate 12% lotion.

Design

The study was a randomized, investigator-masked, parallel trial. In the first phase, subjects applied halobetasol 0.05% ointment either once or twice daily in combination with 12% ammonium lactate lotion twice daily for 2 weeks. In the second phase, subjects either continued ammonium lactate twice daily or discontinued all treatment for 4 weeks.

Setting

University of California San Francisco Psoriasis and Skin Treatment Center. Participants: The study comprised 40 patients with a target plaque of at least 1 cm2 and a Psoriasis Severity Assessment (PSA) score of at least 6.

Measurements

Plaque induration, scale, and erythema were recorded at weeks 0, 1, 2, 4, and 6. Paired t-tests compared improvement between the two groups; unpaired t-tests compared differences between the two arms.

Results

No significant difference was noted in efficacy between once- and twice-daily halobetasol application at weeks 0 and 2 for induration (respectively, P = 0.10 and P = 0.21), scale (P = 0.49 and 0.51), erythema (P = 0.42 and 0.14), and total PSA (P = 0.37 and 0.23). A significant difference was found in scale between weeks 2 and 4 (P = 0.04) and weeks 2 and 6 (P = 0.03) in favor of patients continuing ammonium lactate lotion.

Conclusion

Once-daily halobetasol ointment achieves results similar to those of twice-daily application when used with ammonium lactate lotion in plaque psoriasis treatment. Sequential therapy with 2-week halobetasol ointment followed by twice-daily ammonium lactate may enhance therapeutic duration.
Psoriasis Treatments: A Review of the Current Research Pipeline
Authors: Golant Alexandra K. , Guttman-Yassky Emma
Published: April 2018

Psoriasis treatment is aimed at suppressing skin lesions and preventing relapses. Although in the last decade biological therapies have revolutionized the pharmacologic treatment armamentarium for psoriasis, many patients are still inadequately controlled with currently available therapeutics. An advanced understanding of the immunopathogensis of psoriasis has led to development of new drugs that refine existing treatments or target novel molecular and immunologic pathways. Here we review the most promising topical, oral, and injectable psoriasis treatments in the research pipeline, including agents that target cytokines interleukin (IL)-12/23, tumor necrosis factor-α, IL-20, IL-17, IL-22, inhibitors of calcineurin, phosphodiesterase type 4, protein kinase C, Janus kinase, p38 kinase, purine nucleotide phosphorylase, adenosine receptor agonists, and recombinant chaperonin protein. These targeted therapeutics offer the potential for greater clinical efficacy and less toxicity than traditional agents. As the number of treatment options continues to expand, clinicians will have more diverse opportunities to help patients achieve better psoriasis control.
Treatment with Tumor Necrosis Factor Antagonists and Their Possible Effects on Morbidity and Mortality in Psoriasis Patients
Authors: Carlos Margarita , Ortleb Melanie
Published: April 2018

Psoriasis is associated with numerous comorbid conditions, including psoriatic arthritis, metabolic syndrome, and cardiovascular disease, which often share a similar pathogenesis and follow a progressive pattern. Biologic agents, specifically those targeting tumor necrosis factor, constitute a relatively new, effective, and safe treatment modality for this disease. Because these agents are effective in suppressing the inflammation that occurs in psoriasis, they appear to play a key, but somewhat novel, role in preventing some comorbidities. This review article attempts to elucidate this concept through the currently available literature. We evaluate the possible effects of tumor necrosis factor antagonists on the natural history of psoriasis comorbidities in an effort to shed some light on this exciting frontier.
Psoriasis: What Has Failed and Why
Authors: Avshalumov Kristina , Larian Amir , Fernandes Neil F.
Published: April 2018

