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1.
Medicine (Baltimore) ; 99(9): e19303, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118749

RESUMO

BACKGROUND: Several studies have shown a relationship between psoriasis and hypertension, but no meta-analysis has been restricted to studies that adjusted for confounders. The aim of the study was to estimate the association between psoriasis and hypertension with adjustment for covariates. METHODS: A systematic literature search in the MEDLINE, Embase, Cochrane databases, and Google Scholar was conducted to identify relevant studies which reported the association of psoriasis with the risk of hypertension published up to November 2018 in English. Data analysis was performed with Stata V.12, and Begg adjusted rank correlation test and Egger regression asymmetry test were used to detect publication bias. RESULTS: A total of 16 adjusted-for-covariates studies, involving 50,291 cases with hypertension in 255,132 psoriasis patients and 76,547 cases with hypertension in 814,631 controls (no psoriasis), were included in this meta-analysis. The results indicated that psoriasis was associated with an increased risk of hypertension compared to those without psoriasis, and the prevalence of hypertension in severe psoriasis patients was higher than that in mild psoriasis patients, and the risk of hypertension in psoriasis patients was higher than that in nonpsoriasis patients in Europe and Asia. CONCLUSION: We conducted this meta-analysis using the adjusted-for-covariates odds ratio, demonstrating that psoriasis was associated with an increased risk of hypertension compared to those without psoriasis.


Assuntos
Hipertensão/diagnóstico , Psoríase/diagnóstico , Correlação de Dados , Humanos , Hipertensão/fisiopatologia , Razão de Chances , Psoríase/fisiopatologia , Medição de Risco/métodos
2.
Hautarzt ; 71(3): 227-243, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-32130433

RESUMO

In Germany, approximately 2% of the population suffers from psoriasis, which is no longer considered only a cutaneous, but rather a systemic disease. Accordingly, common comorbidities and potential joint involvement in psoriasis must be recorded. If necessary, interdisciplinary patient care has to be organized. The use of validated scores is recommended to complete the patient's medical history. The individual treatment should include intensified topical therapies as well as short-term phototherapy in case of an acute phase. In addition to conventional systemic therapies (e.g., fumarates, methotrexate), a number of new therapeutics for psoriasis are in development. Apart from the PDE­4 inhibitor apremilast, targeted therapies are currently available to block TNF-alpha, IL-17A, the IL-17 receptor and IL-23. Decisions on individualized, patient-centered psoriasis management should be based on assessment of disease severity and the existence of comorbidities. Furthermore, economic aspects should be taken into account.


Assuntos
Terapia Biológica/métodos , Terapia de Alvo Molecular , Fototerapia/métodos , Psoríase/diagnóstico , Psoríase/terapia , Administração Oral , Administração Tópica , Adulto , Artrite Psoriásica/diagnóstico , Artrite Psoriásica/terapia , Fármacos Dermatológicos/uso terapêutico , Alemanha , Humanos , Metotrexato/uso terapêutico , Inibidores da Fosfodiesterase 4/uso terapêutico , Índice de Gravidade de Doença , Resultado do Tratamento
3.
Adv Clin Exp Med ; 29(1): 157-163, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31990461

RESUMO

Palmoplantar pustulosis (PPP) is a chronic inflammatory disease, most often occurring in middle-aged women. In the course of the condition, painful skin lesions appear on the hands and feet, i.e., areas that are extremely important in everyday life. Therefore, the disease significantly reduces quality of life. The pathogenesis of this disease is poorly understood, although it is known that genetic, immunological and environmental factors play a role in its development. Clinical observations confirm the role of nicotine and contact allergens in the development of the lesions. The skin lesions can also occur as a side effect of certain medications. In some cases, PPP coexists with other diseases, i.e., seronegative arthropathies, as well as celiac and thyroid diseases. There is also a connection between the disease and infectious bacterial foci. Exacerbation of the skin lesions is triggered by stress. Therefore, patients require multidirectional tests, since finding the cause of the disease is essential to administering effective treatment.


Assuntos
Psoríase , Doenças da Glândula Tireoide , Doença Crônica , Feminino , Pé/patologia , Mãos/patologia , Humanos , Pessoa de Meia-Idade , Psoríase/complicações , Psoríase/diagnóstico , Psoríase/terapia , Qualidade de Vida , Doenças da Glândula Tireoide/complicações , Doenças da Glândula Tireoide/diagnóstico , Doenças da Glândula Tireoide/terapia
4.
Scand J Immunol ; 91(3): e12846, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31692008

RESUMO

Psoriasis is a TNF-α/IL-23/IL-17A-mediated inflammatory skin disease that causes a significant socioeconomic burden in afflicted patients. IL-17A-producing immune cells, including Th17 cells, are crucial effector cells in the development of psoriasis. IL-17A stimulates epidermal keratinocytes to produce CCL20, which eventually recruits CCR6 + Th17 cells into the lesional skin. Thus, the CCL20/CCR6 axis works as a driving force that prepares an IL-17A-rich cutaneous milieu. In this review, we summarize the current research topics on the CCL20/CCR6 axis and the therapeutic intervention of this axis for psoriasis.


