Psoriasis is an immune-mediated pro-inflammatory skin condition that is associated with an increase in risk factors for cardiovascular disease, risk of ischemic heart disease, and cardiovascular death. Despite this, traditional modifiable atherosclerotic cardiovascular disease (ASCVD) risk factors are underdiagnosed and undertreated in patients with psoriasis.

At a cellular level, psoriasis and atherosclerosis are driven by a host of shared inflammatory pathways, such as pro-inflammatory cytokines (TNF, IL-6), immune cells, and platelets which act synergistically to drive endothelial damage and atherosclerosis progression.

Optimal prevention of cardiovascular disease in psoriasis centers around modifying known risk factors for the development of ASCVD and emerging data highlight the promise of treating inflammation to further decrease the risk of ASCVD.

Psoriasis is a chronic inflammatory condition of the skin that can be related to a variety of other conditions, including cardiovascular disease and metabolic syndrome. Growth differentiation factor-15 (GDF-15) is a cytokine that reacts to cellular stress. GDF-15 serum levels may have clinical uses in a variety of inflammatory and cardiovascular conditions.

To determine the levels of GDF-15 in the serum of patients with generalized plaque psoriasis (GPP) and its correlation with the metabolic syndrome.

This case-control study included 50 patients with GPP and 50 age- and sex-matched healthy volunteers as controls. A general examination was performed, with a particular emphasis on measurements of body mass index, circumference of the waist, and blood pressure. Psoriasis severity was assessed using the Psoriasis Area and Severity Index (PASI) score. In addition, laboratory tests, including fasting blood sugar, lipid profile, and serum GDF-15 level measurement, were made.

Patients had significantly higher median GDF-15 levels compared to controls (P < 0.001). GDF-15 showed a substantial correlation with both disease duration and PASI score (P < 0.001 for each). GDF-15 levels were considerably greater in participants with metabolic syndrome compared with those without (P = 0.01).

The relatively small sample size could be a disadvantage and drawback of the study.

Serum GDF-15 levels are linked to the severity of psoriasis and the associated metabolic disorders.

Psoriasis is associated with a higher cardiovascular disease burden, with systemic inflammation being the root cause of this association. The concept of residual inflammation (RI) was defined in patients with features of high-risk atherosclerosis who had increased inflammatory markers in blood, as characterized by high-sensitivity CRP, despite receiving optimal medical therapy. This study aims to assess RI in patients with psoriasis undergoing biologic therapy, specifically defined as high-sensitivity CRP ≥ 2 mg/l despite achieving a PASI ≤ 2. A prospective observational study was conducted across 3 international cohorts (Spain, United States, and Sweden) comprising 209 patients with psoriasis who achieved a PASI ≤ 2 after stable biologic therapy. RI was observed in 36.3% of patients and was significantly associated with higher body mass index, metabolic dysfunction-associated steatotic liver disease, increased baseline systemic inflammation, and visceral adipose tissue. Female sex was identified as a predictor of RI in the 3 cohorts. The study concludes that RI persists despite optimal skin response and is strongly linked with obesity and fatty liver disease. These conditions are highlighted as critical drivers and treatment targets of inflammation in psoriasis.

Psoriasis and type 1 diabetes mellitus (T1DM) are chronic autoimmune diseases sharing common immunological pathways, particularly the involvement of interleukin 17 (IL-17), driving Th17-mediated inflammation. This review explores the overlap between psoriasis, obesity, T1DM, and necrobiosis lipoidica (NL), a skin condition associated with diabetes. Obesity exacerbates inflammation through immune cell activation in adipose tissue and the release of proinflammatory adipokines, such as leptin, resistin, and IL-18, which enhance autoimmune responses and insulin resistance. Leptin promotes the differentiation of Th1 and Th17 cells, which are central to autoimmune responses in both psoriasis and T1DM. The coexistence of psoriasis, T1DM, and insulin resistance further complicates metabolic control, increasing the risk of complications like diabetic nephropathy and cardiovascular disease. Biologic treatments targeting IL-17A and IL-17F offer promising therapeutic options for managing both skin and metabolic symptoms. The early identification and management of metabolic risk factors, along with personalized interventions, are essential to improve clinical outcomes in patients with psoriasis and T1DM, particularly in obese individuals. This case report and review highlight the complex interplay of these conditions and emphasize the need for integrated treatment strategies.

Psoriasis is a complex immune-mediated disease that has been closely associated with obesity and lipid metabolism disorders. This study investigated the effects of hydrogen-rich water (HRW) on imiquimod-induced psoriasis-like skin inflammation in ApoE-deficient mice. Psoriasis severity as well as the lipid levels and inflammatory markers were evaluated. The results revealed that HRW significantly reduced plasma triglyceride and total cholesterol levels, increased high-density lipoprotein cholesterol levels, and alleviated skin lesions in mice. Transcriptomic data of the skin tissues indicated significant changes in the inflammatory and lipid metabolism pathways after HRW treatment and quantitative PCR validated the regulation of inflammatory cytokine expression. In addition, HRW promoted M2 macrophage polarization and reduced M1 macrophage polarization in the skin. These results suggest that the consumption of HRW may be a potential therapeutic strategy for psoriasis accompanied by abnormal lipid metabolism.

Psoriasis is a chronic, relapsing inflammatory skin disorder that causes a detrimental physical and psychological impact on people living with the disease. However, little is known about its current prevalence, clinical variants, and quality of life among patients in Uganda.

The purpose of this study was to determine the prevalence of psoriasis, clinical variants, and quality of life (QoL) among patients attending Skin Clinic, Mbarara Regional Referral Hospital (MRRH), in western Uganda.

A cross-sectional study design and consecutive sampling were used. It was conducted between January and March 2023 at the skin clinic, MRRH, with a sample size of 384. The patients were thoroughly examined to assess clinical variants, and Quality of Life was evaluated using the Dermatology Life Quality Index (DLQI). Data obtained was entered using Excel version 20 and analyzed using STATA version 12.0 and GraphPad Prism 9.00. Descriptive statistics and comparison analysis (students t-test and ANOVA) were done.

