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Psoriasis: Diagnosis, Treatment, and Management

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

Deadline for manuscript submissions: closed (25 September 2024) | Viewed by 11539

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Dr. Vito Di Lernia

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Dermatology Unit, Arcispedale S. Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
Interests: psoriasis; atopic dermatitis; acne; alopecia; pediatric dermatology

Special Issue Information

Dear Colleagues,

Psoriasis is a chronic immune-mediated inflammatory skin disease with a prevalence of 2–3% worldwide. Although the diagnosis of psoriasis is usually straightforward, sometimes it may be difficult and challenging.

In addition, no established diagnostic criteria exist for the diagnosis of cutaneous psoriasis. Psoriasis has been classically classified on the basis of age of onset, severity, topography and morphologic evaluation. Regarding the clinical forms, there is not a unified classification for the clinical spectrum of the disease which includes common and rare forms, as the pustular ones. The identification of new biomarkers (clinical, genomic, epigenomic, pharmacogenomic) may help to redefine the classification of the disease.

Regarding the management, psoriasis can be optimally controlled today. In spite of newly developed treatments, current challenges address difficult-to-treat areas, especially the palmoplantar areas and the presence of associated diseases, in particular oncological comorbidities. Therefore, the clinician is fully involved in providing the optimal therapeutic strategy and reducing the disease progression also in difficult-to-treat clinical scenarios. This Special Issue aims to highlight the challenges in diagnosis and the most effective treatment strategies for psoriasis care.

Dr. Vito Di Lernia
Guest Editor

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Keywords

psoriasis
psoriatic arthritis
inflammatory skin disease
diagnosis
treatment
management

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Published Papers (9 papers)

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Research

13 pages, 265 KiB

Open AccessArticle

Psychopathological Profile of Patients with Moderate-to-Severe Plaque Psoriasis and Its Correlation to DLQI: Results from a Prospective, Monocentric Clinical Study

by Natalia Rompoti, Sofia Tsiori, Konstantinos Kontoangelos, Anastasios Kouzoupis, Charalabos Papageorgiou, Stamatios Gregoriou, Alexander Stratigos and Dimitrios Rigopoulos

J. Clin. Med. 2024, 13(21), 6424; https://doi.org/10.3390/jcm13216424 - 26 Oct 2024

Viewed by 601

Abstract

Background: Psoriasis is associated with a high psychological burden and comorbidities, such as depression and anxiety. The aim of this study was to evaluate the psychopathological profile of patients with moderate-to-severe plaque psoriasis under systemic treatment and to explore the association between DLQI and alexithymia, depression, and other psychopathological disorders. Methods: In this monocentric, prospective clinical study, 104 adult patients with moderate-to-severe plaque psoriasis were evaluated according to the disease severity (measured by PASI) influence of psoriasis on their quality of life (measured by DLQI) and their psychopathological profile (measured by the BDI, TAS-20, and SCL-90 questionnaires). Results: The psoriasis patients exhibited high levels of psychopathological symptoms, particularly for depression, obsessive-compulsive behavior, somatization, interpersonal sensitivity, and anxiety. More than half of the psoriatic patients (56.7%) were diagnosed with minimal depression, 26.9% with mild depression, and 16.3% with moderate or severe depression. The symptoms of possible and confirmed alexithymia were present in 19.2% and 15.4% of the patients, respectively. The patients with alexithymia appeared to experience a more significant impact on their QoL. Specifically, the percentage of patients with alexithymia/possible alexithymia who had a DLQI of ≥2 was 77.8% vs. 51.5% in those without alexithymia. Conclusions: Our study illuminates the intricate connection between the disease severity and psychological components that impact the QoL of patients with moderate-to-severe plaque psoriasis. It is advised that clinicians adopt a comprehensive approach to managing psoriasis, which involves addressing both the physical symptoms of the condition and the psychological impact. In cases of patients with a DLQI of ≥2, despite adequate clinical responses, evaluating the possible coexistence of general psychopathology is recommended. Full article

(This article belongs to the Special Issue Psoriasis: Diagnosis, Treatment, and Management)

13 pages, 1164 KiB

Open AccessArticle

Systemic Therapy of Psoriasis in Children—Proposal of an Algorithm for Interdisciplinary Teamwork

by Nesrine Ben-Anaya, Matthias Augustin, Fabian Speth, Roman Scheidmann and Brigitte Stephan