Psoriasis is an immune-mediated disease of complex etiology. This article discusses four medications that “failed” for treatment of psoriasis, each for a different reason. Efalizumab “failed” because patients developed progressive multifocal leukoencephalopathy and the drug was taken off the market. Benoxaprofen was shown to be effective for psoriasis in several small trials. However, the medication was withdrawn from the market due to numerous side effects, including hepatic failure. CTLA4-Ig (abatacept) is currently approved for the treatment of adult rheumatoid arthritis and idiopathic juvenile arthritis and is effective for the treatment of psoriasis. However, a high dose is necessary and cost of the medication becomes prohibitive. In several studies, mycophenolic acid was shown to be effective for treating psoriasis. However, its use is limited because of a wide range of side effects. More specific treatments with fewer side effects should become available as our understanding of psoriasis continues to increase.
Efficacy and Safety of a Second Adalimumab Treatment Cycle in Psoriasis Patients who Relapsed after Adalimumab Discontinuation or Dosage Reduction: A Double-Blind, Randomized, Placebo-Controlled Trial
Authors: Larian Amir , Emer Jason J. , Gordon Kenneth , Blum Robin , Okun Martin , Gu Yihua , Lebwohl Mark
Published: April 2018

Objective

To evaluate re-treatment with weekly adalimumab in patients with moderate to severe psoriasis who had been successfully treated with weekly adalimumab but relapsed following randomization to either dosage reduction or discontinuation.

Methods

Patients who had achieved a Psoriasis Area and Severity Index (PASI) response of 50 or greater after 12 weeks on adalimumab 40 mg weekly in a previous study (M02-538), but then fell below a PASI 50 response within 12 weeks following reduction of dosage frequency to adalimumab 40 mg every other week or treatment discontinuation, could enter study M03-596 and receive open-label re-treatment with 12 weeks of weekly adalimumab.

Results

Thirty-two patients relapsed on or before week 24 of M02-538 and entered study M03-596. Overall, 81.3% (26 of 32) again achieved a PASI 50 response after 12 weeks of re-treatment. Of the 19 M03-596 patients who had a PASI 75 response at week 12 of M02-538, 12 (63.1%) again achieved a PASI 75 response at week 12 of M03-596.

Conclusion

Most patients who had initially responded to weekly adalimumab and who relapsed after randomization to a lower dosage or discontinuation regained response upon re-treatment with weekly adalimumab.
Evaluating Psoriasis: A Review of the Assessments Most Commonly Used in Clinical Trials
Authors: Patel Rita V. , Tsui Cindy L.
Published: April 2018

Psoriasis is a chronic autoimmune inflammatory skin disease that affects 1% to 3% of the global population. Because no psoriasis biomarkers are available to assess disease severity, clinical measures are used in daily practice and in research to measure both severity and treatment response. In the clinic, psoriasis may be graded by the dermatologist as mild to severe and improvement measured as worse, unchanged, better, much better, or clear. However, these scales are insufficient for clinical trials, where objective tools that are reliable, valid, and consistent from investigator to investigator are needed to quantify disease activity more precisely. The aim of this research is to update the reader on how to assess the major evaluation components of psoriasis severity and to review the most common global and local psoriasis scales used by the clinical trial physician (Psoriasis Area and Severity Index, Physician's Global Assessment, Target Lesion Psoriasis Severity Scale, Lattice System Physician's Global Assessment).
Psoriasis Patients' Reflections on Provider Information Giving: Perceptions of Actual and Desired Experiences at Diagnosis
Authors: Wolfe Barat J. , O'Toole Ashley , Tan Jerry , Sirois Fuschia
Published: April 2018

Background

Psoriasis adversely impacts patients' quality of life, yet few studies have explored patients' experiences at diagnosis, a pivotal though largely negative time for any patient suffering from chronic disease.

Objective

Our objective was to identify potential shortcomings in the content and process of information delivery from the patient's perspective.

Methods

Twenty-three psoriasis patients completed an online survey regarding information they considered valuable at diagnosis and, in retrospect, content they would like to have received.

Results

Responses were subjected to a qualitative content analysis that revealed several themes: need for information and options, discussion of time and effort to find the right treatment, for providers to offer hope, and discussion of the psychosocial impact of psoriasis.