The overall prevalence of psoriasis was 3.91%. Majority of cases (86.67%) had chronic plaque psoriasis, 60% had a severe disease, and 60% were between 4 and 40 years. Most affected sites were arms (60%) and back (60%) and shins (53.33%), and the least affected were nails and dorsal feet (6.67%). Psoriasis moderately reduces QoL, with an overall mean DLQI score of 8.95 ± 1.35. There was no significant difference between QoL and age or gender.

Prevalence of psoriasis at MRRH in western Uganda is 3.91%. Chronic plaque psoriasis was the most common variant (86.67%), and the disease moderately affects the quality of life.

Psoriasis is a chronic inflammatory skin disease often associated with obesity. Psoriasis therapies may be less effective in patients with obese. The purpose of this expert consensus panel is to evaluate the relationship between obesity and efficacy of psoriasis therapies, thereby optimizing patient care.

A comprehensive literature search was completed on July 19, 2024, using the keywords "psoriasis," "obesity," "efficacy," "treatments," and "therapies." A panel of 11 dermatologists with significant expertise in treatment of psoriasis gathered to review the articles and create consensus statements. A modified Delphi process was used to approve each statement and a strength of recommendation was assigned.

The literature search produced 500 articles. A screening of the studies resulted in 22 articles that met criteria. The panel unanimously voted to adopt 10 consensus statements and recommendations, 6 were given a strength of "A," 2 were given a strength of "B," and 2 were given a strength of "C."

Psoriasis and obesity have a strong association. Obesity decreases efficacy of biologics and may decrease efficacy and potentiate side effects of conventional therapies. It also impacts drug survival. Weight control is a vital component of caring for patients with psoriasis and the number of therapeutic options available is rising.

We describe comorbidities and cardiovascular diseases (CVD) risk in patients with psoriasis prescribed apremilast in UK clinical practice. Such real-world data are currently sparse.

This observational, retrospective analysis of British Association of Dermatologists Biologic and Immunomodulators Register (BADBIR) included adults with plaque psoriasis first prescribed apremilast between October 2015 and March 2021. We evaluated patient comorbidities, 10-year CVD risk (Framingham risk score), time from psoriasis diagnosis, prior therapy, psoriasis severity and patient-reported quality of life (QoL) at first apremilast prescription or registry enrolment. Patient characteristics were also assessed by CVD risk and Fitzpatrick skin type.

Of 265 eligible patients, 47.5% were female; median (Q1, Q3) age at first apremilast prescription was 50 (38, 60) years. The most common comorbidities were hypertension (23.4%), depression (21.5%), psoriatic arthritis (18.1%) and diabetes (15.8%). Median (Q1, Q3) time from psoriasis diagnosis to first apremilast prescription was 19 (11, 30) years; median (Q1, Q3) number of prior psoriasis therapies was 1 (1, 2). Most patients had a Physician Global Assessment score ≥ 3 (moderate/moderate-to-severe/severe disease; 75.5%), psoriasis area severity index ≥ 10 (severe/extensive disease; 82.6%), nail or scalp involvement (52.8% and 75.5%, respectively), and reported moderate or extreme pain/discomfort (57.4%) and/or a Dermatology Life Quality Index (DLQI) > 10 (large/extremely large effect; 59.2%). Among 186 patients without CVD, 63.4% had an intermediate/high 10-year risk of CVD. Patients with darker skin (Fitzpatrick skin types IV-VI) reported worse QoL than those with lighter skin (Fitzpatrick skin types IV-VI, mean [SD] DLQI, 15.7 [7.9]; I-III, 13.9 [7.8]).

Our data indicate that patients with plaque psoriasis prescribed apremilast in UK clinical practice have a high comorbidity burden and long-term, moderate-to-severe disease with special-site involvement, uncontrolled by systemic therapy, and which had a large detrimental impact on their QoL. These data highlight the need for timely treatment with appropriate therapy following diagnosis.

Deucravacitinib, an oral, selective, allosteric tyrosine kinase 2 inhibitor, is approved in the USA and other countries for treatment of adults with moderate to severe plaque psoriasis who are candidates for systemic therapy. In POETYK PSO-1 and PSO-2, deucravacitinib was superior to placebo and apremilast and well tolerated in patients with plaque psoriasis. Patients who completed PSO-1/PSO-2 could enroll in the POETYK long-term extension (LTE) trial. This analysis evaluates the effects of deucravacitinib on laboratory parameters.

POETYK PSO-1 and PSO-2 were 52-week, phase 3, double-blinded trials that randomized patients 1:2:1 to placebo, deucravacitinib 6 mg once daily, or apremilast 30 mg twice daily. At week 52, eligible patients enrolled in POETYK LTE and received open-label deucravacitinib. Mean changes from baseline in laboratory parameters, laboratory adverse events (AEs), and laboratory AEs resulting in discontinuation were evaluated over 3 years.

A total of 1519 patients received one or more doses of deucravacitinib across trials. Total exposure over 3 years was 3294.3 person-years. No clinically relevant mean changes were observed in laboratory parameters. Grade ≥ 3 laboratory AEs were infrequent during the 1-year period, with incidence rates remaining stable in patients treated with deucravacitinib through 3 years. Most laboratory AEs remained at the same grade; shifts to higher grades were infrequent, with most increases being to grade ≤ 2. Discontinuations due to laboratory AEs were rare.

Deucravacitinib did not result in clinically meaningful changes in laboratory parameters over 3 years, including changes seen with Janus kinase (JAK) 1,2,3 inhibitors. Grade ≥ 3 laboratory AEs and discontinuations were rare.

ClinicalTrials.gov identifier, POETYK PSO-1 (NCT03624127), POETYK PSO-2 (NCT03611751), POETYK LTE (NCT04036435).

