bluuebunny/crossref_metadata_2025 huggingface dataset:
Musculoskeletal Symptoms with Long-term Acitretin Therapy for Psoriasis: An Age- and Sex-matched Retrospective Study
Authors: Fuchs Aaron , Levitt Jacob , Lebwohl Mark
Published: April 2018

Acitretin, an orally administered retinoid, has been part of the psoriasis treatment armamentarium since 1997. While much has been reported regarding the incidence of musculoskeletal symptoms associated with long-term systemic retinoid use, most studies have focused on the older retinoids, isotretinoin and etretinate, the pro-drug of acitretin. The retinoid-associated musculoskeletal symptoms described in the literature include arthralgia, myalgia, arthritis, myopathy and hyperostosis. Owing to acitretin's relatively young market life, few studies have been undertaken to assess its effects on the skeletal system. In this retrospective cohort study, we examine the incidence of musculoskeletal symptoms in patients with psoriasis treated with long-term acitretin, defined as more than 6 months. We performed a cross-sectional, age- and sex-matched survey of 53 patients diagnosed with psoriasis. Twenty-eight patients treated with long-term acitretin, mean length of treatment 3.68 years (range of 6 months to 10 years) were compared with 25 patients who had never received acitretin therapy. Patients were surveyed to identify the presence of back pain, joint pain, morning stiffness and decreased spinal range of motion. These symptoms served as surrogate markers for retinoid-induced musculoskeletal changes. We identify no increase in the incidence of musculoskeletal symptoms between patients with psoriasis who have taken long-term acitretin, and patients with psoriasis who have never taken acitretin.
Purine Synthesis Inhibitors, 6-thioguanine and Azathioprine: Forgotten Treatment Options in Psoriasis and Psoriatic Arthritis
Authors: Nguyen Thao , Koo John
Published: April 2018

Background

The thiopurine drugs azathioprine and 6-thioguanine have been shown to induce significant clinical improvement in patients with moderate to severe psoriasis and/or psoriatic arthritis.

Objective

The aim of this paper is to present a comprehensive review of the available literature concerning the off-label role of thiopurine drugs in the treatment of psoriasis and psoriatic arthritis.

Methods

Studies published with English abstracts between 1960 and 2008 identified in MEDLINE and PubMed with the keywords purine synthesis inhibitors, thiopurine, 6-thioguanine, azathioprine, psoriasis and psoriatic arthritis were reviewed.

Results

Although 6-thioguanine and azathioprine have shown significant efficacy, their side effect profiles have discouraged their use for moderate to severe psoriasis.

Conclusion

For treatment of psoriasis and psoriatic arthritis, purine synthesis inhibitors should not be forgotten. They represent an entirely different option and provide an alternative therapy, especially for difficult cases.
The International Psoriasis Council Presents Top 2009 Research Articles
Authors: Tebbey Paul , Romiti Ricardo , Prens Errol , Menter Alan
Published: April 2018

β–Defensin-2 Protein Is a Serum Biomarker for Disease Activity in Psoriasis and Reaches Biologically Relevant Concentrations in Lesional Skin
Efalizumab: What Went Wrong?
Authors: Bryant Douglas , Ayoub Nedhal
Published: April 2018

Efalizumab was approved for psoriasis in 2003. In 2008, two cases of progressive multifocal leukoenecephalopathy (PML) were reported, and in 2009, a third case was confirmed in patients on efalizumab monotherapy for psoriasis. As a result, in Europe, efalizumab's marketing authorization was suspended by the European Medicines Agency. Shortly thereafter, Genentech announced plans to withdraw the drug from the U.S. The withdrawal, which was completed in June 2009, was the result of the risk of an infection that is often fatal, with three confirmed PML cases out of the approximately 2,000 patients treated with efalizumab for more than three years.

Efalizumab was one of the first biologics approved by the U.S. Food and Drug Administration for the treatment of moderate to severe plaque psoriasis. With the later approval of additional biologic agents for plaque psoriasis, prescribers had additional treatment options with improved efficacy and safety. The risks associated with efalizumab for its relatively low efficacy made it unattractive compared to other biologic product treatment options, ultimately leading to its withdrawal.
IL-12/23 Inhibitors and Their Potential Benefits and Risks for Psoriasis Patients
Authors: Kinney Megan A. , Yentzer Brad A. , Feldman Steven R.
Published: April 2018

Background

Interleukin (IL)-12 and IL-23 are implicated in the pathogenesis of psoriasis and new IL-12/23 inhibitors are currently being studied for psoriasis treatment.

Objective

To review the literature and provide an update on the current use of anti-IL-12/IL-23 therapies for psoriasis, with special emphasis on risks and benefits.

Methods

A PubMed search was performed to identify articles in English with key words “Ustekinumab and psoriasis,” “IL-12 and IL-23 and psoriasis,” “ABT-874 and psoriasis,” “IL-12/23 monoclonal antibody,” “IL-12/23 antibody” and “CNTO-1275.” Supplemental methods included Google Scholar, article reference lists and scholarly posters.

Results

Anti-IL-12/23 therapies may be more effective for psoriasis treatment than concurrent biologics. However, there is a potential risk of compromising cancer surveillance mechanisms through blocking IL-12.

