psoriasis
Jump to navigation
Jump to search
[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53]
Classification
- psoriasis vulgaris* (plaque psoriasis) most common
- inverse psoriasis*
- Guttate psoriasis*
- erythrodermic psoriasis* (exfoliative psoriasis) 3%
- pustular psoriasis*
- sebopsoriasis
- nail psoriasis
* 5 psoriasis subtypes in[34]
Etiology
- unknown
- cold weather exacerbates, incidence higher in colder climates
- hot weather & sunlight improve symptoms
- stress & anxiety exacerbate psoriasis
- trauma to the skin may lead to development of psoriasis in the affected area
- pharmaceutical agents may exacerbate psoriasis:
- infections can cause the onset or a flare of psoriasis
- Streptococcal infection (see guttate psoriasis)
- especially children & adolescents
- thought to be related to circulating factors
- pharyngitis & tonsillitis
- cellulitis
- HIV1 infection (new onset)
- abrupt onset of psoriasis[3]
- lesions psoriasis often resolve with increasing severity of immunodeficiency
- Streptococcal infection (see guttate psoriasis)
Epidemiology
- 1%-2% of population is affected
- 2.2-3.15% in the U.S.
- 1.3-2.6% in the U.K.[22]
- males & females affected equally
- prevalence in U.S. is 3.2% in women & 2.8% in men[47]
- onset at any age, but 20's most common
Pathology
- generalized or localized pustular psoriasis, active stage
- spongiform pustules of Kogoj are larger & are characteristic lesion
- KRT17 may act as an autoantigen
- granulocytes &/or monocytes play a major role[23]
- neutrophils & monocytes aggravate & prolong psoriasis by releasing TNF-alpha[23]
Microscopic pathology
- psoriasis vulgaris, fully developed lesion
- acanthosis with regular elongation of rete ridges which become club shaped
- suprabasal mitotic figures
- thinning of suprapapillary epidermis with occasional presence of small spongiform pustules
- pallor of upper layers of epidermis
- diminished to absent granular layer
- confluent parakeratosis
- Munro microabscesses* (collections of neutrophils in parakeratotic layer, found easily in earlier lesions, less so in long standing lesions)
- spongiform pustules* of Kogoj (collections of neutrophils in spiny & granular layers, small, seen only in early or active stages)
- elongation and edema of dermal papillae
- mild inflammatory infiltrate in papillary & upper dermis, mostly lymphocytes
- dilated tortuous capillaries
* spongiform pustules of Kogoj and Munro microabscesses seen for diagnostic certainty) Mole=
Genetics
- inhibition of RARRES2 expression
- role for epidermal T-cell integrin alpha-1/beta-1, receptor for basement membrane collagen-4[7]
- overexpression of cornifelin, kallikrein-8
- coexpression of KRT16 & KRT17
- familial clusterings of psoriasis
- defects in IL36RN are the cause of generalized pustular psoriasis[20]
- susceptibility associated with HLA class 1 alpha Cw6
- susceptibility associated with increased beta-defensin genomic copy number within beta-defensin gene cluster
- susceptibility associated with deletion of the late cornified envelope LCE3B & LCE3C genes
- susceptibility associated with polymorphisms in IL12B
- mutations or gene deletions of junB[5]
- high levels of ADAM17 expressed in the psoriasis, thus may olay a role in pathogenesis of psoriasis[49]
- low levels of ADAM10 in psoriasis may be attributable to its regulatory role in keratinocyte differentiation and proliferation
- other implicated genes[49] S100A7A, PLA2G4D, BPIL2, FNDC1, PSORS1C1, PSORS1C2, KPRP, RDHE2, SLC12A8, SLURP2, PSORS1C3, MICA, CASP14, IL20RA, IL20RB, S100A7, FABP5
Clinical manifestations
- symptoms:
- cosmetic
- scaling
- pruritus
- discomfort or pain
- heat loss
- arthralgia
- signs:
- skin lesions
- erythema
- silvery micaceous scales
- plaques with:
- well-differentiated borders
- symmetric distribution
- Auspitz sign: removal of a plaque will result in a small amount of bleeding
- papulosquamous pustules
- may appear anywhere on the body
- extensor surfaces (elbows, knees), scalp, ears, intertriginous folds, genitals, nails
- nails
- nail-pitting, thickening
- onycholysis (separation of nail plate from nail bed)
- light brown discoloration of the nails (oil spots)
- may be only manifestation of psoriasis[3]