This study aimed to investigate the association between psoriasis and Life's Essential 8 (LE8), which has demonstrated an inverse relationship with various chronic diseases, though its link to psoriasis remains unexplored. In this cross-sectional study, we analyzed data from the National Health and Nutrition Examination Survey (NHANES) conducted during 2005 to 2006 and 2009 to 2014 that included participants who were 20 years or older. The LE8 score was calculated based on the American Heart Association's recommendations and categorized into three levels: low (0-49), moderate (50-79), and high (80-100). Psoriasis was identified using self-reported questionnaires. Weighted multivariable logistic regression and restricted cubic splines were applied to evaluate the relationship between LE8 scores and psoriasis. The study included 12,744 participants with an average age of 46.2 years (95% CI: 45.53-46.87 years); 6,289 (50.96%) were female, and 374 (2.9%) reported having psoriasis. The weighted mean LE8 score was 68.50 (95% CI: 67.94-69.07). After complete adjustment, a linear negative association was observed between psoriasis and the LE8 score (OR per 1 SD increase: 0.86, 95% CI: 0.75-0.99). Among the subscales, the health factors score showed a linear relationship with psoriasis, while a nonlinear relationship was found between psoriasis and the health behaviors score. Additionally, BMI, an LE8 component, demonstrated a significant association with psoriasis (OR per 1 SD increase: 0.84, 95% CI: 0.72-0.98) in multivariable logistic regression models. Subgroup and sensitivity analyses confirmed the robustness of these findings. We identified a linear negative relationship between psoriasis and LE8, demonstrating that improving LE8 management could serve as a potential strategy for preventing and managing psoriasis.

Psoriasis is a chronic inflammatory autoimmune disease with important systemic and psychosocial impacts. The association with metabolic syndrome (MS) impairs disease severity and negatively influences patient-reported outcomes, particularly their quality of life as measured by the Dermatology Life Quality Index (DLQI). This study aims to investigate the relationship between systemic inflammation, DLQI scores and disease severity, focusing on the persistent impact of MS on patient outcomes after one year of treatment.

This retrospective cross-sectional study included 150 psoriasis patients, with 74 also meeting the diagnostic criteria for MS. Clinical and inflammatory markers such as systemic immune-inflammatory index (SII), cytokines (IL-17A, IL-23), leptin, BMI and triglycerides were analyzed alongside PASI and DLQI scores.

Patients with MS had significantly higher PASI and DLQI scores compared to those without MS, reflecting worse disease severity and quality of life (p < 0.01). Elevated SII levels were strongly associated with higher DLQI scores (p < 0.01). Despite considerable reductions in PASI scores over one year of treatment, DLQI scores indicated a persistent negative impact of MS on quality of life. Notably, markers of systemic inflammation, such as SII, leptin and cytokines, correlated positively with both PASI and DLQI scores, highlighting the role of systemic inflammation in disease burden.

This study underlines the significant role of systemic inflammation and metabolic comorbidities in amplifying the burden of psoriasis. The persistent impact of MS on quality of life despite clinical improvement underscores the need for comprehensive treatment approaches targeting systemic inflammation, metabolic health and psychosocial factors to improve long-term outcomes.

Inflammaging has long been linked to the pathogenesis of various aging-associated disorders, including cardiovascular disease, obesity, type 2 diabetes, and dementia. Yet, the origins of inflammaging remain unclear. Although inflammatory dermatoses such as psoriasis and atopic dermatitis predispose to the development of certain aging-associated disorders, suggesting a pathogenic role of cutaneous inflammation in these disorders, the great majority of aged humans do not have inflammatory dermatoses. Nonetheless, recent studies point to epidermal dysfunction as contributing to inflammaging, even in otherwise normal aged humans. Chronologically aged skin exhibits reduced stratum corneum hydration levels, delayed permeability barrier recovery, and an elevated stratum corneum pH, all of which can provoke and exacerbate cutaneous inflammation. Owing to the prolonged release of proinflammatory cytokines (including TNFα, IL-1β, and IL-6) from the epidermis into the circulation in response to these functional abnormalities, cutaneous inflammation can lead to extracutaneous inflammation, resulting in the downstream development of inflammaging and its accompanying disorders. In support of this concept, topical therapies that improve epidermal function can mitigate some aging-associated disorders, such as mild cognitive impairment. In this perspective, we discuss the link between epidermal dysfunction and inflammaging and highlight the potential management of inflammaging-associated sequelae by enhancing epidermal functions.

Psoriasis is a complex inflammatory skin disorder that is closely associated with metabolic syndrome (MetS). Limited information is available on skin metabolic changes in psoriasis; the effect of concurrent MetS on psoriatic skin metabolite levels is unknown. We aimed to expand this information through skin metabolomic analysis.

Untargeted metabolomics was conducted using skin samples from 38 patients with psoriasis vulgaris with MetS (PVMS), 23 patients with psoriasis vulgaris without MetS (PVNMS), and 10 healthy controls (HC). Data analyses, including multivariate statistical analysis, KEGG pathway enrichment analysis, correlation analysis, and receiver operating characteristic curve analysis, were performed.

Significant discrepancies were found between skin metabolites in the HC and PVNMS groups, particularly those involved in nucleotide and glycerophospholipid metabolism. Fifteen of these metabolites were positively correlated with psoriasis severity. Furthermore, MetS was found to affect the metabolic profiles of patients with psoriasis. There were some metabolites with consistent alterations in both the PVNMS/HC and PVMS/PVNMS comparisons.

This study may provide new insights into the link between skin metabolism and psoriatic inflammation and the mechanism underlying the interaction between psoriasis and MetS.

Individuals with chronic inflammatory and immune disorders are at an increased risk of atherosclerotic events and premature cardiovascular (CV) disease. Despite extensive literature exploring the relationship between "non-traditional" atherosclerotic conditions and CV risk, many aspects remain unresolved, including the underlying mechanisms promoting the "non-traditional CV risk", the development of an innovative and comprehensive CV risk assessment tool, and recommendations for tailored interventions. This review aims to evaluate the available evidence on key "non-traditional" CV risk-enhancer conditions, with a focus on assessing and managing CV risk factors. We conducted a comprehensive review of 412 original articles, narrative and systematic reviews, and meta-analyses addressing the CV risk associated with "non-traditional" atherosclerotic conditions. The analysis examined the underlying mechanisms of these relationships and identified strategies for assessing and mitigating elevated risk. A major challenge highlighted is the difficulty in quantifying the contribution of individual risk factors and disease-specific elements to CV risk. While evidence supports the cardiovascular benefits of statins beyond lipid lowering, such as pleiotropic and endothelial effects, current guidelines lack specific recommendations for the use of statins or other therapies targeting non-traditional CV risk factors. Additionally, the absence of validated cardiovascular risk scores that incorporate non-traditional risk factors hinders accurate CV risk evaluation and management. The growing prevalence of "non-traditional CV risk-enhancer conditions" underscores the need for improved awareness of CV risk assessment and management. A thorough understanding of all contributing factors, including disease-specific elements, is crucial for accurate prediction of cardiovascular disease (CVD) risk. This represents an essential foundation for informed decision-making in primary and secondary prevention. We advocate for future research to focus on developing innovative, disease-specific CV risk assessment tools that incorporate non-traditional risk factors, recognizing this as a promising avenue for translational and clinical outcome research.