Limitations

More research is needed into the long-term effects of anti-IL-12/23 agents.

Conclusions

Convenient dosing of ustekinumab and greater efficacy make the anti- IL-12/23 agents a promising therapeutic option.
Psoriasis is a Disease with Serious Comorbidities
Authors: McGarty Steven , Fernandes Neil F.
Published: April 2018

Psoriasis is a disease with varying degrees of severity. Some clinicians regard the disease as a mild cutaneous illness, the manifestations of which are considered to be limited to slight discomfort or even simply aesthetic concerns. Unfortunately, this view may lead to inadequate treatment. Severe psoriasis can present in dangerous forms such as erythrodermic and pustular psoriasis. In addition, the disease is associated with a number of significant systemic comorbidities. Aside from the profound psychological and physical impact on the patient's everyday life, psoriasis can affect the joints and cardiac and vascular systems, and has even been associated with the metabolic syndrome. This article discusses the numerous serious associations of psoriasis.
Topical Calcitriol: A Review of Its Current Role in the Treatment of Chronic Plaque-type Psoriasis
Authors: Pua Jeni M. , de Campos Silva Gabriel , Henry Michelle
Published: April 2018

Topical calcitriol has been used worldwide in the treatment of psoriasis for a decade and has been proven to be safe and effective for the treatment of plaque psoriasis. Because the marketing of calcipotriol ointment was discontinued throughout much of the world, calcitriol is now the only noncorticosteroid-containing vitamin D ointment available in many countries. This article reviews the history of calcitriol use, as well as how it compares with other current topical treatments for psoriasis.
The Self-Administered Psoriasis and Arthritis Screening Questionnaire (PASQ): A Sensitive and Specific Tool for the Diagnosis of Early and Established Psoriatic Arthritis
Authors: Khraishi Majed , Landells Ian , Mugford Gerry
Published: April 2018

Background

Psoriatic arthritis is a serious chronic inflammatory arthritis that can lead to significant joint damage and often is associated with comorbidities. Early detection and effective management of psoriatic arthritis may prevent the development of such complications. Most patients develop psoriatic arthritis years after onset of psoriasis, and most patients with psoriasis alone are managed by dermatologists or general practitioners. These clinicians are thus in an excellent position to screen for psoriatic arthritis early in the disease course.

Objective

The objective of this study was to evaluate the sensitivity and specificity of the Psoriasis and Arthritis Screening Questionnaire (PASQ) in detecting patients with psoriatic arthritis.

Methods

Two groups of patients were screened: patients with established disease and patients referred for evaluation of possible (i.e., early) psoriatic arthritis.

Results

In patients with established disease, analysis of the PASQ score yielded an optimal cutoff point of 9 with 86.27% sensitivity and 88.89% specificity. In patients with early disease, the PASQ indicated an optimal score of 7 with 92.86% sensitivity and 75% specificity.

Conclusion

The PASQ is an effective screening tool in psoriatic arthritis patients with a long history of disease as well as in those with short disease duration.
Topical Treatment of Mild to Moderate Psoriasis
Authors: Gold Daniel , Almohizea Saad I.
Published: April 2018

Topical therapies are used by most psoriasis patients either alone or in combination with systemic therapies and phototherapy. The objective of this paper is to review the different topical therapies to treat mild to moderate psoriasis, including corticosteroids, vitamin D analogs, tazarotene, topical calcineurin inhibitors, anthralin, salicylic acid, and coal tar and assess their effectiveness and tolerability. Topical therapies are important for treating psoriasis and will continue to play a major role even as new systemic therapies emerge.
How Long Does the Benefit of Biologics Last? An Update on Time to Relapse and Potential for Rebound of Biologic Agents for Psoriasis
Authors: Kamaria Monique , Liao Wilson , Koo J.Y.
Published: April 2018

The biologic agents vary considerably in terms of their long-term duration of effect. Using the definitions provided by the National Psoriasis Foundation Medical Board, the objective of this review was to compare all biologic agents with respect to time to relapse and potential for rebound. Overall, alefacept had the longest off-treatment benefit (29.9 weeks in Psoriasis Area and Severity Index [PASI] 75 responders), followed by ustekinumab (22 weeks), infliximab (19.5 weeks), adalimumab (18 weeks), etanercept (12.1 weeks in PASI 50 responders), and, lastly, efalizumab (9.6 weeks). Rebound was reported commonly for efalizumab (14%) and, extremely rarely, for etanercept (0.002%).
Social Networking and the Psoriasis Patient
Authors: Noiles Kristin , Thomas Richard
Published: April 2018

The idea that social support networks can positively influence health has been well-documented. Face-to-face support groups and group therapy arose in the early 1900s as a means of providing psychological encouragement, and more recently online social networks have become available. Web-based disease representation is rapidly expanding, and virtual groups are now available for patients with psoriasis. Although these networks currently offer many helpful resources to patients and provide a medium by which individuals can communicate, they may also help to optimize psoriasis management and improve adherence to medications. These online communities may also provide a means of collecting data for research. As an adjunct to clinical management with numerous benefits, online forums will likely continue to gain popularity within the psoriasis community.
Comorbidities in Psoriasis
Authors: Kogan Nora , Veira Rosana , Chaparro Elena , Crespo Alejandra , Gusis Simón , Hassan Mercedes
Published: April 2018

Objective

To assess whether psoriasis comorbidities modify the disease.