J. Clin. Med. 2024, 13(21), 6307; https://doi.org/10.3390/jcm13216307 - 22 Oct 2024

Viewed by 548

Abstract

Background/Objectives: Children and adolescents with psoriasis can have severe and long-lasting disease requiring early and effective therapy. The range of associated comorbidities is comparable to adult patients with additional problems deriving from their growth and maturation. Therefore, tailored information and interdisciplinary teamwork is necessary to effectively manage pediatric psoriasis. Methods: We reflected on our experience with therapy management of children and adolescents with psoriasis coming to our university outpatient clinic and summarized the challenges and special features of these patients together with approved medications and recommendations for treatment. We present our algorithm for managing these patients in an interdisciplinary setting. Results: Children can develop psoriasis very early in their life, and they show specific patterns of skin involvement depending on age. Scores such as the cDLQI and the PASI help to quantify the clinical severity and burden of the disease, and the upgraded criteria should reflect that children’s needs are different from adults’. The choice of medication is limited to a few, but increasing approvals for children and the close exchange of information and preparations with pediatricians and other specialties before initiating systemic therapies are crucial for children to support compliance. We emphasize the focus on vaccinations and the treatment of chronic infections, e.g., the management of TBI, which is different from adults. Conclusions: With the increased options for the systemic treatment of children with psoriasis, clear and adapted information for the child, guardian and pediatrician is essential to assure a well-managed environment and to prevent the unnecessary termination of effective therapy. Full article

(This article belongs to the Special Issue Psoriasis: Diagnosis, Treatment, and Management)

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11 pages, 2128 KiB

Open AccessArticle

Effectiveness and Safety of Etanercept in Paediatric Patients with Plaque-Type Psoriasis: Real-World Evidence

by Joanna Narbutt, Zofia Jakubczak, Paulina Wasiewicz-Ciach, Joanna Wojtania, Katarzyna Krupa, Dorota Sobolewska-Sztychny, Magdalena Ciążyńska, Marta Kołt-Kamińska, Adam Reich, Małgorzata Skibińska and Aleksandra Lesiak

J. Clin. Med. 2024, 13(16), 4858; https://doi.org/10.3390/jcm13164858 - 17 Aug 2024

Viewed by 1124

Abstract

Background: Psoriasis is a chronic, multisystemic, inflammatory disease affecting approximately 1% of children and significantly reducing their health-related quality of life. Etanercept is a biologic fusion protein-blocking TNF-α and belongs to one of the biologics used among the children population. The purpose of this study was to assess the effectiveness and safety profile of etanercept in paediatric patients with plaque-type psoriasis. Material and methods: The outcome of the treatment was evaluated based on Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA), and Children’s Dermatology Life Quality Index (CDLQI). Achievement of at least PASI75 at week 16 was assessed as an adequate response to therapy, which was the primary endpoint. Results: Forty-three paediatric patients were included in the study, 24 females and 19 males. The average age at inclusion into our study was 13 years. At baseline, the mean PASI score, BSA, and CDLQI were 16.3 ± 6.5, 22.3 ± 12.2%, and 17.4 ± 5.3, respectively. At week 16, 90.7% of patients achieved PASI 50, 79.1% achieved PASI 75, and 46.5% attained PASI 90. There was also a decrease in mean BSA and CDLQI values to 3.5 ± 3.8 and 5.4 ± 5.7, respectively. Conclusions: Etanercept proved to be effective, safe, and well-tolerated among the paediatric population with psoriasis. Full article

(This article belongs to the Special Issue Psoriasis: Diagnosis, Treatment, and Management)

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14 pages, 1376 KiB

Open AccessArticle

Reaction to Disease and Coping Strategies in Stressful Situations among Psoriasis Patients: Cross-Sectional Study

by Beata Kowalewska, Marta Milewska-Buzun, Mateusz Cybulski, Andriej Szpakow, Dzmitry Khvorik, Marek Sobolewski, Piotr Aleksiejczuk and Wiaczesław Niczyporuk