Safe and effective long-term treatments for moderate to severe plaque psoriasis are needed.

To evaluate the long-term safety and efficacy of deucravacitinib through 3 years (week 148) in the randomized POETYK PSO-1, PSO-2, and nonrandomized long-term extension (LTE) trials.

PSO-1/PSO-2 were global, 52-week, randomized, double-blinded phase 3 trials in patients with moderate to severe plaque psoriasis. After completing 52 weeks of treatment in PSO-1/PSO-2, patients could enroll in the prespecified, ongoing, nonrandomized LTE trial. The peak of the global COVID-19 pandemic coincided with the LTE trial. Patient enrollment in the LTE started August 12, 2019; safety and efficacy were assessed through June 15, 2022; and these data were analyzed through June 28, 2024.

The PSO-1/PSO-2 trials randomized patients 1:2:1 to oral placebo, deucravacitinib, 6 mg once daily, or apremilast, 30 mg twice daily. Patients enrolling in the LTE trial received open-label deucravacitinib, 6 mg once daily.

Safety outcomes were evaluated in patients who received 1 or more doses of deucravacitinib. Efficacy outcomes included 75% or greater or 90% or greater reduction from baseline in Psoriasis Area and Severity Index (PASI 75/90) and static Physician Global Assessment scores of 0 (clear) or 1 (almost clear) (sPGA 0/1) and were assessed in patients who received deucravacitinib treatment from day 1 of the parent trials who continued in the LTE trial.

Of 1519 patients who received 1 or more doses of deucravacitinib, 513 received continuous deucravacitinib treatment from day 1 and entered the LTE trial. Exposure-adjusted incidence rates (EAIRs) per 100 person-years were decreased or similar in the 1-year vs 3-year cumulative periods, respectively, for adverse events (AEs) (229.2 vs 144.8; 95% CI, 215.4-243.9 vs 137.1-153.0), serious AEs (5.7 vs 5.5; 95% CI, 4.4-7.4 vs 4.7-6.4), discontinuations due to AEs (4.4 vs 2.4; 95% CI, 3.3-5.9 vs 2.0-3.0), and deaths (0.2 vs 0.3; 95% CI, 0.1-0.8 vs 0.2-0.6). Incidence rates of the most common AEs (EAIR per 100 person-years ≥5) during the 1-year and 3-year cumulative periods, respectively, were nasopharyngitis (26.1 vs 11.4; 95% CI, 23.0-29.8 vs 10.2-12.7), COVID-19 (0.5 vs 8.0; 95% CI, 0.2-1.2 vs 7.1-9.1), and upper respiratory tract infection (13.4 vs 6.2; 95% CI, 11.3-16.0 vs 5.4-7.2). EAIRs for AEs of interest, including herpes zoster, major adverse cardiovascular events, and malignant diseases, remained low and were decreased or comparable between the 1-year and 3-year cumulative periods. Clinical response rates were maintained through 3 years.

The findings of this integrated analysis of the phase 3 POETYK PSO-1, PSO-2, and nonrandomized LTE trials demonstrate a consistent safety profile and durable clinical response of continuous treatment with deucravacitinib through 3 years of treatment in patients with psoriasis.

ClinicalTrials.gov Identifiers: NCT03624127, NCT03611751, and NCT04036435.

Psoriasis is a systemic inflammatory disease with increased cardiometabolic risk including dyslipidaemia and diabetes. Biologic therapy effectively treats the cutaneous inflammatory burden of psoriasis and evolving evidence suggests potential to reduce systemic inflammatory sequalae that can elevate cardiovascular risk. This study aimed to assess the change in cardiometabolic risk markers in a cohort of patients with psoriasis treated with 1 year of continuous biologic treatment.

A retrospective review was conducted of patients receiving biologic therapy for chronic plaque psoriasis in a single dermatology centre at a major tertiary hospital in Sydney, Australia. The effect of biologic therapy on psoriasis was assessed using the psoriasis area severity index (PASI). Cardiometabolic risk markers assessed included lipid profile (total cholesterol [TC], low-density lipoprotein [LDL] cholesterol, high-density lipoprotein [HDL] cholesterol and triglycerides [TG]) and haemoglobin A1c (HbA1c). Measurements at baseline and 1 year were compared using paired t tests for analysis of the parameters which approximated normal distribution (TC, LDL, HDL) and Wilcoxon signed-rank test for analysis of those which did not (TG, HbA1c, PASI). Two-tailed P values < 0.05 were considered significant.

A total of 200 patients were reviewed, of which 39 had complete data sets. The participants' ages ranged from 21 to 85 years (mean 51, SD 16.9). Of the 39 participants, 31 (79.5%) were male, 8 (20.5%) were female; 26 (67%) were biologic experienced (BE) and 13 (33%) were biologic naïve (BN). The mean PASI at baseline (for BN + BE) was 13.4 (SD 9.8). The biologic agents used, according to frequency, included risankizumab, with 14 participants (35.9%), secukinumab by 7 (17.9%), ustekinumab by 6 (15.4%), ixekizumab by 6 (15.4%), guselkumab by 3 (7.7%), infliximab by 2 (5.1%), and adalimumab by 1 (2.6%). After 12 months, significant skin improvement was seen [PASI reduced from 13.43 (SD 9.8) to 1.1 (SD 2.1), p < 0.001]. There was no significant change in lipid profile, including TC (mean difference - 0.1 mmol/L, p = 0.532), LDL-C (mean difference = - 0.1 mmol/L, p = 0.476), HDL (mean difference = - 0.1 mmol/L, p = 0.125), triglycerides (mean difference = 0.0 mmol/l, p = 0.748) or HbA1c (mean difference 0.38%, p = 0.468).

