Consensus guidelines for the management of plaque psoriasis.

The Canadian Guidelines for the Management of Plaque Psoriasis were reviewed by the entire National Psoriasis Foundation Medical Board and updated to include newly approved agents such as ustekinumab and to reflect practice patterns in the United States, where the excimer laser is approved for psoriasis treatment. Management of psoriasis in special populations is discussed. In the updated guidelines, we include sections on children, pregnant patients or pregnant partners of patients, nursing mothers, the elderly, patients with hepatitis B or C virus infections, human immunodeficiency virus-infected patients, and patients with malignant neoplasms, as well as sections on tumor necrosis factor blockers, elective surgery, and vaccinations.

Prevalence of metabolic syndrome in patients with psoriasis: a population-based study in the United Kingdom.

Increasing epidemiological evidence suggests independent associations between psoriasis and cardiovascular and metabolic disease. Our objective was to test the hypothesis that directly assessed psoriasis severity relates to the prevalence of metabolic syndrome and its components. A population-based, cross-sectional study was undertaken using computerized medical records from the Health Improvement Network Study population including individuals in the age group of 45-65 years with psoriasis and practice-matched controls.

Synergistic enhancement of cellular immune responses by the novel Toll receptor 7/8 agonist 3M-007 and interferon-γ: implications for therapy of cutaneous T-cell lymphoma.

Cutaneous T-cell lymphoma (CTCL) is responsive at all stages to immunotherapy. We determined whether a novel agonist for Toll-like receptor (TLR) 7/8 (3M-007) combined with either interferon-γ (IFN-γ) or interleukin-15 (IL-15) would enhance patients' immune responses in vitro. Our data demonstrate that IFN-γ or IL-15 in combination with 007 significantly increases patients' natural killer (NK) cytolytic activity against CTCL tumor cell lines and synergistically induces dendritic cell cytokines, compared to 007 alone.

Dermatologist preferences for first-line therapy of moderate to severe psoriasis in healthy adult patients.

Background: Despite increasing therapies for moderate to severe psoriasis, dermatologists' treatment preferences are unknown.

Objective: We sought to assess dermatologists' preferences for first-line treatments and their selection determinants.

Methods: We surveyed 1000 US dermatologists (500 National Psoriasis Foundation and 500 American Academy of Dermatology members who treat psoriasis) about their preferences for first-line treatment of moderate to severe psoriasis in healthy adults of childbearing age using standardized patient vignettes.

High clinical response rate of Sezary syndrome to immunomodulatory therapies: prognostic markers of response.

Objectives: To quantify response rates of Sézary syndrome (SS) to multimodality immunomodulatory therapy and to identify the important prognostic parameters that affect overall response to treatment.

Design: Retrospective cohort study.

Setting: Cutaneous T-cell lymphoma clinic at The Hospital at the University of Pennsylvania.

Attributable risk estimate of severe psoriasis on major cardiovascular events.

Background: Recent studies suggest that psoriasis, particularly if severe, may be a risk factor for major adverse cardiac events, such as myocardial infarction, stroke, and mortality from cardiovascular disease. We compared the risk of major adverse cardiac events between patients with psoriasis and the general population and estimated the attributable risk of severe psoriasis.

Methods: We performed a cohort study in the General Practice Research Database.

Systemic and vascular inflammation in patients with moderate to severe psoriasis as measured by [18F]-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT): a pilot study.

Objective: To evaluate the feasibility of using [18F]-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT) to detect and quantify systemic inflammation in patients with psoriasis.

Design: Case series with a nested case-control study.

Setting: Referral dermatology and preventive cardiology practices.

Psoriasis and cardiovascular risk: strength in numbers, part II.

The Psoralen plus Ultraviolet-A (PUVA) cohort study has been a tremendous success in determining how a novel treatment (i.e., PUVA) affects the long-term risk of keratinocyte carcinoma.

The risk of infection and malignancy with tumor necrosis factor antagonists in adults with psoriatic disease: a systematic review and meta-analysis of randomized controlled trials.

Background: There is a need to better understand the safety of tumor necrosis factor (TNF) inhibitors in patients with psoriatic disease in whom TNF inhibitors are frequently used as monotherapy.

Objective: We sought to examine the risks of infection and malignancy with the use of TNF antagonists in adult patients with psoriatic disease.

Methods: We conducted a systematic search for trials of TNF antagonists for adults with plaque psoriasis and psoriatic arthritis.

Guidelines of care for the management of psoriasis and psoriatic arthritis: section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions.