J. Clin. Med. 2024, 13(16), 4693; https://doi.org/10.3390/jcm13164693 - 9 Aug 2024

Viewed by 621

Abstract

Background: In the contemporary world, a cult of perfection is being created, and deviations from such an ideal image are becoming socially unacceptable. A particular situation arises when a defect or symptoms of a disease appear on the skin, which, in the case of people suffering from psoriasis, are a source of stress, dissatisfaction with the disease, and a reduction in quality of life. The aim of this study was to assess whether the quality of life related to the occurrence of psoriasis and the level of acceptance of the disease affect coping strategies in stressful situations. Methods: The study involved 111 people with common psoriasis (46.8% women and 53.2% men). Inclusion criteria were as follows: a diagnosis of common psoriasis for at least 0.5 years, no other types of psoriasis, no mental illnesses, and an informed consent of the respondent to participate in the study. In order to compile the research input, a proprietary questionnaire was used along with the following standardised tools: the Dermatology Life Quality Index (DLQI), the Acceptance of Illness Scale (AIS), and the Coping Inventory for Stressful Situations (CISS). Results: The duration of the disease in the studied population varied and ranged from 0.5 years to over 50 years. Most respondents showed relatively low DLQI scores, with an average value of 10.8 points. In stressful situations (CISS), the respondents primarily used a strategy based on rational thinking (Task-oriented coping), with approximately 54 points on average; followed by an avoidant style (Avoidance-oriented coping), with approximately 50 points on average; and least often an emotional style (Emotion-oriented coping), with approximately 46 points on average. The average level of disease acceptance (AIS) in the studied group equalled approximately 26 points. Conclusions: Psoriatic lesions on the torso caused less rational behaviour in stressful situations (a decrease in the Task-oriented coping) in women but had the opposite result in men, whereas psoriatic lesions on the head stimulated the use of Task-oriented coping in women but had the opposite result in men. The higher the acceptance of the disease (AIS) presented by the respondents, the less often they used an emotional strategy (Emotion-oriented coping) in stressful situations. The higher the quality of life (DLQI) was, the lower the values of Emotion-oriented coping were noted. Full article

(This article belongs to the Special Issue Psoriasis: Diagnosis, Treatment, and Management)

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11 pages, 982 KiB

Open AccessArticle

Risk of Skin Cancer in Patients with Psoriasis: Single-Center Retrospective Study Comparing Anti-TNFα and Phototherapy

by Emanuele Trovato, Martina Dragotto, Eugenio Capalbo, Alessandra Cartocci, Pietro Rubegni and Laura Calabrese

J. Clin. Med. 2024, 13(9), 2452; https://doi.org/10.3390/jcm13092452 - 23 Apr 2024

Cited by 1 | Viewed by 1486

Abstract

Background: The risk of developing non-melanoma skin cancers (NMSCs) in patients with psoriasis is highly debated, and, to date, there is no unambiguous consensus opinion. Psoriasis is known to be related to an increased likelihood of other comorbidities such as psoriatic arthritis, obesity, metabolic syndrome, depression, and cardiovascular disease. Regarding cancer risk, previous studies have reported a greater tendency for the development of cutaneous T-lymphomas and colon, breast, kidney, and lung cancers. Furthermore, data from network meta-analyses have shown that patients with psoriasis have a higher risk of developing squamous cell carcinomas (SCCs) and/or basal cell carcinomas (BCCs). Multiple factors may contribute to the development of NMSCs in psoriatic patients, ranging from immunosuppression induced by biologic agents to previous phototherapy. However, the extent to which each factor may impact this risk has not been entirely assessed. The aim of this study was to evaluate the risk of developing NMSCs in patients with psoriasis observed for at least 5 years, by directly comparing patients only treated with phototherapy and patients treated with anti-tumor necrosis factor α (TNFα) agents, naive to other systemic treatments or phototherapy. Methods: We conducted a single-center retrospective study at Siena University Hospital, Italy, on 200 adult patients with psoriasis divided into two groups: (i) group 1, including 100 patients treated with narrow-band UVB phototherapy (nb-UVB), and (ii) group 2, including 100 patients treated with anti-TNFα. The patients included in group 2 had to be naive to cDMARDs and biologics and treated with anti-TNFα continuously for 5 years without loss of efficacy. All patients were observed for 5 years and underwent annual dermatologic examinations to assess for the occurrence of BCC or SCC. Results: A total of 34 out of 100 patients treated with phototherapy had one BCC or one SCC and 10 out of 34 developed two skin cancers. In particular, five had both types (one BCC and one SCC), and five had two BCCs. Conclusions: The results of our study highlight how the risk of developing NMSCs is greater in patients undergoing phototherapy compared to those treated with anti-TNFα. It also draws attention to the consideration that patients with scalp psoriasis might need closer follow-up as they could be more at risk of developing NMSCs. Full article

(This article belongs to the Special Issue Psoriasis: Diagnosis, Treatment, and Management)

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17 pages, 873 KiB

Open AccessArticle

The Impact of Shared Assistance between Dermatology and Internal Medicine on Patients with Psoriasis

by Ana Julia García-Malinis, Juan Blas Pérez-Gilaberte, Tamara Gracia-Cazaña, Maria Pilar González García, Dolores Planas Linares and Yolanda Gilaberte