Markers of cardiometabolic risk (lipid profile and HbA1c) did not significantly improve after 1 year of biologic therapy despite significant reduction in psoriasis skin severity. Further research in larger cohorts is needed to elucidate the benefits, if any, of biologic therapy on cardiometabolic parameters in individuals with psoriasis, in order to optimise care for this vulnerable cohort.

Background/Objectives: Psoriasis is a chronic inflammatory disease that significantly impacts physical and emotional health. Statins, primarily used as lipid-lowering drugs, have also demonstrated anti-inflammatory effects. While some studies suggest that statins may improve psoriasis symptoms, the findings have been inconsistent. This study aims to investigate the association between prior statin use and the onset of psoriasis in a Korean population, focusing on individuals with dyslipidemia to minimize confounding factors. Methods: Using the Korean Health Insurance database (2002-2019), a nationwide nested case-control study was conducted, enrolling 8285 participants with psoriasis and 33,140 controls, matched 1:4 for sex, age, residence, and income through propensity scoring. Results: Adjusted odds ratios revealed significantly lower risks of psoriasis among short-term statin users (OR = 0.70, 95% CI = 0.66-0.74) and long-term users (OR = 0.77, 95% CI = 0.73-0.82) than in nonusers. This trend was consistent for both lipophilic and hydrophilic statins, and across subgroup analyses. Conclusions: These findings suggest that statins may reduce the incidence of psoriasis. However, further research is needed to assess their effects on psoriasis progression and severity.

Office-based phototherapy is cost-effective for psoriasis but difficult to access. Home-based phototherapy is patient preferred but has limited clinical data, particularly in patients with darker skin.

To compare the effectiveness of home- vs office-based narrowband UV-B phototherapy for psoriasis.

The Light Treatment Effectiveness study was an investigator-initiated, pragmatic, open-label, parallel-group, multicenter, noninferiority randomized clinical trial embedded in routine care at 42 academic and private clinical dermatology practices in the US. Enrollment occurred from March 1, 2019, to December 4, 2023, with follow-up through June 2024. Participants were 12 years and older with plaque or guttate psoriasis who were candidates for home- and office-based phototherapy.

Participants were randomized to receive a home narrowband UV-B machine with guided mode dosimetry or routine care with office-based narrowband UV-B for 12 weeks, followed by an additional 12-week observation period.

The coprimary effectiveness outcomes were Physician Global Assessment (PGA) dichotomized as clear/almost clear skin (score of ≤1) at the end of the intervention period and Dermatology Life Quality Index (DLQI) score of 5 or lower (no to small effect on quality of life) at week 12.

Of 783 patients enrolled (mean [SD] age, 48.0 [15.5] years; 376 [48.0%] female), 393 received home-based phototherapy and 390 received office-based phototherapy, with 350 (44.7%) having skin phototype (SPT) I/II, 350 (44.7%) having SPT III/IV, and 83 (10.6%) having SPT V/VI. A total of 93 patients (11.9%) were receiving systemic treatment. At baseline, mean (SD) PGA was 2.7 (0.8) and DLQI was 12.2 (7.2). At week 12, 129 patients (32.8%) receiving home-based phototherapy and 100 patients (25.6%) receiving office-based phototherapy achieved clear/almost clear skin, and 206 (52.4%) and 131 (33.6%) achieved DLQI of 5 or lower, respectively. Home-based phototherapy was noninferior to office-based phototherapy for PGA and DLQI in the overall population and across all SPTs. Home-based phototherapy, compared to office-based phototherapy, was associated with better treatment adherence (202 patients [51.4%] vs 62 patients [15.9%]; P < .001), lower burden of indirect costs to patients, and more episodes of persistent erythema (466 of 7957 treatments [5.9%] vs 46 of 3934 treatments [1.2%]; P < .001). Both treatments were well tolerated with no discontinuations due to adverse events.

In this randomized clinical trial, home-based phototherapy was as effective as office-based phototherapy for plaque or guttate psoriasis in everyday clinical practice and had less burden to patients.

ClinicalTrials.gov Identifier: NCT03726489.

The advent of biologics has greatly improved patient outcomes, yet some patients are compelled to switch therapies. Predicting these therapeutic failures is important; however, the factors associated with switching biologics have not been fully explored. This study examined patterns and determinants of biologics switching in psoriasis treatment retrospectively over 13 years. We focused on the association between clinical characteristics, basal laboratory data, and frequency of biologics switching. The findings revealed that elevated Psoriasis Area Severity Index scores and the presence of arthritis were observed in patients who experienced two or more treatment switches compared with those without treatment switches. Moreover, neutrophil to lymphocyte ratio was associated with higher biologics switching rates, indicating that systemic inflammation significantly impacts treatment adherence. A treatment approach, taking into account both the clinical presentation and inflammatory biomarkers, may be important for optimizing patient management in psoriasis.

There is a growing body of evidence suggesting the association between psoriasis (PsO) and psoriatic arthritis (PsA) separately with metabolic syndrome (MS) in different populations. The literature is relatively scarce in terms of comparing the prevalence of MS in PsO and PsA with controls without systemic inflammatory diseases.

We aimed to assess the prevalence of MS among patients with PsO, PsA, and a control group without systemic inflammatory disease, in addition to investigating the risks of MS occurrence and its different components in each group.

This is a cross-sectional case-control study with three groups of patients: PsO, PsA, and control. The diagnosis of MS was defined according to the modified 2009 NCTEP ATP III criteria. Patients underwent thorough physical examination and fasting blood samples.

A total of 195 patients were included in this analysis (PsO = 50; PsA = 64, and controls = 81). The prevalence of MS in the control, PsO, and PsA groups was 37%, 56%, and 57.8%, respectively (p < 0.001). Waist circumference (p = 0.013) and arterial hypertension (p < 0.001) were the most significant components of MS in patients with PsO and PsA. Multivariate analysis confirmed an independent risk of MS in women, elderly patients, obese patients, patients with hyperglycemia, and patients with psoriasis, especially PsA (OR = 6.2 [CI 95% 2.4-16.2], p < 0.001).

