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Psoriasis is a chronic inflammatory disorder that is clinically characterized by scaly cutaneous plaques. New evidence suggests that dysregulation of interleukin (IL)-23, a key cytokine in the T-helper-17 pathway, plays a vital role in the development of psoriatic systemic inflammation. The novel biologic medication tildrakizumab is among the first drugs with specific action against IL-23 that has recently been approved by the United States Food and Drug Administration and the European Medicines Agency for moderate-to-severe psoriasis. Tildrakizumab has been shown in large randomized controlled trials to be effective in improving skin manifestations as well as enhancing quality of life outcomes in patients with psoriasis. Its simple dosing, prolonged duration of action, and mild adverse event profile make it a practical option for patients; however, only a small number of trials have investigated the clinical effectiveness of tildrakizumab, and long-term data regarding the drug's efficacy and safety are currently limited. Hence, further research is needed to better understand the risks and benefits of tildrakizumab. This review summarizes and analyzes phase I, phase II, and phase III clinical trials that investigate the mechanism, pharmacokinetics, efficacy, and safety of tildrakizumab. It also identifies areas in which additional studies are warranted to further elucidate the advantages of tildrakizumab over other biologic therapies.

Development of lentigines in areas of resolving psoriatic plaques is a rare phenomenon that has been reported following various treatment modalities including phototherapy, topical therapies, and biologics. Although the exact mechanism is unknown, evidence suggests that the cause may be multifactorial, with factors such as skin type, sun exposure, inflammation, and immunologic cytokines all playing a potential role. Herein, we present the first reported case of a patient developing multiple lentigines following treatment of psoriasis with the IL-23 inhibitor guselkumab.

The article discusses the rare severe generalized pustular psoriasis (GPP) variant of psoriasis that is marked by the sudden widespread onset of small pustules. Topics covered include the GPP pathophysiology, clinical manifestations, diagnosis and treatment, and the possible effectivity of biologics, especially of infliximab, in the rapid clearing of pustules. Also noted is the demonstrated effectivity of such oral systemic agents as acitretin, cyclosporine and methotrexate.

Background: Erythrodermic psoriasis (EP) is a severe, rare form of psoriasis that can be life threatening. Treatment of EP is usually based on anecdotal evidence or past clinical experience, which is in part due to the rarity and often emergent nature of this psoriasis subtype. Methods: In December 2018, a keyword search for 'erythrodermic psoriasis' and 'treatment' was conducted. All studies investigating treatment strategies for EP in at least 2 patients were included in this review. Results: The database search yielded 921 results, and 23 studies comprising over 200 patients with EP were included in the final analysis. Biologics including tumor necrosis factor inhibitors (infliximab [n = 4], etanercept [n = 2], and adalimumab [n = 1]), interleukin-17 inhibitors (secukinumab [n = 3], ixekizumab [n = 2], and brodalumab [n = 1]), ustekinumab (n = 4), and guselkumab (n = 1) have been shown to rapidly achieve clinical improvement in patients with EP. The included studies also demonstrated efficacy of systemic agents cyclosporine (n = 4), etretinate (n = 3), and methotrexate (n = 1). Conclusions: A fair number of poor-quality studies support the use of various biologic and systemic therapies in the treatment of EP. Treatment of EP should be based on the severity of the clinical scenario as well as patient comorbidities. [ABSTRACT FROM AUTHOR]

Background: Inverse psoriasis often requires a targeted treatment strategy due to the inherent sensitivity, thinness, and occlusion of flexural areas. However, most treatment recommendations are based on anecdotal evidence. Methods: A systematic literature search was conducted in October 2018 in Pubmed, Scopus, Embase, and Cochrane Library with keywords 'inverse psoriasis,' 'genital psoriasis,' and 'treatment.' All prospective studies assessing efficacy of treatments for inverse psoriasis that had a sample size of at least 10 patients were included in our analysis. Results: The initial search yielded 340 results, and 14 studies were included in the final analysis. These studies comprised over 1000 patients with mild to severe psoriasis involving axillary, inframammary, facial, and/or anogenital regions. The included studies demonstrated efficacy of topical immunomodulators (N = 7), vitamin D analogs (N = 4), topical corticosteroids (N = 3), antiseptics (N = 2), and biologics (N = 1) in improving genital and flexural psoriasis symptoms. Conclusions: There is a paucity of high-quality studies on which to base treatment recommendations, especially with regard to the role of systemic and biologic therapies. Few studies, many of which are of low evidence quality, suggest that topical immunomodulators, vitamin D analogs, and mid-to-high-potency topical corticosteroids may be effective treatments, but more randomized controlled trials are needed. [ABSTRACT FROM AUTHOR]

