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Immune checkpoint inhibitors (ICI) such as anti-programmed cell death protein 1 (PD-1) or anti-programmed death-ligand 1 (PDL-1) antibodies represent a breakthrough in the treatment of advanced neoplasms such as melanoma, lung, or renal cancer. The therapeutic use of these agents is rapidly growing in both active as well as adjuvant settings. Anti-PD-1 agents such as pembrolizumab or nivolumab target PD-1 present on the surface of T cells and other immune cells, enhancing the antitumoral response. Although they offer a better safety profile than anti-CTLA-4 antibodies such as ipilimumab, immune-related adverse events (irAE) still have an important impact on morbidity during treatment. Gastrointestinal and skin irAE are the most frequent adverse events associated with their use and tend to occur early in treatment. Maculopapular rash and lichenoid dermatitis are among the most common skin irAE, affecting approximately 3%-20% of the patients. Most of these reactions are mild and are easily managed with topical corticosteroids, rendering immunotherapy withdrawal unnecessary. Psoriasis might also be exacerbated or present as de novo, both with nivolumab or pembrolizumab, although the exact incidence rate has not been established. This immune-related psoriasis has also been observed during ipilimumab therapy, but its severity has not been defined according to clinical scales such as the psoriasis area severity index (PASI), body surface area (BSA), or physician's global assessment (PGA). Most published series report mild cases with a good outcome after treatment with topical steroids, ultraviolet B phototherapy, or acitretin. Here, we describe 3 patients with moderate to severe psoriasis related to nivolumab treatment, with a favorable response to apremilast and no impairment of antitumoral efficacy.

Background Identification of epidemiologic and phenotypic variations of psoriasis among different ethnic groups can further our understanding of this perplexing disease, aiming at better management of patients worldwide. Objective To provide a descriptive analysis of psoriasis patients registered at Kasr Al-Ainy Psoriasis Unit Disease Registry. Methods This retrospective single-center registry study included patient records between November 2015 and November 2018 (2534 patients). Sociodemographic and phenotypic data were analyzed. Results The mean age of the registered patients was 39.3 years and 56.3% were men. Stress was the main precipitating factor (48.3%), whereas the most common symptom reported was itching (82.4%). The median body mass index was 27.5, and the median percentage of body surface area involved was 10.0. The mean Psoriasis Area Severity Index score was 8.7, and the mean Psoriasis Disability Index score was 13.0. Both parameters correlated positively, and both showed significantly higher means in smokers. Limitations Despite that the study was performed at a highly specialized tertiary care center with a high flow of patients, this was still a single-center registry. Conclusions This work shows that the characteristics of Egyptian patients with psoriasis are comparable to those of other studied ethnic groups, with minor differences., Graphical abstract

Psoriasis is a chronic inflammatory skin disease that may affect any body area, including sensitive sites such as face, nails, scalp, hands, palms, feet, and genitals. Although less frequent, severe forms of either geographic or fissured tongue accounting for psoriasis manifestations can also occur. The involvement of these sites may lead to a marked impairment of quality of life, interfering with work productivity, leisure, and social activities.1 According to current guidelines, the therapeutic approach for psoriasis of these particular sites, although localized and classified as mild or mild-to-moderate, might require systemic therapies, including biologics.2

Visual Abstract, Highlights • LDGs are a subset of neutrophils that were elevated in psoriasis and associated with the severity of disease. • In psoriasis, LDGs associated with noncalcified coronary plaque burden beyond cardiovascular risk factors and in vitro, induced endothelial cell damage. • Compared to normal-density granulocyte neutrophils, platelet-associated biological pathways were upregulated in LDGs, suggesting enhanced platelet adherence to the LDG surface. • LDGs co-localized with platelets in circulation, and the LDG-platelet interaction associated more strongly with non-calcified coronary burden by coronary CTA compared to LDGs alone., Summary Psoriasis is an inflammatory skin disease associated with increased cardiovascular risk and serves as a reliable model to study inflammatory atherogenesis. Because neutrophils are implicated in atherosclerosis development, this study reports that the interaction among low-density granulocytes, a subset of neutrophils, and platelets is associated with a noncalcified coronary plaque burden assessed by coronary computed tomography angiography. Because early atherosclerotic noncalcified burden can lead to fatal myocardial infarction, the low-density granulocyte−platelet interaction may play a crucial target for clinical intervention.

Objective To investigate the relationship between psoriasis and interstitial pneumonia (IP). Patients and Methods We analyzed the clinical data of patients with psoriasis treated with biologic agents from June 1, 2008, to June 30, 2017, retrospectively. Chest computed tomography was performed in 392 patients before treatment. The clinical characteristics and radiographic findings of these patients were evaluated. Results Of the 392 patients with psoriasis, IP was detected in 8 patients (2%). Bilateral ground-glass and/or irregular linear (reticular) opacity in the lower lung zone was the most common chest computed tomography finding. Five of the 8 patients with IP were treated with anti–interleukin (IL) 12/IL-23 or IL-17 antibodies, leading to decreased or stable IP activity. Conclusion Interstitial pneumonia was detected in 2% of patients with psoriasis who needed systemic treatments. Ground-glass and/or irregular linear (reticular) opacity in the bilateral lower lobes was characteristic of IP with psoriasis. The IL-23/IL-17 axis may play important roles in the pathogenesis of IP in psoriasis.

Contains fulltext : 169829.pdf (Publisher’s version ) (Open Access) Elucidating the poorly defined mechanisms by which inflammatory lesions are spatially restricted in vivo is of critical importance in understanding skin disease. Chemokines are the principal regulators of leukocyte migration and are essential in the initiation and maintenance of inflammation. The membrane-bound psoriasis-associated atypical chemokine receptor 2 (ACKR2) binds, internalizes and degrades most proinflammatory CC-chemokines. Here we investigate the role of ACKR2 in limiting the spread of cutaneous psoriasiform inflammation to sites that are remote from the primary lesion. Circulating factors capable of regulating ACKR2 function at remote sites were identified and examined using a combination of clinical samples, relevant primary human cell cultures, in vitro migration assays, and the imiquimod-induced model of psoriasiform skin inflammation. Localized inflammation and IFN-gamma together up-regulate ACKR2 in remote tissues, protecting them from the spread of inflammation. ACKR2 controls inflammatory T-cell chemotaxis and positioning within the skin, preventing an epidermal influx that is associated with lesion development. Our results have important implications for our understanding of how spatial restriction is imposed on the spread of inflammatory lesions and highlight systemic ACKR2 induction as a therapeutic strategy in the treatment and prevention of psoriasis and potentially a broad range of other immune-mediated diseases.