- joints (also see psoriatic arthritis)
- generally occurs after skin involvement, but may precede it
- most often involves distal interphalangeal joints
- usually asymmetric oligoarthritis
- sacroiliitis
- spondylitis
- joint involvement occurs in 10-25% of patients with psoriasis
- extent of skin disease does NOT correlate with severity of arthritis
- skin lesions
- generalized pustular psoriasis
- life-threatening disease
Laboratory
- skin biopsy
- suspected generalized pustular psoriasis
- complete blood count (CBC): marked leukocytosis
- serum C-reactive protein is elevated
- flow cytometry (investigational)
- circulating Th17 cells, Th22 cells, & Th1 cells are increased[32]
Complications
- pustular psoriasis: life threatening variant associated with glucocorticoid or cyclosporine withdrawal[3]
- erythrodermic psoriasis: life-threatening exfoliative dermatitis associated with glucocorticoid or cyclosporine withdrawal[3]
- increased risk of several associated systemic diseases:
- osteoporosis in men[10]
- metabolic syndrome[12]
- coronary artery disease & myocardial infarction[13]
- 10-fold increased risk of dilated cardiomyopathy[41]
- hypercholesterolemia (69%)[37]
- hypertension (47%)[11]
- diabetes mellitus type 2 (10%)[11][37]
- lymphoma[14]
- increase risk of cancer[16][46] (18% overall)
- lymphoid neoplasms RR=1.8
- pancreatic cancer RR=1.4
- oral cancer RR~3[46]
- esophageal cancer RR~2
- squamous cell carcinoma RR~2
- liver cancer RR=1.8
- laryngeal cancer RR=1.8
- bladder cancer[46]
- increased risk of chronic renal failure[25]
- cardiovascular disease is the most common cause of death in patients with severe psoriasis[3]
- hyperuricemia & gout are comorbidities associated with psoriasis[3]
- cognitive impairment [50'
- disease interaction(s) of heart failure with psoriatic disease
- disease interaction(s) of hepatitis C infection with psoriasis
- disease interaction(s) of HIV1 infection with psoriasis
- disease interaction(s) of erectile dysfunction (ED) with psoriasis
- disease interaction(s) of psoriasis with Alzheimer's disease
Differential diagnosis
- eczema
- tinea
- candidiasis
- drug eruptions
- syphilis
- seborrhea
- Paget's disease
- Bowen's disease
- mycosis fungoides
- lichen planus
Management
topical therapy: usually adequate
- topical glucocorticoids for localized disease
- first line therapy
- use less potent topical glucocorticoids first, especially in areas of occlusion or in skin folds[36]
- occlusive dressing with or without topical steroids (Topiclude)
- emollients
- coal tar
- anthralin
- calcipotriene (Dovonex) vitamin D analog
- calcipotriene/betamethsone (Dovobet)[21]
- calcineurin inhibitors
- tacrolimus (Protopic) or pimecrolimus (Elidel)[21]
- tazarotene (Tarozac) gel 0.05%[21]
phototherapy
- reserve for involvement of > 10% of body surface or unresponsive to topical therapy[3]
- recommended for Guttate psoriasis & chronic plaque psoriasis
- narrow band UV-B has become standard for phototherapy[3]
- home narrow band UV-B units for use without oral photosensitizer are almost as effective as PUVA[15]
- UV-B light used in conjunction with tar or anthralin
- add to topical glucocorticoid in pregnant women with worsening psoriasis not responding to topical glucocorticoid alone[52]
- PUVA (oral psoralen & UV-A light)
- increased risk of squamous cell carcinoma of the skin with PUVA
- excimer laser vs pulsed-dye laser[6]
- sunlight often leads to improvement of psoriasis
systemic therapy
- reserve for involvement of > 10% of body surface or unresponsive to topical therapy[3]
- methotrexate: especially psoriatic arthritis
- etretinate:
- may be used in conjunction with PUVA
- contraindicated in women who may bear children
- acitretin[3]
- cyclosporine[3]
- hydroxyurea may deplete leukocytes[23]
- glitazones (rosiglitazone & pioglitazone) off-label use[4]
- etanercept (Enbrel) safe & effective[18]
- adalimumab (Humira) safe & effective[18]
- infliximab (Remicade) for severe refractory psoriasis[9]
- IL-23 inhibitors
- ustekinumab (Stelara) IL-12 & IL-23 inhibitor for severe refractory psoriasis; (first line)[39]
- risankizumab IL-23 inhibitor
- associated with better clinical responses than with ustekinumab[38]
- >50% achieve clear skin in 1 year[43]