J. Clin. Med. 2024, 13(8), 2441; https://doi.org/10.3390/jcm13082441 - 22 Apr 2024

Cited by 1 | Viewed by 1464

Abstract

Background: The care of psoriatic patients requires a multidisciplinary approach that addresses not only skin involvement but also cardiovascular risk factors. Coordination between dermatology and internal medicine departments, with a specific focus on treatment and long-term follow-up, can substantially improve the course of a disease and its associated complications. Objective: to evaluate the effects of the holistic management of patients with psoriasis by a multidisciplinary team consisting of dermatology and internal medicine specialists. Methods: We conducted an observational, prospective, single-center case–control study between October 2016 and December 2019 in San Jorge University Hospital (Huesca, Spain). Cases included patients undergoing follow-up in the combined dermatology and internal medicine clinic. The control group consisted of an equivalent number of randomly selected, age- and sex-matched patients with moderate-to-severe psoriasis who were seen in the general dermatology department of the same hospital during the same time period. Main outcomes and measures: The primary outcome was the control of psoriatic disease and cardiovascular risk factors such as weight, blood pressure, waist circumference, body mass index (BMI), SCORE index (Systematic Coronary Risk Evaluation), and blood test parameters, as well as diet, physical exercise, and habits such as tobacco and alcohol consumption. To compare data collected over time, data were grouped into three time periods: baseline (t1), intermediate (t2), and final (t3). Results: The case group consisted of 27 patients, and the control group consisted of 25 patients. Multivariate analysis was used to evaluate the relationship between the 10-year risk of experiencing a cardiovascular event (SCORE) and the clinical characteristics and analytical variables of patients with psoriasis and controls (n = 52). The variables that were significantly associated with a higher 10-year risk of experiencing a cardiovascular event were age (OR, 1.33; CI95% 1.21–1.50; p < 0.001); smoking (OR, 5.05, CI95% 1.07–27.37; p = 0.047); PASI (OR, 7.98, CI95% 2.32–35.86; p = 0.003); BSA (OR, 1.22, CI95% 1.01–1.49; p = 0.044); and being a control patient (OR, 3.26; CI95% 0.84–13.56; p = 0.029). Conclusions: Pharmacological and behavioral interventions carried out as part of the procedure of the multidisciplinary clinic resulted in improvements in the following variables relative to the control group: PASI, BSA, DLQI, PSOLIFE, lipid profile, insulin and HOMA-IR GGT levels, vitamin D levels, and SCORE. These findings indicate the beneficial effect of the multidisciplinary clinic, which reduced the risk of cardiovascular events in psoriatic patients with metabolic comorbidities. Full article

(This article belongs to the Special Issue Psoriasis: Diagnosis, Treatment, and Management)

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15 pages, 306 KiB

Open AccessArticle

Multimorbidity of Psoriasis: A Large-Scale Population Study of Its Associated Comorbidities

by Manuel Almenara-Blasco, Tamara Gracia-Cazaña, Beatriz Poblador-Plou, Clara Laguna-Berna, Jonás Carmona-Pírez, Alba Navarro-Bielsa, Alexandra Prados-Torres, Antonio Gimeno-Miguel and Yolanda Gilaberte

J. Clin. Med. 2024, 13(2), 492; https://doi.org/10.3390/jcm13020492 - 16 Jan 2024

Cited by 2 | Viewed by 1622

Abstract

Introduction: Psoriasis is a chronic disease of the skin with a prevalence of 2% in the general population. The high prevalence of psoriasis has prompted the study of its comorbidities in recent decades. We designed a study to determine the prevalence of psoriasis in a large-scale, population-based cohort, to exhaustively describe its comorbidities, and to analyze which diseases are associated with psoriasis. Methods: Retrospective, observational study based on the clinical information contained in the electronic health records of the individuals in the EpiChron Cohort with a diagnosis of psoriasis (31,178 individuals) in 2019. We used logistic regression models and calculated the likelihood of the occurrence of each comorbidity based on the presence of psoriasis (p-value < 0.05). Results: The prevalence of psoriasis was 2.84%, and it was more prevalent in men (3.31% vs. 2.43%). The most frequent chronic comorbidities were disorders of lipid metabolism (35.87%), hypertension (35.50%), and other nutritional-endocrine-metabolic disorders (21.79%). The conditions most associated with psoriasis were (odds ratio; 95% confidence interval) tuberculosis (2.36; 1.24–4.49), cystic fibrosis (2.15; 1.25–3.69), amongst others. We did not find a significant association between psoriasis and hypertension or neoplasms (0.90; 0.86–0.95). Conclusions: This study revealed significant associations between psoriasis and cardiac, psychological, and musculoskeletal comorbidities. Full article