Conclusions

Many patients perceived negative actual experiences at diagnosis that were incongruent with their desired experiences. Psoriasis patients wanted information about disease and management, acknowledgement of psychosocial impact, and an empathetic mode of communication.
Dermatologist–Patient In-Office Discussions of Psoriasis: Focus on Quality of Life
Authors: Lofland Jennifer H. , Eagan Corey , Onofrey Meaghan , Waters Heidi C. , Trainer Pamela
Published: April 2018

Psoriasis is a chronic inflammatory disease that can significantly affect quality of life. Effective communication between health care providers and patients is important for managing psoriasis, and sociolinguistic analysis is a validated method for researching physician–patient interactions. To characterize current in-office communication patterns and to identify potential ways in which such interactions may be improved regarding quality of life, we studied the in-office discussions between 24 patients with psoriasis and their physicians using audio and video recordings. Although many physicians acknowledged the effect of psoriasis on quality of life, few discussed this aspect of the disease with patients. This study offers a foundation for additional research examining communication strategies between patients with psoriasis and their health care providers.
Recurrent Erythema Multiforme in a 63-Year-Old Woman Undergoing Biologic Therapy
Authors: Stevenson Mary L. , Markoff Sarah
Published: April 2018

Erythema multiforme (EM) is a type IV hypersensitivity reaction that usually manifests as target lesions and is known to be associated with various medications and infections. We report a case of recurrent EM with underlying occult herpes simplex virus in a patient being treated with biologic therapy for psoriasis and psoriatic arthritis. Occult herpes simplex infection should be considered in patients who have been treated with biologic therapy and develop EM. Recognition of such patients will allow for appropriate prophylaxis therapy so that continued biologic therapy for their primary diagnosis need not be interrupted.
Insulin Resistance may be a Central Pathogenetic Mechanism in the Development of Psoriatic Plaques
Authors: Boehncke Wolf-Henning , Boehncke Sandra , Bürger Claudia
Published: April 2018

Background

Insulin is a multifunctional hormone. It provides a link for the regulation of metabolic as well as nonmetabolic cells. Inefficient signal transduction (ie, insulin resistance) is the central pathomechanism in type 2 diabetes mellitus; it also drives atherosclerosis through induction of endothelial dysfunction.

Objective

Because epidermal homeostasis depends on insulin, too, we speculate on a potential role of insulin resistance in the formation of psoriatic plaques.

Methods

We comment on the effects of insulin on keratinocyte biology, with an emphasis on cytokine-induced insulin resistance in the light of recent original work from our group.

Results

There is increasing evidence for cytokine-induced insulin resistance in keratinocytes that contributes to the epidermal phenotype in lesional psoriatic skin.

Conclusion

Pro-inflammatory cytokines might induce a state of epidermal dysfunction, much like the state of endothelial dysfunction induced by similar mechanisms. Kinases involved in insulin- and cytokine-receptor signalling represent potential targets for innovative topical antipsoriatic therapies.
Biologic Drugs and Malignancy: A Literature Review Examining the Impact of Concomitant Immunosuppressive Medications
Authors: Bernardo Sebastian , Harcharik Sara , Pan Michael , Keeley Brieze , Lebwohl Mark
Published: April 2018

