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Background: Narrowband ultraviolet B (NB‐UVB) phototherapy is a popular and relatively contemporary treatment option. However, only a few studies to date have explored the potential risk of skin cancer following NB‐UVB treatment. Objective: This study aimed to investigate the potential long‐term risk of skin cancer in patients treated with NB‐UVB. Methods: This cohort study included patients with psoriasis, vitiligo, and mycosis fungoides treated with NB‐UVB at two university hospitals in Israel in 2000–2005. Patients were followed up for skin cancer for at least 10 years. Data were extracted from the hospital and community medical records. Results: A total of 767 patients were included in this study: 509 with psoriasis, 122 with vitiligo, and 136 with mycosis fungoides. The mean follow‐up duration was 13 years. Among these patients, 4.43% developed skin cancer during the follow‐up (3.93% had psoriasis, 2.46% had vitiligo, and 8.09% had mycosis fungoides). Old age and fair skin type were the only significant independent risk factors for skin cancer. There was no significant difference in the mean number of NB‐UVB treatments among patients who developed skin cancer and those who did not (99.09 vs. 94.79, respectively). Conclusion: No association was observed between the number of NB‐UVB treatments and carcinogenesis in any study group. Age is a significant risk factor, and older patients treated with NB‐UVB should be followed up carefully. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of biologic treatments for psoriasis on the incidence of psoriatic arthritis (PsA). Methods: This retrospective cohort study was conducted using electronic medical records from a large health maintenance organization. Patients who received biologic treatment for psoriasis and were not diagnosed as having PsA before or at the time of biologic treatment initiation were included. Control psoriasis patients who did not receive biologic treatment were matched by age at time of diagnosis, sex, time from psoriasis diagnosis until treatment initiation, maximum body mass index, and smoking status. The groups were different in most characteristics. Therefore, propensity score matching was implemented. Log rank test and multivariable Cox proportional hazards regression were used to compare the groups. Results: Overall, 1,326 patients were included, of whom 663 had received biologic treatment and 663 had not. The Kaplan‐Meier curve for the propensity score–matched groups reflected a statistically significant increased risk for PsA among the control group compared to the biologic treatment group. The results of the multivariable Cox regression showed that the control group had a significantly higher risk for PsA compared to the biologic treatment group within 10 years of follow‐up (adjusted hazard ratio 1.39 [95% confidence interval 1.03–1.87]). Conclusion: Our findings show a statistically and clinically significant decreased risk for developing PsA among patients with psoriasis who receive biologic treatments. The results suggest that biologic medications should be considered for patients who present with significant risk factors for PsA at an earlier stage of treatment. [ABSTRACT FROM AUTHOR]

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory disease involving the skin bearing apocrine glands. There are numerous comorbidities and associated diseases among patients with HS. The association of HS and thyroid abnormalities is equivocal. We aimed to explore whether HS is associated with thyroid disorders. Methods: In this cross‐sectional large‐scale population‐based study in Israel, patients with a validated diagnosis of HS were matched at a proportion of 1:5 with age‐ and gender‐matched healthy controls without HS. A cross‐checking for HS diagnosis by International Classification of Diseases, ninth revision (ICD‐9) coding, and hyperthyroidism and hypothyroidism by ICD‐9 coding was performed. Demographic and exposure covariates were identified. Univariate and multivariate logistic regressions were utilized to establish the association of HS with thyroid disorders. Results: Study participants included 4,191 HS patients and 20,941 controls. The average age of patients was 39.7 years old, and 61.8% were female. 53.4% of HS patients and 13.5% of controls (P < 0.001) were smokers. Odds ratios (ORs) for hypothyroidism and hyperthyroidism in HS were 2.91 (95% confidence interval [CI] 2.48–3.40) and 2.25 (95% CI 1.55–3.28), respectively (P < 0.001 for both). While the association of HS with hypothyroidism was maintained across genders and all age groups, and remained positive after controlling for smoking status, the association with hyperthyroidism remained positive only among females, middle‐aged patients, and nonsmokers. Conclusion: HS is independently associated with hypothyroidism. The association of HS with hyperthyroidism held significance only in limited subgroups. Smoking status is a major modifier, mainly in the association of HS with hyperthyroidism. [ABSTRACT FROM AUTHOR]