MS is more prevalent in patients with PsA, which can be determined by the increase in inflammatory pathways.

The mechanism linking psoriasis to metabolic syndrome (MetS) remains poorly understood. Recent reports indicate upregulation of glycolysis-related proteins in psoriatic keratinocytes (KCs). However, the role of glucose metabolism reprogramming in psoriatic KCs, psoriasis, and psoriasis with MetS remains unclear. In this study, we confirmed glucose metabolism reprogramming in psoriatic KCs by examining glycolysis-related genes, proteins, and metabolites. We found that inhibiting glucose metabolism reprogramming in psoriasiform KCs led to improvements in psoriasiform features. Notably, we observed enhanced glucose metabolism reprogramming in KCs within psoriatic skin lesions of patients with MetS. In vitro, high-glucose and high-fat culture intensified glucose metabolism reprogramming in psoriasiform KCs partially via the AKT/mTOR pathway. These findings highlight a strong link between the glycolytic switch and KC function and suggest that glucose metabolism reprogramming in KCs contributes to heightened psoriatic inflammation in MetS.

Systemic inflammation or insulin resistance drive atherosclerosis. However, they are difficult to capture for assessing cardiovascular risk in clinical settings. The monocyte-to-high-density lipoprotein ratio (MHR) is an accessible biomarker that integrates inflammatory and metabolic information and has been associated with poorer cardiovascular outcomes. Our aim was to evaluate the association of MHR with the presence of subclinical atherosclerosis in patients with psoriasis. The study involved a European and an American cohort including 405 patients with the disease. Subclinical atherosclerosis was assessed by coronary computed tomography angiography. First, MHR correlated with insulin resistance through homeostatic model assessment for insulin resistance, with high-sensitivity CRP and with 18F-fluorodeoxyglucose uptake in spleen, liver, and bone marrow by positron emission tomography/computed tomography. MHR was associated with both the presence of coronary plaques >50% of the artery lumen and noncalcified coronary burden, beyond traditional cardiovascular risk factors (P < .05). In a noncalcified coronary burden prediction model accounting for cardiovascular risk factors, statins, and biologic treatment, MHR added value (area under the curve base model = 0.72 vs area under the curve base model plus MHR = 0.76, P = .04) within the American cohort. These results suggests that MHR may detect patients with psoriasis who have subclinical burden of cardiovascular disease and warrant more aggressive measures to reduce lifetime adverse cardiovascular outcomes.

Psoriasis is an increasingly common chronic immune-mediated skin disease recognized for its systemic effects that extend beyond the skin and include various cardiovascular diseases, neurological diseases, type 2 diabetes, and metabolic syndrome. This study aimed to explore the complex relationship between psoriasis and metabolic syndrome by analyzing clinical, biochemical, and immunological parameters in patients with psoriasis alone and in patients combining psoriasis and metabolic syndrome. A total of 150 patients were enrolled, 76 with psoriasis only (PSO) and 74 with psoriasis and metabolic syndrome (PSO-MS). Data collected included anthropometric measurements, blood tests, and inflammatory markers. Statistical analysis was performed using the independent t-test, Mann-Whitney U test, Kruskal-Wallis test, and chi-square test to compare the two groups. Patients in the PSO-MS group had a significantly higher body weight, abdominal circumference, BMI, and inflammatory markers compared to patients with PSO. In addition, increased levels of IL-17A, cholesterol, triglycerides, and glucose were observed in the PSO-MS group. This study highlights the increased metabolic risk and exacerbated systemic inflammation associated with the coexistence of psoriasis and metabolic syndrome. These findings demonstrate the need for a comprehensive therapeutic approach and early intervention to manage metabolic complications in patients with psoriasis and metabolic syndrome.

Introduction Psoriasis is a chronic, recurrent inflammatory skin condition that affects 1-3% of the global population. Increasing evidence suggests a higher prevalence of metabolic syndrome (MetS) among individuals with psoriasis. This study aims to investigate the prevalence of MetS in patients with psoriasis and compare the findings with existing literature. Methods This cross-sectional, hospital-based study included 311 patients with psoriasis. Data were retrospectively collected from hospital records. Results The study included 311 patients with psoriasis (144 females and 167 males), with a mean age of 41.6 years (range 18-87). The mean BMI was 27.13 ± 5.29 kg/m², and the average waist circumference was 93 cm. Mean fasting blood sugar levels were 100 mg/dL, mean high-density lipoprotein (HDL) cholesterol was 44 mg/dL, and mean triglycerides were 132 mg/dL. MetS was diagnosed in 60 patients (19.3%). Patients with MetS had significantly higher mean waist circumference, higher rates of hypertriglyceridemia, hyperglycemia, and hypertension, and lower mean HDL levels (p < 0.05). There was no significant association between MetS and psoriasis severity, disease duration, family history, smoking, or alcohol consumption habits. Conclusions In this study, the prevalence of MetS among patients with psoriasis was 19.3%. MetS prevalence was not linked to smoking status, alcohol consumption, family history of psoriasis, disease duration, or severity. It is crucial for dermatologists treating psoriasis patients to be aware of MetS, its components, and associated cardiovascular risks.

A strong link has been established between psoriasis and lipid disturbances; however, no study has systematically examined their global epidemiology.

We searched six databases from their inception up to October 1, 2023. Data analysis was conducted using Stata SE 15.1. We performed subgroup, meta-regression, and sensitivity analyses to assess the heterogeneity of the pooled studies.

Our review included 239 studies comprising 15,519,570 participants. The pooled prevalence rate of dyslipidemia among individuals with psoriasis was 38%.

Patients with severe psoriasis should undergo screening for lipid abnormalities. This can facilitate the early detection of lipid dysfunction and associated cardiovascular comorbidities.

Psoriasis, a systemic inflammatory disease classically presenting with cutaneous lesions, has significant involvement in other organ systems. This article explores the prevalence, clinical manifestations, screening mechanisms, and laboratory testing by which to evaluate these comorbidities. Treatment approach for these comorbidities must combine patient preference with established treatment algorithms while recognizing innovative therapeutics currently under development.