(This article belongs to the Special Issue Psoriasis: Diagnosis, Treatment, and Management)

9 pages, 249 KiB

Open AccessArticle

Incidence of New-Onset Inflammatory Bowel Disease, Oral and Gastrointestinal Candidiasis, Herpes Zoster, Pulmonary Tuberculosis, and Major Cardiovascular Events in Patients with Moderate-to-Severe Psoriasis Exposed to Biologics

by Da-Hyun Kang, Bark-Lynn Lew and Soon-Hyo Kwon

J. Clin. Med. 2023, 12(24), 7653; https://doi.org/10.3390/jcm12247653 - 13 Dec 2023

Cited by 2 | Viewed by 1433

Abstract

The multicenter, retrospective cohort study was aimed at examining adverse events in biologic-treated patients with moderate-to-severe psoriasis by using a real-world database. Thus, we analyzed exposure-adjusted incidence rates for new-onset inflammatory bowel disease (IBD), oral and gastrointestinal candidiasis, pulmonary tuberculosis, herpes zoster, and major cardiovascular events (MACEs) in biologic-treated patients with moderate-to-severe psoriasis. Overall, 2085 patients were found to have been exposed to tumor necrosis factor (TNF)-α, interleukin (IL)-12/23, IL-17, and IL-23 inhibitors (n = 463, 540, 635, and 447, respectively). No patient developed new-onset IBD. The incidence rates of oral and gastrointestinal candidiasis were comparable between patients treated with IL-23 and IL-17 inhibitors (5.6 and 5.3 per 1000 PY, respectively). None treated with IL-17 or IL-23 inhibitors reported pulmonary tuberculosis. The incidence rate of herpes zoster was the highest in patients treated with TNF-α inhibitors (17.0 per 1000 PY), followed by IL-17, IL-23, and IL-12/23 inhibitors (13.3, 7.8, and 2.7 per 1000 PY, respectively). MACEs were not reported in patients treated with IL-17 inhibitors but were reported in those treated with TNF-α, IL-23, and IL-12/23 inhibitors (incidence: 5.6, 3.8, and 1.8 per 1000 PY, respectively). The study indicated favorable safety profiles of biologics in Korean patients with moderate-to-severe psoriasis. Full article

(This article belongs to the Special Issue Psoriasis: Diagnosis, Treatment, and Management)

12 pages, 419 KiB

Open AccessArticle

Comparing Meta-Analyses with ChatGPT in the Evaluation of the Effectiveness and Tolerance of Systemic Therapies in Moderate-to-Severe Plaque Psoriasis

by Xuân-Lan Lam Hoai and Thierry Simonart

J. Clin. Med. 2023, 12(16), 5410; https://doi.org/10.3390/jcm12165410 - 20 Aug 2023

Cited by 8 | Viewed by 1970

Abstract

Background: Meta-analyses (MAs) and network meta-analyses (NMAs) are high-quality studies for assessing drug efficacy, but they are time-consuming and may be affected by biases. The capacity of artificial intelligence to aggregate huge amounts of information is emerging as particularly interesting for processing the volume of information needed to generate MAs. In this study, we analyzed whether the chatbot ChatGPT is able to summarize information in a useful fashion for providers and patients in a way that matches up with the results of MAs/NMAs. Methods: We included 16 studies (13 NMAs and 3 MAs) that evaluate biologics (n = 6) and both biologic and systemic treatment (n = 10) for moderate-to-severe psoriasis, published between January 2021 and May 2023. Results: The conclusions of the MAs/NMAs were compared to ChatGPT’s answers to queries about the molecules evaluated in the selected MAs/NMAs. The reproducibility between the results of ChatGPT and the MAs/NMAs was random regarding drug safety. Regarding efficacy, ChatGPT reached the same conclusion as 5 out of the 16 studies (four out of four studies when three molecules were compared), gave acceptable answers in 7 out of 16 studies, and was inconclusive in 4 out of 16 studies. Conclusions: ChatGPT can generate conclusions that are similar to MAs when the efficacy of fewer drugs is compared but is still unable to summarize information in a way that matches up to the results of MAs/NMAs when more than three molecules are compared. Full article

(This article belongs to the Special Issue Psoriasis: Diagnosis, Treatment, and Management)

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