Therapeutic implications of adding the psychotropic drug escitalopram in the treatment of patients suffering from moderate-severe psoriasis and psychiatric comorbidity: a retrospective study.

BACKGROUND: It is known that stress and/or psychiatric diseases can play an important role in determining psoriasis, including the well-known negative somato-psychiatric rebound that comes with the disease. METHODS: Samples of 38 subjects suffering from both moderate-severe psoriasis treated with anti-TNFα, and depressive and/or anxious mood disorders were studied. Part of them were additionally treated with escitalopram, whereas the other group only consulted to a dermatological and psychiatric follow-up. The aim of this study was to determine if an improvement in the dermatological manifestation as well as an improvement in the anxious-depressive disorder can be observed. RESULTS: The study revealed that patients treated with escitalopram had a reduction of psycho-diagnostic test scores that measure depression and anxiety levels as well as the values of pruritus. CONCLUSION: Our study suggests that psychological interventions and antidepressant medications may improve perceived symptom severity, quality of life and major compliance to the treatment in selected patients (suffering from psoriasis and mood disturbance), without a clinician necessarily being able to see an impact on psoriasis severity.

The importance of stressful family events in psoriatic patients: a retrospective study.

BACKGROUND: Psychosomatic stress events are believed to play an important role in psoriasis either by inducing or worsening the disease. OBJECTIVE: In this article, we compared the role of family stress events against other types of stress events on the psychological well being of patients and on their skin disease. We used our sample of psoriasis patients with said stress events. METHOD: Patients underwent a dermatological examination which was evaluated through the PASI index. Simultaneously, they underwent interviews for psychological evaluations. The Hamilton scales were administered to assess anxiety and depression (Ham-A scores significant >20, Ham-D >15). RESULTS: It has been demonstrated that family stress influences the psychological well being more than other types of daily stress events. In fact, people with family stress events reported higher value HAM-A (P = 0.03) and HAM-D (P = 0.02) compared with those who reported other types of stress events. Women reported higher values of HAM-A and HAM-D than men. The value of PASI in the two groups (with family stress events and those with other stress events) was not statistically significant. CONCLUSION: Results obtained from this analysis show the importance of family stress events on the quality of life and on psychiatric and dermatological status. For the psychological morbidity, a parallel approach of both bio-psychiatric and skin care is recommended, especially for women.

Tumour necrosis factor-α antagonists in patients with concurrent psoriasis and hepatitis B or hepatitis C: a retrospective analysis of 17 patients.

INTRODUCTION: Tumour necrosis factor (TNF)-α antagonists are effective for the treatment of plaque-type psoriasis and psoriatic arthritis, but concerns remain about the safety of these agents in the presence of chronic infections, including past hepatitis B (HBV) and chronic hepatitis C virus (HCV) infections. OBJECTIVE: To assess the safety of TNF-α therapy in patients with plaque-type psoriasis and concurrent past HBV or chronic HCV. METHODS: Data were collected retrospectively from patients in the PsoCare Centre, Division of Dermatology II, Florence University. Patients with plaque-type psoriasis who were receiving anti-TNF-α therapy were retrospectively reviewed for the presence of HBV or HCV by a serological evaluation. RESULTS: Seventeen patients (13 men and four women, age 36-74 years) with plaque-type psoriasis associated with hepatitis infections (11 with past HBV infection, five with chronic HCV infection and one affected by both HBV and HCV) were identified. Fourteen patients had received etanercept, two adalimumab and one adalimumab as a second biologic treatment after an unsuccessful trial of etanercept. In none of the cases were changes in serum aminotransferases or viral load reported. CONCLUSIONS: In our analysis, the use of anti-TNF-α therapy appears to be safe as it did not affect serum aminotransferases or viral load. However, repeated monitoring is necessary throughout the treatment period. Systematic, large-scale studies are also needed to assess the risks and benefits of TNF-α antagonists in these patients.

Comparison of body weight and clinical-parameter changes following the treatment of plaque psoriasis with biological therapies.

OBJECTIVE: This study is a retrospective analysis evaluating the presence of comorbidities, as well as the changes in body weight and clinical parameters in psoriasis patients following treatment with anti-TNF-alpha agents and with the anti-CD11a agent efalizumab. RESEARCH DESIGN AND METHODS: A total of 268 patients affected by chronic plaque psoriasis, and receiving systemic monotherapy with efalizumab, etanercept, or infliximab, were included. The follow-up period was 2, 4 and 6 months. MAIN OUTCOME MEASURES: Clinical data including age, gender, weight, type and severity of psoriasis and age of onset were collected. Severity of psoriasis was assessed according to the Psoriasis Area and Severity Index (PASI) and body surface area (BSA). RESULTS: Hypertension and hyperlipidaemia were the comorbidities present with the higher frequency in our group of patients. PASI score was reduced by between 43.8 and 52% in all treatment groups. No relevant blood chemistry changes were observed following therapy, with the exception of a decrease in neutrophils and an increase in leukocyte numbers reported in the efalizumab and etanercept groups. Interestingly, after 6 months of therapy, the weight of the patients remained unvaried in those taking efalizumab (-0.05%) but was moderately increased in the etanercept (+0.72%) and in infliximab groups (+0.3%). CONCLUSIONS: The present study shows that there were clinically significant differences in weight gain effects between efalizumab and anti-TNF-alpha agents in psoriatic patients. The changes in body weight gain increase did not reach statistical significance, although there is a trend towards this, and this may be due to the relatively small number of patient studied.

Switch from etanercept to efalizumab in a psoriatic patient with HCV infection: a case report.

Psoriasis vulgaris is a chronic dermatosis and is a widespread dematological disease. The most represented lesions are erythemato-squamous plaques with a tendency to cover large body areas with a great impairment of normal activities and a poor quality of life. Very often psoriasis is associated to other illnesses and the dermatologist has to be aware that comorbidities have to be taken in account for a successfull treatment of the disease. We report a case of a patient affected by severe psoriasis and HCV infection. He underwent a first treatment with etenarcept with good clinical results and no change of his viral load. When etenarcept became ineffective, he received efalizumab, with a good control of his dermatological condition and a reduction of the viral load.

Efalizumab-induced severe thrombocytopenia can be resolved.

Efalizumab is a monoclonal a humanized recombinant IgG1 monoclonal antibody which targets the CD11a, the alpha-subunit of LFA-1 (lymphocyte function-associated antigen-1). It acts by blocking the T-lymphocyte pathogenetic mechanisms of psoriasis. Thrombocytopenia is an adverse event that occurs during therapy. Thrombocytopenia can be mild and can occur quite early during treatment, together with leukocytosis. Both adverse events tend to normalize with ongoing therapy, or, in cases worsening, with therapy suspension. There have been multiple reports of thrombocytopenia associated with efalizumab therapy for the treatment of psoriasis. The general recommendation is to check platelet counts monthly for the first 3 months of efalizumab therapy, then every 3 months for the duration of therapy. According to our experience on a wide range of patients, it is useful to check platelets every month for the first 6 months of therapy. We report a case of efalizumab-associated thrombocytopenia that occurred after 16 weeks of therapy together with clinical worsening of skin lesions. The peculiarity of our case is the absence of signs and symptoms linked to thrombocytopenia and the quick return to normal platelet count without corticosteroid therapy.