tbuckley/cabot-search huggingface dataset:
P85 Genital psoriasis in Asians: impact on quality of life and sexual health
Journal: British Journal of Dermatology (2024)

Abstract Genital involvement and sexual dysfunction are common amongst patients with psoriasis; however, most patients do not discuss their genital rashes or sexual health with their doctor. The aim of this study was to evaluate the impact of genital psoriasis on quality of life (QoL) and sexual health in adult Asian psoriasis patients with genital psoriasis, an entity that is poorly understood, under-recognized and undertreated. We performed an observational study on adult Asian psoriasis patients attending psoriasis subspecialty clinics at a tertiary dermatology centre over 1 year. Participants underwent clinical examination of the whole-body surface, with particular attention to the genitalia, and questionnaires to evaluate QoL and psychosexual health were administered. Patients received a small renumeration for their participation. The study received no commercial funding. A total of 62 patients participated. Most participants were male (82.3%) and Chinese (59.7%) with a mean age of 41.7 years [standard deviation (SD) 12.5]. The commonest site involved was the suprapubis (61.3%). Perianal, glutaeal cleft and perineum involvement were more common amongst females (P &amp;lt; 0.05). The mean psoriasis area and severity index (PASI) score was 7.0 (SD 4.3) with a mean Dermatology Life Quality Index (DLQI) score of 9.8 (SD 6.7), indicating moderately impaired QoL. Higher PASI scores were associated with increasing QoL impairment on DLQI (P = 0.021). Males in whom genital psoriasis prevented sexual intercourse or diminished their libido reported more sexual dysfunction. Females reported greater severity in terms of symptomatic burden and feelings of embarrassment (P = 0.038) yet were less likely to be on treatment (37.5 vs. 45.0%). Perceived efficacy of treatment was low and younger patients fared poorer on the Patient Health Questionnaire-9 depression questionnaire (P = 0.047). Genital involvement may be a key contributor to the lower QoL compared with psoriasis patients without genital involvement. Although patients desire more efficacious treatment, they may be reluctant to discuss their genital rashes or sexual health when not prompted leading to under-recognition and under-treatment, particularly amongst female patients. More studies need to be performed with age and gender-matched control groups using validated QoL and sexual health questionnaires for genital psoriasis. Nonetheless, clinicians should proactively evaluate for and treat genital psoriasis, as disease control has been shown to restore both QoL and sexual function.
P99 Dietary habits including use of nutritional supplements and adherence to national dietary guidelines in patients with psoriasis: a cross-sectional study
Journal: British Journal of Dermatology (2024)

Abstract The potential role of diet in psoriasis has been the subject of considerable interest in recent years, yet the evidence remains limited. This study aims to describe the dietary habits of patients with psoriasis, including the use of nutritional supplements and adherence to national dietary guidelines. This cross-sectional study included patients with psoriasis from a prospective observational cohort from a university hospital. At inclusion or at the annual visit, the participants completed a questionnaire about dietary habits. Anthropometric measurements and information about treatments were recorded by a healthcare professional. We enrolled 466 participants in this study, with a mean age of 49 (SD ± 16) and 44% of whom were women. The mean body mass index (BMI) was 28.3 (±6.5), with 66% of the participants being overweight or obese. Eighty-one per cent of the patients received systemic treatments (conventional therapies or biologics) and 19% solely used topical therapies. The median psoriasis area and severity index was 2.5 (range, 0–40.8). In the self-reported questionnaire about dietary habits, 53% participants indicated that they adhere to a ‘a healthy and varied diet’, whereas 39% stated that they do not follow any specific diet. Around 18% reported to eat organic food, and 5% followed a vegan or vegetarian diet. Almost 10% reported to practice some kind of intermittent fasting. Only very few participants followed other diets such as Mediterranean (4%), Ketogenic/Low Carb High Fat (3%), or anti-inflammatory diet (2%). Half of the participants reported eating wholegrain and vegetables daily, and 73% marked eating fast food less than once a week. However, more than half of them also reported consuming sweets several times a week or daily. When comparing the dietary habits of the participants to guidelines from the national health authorities, 90% showed high or intermediate adherence to these guidelines. Notably, 34% of participants with mild psoriasis showed a high adherence to guidelines compared with 16% with moderate-to-severe psoriasis. Interestingly, only 16% experienced that specific food products triggered their psoriasis, most commonly being alcohol, sugar, and processed food. Even fewer (7%) experienced that specific food products improved their psoriasis. Regarding nutritional supplements, 37, 41, and 23% of the participants reported daily use of multivitamins, vitamin D supplements, and omega-3, respectively. In conclusion, most participants reported following ‘a healthy and varied diet’, and a healthy dietary pattern was confirmed when comparing the intake of specific food products to the national dietary guidelines, with 90% of the participants showing either high or intermediate adherence to the national dietary guidelines.