The objective of this work was to conduct a systematic review of the frequency with which concomitant immunosuppressive medication(s) are used in patients receiving biologics who develop malignancy. We conducted a PubMed search using the term “malignancy” and specific cancers combined with “biologic” and specific biologic drug names to identify case reports and case series written in English documenting patients who were diagnosed with malignancy while being treated with a biologic agent. Demographic information, biologic medication including treatment indication, malignancy type, time to malignancy diagnosis, patient outcome, and information regarding concomitant usage of immunosuppressive medication(s) were recorded. A total of 210 patients from 78 case reports and 21 case series met inclusion criteria and were evaluated. Among patients who developed malignancy while on biologic therapy, 64.8% were simultaneously being treated with ≥1 other immunosuppressive medication. A median time of 12 months was observed between initiation of biologic therapy and development of disease in this cohort. Methotrexate (28.6%) and azathioprine (23.8%) were the most common concomitant therapies. When compared with patients receiving biologic monotherapy, patients who received biologics with other immunosuppressive medications experienced 3.21 times more deaths because of malignancy with an odds ratio of 2.12 (95% CI, 1.07–4.19). The risk of malignancy among patients receiving biologic therapy is significantly confounded by the prevalent use of concomitant immunosuppressive medication(s). This risk may be overestimated, particularly for patients who take biologic drugs as monotherapy.
Impact of Accountable Care Organizations on Psoriasis Care
Authors: Kim Noori , Cressey Brienne , Do Michael , Wang Rona , Gottlieb Alice B. , Lizzul Paul F.
Published: April 2018

The Center for Medicare and Medicaid Services implemented the groundwork for health care providers to use integrated delivery models, such as accountable care organizations, which are designed to improve quality of care while decreasing costs. The objective of these units is to promote health maintenance through primary care services and to avoid inpatient hospitalizations. This strategy may not account for the role of specialty services, like dermatology, that are primarily conducted in an outpatient setting. Psoriatic patients, who are regularly seen in dermatology clinics, represent a model patient cohort with a chronic, complex, and debilitating skin disorder that incurs significant annual costs. Accountable care organizations can hinder appropriate referrals for these at-risk patients, leading to greater morbidity and possibly even greater costs. While rising health care costs make reforms necessary, it is crucial that the impact of accountable care organizations across all facets of healthcare be examined to be effective.
Frequency of Monotherapy versus Combination Therapy in Reported Cases of Infections Occurring in the Setting of Biologic Agents
Authors: Bernardo Sebastian , Geraghty Laurel , Freilich Ahuva , Pan Michael , Lebwohl Mark
Published: April 2018

The purpose of this work was to determine the frequency with which concomitant immunosuppressive medications were used in a systemic review of reported cases of infection occurring in the setting of biologic therapy. A Pub Med search was conducted using the term “infection” combined with “biologic” and specific biologic drug names to identify case reports and case series written in English documenting patients who were diagnosed with an infection while being treated with a biologic agent. Demographic information, biologic medication, treatment indication, and patient outcomes, as well as information regarding the use of concomitant immunosuppressive therapies, were recorded. A total of 246 patients from 148 case reports and 20 case series met inclusion criteria and were evaluated. Among reported cases of infection occurring in the setting of biologic therapy, 69.9% were being treated with ≥1 other immunosuppressive medication. Of patients receiving concomitant therapies, corticosteroids (56.4%) and methotrexate (53.5%) were taken most frequently. Bacteria composed the majority of infections in this review (57.7%) with nonmycobacteria implicated in 38.6% of cases and mycobacteria in 19.1% of patients. In this cohort, patients receiving tumor necrosis factor-α inhibitors with other immunosuppressive medications experienced 2.67 times more reported nonserious infections (outpatient management), 2.33 times more reported hospitalizations, and 2.75 times more deaths than patients receiving biologic monotherapy. Infection risk among patients on biologic therapy is significantly confounded by the widespread use of concomitant immunosuppressive medication(s) and may be overestimated, particularly for patients who take biologic drugs as monotherapy.
Safety of Herpes Zoster Vaccine in Psoriasis Patients on Biologic Therapies
Authors: Menkes Chloë S. , On Shelbi C. Jim
Published: April 2018

Herpes zoster (HZ) is a blistering, dermatomal cutaneous eruption caused by the reactivation of varicella zoster virus. The incidence of HZ increases exponentially with age and is commonly seen in adults >60 years of age. Patients with psoriasis on biologic therapies have ≍2 times the risk of developing HZ compared with the general population. The approval of HZ vaccine by the US Food and Drug Administration in 2006 has significantly reduced the incidence of HZ and postherpetic neuralgia by 61.1% and 66.5%, respectively. However, this live vaccine is not currently recommended for immunocompromised patients, such as individuals with psoriasis on biologics. Two major concerns with live vaccinations in this patient population include the risk of impaired immunologic response and the increased incidence of HZ and its complications. However, recent evidence has shown that, despite these concerns, vaccinating patients with psoriasis on biologics with an HZ vaccine can be both safe and effective.
TNF-Alpha Antagonists and Neurologic Side Effects: A Literature Review
Authors: Posnick David S. , AlBahhar Majdy , Golant Alexandra
Published: April 2018

