Arcutis Biotherapeutics have published positive results from a pivotal Phase 3 study evaluating the efficacy and safety of Zoryve (roflumilast) foam 0.3% as a once-daily monotherapy treatment for psoriasis of the scalp and body.

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The study showed that treatment with investigational ZORYVE foam resulted in significant improvements across multiple efficacy endpoints, including the co-primary efficacy endpoints of S-IGA Success and B-IGA Success, as well as key secondary endpoints. The data also show improvement in pruritus (itch) was observed as early as 24 hours after the first application.

These compelling results demonstrate that ZORYVE foam 0.3% may provide rapid and significant relief of plaques anywhere on the body and is well-tolerated according to both investigator and patient-reported assessments. The foam formulation is particularly beneficial for its versatility in treating hair-bearing and non-hair-bearing skin, which could ultimately help patients adhere to their treatment.

A Randomized tRial Employing topiCal roflumilasT foam to treat scalp psORiasis (ARRECTOR), was a Phase 3, randomized, double-blinded, vehicle-controlled trial which enrolled 432 adults and adolescents aged 12 years and older with plaque psoriasis affecting the scalp and body, across 49 sites in the United States and Canada.

Significantly greater proportions of individuals treated with ZORYVE foam 0.3% achieved the co-primary efficacy endpoints of S-IGA Success and B-IGA Success, defined as an IGA score of ‘clear’ or ‘almost clear’ plus a 2-point improvement from baseline. At Week 8, 66.4% of individuals treated with ZORYVE foam 0.3% achieved S-IGA success compared to 27.8% for vehicle (P<0.0001). At Week 8, 45.5% of patients treated with ZORYVE foam achieved B-IGA success compared to 20.1% for vehicle (P<0.0001).

Other key findings include:

• ZORYVE foam provided a clinically meaningful improvement in scalp itch. 65.3% of individuals treated with ZORYVE achieved a clinically significant reduction in itch compared to 30.3% of individuals treated with vehicle at Week 8 (P<0.0001) as measured by a ≥ 4-point change from baseline in Scalp Itch-Numeric Rating Scale (SI-NRS). Significant improvement was seen in the ZORYVE treatment group as early as Week 2. The data also demonstrated improvement in body itch as measured by the Worst Itch-Numeric Rating Scale (WI-NRS) at Week 8, with 63.1% of those treated with ZORYVE foam 0.3% achieving a ≥ 4-point reduction in WI-NRS compared to 30.1% of those treated with vehicle (P<0.0001). Significant improvement was seen in the ZORYVE treatment group as early as Week 2.
  
  
• Importantly, there was a greater improvement in itch observed with ZORYVE within 24 hours after the first application compared to vehicle (as measured by mean SI-NRS change from baseline, relative to vehicle; P=0.0164). This improvement over vehicle within 24 hours after the first application was also observed in body itch (as measured by WI-NRS change from baseline, relative to vehicle; nominal P=0.0094).
  
  
• At Week 8, 70.9% of those treated with ZORYVE foam versus 31.3% treated with vehicle achieved at least 75% improvement in Psoriasis Scalp Severity Index (PSSI-75) (P<.001), another secondary endpoint.
  
• Similarly, 50.1% of people treated with ZORYVE foam 0.3% achieved at least 75% improvement in Psoriasis Area and Severity Index (PASI-75), a key secondary endpoint, as compared to 16.8% of those treated with vehicle at Week 8 (P<.001).
  

ZORYVE foam was well-tolerated. The incidence of Treatment Emergent Adverse Events (TEAEs) was low and similar in both active treatment and vehicle arms. The most frequent adverse events in the ZORYVE foam arm (≥1%) included headache, diarrhea, and nausea. Investigator-rated application-site tolerability was similar between ZORYVE and vehicle groups, with investigators reporting no evidence of irritation for at least 99.2% of all patients at all time points. Patient-rated application-site tolerability was also similar between ZORYVE and vehicle with at least 94.4% of patients reporting no or mild sensation on local tolerability assessments at all time points.

This study suggests the protective effect of riboflavin on psoriasis merits further attention.

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Psoriasis is a chronic inflammatory skin disease characterised by oxidative stress in the epidermis. Riboflavin (vitamin B2), an essential vitamin with antioxidant properties, may play a role in modulating this condition.

Using data from three cycles of the National Health and Nutrition Examination Survey (NHANES), we analysed 13 825 U.S. citizens, including 409 (2.96%) cases of psoriasis.

