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Background. This article discusses issues of diagnosis and management of pustular psoriasis in a child associated with recurrent dermatomycosis, immunopathogenetic mechanisms of pustular psoriasis, its course and prognosis. Clinical Case Description. The clinical case of infiltrative-suppurative form of scalp microsporia in 11 years old child with long-term psoriasis vulgaris and its transformation to generalized pustular psoriasis (von Zumbusch) is described. The need of immunosuppressive therapy prescription for severe psoriasis was challenged with fungal skin infection as immune suppression would lead to its recurrent course. Conclusion. Combination treatment (systemic glucocorticosteroids, methotrexate, antibiotics, and griseofulvin) resulted in clinical and laboratory recovery for microsporia in a child with generalized pustular psoriasis.

PUVA is a treatment that combines oral methoxypsoralen (8-MOP) with ultraviolet radiation A (UVA). It is used for severe psoriasis and the early stages of T-cell lymphoma. X-rays are an effective treatment for skin cancers. Both treatments are in higher doses used to treat skin malignancies and simultaneously increase the risk of keratinocyte cancer. The main objective of this study was to test whether a few PUVA or X-ray treatments could delay the development of ultraviolet radiation (UVR)-induced skin tumors in a well-established hairless mouse model. Three groups of immunocompetent mice (total, N = 75) were included in the study. All groups were UVR-exposed during the study period. In addition, one group was treated with PUVA and another group was treated with X-rays at days 45, 52, 90 and 97. A control group was treated with UVR only. We recorded when the first, second and third skin tumors were induced in each mouse. Skin tumors developed significantly earlier in both the PUVA and X-ray groups (median, 188 days) than in the control mice (median, 215 days; p

Psoriasis is an autoimmune, chronic proliferative, inflammatory skin disease with high comorbidity. Psoriasis is not a curable disease; it can only be managed. Cyclosporine A (CyA) is one of the FDA-approved immunosuppressant drug used in severe Psoriasis. Till date only oral route is used for its administration. Administration of CyA by this route causes serious side effects such as hypertension and renal toxicity. Due to these side effects, a number of researches have been done and taking place in the current times for the dermal delivery of CyA for the management of psoriasis. Dermal delivery of CyA is not an easy task because of its physiochemical properties like high molecular weight, lipophilicity and resistance offered by stratum corneum (SC). Because of the above problems in the dermal delivery a number of new approaches such as nanolipid carriers, microemulsion, liposomes, niosomes etc. are explored. To those deep findings for psoriasis management with dermal delivery of CyA have not been discussed. This comprehensive review includes all the studies, advancements and their critical findings which took place in the recent times for the dermal delivery of CyA and along with the suitable modification needed for the efficient dermal delivery of CyA are also suggested.

Psoriasis is a chronic autoimmune condition characterized by patches of abnormal skin. Currently, there is no cure for psoriasis, and treatment strategies aim to reduce the severity of symptoms. We report the case of a 71-year-old female with severe psoriasis under treatment with topical steroids, ultraviolet light, and immunosuppressants for 13 years. After receiving intravenous nutritional therapy, antihistamines, and adrenal extract, the patient experienced almost complete resolution of psoriatic patches on her body.

Psoriasis is a life-long disease that requires long-term treatment. The long-term use of conventional systemic treatments is limited mostly by poor tolerability and cumulative toxicity. Psoriasis significantly impairs the quality of life of patients .In contrast, the long-term use of biologics is more advisable, because of better tolerability and safety, although their cost hinders their clinical usage Evidence suggests that PASI 100 (i.e., complete clearance of psoriasis) may be achievable for many patients with moderate-to severe psoriasis using biologics in development brodalumab and ixekizumab or secukinumab that inhibit interleukin (IL)-17. Keywords: Psoriasis, Inflammation, TCell Activation biologics.

