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Recent advances in biologic treatments have made clear skin a realistic treatment goal for psoriasis. However, clear skin may not uniformly translate to an absence of impact on patients' quality of life. This retrospective observational study aimed to elucidate the factors influencing patient-reported outcomes in patients with psoriasis who have demonstrated successful clinician-reported outcomes on using biologics. A total of 96 patients who have achieved a ≥75% improvement in Psoriasis Area and Severity Index (PASI) scores with ≥6 months of biologic treatment were included. Their median PASI score was 0.4, with 37.5% having achieved PASI 100 (clear skin). Furthermore, 47.9% reported no impact of psoriasis on their quality of life (Dermatology Life Quality Index [DLQI] score 0 or 1), while 52.1% reported a negative impact (DLQI score ≥2). Notably, 28.1% of the participants had a history of biologic treatment failure, defined as the inability to achieve or sustain a 75% PASI improvement with the previously used biologic agent. Multivariable logistic regression analysis revealed a positive association between achieving PASI 100 and reporting no impact of psoriasis on quality of life (adjusted odds ratio [aOR] 3.88, 95% confidence interval [CI] 1.49-10.91, P = 0.007). Conversely, prior biologic treatment failure was negatively associated with reporting no impact of psoriasis on quality of life (aOR 0.13, 95% CI 0.02-0.65, P = 0.023). Furthermore, among patients with clear skin, those with experience of previous biologic treatment failure reported significantly lower quality of life than those without such experience (P = 0.033). In conclusion, minimal residual skin lesions and prior biologic treatment failure were associated with poorer patient-reported outcomes in patients with psoriasis. Opting for a biologic agent with the highest predicted efficacy, rather than pursuing a "step-up" approach with a higher possibility of treatment failure, may be a more suitable strategy in the biologic treatment of psoriasis., (© 2024 The Authors. The Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Japanese Dermatological Association.)

Competing Interests: Conflicts of interest None disclosed.

Previous studies have shown that imiquimod-induced psoriasis-like skin inflammation in mice resembles phenotypic changes and cytokine profiles of human psoriasis. However, a psoriasis animal model reflecting the chronic inflammatory course and comorbidities has not yet been established. We aimed to evaluate the imiquimod-applied interleukin (IL)-10 deficient mouse model in comparison with previous models. IL-10 deficient and wild-type (WT) mice received either imiquimod or vehicle cream for 12 days and were sacrificed on day 15. For earlier time point data, either imiquimod or vehicle cream was applied for 2 days, and the mice were sacrificed on day 3. Imiquimod-applied IL-10 deficient mice showed more persistent psoriasis-like inflammation and higher severity index than did WT between day 8 and 15. Histopathologically, they demonstrated significantly thicker epidermis and larger number of CD45+, myeloperoxidase+ and IL-17+ cell counts on day 15. Quantitative reverse transcription-polymerase chain reaction with skin tissue revealed significantly higher imiquimod-induced IL-23p19 expression in imiquimod-applied IL-10 deficient mice on day 15. IL-10 deficient mice also showed significantly higher serum levels of imiquimod-induced IL-17A and tumor necrosis factor-α by enzyme-linked immunosorbent assay on day 15. Furthermore, IL-10 deficient mice showed more prominent increase of spleen weight and decrease of body weight in response to imiquimod application on day 3 and 15. In conclusion, IL-10 deficient mice model with imiquimod application may better reflect severe and persistent psoriasis with systemic inflammatory state., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Psoriasis is a common chronic inflammatory skin disease that may involve any skin site. In particular, psoriasis on the face gives rise to considerable concern because of associated cosmetic problems and psychosocial distress. Some authors have reported that a significant proportion of patients with psoriasis have facial involvement, and several reports have suggested that facial involvement is a marker of severe psoriasis. However, patients with facial psoriasis seem to have clinical characteristics that depend on the distributions of their facial lesions., Objective: We sought to classify facial psoriasis and evaluate clinical characteristics according to the distribution of facial psoriatic lesions, and to compare the severities of body and scalp psoriasis in patients with central or peripheral facial lesions., Methods: A total of 194 patients with psoriasis with facial involvement who presented at our psoriasis clinic were enrolled in this study. Onset of psoriasis, family history, history of phototherapy or systemic therapy, and admission history were recorded. Severity of psoriasis on whole body, face, and scalp were rated using Psoriasis Area and Severity Index (PASI) scores. Patients were categorized into 3 types according to facial lesion distribution: peripherofacial type (PF) (upper forehead and/or periauricular lesions), centrofacial type, and mixed type., Results: The PF and mixed type were more common than the centrofacial type. Peripherofacial involvement was related to a high scalp PASI score, whereas centrofacial involvement was associated with a high whole body PASI score. Disease duration before facial lesion development was less for the PF. Early onset of disease and extensive treatment were more frequent for centrofacial type than PF. The relationship between facial and body psoriasis progression was less strong for PF., Limitations: This was a retrospective study conducted at a single location, and the severity and extent of psoriasis were evaluated only once, at first visits., Conclusion: Facial psoriasis can be categorized into 3 different types. Peripherofacial involvement might be a consequence of severe scalp psoriasis, whereas centrofacial involvement might be a marker of severe body psoriasis. Thus, it would help during the treatment of patients with psoriasis to consider that different lesion distributions may reflect different clinical characteristics.

