Another transition Feldman, Steven R.; van de Kerkhof, Peter C. M.
The Journal of dermatological treatment,
01/2022, Letnik:
33, Številka:
1
Journal Article
The scalp is a well-known predilection site for psoriasis. Epidemiological data on the various manifestations of scalp psoriasis as well as on its therapeutic management are sparse. The understanding ...of the natural course of scalp psoriasis is relevant for its therapeutic management. In over 25% of patients, scalp psoriasis is the first signal of the psoriatic condition. Nevertheless, few of the therapies currently used for the treatment of scalp psoriasis have been evaluated for efficacy in the setting of well-designed, well-controlled clinical studies. The lack of comparative data impedes the interpretation of the results from studies of scalp psoriasis. Long-term studies of the efficacy and safety of scalp treatments are lacking. Moreover, clinical studies generally do not incorporate quality of life impact or mechanisms to enhance adherence thus hindering the optimal management of the patient over the long-term. Consequently, this report will evaluate the available data and the associated factors to be considered in the development of a treatment paradigm for the long-term management of the scalp psoriasis patient.
Objective: Stigmatization is common in people with chronic skin conditions and may also affect their significant others (SOs). The fast and implicit processing of stigmatization-related stimuli has ...received little attention in these populations; however, such knowledge may offer indications for new treatment methods. This study aimed to investigate implicit processing of stigmatization-related stimuli in people with skin conditions and their SOs. Method: A modified Stroop task and 2 approach-avoidance tasks were administered to participants with chronic skin conditions (alopecia: n = 50 and psoriasis: n = 50); their significant others (alopecia SOs: n = 47 and psoriasis SOs: n = 50); and controls (n = 50). The aim was to examine attentional and behavioral biases toward disease-related and social threat-related stigmatization stimuli. Results: An attentional bias to disease-related stimuli was found in participants with alopecia and their SOs, compared with controls (p < .001). This effect was not found for participants with psoriasis and their SOs. Increased behavioral avoidance of disgusted faces was found in participants with psoriasis and their SOs, compared with controls (p = .047). This effect was not found in participants with alopecia and their SOs. Conclusions: These results provide support for the idea that individuals with skin conditions and their SOs are characterized by a stigmatization-related stimulus bias regarding implicit cognitive and behavioral reactions, in comparison to healthy individuals. Furthermore, preliminary results suggest that these processes may differ across skin conditions, with people with psoriasis being more affected by social reactions (i.e., disgusted faces) and people with alopecia by disease-related cues possibly related to internalized self-stigma.
Dimethylfumarate for Psoriasis Bovenschen, H. Jorn; Langewouters, Annechien M.G.; van de Kerkhof, Peter C.M.
American journal of clinical dermatology,
01/2010, Letnik:
11, Številka:
5
Journal Article
Recenzirano
Background:
T-cell infiltration, epidermal hyperproliferation, and disturbed keratinization are pathologic hallmarks of plaque psoriasis. Oral fumaric acid esters are an effective therapy for ...psoriasis and are believed to exert their effects mainly through their anti-inflammatory properties.
Objective:
To investigate the differential effects of dimethylfumarate (BG-12; FAG-201) for psoriasis on lesional T-cell subsets, natural killer (NK) T cells, and keratinocyte hyperproliferation and differentiation.
Study Design:
A before-and-after clinical and immunohistochemical study as part of a larger clinical trial.
Setting:
Single outpatient clinic.
Patients:
Six patients with moderate-to-severe psoriasis.
Intervention:
Dimethylfumarate 720mg daily for 16 weeks.
Methods:
Biopsies were taken from the lesional skin of six psoriatic patients, at baseline and after 16 weeks of treatment with dimethylfumarate. Clinical severity scores were obtained (Psoriasis Area Severity Index PASI and psoriasis severity SUM scores). T-cell subsets (CD4+, CD8+, CD45RO+, CD45RA+, CD2+, CD25+), cells expressing NK receptors (CD94, CD161), an epidermal proliferation marker (Ki67), and a keratinization marker (K10) were immunohistochemically stained and, together with ‘epidermal thickness,’ quantified using image analysis.
Results:
At week 16, the mean PASI and SUM scores were reduced by 55% (p < 0.01) and 49% (p < 0.01), respectively. In line with these results, epidermal hyperproliferation, keratinocyte differentiation, and epidermal thickness significantly improved. In the dermis and the epidermis, the relevant T-cell subsets significantly declined. However, in both the lesional psoriatic dermis and epidermis, cells expressing NK receptors (CD94 and CD161) persisted after 16 weeks of treatment.
Conclusions:
Dimethylfumarate is an effective therapy for moderate-to-severe plaque psoriasis. The drug may act by reducing lesional T-cell subsets and normalizing epidermal hyperproliferation and keratinization, but does not reduce NKT cells.
