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Modern Approaches to Psoriasis: Current Treatments and Future Possibilities
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Modern Approaches to Psoriasis: Current Treatments and Future Possibilities

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dermatology".

Deadline for manuscript submissions: 15 January 2025 | Viewed by 7861

Special Issue Editors

Dr. Teresa Battista

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Guest Editor
Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, Napoli, Italy
Interests: dermatology; psoriasis; psoriatric arthritis; biologic drugs
Dr. Matteo Megna

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Guest Editor
Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Napoly, Italy
Interests: inflammatory skin diseases; psoriasis; hidradenitis; atopic dermatitis; acne and rosacea; infective diseases; ontological diseases in dermatology (including melanoma and nonmelanoma skin cancers); teledermatology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Psoriasis is a chronic inflammatory disease that affects about 2-4% of the global population. This systemic disease has a significant negative impact on the quality of life of affected patients. Research on psoriasis has largely increased knowledge about possible selective therapeutic targets. Indeed, advances in the understanding of the pathogenesis of psoriasis has resulted in increasingly targeted and highly effective therapies (including small molecules, as well as different classes of biologic drugs). At present, more than 10 different biologics drugs and 2 small molecules are available for psoriasis treatment. In this context, the dermatologist should choose the right treatment for the right patient at the right time while analyzing numerous different factors, such as comorbidities, the patient’s preferences, drugs peculiarities, etc. In this Special Issue, we invite the authors to present articles on modern approaches to psoriasis, with specific attention paid to real-life treatments as well as future possibilities.

Dr. Teresa Battista
Dr. Matteo Megna
Guest Editors

Manuscript Submission Information

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Keywords

  • psoriasis
  • psoriatic arthritis
  • biologics
  • small molecules
  • comorbidities

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Published Papers (5 papers)

