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Nineteen patients with psoriasis vulgaris and no other cause for systemic complement activation were studied for evidence of such activation. There was a marked elevation in serum C5b-A9 complexes with no other significant complement abnormalities, and no correlation between C5b-A9 levels and disease activity. This is the most detailed study of complement in psoriasis yet attempted and confirms that complement activation is a feature of psoriasis vulgaris. [ABSTRACT FROM AUTHOR]

It has been suggested that allergic contact dermatitis (ACD) is uncommon in psoriasis, but associated with flexural and palmoplantar involvement. Previous studies have suggested an association between site and morphology of psoriasis and allergic contact sensitivity but it was found that a similar proportion of patients with and without positive patch test reactions had flexural, palmoplantar and chronic plaque psoriasis. Contact allergy to medicaments including dithranol has been recorded in psoriatics.

It is well documented that patients with human leucocyte antigen ( HLA)-Cw6+ (type 1) psoriasis have increased severity and reduced age of onset of psoriasis. However, not much is known about any differential response of this genetic subgroup to various treatments. We set out to determine if there was any genetic association of the HLA-Cw6 allele with the first-line systemic treatment commonly used in psoriasis, methotrexate. A cohort of patients from Tayside in Scotland was recruited through a novel generic consenting process (GoShare); they were extensively phenotyped and analysed for an association of their HLA-Cw6 genotype status with treatment outcomes. HLA-Cw6+ patients showed notably improved response to methotrexate ( P = 0.05), and further analysis demonstrated an even greater response in a subcohort of the HLA-Cw6+ patients, who did not have concomitant psoriatic arthritis ( P = 0.01). HLA-Cw6+ patients also exhibited fewer treatment-limiting adverse events. In addition to these findings, the methodology and primary clinical outcome phenotype, which we validate here, will greatly facilitate replication of the present results in independent cohorts. [ABSTRACT FROM AUTHOR]

The article discusses several aspects related to role of methotrexate for treatment of psoriasis including tolerability and long-term efficiency. Topics discussed include documentation on requirements of patients surviving skin disease psoriasis, evaluations made by National Health Service, and observations based on intensity of skin disease.

Background The calcipotriol/betamethasone dipropionate two-compound product Dovobet®/Daivobet®/Taclonex®(LEO Pharma A/S, Ballerup, Denmark) has been shown to be safe and effective in the treatment of psoriasis for up to 8 weeks. As psoriasis is a chronic disease, long-term treatment may be required, so there is a need to investigate the safety of its use over a longer period of time. Objectives To investigate the safety of two treatment regimens involving use of the two-compound product over 52 weeks in the treatment of patients with psoriasis. Methods Patients ( n = 634) were randomized double-blind to treatment with: (i) 52 weeks of the two-compound product (two-compound group); (ii) 52 weeks of alternating 4-week periods of the two-compound product and calcipotriol (alternating group); or (iii) 4 weeks of the two-compound product followed by 48 weeks of calcipotriol (calcipotriol group). Treatments in all groups were used once daily when required. Results Adverse drug reactions (ADRs) occurred in 45 (21·7%) patients in the two-compound group, 63 (29·6%) in the alternating group and 78 (37·9%) in the calcipotriol group. The odds ratio for an ADR in the two-compound group relative to the calcipotriol group was 0·46 (95% confidence interval 0·30–0·70; P < 0·001). ADRs of concern associated with long-term topical corticosteroid use occurred in 10 (4·8%) patients in the two-compound group, six (2·8%) in the alternating group and six (2·9%) in the calcipotriol group; those with the highest incidence were skin atrophy, occurring in four (1·9%), one (0·5%) and two (1·0%) patients, respectively, and folliculitis, in three (1·4%), one (0·5%) and no patients, respectively. Conclusions Treatment with the two-compound product for up to 52 weeks appears to be safe and well tolerated whether used on its own or alternating every 4 weeks with calcipotriol treatment. [ABSTRACT FROM AUTHOR]

.ASA-A two-compound ointment containing calcipotriol 50 µg g−1 and betamethasone dipropionate 0·5 mg g−1 has recently been shown to be an effective treatment for psoriasis. This study was designed to investigate efficacy and safety of different treatment regimens with the two-compound product (Daivobet®/Dovobet®; LEO Pharma, Ballerup, Denmark) and calcipotriol 50 µg g−1 ointment (Daivonex®/Dovonex®; LEO Pharma). In total, 972 patients with psoriasis vulgaris were randomized to one of three treatment regimens: group 1, the two-compound product once daily for 8 weeks followed by calcipotriol ointment once daily for 4 weeks; group 2, the two-compound product once daily for 4 weeks followed by 8 weeks of treatment with calcipotriol ointment once daily on weekdays and the two-compound product once daily at weekends; and group 3, calcipotriol ointment twice daily for 12 weeks. The efficacy was evaluated by Psoriasis Area and Severity Index (PASI) and investigators' global assessments of disease severity. The primary response criteria were percentage reduction in PASI and proportion of patients with absent/very mild disease according to the investigators' global assessments after 8 weeks of treatment. The mean reduction in PASI from baseline to the end of 8 weeks of treatment was 73·3% for group 1, 68·2% for group 2 and 64·1% for group 3. The proportion of patients with absent/very mild disease at the end of 8 weeks of treatment was 55·3% for group 1, 47·7% for group 2 and 40·7% for group 3. For both primary response criteria, group 1 was statistically superior to group 3 ( P < 0·001), whereas group 2 did not differ significantly from group 3. The difference between group 1 and group 2 was statistically significant with regard to PASI but not regarding the proportion of patients with absent/very mild disease. Patients receiving initial therapy with the two-compound product achieved the fastest treatment response, and the maximum treatment effect for these patients was seen after 5 weeks. This effect was maintained with continued treatment with the two-compound product for up to 8 weeks. After 12 weeks of treatment, no significant differences were seen between the three groups with regard to reduction in PASI, whereas the proportion of patients with absent/very mild disease in group 2 was superior to that in group 3. Patients receiving therapy with the two-compound product experienced fewer lesional/perilesional adverse drug reactions than the calcipotriol-treated patients ( P < 0·001): 10·9% in group 1, 11·5% in group 2 and 22·3% in group 3. Two different short-term treatment regimens employing a recently developed two-compound product (calcipotriol/betamethasone dipropionate) provided rapid and marked clinical efficacy and were shown to be safe therapies for psoriasis vulgaris. [ABSTRACT FROM AUTHOR]

Summary: Psoriasis is a very common disease, affecting around 2% of people worldwide and 1.5 million in the UK. Many patients are affected throughout their lives. Psoriasis can often be treated with creams. However, when this is not enough patients can be treated by specially filtered ultraviolet light called "narrowband‐UVB". This treatment is very effective in 3 out of 4 people, safe, and does not require blood testing. However, in many regions it is not readily available. One reason for this is that it is regarded as expensive since patients have to attend 3 times per week for a few minutes for several weeks, and staff administer the treatment. In this study, the authors extracted all the treatment cost that one large provider in the UK, NHS Tayside, has incurred over six years for this treatment. Including even all indirect costs such as pension contribution, estate etc., NHS Tayside spent an average of only £257 per person for a complete treatment. This result suggests that offering this treatment to more patients would be very cost effective and might avoid or delay the need to use immunosuppressive drugs in many patients. Linked Article: Boswell et al. Br J Dermatol 2018; 179:1148–1156 [ABSTRACT FROM AUTHOR]