Annotation. The constitutional approach is a valuable tool in the hands of practicing dermatologists, which allows an individual approach to the diagnosis and treatment of patients with psoriasis. The aim of the study was to examine the differences in total, longitudinal and transverse body sizes between healthy and/or psoriatic men depending on the severity of the disease. Anthropometric examination according to Bunak was performed for 32 men of the first mature age in patients with mild and 68 men with severe psoriasis. The PASI index was used to clinically assess the severity and area of psoriatic lesions. As a control from the data bank of the research center of National Pirogov Memorial Medical University, Vinnytsya anthropometric data of 82 practically healthy men of the same age group were selected. Statistical data processing was performed in the license package “Statistica 5.5” using non-parametric methods of evaluation of the obtained results. In patients with mild and severe psoriasis compared with healthy men found: lower values – pubic height (by 3.2 % and 5.4 %) and trochanter (by 8.2 % and 7.0 %) anthropometric points, shoulder width (by 19.6 % and 19.0 %) and the width of the distal epiphysis of the shin (by 5.2 % and 4.8 %); greater values – body weight (by 20.1 % and 17.5 %), body length (by 1.7 % in mild course), body surface area (by 10.0 % and 7.8 %), height of suprasternal (by 3.0 % and 1.5 %), acromial (by 2.3 % and 1.0 %) and finger (by 6.1 % and 4.4 %) anthropometric points, width of the distal epiphysis of the shoulder (by 6.9 % and 5.7 %), forearm (by 3.3 % in mild course) and thigh (by 10.3 % and 7.1 %), mid-thoracic diameter (by 16.5 % and 16.3 %), transverse lower thoracic diameter (by 16.5 % and 15.7 %), anterior-posterior mid-thoracic diameter (by 17.7 % and 20.2 %), interspinous (by 12.2 % and 12.1 %), intercristal (by 13.4 % and 11.7 %) and intertrochanteric (by 11.3 % and 10.4 %) distances. Differences in the studied body size in patients with varying degrees of psoriasis found. Thus, in patients with mild psoriasis, compared with patients with severe psoriasis, higher values were found for: body length (by 1.6 %); heights of suprasternal (by 1.5 %), pubic (by 2.1 %) and finger (by 1.4 %) anthropometric points; width of the distal epiphysis of the forearm (by 2.3 %). Thus, pronounced differences in total, longitudinal and transverse dimensions between healthy and patients with mild and severe psoriasis were revealed by Ukrainian men of the first mature age. Between patients with varying degrees of severity of dermatosis, most differences are found only for longitudinal body size.

Given the most frequent manifestation of psoriasis at a young working age and in some cases severe, continuously recurrent course, the presence of many treatments, none of which is a guarantee of complete recovery and no recurrence – now there is an urgent need to find prognostic signs therapy and prevention of relapses. In the absence of ideal biomarkers, the study of constitutional markers becomes crucial. The aim of the study was to examine the differences in girth body sizes between healthy and/or psoriatic men depending on the severity of the disease. Anthropometric examination according to V.V. Bunak was performed for 32 men of the first mature age patients with mild and 68 with severe psoriasis course. The PASI index was used to clinically assess the severity and area of psoriatic lesions. The control group, according to anthropometric parameters, consisted of 82 practically healthy men of the same age, selected from the database of the research center of National Pirogov Memorial Medical University, Vinnytsya. Statistical data processing was performed in the license package “Statistica 5.5” using non-parametric methods of evaluation of the obtained results. In patients with psoriasis of mild and severe course, compared with healthy, we found: greater values for – the girth of the shoulder in a tense state by 8.9% and 6.8%; shoulder girth in the unstressed state by 14.2% and 12.3%; forearm girth in the upper part by 8.0% and 7.1%; forearm girth in the lower part by 4.2% and 4.5%; hand girth by 5.1% and 5.8%; hip girth by 11.4% and 9.3%; hips circumference by 8.7% and 6.5%; crus girth in the upper part by 10.2% and 7.9%; crus girth in the lower part by 8.7% and 5.9%; neck girth by 6.9% and 7.8%; waist circumference by 17.1% and 18.2%; chest girth on inspiration by 7.8% and 7.2%; chest girth on exhalation by 10.6% and 10.3%; chest circumference at rest by 10.0% and 9.6%. Thus, there are pronounced differences in the girth sizes between healthy and patients with mild and severe psoriasis Ukrainian men of the first mature age. Between patients with varying degrees of severity of dermatosis, differences are established only for the girth of the crus in the lower part.