Assuntos
Quimiocina CCL20/metabolismo , Suscetibilidade a Doenças , Psoríase/etiologia , Psoríase/metabolismo , Receptores CCR6/metabolismo , Animais , Biomarcadores , Quimiocina CCL20/genética , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Terapia de Alvo Molecular , Psoríase/diagnóstico , Psoríase/terapia , Receptores CCR6/genética , Transdução de Sinais/efeitos dos fármacos
5.
Medicine (Baltimore) ; 98(50): e17917, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852063

RESUMO

OBJECTIVE: Psoriasis is a chronic inflammatory disease that affects the skin, joints, and nails. To investigate the efficacy of sonoelastographic evaluation for assessing nail involvement and severity in psoriasis. MATERIALS AND METHODS: Thirty-one psoriasis patients and 31 healthy control subjects were included in the study. The nail thickness and nail bed thickness of the thumbs of all cases were measured by gray scale ultrasonography. In addition, the values of strain elastography were measured by sonoelastography. RESULTS: Of the participants, 38 were male and 24 were female; the ratio of males and females was equal in both groups. There was no significant difference between the patient and control group in terms of gender and age. In the patient group, the mean duration of illness was 13.87 ±â€Š9.8 years, mean PASI score was 5.53 ±â€Š2.38, and mean NAPSI score was 33.97 ±â€Š37.99. The nail plate thickness and elastography strain ratios were found to be statistically higher in the psoriasis group compared to the control group. There was also significant correlation between elastography strain ratios and nail thickness (P = .014), nail bed thickness (P < .001) and NAPSI scores (P = .01). CONCLUSION: Due to the superiority of ultrasound in real-time imaging of the nail structure and the compatibility of sonographic elastography with clinical scores in the assessment of the nail bed, we believe that it can be used as a complementary method.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Doenças da Unha/diagnóstico , Unhas/diagnóstico por imagem , Psoríase/diagnóstico , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Unha/etiologia , Psoríase/complicações , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Adulto Jovem
6.
J Immunol Res ; 2019: 2546161, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31583255

RESUMO

Background: The role of interleukin-12 (IL-12), interleukin-23 (IL-23), and interleukin-17 (IL-17) has been recognized in psoriasis pathogenesis, and new drugs targeting this axis have already been developed which may provide a new therapeutic approach for patients with moderate to severe psoriasis. Objective: To compare the direct and indirect evidences of the efficacy and safety of brodalumab, secukinumab, ixekizumab, ustekinumab, guselkumab, tildrakizumab, and risankizumab in the short-term treatment of moderate to severe plaque psoriasis using network meta-analysis (NMA). Methods: A comprehensive literature search was performed in PubMed, EMBASE, and Cochrane Central Register of Controlled Trials for the available relevant studies. NMA was conducted by Stata 15.0 software using relative risks (RR) with 95% confidence interval to assess the clinical effectiveness and safety. Ranked the efficacy and safety for each drug accordance with the surface under the cumulative ranking curve (SUCRA). Results: This meta-analysis included 28 studies. All the interventions performed better than placebo in short-term achievement. Based on the result of SUCRA, ixekizumab 80 mg every 2 weeks ranked the highest in short-term achievement of PASI 75 (SUCRA = 93.0%). Brodalumab 210 mg ranked the highest in short-term achievement of PASI 100 (SUCRA = 85.0%). Secukinumab 300 mg ranked the highest in short-term achievement of sPGA 0/1 or IGA 0/1 or PGA 0/1 (SUCRA = 98.1%). In terms of having a risk of adverse events, the rates were higher in brodalumab, secukinumab, ixekizumab, and ustekinumab 45 mg compared with placebo. Ixekizumab 80 mg every 4 weeks ranked the highest in the risk of adverse events during short-term treatment (SUCRA = 4.5%). Guselkumab 50 mg ranked the highest in the risk of serious adverse events during short-term treatment (SUCRA = 25.9%). Ixekizumab 80 mg every 4 weeks ranked the highest in the risk of discontinuations due to adverse events during short-ter treatment (SUCRA = 10.7%). Conclusions: IL-17, IL-12/23, and IL-23 inhibitors had high efficacy in the achievement of PASI 75, PASI 100, and sPGA 0/1 or IGA 0/1 or PGA 0/1 in moderate to severe plaque psoriasis after 12 or 16 weeks of treatment. IL-17 inhibitors showed superior efficacy. However, its clinical safety was poor. Risankizumab appeared to have relatively high efficacy and low risk. The clinical tolerance of other biological agents needs to be further observed.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Citocinas/antagonistas & inibidores , Terapia de Alvo Molecular , Psoríase/diagnóstico , Psoríase/tratamento farmacológico , Animais , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/farmacologia , Anticorpos Monoclonais Humanizados/administração & dosagem , Citocinas/metabolismo , Quimioterapia Combinada , Humanos , Terapia de Alvo Molecular/métodos , Psoríase/etiologia , Psoríase/metabolismo , Índice de Gravidade de Doença , Resultado do Tratamento , Ustekinumab/administração & dosagem
7.
J Drugs Dermatol ; 18(10): 1012-1018, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31584780