Although several tumor necrosis factor-alpha antagonists (TNF-α therapy) have been approved by the FDA for the treatment of moderate to severe plaque psoriasis and psoriatic arthritis, dermatologists had concerns regarding their potential for the rare induction or exacerbation of demyelinating processes. Whether TNF-α therapy induces new-onset demyelination or exacerbates pre-existing latent multiple sclerosis is not fully understood. TNF-α antagonists are immunosuppressive agents used to treat various chronic inflammatory diseases, including rheumatoid arthritis (RA), Crohn's disease, ankylosing spondylitis (AS), psoriasis, and psoriatic arthritis. Demyelinating symptoms have been observed in many of the diseases for which TNF-α therapy is approved. In addition, neurological disorders have been reported during treatment with all TNF-α antagonists, most commonly etanercept. Based on the data, it seems most reasonable to exercise caution in patients with established demyelinating disease and to immediately discontinue therapy and pursue diagnostic tests in any patient with suspected demyelination.
Worms: A Remarkably Reasonable Treatment Option for Psoriasis
Authors: Greb Jacqueline , Gottlieb Alice
Published: April 2018

There is a need to expand safe and effective treatment options for patients with moderate to severe psoriasis. This article hypothesizes one promising novel treatment option: Trichuris Suis. Epidemiological, experimental, and clinical evidence suggest that Trichuris Suis therapy may be both applicable and advantageous in the treatment of psoriasis. Epidemiologically, the de-worming of developed nations has been correlated with the increased prevalence of immune-mediated disease such as psoriasis. Additionally, the mechanisms of helminth immune regulation should mitigate the underlying immunopathology in psoriasis. Finally, safety and efficacy of Trichuris Suis has been demonstrated in other immune-mediated diseases such as Crohn's, ulcerative colitis, and multiple sclerosis with clinical responses in as many as 80% of patients. Evidently, there is ample evidence to warrant the investigation of Trichuris Suis therapy as a novel psoriasis treatment.
IDEOM: International Dermatology Outcomes Measures; A Call to Action
Authors: Gottlieb Alice B. , Swerlick Robert
Published: April 2018

Access is the number one issue facing psoriasis patients today. This is due in part to the fact that we do not have outcome measures that are useful in clinical practice and which are available in standard clinical care databases that payers and governmental agencies use to compare the performance of physicians and treatments. The International Dermatology Outcomes Measures (IDEOM) group includes all willing stakeholders – patients, physicians, payers, and pharmaceutical scientists. Its goal is to develop outcome measures in dermatology which address the needs of all stakeholders. For our first project, Delphi analyses of psoriasis outcomes will be performed among doctors and patients.
Alternative Medicine for the Treatment of Psoriasis
Authors: Zahir Amir , Kaviany Parisa , Ehrlich Alison
Published: April 2018

The use of complementary and alternative medicine has an estimated prevalence of about 51% amongst patients with psoriasis. The relatively lower costs, perceived fewer side effects, and versatile use alone or in combination with standard psoriasis treatments have increased its appeal. Clinical trials and case reports have investigated the use of dietary supplements, herbs, gluten-free diet, acupuncture, psychotherapy, meditation, and hypnosis for the treatment of psoriasis. Fish oil, vitamin D, inositol, curcumin, indigo naturalis, Aloe vera, capsaicin, and Mahonia aquifolium have shown some efficacy in some of the clinical trials covered in this review. Gluten-free diets and the use of meditation and stress-reduction exercises also have shown to help improve the clinical symptoms of psoriasis. Knowledge of these treatments can help dermatologists educate their patients who are interested in alternative remedies for psoriasis.
Systemic Lupus Erythematosus and Psoriasis: Comparison of Immunopathogenesis
Authors: Perl Marcel , Wolinsky Claire
Published: April 2018