Material and Methods

In 170 patients with psoriasis, we considered the following comorbidities: hypertension, metabolic syndrome, diabetes, dyslipidemia, overweight, cardiovascular disease, liver disease, and thyroid diseases. We compared patients with any number of comorbidities to patients without comorbidities, and we also compared patients with one, two, or three or more comorbidities to patients who lacked comorbidities.

Results

We identified 62 patients (36%) without comorbidities and 108 patients (64%) with comorbidities. Only age, duration of the disease, and guttate psoriasis showed statistically significant correlation with comorbidities. When the group without comorbidities was compared with the groups of patients with differing numbers of comorbidities, we found significant differences only in age and duration of the disease.

Conclusions

The presence and the increased number of comorbidities were associated with advanced age and greater duration of the disease, whereas guttate psoriasis had an inverse relation with concomitant diseases.
A Practical Approach to the Use of Methotrexate
Authors: Busse Kristine , Koo John
Published: April 2018

Background

Methotrexate is approved by the Food and Drug Ad ministration for the treatment of severe, recalcitrant, and disabling psoriasis that is not adequately responsive to other forms of therapy. It is a systemic immunosuppressant that requires appropriate patient selection, screening laboratory values, and close monitoring before initiation of a maintenance regimen.

Purpose

This clinical review outlines a practical approach for the use of methotrexate in psoriasis.

Methods

A review of English-language literature between 1950 and 2010 was conducted, and the results are presented here.

Results

With close monitoring and appropriate patient selection, methotrexate is often an effective treatment option for moderate to severe psoriasis. Attention to individual patient risk factors and understanding of dosing regimens, contraindications, and “black box” warnings regarding methotrexate use can assist dermatologists in safely prescribing methotrexate for psoriasis treatment.

Limitations

This practical approach is based on an extensive literature review and the National Psoriasis Foundation and American Academy of Dermatology guidelines formulated after years of clinical practice, newer efficacy trials, and expert consensus regarding management in psoriasis patients. We have additionally incorporated some recommendations from our clinical experience at the University of California-San Francisco Psoriasis Treatment Center as indicated in the text. As always, clinical judgment and risk assessment should be used in selecting appropriate psoriasis patients for methotrexate therapy.

Conclusion

Methotrexate remains an effective, less expensive, and safe option for psoriasis patients who were previously unresponsive to other forms of therapy.
Adalimumab Treatment and Work Productivity in Patients with Moderate to Severe Psoriasis: Results from a Prospective Clinical Trial
Authors: Bhutani Tina , Patel Tejas , Koo Bonnie
Published: April 2018

Objective

The effect of adalimumab on work productivity and occupational functioning was evaluated in patients with moderate to severe psoriasis during a prospective 24-week open-label, single-center trial.

Methods

Thirty-four patients received adalimumab 80 mg subcutaneously at week 0, followed by 40 mg every other week from weeks 1 through 24. Patients were allowed to continue previous topical treatments and phototherapy while enrolled. Occupational functioning was evaluated at monthly intervals throughout the study using the Work Productivity and Activity Impairment Questionnaire—Specific Health Problem.

Results

There was a statistically significant improvement from baseline to week 24 in the percent of impairment while working (P = 0.0029) and in the percent of overall work impairment (P = 0.0026). The percent of work time missed because of psoriasis decreased, but this change did not reach statistical significance (P = 0.11).

Conclusion

Adalimumab was efficacious in improving work and activity limitations in patients with moderate to severe psoriasis over a 24-week period.
Which Psoriasis Patients Develop Psoriatic Arthritis?
Authors: Busse Kristine , Liao Wilson
Published: April 2018

Psoriatic arthritis is a major comorbidity of psoriasis that significantly impairs quality of life and physical function. Because skin lesions classically precede joint symptoms, dermatologists are in a unique position to identify patients at risk for psoriatic arthritis before irreversible joint damage occurs. Here we review the literature to identify the clinical and genetic factors most highly associated with development of psoriatic arthritis, with the goal of assisting dermatologists in risk-stratifying their psoriasis patients.
The International Psoriasis Council Presents Top 10 Psoriasis Research Articles for 2010
Authors: Tebbey Paul , David Burden Arthur , Smith Catherine , Menter Alan
Published: April 2018

The International Psoriasis Council (IPC) is a global nonprofit organization dedicated to advancing psoriasis research and treatment by providing a forum for education, collaboration, and innovation among physicians, researchers, and other professionals interested in psoriasis. Each year, the IPC identifies the top papers in the field of psoriasis. They are reviewed here.
Scalp Psoriasis: A Review of the Current Therapies and Case Report of the Successful Use of the Excimer Laser in Recalcitrant Disease
Authors: Glodny Bradley , Penrose Carolin
Published: April 2018