RESUMO

Background: The use of topical therapy is a key component in the management of almost all psoriasis patients. Topicals are considered first-line therapy for mild disease and are having an increasing role in moderate or severe psoriasis as an integral part of combination therapy. Halobetasol has been shown be effective in moderate or severe localized plaque psoriasis, and tazarotene affords important effects on epidermal hyperproliferation that may be important in more severe disease. Objective: To investigate the efficacy, safety and tolerability of a once-daily application of a fixed combination halobetasol propionate 0.01% and tazarotene 0.045% (HP/TAZ) lotion in comparison with its vehicle in patients with severe localized plaque psoriasis (as defined by an Investigator Global Assessment (IGA) of 4 and Body Surface Area (BSA) of 3%-12%. Methods: Post hoc analysis of two multicenter, randomized, double-blind, vehicle-controlled phase 3 studies. Sixty-two patients with severe localized psoriasis (mean BSA 7.4) randomized (2:1) to receive HP/TAZ lotion or vehicle, once-daily for 8 weeks, with a 4-week posttreatment follow-up. Efficacy assessments included treatment success (defined as at least a 2-grade improvement from baseline in the IGA score and a score of 'clear' or 'almost clear'), impact on individual signs of psoriasis (erythema, plaque elevation, and scaling) at the target lesion, BSA, reduction in mean baseline IGAxBSA and achievement of a clinically meaningful response (number of patients who achieved at least a 75% improvement in IGAxBSA). Safety and treatment emergent adverse events (TEAEs) were evaluated throughout. Results: By week 8, 34.8% of patients were treatment successes compared with 0.0% on vehicle (P=0.004). HP/TAZ lotion was also significantly superior in reducing psoriasis signs and symptoms and improving BSA. At week 8, 47.4% (erythema), 66.4% (plaque elevation), and 65.4% (scaling) subjects achieved at least a 2-grade improvement, compared with 14.0% (P=0.016), 14.8% (P<0.001) and 14.7% (P<0.001) respectively with vehicle. Patients treated with HP/TAZ lotion achieved a 32.8% reduction in baseline mean BSA, compared with a 39.6% increase with vehicle (P=0.013). HP/TAZ lotion achieved a statistically significant superior reduction in mean IGAxBSA compared to vehicle from week 2 (P<0.001 versus vehicle). By week 8, almost half of the patients treated with HP/TAZ lotion achieved a clinically meaningful response (IGAxBSA-75) and a 52.9% reduction in mean IGAxBSA score compared with a 17.5% increase in those patients treated with vehicle (P<0.001). One patient (2.6%) treated with HP/TAZ lotion discontinued due to AE. Most frequently reported treatment related AEs were application site pain (7.9%), contact dermatitis (5.3%) and pruritus (5.3%). Conclusions: HP/TAZ lotion provides significantly greater efficacy than vehicle that is both rapid and sustained, in patients with severe localized plaque psoriasis, with good tolerability and safety over 8 weeks' once-daily use. J Drugs Dermatol. 2019;18(10):1012-1018.


Assuntos
Clobetasol/análogos & derivados , Fármacos Dermatológicos/administração & dosagem , Ácidos Nicotínicos/administração & dosagem , Psoríase/tratamento farmacológico , Creme para a Pele/administração & dosagem , Adulto , Clobetasol/administração & dosagem , Clobetasol/efeitos adversos , Dermatite de Contato/epidemiologia , Dermatite de Contato/etiologia , Fármacos Dermatológicos/efeitos adversos , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ácidos Nicotínicos/efeitos adversos , Dor/epidemiologia , Dor/etiologia , Prurido/epidemiologia , Prurido/etiologia , Psoríase/diagnóstico , Índice de Gravidade de Doença , Creme para a Pele/efeitos adversos , Resultado do Tratamento
8.
J Drugs Dermatol ; 18(10): 1029-1036, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31584782