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Research

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14 pages, 1077 KiB  
Article
Blood-Count-Derived Inflammatory Markers as Predictors of Response to Biologics and Small-Molecule Inhibitors in Psoriasis: A Multicenter Study
by Silviu-Horia Morariu, Ovidiu Simion Cotoi, Oana Mirela Tiucă, Adrian Baican, Laura Gheucă-Solovăstru, Hana Decean, Ilarie Brihan, Katalin Silaghi, Viorica Biro, Diana Șerban-Pescar, Ioana Măgureanu, Mircea Ambros, Roxana Ioana Ilcuș, Lavinia Prodan, Andreea Beatrix Bălan, Mădălina Husariu, Dumitrita Lenuta Gugulus, Radu Alexandru Stan, Vlad Voiculescu and Alin Codruț Nicolescu
J. Clin. Med. 2024, 13(14), 3992; https://doi.org/10.3390/jcm13143992 - 9 Jul 2024
Viewed by 1349
Abstract
Background: Psoriasis is an immune-mediated chronic disorder associated with various comorbidities. Even though biologics and small-molecule inhibitors are the mainstay treatment for moderate-to-severe psoriasis, there is no current consensus regarding which agent should be used for a specific type of patient. This [...] Read more.
Background: Psoriasis is an immune-mediated chronic disorder associated with various comorbidities. Even though biologics and small-molecule inhibitors are the mainstay treatment for moderate-to-severe psoriasis, there is no current consensus regarding which agent should be used for a specific type of patient. This paper aims to test the reliability of blood-count-derived inflammatory markers in assessing treatment response to biologics and small-molecule inhibitors in psoriasis. Material and Methods: Bio-naïve adult patients diagnosed with chronic plaque psoriasis fulfilling the inclusion criteria were enrolled. They were divided into study subgroups based on treatment of choice, and blood-count-derived inflammatory markers were analyzed at baseline, three-month, six-month, and at twelve-month visits. Results: A total of 240 patients were included. The highest number of patients underwent treatment with ixekizumab. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platelet-to-monocyte ratio (PMR), monocyte-to-lymphocyte ratio (MLR), derived neutrophil-to-lymphocyte ratio (d-NLR), systemic inflammation response index (SIRI), systemic immune inflammation index (SII), and aggregate index of systemic inflammation (AISI) all varied significantly (p < 0.005) between the four visits. The psoriasis area severity index (PASI) score correlated with PLR, d-NLR, and SII, while the psoriasis scalp severity index (PSSI) score correlated with AISI and SIRI. More than half of patients reached the target goal of PASI90 at the six-month visit. A total of 77 patients were super-responders, with the highest number undergoing treatment with ixekizumab. Higher baseline values of d-NLR and SIRI are independent predictors of the super-responder status. Conclusions: Blood-count-derived inflammatory markers can serve as indicators of treatment response to biologics in psoriasis, while d-NLR and SIRI were independent predictors of super-responders in our study. Full article
(This article belongs to the Special Issue Modern Approaches to Psoriasis: Current Treatments and Future Possibilities)
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13 pages, 923 KiB  
Article
Long-Term Persistence Rate of Secukinumab in Psoriatic Patients: A Six-Year Multicenter, Real-World Experience, Retrospective Study
by Marco Galluzzo, Emanuele Trovato, Marina Talamonti, Giacomo Caldarola, Lucia Di Nardo, Laura Lazzeri, Cristina Mugheddu, Martina Burlando, Riccardo Balestri, Nicoletta Bernardini, Gabriele Biondi, Laura Vellucci, Filomena Russo, Clara De Simone, Claudia Paganini, Giulia Rech, Emanuele Claudio Cozzani, Laura Atzori, Maria Antonia Montesu, Concetta Potenza, Andrea Chiricozzi and Pietro Rubegniadd Show full author list remove Hide full author list
J. Clin. Med. 2024, 13(13), 3864; https://doi.org/10.3390/jcm13133864 - 30 Jun 2024
Viewed by 1542
Abstract
Background: Psoriatic disease, a chronic immune-mediated systemic inflammatory condition, significantly impairs patients’ quality of life. The advent of highly targeted biological therapies has transformed treatment strategies, emphasizing the importance of selecting the most effective and cost-efficient option. Secukinumab, an IL-17A inhibitor, has [...] Read more.
Background: Psoriatic disease, a chronic immune-mediated systemic inflammatory condition, significantly impairs patients’ quality of life. The advent of highly targeted biological therapies has transformed treatment strategies, emphasizing the importance of selecting the most effective and cost-efficient option. Secukinumab, an IL-17A inhibitor, has demonstrated efficacy and safety in treating moderate-to-severe plaque psoriasis (PsO). However, long-term real-world data on its effectiveness and persistence rate are limited. Methods: This retrospective study, conducted across eight Italian dermatology centers, aimed to evaluate the 6-year persistence rate and effectiveness of secukinumab in patients with PsO. Additionally, the study investigated the onset of psoriatic arthritis during treatment. Results: Overall, 166 adult patients were analyzed. Their median age was 53.9 years. The mean BMI was 26.5. Of the 166 patients, 64 were bio-experienced while 102 were bio-naïve. A progressive reduction in PsO severity measured by PASI scores over 6 years of treatment was revealed: the PASI score decreased from a baseline value of 18.1 (±9.1) to 0.7 (±1.6) after 6 years of follow-up. Adverse events, including mucocutaneous fungal infections and cardiovascular disturbances, were reported in 19.9% of patients. The persistence rate was 86.8% at 24 months, decreasing to 66.4% at 72 months. Psoriatic arthritis onset during treatment was observed in 15 (9.0%) of patients. Conclusions: This study highlights the sustained effectiveness and favorable safety profile of secukinumab over 6 years, providing valuable real-world evidence. Understanding the long-term persistence rate and predictors of discontinuation could help clinicians optimize treatment decisions and improve patient outcomes in PsO management. We found that the absence of scalp PsO, no involvement of the genital area and normal weight were the best factors of persistence in secukinumab treatment in the long term. Full article
(This article belongs to the Special Issue Modern Approaches to Psoriasis: Current Treatments and Future Possibilities)
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16 pages, 290 KiB  
Article
Biological Therapy for Psoriasis in Cancer Patients: An 8-Year Retrospective Real-Life Study
by Teresa Battista, Lucia Gallo, Fabrizio Martora, Davide Fattore, Luca Potestio, Sara Cacciapuoti, Massimiliano Scalvenzi and Matteo Megna
J. Clin. Med. 2024, 13(7), 1940; https://doi.org/10.3390/jcm13071940 - 27 Mar 2024
Cited by 3 | Viewed by 2776
Abstract
Background: It is now recognized that psoriasis plays a key role in the development of several comorbidities, such as cardiovascular disease, and metabolic syndrome. Some authors have hypothesized that patients with psoriasis may have an increased risk of developing certain types of [...] Read more.
Background: It is now recognized that psoriasis plays a key role in the development of several comorbidities, such as cardiovascular disease, and metabolic syndrome. Some authors have hypothesized that patients with psoriasis may have an increased risk of developing certain types of cancer. The efficacy and safety of biologic drugs are well-documented in clinical trials and in real-life studies. However, there is limited evidence on the safety of the use of biologic treatments in cancer patients with psoriasis, and the use of this therapeutic class in patients with a pre-existing or concomitant malignancy is still debated. Methods: We have conducted a retrospective observational study of a group of oncology patients with moderate-to-severe psoriasis treated with biologic therapy at the Dermatology Clinic of the University of Naples Federico II, during the period from 2016 to 2024. We included 20 adult patients; in 15 of them the diagnosis of neoplasm preceded the start of treatment biologic, while four of these patients had been diagnosed with cancer during the course of therapy biologics. Results: The most represented neoplasms in our population were breast carcinoma, prostate carcinoma, thyroid carcinoma, and chronic lymphatic leukemia. Anti-IL17 drugs were the most frequently prescribed (47.7%), followed by anti-IL23p19 (36.8%), anti-IL-12/23 (10.5%) and anti-TNF alpha (5.26%). All patients showed improvement of psoriasis after starting the therapy. Conclusions: Our experience supports the effectiveness and safety of biological therapy for psoriasis in patients with a history of cancer or recent onset neoplasia. Full article
(This article belongs to the Special Issue Modern Approaches to Psoriasis: Current Treatments and Future Possibilities)