Physical complaints, such as pain, can be effectively reduced by placebo effects through induction of positive expectations, or increased by nocebo effects through induction of negative expectations. ...In the present study, verbally induced nocebo and placebo effects on itch were experimentally investigated for the first time. In part 1, the role of verbal suggestions in inducing nocebo effects on itch and pain was investigated. All subjects received the same somatosensory quantitative sensory testing stimuli, that is, mechanical and electrical stimuli and application of histamine, and verbal suggestions to manipulate expectations regarding the stimuli. The suggestions were designed to produce either high expectations for itch (itch nocebo) or pain (pain nocebo) or low expectations for itch (itch nocebo control) or pain (pain nocebo control). Results showed that high itch and pain expectations resulted in higher levels of itch and pain, respectively. When comparing nocebo effects, induced by verbal suggestions, results were more pronounced for itch than for pain. In part 2, verbal suggestions designed to produce a placebo effect on itch (itch placebo) or pain (pain placebo), or neutral suggestions (itch placebo control and pain placebo control) were given regarding a second application of histamine and compared with the first application applied in part 1. Results of placebo effects only showed a significantly larger decrease in itch in the itch placebo condition than in the pain placebo condition. In conclusion, we showed for the first time that nocebo and possibly placebo responses can be induced on itch by verbal suggestions.
Evidence-based guidance in older adults (≥65 years) with psoriasis is sparse and undertreatment might be present.
To assess prescribing patterns, comfort levels, barriers and needs of dermatologists ...when treating older adults with systemic antipsoriatic therapy.
A mixed-methods design was used including a survey among all Dutch dermatologists and residents, followed by semi-structured interviews.
Most of the survey respondents applied systemic treatment to the same extent in older versus younger patients (n = 49; 67.1%) and weren't reluctant prescribing systemic therapy (n = 50; 68.5%) in older adults. However, 26% (n = 19) of the respondents treated older adults less often with systemic therapy compared to younger patients and 68.1% (n = 49) performed additional actions in older adults, e.g. intensified monitoring or dose reduction. Based on the survey and interviews (n = 10), the main reasons for these age-based treatment differences were comorbidity, comedication, and fear of adverse events. More evidence-based guidance, education, and time to assess older adults were identified as most important needs, especially regarding frailty screening.
Age-based treatment differences in and reluctance to treating older adults with systemic antipsoriatic therapy were common. There is a need for more evidence-based guidance, education, and consultation time, to improve treatment in this growing population.
Background: Psoriasis can have a substantial impact on health-related quality of life (HRQoL), life course, and work productivity. Young adulthood is a critical, sensitive period of development that ...includes major life changing decisions. The impact of psoriasis on this vulnerable population is yet unknown.
Objectives: To assess QoL, life course, and work productivity in young adults with psoriasis and identify characteristics influencing these patient-reported outcomes (PRO).
Methods: An explorative, cross-sectional study was performed in psoriasis patients aged 18-30 years. Individuals completed a set of questionnaires regarding their health status (DLQI, SF-36, EQ-5D), achievement of developmental milestones (COLQ), and work productivity (WPAI-PSO, PRODISQ).
Results: Seventy-five patients (22 males, 53 females; median age IQR, 21.0 8.0). Median PASI and BSA, respectively, were 4.4 4.9 and 4.5 8.4. Young adults experienced feelings of embarrassment, impairments in physical health and work productivity, and difficulties in social development. Patients with more severe psoriasis, longer disease duration, higher body mass index (BMI), female patients and patients closer to their thirties tended to be more affected.
Conclusion: In the young adult psoriasis population, substantial QoL impairments were found. Female patients, patients with high BMI, or long disease duration in particular tended to experience more difficulties. These exploratory findings indicate the need for further studies in young adults to detect potential clinical predictors for severe HRQoL impairments.
Biologics for psoriasis are registered in standard dosages. In patients with low disease activity, reduction of the dose by interval prolongation can prevent overtreatment, and lower risks and costs. ...However, fear for increased anti-drug antibody (ADA) formation due to interval prolongation of biologics is an important barrier.
To investigate the course of serum drug concentrations, ADA levels, and predictors for successful dose reduction of adalimumab, ustekinumab, and etanercept for psoriasis.
Patients were randomized to dose reduction (DR) or usual care (UC) and followed for one year. The course and extent of detectable ADA levels were expressed as proportions/relative risks for DR
UC. Association of baseline characteristics with successful tapering was investigated with log-binomial regression analysis.
In total, 118 patients were included. In adalimumab-treated patients, no significant difference in the proportion of patients with relevant ADA levels in DR
UC was seen. For ustekinumab, relevant ADA development was absent in both groups. Baseline trough levels were not predictive for successful DR.
Immunogenicity may not increase by interval prolongation in psoriasis patients with low disease activity. This pilot provides important and reassuring insight into the pharmacological changes after dose tapering of adalimumab, etanercept, and ustekinumab.
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