Patients with mycosis fungoides (MF) are thought to be at increased risk of melanoma. However, studies addressing surveillance-bias and treatments as a possible confounder are lacking. This retrospective study compared the prevalence and risk of melanoma between 982 patients with MF, and 3,165 patients with psoriasis attending tertiary cutaneous-lymphoma/psoriasis clinics during 2009 to 2018. Melanoma was diagnosed in 47 patients with MF (4.8%; 43 earlystage) and in 23 patients with psoriasis (0.7%) (odds ratio 6.6, p < 0.0001). In 60% of patients, MF/psoriasis preceded melanoma diagnosis. Hazard ratio (HR) for a subsequent melanoma in MF vs psoriasis was 6.3 (95% confidence interval (95% CI) 3.4-11.7, p < 0.0001). Compared with the general population, melanoma standardized incidence ratios were 17.5 in patients with MF (95% CI 11.0-23.9, p < 0.0001), and 2.2 (95% CI 0.6-3.8, p = 0.148) in patients with psoriasis. Narrow-band ultraviolet B was not a contributory factor (HR 1.15, 95% CI 0.62-2.14, p = 0.66). These findings add evidence that patients with MF have a significantly higher risk of melanoma, not only compared with the general population, but also compared with patients with psoriasis. This comorbidity may be inherent to MF. [ABSTRACT FROM AUTHOR]

Interleukin-17A inhibitors are a promising alternative to tumor necrosis factor-a inhibitors for the treatment of psoriasis. In-class switch has been hardly investigated for interleukin-17A inhibitors. We report the experience (2017-2018) of a tertiary medical center with interleukin-17A-inhibitor switch in patients with moderate-to-severe psoriasis. Patient-, disease- and outcome-related data were retrospectively collected from the electronic files of 25 patients switched to ixekizumab following secukinumab failure. Mean ± standard deviation patient age was 56.7 ± 12.2 years. Mean baseline Psoriasis Area and Severity Index was 25. Secukinumab was discontinued due to primary failure in 7 patients and secondary failure in 18. Ixekizumab was administered for 7.3 ± 2.8 months; 22 patients were still on ixekizumab at the end of the study. Mean ± standard deviation Psoriasis Area and Severity Index reduction from baseline at study end was 75.5 ± 20.0%. Patients with moderate-to-severe psoriasis seem to be amenable to treatment with ixekizumab following secukinumab failure. Further large multicenter studies are needed. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of data on the use of biologic therapy in recalcitrant pediatric psoriasis. The current study presents pediatric psoriasis cases treated with biologic agents in a tertiary referral center. Methods: In this retrospective case series, data were collected on all patients ≤18 years old with severe psoriasis treated with biological therapy from 2010 through 2016 in a tertiary children's hospital. We included demographic data, previous systemic treatments, reason for discontinuation or switch to other systemic treatments, efficacy and side effects. Results: There were 10 patients, mean age 5.75 (±3.3) years treated with biologic agents in our center; Etanercept was the most frequent biological treatment prescribed (n = 9) followed by adalimumab (n = 5) ustekinumab (n = 3) and infliximab (n = 2). Additional systemic therapy was added to the biological therapy in seven cases: Methotreaxate (n = 5), phototherapy (n = 4), cyclosporine A and colchicine (1 case each). The most common reason for discontinuation was secondary failure (5 for etanercept, 3 for adalimumab). Six patients failed one biological treatment and three patients failed two biological treatments. Four patients are still being treated with a first line biologic (Etanercept in all). Adverse events were rare. Conclusion: Biologic therapy is effective and safe in recalcitrant pediatric psoriasis. Larger series are needed to confirm our observation. [ABSTRACT FROM AUTHOR]

Data on the treatment of early folliculotropic mycosis fungoides, a recently defined clinicopathological subgroup of folliculotropic mycosis fungoides with an indolent course, is limited. Treatment outcomes were studied in a retrospective cohort of 47 adults with early folliculotropic mycosis fungoides, with a focus on psoralen plus ultraviolet A (PUVA) monotherapy, including dosimetric data, and the findings were compared with data for PUVA in 18 adults with early-classic mycosis fungoides. PUVA was given to 27 patients with early folliculotropic mycosis fungoides: 70% achieved complete response and 26% partial response. Significantly more treatments were needed to achieve complete response in stage IB compared with stage IA. There was no significant difference in the complete response rate from classic plaque-stage disease, although the early folliculotropic mycosis fungoides group required more treatments to achieve complete response, and a higher cumulative dose of UVA. Thus, PUVA is an effective treatment for early folliculotropic mycosis fungoides. Its complete response rate might be equal to early-classic mycosis fungoides; however, a longer induction phase is needed to achieve complete response. [ABSTRACT FROM AUTHOR]