RESUMO

Background: Psoriasis is a chronic, immune-mediated disease that varies widely in its clinical expression. Topical corticosteroids (TCS) are the mainstay of treatment. Long-term safety remains a concern, limiting use, and posttreatment flare is common. Recently data were reported on the use of halobetasol propionate (HP) 0.01% lotion in moderate or severe localized plaque psoriasis, once-daily for 8 weeks. In addition, a 2-week label-restricted study reported comparable efficacy to HP 0.05% cream. Data evaluating efficacy in specific locations has not been reported and while psoriasis commonly affects lower extremities treatment can be more problematic and burden of disease heightened. Objective: To investigate the efficacy of a once-daily application of HP 0.01% lotion in comparison with its vehicle in patients with moderate-to-severe plaque psoriasis of the lower extremities. Methods: A post hoc analysis of two multicenter, randomized, double-blind, vehicle-controlled phase 3 studies in moderate or severe psoriasis. Subjects (N=234) where the leg was identified as the target lesion were randomized (2:1 ratio) to receive HP 0.01% lotion or vehicle, once-daily for 8 weeks. Efficacy assessments included treatment success (defined as at least a 2-grade improvement from baseline) in each individual sign of psoriasis (erythema, plaque elevation, and scaling) at the target lesion (leg) and overall treatment outcomes including at least a 2-grade improvement from baseline in the Investigator Global Assessment (IGA) score, and 'clear' or 'almost clear', improvement in Body Surface Area (BSA) and reduction in IGAxBSA. Quality of Life (QoL) was assessed using the Dermatology Life Quality Index (DLQI) at baseline, week 4, 8, and 12. Results: At the end of the 8-week treatment period, more than half of subjects had achieved treatment success, with 52.1%, 55.5%, and 58.2% of subjects achieving at least a 2-grade reduction in erythema, plaque elevation and scaling severity on the leg, compared with 15.7% and 22.9%, and 22.2% of those treated with vehicle (P<0.001). In addition, overall treatment success (IGA) was achieved in 37.1% of these subjects who had been treated with HP 0.01% lotion compared with 8.4% treated with vehicle (P<0.001); with a corresponding 34.2% reduction in baseline BSA and 50.5% change in mean baseline IGAxBSA (both P<0.001 versus vehicle). Overall, a clinically relevant improvement in QoL was achieved by week 4; by week 8 37.7% of subjects where the leg was the target lesion had a clinically meaningful improvement in disease severity (IGAxBSA-75). Conclusions: In conclusion, halobetasol propionate 0.01% lotion provides statistically significant efficacy following 8 weeks' therapy compared with vehicle in subjects where the leg was identified as the target lesion, with clinically relevant improvements in QoL and more than a third of subjects achieving a clinically meaningful result. J Drugs Dermatol. 2019;18(10):1029-1036.


Assuntos
Clobetasol/análogos & derivados , Fármacos Dermatológicos/administração & dosagem , Psoríase/tratamento farmacológico , Creme para a Pele/administração & dosagem , Adulto , Idoso , Clobetasol/administração & dosagem , Clobetasol/efeitos adversos , Fármacos Dermatológicos/efeitos adversos , Método Duplo-Cego , Esquema de Medicação , Feminino , Humanos , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Psoríase/diagnóstico , Qualidade de Vida , Índice de Gravidade de Doença , Creme para a Pele/efeitos adversos , Resultado do Tratamento
9.
J Drugs Dermatol ; 18(9): 950, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31524995

RESUMO

Psoriasis is a common, chronic inflammatory skin disease that can affect any part of the body. It is a highly visible condition with symptoms that include the appearance of red, thick, scaly patches on the arms, legs, trunk, soles of the feet, palms, and nails, but most commonly on the elbows, knees, and scalp.


Assuntos
Emoções , Psoríase/psicologia , Qualidade de Vida , Saúde da Mulher , Doença Crônica/psicologia , Estética , Feminino , Humanos , Psoríase/diagnóstico , Índice de Gravidade de Doença
10.
Int J Mol Sci ; 20(18)2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31491865

RESUMO

Psoriasis is an immune-mediated genetic skin disease. The underlying pathomechanisms involve complex interaction between the innate and adaptive immune system. T cells interact with dendritic cells, macrophages, and keratinocytes, which can be mediated by their secreted cytokines. In the past decade, biologics targeting tumor necrosis factor-α, interleukin (IL)-23, and IL-17 have been developed and approved for the treatment of psoriasis. These biologics have dramatically changed the treatment and management of psoriasis. In contrast, various triggering factors can elicit the disease in genetically predisposed individuals. Recent studies suggest that the exacerbation of psoriasis can lead to systemic inflammation and cardiovascular comorbidity. In addition, psoriasis may be associated with other auto-inflammatory and auto-immune diseases. In this review, we summarize the risk factors, which can be divided into two groups (namely, extrinsic and intrinsic risk factors), responsible for the onset and exacerbation of psoriasis in order to facilitate its prevention.