A fully adjusted weighted logistic regression model revealed that psoriasis was associated with decreased riboflavin intake: for each natural-log unit increase in riboflavin intake, the risk of psoriasis decreased by an average of 16% (OR: 0.84, 95% CI: 0.73–0.96). This association was particularly significant among middle-aged and elderly people (> 40 years).

Transcriptome analysis of data series GSE41662 and GSE121212 demonstrated upregulation of riboflavin metabolising genes (SLC52A2, SLC52A3, RFK, FLAD1 and SLC25A32) in psoriatic lesional skin. In an in vitro psoriatic keratinocyte model, riboflavin reduction induced upregulation of inflammatory cytokines, ROS response and delayed keratinisation.

These findings indicate that psoriasis is significantly associated with decreased riboflavin intake, and riboflavin metabolism is activated in psoriasis. The protective effect of riboflavin on psoriasis merits further attention.

This study suggests the findings underscore the importance of considering cardiovascular outcomes when selecting systemic therapies for patients with psoriasis. 

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Background:
Psoriasis is a chronic inflammatory disease with multiple comorbidities, including an increased risk of major adverse cardiovascular events (MACE). There is limited and contradictory evidence comparing the impact of systemic treatments for psoriasis on MACE.

Objectives:
To evaluate the incidence of MACE associated with each systemic treatment used for patients with psoriasis and compare these rates to those observed with methotrexate (MTX).

Methods:
We conducted a prospective cohort study using data from the BIOBADADERM registry. Propensity score matching was used to adjust for baseline differences between treatment groups. We calculated the incidence rate (IR) of MACE for each systemic treatment class, including biologics (anti-TNF, IL-12/23, IL-17 and IL-23 inhibitors), conventional systemic therapies (MTX, cyclosporine, dimethyl fumarate and acitretin) and apremilast (APR). The IR for each group was compared to those observed in patients treated with MTX using Poisson regression models adjusted for potential confounders, with 95% confidence intervals (95% CI). The primary outcome was the adjusted incidence rate ratios (IRR) for MACE between patients receiving MTX and those receiving another systemic treatment.

Results:
We analysed data from 5622 patients, 11,368 treatment cycles and 21,762 person-years (PYs). APR (IRR = 0.17; 95% CI, 0.04–0.70) and IL-17 (IRR = 0.43; 95% CI, 0.20–0.91) were associated with a significant reduction in the risk of MACE compared to MTX. Cyclosporine was associated with an increased risk of MACE (IRR = 3.59; 95% CI, 1.17–10.99) compared to MTX. The remaining systemic psoriasis treatments were not significantly associated with an increased or decreased risk of MACE.

Conclusions
This real-world evidence study indicates a potential association between APR and IL-17 with a lower incidence of MACE, while CYC showed a higher incidence compared to MTX. These findings underscore the importance of considering cardiovascular outcomes when selecting systemic therapies for patients with psoriasis.

This study is the largest single cohort investigation to date examining the clinical symptoms and management of vulval psoriasis.

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Background/Objectives:
To explore the clinical presentation, management and impact on quality of life in women with vulval psoriasis.

Methods:
A retrospective, single-centre cohort study of women was conducted at a large dermatology practice from January 2016 to January 2024. Sequential Vulval Quality of Life Index scores and patient data were systematically collected and recorded in an online patient database. Treatment regimens were individualised and titrated to clinical response.

Results:
The study included a total of 350 patients with vulval psoriasis over an eight-year period. 13.1% of patients required systemic treatment solely for vulval disease. The median VQLI score improved from 18.0 ± 9.4 at baseline to 9.7 ± 7.6 at the end of follow-up (p < 0.0001). All domains showed statistically significant improvements except for ‘Sexual Function’. The domains with the greatest improvement were ‘Future Health Concerns’ (69.2%, p < 0.001), ‘Feelings and Emotions’ (63.4%, p < 0.001) ‘Symptoms’ (58.6%, p < 0.001) and ‘Activities of Daily Living’ (56.8%, p < 0.001).

Conclusions and Relevance:
Vulval psoriasis has a substantial impact on quality of life but remains underdiagnosed and undertreated. While treatment can significantly improve outcomes, issues related to sexual function and relationships often persist. Systemic therapy may be required for a subset of patients with vulval-only disease. Routine assessment and targeted management of vulval involvement are crucial to optimising patient well-being.

This study looked at nail involvement in 2888 Egyptian psoriasis patients.

