[|In this chapter it is
easy to disagreement by saying “yes, however…”. I think the various aspects
have been taken care of very well. But what we all miss is an overall score,
which comprises everything. Therefore, we need well-trained dermatologists for
professional decisions. I will explain what may happen if we assess disease
severity exclusively with nice scores as described in chapter 9. A patient with chronic
plaque psoriasis, PASI 7 visits the dermatologist. She has an alarming DLQI and
feels very depressed. Her psychiatrist considers adequate antidepressive
medication which is refused by the patient. As she could not stand photo
chemotherapy and none of the systemic treatments she now urges a biological
treatment. The resident was of the opinion that a biological treatment was
entirely justifiable. My view was entirely different. The patient did not need
a biological but an antidepressive drug.|auteur197]
[|This is an exceptionally well-done chapter, very broad in concept and discussion. The various outcome measures in psoriasis are well-discussed. The only addition that I would like to have seen would be a discussion on how dermatologists in clinical practice, ie non-academic centers, can assess these outcome measures in a rapid and informative way as measure such as SF36, PASI are seldom, if ever, done on a routine basis outside of clinical research or academic institutions. Is there a place for a new outcome measure that mirrors the ACR measure which uses quality of life, clinical evaluations, and even serological evaluations in one easily understood measurement? In this regard, Professor Jim Krueger will be hosting an International Psoriasis Council based Roundtable in February, 2006 with a new 4 part tool encompassing physical evaluation, quality of life, psoriatic arthritis and patient satisfaction undergoing clinical trial validations.. Two further outcome measures which have gained credibility in the United States are the PQOL (Psoriasis Quality of Life) developed by Professor John Koo from San Francisco, which has been validated in a large study with Drs. Lebwohl and Menter with over 400 patients, with concomitant clinical evaluation. From this PQOL, the Koo-Menter Psoriasis Index (KMPI) has been developed, a two-page index utilizing a series of patient-based 12 quality of life questions, and key questions relating to arthritic manifestations. This is then utilized to do a rapid body surface area evaluation after which key questions relating to access to phototherapy, etc., are discussed, with a final evaluation relating to patient applicability for systemic therapy, Yes or No. It is only by dermatologists and rheumatologists creating “easy to use” evaluations that psoriasis will finally be accepted as a systemic disease worthy of systemic treatment in those patients with moderate to severe disease, with or without associated psoriatic joint disease. This begs the question: What do we mean by mild, moderate, and severe psoriasis and how do quality of life issues relate to these artificial divisions? Thus, would somebody with palmar-plantar disease involving less than 5% BSA, with difficulties in ambulation and manual dexterity, not deserve systemic therapy as much as a patient with mild-moderate Crohn’s disease or mild-moderate rheumatoid arthritis? Again, a quality of life tool for palmar-plantar disease has been developed by our group and submitted for publication. Certainly, I would believe that such psoriatic patients have more disabling disease than the aforementioned conditions.|auteur215]
In life-threatening illnesses, it is the doctor who, with the help of scientifically validated clinical and biological markers, assesses the severity of the illness and, on the basis of this assessment, suggests the treatment with the best benefit/risk ratio.
In illnesses involving the quality of life—of which psoriasis is the prototype—only the patient can assess the illness’s repercussions on his or her quality of life, and hence its severity.
This severity, if any, justifies suggesting systemic treatments.
There is consensus or agreement between European psoriasis specialists to accept Professor Christopher Griffiths’ suggestion of assessing the severity of psoriasis by taking into consideration, in decreasing order of importance:
- the effect on the quality of life,
- the resistance of psoriasis to various treatments,
- the extent of the lesions.
- 2019/08/12 Focus on...Latin American Clinical Practice Guidelines on the Systemic Treatment of Psoriasis
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News from medical groups
- 2018/04/183rd Turkish National Psoriasis Symposium
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- 2017/06/21Costa Rica Psoriasis Group - Meet them!
- 2017/02/02Works of the 1st Senegalese Psoriasis Day published!
- 2016/07/29Swiss S1 Guidelines for Systemic treatment of psoriasis vulgaris
News from patients associations
- 2017/02/08France Psoriasis - 2016 World Psoriasis Day
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- 2015/08/04Epidermia Greece: a new partner association of PIN
- 2015/08/01Canadian Association of Psoriasis Patients joins PIN!