Assuntos
Psoríase/epidemiologia , Psoríase/etiologia , Idade de Início , Animais , Comorbidade , Progressão da Doença , Humanos , Psoríase/diagnóstico , Psoríase/prevenção & controle , Medição de Risco , Fatores de Risco
11.
J Dermatol ; 46(10): 886-897, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31418479

RESUMO

Patients with dermatomyositis positive for anti-aminoacyl tRNA synthetase (ARS) antibodies, also known as antisynthetase syndrome (ASS), frequently present with mechanic's hand and interstitial lung disease (ILD). We first screened the antibody profiles of 59 patients with dermatomyositis, and then examined the cutaneous, muscular and pulmonary manifestations characteristic for patients with ASS. The anti-ARS antibodies Jo-1, PL-7, PL-12, EJ and KS, along with antibodies to TIF1-γ, MDA5 and Mi-2, were examined. Among the 59 patients, 20, 21, 15 and three patients were classified into the ASS, non-ASS, myositis-specific antibody-negative and unknown groups, respectively. Five of 16 patients (31%) with ASS had six relatives with a history of collagen diseases, within the second degree of relationship, including two cases of dermatomyositis (vs the non-ASS group, P = 0.018). Patients with ASS more frequently presented with fever and arthralgia, and had elevated levels of C-reactive protein. Nine of the 11 finger lesions (82%) clinically diagnosed as mechanic's hands showed a psoriasiform tissue reaction. ILD was observed in 19 of 20 patients (95%) with ASS, and eight of 21 patients (38%) in the non-ASS group, in which six patients possessed anti-MDA5 antibody. Patients with ASS showed higher serum levels of muscle enzymes, and four of 12 patients (33%) had fasciitis-dominant myopathy, while only one of 11 patients (9%) in the non-ASS group had fasciitis-dominant myopathy. Patients with ASS often present with a psoriasiform tissue reaction in the hand lesions and fasciitis-dominant myopathy, and the relatives of those with ASS are at high risk for collagen diseases.


Assuntos
Aminoacil-tRNA Sintetases/imunologia , Autoanticorpos/sangue , Dermatomiosite/complicações , Doenças Pulmonares Intersticiais/diagnóstico , Miosite/diagnóstico , Psoríase/diagnóstico , Adulto , Idoso , Autoanticorpos/imunologia , Dermatomiosite/sangue , Dermatomiosite/imunologia , Feminino , Humanos , Pulmão/diagnóstico por imagem , Doenças Pulmonares Intersticiais/sangue , Doenças Pulmonares Intersticiais/imunologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Miosite/sangue , Miosite/imunologia , Psoríase/sangue , Psoríase/imunologia , Tomografia Computadorizada por Raios X
12.
Int J Health Policy Manag ; 8(7): 394-402, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31441276

RESUMO

BACKGROUND: There is limited evidence detailing the cost-effectiveness of psoriasis treatments in the Asian region. Therefore, this study is aimed to evaluate the cost-effectiveness of 3 psoriasis treatments tailored for moderate to severe psoriasis, namely topical and phototherapy (TP), topical and systemic (TS), and topical and biologic (TB) regimens, respectively. METHODS: This has been achieved by the participation of a prospective cohort involving a total of 90 moderate to severe psoriasis patients, which has been conducted at 5 public hospitals in Malaysia. The main outcome measures have been evaluated via cost and effectiveness psoriasis area severity index (PASI)-75 and/or body surface area (BSA) <5 and/or dermatology life quality index (DLQI) ≤5), estimated from the societal perspective over a 6-months duration. All costs are based on 2015's recorded Malaysian Ringgit (RM) currency. RESULTS: Consequently, TS has been found to be the most cost-effective treatment with the lowest cost/PASI-75/and/or BSA <5 and/or DLQI ≤5, valued at RM9034.56 (US$2582.55). This is followed by TP, which is valued at RM28 080.71 (US$8026.93) and TB, valued at RM54 287.02 (US$15 518.06). Furthermore, one-way sensitivity analysis has highlighted the cost of medication as the most sensitive parameter. CONCLUSION: Thus, the input from this study is helpful for policy-makers in determining the first line treatment for moderate to severe psoriasis with consideration of the costs and its effectiveness in Malaysia. This will consequently allow hospitals to justify and provide the essential resources for further research and development, as well as the adoption of better treatment options.


Assuntos
Análise Custo-Benefício , Gastos em Saúde , Psoríase/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais , Humanos , Malásia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Psoríase/diagnóstico , Adulto Jovem
13.
J Dermatol ; 46(10): 859-866, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31432567

RESUMO

The association between psoriasis and risk of atherosclerotic cardiovascular disease has not been thoroughly evaluated in a large longitudinal cohort of an Asian population. We conducted a nationwide population-based retrospective cohort study encompassing more than 1.7 million Koreans with a 15-year follow-up period. The period prevalence of psoriasis was 0.33% among the baseline participants (1997-2000). In Cox proportional hazard analyses, the individuals with psoriasis had a higher adjusted hazard ratio (HR) for incidence of overall atherosclerotic cardiovascular disease (HR, 1.18; 95% confidence interval [CI], 1.09-1.27) compared with controls. Subgroup analyses revealed that the risk for myocardial infarction was commonly increased in both sexes with moderate to severe psoriasis (male: HR, 2.09; 95% CI, 1.35-3.24; female: HR, 3.23; 95% CI, 1.34-7.76), whereas the risk for ischemic stroke was specifically increased in female individuals with moderate to severe psoriasis (HR, 2.02; 95% CI, 1.24-3.30). Our data suggest that appropriate medical screening for possible cardiovascular comorbidities is warranted in Asian psoriatic patients according to disease severity and sex.