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Nail involvement in psoriasis was reported in 10%–55% of psoriasis patients. Nail psoriasis treatment can be more challenging than treating skin lesions for lack of adequate absorption of topical agents plus the slower nail turnover.

To study the demographic and clinical characteristics of psoriasis patients with nail involvement compared to psoriasis patients without nail involvement. Retrospective analysis of all patients attending the psoriasis unit between 2015 and 2020 was performed.

Patients with and without nail involvement were compared accordingly. A total of 2888 patients were included in the analysis, 2363 of which had no nail involvement and 525 had clinical involvement of nails (18%). Nail involvement was significantly higher among male patients, smokers, patients with longer disease duration, patients with evidence of psoriatic arthritis and those on metformin.

Patients with nail involvement did not show a significant association with diabetes or the manual nature of occupations. The retrospective nature of the study carries the risk of poor registration and has little control over the potential confounders.

The involvement of nails in psoriasis was associated with severe disease and was a risk factor for other comorbidities including psoriatic arthritis.

In this retrospective study, 121 patients with moderate-to-severe plaque psoriasis treated with Cosentyx (secukinumab), Taltz (ixekizumab), Tremfya (guselkumab), or Skyrizi (risankizumab) were analysed.

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Biologic therapies targeting interleukin (IL)-17 and IL-23 have transformed psoriasis treatment, yet real-world evidence on the impact of age on treatment responses and drug survival is limited.

This study aims to compare early (12/16 weeks), mid term (24 weeks) and long term (52 weeks) Psoriasis Area and Severity Index (PASI) responses and drug survival in psoriasis patients aged < 65 versus ≥ 65 years receiving IL-17 or IL-23 inhibitors. In this retrospective study, 121 patients with moderate-to-severe plaque psoriasis treated with secukinumab, ixekizumab, guselkumab, or risankizumab were analyzed.

Patients were stratified into two age groups (< 65, n = 78; ≥ 65, n = 43). PASI75, PASI90, and PASI < 2 outcomes were assessed at 12/16, 24, and 52 weeks. Drug survival was evaluated via Kaplan–Meier analysis (censoring at 24 months) and Cox regression was used to identify predictors of discontinuation. At 12/16 weeks, the < 65 group achieved significantly higher PASI75 (90.5% vs. 65.1%, p = 0.010), PASI90 (75.7% vs. 32.6%, p = 0.030) and PASI < 2 (55.8% vs. 79.7%, p = 0.006) responses than the ≥ 65 group. At 52 weeks, PASI75, PASI90, and PASI < 2 rates were similar between groups (86.3% vs. 97.5%, p = 0.055; 78% vs. 90%, p = 0.112; 85.1% vs. 92.5%, p = 0.253).

There were no significant differences between IL-17 and IL-23 inhibitors within any age group. Overall drug survival at 24 months was high (79.6% for < 65 and 90.3% for ≥ 65, log-rank p = 0.407), with no difference between biologic classes (mean survival: 21.8 vs. 22.4 months, p = 0.520). In Cox regression, female sex (HR 0.23, p = 0.005) and higher baseline PASI (HR 1.093 per point, p = 0.013) predicted discontinuation, whereas age, biologic class, BMI, and prior biologic use were not significant.

Despite a delayed initial response, older patients achieve long-term PASI outcomes comparable to younger patients when treated with IL-17 and IL-23 inhibitors. Drug survival is similarly excellent across age groups and biologic classes.

These findings support the successful use of modern biologics in elderly psoriasis patients.

VYNE has suspended all screening, enrolment and patient dosing in the Phase 1b trial of VYN202 for psoriasis.

VYN202: Oral BD2-selective BET inhibitor

VYN202 has been designed to achieve class-leading selectivity (BD2 vs. BD1), maximum potency versus BD2 and optimal oral bioavailability. Maximizing on-target potency vs. BD2 and minimizing affinity to BD1 may be the key to optimizing the benefit/risk profile of BET inhibitors for autoimmune diseases.

Target Markets:
Moderate-to-severe plaque psoriasis
Moderate-to-severe rheumatoid arthritis

Focused activity:
VYN202 is believed to be the most potent and BD2-selective BET Inhibitor in clinical development which is designed to improve efficacy and tolerability.

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VYNE Therapeutics today announced that the U.S. Food and Drug Administration (FDA) verbally informed the Company that it placed a clinical hold on the Company’s Phase 1b study evaluating VYN202 for the treatment of moderate-to-severe plaque psoriasis. The clinical hold determination was made following a recent observation of testicular toxicity in dogs from a non-clinical toxicology study with VYN202.