P111 An AI-assisted similarity search engine for enhanced psoriasis case identification and patient engagement
Journal: British Journal of Dermatology (2024)

Abstract Each psoriasis patient's clinical features follow a unique pattern that does not normally fit perfectly within classical subtypes of psoriasis as described in textbooks. The objective of this study is to develop an AI-assisted similarity search engine for psoriasis patients. This enables users to upload images and retrieve similar cases from both publicly available data, namely peer-reviewed literature and public datasets, and a private collection. With a match, a patient may glean additional information about his or her personal subtype of psoriasis including potential treatment strategies, and even get in touch with other patients affected with a similar clinical pattern. The system is designed to be self-hosted, thereby enabling patients to share their own images through the completion of an informed consent form. The types of psoriasis covered are plaque-type, guttate, inverse, erythrodermic, pustular and mixed. The system offers the option of linking to similar images of lesions by manually selecting an area of interest. Furthermore, the system is capable of suggesting similarities to differential diagnoses, i.e. eczema or pityriasis rubra pilaris. The tool is intended for use by patients, general physicians and dermatologists, with the objective of enhancing patients' understanding of their conditions and facilitating discussion and exchange through an integrated forum. The system employs visual transformers as feature extractors to vectorize the uploaded images and utilizes cosine similarity to compare them with images in the database. Furthermore, supplementary data, such as sparse matching, is presented to the user in order to facilitate a deeper comprehension of the similarities between the images in question. Furthermore, the system is capable of displaying supplementary data regarding the cases stored in the database, as well as links to pertinent literature. Should they so desire, patients are afforded the opportunity to interact with other patients who have been diagnosed with similar conditions, thereby facilitating discussion of their respective cases. The preliminary findings suggest that this tool has the potential to markedly enhance patients' comprehension of their conditions, while also enabling them to utilize the tool for diagnostic assistance. Furthermore, patients can gain deeper insights into their condition, which may facilitate informed discussions and community support through the forum. The system has the potential to transform psoriasis management by providing a reliable, user-friendly platform for case comparison and patient engagement. Further research will focus on expanding the database and refining the algorithm to enhance its diagnostic capabilities and user experience.