Assuntos
Angina Pectoris/epidemiologia , Aterosclerose/epidemiologia , Infarto do Miocárdio/epidemiologia , Psoríase/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adulto , Comorbidade , Feminino , Seguimentos , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Modelos de Riscos Proporcionais , Psoríase/diagnóstico , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais
14.
J Drugs Dermatol ; 18(8): 731-740, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31424705

RESUMO

IMPORTANCE: There are increasing options for systemic combination therapy for psoriasis but a lack of literature around the characteristics of patients who are started on these regimens. OBJECTIVE: We aimed to determine how combination systemic therapy patients differ from monotherapy patients in their social, medical, or treatment history. DESIGN: This was a cross-sectional study of patients enrolled in the Corrona Psoriasis Registry. Descriptive characteristics were compared in biologic monotherapy and combination therapy groups. SETTING: The Corrona PsO registry is a prospective multicenter observational disease-based registry with patients recruited from 154 private and academic practice sites in the US and Canada with 373 participating dermatologists. PARTICIPANTS: Patients 18 years of age or older who enrolled in the Corrona Psoriasis Registry between April 2015 and March 2017 and initiated an eligible biologic therapy at the time of enrollment were included. EXPOSURES: Eligible biologic therapies included adalimumab, etanercept, infliximab, ixekizumab, secukinumab, and ustekinumab. Non-biologic and small molecule adjunctive therapies included acitretin, apremilast, CsA, and MTX. RESULTS: Patients on combination therapy were more likely to identify as black, to have Medicaid, and to report disabled work status. While combination therapy patients were more likely to have concomitant PsA, no major differences were seen in disease morphology, duration, IGA, PASI, or BSA affected at treatment initiation. CONCLUSIONS: Various demographic and socioeconomic factors are associated with use of combination systemic therapy compared to use of systemic monotherapy for psoriasis. An association with commonly used disease severity indices was not observed. RELEVANCE: An understanding of which patients are more likely to be prescribed combination systemic therapy will provide important context for long-term efficacy and safety data as they become available.


Assuntos
Produtos Biológicos/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Psoríase/tratamento farmacológico , Adolescente , Adulto , Idoso , Canadá , Estudos Transversais , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Psoríase/diagnóstico , Sistema de Registros/estatística & dados numéricos , Índice de Gravidade de Doença , Resultado do Tratamento , Estados Unidos , Adulto Jovem
15.
J Drugs Dermatol ; 18(8): 745-750, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31424706

RESUMO

INTRODUCTION: Selecting a systemic therapy for patients with psoriasis is a complex process, based on a variety of factors including psoriasis severity, comorbid health conditions, access to care, and both patient and provider preference. The objective of this study was to use data from electronic health records to understand prescribing patterns associated with biologic therapies for psoriasis and utilization of concomitant non-biologic psoriasis therapies in patients on biologics. METHODS: A retrospective cohort study was performed using OptumInSight's electronic health records database. Patients were classified as having psoriasis if they had 2 diagnosis codes for psoriasis or 1 diagnosis for psoriasis and a subsequent prescription for a systemic psoriasis therapy or phototherapy on a separate day. Only patients with at least 1 prescription for a biologic medication were included. The time between the first and last prescription in each prescription episode was calculated; at least 1 prescription every 180 days was required to be considered continuous therapy. We also identified a subgroup of patients with prescription episodes of at least 12 months duration in which to evaluate concomitant use of topical medications, phototherapy, and other systemic agents in patients receiving prescriptions for biologics. RESULTS: There were 34,714 eligible psoriasis patients. The median time between first and last prescriptions was 3.3 - 7.0 months, depending on the drug and up to 50% of patients that received a prescription for a biologic medication did not receive a second prescription for the same medication. In a subset of patients with prescription episodes of at least 12 months duration, more than 50% continued to receive prescriptions for topical therapies, most commonly topical steroids. DISCUSSION: Recognition of prescribing patterns associated with biologic medications for psoriasis is important to understand healthcare utilization and improve health systems practices for patients and providers.