Psoriasis is a common, chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In the first 5 parts of the American Academy of Dermatology Psoriasis Guidelines of Care, we have presented evidence supporting the use of topical treatments, phototherapy, traditional systemic agents, and biological therapies for patients with psoriasis and psoriatic arthritis. In this sixth and final section of the Psoriasis Guidelines of Care, we will present cases to illustrate how to practically use these guidelines in specific clinical scenarios.

Prevalence of the metabolic syndrome in psoriasis: results from the National Health and Nutrition Examination Survey, 2003-2006.

Objectives: To estimate the prevalence of the metabolic syndrome among individuals with psoriasis and to examine the association between these 2 conditions in the general US population.

Design: Cross-sectional health survey of a nationally representative random sample of the noninstitutionalized civilian US population.

Setting: The National Health and Nutrition Examination Survey, 2003-2006.

Seeing red: flushing out instigators of niacin-associated skin toxicity.

The use of niacin to improve plasma lipid levels and reduce risk of myocardial infarction is limited by noxious skin effects that result from stimulation of G protein-coupled receptor 109A (GPR109A) in skin immune cells. Niacin causes vasodilation, manifest as rubor (redness) of the head and neck, providing a visible sign associated with other, more bothersome skin complaints. The working theory is that niacin provokes Langerhans cells to produce prostaglandin D2 (PGD2), stimulating vascular DP1 receptors to cause vasodilation.

Diet and weight loss as a treatment for psoriasis.

Question: Does moderate weight loss induced by a calorie-restrictive diet improve the therapeutic response to low dose cyclosporine in obese patients with moderate to severe psoriasis?

Design: A 24 week randomized controlled investigator blinded clinical trial.

Setting: Psoriasis outpatient clinic of the University Hospital of Verona.

Patients: Patients were 18 or older, had active but clinically stable plaque psoriasis involving ≥ 10% of the body surface area and a Psoriasis Area and Severity Index (PASI) of ≥ 10, and had a BMI of ≥30 but ≤45.

Curcuminoids activate p38 MAP kinases and promote UVB-dependent signalling in keratinocytes.

Curcuminoids exhibit anti-proliferative properties in many cell lines by modulating signalling pathways to inhibit cell growth. However, the specific effects of curcuminoids on human keratinocytes are not well defined, and this situation impairs mechanistic thinking regarding potential therapeutic uses. We hypothesized that curcuminoids would modulate key growth regulatory pathways in keratinocytes to inhibit cell proliferation.

Assessing long-term drug safety: lessons (re) learned from raptiva.

Efalizumab was approved for moderate to severe psoriasis in 2003 based on studies in approximately 2700 patients, of whom only 218 were exposed to the drug for more than 1 year. In 2009, after more than 46,000 patients were exposed to efalizumab, the drug was withdrawn from the market after 3 confirmed and 1 suspected case of progressive multifocal leukoencephalopathy (PML) were spontaneously reported. As PML is very rare, it is extremely unlikely that the 4 reported cases were due to chance and given that PML occurs primarily in patients who are immunosuppressed, the association is likely causal.

Psoriasis and cardiovascular risk: strength in numbers.

In this issue, Wakkee and colleagues report a self-described exploratory cohort study and conclude that psoriasis may not be an independent risk factor for ischemic heart disease (IHD) hospitalization and that there is only a slight and borderline increased risk of ischemic heart disease among psoriasis patients. This negative result should be interpreted in light of the study's limitations, the complex relationship among levels of psoriasis severity, patient age, and cardiovascular (CV) risk, and the context of the rapidly growing literature.

Patients with severe psoriasis are at increased risk of cardiovascular mortality: cohort study using the General Practice Research Database.

Aims: Psoriasis is a common chronic inflammatory T-helper cell-1/17 mediated skin disease. Recent studies suggest that psoriasis, particularly if severe, may be an independent risk factor for atherosclerosis, myocardial infarction (MI), and stroke. We conducted a cohort study using the General Practice Research Database to determine if severe psoriasis patients have an increased risk of cardiovascular (CV) mortality.

Is there truly a risk of lymphoma from biologic therapies?

The treatment of psoriasis has undergone a revolution with the advent of biologic therapies, including infliximab, etanercept, adalimumab, efalizumab, and alefacept. Biologics are generally safe and well tolerated. However, there has been concern over the risk of lymphoma with use of these agents because of their immunosuppressive properties.

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.

Psoriasis is a common, chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In this fifth of 6 sections of the guidelines of care for psoriasis, we discuss the use of ultraviolet (UV) light therapy for the treatment of patients with psoriasis. Treatment should be tailored to meet individual patients' needs.