Background: Few reports have been issued which compare the efficacy and tolerability of cyclosporine dose adjustments before 12 weeks of treatment., Objective: To compare the efficacy and tolerability of two different dosage regimens of cyclosporine in severe psoriasis., Methods: This 12-week, prospective, open-label study included 61 severe psoriasis patients. Patients were assigned to a 2.5 mg/kg per day starting dose and an increasing regimen ('standard regimen') or a 5.0 mg/kg per day starting dose and a decreasing regimen ('step-down regimen') group. The end point included 50% and 75% reductions in Psoriasis Area and Severity Index (PASI) scores. Adverse events were also evaluated., Results: According to a 50% PASI reduction (PASI 50), the response rate at 12 weeks was similar for two groups. The percentage of patients achieving a 75% PASI reduction (PASI 75) at 12 weeks was higher in the step-down regimen group. The mean time to PASI 50 or PASI 75 was shorter in the step-down regimen group. No difference was found between the two groups in terms of the number of patients with adverse events requiring intervention., Conclusion: This study suggests that the 'step-down' cyclosporine regimen offers an effective and safe therapeutic option for the management of severe psoriasis.

Background: Narrow-band (TL-01) UVB lamps are being increasingly used for phototherapy in cases of psoriasis and other dermatoses due to the excellent results obtained. However, in Korea many patients receiving phototherapy have complained about the tanning effect of ultraviolet radiation., Objective: The aim of this study was to determine the time-course of pigmentation induced by phototherapy during and after narrow-band UVB treatment., Methods: Changes in skin color were recorded during phototherapy in 40 patients and after treatment in 20 patients. All patients were Korean and were evaluated during 10 weeks of phototherapy (three sessions per week), and then weekly post-phototherapy using two different reflectance spectrophotometers for 10 weeks. Results are presented as erythema (E)- and melanin (M)-indexes and as L*a*b* values as recommended by the Commission Internationale de l'Eclairge and individual typology angle (ITA)., Results: L* values, which indicate luminance, decreased continuously over the 5 weeks of phototherapy and showed a plateau after 5 weeks of treatment, and then slowly recovered over 10 weeks of post-treatment observation. Patterns of a* and b* values were comparable with L* values both during and after therapy. Mean ITA values also showed a pattern similar to L* values. E and M indexes changed slowly both during and post-phototherapy. In addition, when data were analyzed by skin type, the different skin types showed temporal patterns similar to the overall skin values, but the L* values and ITA and M indexes of skin type III recovered faster than those of skin types IV or V., Conclusion: This study shows that pigmentation induced by narrow-band UVB phototherapy increases continuously during the therapy and that recovery requires 10 weeks or more.

Acrodermatitis continua of Hallopeau (ACH) is a rare chronic pustular eruption that predominantly involves the fingertips. The characterization of this disease has been confused. Some have considered it as a separate entity while others as a variant of pustular psoriasis. The presented patient simultaneously had ACH and joint lesions which were diagnosed as psoriatic arthritis. We believe that because ACH may be accompanied by psoriatic arthritis, as in this case, it could be evidence that it is a variant of psoriasis. [ABSTRACT FROM AUTHOR]