Assuntos
Produtos Biológicos/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Psoríase/tratamento farmacológico , Adulto , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psoríase/diagnóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Estados Unidos
16.
J Drugs Dermatol ; 18(8): 776-788, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31424708

RESUMO

Psoriasis (PsO) is a common, systemic, chronic inflammatory disease characterized by key clinical symptoms, including itching, pain, and scaling, and is associated with substantial physical, psychosocial, and economic health burdens. Currently, there is no cure for PsO; however, the introduction of biologic therapies has revolutionized the clinical management of patients with PsO by expanding treatment options to include multiple therapies with different mechanisms of action targeting cytokines, including tumor necrosis factor inhibitors (TNFis), interleukin (IL)-17A inhibitors, an IL-12/23 inhibitor, and IL-23 inhibitors. TNFis are historically considered the first-line biologic treatment and the first-generation biologics; however, increased understanding of TNF-α and IL-17 synergistic functions have recently led to evidence that specifically targeting IL-17 may be more likely to improve disease activity than a more general, nonspecific therapy target, such as TNF-α. This review highlights currently available evidence and demonstrates the differences between TNFis and IL-17A inhibitors in patients with PsO with regard to efficacy and safety.


Assuntos
Produtos Biológicos/uso terapêutico , Interleucina-17/antagonistas & inibidores , Psoríase/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Produtos Biológicos/farmacologia , Ensaios Clínicos como Assunto , Humanos , Reação no Local da Injeção/epidemiologia , Reação no Local da Injeção/etiologia , Interleucina-17/imunologia , Psoríase/diagnóstico , Psoríase/imunologia , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/etiologia , Índice de Gravidade de Doença , Resultado do Tratamento , Fator de Necrose Tumoral alfa/imunologia
17.
J Drugs Dermatol ; 18(8): 790-796, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31424709

RESUMO

BACKGROUND: A novel foam formulation of halobetasol propionate, 0.05% (HBP-Foam) has been developed to treat plaque psoriasis in patients who prefer a thermostable topical foam with low application shear that allows for easier coverage over large and/or hirsute areas than existing formulations. OBJECTIVE: To determine the safety and effectiveness of HBP-Foam in subjects with plaque psoriasis. METHODS: Two randomized, double-blind, vehicle-controlled clinical studies were conducted in 560 adult subjects with moderate to severe plaque psoriasis. Subjects applied the assigned test article to all psoriatic plaques twice daily for 14 days. The key efficacy measures were the proportion of subjects with "treatment success," defined as those subjects that achieved a score of 0 (clear) or 1 (almost clear) and at least a two-grade improvement compared to baseline for the Investigator's Global Assessment (IGA) and for the clinical signs of psoriasis (plaque elevation, scaling, and erythema) as well as pruritus. Safety measurements included adverse events and local skin reactions in the treatment area. RESULTS: HBP-Foam was statistically superior to vehicle in achieving "Treatment Success" in 25.3% and 30.7% vs 3.9% and 7.4% (P<0.001) in Studies 1 and 2, respectively. Pruritus scores statistically improved by over 30% in HBP-Foam treated subjects. In addition, these subjects experienced a significant reduction in the clinical signs of psoriasis (plaque elevation, scaling, and erythema). In contrast, in the vehicle groups the decrease in psoriasis-related signs was generally not observed. Safety outcomes were unremarkable and similar in both the HBP-Foam and vehicle treatment groups. CONCLUSIONS: These results demonstrate the safety and effectiveness of HBP-Foam in the treatment of plaque psoriasis. Furthermore, this novel foam formulation has demonstrable for its ease of application over large and/or hairy treatment areas. ClinicalTrials.gov Registration: NCT02742441 NCT02368210


Assuntos
Clobetasol/análogos & derivados , Fármacos Dermatológicos/administração & dosagem , Veículos Farmacêuticos/administração & dosagem , Prurido/tratamento farmacológico , Psoríase/tratamento farmacológico , Vasoconstritores/administração & dosagem , Adulto , Idoso , Clobetasol/administração & dosagem , Clobetasol/efeitos adversos , Fármacos Dermatológicos/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Veículos Farmacêuticos/efeitos adversos , Prurido/diagnóstico , Prurido/etiologia , Psoríase/complicações , Psoríase/diagnóstico , Índice de Gravidade de Doença , Pele , Resultado do Tratamento , Vasoconstritores/efeitos adversos
18.
J Drugs Dermatol ; 18(8): 815-820, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31424713