VYNE has suspended all screening, enrollment and patient dosing in the Phase 1b trial of VYN202 and intends to work diligently with the FDA to resolve the clinical hold as soon as possible. To date, there have been no serious adverse events observed in subjects that have been enrolled in the Phase 1b study.

“While we are disappointed by this unexpected development, the safety and well-being of patients in our studies is our top priority,” said David Domzalski, President and Chief Executive Officer of VYNE. “We intend to work closely with the FDA to address the clinical hold as expeditiously as possible and we plan to provide additional updates pending continued engagement with FDA.”

Comparing the efficacy, safety, and drug survival of biologics in psoriasis patients aged 65 + years with matched controls aged 18–64 years during the first year of treatment.

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Background:
Older people represent an increasing proportion of patients treated with biologics for psoriasis. However, data availability is limited due to the underrepresentation of older patients in clinical trials.

Materials and Methods:
This is a multicentric real-world observational study conducted in dermatology centers in the Czech Republic. It aims to compare the efficacy, safety, and drug survival of biologics in psoriasis patients aged ≥ 65 years with matched controls aged 18–64 years (1:2 ratio) during the first year of treatment. Data were extracted from the prospective BIOREP registry and patient medical records for adverse events (AEs).

Results:
A total of 265 elderly patients and 530 matched controls were included. In both groups, a similar proportion of patients achieved a Psoriasis Area and Severity Index (PASI) ≤ 2 after 14 weeks (67% older vs. 63% younger adults), 26 weeks (71% vs. 76%), and 52 weeks (72% vs. 76%). During the first year of biologic therapy, at least one AE was reported in 108 (41%) older and 214 (40%) younger patients. Serious adverse events (SAEs) were reported in 13 (5%) older and 16 (3%) younger patients. Drug survival during the first year of therapy was lower in older (88%) compared to younger patients (96%), especially in those treated with adalimumab (81% vs. 99%).

Conclusion:
The efficacy of biological treatment was comparable between older and younger patients. Despite older people having more comorbidities, SAEs did not increase in this age group. Nonetheless, the survival rate of older patients was notably lower during the treatment period, especially when adalimumab was administered.

The objectives of this study were to estimate the prevalence of excessive sun exposure (ESE) as a proxy for tanning addiction in patients with moderate-to-severe psoriasis and to identify the factors associated with this behaviour.

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Background:
Tanning addiction is a behavioral addiction characterized by an irrepressible desire for sun or ultraviolet light exposure. It is thought to affect 10% to 25% of the population.

Objectives:
This study aimed to estimate the prevalence of this behavior in patients with moderate-to-severe psoriasis and identify associated factors.

Methods:
A cross-sectional study of baseline data from patients included in the PsoBioTeq cohort between 2012 and 2022. Tanning addiction was approximated by patient-reported excessive sun exposure (ESE), defined by the response “I try to expose myself to the sun as often as possible” to a registry question on current behavior. Factors associated with ESE including clinical characteristics, psoriasis and medical history, and previous treatments were also analyzed.

Results:
Among 3705 patients included in the analysis, 636 (17.2%) reported ESE. In multivariate analysis, being younger (OR 0.97, 95% CI [0.96; 0.97]) and female (OR 1.52, 95% CI [1.20; 1.93]), and having a normal weight (OR 0.57, 95% CI [0.42; 0.77]), intermediate skin phenotype (OR 1.80, 95% CI [1.36; 2.38]), and history of phototherapy (OR 1.53, 95% CI [1.19; 1.96]) were associated with a higher ESE risk, whereas previous ustekinumab treatment (OR 0.40, 95% CI [0.19; 0.84]) was associated with a lower ESE risk.

Conclusions:
The prevalence of ESE in patients with psoriasis was 17% and revealed demographic factors that may help to identify the patient population most risk of ESE behavior. Education about photoprotection and optimal rapid control of psoriasis may be particularly important for this population.

This study looked at the preferences of psoriasis patients when talking to a dermatologist.

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Background/Objective:
Despite supporting guidelines and evidence, teledermatology adoption in Germany is low, also possibly due to a lack of services that reflect patients' preferences. This study investigates these preferences in psoriasis care and the influence of sociodemographic, geographic and disease-related factors.

