Biological therapy in Psoriasis: An emphasis on its dermatologic adverse events.

OBJECTIVE: To report an overview of dermatologic adverse events (AEs) related to biologics used for psoriasis and compare common dermatologic AEs across different biologic classes. DATA SOURCE: A comprehensive search in MEDLINE via PubMed from inception through June 9, 2021, was conducted. STUDY SELECTION: The selection process was performed independently by two reviewers. Studies were eligible if patients were diagnosed with plaque-type psoriasis, were treated with biologics, and had ≥ 1 dermatologic AE. RESULTS: A total of 1023 records were identified, and 127 studies were included. The incidence of dermatologic AEs was 4.17% for tumor necrosis factor-α (TNF-α) inhibitors, 9.49% for interleukin (IL)-12/23 inhibitor, 12.40% for IL-17 inhibitors, and 7.37% for IL-23 inhibitors. Biologic-related dermatological AEs can be classified into allergic skin reactions, inflammatory skin diseases, skin infections, skin neoplasms, and miscellaneous AEs. An evident class effect was observed. Skin neoplasms (1.45%), mainly nonmelanoma skin cancer (1.36%), predominated among TNF-α inhibitors. Allergic skin reactions (6.25%) were frequently reported with IL-12/23 inhibitor. During treatment with IL-17 inhibitors, skin infections (5.01%) were common, and the most common was driven by mucocutaneous candidiasis (4.85%). Inflammatory skin disease (2.32%), mainly eczematous eruptions (0.84%), dominated in IL-23 inhibitors. CONCLUSIONS: A predominance of specific dermatologic AEs appears in distinct biologic classes due to their different specific targets of action. Further study is needed to understand the mechanisms of these potential AEs, which will help in their management.

308-nm Excimer Lamp vs. Combination of 308-nm Excimer Lamp and 10% Liquor Carbonis Detergens in Patients With Scalp Psoriasis: A Randomized, Single-Blinded, Controlled Trial.

Background: Scalp psoriasis is usually refractory to treatment. Excimer devices have been proved to be a promising therapeutic option in psoriasis. Greater efficacy of phototherapy can be achieved by concurrent use of coal tar derivatives. Objective: We aimed to compare efficacy and safety between 308-nm excimer lamp monotherapy and a combination of 308-nm excimer lamp and 10% liquor carbonis detergens in the treatment of scalp psoriasis. Methods: In this randomized, evaluator-blinded, prospective, comparative study, 30 patients with scalp psoriasis received either 308-nm excimer lamp monotherapy or a combination of 308-nm excimer lamp and 10% liquor carbonis detergens twice per week until complete remission of the scalp or for a total of 30 sessions. Efficacy was evaluated by the improvement of Psoriasis Scalp Severity Index (PSSI) score, itch score, and Scalpdex score. Results: Both treatments induced significant improvement in PSSI score with greater reduction observed in the combination group. At 30th visit, a 75% reduction in PSSI (PSSI75) was attained by 4 (28.6%) and 9 (69.2%) patients treated with monotherapy and combination therapy, respectively (P < 0.05). Conclusions: Excimer lamp is well-tolerated in patients with scalp psoriasis and liquor carbonis detergens can be used as a combination therapy to improve the efficacy of excimer lamp.

Phototherapy as a treatment of early-stage mycosis fungoides and predictive factors for disease recurrence: A 17-year retrospective study.

BACKGROUND: Mycosis fungoides is the most common form of cutaneous T-cell lymphoma. Narrowband ultraviolet B and psoralen and ultraviolet A are effective treatment options, but studies of their treatment efficacy and disease relapse remain limited. OBJECTIVES: This study aimed (1) to determine the efficacy of narrowband ultraviolet B and psoralen and ultraviolet A as a treatment for early-stage mycosis fungoides and explore the predictive factors for complete remission and (2) to determine the relapse rate and analyze their predictive factors, including the utility of maintenance therapy. METHODS: This was a retrospective cohort study consisting of 61 patients with early-stage mycosis fungoides (IA - IB) treated with narrowband ultraviolet B or psoralen and ultraviolet A as the first-line therapy from January 2002 to December 2018 at the Division of Dermatology, Ramathibodi Hospital, Bangkok, Thailand. Cox regression analysis and Kaplan-Meier survival curve were performed for the main outcomes. RESULTS: A complete remission was achieved by 57 (93.5%) patients. The median time to remission was 7.80 ± 0.27 months. Types of phototherapy (narrowband ultraviolet B or psoralen and ultraviolet A), age and gender did not associate with time to remission, while the presence of poikiloderma and higher disease stage led to a longer time to remission. The cumulative incidence of relapse was 50.8%. The median time to relapse was 24.78 ± 5.48 months. In patients receiving phototherapy during the maintenance period, a treatment duration longer than six months was associated with a significantly longer relapse-free interval. CONCLUSION: Narrow-band-ultraviolet B and psoralen and ultraviolet A are effective treatment options for early-stage mycosis fungoides. Maintenance treatment by phototherapy for at least six months seems to prolong remission.

Efficacy and safety of 308-nm excimer lamp in the treatment of scalp psoriasis: a retrospective study.

BACKGROUND: Scalp psoriasis is a major therapeutic challenge due to the hindrance caused by hair. Treatment with the 308-nm excimer lamp is purported to provide many benefits over conventional phototherapy. This retrospective study evaluates the efficacy, safety, and effective dosage of 308-nm excimer light in the treatment of scalp psoriasis. METHODS: We retrospectively reviewed the medical records of patients with scalp psoriasis who received treatment with 308-nm excimer light. Clinical and epidemiological data as well as details regarding treatment were statistically analyzed to determine the treatment outcomes. RESULTS: Twenty patients with scalp psoriasis were included in the study. Their mean age was 47.45 ± 17.93 years. Eleven patients responded to treatment at the end of 10 sessions. The median baseline Psoriatic Scalp Severity Index (PSSI) was 12 (range, 3-32). At the end of the protocol, the median PSSI was 4.5 (range, 0-24), indicating a statistically significant reduction (P < 0.001). Common adverse effects included erythema, irritation, and desquamation. CONCLUSION: The 308-nm excimer light appears to be an effective and safe modality that requires short treatment time. The modality could be considered as an alternative or adjuvant treatment for scalp psoriasis.

Cutaneous Mycobacterium abscessus Infection Associated with Mesotherapy Injection.

Non-tuberculous mycobacterial skin infections have an increasing incidence. In immunocompetent patients, they usually follow local trauma. We present a case of cutaneous Mycobacterium abscessus infection following mesotherapy. The lesions were successfully treated with a combination of clarithromycin, ciprofloxacin, and doxycycline. Atypical mycobacterial infection should be suspected in patients who develop late-onset skin and soft tissue infection after cutaneous injury, injection, and surgical intervention, particularly if they do not respond to conventional antibiotic treatment.