RESUMO

BACKGROUND: Psoriasis is a chronic, immune-mediated disease that varies widely in its clinical expression. Topical corticosteroids (TCS) are the mainstay of treatment. Long-term safety remains a concern, limiting use and recurrence is common. Tazarotene has also been shown to be effective in psoriasis, with efficacy maintained several weeks posttreatment. Fixed combination therapy with TCS and tazarotene may improve psoriasis signs and maintain efficacy between treatment sessions. OBJECTIVE: To investigate the maintenance of effect posttreatment with a once-daily application of halobetasol propionate 0.01%/tazarotene 0.045% (HP/TAZ) lotion in comparison with vehicle in patients with moderate or severe plaque psoriasis. METHODS: Two multicenter, randomized, double-blind, vehicle-controlled Phase 3 studies in moderate or severe psoriasis (N=418). Patients randomized (2:1) to receive HP/TAZ lotion or vehicle, once-daily for 8 weeks with a 4 week posttreatment follow-up. Efficacy assessments included treatment success (defined as at least a 2-grade improvement from baseline in the IGA score, and 'clear' or 'almost clear'), impact on individual signs of psoriasis (erythema, plaque elevation, and scaling) at the target lesion, and maintenance of improvements in Body Surface Area (BSA), IGAxBSA and clinically meaningful benefit (IGAxBSA-75). RESULTS: At week 8, 40.7% of patients achieved treatment success with HP/TAZ lotion, compared with 9.9% treated with vehicle (P<0.001). Four weeks posttreatment, 33.3% of patients achieved treatment success. Two thirds of patients (63%) who were treatment successes at week 8 remained treatment successes posttreatment. In addition, up to 20% of patients who were not treatment successes at week 8 became treatment successes by the end of the study. Three-quarters of patients maintained BSA improvements or reported further reductions in BSA that seemed to be unrelated to baseline BSA severity. At the end of the 4 week posttreatment period, patients who had been treated with HP/TAZ lotion achieved a 46.6% reduction in IGAxBSA, compared with 7.9% on vehicle. 41.7% of patients achieved a clinically meaningful effect at week 8 and this was maintained posttreatment. LIMITATIONS: The studies only had a 4 week follow-up period. CONCLUSIONS: In conclusion, HP 0.01%/TAZ 0.045% lotion provides effective maintenance of efficacy over a 4 week posttreatment period.


Assuntos
Clobetasol/análogos & derivados , Fármacos Dermatológicos/administração & dosagem , Ácidos Nicotínicos/administração & dosagem , Psoríase/tratamento farmacológico , Creme para a Pele/administração & dosagem , Clobetasol/administração & dosagem , Clobetasol/efeitos adversos , Fármacos Dermatológicos/efeitos adversos , Método Duplo-Cego , Combinação de Medicamentos , Seguimentos , Humanos , Ácidos Nicotínicos/efeitos adversos , Psoríase/diagnóstico , Índice de Gravidade de Doença , Creme para a Pele/efeitos adversos , Resultado do Tratamento
19.
J Drugs Dermatol ; 18(8): 825-826, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31424715

RESUMO

Psoriasis is a common dermatologic condition with a variety of morphologic presentations. These variations include the less common hyperkeratotic form, psoriasis ostracea, defined as having pronounced adherent scales resembling an oyster shell. Of the ostraceous cases that have been reported in the literature, many occur as generalized outbreaks in patients with long-standing history of psoriasis. Rarely does this remarkable variant occur as a direct flare from a cutaneous insult. In these situations, when a pre-existing dermatosis appears in response to a traumatic insult to skin, the process is referred to as the Koebner phenomenon. In addition to lichen planus and vitiligo, psoriasis is a commonly known condition that can present as a Koebner reaction. In this atypical case, the authors present a 21-year-old male with remarkable ostraceous psoriatic lesions precipitated by an upper arm tattoo, demonstrating the Koebner phenomenon.


Assuntos
Psoríase/diagnóstico , Tatuagem/efeitos adversos , Biópsia , Dermatite Seborreica/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Psoríase/etiologia , Psoríase/patologia , Índice de Gravidade de Doença , Pele/patologia , Tinha/diagnóstico , Adulto Jovem
20.
J Drugs Dermatol ; 18(8): 828-830, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31424716

RESUMO

A 56-year-old Caucasian male with a history of chronic plaque psoriasis, primary sclerosing cholangitis status-post liver transplant on tacrolimus, and ulcerative colitis on infliximab developed a progressive erythematous eruption with associated fatigue, anorexia, myalgias, and arthralgias. On two separate occasions, his skin biopsy demonstrated a lichenoid interface dermatitis (LID). Despite multiple courses of oral prednisone, topical steroids, and a short course of hydroxychloroquine, his symptoms continued to relapse and remit. When a temporal association between increasing his infliximab dose and the global progression of his disease was identified, he was ultimately diagnosed with a TNF-α inhibitor-induced psoriasis flare. Despite the patient's long-standing history of psoriasis, a plausible psoriasis rebound reaction after systemic steroids was not strongly considered in light of his histopathology. Though lichenoid interface dermatitis is a commonly reported histologic finding in patients on TNF-α inhibitors, it has scarcely been reported in patients with psoriasiform eruptions clinically.


Assuntos
Erupção por Droga/diagnóstico , Infliximab/efeitos adversos , Erupções Liquenoides/diagnóstico , Psoríase/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Biópsia , Diagnóstico Diferencial , Erupção por Droga/etiologia , Erupção por Droga/patologia , Humanos , Erupções Liquenoides/patologia , Masculino , Pessoa de Meia-Idade , Psoríase/diagnóstico , Pele/efeitos dos fármacos , Pele/patologia , Exacerbação dos Sintomas
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