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Nail psoriasis
Published in Archana Singal, Shekhar Neema, Piyush Kumar, Nail Disorders, 2019
Scoring systems for evaluation of nail psoriasis are essential for both gauging the initial severity of disease as well as the response achieved by various treatments. For cutaneous psoriasis, the Psoriasis Area and Severity Index (PASI) is the most widely accepted system for assessment of severity. It does not, however, cover nail involvement. Thus, the need for a separate system led to the development of several scoring systems. All the indices score the absence or presence of characteristic features of nail psoriasis.32 Some of the commonly used indices are detailed below and their salient features are tabulated (Table 13.4).
Topical Therapies for Psoriasis
Published in Siba P. Raychaudhuri, Smriti K. Raychaudhuri, Debasis Bagchi, Psoriasis and Psoriatic Arthritis, 2017
These aspects set the stage for topical treatment, which is also referred to as local or external treatment [4–11]. Until today, and even more in times of very effective and well-tolerated systemic treatments, topical therapy still plays an important role either (1) as monotherapy in limited disease, (2) as combination therapy with systemic or UV treatment, or (3) when these modalities are contraindicated [12–15]. Following current treatment algorithms, mild psoriasis may be treated locally only. Mild disease is defined by a limited area of affected skin and limited disease activity, as well as the absence of relevant comorbid diseases like metabolic disorders and psoriasis arthritis. Established instruments to define severity are, for example, body surface area (BSA), the Psoriasis Area and Severity Index (PASI) (ranging from 0 to 72) [16–18], and the Dermatology Life Quality Index (DLQI) (ranging from 0, no impairment, to 30, strongest impairment) [17]. Mild psoriasis disease is defined as any of the three below 10, and moderate to severe disease as above 10–12 [19]. Some authors further divide into moderate (PASI between 10 and 20) and severe (PASI above 20) disease. However, limited disease at critical areas like the scalp, face, intertriginous areas, and nails, as well as accompanying itch [20], may become severe disease when life quality, as well as social and work issues, is affected. In these cases, systemic treatment may be advisable; however, local or national health reimbursement regulations have to be taken into account.
Conclusion
Published in M. Alan Menter, Caitriona Ryan, Psoriasis, 2017
The future for psoriasis patients is bright, with considerable advances in our understanding of disease pathogenesis and drug development over the past two decades. With the advent of the biologic era, we have had a dramatic growth in the therapeutic armamentarium at our disposal to treat patients with moderate-to-severe psoriasis. Deconvolution of the complex molecular basis of psoriasis has driven pharmacologic development, and patients can look forward to an even greater array of more targeted therapeutic options that are currently in the late stages of clinical development. With increasing efficacy of these newer therapies, Psoriasis Area and Severity Index (PASI) 90 and PASI 100 are soon becoming the new measures of optimal treatment response.
Oral roflumilast as a therapeutic option for psoriasis, what role does it have? Case report and literature review
Published in Journal of Dermatological Treatment, 2023
Javier Gimeno Castillo, Francisco Javier De la Torre Gomar, Aida Menéndez Parrón, Zuriñe Martínez de Lagrán Álvarez de Arcaya
A 49-year-old man with no previous medical history other than obesity, was referred to the dermatology outpatient clinic for a 6-month history of skin lesions. Examination revealed erythematous and scaly plaques predominantly on the scalp and face, with particular involvement of the interciliary region, as well as the trunk and extremities. The latter were not pruritic, and the patient denied any systemic symptoms. Fungal culture was negative, and a clinical diagnosis of psoriasis was made. The total affected body surface area was 14%, while the Psoriasis Area and Severity Index (PASI) was 12.2, and the Physician’s Global Assessment (PGA) was 3 (moderate). Daily treatment was started with clobetasol foam (0.05%) on the scalp, fluticasone cream (0.05%) on the face, and betamethasone salicylic dipropionate ointment (0.05% + 2%) on the body. Blood tests revealed no relevant findings except for positive Interferon-Gamma Release Assays (IGRAs) for Mycobacterium tuberculosis (TBC). Active TBC was ruled out, and the patient refused treatment for latent TBC infection at that time.
Long-term management of pediatric psoriasis with ixekizumab: a case report
Published in Journal of Dermatological Treatment, 2023
Diego Orsini, Luciano Ibba, Alessandra Narcisi, Pasquale Frascione, Alessia Pacifico, Mario Valenti, Antonio Costanzo, Luigi Gargiulo
She came to our attention in January 2021 with several erythematous-desquamative plaques, which involved the upper and lower limbs, the trunk, and the head (Figure 1(a,b)). The involvement of the scalp and retro-auricular regions was particularly severe, with a scalp-PGA (Psoriasis Global Assessment) of 4. The Psoriasis Area and Severity Index (PASI) was 18, and the Dermatology Life Quality Index (DLQI) of the patient was 24. A rheumatological examination did not evidence any joint involvement. Given the psychiatric comorbidities, concomitant medications, and previous failure of both topical and systemic therapies, we suggested to the patient and her family treatment with ixekizumab. As screening blood exams were all within normal ranges, we started therapy with ixekizumab 80 mg according to the summary of product characteristics. The patient returned after only eight weeks showing already complete skin clearance with a PASI of 0 (Figure 2(a,b)). To date, the patient is still on treatment and has completed two years of follow-up with no reported relapses or adverse events. The patient did not report any worsening of her anxiety-depressive disorder, and she is still undergoing psychiatric follow-up visits.
A subset analysis of efficacy and safety outcomes from phase 3 clinical studies of ixekizumab for the treatment of patients with severe plaque psoriasis
Published in Journal of Dermatological Treatment, 2022
Lynda Spelman, Diana Rubel, Alan Brnabic, Nicole Burkhardt, Elisabeth Riedl, Peter Foley
Despite a growing understanding of the pathophysiology, impact, and nature of psoriasis, a comprehensive definition of disease severity for chronic plaque psoriasis is still missing. Even in the setting of clinical studies with stringent patient inclusion and exclusion criteria, study populations are heterogeneous, with skin disease severity scores ranging from moderate to severe using unified definitions of cutoff values [13]. On the other hand, disease severity is the basis for treatment decisions, and specific parameters have been established to determine the eligibility of patients for reimbursement of biologic treatments. In this context, disease severity is usually defined by specific Psoriasis Area and Severity Index (PASI) score cutoffs [14]. Evaluating the number of previous systemic therapies might be another parameter to assess disease severity in patients with chronic plaque psoriasis. Moreover, patients with severe psoriasis might not only differ in skin disease scores from those with moderate disease but also differ in other respects, including disease duration, onset, and response rates to therapies [15,16].