- guselkumab (Tremfya) IL-23 inhibitor FDA approved
- tildrakizumab-asmn[48]
- IL17 inhibitors
- brodalumab, an IL17A receptor monoclonal antibody (investigational) appears to be effective[19]
- ixekizumab (Taltz) an IL17 monoclonal antibody
- appears to be effective[19]
- more effective at 12 weeks than ustekinumab[40]
- caution with inflammatory bowel disease[39]
- secukinumab (Cosentyx) an IL17A monoclonal antibody
- caution with inflammatory bowel disease[39]
- bimekizumab, an IL17A & IL17F inhibitor (investigational) effective in phase 2 study[42]
- deucravacitinib (Sotyktu) FDA-approved for treatment of moderate to severe plaque psoriasis
- tazarotene activates RARRES2 in psoriatic lesions
- apremilast (Otezla) not recommended (NICE)
systemic therapy to avoid
- do NOT use systemic glucocorticoids[3]
- rebound worsening upon withdrawal
- possible conversion to pustular form with glucocorticoid withdrawal
- psoriasis exacerbated by lithium carbonate, antimalarials, tetracyclines, beta-blockers, NSAIDs & ACE inhibitors
other considerations
- adsorptive granulocyte & monocyte apheresis is effective[23]
- dietary measures to achieve weight reduction result in improvement of psoriasis & quality of life[31]
- smoking cessation, smoking worsens psoriasis[3]
- screening for cardiovascular disease[37]
- cardiovascular disease common among patients with psoriasis[3]
- reclassification of 1 in 3 patients with psoriasis to high cardiovascular risk[37]
- referrals
- generalized erythema & scaling involving most of the body (erythroderma) requires immediate referral to a dermatologist[3]
Notes
- patient dissatisfaction with treatment common[24]
More general terms
More specific terms
- erythrodermic psoriasis; exfoliative psoriasis
- inverse psoriasis
- nail psoriasis
- plaque psoriasis
- psoriasis vulgaris, Guttate-type
- psoriatic arthritis
- pustular psoriasis; impetigo herpetiformis, von Zumbusch's disease; acrodermatitis continua of Hallopeau
- rupioid psoriasis
- sebopsoriasis
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 947-48
- ↑ Color Atlas and Synopsis of Clinical Dermatology, Common and Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY, 1997, pg 82-83
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 3.15 3.16 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015, 2018, 2022.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 4.0 4.1 Prescriber's Letter 11(8):41 2004 Avandia and Actos for Psoriasis Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200802&pb=PRL
- ↑ 5.0 5.1 Zenz R et al. Psoriasis-like skin disease and arthritis caused by inducible epidermal deletion of Jun proteins. Nature 2005 Sep 15; 437:369-75. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/16163348 (subscription needed) <Internet> http://www.prescribersletter.com
- ↑ 6.0 6.1 Taibjee SM et al, Controlled study of excimer and pulsed dye lasers in treatment of psoriasis Br J Dermatol 2005; 153:960 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16225606
- ↑ 7.0 7.1 Conrad C, Boyman O, Tonel G, Tun-Kyi A, Laggner U, de Fougerolles A, Kotelianski V, Gardner H, Nestle FO. alpha(1)beta(1) integrin is crucial for accumulation of epidermal T cells and the development of psoriasis. Nat Med. 2007 Jul;13(7):836-42. Epub 2007 Jul 1. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17603494
- ↑ Menter A et al, Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol 2008 May;58(5):826-50 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18423260
- ↑ 9.0 9.1 Nair RP et al Genome-wide scan reveals association of psoriasis with IL-23 and NF-B pathways. Nat Genet 2009 Feb; 41:199. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19169254
Zhang X-J et al Psoriasis genome-wide association study identifies susceptibility variants within LCE gene cluster at 1q21. Nat Genet 2009 Feb; 41:205. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19169255
de Cid R et al Deletion of the late cornified envelope LCE3B and LCE3C genes as a susceptibility factor for psoriasis. Nat Genet 2009 Feb; 41:211. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19169253 - ↑ 10.0 10.1 Dreiher J et al. Psoriasis and osteoporosis: A sex-specific association? J Invest Dermatol 2009 Jan 22 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19158845 <Internet> http://dx.doi.org/10.1038/jid.2008.432
