Effect of Treatment With Biologic Agents on the Novel Inflammatory Biomarkers Systemic Immune Inflammation Index and Systemic Inflammation Response Index for Psoriasis.

INTRODUCTION: Psoriasis is a chronic cutaneous disorder with underlying systemic inflammation. The systemic immune inflammation (SII) and systemic inflammation response indexes (SIRI) are novel biomarkers that indicate systemic inflammation. OBJECTIVES: We aimed to evaluate the effect of biological agent treatment on SII and SIRI in psoriasis patients. METHODS: Between April 2019 and October 2022, SII and SIRI were retrospectively evaluated in patients with psoriasis before and three months after the initiation of biological agents. RESULTS: This study included 220 patients, 101 females and 119 males. SIRI was significantly higher in male patients compared to females (P < 0.001). Although not statistically significant, SII and SIRI were higher in obese patients, patients with severe psoriasis, longer disease duration, nail involvement and patients who received previous biological agent treatment. SII was also higher in patients with hypertension, diabetes, hepatic steatosis, depression and coronary artery disease (P = 0.801, P = 0.752, P = 0.706, P = 0.079, P = 0.861, respectively), whereas SIRI was higher in patients with diabetes and depression (P = 0.263, P = 0.777, respectively). Both SII and SIRI statistically significantly decreased after treatment with adalimumab, infliximab, ixekizumab, secukinumab, ustekinumab and risankizumab. CONCLUSIONS: SII and SIRI may indicate the severity of psoriasis as well as SII may be associated with psoriatic arthritis, hypertension, hepatic steatosis and coronary artery disease in patients with psoriasis. There is no consensus on the biomarkers that can be used to create an optimized treatment strategy in psoriasis. Therefore, SII and SIRI may be helpful in making the choice of treatment and in the follow-up of patients with psoriasis treated with biological agents.

Clinical, histopathological and immunohistochemical evaluation of ultraviolet A1 treatment in early-stage mycosis fungoides.

BACKGROUND/PURPOSE: Mycosis fungoides (MF) is the most common variant of cutaneous T-cell lymphomas primarily involving the skin. Early-stage MF is characterised by non-specific skin lesions and non-diagnostic biopsies. While skin-focused treatments, such as PUVA and narrowband UVB (nbUVB), are the most frequently recommended treatments, the UVA1 efficacy has been researched in recent years. The purpose of this study was to evaluate the clinical, histopathological and immunohistochemical aspects of UVA1 treatment in patients with early-stage MF. METHODS: The modified severity weighted assessment scale (mSWAT) was used for total skin body scoring before and after treatment. Skin punch biopsies were taken from the patients before and after treatment. UVA1 therapy was performed five times each week. RESULTS: This study included 26 patients with early-stage MF. The total number of UVA1 sessions varied between 15 and 34. Complete response was observed in 8 (30.8%) of 26 patients (30.8%). The median mSWAT score decreased statistically significantly from 7.1 to 2.0 after treatment (p < .001). Histopathological complete response was observed in 2 (9.5%) of 21 patients. A statistically significant decrease in dermal interstitial infiltrate was observed on histopathological examination after treatment (p = .039). Epidermal CD4/CD8 levels decreased statistically significantly higher from a median of 2.5-1.2 in the complete clinical response group after treatment (p = .043). CONCLUSION: According to our results, UVA1 treatment has an effect on early-stage MF in terms of clinical, histopathological and immunohistochemistry.

Topical Insulin Application in the Management of Resistant Leg Ulcers in a Patient With Prolidase Deficiency: A Case Report.

Leg ulcers are a significant cause of morbidity and mortality and can be caused by vascular, neuropathic, infectious, and traumatic factors, as well as rare metabolic diseases like prolidase deficiency. Despite various wound care methods and systemic treatments, managing ulcers can be challenging. This case presents a male patient with prolidase deficiency for 35 years whose leg ulcers were resistant to standard treatments such as wound dressings, topical treatments, and hyperbaric oxygen therapy. Considering the ulcers' resistant nature, we applied topical insulin to ulcers as an add-on therapy and observed clinical improvement. In this case, we want to emphasize the potential of insulin as a supplementary treatment agent in prolidase deficiency-induced ulcer treatment.

Does biological agent treatment have an impact on serum uric acid levels in patients with psoriasis?

OBJECTIVE: High serum uric acid levels have been associated with psoriasis as well as cardiovascular diseases and metabolic syndrome. The aim of this study was to evaluate the effect of biologic agent treatment on serum uric acid levels in patients with psoriasis. METHODS: Between April 2019 and September 2022, serum uric acid levels were retrospectively evaluated in patients with psoriasis before and 3 months after biologic agent treatment. RESULTS: This study included 224 patients, 100 females and 124 males, who were treated with TNF-α, IL-17, IL-12/23, and IL-23 inhibitors. Uric acid levels were significantly higher in men compared to women (p < 0.001), higher in overweight and obese patients compared to those with normal weight (p = 0.004), and higher in patients with severe versus mild psoriasis (p = 0.028). The mean serum uric acid level decreased significantly from 5.89 ± 1.53 mg/dL to 5.41 ± 1.39 mg/dL in all patients 3 months after biological agent treatment (p < 0.001). A statistically significant decrease in serum uric acid levels was detected in patients treated with adalimumab (p < 0.001), infliximab (p = 0.002), ixekizumab (p = 0.001), secukinumab (p = 0.012), and ustekinumab (p < 0.001). CONCLUSIONS: Since high serum uric acid levels have been associated with increased risk for cardiovascular diseases and metabolic syndrome, treatment of psoriasis with adalimumab, infliximab, ixekizumab, secukinumab, and ustekinumab may have a positive impact on cardiometabolic comorbidities.