Epidemiological data demonstrate strong associations between psoriasis and metabolic comorbidities, including obesity, hypertension, diabetes mellitus, dyslipidemia, and non-alcoholic fatty liver disease. The presence of metabolic comorbidities significantly influences the selection and effectiveness of pharmacological treatments. Some drugs should be prescribed with caution in patients with metabolic comorbidities because of an increased risk of adverse events, while others could have a reduced effectiveness. The aim of this narrative review is to highlight the challenges that healthcare professionals may face regarding the management of psoriasis in patients with metabolic comorbidities. In the first part of the article, the epidemiological association between psoriasis and metabolic comorbidities and their pathogenetic mechanisms is summarized. The second part describes the efficacy and safety profile of conventional and biologic drugs in patients with selected metabolic comorbidities including obesity, non-alcoholic fatty liver disease/hepatic steatosis, and diabetes. Finally, the role of pharmacological and non-pharmacological interventions, such as diet, alcohol abstinence, physical activity, and smoking avoidance is discussed. In conclusion, the choice of the best approach to manage patients with psoriasis with metabolic comorbidities should encompass both tailored pharmacological and individualized non-pharmacological interventions.

A 52-week postmarketing surveillance study was initiated to evaluate the safety and effectiveness of guselkumab, a human anti-interleukin 23 subunit p19 monoclonal antibody, in Japanese patients with psoriasis vulgaris, psoriatic arthritis, generalized pustular psoriasis, and erythrodermic psoriasis in real-world practice. Here, we report results of the 20-week interim analysis of the ongoing postmarketing surveillance study. Patients who received guselkumab between May 2018 (the date of commercial launch in Japan) and October 2020 were registered in this study. In total, 411 and 245 patients were included in the safety and effectiveness analysis sets, respectively. Adverse drug reactions (ADRs) occurred in 6.6% (27 of 411) and serious ADRs in 2.2% (nine of 411) of patients. The most frequent ADRs by System Organ Class were "Infections and infestations" (2.4%), with nasopharyngitis being the most frequently observed ADR (0.7%). The mean Psoriasis Area Severity Index score decreased from 11.6 at baseline to 6.5 at week 4 and 2.2 at week 20, with improvements achieving statistical significance at each time point. Clinical Global Impression, Dermatology Life Quality Index, and Nail Psoriasis Severity Index outcomesalso showed substantial improvements. Our findings demonstrate that guselkumab is well tolerated and effective in Japanese patients with psoriasis through 20 weeks of treatment in real-world clinical practice, showing significant effectiveness observed as early as 4 weeks. The study was officially registered with the University Hospital Medical Information Network Clinical Trials Registry with the identifier UMIN000032969.

Although many epidemiological surveys for patients with psoriasis have been reported based on individual countries or facilities, there has been no study encompassing the major countries or the region in Asia. The Asian Society for Psoriasis (ASP) has been conducting an epidemiological study across various Asian countries and regions to elucidate the and compare the epidemiology of psoriasis. A total of 1948 cases were analyzed, with 938 cases from Japan, 530 cases from China, 325 cases from Korea, 141 cases from Chinese Taipei, and 14 cases from Thailand, all of which were enrolled between 2020 and 2022. In the Asian region total, the male-female ratio was 1.87:1 and the peak age at disease onset was 20-29 years. The proportion of psoriasis vulgaris (PsV), psoriatic arthritis (PsA), and pustular psoriasis (PP) was 80.1%, 17.7%, and 2.2%, respectively, and PsA was more commonly associated with nail symptoms than psoriasis vulgaris (PsV). Of the patients, 13% had a familial history of psoriasis and the most frequently affected family member was the father. Regarding treatment, 78.3% of the patients received topical medications, 9.0% underwent phototherapy, 34.0% received oral medications, and 36.1% were treated with biological agents. This study provided valuable information on the epidemiology and treatment of psoriasis using the registry data collected with the common reporting form in the same period in major Asian countries and regions. Male predominance is a distinctive feature of psoriasis in Asia. This epidemiological data registry in the ASP will continue afterwards.

Our observational study included on 54 patients with PsO, evaluated into the Dermatology Department of the Emergency County Hospital Craiova, Romania, between August 2023 and January 2024, and 40 controls. Our research proposed determining the prevalence of MetS in a cohort of PsO patients, and its relationship to subclinical atherosclerosis, evaluated by carotid ultrasound. Metabolic syndrome (MetS) was established according to National Cholesterol Education Program (NCP) Adult Treatment Panel (ATP) III criteria for MetS for 35 of the patients (64.81%) vs. 11 of the control group (27.5%), p=0.0003. An overview of each component of MetS depending on the diagnostic criteria for MetS showed that waist and total cholesterol exerted significant differences. Carotid ultrasound evaluation revealed an increased ITM, of over 0.9mm, for 19 (35.18%) or PsO patients, significantly increased compared to controls, as well as the presence of carotid plaques in significantly different percentages (37.03% PsO vs. 17.5% controls, p=0.001). We also noted that for patients with MetS, US examination displayed increased results for IMT compared to those without MetS. The prevalence of carotid atheroma plaque was augmented in patients with MetS and PsO. In our PsO group IMT exerted a positive inter-relation with: age, MetS, blood glucose, disease duration, and PASI. Important to note is that after multiple linear regression analysis, age and MetS were independent indicators of IMT (p=0.02 for age and p=0.001 for MetS). Our findings sustain a firm relationship between MetS and psoriasis and the major consequence of this observation is the inherent risk of cardiovascular events.

To explore the influence of serum metabolites on the risk of psoriasis.

In the initial stage, we applied Mendelian randomization to evaluate the association between 1,400 serum metabolites and the risk of psoriasis. Causal effects were primarily assessed through the Inverse-Variance Weighted method and Wald Ratio's odds ratios, and 95% confidence intervals. False Discovery Rate was used for multiple comparison corrections. Sensitivity analyses were conducted using Cochran's Q Test, MR-PRESSO. MR-Steiger Test was employed to check for reverse causality. In the validation stage, we sought other sources of psoriasis GWAS data to verify the initial results and used meta-analysis to combine the effect sizes to obtain robust causal relationships. In addition, we also conducted metabolic pathway enrichment analysis on known metabolites that have a causal relationship with the risk of psoriasis in both stages.