- ↑ 11.0 11.1 11.2 Qureshi AA et al Psoriasis and the risk of diabetes and hypertension: A prospective study of US female nurses. Arch Dermatol 2009 Apr; 145:379. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19380659
- ↑ 12.0 12.1 Gisondi P et al. Prevalence of metabolic syndrome in patients with psoriasis: A hospital-based case-control study. Br J Dermatol 2007 Jul; 157:68-73. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17553036
- ↑ 13.0 13.1 Gelfand JM et al Risk of myocardial infarction in patients with psoriasis. JAMA 2006 Oct 11; 296:1735-41. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17032986
Rapaport L Psoriasis Patients Face Increased Risk of Heart Attacks and Death Medscape - Sep 28, 2017. http://www.medscape.com/viewarticle/886308 - ↑ 14.0 14.1 Gelfand JM et al The risk of lymphoma in patients with psoriasis. J Invest Dermatol 2006 Oct; 126:2194-201. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16741509
- ↑ 15.0 15.1 Koek MBG et al Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis: Pragmatic multicentre randomised controlled non-inferiority trial (PLUTO study). BMJ 2009 May 7; 338:b1542. http://dx.doi.org/10.1136/bmj.b1542
Anstey A Home UVB phototherapy for psoriasis. BMJ 2009 May 7; 338:b607. http://dx.doi.org/10.1136/bmj.b607 - ↑ 16.0 16.1 Brauchli YB et al. Psoriasis and risk of incident cancer: An inception cohort study with nested case-control analysis. J Invest Dermatol 2009 Nov; 129:2604. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19440219
- ↑ Menter A et al Guidelines of care for the management of psoriasis and psoriatic arthritis Section 5. Guidelines of care for the treatment of psoriasis with phototherapy and photochemotherapy American Academy of Dermatology http://www.guideline.gov/Compare/comparison.aspx?file=COPD_Pulmonary_Rehab4.inc
- ↑ 18.0 18.1 18.2 van Lumig PPM et al Relevance of laboratory investigations in monitoring patients with psoriasis on etanercept or adalimumab. Br J Dermatol 2011 Mar 24 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21428975 <Internet> http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2133.2011.10329.x/abstract;jsessionid=A6466AB81A3BD26BF82E78A14E9B7D68.d01t03
- ↑ 19.0 19.1 19.2 Papp KA et al. Brodalumab, an anti-interleukin-17-receptor antibody for psoriasis. N Engl J Med 2012 Mar 29; 366:1181. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22455412
Leonardi C et al. Anti-interleukin-17 monoclonal antibody ixekizumab in chronic plaque psoriasis. N Engl J Med 2012 Mar 29; 366:1190. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22455413 - ↑ 20.0 20.1 OMIM https://mirror.omim.org/entry/614204
- ↑ 21.0 21.1 21.2 21.3 Prescriber's Letter 19(9): 2012 Comparison of Topical Psoriasis Treatments Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=280908&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 22.0 22.1 Parisi R et al. Global epidemiology of psoriasis: A systemic review of incidence and prevalence. J Invest Dermatol 2012 Sep 27 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23014338
- ↑ 23.0 23.1 23.2 23.3 23.4 Journal Watch. Feb 12 2013 Massachusetts Medical Society http:www.jwatch.org
Ikeda S et al. Therapeutic depletion of myeloid lineage leukocytes in patients with generalized pustular psoriasis indicates a major role for neutrophils in the pathogenesis of psoriasis. J Am Acad Dermatol 2013 Jan 17 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23332516 <Internet> http://www.jaad.org/article/S0190-9622(12)01042-0/abstract - ↑ 24.0 24.1 Armstrong AW et al Undertreatment, Treatment Trends, and Treatment Dissatisfaction Among Patients With Psoriasis and Psoriatic Arthritis in the United States. Findings From the National Psoriasis Foundation Surveys, 2003-2011 JAMA Dermatol. August 14, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23945732 <Internet> http://archderm.jamanetwork.com/article.aspx?articleid=1729130
- ↑ 25.0 25.1 Wan J et al Risk of moderate to advanced kidney disease in patients with psoriasis: population based cohort study. BMJ 2013;347:f5961 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24129480 <Internet> http://www.bmj.com/content/347/bmj.f5961