Psoriasis vulgaris is an extremely common immune-mediated inflammatory disease that affects about 0.6% to 4.8% of the general population worldwide. As reported by several surveys, the most common anatomic location affected by psoriasis is the scalp. The clinical presentation varies from mild to severe and typically presents with asymmetric, sharply demarcated, silvery white erythematous scaly plaques that are often pruritic. Additionally, serious psychosocial consequences are often experienced by patients with scalp psoriasis. Despite the fact that scalp disease is so frequent and debilitating, it remains particularly difficult to treat because of the lack of patient compliance and a paucity of evidence-based data to help guide treatment. In 2009, however, the medical board of the National Psoriasis Foundation created an algorithm to facilitate the treatment of scalp psoriasis. In this case review, we describe a scenario in which this algorithm was used successfully. Our patient suffered from psoriasis limited to the scalp for almost 14 years. After several first- and second-line therapies failed, this patient was treated successfully 4 years ago and currently remains in remission after therapy with the ultraviolet B narrowband (308 nm) excimer laser. Therefore, for patients with recalcitrant plaques limited to the scalp, the excimer laser should be considered as a third-line therapy.
Treatment of Psoriasis in the Obese: A Clinical Dilemma
Authors: Anvekar Rina A. , Stevenson Mary L. , Fuchs Aaron E.
Published: April 2018

Treatment of obese patients with psoriasis is a therapeutic challenge. Because of the lack of safety and efficacy data in the literature, the Medical Advisory Board of the National Psoriasis Foundation has been unable to provide a treatment algorithm to be used with these patients. Psoriasis in obese patients is often more severe, responds less favorably to treatment, and is complicated by challenging comorbid conditions that limit therapeutic options. We present a case report highlighting the difficulty of safely and effectively treating an obese patient with psoriasis.
Treatment of Inverse Psoriasis: Practical Application of the National Psoriasis Foundation Consensus Statement
Authors: Stevenson Mary L. , Fuchs Aaron
Published: April 2018

The treatment of inverse psoriasis with the traditional use of topical steroids may be associated with a greater risk of unwanted side effects, including striae, atrophy, and telangiectasia. The National Psoriasis Foundation consensus statement provides a practical treatment algorithm that should be used when treating these patients. We present a case report highlighting use of these guidelines.
Treatment of Psoriasis in HIV-Infected Persons
Authors: Lee Eric S. , Heller Misha M. , KyungHwa Park Kelly
Published: April 2018

Choosing a treatment modality for psoriasis in HIV-infected patients can be quite a difficult task for dermatologists. These physicians may be reluctant to treat HIV-infected patients with immunosuppressive agents when the host is already immunologically compromised. The available data on safety and efficacy for various psoriasis treatment options in HIV-infected individuals are very limited; yet it is still a physician's duty to provide the best possible treatment for these patients. A revised algorithm is proposed for the treatment of HIV-infected patients with psoriasis based on a previous recommendation from the medical advisory board of the National Psoriasis Foundation. For psoriasis in HIV-infected persons, good HIV control should be the mainstay of treatment. The use of hydroxyurea is reintroduced as an option to consider before the use of systemic immunosuppressant agents. In addition, tumor necrosis factor-α inhibitors may be considered over the oral systemic immunosuppressive agents.
Psoriatic Eye Manifestations
Authors: Au Shiu-chung , Yaniv Shimrat , Gottlieb Alice B.
Published: April 2018

The relationship between the eye and psoriasis has been recognized for decades, but the precise eye manifestations in patients with psoriasis and psoriatic arthritis are only recently coming to light. Psoriatic eye findings may include conjunctivitis, dry eye, episcleritis, and uveitis, all of which may precede articular changes. Uveitis, seen in 7% to 25% of psoriatic arthritis patients, may be recognized by the presence of conjunctival injection, photophobia, pain, lid swelling, or otherwise unexplained visual changes. Early recognition is paramount because its natural course may lead to vision loss. Immunopathogenesis has shown evidence for T-helper cell (Th) type 1 (Th1) and Th17 involvement in the pathogenesis of uveitis according to the murine experimental autoimmune uveitis model. Corticosteroids are the primary treatment modality; however, increasing emphasis has been placed on immunomodulators and biologics for more intractable cases. Referral to an ophthalmologist is essential for definitive diagnosis and treatment.
Hydroxyurea for the Treatment of Psoriasis with an Emphasis on HIV-Infected Psoriasis Patients: A Review
Authors: Lee Eric S. , Heller Misha M. , Kamangar Faranak , Park Kelly , Liao Wilson , Koo John
Published: April 2018

Hydroxyurea is a drug that has been long forgotten for the treatment of psoriasis. In addition to its anti-psoriatic effects, it has also been shown to have antiviral effects. This dual effect makes it a drug that dermatologists may want to consider when treating psoriasis in HIV-infected patients. Currently, no studies are available that discuss the safety and efficacy of hydroxyurea in the treatment of psoriasis in this immunocompromised group; however, numerous reports discuss the safety and efficacy of hydroxyurea in psoriasis and HIV separately. This review suggests that hydroxyurea is generally safe and effective. The main risk involves the hematologic adverse events (anemia, leukopenia, thrombocytopenia, and macrocytosis), which appear to be dose dependent. Because of the common hematologic adverse events, hydroxyurea may be considered a viable therapeutic option for patients with generalized psoriasis that is inadequately responsive to other safer options, whether or not the patient is HIV positive.
The Treatment of Nail Psoriasis: A Review
Authors: Steele Gabrielle , Emer Jason , Larian Amir
Published: April 2018

