Clinical trials successfully using antibodies targeting IL-17 in psoriasis support the importance of IL-17 in the pathophysiology of this disease. However, there is a debate concerning the source and ...dynamics of IL-17 production in inflamed skin. Here we characterized IL-17-producing immune cells over time, using two established in vivo models of human skin inflammation that share many histological features with psoriasis, i.e., leukotriene B4 application and tape-stripping. Both treatments revealed a clear influx of neutrophils and T cells. Staining for IL-17 revealed that the majority of IL-17 was expressed by neutrophils and mast cells, in both models. Neutrophils, but not mast cells, coexpressed the IL-17-associated transcription factor RORγt and were able to form extracellular traps. While the presence of mast cells remained steady during the skin inflammatory process, the presence of neutrophils was clearly dynamic in time. Therefore, it is attractive to hypothesize that IL-17+/RORγt+ neutrophils contribute to human skin inflammation in vivo and possibly to the pathogenesis of skin diseases such as psoriasis. Surprisingly, T cells represented a minority of the IL-17-expressing cell population. These observations challenge the classical opinion that IL-17 is predominantly associated with T cells in skin inflammation.
Summary
Background Psychological stressors might contribute to the severity of chronic inflammatory diseases such as psoriasis by dysregulating hypothalamic–pituitary–adrenal (HPA) axis activity.
...Objectives To evaluate the role of cortisol, a key component of the HPA axis, in reaction to psychological stress in patients with psoriasis.
Methods Serum cortisol, clinical indicators of disease severity (Psoriasis Area and Severity Index) and self‐report measures of daily stressors were measured monthly for 6 months in 62 patients with psoriasis.
Results In addition to the previous findings in this sample showing that peak levels of daily stressors predicted an increase in disease severity a month later, the peak levels of daily stressors were also significantly associated with a lower cortisol level. Moreover, patients who persistently experienced higher levels of daily stressors had lower mean cortisol levels than patients who experienced lower levels of daily stressors.
Conclusions Results suggest that daily stressors influence disease outcome in patients with psoriasis by affecting cortisol levels at moments of high stress. Furthermore, patients with persistently high levels of stressors seem to have a specific psychophysiological profile of lowered cortisol levels and may be particularly vulnerable to the influence of stressors on their psoriasis.
Summary
Background
Although the effectiveness of biologics for psoriasis has been measured extensively with objective outcome measures, studies based on subjective, patient‐reported outcome measures ...remain scarce.
Objectives
To investigate satisfaction with medication, as measured by the Treatment Satisfaction Questionnaire for Medication (TSQM) for biologics in daily practice psoriasis care in the first 6 months of treatment; and to identify possible differences in satisfaction with medication between patients experienced (biologics‐experienced) and inexperienced (biologics‐inexperienced) in the use of biologics.
Methods
TSQM baseline measurements were compared using measurements taken after 6 months, using the Wilcoxon signed‐rank test for paired comparisons. Intention‐to‐treat with last observation carried forward (ITT with LOCF) and as‐treated analyses were performed. The difference between biologics‐experienced and biologics‐inexperienced patients for TSQM was analysed using ITT with LOCF. At 6 months, outcomes for biologics‐experienced and biologics‐inexperienced patients were compared using the Mann–Whitney U‐test.
Results
One hundred and six patients were eligible for analysis, and treated with etanercept (n = 34), adalimumab (n = 49) or ustekinumab (n = 23). Fifty‐four per cent of patients were biologics‐inexperienced. A statistically significant improvement was seen in all domains of the TSQM (‘effectiveness’, ‘side‐effects’, ‘convenience’ and ‘global satisfaction’) by comparison of months 3 or 6 with baseline (all P ≤ 0·02). After 6 months, biologics‐inexperienced patients scored better on the ‘global satisfaction’ domain than biologics‐experienced patients (P < 0·01).
Conclusions
We provide a prospective, longitudinal analysis of TSQM for biologics in daily practice psoriasis care. High satisfaction rates were achieved. The ‘effectiveness’ and ‘convenience’ domains showed the most room for improvement.
What's already known about this topic?
Maximum satisfaction with medication is thought to be positively related to adherence, health‐related quality of life and patients' preferences.