Review

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18 pages, 956 KiB  
Review
The Role of Vitamin D3 Deficiency and Colonization of the Oral Mucosa by Candida Yeast-like Fungi in the Pathomechanism of Psoriasis
by Mariola Marchlewicz, Paulina Sagan, Marta Grabowska, Magdalena Kiedrowicz, Joanna Kruk, Kamil Gill, Małgorzata Piasecka and Ewa Duchnik
J. Clin. Med. 2024, 13(22), 6874; https://doi.org/10.3390/jcm13226874 - 15 Nov 2024
Viewed by 363
Abstract
Psoriasis is a chronic inflammatory skin disease with complex pathogenesis and variable severity. Performed studies have indicated the impact of vitamin D3 deficiency on the pathogenesis of psoriasis and its severity. However, there is no clear evidence of the influence of the mucosal [...] Read more.
Psoriasis is a chronic inflammatory skin disease with complex pathogenesis and variable severity. Performed studies have indicated the impact of vitamin D3 deficiency on the pathogenesis of psoriasis and its severity. However, there is no clear evidence of the influence of the mucosal microbiome on the onset and progression of psoriasis. This review aims to present the current evidence on the role of vitamin D3 and colonization of the oral mucosa by Candida yeast-like fungi in the pathogenesis of psoriasis. Candida albicans is a common yeast that can colonize the skin and mucosal surfaces, particularly in individuals with weakened immune systems or compromised skin barriers. In psoriasis, the skin’s barrier function is disrupted, potentially making patients more susceptible to fungal infections such as Candida. Since patients with psoriasis are at increased risk of metabolic syndrome, they may experience the vicious circle effect in which chronic inflammation leads to obesity. Vitamin D3 deficiency is also associated with microbiological imbalance, which may promote excessive growth of Candida fungi. Under normal conditions, the intestinal and oral microflora support the immune system. Vitamin D3 deficiency, however, leads to disruption of this balance, which allows Candida to overgrow and develop infections. Full article
(This article belongs to the Special Issue Modern Approaches to Psoriasis: Current Treatments and Future Possibilities)
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15 pages, 1836 KiB  
Review
Health-Related Quality of Life in Psoriasis: Literature Review
by Gioele Ghezzi, Antonio Costanzo and Riccardo G. Borroni
J. Clin. Med. 2024, 13(16), 4623; https://doi.org/10.3390/jcm13164623 - 7 Aug 2024
Viewed by 1294
Abstract
The assessment of quality of life (QoL) in patients with psoriasis plays a crucial role in understanding the impact of the disease and evaluating treatment outcomes. We provide an overview of the key measures used to assess QoL in psoriasis patients, including both [...] Read more.
The assessment of quality of life (QoL) in patients with psoriasis plays a crucial role in understanding the impact of the disease and evaluating treatment outcomes. We provide an overview of the key measures used to assess QoL in psoriasis patients, including both generic and psoriasis-specific instruments. The limitations and strengths of instruments such as the Dermatology Life Quality Index (DLQI), Skindex, and Psoriasis Disability Index (PDI) are discussed, highlighting their psychometric properties and areas for improvement. Furthermore, this review examines the potential of disease-specific QoL measures in providing greater sensitivity to disease-related burden and change compared to generic instruments. However, most of the available psoriasis-specific patient-reported outcome measures need further validation. We aim to provide valuable insights into the importance of using validated QoL measures in clinical practice and research, ultimately contributing to a more comprehensive assessment of the impact of psoriasis on patients’ lives and enhancing the evaluation of treatment interventions. Full article
(This article belongs to the Special Issue Modern Approaches to Psoriasis: Current Treatments and Future Possibilities)
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