Nail disease affects most patients with psoriasis and has a substantial medical and psychological impact on the lives of those affected. Frequently, nail psoriasis is associated with severe pain, restriction in daily activity, and emotional agony that require the dermatologist to know the most up-to-date therapies. Unfortunately, no single treatment is paramount, and the choice of therapy must be individualized to disease severity, patient tolerability, cost, and risk of adverse events. Some clinical manifestations include nail pitting, discoloration, onycholysis, subungual hyperkeratosis, and splinter hemorrhages. Currently, no standardized therapeutic regimen exists; and, given the variability in clinical manifestations, multiple modalities may be needed for adequate results. More recently added to the armamentarium of topical and injectable therapies for nail disease are systemic agents, such as biologics, and photochemotherapeutic treatments. These therapies have been used with varying degrees of success. This review highlights the current treatments available for the treatment of nail psoriatic disease.
The Management of Women with Chronic Immune Disorders in the Era of Biologics: Caveats from Other Specialties
Authors: Kardos Marisa , Kroshinsky Daniela , Friedman Sonia , Silverman Neil , Strand Vibeke , Dubinsky Marla , Van Voorhees Abby S. , Kimball Alexandra B.
Published: April 2018

The management of women with chronic immune diseases, including inflammatory bowel disease, rheumatoid arthritis, and psoriasis, is often challenging. In September 2010, gastroenterologists, rheumatologists, dermatologists, and obstetricians convened for the second annual conference, “The Management of Women with Chronic Immune Disorders in the Era of Biologics.” Although the therapeutic options for these chronic diseases are similar across specialties, this meeting highlighted variations in patient management among the specialists present. Topics addressed included screening and monitoring, vaccinations, and specifically the use of the human papillomavirus vaccine, bone loss, the role of vitamin D, and care during pregnancy. The information presented at the meeting is summarized here to give the dermatology community a better understanding of how patients on similar medications are cared for in other specialties and to recognize areas of research needed in the field of dermatology.
Cyclosporine a for Plaque Psoriasis: An Update on the Most Relevant Adverse Reactions
Authors: Hajdarbegovic Enes , Thio H. Bing , Neumann A. Martina
Published: April 2018

Cyclosporine has an important place in the treatment of plaque psoriasis. Similar to other systemically administered anti-psoriatic agents, several common adverse effects have been noted with its use. We present an overview of the most frequent and clinically relevant side effects of cyclosporine therapy, and, to refresh dermatologists' knowledge, we discuss various aspects of structural and functional nephrotoxicity; hypertension; and the occurrence squamous cell carcinoma, lymphoma, and gingival hyperplasia.
A Review of Drugs that Induce or Exacerbate Psoriasis
Authors: Hong Julie , Bernstein Daniel
Published: April 2018

Background

Psoriasis is a common disorder of the skin, immune system, and joints that is influenced by genetic and environmental factors. It can be aggravated or induced by drugs.

Objectives

To identify the major drugs implicated in inducing or exacerbating psoriasis and to discuss their characteristics.

Methods

We performed a PubMed literature search for reviews and case reports on drugs that exacerbate or induce psoriasis. Articles were screened by title and abstract and then examined for their findings and references.

Results

Drugs most often reported to exacerbate or induce psoriasis were β-blockers, lithium, synthetic antimalarials, nonsteroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, interferons, tetracyclines, tumor necrosis factor-α inhibitors, and steroid withdrawal.

Conclusions

Characterizing drugs that induce or exacerbate psoriasis by latency and type of psoriatic eruption can help guide clinical reasoning. Although a relatively uncommon occurrence, psoriatic lesions can be caused by drugs, allowing astute physicians to recognize and change their management plans accordingly.
The Unique Impact of Psoriasis on the Geriatric Population: A Review
Authors: Wong Jillian W. , Koo John Y. M.
Published: April 2018

Background

The geriatric population is growing steadily worldwide; therefore, greater emphasis on optimizing care for this patient population is needed. Psoriasis in particular has the highest rate of occurrence in the geriatric age group compared with younger cohorts. It also has a significant negative impact, both physically and psychologically, on the geriatric population. Psoriasis therapies that include immunosuppressive agents can be more risky to the elderly patients with age-related comorbidities.

Objective

We present a literature review of the unique impact of psoriasis on older patients.

Methods

A search of PubMed's MEDLINE database of articles published from 2000 to 2011 was performed, and 57 articles were included in the review.

Results

Multiple unique physical and psychological challenges from psoriasis affecting the geriatric population were identified. The use of systemic immunosuppressive therapies requires special consideration for the less healthy segment of the elderly population.