- ↑ Savary J, Ortonne JP, Aractingi S. The right dose in the right place: an overview of current prescription, instruction and application modalities for topical psoriasis treatments. J Eur Acad Dermatol Venereol. 2005 Nov;19 Suppl 3:14-7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16274407
- ↑ Pardasani AG, Feldman SR, Clark AR. Treatment of psoriasis: an algorithm-based approach for primary care physicians. Am Fam Physician. 2000 Feb 1;61(3):725-33, 736. PMID: https://www.ncbi.nlm.nih.gov/pubmed/10695585
- ↑ Jiaravuthisan MM, Sasseville D, Vender RB, Murphy F, Muhn CY. Psoriasis of the nail: anatomy, pathology, clinical presentation, and a review of the literature on therapy. J Am Acad Dermatol. 2007 Jul;57(1):1-27. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17572277
- ↑ Nestle FO1, Kaplan DH, Barker J. Psoriasis. N Engl J Med. 2009 Jul 30;361(5):496-509 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19641206
- ↑ Huerta C, Rivero E, Rodriguez LA Incidence and risk factors for psoriasis in the general population. Arch Dermatol. 2007 Dec;143(12):1559-65. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18087008
- ↑ 31.0 31.1 Jensen P, Zachariae C, Christensen R et al Effect of weight loss on the severity of psoriasis: a randomized clinical study. JAMA Dermatol. 2013 Jul;149(7):795-801 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23752669
- ↑ 32.0 32.1 Kagami S, Rizzo HL, Lee JJ, Koguchi Y, Blauvelt A. Circulating Th17, Th22, and Th1 cells are increased in psoriasis. J Invest Dermatol. 2010 May;130(5):1373-83 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20032993
- ↑ 33.0 33.1 DermNet NZ. Psoriasis (images) http://www.dermnetnz.org/scaly/psoriasis.html
- ↑ 34.0 34.1 34.2 Meffert J, James WD (images) Medscape: Psoriasis http://emedicine.medscape.com/article/1943419-overview
Psoriasis: Manifestations, Management Options, and Mimics Medscape. Dec 17, 2015 http://reference.medscape.com/features/slideshow/psoriasis-subtypes - ↑ Potts GA, Hurley MY. Psoriasis in the geriatric population. Clin Geriatr Med. 2013 May;29(2):373-95. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23571034
- ↑ 36.0 36.1 Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - ↑ 37.0 37.1 37.2 37.3 37.4 Rutter MK, Kane K, Lunt M et al Primary care-based screening for cardiovascular risk factors in patients with psoriasis. Br J Dermatol. 2016 Aug;175(2):348-56. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26990294
- ↑ 38.0 38.1 Papp KA, Blauvelt A, Bukhalo A et al Risankizumab versus Ustekinumab for Moderate-to-Severe Plaque Psoriasis. N Engl J Med 2017; 376:1551-1560. April 20, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28423301 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1607017
- ↑ 39.0 39.1 39.2 39.3 Anello J, Feinberg B, Heinegg J et. al. New Guidelines and Recommendations, October 2017 Medscape - Oct 06, 2017. http://reference.medscape.com/viewarticle/886616_16
- ↑ 40.0 40.1 McNamara D Head-to-Head Results Compare Biologics for Psoriasis Medscape - Oct 05, 2016. Coverage from the 25th European Academy of Dermatology and Venereology (EADV) Congress. https://www.medscape.com/viewarticle/869842
- ↑ 41.0 41.1 Hashim T, Ahmad A, Chaudry A, Khouzam R. Psoriasis and Cardiomyopathy: A Review of the Literature. South Med J. 2017;110(2):97-100. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28158878 https://www.medscape.com/viewarticle/876186
- ↑ 42.0 42.1 Bassett M Psoriasis Falls to Novel Biologic Bimekizumab brings clear or almost clear skin to vast majority of patients in phase II trial. MedPage Today. February 19, 2018 https://www.medpagetoday.com/meetingcoverage/aad/71243
Papp K, et al Dual neutralization of interleukin (IL)-17A and IL-17F with bimekizumab in moderate-to-severe psoriasis: Results from a phase 2b, randomized, double-blinded, placebo-controlled, dose-ranging study. American Academy of Dermatology (AAD) 2018 - ↑ 43.0 43.1 Bassett M Risankizumab Resolves Psoriasis in Half of Patients. Superior to ustekinumab for many endpoints in two RCTs. MedPage Today. February 19, 2018 https://www.medpagetoday.com/meetingcoverage/aad/71238?