- 2015/04/09AEPSO Argentina launches digital map to find people with psoriasis in the country
Recent publications on Psoriasis and Atopic Dermatitis
JAK-inhibitors in dermatology: current evidence and future applications.
J Dermatolog Treat. 2019 Nov , 30, (7):648-658.
The Janus kinase (JAK) and signal transducer and activator of transcription (STAT) pathway is a ubiquitous intracellular signaling network. Selective JAK-inhibitors have anti-inflammatory properties and have been approved in many countries for the treatment of rheumatoid arthritis (tofacitinib, baricitinib) and myelofibrosis or polycythemia vera (ruxolitinib). The aim of the publication was to summarize and critically analyze the efficacy and safety of JAK-inhibitors in skin diseases, such (...)see on pubmed
Patient preferences for attributes of topical anti-psoriatic medicines.
J Dermatolog Treat. 2019 Nov , 30, (7):659-663.
Patient preferences should be considered when prescribing topical treatments to drive up adherence and improve clinical outcomes. The aim of this work was to identify the most important attributes of topical medicines for psoriasis treatment in the patients' view, and explore the sociodemographic and clinical determinants of these preferences. A questionnaire for the evaluation of the relevancy given to specific attributes of topical medicines used for psoriasis treatment was developed (...)see on pubmed
Salidroside inhibits MAPK, NF-κB, and STAT3 pathways in psoriasis-associated oxidative stress via SIRT1 activation.
Redox Rep.. 2019 Dec , 24, (1):70-74.
To unveil the role of SIRT1 in limiting oxidative stress in psoriasis and to further discuss the therapeutic prospects of salidroside in psoriasis. Literature from 2002 to 2019 was searched with "psoriasis", "oxidative stress", "SIRT1", "salidroside" as the key words. Then, Oxidative stress in psoriasis and the role of SIRT1 were summarized and the potential role of salidroside in the disease was speculated. Oxidative stress might contribute to the pathogenesis of psoriasis. High levels (...)see on pubmed
A case of infective endocarditis associated with atopic dermatitis perioperatively treated with dupilumab.
J Dermatolog Treat. 2019 Nov , 30, (7):674-676.
Several case reports and reviews support a relationship between atopic dermatitis (AD) and infective endocarditis (IE). Here, we present a case of severe AD suspected of causing IE. A 21-year-old man with severe AD was admitted to our hospital due to unidentified fever, syncope, and headache. He was diagnosed with IE with cerebral embolism and mitral regurgitation. Before elective cardiac surgery, he was subcutaneously administered dupilumab for 2 months to control AD. Dupilumab improved (...)see on pubmed
Effect of cinnamamides on atopic dermatitis through regulation of IL-4 in CD4 cells.
J Enzyme Inhib Med Chem. 2019 Dec , 34, (1):613-619.
This study aimed to evaluate the effects of cinnamamides on atopic dermatitis (AD) and the mechanisms underlying these effects. To this end, the actions of two cinnamamides, (E)-3-(4-hydroxyphenyl)-N-phenylethyl acrylamide (NCT) and N-trans-coumaroyltyramine (NCPA), were determined on AD by orally administering them to mice. Oral administration of the cinnamamides ameliorated the increase in epidermal and dermal thickness as well as mast cell infiltration. Cinnamamides suppressed serum (...)see on pubmed
Sublingual immunotherapy of atopic dermatitis in mite-sensitized patients: a multi-centre, randomized, double-blind, placebo-controlled study.
Artif Cells Nanomed Biotechnol. 2019 Dec , 47, (1):3540-3547.
Allergen-specific immunotherapy is widely used for allergic rhinitis and asthma treatment worldwide. This study explored the efficacy and safety of sublingual immunotherapy (SLIT) with the extracts of ( Drops) on house dust mites (HDM)-induced atopic dermatitis (AD). 239 patients with HDM-induced AD were recruited and exposure to a multi-centre, randomized, double-blind, and placebo-controlled clinical trials for 36 weeks, which were randomly divided into placebo and sublingual Drops (...)see on pubmed