Background. Psoriasis is a widespread skin disorder characterized by cytokines as the main modulators of skin inflammation. A promising psoriasis therapy approach is targeted on cytokine networks by inhibiting the phosphodiesterase 4 (PDE-4). The efficacy and safety of the PDE-4 inhibitor apremilast in psoriasis confirmed in multicenter controlled studies, which, however, are accompanied by reports of unsuccessful therapy cases. Aims — to determine early immunological predictors for PDE-4 inhibitor (apremilast) therapy efficacy based on skin lesions cytokines analyzes in patients with moderate to severe psoriasis. Methods. An open, uncontrolled prospective clinical study was performed. Efficacy of apremilast was analyzed by PASI, BSA, sPGA and DLQI. The outcomes at 26 therapy week were compared with the cytokine levels in skin biopsies selected before starting therapy and analyzed using xMAP technology. The multiparameter prognostic model for apremilast therapy effectiveness was developed based on a heterogeneous sequential recognition procedure. Results. The 34 patients with moderate to severe psoriasis were included in the study. According to the clinical outcomes, two comparison groups were formed: high (75% reduction in PASI score or more; n = 14) and insufficient (50% reduction in PASI score or less; n = 20) apremilast efficiency. Cytokines analyses showed an inverse relationship between the initial anti-inflammatory IL-10 level and the PASI reduction (r = –0.37; p

Background. Psoriasis is a chronic, inflammatory, and multifactorial dermatosis that impairs quality of life (QoL). Health-related QoL has become an important element in medical decision-making along with the effectiveness and the harmlessness of the treatments. Objective. To assess the impact of psoriasis in the QoL of patients with psoriasis by using the DLQI scales. Methods. A cross-sectional study from January to June 2018 was conducted in the Department of Dermatology of the University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar, including patients more than 18 years old with mild to severe psoriasis. The severity of psoriasis was assessed using the “Psoriasis Area and Severity Index (PASI)”. QoL of patients with psoriasis was evaluated by using the DLQI scales. Results. 80 patients were included, their mean age was 36.5 years, and the male to female was 1.5 : 1. The mean DLQI score was 13.8. Symptoms, feelings, and psychic were the most altered dimensions. QoL was impaired in young patients, single, having medium level education. Even though patients with disease duration more than 5 years had higher DLQI score than other patients, the difference was not statistically significant (p=0.36). Furthermore, the clinical presentation of psoriasis did not influence the patient’s QoL (p=0.73). Patients with nail involvement had QoL impaired but the difference with another localization was not statistically significant (p=0.2). The quality of life was influenced by body area involved. The higher the body surface area involved, the more QoL is impaired (p=0.002). Furthermore, the higher the PASI, the more QoL is altered (p=0.002). Conclusion. Psoriasis has a negative impact in the quality of life in Malagasy patients with psoriasis, especially in younger and single patients. Worse quality of life is correlated to severity of psoriasis.

Verrucous carcinomas are a rare variant of squamous cell carcinoma. Vulval verrucous carcinoma comprises only 1% of vulval malignancies. This case report discusses the successful management of aggressive recurrent vulval verrucous carcinoma with acitretin, an oral synthetic retinoid used to manage severe psoriasis, after multiple surgical interventions and radiotherapy had failed. This is the first reported case in which verrucous carcinoma had recurred in a musculocutaneous graft. To manage the recurrence, the patient underwent radiotherapy, which did not resolve the condition. The patient was then administered acitretin 25 mg once daily, which successfully resolved the condition, and the patient has been symptom free for 6 months. This report aims to propose the use of acitretin as a management option for recurrent verrucous carcinomas.

Below you will find the analysis of the first published data and international clinical recommendations for the systemic treatment of patients with moderate and severe psoriasis in the context of the COVID-19 pandemic in different countries (France, Italy, USA, Spain, and Germany).