Methods:
A discrete choice experiment was conducted. The attributes included the two teledermatology modes (live-interactive, store-and-forward), treating physician, possibility to ask questions and acknowledgment of concerns. The opportunity to prefer the standard of care was given. Participants were randomly assigned to two scenarios: consultation for acute flare-ups or follow-up. Conditional logit models were used for analysis.

Results:
Among 221 patients with psoriasis (mean age: 58.9 years, 39.8% female), a general preference for the standard of care was observed (acute: β = −0.86, p = 0.001; follow-up: β = −1.24, p = 0.001). Factors that positively influenced preference for teledermatology were medical care provided by the known physician (acute: β = 0.49, p < 0.001; follow-up: β = 0.51, p < 0.001), the possibility to ask questions (acute: β = 0.35, p < 0.001; follow-up: β = 0.52, p < 0.001) and a very good acknowledgment of patients' concerns (acute: β = 0.48, p < 0.001; follow-up: β = 0.50, p < 0.001). Immediate feedback (<24 h) was crucial in acute consultations (β = 0.51, p < 0.001). No preference for a teledermatology mode was noted in either scenario. In both scenarios, lower privacy concerns and higher technology acceptance positively influenced teledermatology preference. In acute care, current long waiting times, whereas in follow-up care, current regular blood sampling positively influenced the preference for teledermatology.

Conclusion:
Patients with psoriasis generally preferred standard-of-care over teledermatology. However, certain attributes positively influenced their preference for teledermatology, including consultations with their known treating physician, acknowledgment of patient concerns and prompt consultation during acute flare-ups. Adapting services to these preferences could increase the use of teledermatology.

This study looked at liver fibrosis in psoriasis patients treated with Tremfya (guselkumab)

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Psoriasis is associated with comorbidities like metabolic syndrome and nonalcoholic fatty liver disease, increasing the risk of liver fibrosis.

This study evaluated the long-term effects of guselkumab on liver fibrosis in 154 psoriasis patients using the Fibrosis-4 (FIB-4) index, a noninvasive marker of fibrosis, over 3 years.

Patients were stratified by baseline FIB-4 (≥ 1.3 or < 1.3) and age (35–65 years). Mean FIB-4 values remained stable across all subgroups, with no significant changes observed. High-risk patients (FIB-4 ≥ 1.3) showed minor, nonsignificant fluctuations, while low-risk patients (FIB-4 < 1.3) exhibited a mild, age-related upward trend.

Disease duration emerged as a key factor influencing FIB-4, highlighting the importance of early treatment. These findings suggest guselkumab does not contribute to liver fibrosis progression in psoriasis patients.

Further research with advanced methods like imaging or biopsy is needed to confirm the long-term hepatic safety of IL-23 inhibitors like guselkumab.

Scientists at the university of Birmingham have shown that a sequence of just three amino acids may reduce the severity of psoriasis when applied topically in an emollient cream.

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The researchers identified the smallest part of a peptide (small protein) called PEPITEM, which occurs naturally in the body and regulates inflammation.

The study also showed that both PEPITEM and the three amino acid (tripeptide) sequence delivered a significant reduction in the severity of psoriasis, that is comparable to a steroid cream.

In its native state, PEPITEM consists of a chain of 14 amino acids, but in this most recent study, researchers led by Professor Ed Rainger from the University of Birmingham and Professor Francesco Maione from the University of Naples Federico II, looked for, and identified the smallest parts of the PEPITEM molecule that influence immune cells and inflammation in psoriasis.

Work by the Birmingham scientists identified two sequences of three amino acids that showed biological activity comparable to the full-length PEPITEM molecule.

The scientists then optimised these tripeptides to improve their stability in the body, and tested their ability to reduce immune cell activation and migration, which are hallmarks of inflammatory disease. Their findings showed these two sequences had at least the same activity as the original PEPITEM molecule.

They then selected the sequence with the greatest biological activity and researchers from the University of Naples Federico II trialled its effectiveness in psoriasis, using an animal model of disease.

They found that topical application directly to the skin every day for seven days in an emollient cream resulted in a clear reduction in disease compared to untreated animals, and their findings were confirmed using PASI (Psoriasis Area and Severity Index) scoring, which is used in clinical practice to measure the extent and severity of psoriasis.

Importantly, the study also showed that both PEPITEM and the tripeptide sequence reduced the PASI score by 50%, making it comparable to the steroid cream Clobetasol Proprionate 0.05%.