Conclusions

Very little research specifically examining the geriatric population with psoriasis has been performed. More focused research is needed to determine how to treat these patients optimally and improve the quality of life for this unique subset of patients with psoriasis.
Exogenous Progesterone and Psoriatic Flares: Two Recent Cases
Authors: McLean Riley , Mailhot Jeffrey , Goldberg Dori
Published: April 2018

Two patients seen in the dermatology clinic experienced psoriasis flares after exposure to exogenous progesterone without simultaneous exogenous estrogen administration. Although the effects of estrogen on psoriasis have been studied extensively, there are little published data regarding the role of progesterone in the pathogenesis of psoriasis.
Safety Updates on Tumor Necrosis Factor Blockers
Authors: Au Shiu-chung , Goldminz Ari , Bhandarkar Manasa , Gottlieb Alice
Published: April 2018

Tumor necrosis factor (TNF) blockers are highly effective in treating psoriasis and psoriatic arthritis. This article provides an update on the safety profile of TNF blockers to include new data regarding exposures during pregnancy, as well as serious infections. Currently, the published literature suggests that TNF inhibitors carry low risk to the fetus. New data show that immunization of neonates with live vaccines is not advisable until after 6 months of age if their mothers were administered TNF blockers during pregnancy. However, there is no evidence that mothers receiving TNF blockers should refrain from breastfeeding. In 2011 the US Food and Drug Administration modified its warnings regarding infection, because recent evidence suggests that TNF blockers may increase the risk of both Listeria and Histoplasma fungal infections.
Itch in Psoriasis: From Basic Mechanisms to Practical Treatments
Authors: Valdes-Rodriguez Rodrigo , Kwatra Shawn G. , Yosipovitch Gil
Published: April 2018

Itch is a common symptom among psoriasis patients, affecting up to 80% of patients. This article reviews recent advances in the pathophysiology, clinical presentation, and treatment options for psoriatic itch. English articles between 2003 and 2012, using the key words “psoriasis,” “pruritus,” and “itch,” were searched in Medline and PubMed and reviewed.
The Therapeutic Applications of Janus Kinase Inhibition in Psoriasis
Authors: Kim Noori , Gottlieb Alice B.
Published: April 2018

Janus kinases (JAKs) are non-receptor tyrosine kinases that ultimately mediate the signal transduction of several key cytokines that help maintain the immune system and regulate hematopoiesis in humans. While a particular JAK deficiency has been identified in cases of autosomal recessive severe combined immunodeficiency, a hyperactive JAK pathway has pathological consequences as well, including myelo- and lympho-proliferative disorders, autoimmune diseases, and chronic inflammatory disorders like psoriasis and rheumatoid arthritis. In fact, the JAK pathway plays a major role in the signaling of cytokines responsible for the immune and inflammatory response in psoriasis, including interleukin (IL)-12, IL-17, and IL-23. Preclinical evidence and phase 2 trials have already shown the safety and efficacy of topical and small molecule oral JAK inhibitors in patients with chronic plaque psoriasis. Ongoing clinical studies are further evaluating the safety, efficacy, and durability of these investigational drugs. JAK inhibition provides another option for effective targeted-therapy for such a complex disease as psoriasis.
Use of Teledermatology in the Management of Psoriasis
Authors: Kumar Neal
Published: April 2018

Teledermatology involves the use of digital photography, videoconferencing, and secure data transmission to provide dermatologic care from a distance. The purpose of this article is to review the literature related to teledermatology and the management of patients with psoriasis. Various search queries were used to search the PubMed database for original articles only. Separate studies of 10 and 12 patients both showed agreement of skin assessment scores between teledermatology and in-person consultations. A study of 64 patients randomly assigned to either teledermatology or in-office care resulted in similar improvements in patient outcomes scores. Lastly, a cost-effectiveness analysis showed that an online treatment group incurred less costs but similar improvements in outcome scores compared with an in-office treatment group. The evidence presented in this review offers preliminary, yet positive insight into the improvement of health outcomes, reliability of skin assessments, and cost-effectiveness associated with the use of teledermatology and psoriasis.
Stress on Psoriasis
Authors: Huynh Monica , Gupta Rishu , Levin Ethan , Butler Daniel , Leon Argentina , Koo John
Published: April 2018

Psoriasis is a common chronic inflammatory skin disorder, and the disease state is influenced by multiple factors including stress during difficult life events, psychological disturbance, or lack of social support. Investigators have observed a temporal association to stress and psoriasis, and many investigators attribute this to a possible effect of stress on hypothalamic-pituitary-adrenal and sympathetic-adrenal-medullary axes. This article reviews the impact of stress on patients and their psoriasis and the approaches for proper management.
Barriers Imposed by Insurance Companies to Biologic Therapy in Patients with Moderate-to-Severe Psoriasis
Authors: Jim On Shelbi C. , Lebwohl Mark
Published: April 2018

Psoriasis is a chronic, multisystem autoimmune disease that has affected over 7.5 million Americans to date. The annual cost of psoriasis in the United States is $5,508/patient per year. These patients typically incur greater health care costs compared to the general population, especially those patients with more extensive disease. This rise in health care costs is largely due to the increasing expense of new therapies such as biologics. Biologics have revolutionized psoriasis treatment, but the lack of generic alternatives has made this medication very expensive. Further limiting the accessibility of biologics is the overwhelmingly restrictive nature of health insurance policies. Practices such as tiered cost-sharing, high out-of-pocket costs, step-therapy, coverage gaps, rigid preauthorization policies, and burdensome re-authorization policies have obstructed access to biologic therapies. These barriers have not only made biologic therapy unattainable for most patients but have delayed treatment resulting in inadequate care.
Psoriasis: Impact on Quality of Life
Authors: Butler Daniel , Huynh Monica , Gupta Rishu , Levin Ethan , Leon Argentina , Koo John
Published: April 2018