Introduction: Apremilast is an oral phosphodiesterase inhibitor, approved for moderate to severe psoriasis in adults. Despite the advancement in dermatology, and the introduction of newer biological drugs, apremilast this is the only novel oral medication that has been introduced to treat psoriasis in the past two decades. Like additional other more traditional oral medications, its advantages and disadvantages should be discussed and compared within this group of oral-systemic medications.Area covered: We conducted a review to assess the safety, efficacy, and adherence of apremilast for psoriasis treatment. The aim of this paper was to provide an overview of apremilast regarding its mechanism of action, indications, and adverse events.Expert opinion: Apremilast has been found to be a safe and efficacious drug for moderate-to-severe psoriasis, and despite minor numerous side effects, most of the patients adhere to the therapy. Therefore, overall, it may be easily embraced as the drug of choice for this category. However, for more severe psoriasis cases newer biological drugs seem to be superior to apremilast.

Psoriasis is an inflammatory skin disease with a well-established link to obesity. Excess body weight is associated with higher psoriasis severity. Besides, obesity reduces the effectiveness of systemic therapy. Herein, we reported a morbidly obese patient with severe psoriasis who had only partial response to adalimumab, achieved satisfactory clearance of psoriatic lesions after bariatric surgery in combination with adalimumab therapy. Since bariatric surgery is effective for reducing weight as well as improving psoriasis severity, morbidly obese psoriasis patients who failed noninvasive weight reduction strategies may consider bariatric surgery as a potential adjuvant treatment.

Relevance. Of particular relevance in recent years has become the problem of psoriasis in children, it is noted an increase in cases of severe psoriasis refractory to traditional drug therapy, which together with a high incidence raises the questions of optimization of therapeutic interventions in this category of patients in the category of social.The purpose of the study. To study the efficacy and safety of UVB-phototherapy 311 nm, tacrolimus from pediatric patients with psoriasis.Material and methods. Under supervision there were 26 patients from 5 to 16 years old. All patients received UVB 311 nm phototherapy. The effectiveness evaluated in accordance with the dynamics of the indexes PASI, BSA, Quality of Life.Results. As a result of the course of UVB-therapy with 311 nm wave-length the number of patients with PASI 100 was 69 %, PASI 90 was 23 %, PASI 75 was 8 %. Index BSA were thus reduced to 81.5 %, DIKE improved by 65.3 %. The tolerance to UVB 311 nm was evaluated as very good. Adverse reactions such as transient erythema was observed in 11.5 % of patients, xerosis in 19.2 %.Conclusion. UVB 311 nm phototherapy is a highly effective and safe method of therapy of medium-severe psoriasis in children.

Aim: This study aims to study precipitating factors of psoriasis in the north Indian population.Material & Method:Two hundred twenty-eight psoriasis patients regardless of age, sex, religion,occupation, attending the skin, and V.D. outpatients Department, B.R.D. Medical College, Gorakhpurfor were taken because of the subject of this study. The bulk of patients belonged to the Eastern U.P.and adjoining areas of Bihar and Nepal. The clinical criteria for diagnosis of psoriasis were thepresence of Erythematous and papulosquamous lesions with loosely adherent silvery-white scales.The auspitz's sign was demonstrated all told the cases. The detailed clinical history and examinationwere recorded. Each patient was categorized into mild to severe psoriasis. Result: The maximumpercentage of cases was aggravated by weather (winter), 55.26%, next to that was trauma 27.19%, and least after infections 4.35%. The summer and spring seasons showed an improved effecton the condition of psoriasis. Alcohol, smoking, and mental stress found no relation with psoriasis.In most cases, where the infection was associated with the disease, it had been aggravated only inchildren, and young adults and lesions were of guttate type. Pregnancy had no effect in 25.43% ofcases, while the disease was improved in 3.50% of patients and worsen in 4.35% of cases.Conclusion: Psoriasis is positively correlated with the winter season and negatively associated withSummer and Spring.