P05 Evaluation of changes in serum cytokine (TNFα, IFNα2, IFNγ, IL-1β, IL-6, IL-8, IL-10, IL-10, IL-12p70, IL-17A, IL-18, IL-23, IL-23, IL-33, and MCP-1) values in biologic-naive psoriasis patients during biologic agent use
Journal: British Journal of Dermatology (2024)

Abstract Psoriasis is an immune-mediated chronic inflammatory skin disease. Proinflammatory cytokines have an important role in the pathogenesis. Current treatments mainly act on TNF-α, IL-12, IL-17 or IL-23 pathways. It is thought that determination of cytokine levels before treatment can be used as useful biomarkers for monitoring disease activity and personalized treatment selection. The aim of this study is to contribute to the establishment of biomarkers that can help predict disease severity, treatment response and disease prognosis in patients with psoriasis and also compare healthy controls. We analysed the changes in serum levels of cytokines (TNFα, IFNα2, IFNγ, IL-1β, IL-6, IL-8, IL-10, IL-10, IL-12p70, IL-17A, IL-18, IL-23, IL-23, IL-33, MCP-1) before and 4 months after treatment with biological agents in 40 bio-naive psoriasis patients and 15 healthy subjects. Flow cytometry method [LEGENDplex™ Multi-Analyte Flow Assay Kit Human Inflammation Panel 1, 13 Plex with V-bottom Plate (BioLegend, San Diego, CA, USA)] was used for the determination of cytokine levels. Clinical and demographic information, including PASI (psoriasis area and severity index) and DQLS (Dermatology Quality of Life Scale) scores were recorded. In addition, acute phase reactants (CRP, ESR, ferritin, albümin) were measured before and after 4 months of treatment. The data obtained were analysed using NCSS 2007 software. PASI and DQLS scores at the fourth month of treatment were found to be significantly lower compared with the onset (P = 0.000, P = 0.0001, respectively). When cytokine values were analysed; IFN-γ levels of the patients increased after treatment (P = 0.007). Pre-treatment IL-33 and IL-1β levels of the patients were lower than healthy subjects (P = 0.045), but there was no difference between the mean levels of these cytokines before and after treatment. Among the biologic agents, IL-17A levels were found to be lower only in patients using secukinumab (P = 0.022). Pre-treatment and post-treatment IL-17A difference of the secukinumab group was higher than the other drugs (P = 0.004, P = 0.009), while no statistical difference was observed between the other biologic agents (P &amp;gt; 0.05). There was no correlation between age at disease onset, PASI and DQLS and cytokine levels. The ESR, CRP, and ferritin values of the patients were higher than the healthy controls before treatment (P = 0.011, P = 0.022, and P = 0.037, respectively). However, only ESR decreased after treatment in psoriasis patients (P = 0.027). In this study, no significant differences were found in serum cytokine levels. However, the literature shows that while serum levels may remain unchanged, tissue levels can be significantly different. Future studies should include cytokine analyses in both serum and tissue levels.
FC03 T17 polarization of skin-homing (CLA-positive) T cells is maintained by activation-dependent, AP-1-mediated chromatin remodelling
Journal: British Journal of Dermatology (2024)

Abstract Background T cells undergo polyclonal expansion in psoriasis and PsA, with persistence of ‘driver clones’ after effective treatment (JCI 127:4031; JI 172:1935). A recent study found roughly equally sized compartments of clonally expanded and polyclonal Th17 and Tc17 cells in psoriasis (Science 371:364). Memory T17 cells undergo monocyte-dependent expansion in CD3/CD28-activated PBMC cultures (PNAS 104:17034; JID 139:1245). Methods We stimulated PBMC from 85 psoriatic and 68 controls for 1 day with anti-CD3/CD28 Dynabeads (24 h), or without beads (0 h), followed on Day 0 or Day 1 by flow sorting (CD3+CD45RO+, CD4/CD8 × CLA+/CLA- × 0/24 h), RNA-seq and ATAC-seq. Results CD3/CD28 activation provoked marked (&amp;gt;100-fold) upregulation of the T17 signature transcripts IL17A, IL17F, IL22, and CCL22, and of the T1 signature transcript IFNG. However, stratified analysis of CLAP vs. CLAN in activated T cells revealed 2.9- to 12.1-fold upregulation of the four T17 signature mRNAs, without a corresponding increase in IFNG. Notably, IL17A and IL17F were overexpressed in activated T cells from psoriatic vs. control donors (each 1.9-fold, P = 4.7E−4). Occupancy analysis of 702 transcription factor (TF) motifs using CENTIPEDE revealed remarkable correlations between activation (CLAN at 24 vs. 0 h) and skin-homing status (CLAP vs. CLAN at 0 h) [Spearman’s rho = 0.94 for CD4 and 0.93 for CD8; rho(expected)∼0.5]. Compared with CLAP/CLAN, correlations with activation were much weaker for CD8/CD4, the other dimension in our 2 × 2 × 2 study design (rho = 0.41 for CLAN and 0.29 for CLAP). AP-1 motifs were significantly enriched among CLAP vs. CLAN differentially occupied motifs (P &amp;lt; 2.2E−16 for CD4 and CD8, Fisher’s exact). Discussion CLAP are effector memory T cells (Tem) arising after injury/infection of skin (or tonsils), whereas CLAN are central memory T cells (Tcm) that may arise in the skin, lung, or gut (JID 130:362; STM 7:269). Our results support findings that human Th17 cells are long-lived Tem (STM 3:104) and that Tem are more responsive than Tcm due to increased TF occupancy driven by AP-1 TFs (Commun Biol 6:363). Our results nominate repetitive activation of memory T cells (whether clonally via TCR activation or polyclonally via cytokines) as a mechanism for increased responsiveness of CLAP/Tem vs. CLAN/Tcm. They also advance a plausible explanation for the presence of polyclonal T cells in psoriasis lesions (‘chromatin memory’ of secondarily activated T cells), suggesting a molecular basis of the Koebner phenomenon (heterologous activation of poised chromatin, Nature 580:475), and provide a rationale for implementing highly effective treatment early in the course of psoriasis (to prevent expansion of memory T cells, clonal or not, with chromatin poised for T17 reactivation).
FC14 Modulation of the IL23/IL17 axis beyond IL-17A drives response to risankizumab in palmoplantar psoriasis
Journal: British Journal of Dermatology (2024)

Abstract Palmoplantar psoriasis (PPPsO) is a variant of plaque psoriasis (PsO) that is characterized by difficult-to-treat lesions on the hands and feet and is associated with substantial physical disability and discomfort. A better understanding of pathogenic disease drivers is critical to ensuring patients receive treatments that will drive high levels of efficacy. Data from non-head-to-head randomized clinical trials suggest that IL-23 blockade may be more efficacious than IL17A blockade in PPPsO. Here, we evaluated changes in downstream mediators of the IL-23/IL-17 axis following treatment with risankizumab, an interleukin (IL)-23 inhibitor approved for the treatment of PsO and demonstrate that broad coverage of the IL-23 pathway beyond IL-17A may be required to achieve &amp;gt;90% improvement in clinical score in PPPsO. IMMprint (NCT04713592) is an ongoing Phase 3b, multicentre, randomized, double-blind, placebo-controlled study for patients with PPPsO. Patients were randomized 1:1 to receive either blinded 150 mg risankizumab or placebo at Weeks 0 and 4. At Week 16 all patients entered the open-label extension and received risankizumab at Week 16 and every 12 weeks thereafter. Whole blood was collected (N = 35 in each arm) at baseline and Weeks 4, 16, and 52. Serum cytokine levels of IL-17A and IL-17C were assessed by proximity extension assay and IL-22 and beta-defensin 2 (BD-2) were assessed by high sensitivity individual assays. Efficacy at Week 16 was assessed by psoriasis area and severity index (PASI) and palmoplantar PASI (PPASI). Response to risankizumab was defined as achieving the PPASI 90 endpoint. A total of 13 patients receiving risankizumab and 2 patients receiving placebo achieved PPASI 90 at Week 16. Patients that achieved PPASI 90 with risankizumab had a significant reduction in serum levels of IL-22 (pro-inflammatory cytokine), BD-2 (host defence), and IL-17C (amplification of epithelial inflammation) as early as 4 weeks after treatment, continuing through Week 52, compared with patients that did not achieve PPASI 90. Further, a positive correlation between reduction in IL-22, BD-2, and IL-17C and PASI and PPASI scores was observed at Week 16 for patients receiving risankizumab but not placebo. No association was observed between other inflammatory molecules, including IL-17A, and patient achievement of PPASI 90. The data suggest that the IL-23/IL17 axis beyond just IL-17A is important for driving disease pathology in PPPsO.
P89 Psoriasis and lifestyle recommendations on the internet. Do they help?