The impact of psoriasis goes beyond what can be seen on a skin examination, and there is significant literature revealing the negative effect on quality of life for patients with the disease. The purpose of this review was to investigate the quality of life of psoriatic patients to give a thorough perspective as to the difficulties that the patient population faces. We conducted a PubMed search of relevant articles related to psoriasis and its effect on quality of life. There is significant evidence that identifies the negative effects of psoriasis on the social, financial, physical, and emotional aspects of a patient's life. Combining these negative effects, overall quality of life is impaired predominantly for untreated disease. The quality of life impairment for patients with psoriasis is substantial and results in significant additional burden.
Duration of Remission of Topical Psoriasis Therapies
Authors: Levin Ethan C. , Gupta Rishu , Shinkai Kanade
Published: April 2018

Topical medications are a mainstay of psoriasis therapy. Choosing a therapy with a favorable duration of remission is important in preventing disease relapse. Our aim was to review available data on the duration of remission of different topical therapies used in the treatment of psoriasis. We performed a PubMed search for English language literature that evaluated the duration of remission for topical therapy of psoriasis. Data were reviewed for Goeckerman therapy, Ingram therapy, topical corticosteroids, vitamin D derivatives, tazarotene, anthralin, and coal tar. The combination of a superpotent corticosteroid with anthralin or a vitamin D derivative induced longer remission than either of these agents as monotherapy. The longest duration of remission was reported in patients treated with Goeckerman or Ingram therapy. The mean time to relapse in 3 retrospective Goeckerman studies was 9.5 months, 1.7 years, and 2.6 years. Superpotent topical corticosteroids combined with a second agent, such as anthralin or vitamin D derivatives, may increase duration of remission compared with monotherapy. Goeckerman and Ingram therapies may provide the longest duration of remission among topical psoriasis treatments.
Successful Treatment of Plaque Psoriasis with Ustekinumab in a Patient with Chronic Hepatitis B and Latent Tuberculosis
Authors: Ensanyat Shaheen H. , Luber Adam J. , Levitt Jacob O.
Published: April 2018

Ustekinumab is a human monoclonal antibody that binds to the shared p40 subunit of interleukin (IL)-12 and IL-23 and is approved for the treatment of moderate to severe psoriasis. Given its immunosuppressive effects, particularly of IL-12, there is concern for reactivation of chronic viral and mycobacterial infections. We report a case of a male with psoriasis successfully treated with ustekinumab without reactivation of his chronic hepatitis B virus (HBV) and latent tuberculosis infection (LTBI). Although the risks and benefits should be carefully assessed, ustekinumab is a therapeutic option for patients with psoriasis and chronic hepatitis B or latent TB, provided that careful consideration is given to hepatitis B and TB prophylaxis during therapy.
Are New Tools for Early Detection of Psoriatic Arthritis Ready for Widespread Clinical Use? A Review
Authors: Harvey Bethany D. Wood , Gottlieb Alice B.
Published: April 2018

Despite garnering new research interest within the past several years, the pathological progression of psoriasis to psoriatic arthritis is still poorly understood. Treatment for the disease, which is most often identified in patients with psoriasis, can be most effective when a patient is diagnosed early. Currently, physicians utilize tools such as questionnaires, conventional radiography, ultrasonography, and magnetic resonance imaging to identify these patients. Unfortunately, these tools are not without limitations, and a more specific criterion has yet to be validated. The identification and validation of biomarkers of early psoriatic arthritis and treatment may provide clinicians with a new tool with which to accelerate disease diagnosis and measure treatment efficacy.
Do We Have to Stop Biologics before Surgery?
Authors: Albukhari Faten , Golant Alexandra
Published: April 2018

The recent development of biological therapy has revolutionized care for patients with psoriasis, psoriatic arthritis, rheumatoid arthritis, and other diseases. Treatment with biologics can provide significant symptomatic and functional improvement. However, these agents have been associated with risks of compromised healing, such as infection, owing to their systemic blockade of mediators to the normal inflammatory responses required for tissue healing and immune surveillance. Given these potential risks and benefits, the question of how best to manage biologic therapy before planned surgery is an important consideration for practitioners. In an attempt to answer this question, we performed a review of the literature on this topic.
Screening for Latent TB Infection in a Psoriasis Patient with History of BCG Vaccination and Exposure to TB Prior to Treatment with an Anti-TNF-α Agent
Authors: Gropper Jaime R. , Aljehani Fawaz
Published: April 2018

The treatment of psoriasis has undergone a revolution with the introduction of biologic therapies like anti-tumor necrosis factor-α (TNF-α) antibodies. TNF-α not only plays a major role in the pathogenesis of psoriasis, but also is a key cytokine in the body's defenses against microbacterial infection. In patients with latent tuberculosis (TB), treatment with anti-TNF antibodies may result in the development of active TB. Historically, tuberculin skin tests have been used to detect the presence of latent TB infection. More recently, interferon-gamma release assays have been developed. We report a patient who demonstrates pitfalls of some of our testing for latent TB.
Controversies in the Treatment of Psoriasis: Is There a Role for Tonsillectomy?
Authors: Fisher Jonathan M. , Czernik Annette
Published: April 2018