Topical Insulin as an Add-On Therapy for Leg Ulcer: A Case Report.

Leg ulcers affect millions of people worldwide, and are a significant cause of morbidity and mortality. Various factors can be etiological agents of leg ulcers such as vascular, neuropathic, infectious, and traumatic factors. Treatment of the leg ulcer can be difficult in some cases despite using different systemic treatments and local wound care, but various newly defined treatment modalities are discussed in the literature and topical insulin application is one of them. Insulin is a hormone that is essential for regulating blood glucose and lipid levels, also insulin can have local effects when applied topically. Various mechanisms like regulation of inflammation, collagen synthesis, and angiogenesis have been explained to understand topical insulin's effects on the wound. There are case reports and studies on the usage of topical insulin on diabetic ulcers and decubitus ulcers. We applied topical insulin as an add-on therapy on a treatment-resistant leg ulcer and observed the healing of the lesion. The use of topical insulin as an add-on therapy may reduce treatment time and speed up wound healing. Topical insulin can be considered as an additional therapy for treatment-resistant ulcers.

A case of drug-induced bullous pemphigoid associated with teriflunomide: A patient with relapsing multiple sclerosis.

BACKGROUND: There aren't many reported skin changes associated with teriflunomide use in patients with multiple sclerosis (MS) mm Only one life-threatening gross skin change has been reported so far; a patient with toxic epidermal necrolysis. There are also a few case reports about cutaneous adverse effects of teriflunomide, such as eczema, rash and palmar pustular psoriasis. METHODS: We herein report the first case of bullous drug reaction in a patient receiving teriflunomide treatment. RESULTS: A 55-year-old women with relapsing multiple sclerosis (RMS) was diagnosed teriflunomide induced bullous pemphigoid as it was detected in the first three months following the initiation of therapy. It is fully recovered after withdrawal of teriflunomide, in combination with systemic steroid treatment. DISCUSSION: We report the first case of bullous drug reaction associated with teriflunomide. Multiple drugs have been implicated in the pathogenesis of the disease so far. It is important to point out some immunosuppressants may trigger autoimmune diseases like bullous pemphigoid. CONCLUSION: Considering recently reported skin reactions associated with teriflunomide, neurologists and patients should be careful on potential warning symptoms and signs of cutaneous drug reactions of this drug.

Comparison of Efficacy of Doxycycline and Isotretinoin on Cutaneous Human Beta-Defensin-1 and -2 Levels in Acne Vulgaris.

BACKGROUND: Recent studies have shown that human beta-defensin-1 (hBD-1) and (human beta-defensin-2 hBD-2), which are antimicrobial peptides produced by the skin, play a role in the pathogenesis of acne vulgaris (AV). OBJECTIVE: The aim of this study was to determine the role of antimicrobial peptides in the pathogenesis of AV and enlighten the effects of doxycycline and isotretinoin in the expression of these defensins in AV. MATERIALS AND METHODS: A total of 44 patients (22 patients in each group) with Grade 6 and 8 AV who were indicated doxycycline or isotretinoin for their treatment, and 20 healthy volunteers were included in this study. Pretreatment cutaneous samples were obtained from pustular lesions and uninvolved skin of AV patients and were repeated after the treatment. Only one biopsy was obtained from controls. RESULTS: Cutaneous levels of hBD-1 and hBD-2 were significantly increased in AV patients when compared with healthy controls (P<0.05). Doxycycline therapy achieved a decrease in hBD-1 levels (P<0.05), whereas isotretinoin therapy achieved a reduction in hBD-2 levels when compared with pretreatment levels (P<0.05). Posttreatment hBD-1 and hBD-2 levels were not different between doxycycline and isotretinoin groups (P>0.05). CONCLUSION: In the light of these results, it was reasonable to assume the role of hBD-1 and hBD-2 in the pathogenesis of AV. Our results showing a significant reduction in hBD-1 staining with doxycycline treatment and in hBD-2 with isotretinoin suggested that some part of their anti-acne effect worked through these mechanisms.

Excellent response to tofacitinib treatment in a patient with alopecia universalis.

Alopecia universalis (AU) is generally considered a variant of alopecia areata (AA), in which the treatment options seldom provide satisfactory results. However, successful treatment of several cases of AA and its variants with oral Janus kinase (JAK) inhibitors have been reported recently. Here we report a 23-year-old female patient with AU successfully treated with tofacitinib, a selective JAK-3 inhibitor. The initial tofacitinib dose was 5 mg twice daily. After 2 months of treatment, partial hair regrowth was seen on the scalp and eyebrows. Thereafter, the dose was increased to 10 mg in the morning and 5 mg at night. By 6 months of the treatment, there was complete hair regrowth throughout the entire body. Our patient tolerated tofacitinib well, without any significant side effects. Tofacitinib emerges as a promising novel therapy in alopecia universalis. We believe further study is required to establish the safety and confirm the efficacy of tofacitinib treatment for alopecia universalis.