As shown in cross‐sectional research, patients' dissatisfaction with treatment plays an important role in psoriasis. Those receiving biologics are the most satisfied with treatment among patients with psoriasis.
In an open‐label extension trial with etanercept, significant improvement in the ‘global satisfaction’, ‘effectiveness’ and ‘convenience’ domains was achieved after 3 months of treatment.
What does this study add?
A prospective, longitudinal study on satisfaction with etanercept, adalimumab and ustekinumab for patients with psoriasis in daily practice.
Significantly improved satisfaction rates (using the Treatment Satisfaction Questionnaire for Medication) were achieved after 3 and 6 months. As reported by the patients, the ‘effectiveness’ and ‘convenience’ domains showed the most room for improvement.
After 6 months, biologics‐inexperienced patients scored significantly better on the ‘global satisfaction’ domain than experienced patients.
BACKGROUNDChronic pruritus is frequently seen in daily dermatological practice and is associated with marked impact on quality of life. Research on the use of gabapentin and oral antidepressants in ...daily dermatological practice is scarce.OBJECTIVETo evaluate the efficacy and safety of gabapentin and oral antidepressants in patients with chronic pruritus in daily clinical practice.METHODSA prospective observational single-center cohort study was conducted including adult patients with chronic pruritus and an indication for systemic treatment between June 2016 and May 2019.RESULTSSystemic treatment with gabapentin and/or antidepressants was initiated in 31 patients with severe chronic pruritus (median average pruritus NRS score 7.0), in which most cases no underlying origin was identified (83.9%). In patients treated with gabapentin 900-1800 mg/day (N = 25), median average pruritus NRS decreased to 5.5 (IQR 3.0) after 4 weeks and remained stable up to 24 weeks of treatment. Efficacy of antidepressants was variable, with the highest response after initiation of amitriptyline, nortriptyline, and mirtazapine. Side effects were frequently observed in both gabapentin and antidepressant treatments; however, were mostly mild and temporary.LIMITATIONSThis was a single-site observational study, with limited sample size.CONCLUSIONTreatment with gabapentin and antidepressants should be considered in patients with chronic pruritus unresponsive to conventional treatment.
Summary
Background
Localized scleroderma (LoS) is characterized by a phase of disease activity followed by remission. However, disease recurrences occur. Knowledge concerning these recurrences can ...help prompt treatment, thereby preventing disease damage.
Objectives
To investigate the frequency and characteristics of disease recurrences in paediatric‐ and adult‐onset LoS, and to identify patient variables that are associated with a higher risk of disease recurrence.
Methods
Retrospective chart reviews were performed of patients with LoS. Data concerning the frequency and characteristics of the disease recurrences were collected. A multivariate analysis was performed to identify patient variables that were associated with a higher risk of disease recurrence.
Results
In total, 344 patients were included in the analysis, of whom 119 (35%) had paediatric‐onset LoS and 225 (65%) had adult‐onset LoS. Disease recurrence was present in 27% (n = 32) of the paediatric‐onset group and 17% (n = 39) of the adult‐onset group (P = 0·037). Multivariate analysis identified a statistically significant association between disease recurrence and the linear LoS of the limbs subtype, independent of age at disease onset.
Conclusions
Recurrences in LoS occurred in almost one‐quarter of the patients and were most frequent in the linear LoS of the limbs subtype, independent of age at disease onset. These disease recurrences can occur even after many years of quiescent disease. Awareness of the high recurrence rates may help treating physicians to recognize reactivation of the disease, leading to a decreased delay in treatment reinitiation.
What's already known about this topic?
Localized scleroderma is characterized by a phase of disease activity followed by remission. However, disease recurrences occur.
What does this study add?
Recurrences occur in almost one‐quarter of patients and are more frequent in the linear localized scleroderma of the limbs subtype, independent of age at disease onset.
Awareness of high recurrence rates may help treating physicians to recognize reactivation of the disease, leading to a decreased delay in treatment reinitiation.
Nail Psoriasis, the unknown burden of disease Klaassen, K.M.G.; van de Kerkhof, P.C.M.; Pasch, M.C.