Gordon K et al Efficacy and safety of risankizumab: Results from two double- blind, placebo- and ustekinumab-controlled, phase 3 trials in moderate-to-severe plaque psoriasis. American Academy of Dermatology (AAD) 2018 - ↑ Elyoussfi S, Thomas BJ, Ciurtin C. Tailored treatment options for patients with psoriatic arthritis and psoriasis: review of established and new biologic and small molecule therapies. Rheumatol Int. 2016 May;36(5):603-12. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26892034 Free PMC Article
- ↑ Mansouri Y, Goldenberg G. New systemic therapies for psoriasis. Cutis. 2015 Mar;95(3):155-60. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25844781
- ↑ 46.0 46.1 46.2 46.3 Voelker R Study Clarifies Cancer Risk Among People With Psoriasis. JAMA. Published online November 27, 2019. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31774450 https://jamanetwork.com/journals/jama/fullarticle/2756957
- ↑ 47.0 47.1 Armstrong AW, Mehta MD, Schupp CW et al Psoriasis Prevalence in Adults in the United States. JAMA Dermatol. 2021;157(8):940-946. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34190957 PMCID: PMC8246333 (available on 2022-06-30) https://jamanetwork.com/journals/jamadermatology/fullarticle/2781378
- ↑ 48.0 48.1 Thaci D, Piaserico S, Warren RB et al Five-year efficacy and safety of tildrakizumab in patients with moderate-to-severe psoriasis who respond at week 28: pooled analyses of two randomized phase III clinical trials (reSURFACE 1 and reSURFACE 2). Br J Dermatol. 2021 Aug;185(2):323-334 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33544883 Clinical Trial.
Lebwohl MG, Leonardi CL, Mehta NN et al Tildrakizumab efficacy, drug survival, and safety are comparable in patients with psoriasis with and without metabolic syndrome: Long-term results from 2 phase 3 randomized controlled studies (reSURFACE 1 and reSURFACE 2). J Am Acad Dermatol. 2021 Feb;84(2):398-407. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32961255 Free article - ↑ 49.0 49.1 49.2 Gul C, Kilic S, Sehitoglu MH. The importance of ADAM10 and ADAM17 metalloproteinases in the pathogenesis of psoriasis. Clin Exp Dermatol. 2022. April 26 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35474465
- ↑ Garlewicz J Cutaneous T-Cell Lymphoma and Psoriasis Associated With Memory Impairment. The Dermatologist. Aug 8, 2022 https://www.hmpgloballearningnetwork.com/site/thederm/news/cutaneous-t-cell-lymphoma-and-psoriasis-associated-memory-impairment
Damiani G, Tacastacas JD, Wuerz T et al. Cognition/psychological burden and resilience in cutaneous T-cell lymphoma and psoriasis patients: real-life data and implications for the treatment. Biomed Res Int. Published online July 21, 2022 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35937394 PMCID: PMC9348939 Free PMC article - ↑ Lebwohl M. Psoriasis. Ann Intern Med. 2018;168:ITC49-ITC64. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29610923
- ↑ 52.0 52.1 NEJM Knowledge+
Murase JE, Heller MM, Butler DC. Safety of dermatologic medications in pregnancy and lactation: Part I. Pregnancy. J Am Acad Dermatol. 2014 Mar;70(3):401.e1-14; PMID: https://www.ncbi.nlm.nih.gov/pubmed/24528911 Review. - ↑ National Institute of Arthritis and Muscluloskeletal and Skin Diseases (NIAMS) Psoriasis https://www.niams.nih.gov/health-topics/psoriasis