Psoriasis is a systemic inflammatory disease commonly associated with postinflammatory hyper- and hypo-pigmentation. Psoriasis-related cytokines such as IL-17 and TNF can contribute to these pigmentation changes by regulating both the growth and pigment production of melanocytes. Here, we present the first reported the case of a patient with a 10-year history of severe psoriasis vulgaris, who developed multiple lentigines in areas of resolved psoriatic plaques during anti-IL-17A antibody secukinumab. This article is protected by copyright. All rights reserved.

Raphaella Cohen-Sors,1 Anne-Claire Fougerousse,2 Ziad Reguiai,3 Francois Maccari,2 Emmanuel Mahé,4 Juliette Delaunay,5 Aude Roussel,2 Maud Amy de la Breteque,4 Caroline Cottencin,6 Antoine Bertolotti,7 Hélène Kemp,8 Guillaume Chaby1 1Dermatology Department, Amiens-Picardie University Hospital Center, Amiens, France; 2Dermatology Department, Military Teaching Hospital Bégin, Saint-Mandé, France; 3Dermatology Department, Polyclinic Courlancy, Reims, France; 4Dermatology Department, Argenteuil Hospital, Argenteuil, France; 5Dermatology Department, University Hospital, Angers, France; 6Dermatology Department, University Hospital, Lille, France; 7Dermatology Department, University Hospital, Saint-Pierre, Ile de la Réunion, France; 8Hematology Department, Amiens-Picardie University Hospital Center, Amiens, FranceCorrespondence: Guillaume Chaby Email chaby.guillaume@chu-amiens.frBackground: Few studies addressing the safety and efficacy of biological therapy (BT) or apremilast (APR) in patients with psoriasis with a history of hematologic malignancy (HM) exist.Aim: To describe the tolerance and efficacy of BT and APR in moderate-to-severe psoriasis in patients with a history of in-remission or evolving HM.Methodology: A retrospective, multicenter chart review of the tolerance and efficacy of BT or APR in patients with moderate-to-severe psoriasis and a clinical history of in-remission or evolving HM.Results: Twenty-one patients with severe psoriasis and a history of HM were included in France by the GEM Resopso study group. Of the 16 patients treated with one or more BT lines, none showed recurrence of their HM which was considered as stable or in remission, and only 2 patients showed an evolution of their HM which had been considered as stable at the beginning of treatment. In the 10 patients treated with APR, the HM of one patient who also received BT worsened. The 3 evolutions did not impact the treatment with BT or APR. Tolerance was very satisfactory, with a low occurrence of infections. Regarding efficacy, only one patient treated with APR did not achieve any notable clinical improvement.Conclusion: Despite supportive data regarding tolerance, the heterogeneity of the analyzed population and limited available data, BT and APR should be used with caution in this patient population and investigations on larger cohorts should be conducted to further assess their tolerance in this patient population.Keywords: biological therapies, apremilast, psoriasis, hematological malignancies

The management of moderate-to-severe psoriasis has been transformed by the introduction of biological therapies. These medicines, particularly those targeting interleukin (IL)-17 and IL-23p19, can offer clear or nearly clear skin for the majority of patients with psoriasis, with good long-term drug survival. However, as currently used, none of these therapies is curative and disconcertingly there is a small but increasing number of patients with severe psoriasis who have failed all currently available therapeutic modalities. A similar scenario has occurred in other immune-mediated inflammatory diseases (IMIDs) where treatment options are limited in severely affected patients. In these cases, cell therapy, including haematopoietic stem cell transplantation (HSCT) and mesenchymal stromal cells (MSC), has been utilized. This review discusses the various forms of cell therapy currently available, their utility in the management of IMIDs and emerging evidence for efficacy in severe psoriasis that is unresponsive to biological therapy. Balancing the risks and benefits of treatment vs. the underlying disease is key; cell therapy carries significant risks, costs, regulation and other complexities, which must be justified by outcomes. Although HSCT has anecdotally been reported to benefit severe psoriasis, sometimes with apparent cure, this has mainly been in the setting of other coincidental 'routine' indications. In psoriasis, cell therapies, such as MSC and regulatory T cells, with a lower risk of complications are likely to be more appropriate. Well-designed controlled trials coupled with mechanistic studies are warranted if advanced cell therapies are to be developed and delivered as a realistic option for severe psoriasis.