Journal: British Journal of Dermatology (2024)

Abstract Introduction Pathogenesis of psoriasis is multifactorial: genetic, immunological and environmental factors contribute together. Although intrinsic pathways of the disease patients are not able to modify, extrinsic factors (e.g. lifestyle, environmental factors) are those who pay patient’s attention. Chronicity of psoriatic disease promotes to seek for additional factors and recommendations that could help to prevent disease progression/symptoms/outbreaks. From the patient’s perspective using the internet to look for information in non-scientific portals is the most accessible and easiest way to find wanted. The aim of this study was to look for lifestyle recommendations in Latvian non- scientific mass media websites, which are given to prevent psoriasis outbreaks and relieve symptoms. Materials and Methods In June 2024, 8 Latvian mass media non-scientifical web portals and 30 articles (01.2022–06.2024) under the keywords ‘psoriasis’, ‘psoriasis treatment’, and ‘how to deal with psoriasis’ were analysed. Information was summarized to find out the most common lifestyle recommendations that are given to patients. Results The study showed that the most often was recommended to moisturize the skin with emolients (15 articles); 10 articles recommended skin cleansing as a daily routine with non-irritating, fragrance- and colour-free agents. The majority of received articles (25) mentioned that stress management, healthy sleep routine, physical activity and maintaining a healthy weight are the main factors that can help to prevent outbreaks. In five articles: vitamins D, B and A, and primrose oil were mentioned, but three of them recommended a special diet reducing consumption of dairy products, carbohydrates-, especially sugar, wheat flour and gluten. In six articles, it was recommended to stop smoking and using alcohol. Three of them suggested avoiding any skin traumas as well as tattoos and piercings, but only two recommended not to scratch and exfoliate the skin aggressively. In two articles it was recommended to use natural fabric clothing, do meditation and use phototherapy with UVB light. Two articles revealed the use of cold-pressed onion juice on celandine tincture to remove hyperkeratotic plaques. Only 3 of 30 articles recommended specialists' advice and specific treatment. Conclusions On the one hand from the patient's perspective, the internet is fulfilled with information and recommendations and can help to answer patient questions. On the other hand recommendations, fulfilment of the information can distract and delude the patients. Non-scientifical websites should be analysed critically. Most of them are made by non-health providers or translated from different languages. The lack of objectivity and not evidence-based information can lead to inadequate disease management, increase disbelief in treatment methods or even harm the patient.
P44 Upregulation of beta defensin in human epidermal organoids treated with combinations of IL17 and IL23
Journal: British Journal of Dermatology (2024)

Abstract Psoriasis is a chronic inflammatory skin disease characterized by the hyperproliferation of keratinocytes and an aberrant immune response. The pro-inflammatory cytokines IL-17 (a, e, f) and IL-23 play crucial roles in the pathogenesis of psoriasis. Human epidermal organoids (HEOs) are an in vitro model that recapitulates the epidermis and a useful tool for studying epidermal biology and disease mechanisms. HEOs were treated with various combinations of cytokines, including IL-17a, IL-17e, IL-17f, and IL-23. Following treatment, quantitative PCR (qPCR) and immunohistochemistry (IHC) were performed to assess the expression levels of beta-defensin, an antimicrobial peptide implicated in psoriasis. The qPCR analysis revealed significant upregulation of beta defensin in HEOs treated with the following cytokine combinations: IL-17a alone, IL-17f alone, IL-17a+e, IL-17a+f, IL-17a+IL-23, IL-17a+e+f, IL-17a+e+IL-23, IL-17a+f+IL-23, and IL-17a+e+f+IL-23. Conditions lacking IL-17a exhibited markedly lower beta-defensin expression, indicating the critical role of IL-17a in this process. However, IL-17f alone induced a moderate upregulation of beta-defensin. The study demonstrates that IL-17a is a pivotal cytokine in inducing beta-defensin expression in HEOs, with IL-17f also contributing to a lesser extent. The significant upregulation of beta-defensin in response to these cytokines suggests a key role for beta-defensin in the pathophysiology of psoriasis, potentially linking antimicrobial peptide activity to disease severity and progression.