In the initial stage, we identified 112 metabolites causally associated with psoriasis, including 32 metabolite ratios and 80 metabolites (69 known and 11 unknown). In the validation stage, 24 metabolites (16 known, 1 unknown, and 7 metabolite ratios) were confirmed to have a causal relationship with psoriasis onset. Meta-analysis results showed that the overall effect of combined metabolites was consistent with the main analysis in direction and robust in the causal relationship with psoriasis onset. Of the 16 known metabolites, most were attributed to lipid metabolism, with 5 as risk factors and 8 as protective factors for psoriasis. Peptidic metabolite Gamma-glutamylvaline levels had a negative causal relationship with psoriasis, while exogenous metabolite Catechol sulfate levels and amino acid 3-methylglutaconate levels had a positive causal relationship with the disease onset. The metabolites associated with psoriasis risk in the two stages are mainly enriched in the following metabolic pathways: Glutathione metabolism, Alpha Linolenic Acid and Linoleic Acid Metabolism, Biosynthesis of unsaturated fatty acids, Arachidonic acid metabolism, Glycerophospholipid metabolism.

Circulating metabolites may have a potential causal relationship with psoriasis risk, and targeting specific metabolites may benefit psoriasis diagnosis, disease assessment, and treatment.

Psoriasis is a frequent form of chronic inflammation in dermatology that is unmistakably linked to the metabolic syndrome (MetS) and its elements. This study was to explore the current status and new developments in the global research, and the holistic landscape of this field more intuitively through bibliometric analysis of scientific output and activity.

Publications regarding psoriasis and MetS were searched and chosen from the database of the Web of Science Core Collection. Excel 2019, VOSviewer, and CiteSpace software were utilized to conduct bibliometric analysis.

There were 1096 publications included. The scientific outputs in this field had increased from 2004 to 2022, and the expansion could continue in the following years. The United States contributed the most publications (241, 21.99%) and had the most citation frequency (13,489 times). The University of California System was the most productive affiliation. Girolomoni G., Armstrong A.W., Gisondi P. and Gelfand J.M. were key and influential researchers. Journal of the European Academy of Dermatology and Venereology published the greatest number of articles (65 articles). By analyzing keyword frequency and clustering, we have identified the following areas of research interest and frontiers: prevalence, risk, association, gene expression, waist circumference, adipose tissue inflammation, vascular inflammation, cardiovascular disease, psoriatic arthritis, and fibrosis.

This bibliometric analysis elucidates research domain of psoriasis and MetS, portraying present hotspots and future emerging trends. This field has generated significant interest and displays potential for further growth. The United States has made distinguished contributions, and currently dominates this field.

Cardiometabolic risk factors have been shown to decrease biologic efficacy in patients treated for inflammatory conditions. The purpose of this systematic review is to provide a qualitative evaluation of studies investigating biologic response among psoriasis patients with cardiometabolic comorbidities.

A comprehensive review was conducted according to the Preferred Reporting Guidelines for Systematic Reviews and Meta-Analysis guidelines to screen for studies including patients with cardiometabolic risk factors receiving biologic therapy for psoriasis. Studies not including a Psoriasis Area and Severity Index (PASI) score to evaluate treatment outcomes were not included. All studies underwent quality/bias analysis using the Methodological Index for Non-Randomized Studies (MINORS) scale.

Obesity and Body Mass Index (BMI) were the most studied cardiometabolic risk factors. The majority of the studies reported a lower frequency of achieving PASI75 and PASI90 response with increasing BMI/obesity rates. Diabetes and hypertension showed similar findings but were not studied as frequently. Hyperlipidemia and other lipid disorders were less frequently studied.

Relationships between cardiometabolic risk factors and lower frequencies of achieving PASI75/90 exist in current literature. This qualitative systematic review reports evidence of lower PASI75 and PASI90 response rates in the presence of cardiometabolic risk factors.

Psoriasis is an immune-mediated chronic inflammatory skin disease. Great progress has been made in the pathogenesis of psoriasis in recent years, but there is no bibliometric study on the pathogenesis of psoriasis. The purpose of this study was to use bibliometrics method to analyze the research overview and hot spots of pathogenesis of psoriasis in recent 10 years, so as to further understand the development trend and frontier of this field.

The core literatures on the pathogenesis of psoriasis were searched in the Web of Science database, and analyzed by VOSviewer, CiteSpace, and Bibliometrix in terms of the annual publication volume, country, institution, author, journal, keywords, and so on.

A total of 3570 literatures were included. China and the United States were the main research countries in this field, and Rockefeller University was the main research institution. Krueger JG, the author, had the highest number of publications and the greatest influence, and Boehncke (2015) was the most cited local literature. J INVEST DERMATOL takes the top spot in terms of the number of Dermatol articles and citation frequency. The main research hotspots in the pathogenesis of psoriasis are as follows: (1) The interaction between innate and adaptive immunity and the related inflammatory loop dominated by Th17 cells and IL-23/IL-17 axis are still the key mechanisms of psoriasis; (2) molecular genetic studies represented by Long Non-Coding RNA (LncRNA); (3) integrated research of multi-omics techniques represented by gut microbiota; and (4) Exploring the comorbidity mechanism of psoriasis represented by Metabolic Syndrome (MetS).

This study is a summary of the current research status and hot trend of the pathogenesis of psoriasis, which will provide some reference for the scholars studying the pathogenesis of psoriasis.

Psoriasis is a chronic, complex, and immunologically mediated systemic disease that not only affects the skin, but also the joints and nails. It may coexist with various other disorders, such as depression, psoriatic arthritis, cardiovascular diseases, diabetes mellitus, and metabolic syndrome. In particular, the potential link between psoriasis and metabolic syndrome is an issue worthy of attention. The dysregulation of growth factors could potentially contribute to the disturbances of keratinocyte proliferation, inflammation, and itch severity. However, the pathophysiology of psoriasis and its comorbidities, such as metabolic syndrome, remains incompletely elucidated. Growth factors and their abnormal metabolism may be a potential link connecting these conditions. Overall, the objective of this review is to analyze the role of growth factor disturbances in both psoriasis and metabolic syndrome.