YouTube is increasingly utilized by patients for health information. We aimed to assess the educational quality of YouTube videos about phototherapy and excimer laser for psoriasis. A cross-sectional analysis of YouTube videos was conducted using the search terms psoriasis phototherapy and psoriasis laser. Of the 200 videos screened, 124 met inclusion criteria. Sixty-eight (54.8%) were generated by device manufacturers advertising their product, 35 (28.2%) by healthcare professionals, and 8 (6.5%) by patients delivering testimonials from experiences receiving therapy. Fourteen (11.2%) contained high-quality patient education content, 28 (22.5%) were fair quality, and 82 (66.1%) were low quality. Compared to videos generated by advertisers, those created by healthcare providers were of higher educational quality and more likely to be patient-directed. Neither the number of views nor interaction differed significantly among videos of varying educational quality, between videos presenting evidence-based versus non-evidence-based claims about psoriasis, and between videos conveying positive versus negative messages regarding medical consultation. Overall, the majority of YouTube videos about phototherapy and excimer laser advertise devices are of fair-to-low educational quality and are not patient-centric. The addition of more videos that accurately and holistically discuss patient-relevant aspects of these therapies may transform YouTube into a more effective resource for informing patient choices. [ABSTRACT FROM AUTHOR]

YouTube is becoming an increasingly popular resource for patients seeking knowledge regarding treatment options for dermatologic conditions. This study assessed the quality of content on YouTube regarding topical treatment for psoriasis. A cross-sectional analysis of YouTube videos was conducted using search terms related to psoriasis topical therapies. Of the 400 videos screened, 199 met inclusion criteria. One hundred and ten (55.3%) videos discussed natural treatments, 56 (28.1%) discussed therapies with grade A recommendations by the American Academy of Dermatology, 22 (8.5%) discussed therapies with grade B recommendations, and 14 (7.0%) discussed combinations of these. One hundred twelve (56.3%) were financially biased, 36 (18.1%) were uploaded by natural remedy channels without evident financial interests, 31 (15.5%) were patient-generated testimonials, and 20 (10.1%) featured healthcare professionals. Patient testimonials had the most views and user interaction while videos depicting healthcare professionals had the lowest. Videos criticizing medically-prescribed therapies and consultations with healthcare providers had significantly more views than those encouraging seeking medical expertise. Overall, YouTube videos about topical treatment options for psoriasis largely favor natural treatments over medical recommendations and discourage seeking medical advice. Dermatologists should consider posting information to YouTube to increase the volume of evidence-based, patient-directed material available through this platform. [ABSTRACT FROM AUTHOR]

Pruritus, a very broad, subjective, and complex symptom, troubles the majority of patients with psoriasis. However, the subjective and multidimensional nature of the symptom renders it challenging for patients to appropriately communicate their experiences with itch to providers. This review explores current perspectives regarding the underlying mechanisms, assessment tools, burden, and treatment modalities for psoriatic pruritus. It emphasizes the significance of incorporating a standardized, thorough, and verified metric that incorporates severity, distribution, and character of pruritus as well as its effects on various aspects of quality of life. It also underscores the importance of continued research to fully understand the pathogenesis of psoriatic itch for establishment of novel, targeted therapeutics. [ABSTRACT FROM AUTHOR]

Cutaneous pain, a very broad, subjective, and complex symptom, is prevalent in patients with psoriasis. It is prompted by neurogenic inflammation and augmented by physical and psychosocial stress. Many psoriasis patients are troubled by aching, burning, stinging, tenderness, cramping, and tingling in their skin. However, there lacks a thorough and verified metric that allows patients to adequately report their unique skin pain experiences. Limited literature exists that aims to understand cutaneous pain in psoriasis patients; most studies focus on joint pain and generalized pain, and many do not specify the location of pain. This review explores and analyzes current literature on the etiology, assessment, burden, and management of skin pain in psoriasis patients. It emphasizes the significance of appropriately quantifying the skin pain experience in psoriasis and developing therapeutics that target the underlying processes that contribute to noxious skin sensations. [ABSTRACT FROM AUTHOR]