Treatment of psoriasis traditionally has been directed at epidermal symptoms. Recent findings from a prospective study have implicated a circulating cross-reactive T-cell population in psoriasis etiology. These T cells appear to originate from streptococcal infection in the tonsils, and the study showed that tonsillectomy may lead to stable clinical improvement in psoriasis. Here, we review previous case reports and retrospective studies of tonsillectomy in the treatment of psoriasis and discuss findings in relation to the prospective study.
Immunobiologics: Intermittent versus Continuous Use in the Treatment of Moderate to Severe Psoriasis
Authors: Okereke Uchenna , Nazarian Rachel , Lebwohl Mark
Published: April 2018

Immunobiologics are used to treat patients with moderate to severe psoriasis and allow for continuous maintenance therapy for longer periods of time without the adverse effects seen with older systemic medications, such as methotrexate or cyclosporine. However, will patients stop responding to the drug if they discontinue and restart therapy? This review will examine four biologic agents currently used in the treatment of psoriasis – etanercept, adalimumab, infliximab, and ustekinumab — to determine whether patients can re-achieve comparable clinical response with intermittent therapy versus continuous therapy. While some data suggest that continuous immunologic therapy may lead to decreased efficacy over time, etanercept, adalimumab, and ustekinumab provide patients with durable response should a patient need to discontinue and reinitiate treatment. These findings may assist clinicians in selecting an appropriate agent should interruption of therapy be necessary.
Treatment of Refractory Psoriasis with Ustekinumab in an HIV-Positive Patient: A Case Presentation and Review of the Biologic Literature
Authors: Wieder Shira , Routt Ethan , Levitt Jacob , Lebwohl Mark
Published: April 2018

Here we describe a case of a 39-year-old male with HIV and a 20-year history of generalized plaque psoriasis and psoriatic arthritis. The patient had been refractory to all treatments until initiating ustekinumab, the monoclonal antibody against IL-12/23. While using ustekinumab, the patient's CD4 T-cell count and HIV viral load have remained stable. Due to the questions surrounding the use of biologics in HIV-positive patients, we review the successful use of anti-TNF agents in patients with chronic HIV infection as well as the single other reported case of ustekinumab's use in an HIV-positive patient. We therefore begin to build the case for ustekinumab as an alternative biologic therapy for the HIV-infected psoriasis patient.
A Review of Tofacitinib in the Treatment of Rheumatoid Arthritis and Psoriasis
Authors: Fanucci Kristina A. , Rosmarin David M. , Gottlieb Alice B.
Published: April 2018

Tofacitinib is a novel Janus kinase (JAK) inhibitor. JAKs activate immune cells and pro-inflammatory cytokines. Thus, they are critical in the pathogenesis of many diseases including autoimmune diseases such as rheumatoid arthritis (RA) and psoriasis. Existing treatments for RA and psoriasis do not provide all patients with sufficient disease control. Furthermore, some patients develop resistance or have adverse events to current therapies. Patients whose disease is not controlled appropriately by available treatments highlight the need for drugs with novel targets, convenient administration routes, continued efficacy, and long-term tolerability. Tofacitinib can be administered orally or topically and has been shown to be an effective treatment for RA and psoriasis. This article reviews the mechanism of action, pharmacodynamics, pharmacokinetics, and metabolism of tofacitinib and discusses the clinical trials conducted to show the efficacy and safety of oral tofacitinib in the treatment of RA and oral and topical tofacitinib in the treatment of psoriasis.
Effect of Pregnancy on Psoriasis and Psoriatic Arthritis
Authors: Garber Caren , Gottlieb Alice
Published: April 2018

Psoriasis and psoriatic arthritis are chronic illnesses that are prevalent in women of childbearing age. The aim of this review is to bring to light data regarding the effect of pregnancy and the postpartum period on psoriasis and psoriatic arthritis and to discuss the major theories underlying these changes. To date, evidence indicates a tendency toward improvement of psoriasis and psoriatic arthritis during pregnancy and a flare in the postpartum period. This is likely a consequence of physiologic adaptations during pregnancy and the subsequent loss of these protective factors in the postpartum period. Most prominent among these adaptations are hormonally induced changes in helper T cell (Th1, Th2, and Th17) cytokines. However, alterations in proteins and cell surface molecules also have been implicated. The relatively high prevalence of psoriasis and psoriatic arthritis in women of childbearing age mandates that patients, dermatologists, and obstetricians alike be knowledgeable of the gestational and postpartum changes that occur in these diseases.
President's Page
Authors: Detomo Rocky
Published: April 2018

The role of geophysicists has been changing and maturing ever since the earliest references to them. Geophysics is defined as “a branch of earth science concerned with the physical processes and properties of the earth and its surrounding space environment, and the use of quantitative methods for their analysis.” Accordingly, early geophysicists collected physical measurements of the earth such as potential-field responses and source-receiver-pair refraction acoustic data. From these measurements, they made simple calculations outlining the existence, position, and properties of shallow anomalies that might offer insights to locating valuable mineral, water, and hydrocarbon deposits.