Journal of Clinical and Aesthetic Dermatology

Updates on Psoriasis & Cutaneou Oncology

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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S17 P r o c e e D i n G s JCAD jOUrnAl Of ClInICAl And AEsthEtIC dErMAtOlOgy september 2017 • volume 10 • number 9 • supplement gene transcription and secretion of the specifc cytokine that activated the receptor. When the signaling processes are disrupted, some pro- ingammatory cytokines may be overproduced; increased cell proliferation may occur; and there may be an increase in multiple cellular processes, including growth/maturation of lymphoid cells and the diderentiation/ homeostasis of t-cells and B-cells. 4 6– 50 tofacitinib is a new small molecule that can be applied in an ointment formulation for the treatment of plaque psoriasis based on the inhibition of JaK1/JaK3. in a randomized, double-blind, parallel-group, vehicle- controlled Phase 2b study over 12 weeks, tofacitinib ointment in two strengths (2% and 1%) was applied once or twice daily in adults with mild-to-moderate plaque psoriasis. 51 a total of 430 patients were treated; tofacitnib ointment 2% applied once or twice a day was associated with greater edectiveness than the vehicle at Week 8 but not Week 12; about half of patients (44.2%) experienced adverse events but the higher rate of adverse events occurred in the vehicle rather than active-treatment group. 51 a novel agent, known currently as incB018424, is a powerful JaK1/JaK2 inhibitor that is able to block signal transduction of several pro-ingammatory cytokines. topical incB018424 phosphate 1% or 1.5% cream was applied once or twice daily for four weeks over 2 to 20 percent of the Bsa in fve sequential cohorts of fve patients each. target lesions were rated on a scale of 0 to 4 for erythema, scaling, and thickness; the Physician's Global assessment was also used to assess overall disease activity. Both formulations improved lesion scores. 52 another new small module, GsK2894512, has undergone a dose-fnding Phase 2 study set up as a double-blind, vehicle-controlled, six-arm, parallel-group trial. More small molecules will likely be tested soon for topical delivery. UPdAtE On PsOrIAsIs COMOrbIdItIEs Psoriasis is associated with many comorbidities that may adect prescribing considerations. it has been known that psoriasis is comorbid with many cardiometabolic conditions (e.g., atherosclerosis, atrial fbrillation, diabetes, dyslipidemia, hypertension, metabolic syndrome, obesity, and peripheral vascular disease) as well as noncardiovascular conditions (e.g., anxiety, asthma, chronic kidney disease, chronic obstructive pulmonary disorder, depression, migraines, multiple sclerosis, and uveitis). 53 new and ongoing research continues to associate other conditions with psoriatic disease. a family history of cardiovascular disease may predict Mace in patients with psoriasis. in a retrospective study from data drawn from the Danish national Patient register (n=2,722,375), 54 investigators found that patients who had both psoriasis and a family history of cardiovascular disease had an adjusted incidence rate ratio for Mace of 1.28 for mild disease (95% ci: 1.12–1.46) and 1.62 for severe disease (95% ci: 1.14–2.30). Patients with psoriasis of any degree of severity but without a family history of cardiovascular disease had no incremental risk for Mace. abnormalities in liver enzyme levels are commonly reported in patients with psoriasis. 55 to investigate a potential association between psoriasis and autoimmune hepatitis, a retrospective Danish nationwide cohort study (n=5,404,503) observed 56,739 people with mild and 10,909 with severe psoriasis. 56 the adjusted incidence rate ratio for autoimmune hepatitis was 2.64 (95% ci: 1.70–4.11) and 3.05 (95% ci: 0.98–9.47) for mild and severe psoriasis, respectively (p<0.001 for mild psoriasis vs. reference population, p=0.054 for severe psoriasis vs. reference population). 56 chronic pancreatitis may develop following episodes of acute pancreatitis. it is an irreversible ingammatory disease of the pancreas and confers a risk of morbidity and mortality. 57 a retrospective analysis of the taiwan national Health insurance research Database (n=48,430 people with psoriasis and n=193,720 without psoriasis) found the incidence of chronic pancreatitis to be 0.61 per 1,000 person-years in patients with psoriasis compared to controls over a mean of 6.6 years. 58 Patients with mild psoriasis had signifcantly higher risk of chronic pancreatitis (crude hazard ratio 1.81, 95% ci: 1.53–2.15), and the risk appears to be similar with severe psoriasis (crude hazard ratio 1.68, 95% ci: 1.02–2.89). Data in this study were analyzed two ways: once including patients with psoriasis and Psa and once excluding the patients with Psa from the psoriasis group. results did not dider signifcantly. avascular necrosis (avn), sometimes called osteonecrosis, is an ischemic bone necrosis that can occur when blood supply to the bone is lost or diminished. in a retrospective study based on the taiwanese national Health insurance research Database, 28,268 patients with psoriasis were identifed and then matched to 113,072 randomly selected controls without psoriasis. 59 Patients with psoriasis had higher adjusted hazard ratio for avn than control patients (Hr: 1.96, 95% ci: 1.62–2.38), and men with psoriasis had signifcantly higher adjusted hazard ratio for avn than women. the risk for avn occurs in both mild and severe psoriasis disease (although severe psoriasis confers a greater risk than mild psoriasis) and in patients with and without Psa (although those with Psa had a greater risk for developing avn). the risk for avn was greater in patients under age 30 years than other age groups (adjusted Hr 2.64, 95% ci: 1.24–5.61).

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