Journal of the European Academy of Dermatology and Venereology,
December 2014, Letnik:
28, Številka:
12
Journal Article
Recenzirano
Background
Psoriasis can be found at several different localizations which may be of various impact on patients' quality of life (QoL). One of the easy visible, and difficult to conceal localizations ...are the nails.
Objective
To achieve more insight into the QoL of psoriatic patients with nail psoriasis, and to characterize the patients with nail involvement which are more prone to the impact of the nail alterations caused by psoriasis.
Method
A self‐administered questionnaire was distributed to all members (n = 5400) of the Dutch Psoriasis Association. The Dermatology Life Quality Index (DLQI) and the Nail Psoriasis Quality of life 10 (NPQ10) score were included as QoL measures. Severity of cutaneous lesions was determined using the self‐administered psoriasis area and severity index (SAPASI).
Results
Patients with nail psoriasis scored significantly higher mean scores on the DLQI (4.9 vs. 3.7, P = <0.001) and showed more severe psoriasis (SAPASI, 6.6 vs. 5.3, P = <0.001). Patients with coexistence of nail bed and nail matrix features showed higher DLQI scores compared with patients with involvement of one of the two localizations exclusively (5.3 vs. 4.2 vs. 4.3, P = 0.003). Patients with only nail bed alterations scored significant higher NPQ10 scores when compared with patients with only nail matrix features. Patients with psoriatic arthritis (PsA) and nail psoriasis experiences more impairments compared with nail psoriasis patients without PsA (DLQI 5.5 vs. 4.3, NPQ10 13.3 vs. 7.0). Females scored higher mean scores on all QoL scores.
Conclusion
Greater attention should be paid to the possible impact nail abnormalities have on patients with nail psoriasis, which can be identified by nail psoriasis specific questionnaires such as the NPQ10. As improving the severity of disease may have a positive influence on QoL, the outcome of QoL measurements should be taken into account when deciding on treatment strategies.
A dose reduction strategy for adalimumab, etanercept and ustekinumab in patients with psoriasis who have stable and low disease activity has recently been compared with usual care in the CONDOR study ...(CONtrolled DOse Reduction) of biologics in patients with psoriasis with low disease activity. The aim of the current study was to perform a cost-utility analysis with a 12-month time horizon alongside this trial, using prospectively measured healthcare costs and quality-adjusted life years, based on Short-Form Six-Dimension utilities. Bootstrap analyses were used to calculate the decremental cost-utility ratio and the incremental net monetary benefit. The dose reduction strategy resulted in a mean cost saving of €3,820 (95
th
percentile –€3,099 to –€4,509) per patient over a period of 12 months. There was an 83% chance that dose reduction would result in a reduction in quality adjusted life years (mean –0.02 (95
th
percentile –0.06 to 0.02). In conclusion, dose reduction of biologics resulted in substantial cost savings with an acceptable reduction in quality of life.
Summary
Background In dermatological research and clinical practice, there is a need for comprehensive self‐report instruments that assess a broad spectrum of health implications of chronic skin ...diseases, including generic and skin‐specific aspects of disease‐related quality of life. The advantages of dermatology‐specific, multidimensional instruments over generic instruments or single‐dimensional quality‐of‐life measures are in the detailed and specific information they provide about health areas that are affected by the skin condition and that may change through therapeutic intervention.
Objectives The development of a multidimensional health status inventory for chronic skin diseases (Impact of Chronic Skin Disease on Daily Life, ISDL) is described. The dermatology‐specific part of the inventory assesses dimensions of physical functioning, more specifically skin status, physical symptoms of itch, pain and fatigue and scratching responses as well as disease‐related stressors like stigmatization. The generic part gauges dimensions of psychological functioning, disease‐related impact, illness cognitions and social support by means of existing scales validated for other chronic diseases.
Methods Reliability and validity of the questionnaire were studied in various samples of patients with psoriasis and atopic dermatitis.
Results The ISDL showed high reliability and test–retest reliability in both patient groups. Convergent validity was indicated by moderate to strong correlations with other validated questionnaires. The scales proved sensitive to change both for dermatological ultraviolet B radiation therapy and cognitive behavioural treatment for itching.
Conclusion With its convincing results for reliability and validity the present evaluation supports the usefulness and applicability of the instrument for different chronic skin diseases.
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