Psoriasis and systemic lupus erythematosus (SLE) are complex immune-mediated diseases with burdens to patients and society. Recently, there has been considerable progress in understanding of autoimmunity, revealing critical roles for cytokine-mediated pathways that are common to both SLE and psoriasis. Ongoing pharmacogenomic and signaling studies coupled with clinical trials hold promise to better delineate overlaps and divergence in pathogenesis and lead to definition of biomarkers that can predict disease subsets, disease states, organ involvement and responsiveness to treatment. This review will compare SLE and psoriasis with regard to mutually relevant immune pathways and examine their significance as an influx of new biologic treatments comes into use.
Evaluating the Effectiveness of Psychological Interventions in Patients with Psoriasis: A Review
Authors: Tran Anh N. , Koo John Y.
Published: April 2018

Psoriasis is a common condition, often associated with substantial psychological morbidity. Stress is frequently implicated in the onset or exacerbation of psoriasis, giving rise to the possible use of psychotherapeutic modalities in treatment. This article reviewed the literature describing cases and trials of psychological interventions (i.e., psychotherapy, biofeedback, hypnosis, meditation, and emotional disclosure) in the treatment of patients with psoriasis. All six case reports/series demonstrated positive outcomes. Among the trials, seven out of 11 found significant physical improvement and four out of seven found significant psychological benefit. Psychological interventions appear to have the potential to serve as helpful adjuncts to conventional dermatological treatments, although further research is needed with emphasis on randomized controlled trials with more standardized, validated outcome measures.
A Guide to the Ingredients of Over-the-Counter Moisturizers for Psoriasis
Authors: Chularojanamontri Leena , Wongpraparut Chanisada , Silpa-archa Narumol , Pongparit Kamolwan
Published: April 2018

It is believed that moisturizers can improve the efficacy of treatment for psoriasis. This study sought to analyze the active ingredients and properties of moisturizers that claimed to be suitable for psoriasis. Moisturizers for psoriasis were identified on electronic markets using the search terms “moisturizers” and “psoriasis.” Forty-seven moisturizers that claimed to be suitable for psoriasis were identified. Vitamin E was the most common ingredient used for emollient properties. Of the 47 moisturizers, 35 (74%) contained anti-inflammatory properties and 12 (26%) contained keratolytic properties. Coal tar, low-potency corticosteroids, and botanical extracts were added for anti-inflammatory properties while salicylic acid, lactic acid, and ≥ 10% urea cream were used for keratolytic effect. Although it seems that each active ingredient added into moisturizers for psoriasis can decrease the severity of psoriasis, there is a lack of well-done studies on the over-the-counter preparations. Therefore, the recommendations to use them are currently not evidence-based.
Abatacept in Psoriatic Arthritis: A Review
Authors: Varada Sowmya
Published: April 2018

Abatacept is a soluble, fully human, recombinant fusion protein composed of the extracellular domain of CTLA-4 and a modified Fc portion of IgG1. It is the first in a class of agents that competitively inhibit the interaction of cell surface CD28 with CD80/86 to modulate T lymphocyte costimulation and activation. Its success in treating moderate to severe rheumatoid arthritis and juvenile idiopathic arthritis has prompted its investigation for use in psoriatic arthritis. Many psoriatic arthritis patients fail tumor necrosis factor inhibitor therapy, highlighting the need for treatments with novel mechanisms of action. One phase I trial studying abatacept in psoriasis and one phase II trial in psoriatic arthritis have been published, with phase III trials under way. Results thus far have been promising, but the drug's long-term efficacy and safety profile are not yet known. This article reviews the agent's mechanism of action, efficacy, safety profile, and clinical potential in treating psoriatic arthritis.