Professor Ed Rainger said: “While there are a number of therapies for psoriasis, there is a clear need for new therapeutic agents that can be used continuously, and without the risk of excessive side effects, to prevent psoriasis flares. Our findings raise the possibility of using PEPITEM derived peptides for the treatment of psoriasis.”

“This study also raises the interesting possibility that PEPITEM derived peptides could be used in combination with other psoriasis therapies, allowing lower dosing for longer durations, for example, a ‘steroid sparing’ approach, to reduce the side effects associated with prolonged use of such agents.”

University of Birmingham Enterprise has filed several patent families related to PEPITEM and the components of the PEPITEM molecule responsible for maintaining a normal immune response.

The research team is now seeking investment, licensing, partnering and/or collaborative research opportunities.

This study looked at the use of Cosentyx (secukinumab) in Japanese patients with generalised pustular psoriasis (GPP)

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Secukinumab is one of the human monoclonal antibodies recommended in the Japanese guidelines for patients with psoriasis, but few case reports and clinical studies on secukinumab for pustular psoriasis are available because of the rarity of the disease.

This was an open-label, multicenter, uncontrolled, single-arm, prospective observational surveillance conducted in a clinical practice setting to evaluate the safety and effectiveness of secukinumab in Japanese patients with generalized pustular psoriasis (GPP).

Patients were monitored for 1 year after starting secukinumab and followed up for an additional 2 years. Of 99 patients from 71 sites, 95 were included in safety and 82 in effectiveness analysis. The mean (standard deviation) observation period was 346.2 (64.87) days, and 91.58% of patients were observed over 52 weeks.

Adverse events, serious adverse events, and adverse reactions were reported in 51.58%, 12.63%, and 35.79% of patients, respectively. Safety evaluations showed no significant difference in the incidence of events based on the history of biologics The proportion of patients with either “complete response” or “partial response” was ~90% from week 2 and remained stable until week 52.

The proportion of patients with “remission (no symptom)” in the Japanese Dermatological Association total score increased from week 4 (22.22%) to week 52 (47.83%). The mean Psoriasis Area and Severity Index score decreased from week 1 (17.26) to week 16 (1.18), with the mean percentage change decreasing from −28.07% to −90.18%. The mean Dermatology Life Quality Index (DLQI) total score decreased from 8.7 at the start of secukinumab treatment to 1.9 at week 52. At week 52, the proportion of patients with DLQI total score of 0/1 was 57.14%.

No new safety signals for secukinumab in long-term treatment were observed from this surveillance, and no additional measures needed to be taken. Moreover, secukinumab showed sustained effectiveness in patients with GPP in Japan.

This study suggests higher c-reactive protein (CRP) levels were associated with future development of psoriatic arthritis (PsA)

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Objective:
We aimed to assess whether high sensitivity c-reactive protein (hsCRP) could predict the development of psoriatic arthritis (PsA) in patients with psoriasis.

Methods:
We analyzed data from a prospective cohort of patients with psoriasis without PsA at enrollment. Participants were assessed annually by a rheumatologist for signs and symptoms of PsA. Information on patient demographics, psoriasis features, medications and musculoskeletal symptoms was collected. hsCRP levels were measured in serum samples collected at baseline using standard commercial assays. The association between hsCRP levels and risk of development of PsA was assessed using multivariable Cox proportional hazards model adjusted for age, sex, psoriasis severity and duration, nail lesions, body mass index (BMI), fatigue, and medication use.

Results:
A total of 589 patients with psoriasis followed from 2006 to 2019 were analyzed. 57 patients developed PsA during the follow up period. Mean level of hsCRP was 3.1±5.5 mg/L (hsCRP levels in incident PsA cases: 5.4±13.1). Significantly higher levels of hs-CRP at baseline were found in patients with arthralgia, obesity and in females. Higher hs-CRP levels were associated with future development of PsA in multivariable analysis (hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.01, 1.07, p=0.007). Similar effect size was seen in males and females. No significant interaction was found between hsCRP and sex or BMI.

Conclusion:
Higher levels of systemic inflammation, as measured by hsCRP, are associated with future development of PsA.

This retrospective cohort study evaluated the clinical outcomes of HIV-positive patients undergoing anti-IL-23 therapy in real-world settings at the Dermatology Units of four leading reference centres in Northern Italy for the treatment of psoriasis.

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HIV-positive patients with psoriasis often face delays in accessing biologic therapies due to their exclusion from clinical trials and concerns about the impact of immunomodulatory drugs on viral replication.

Anti-IL-23 therapies, such as risankizumab and guselkumab, have shown great promise thanks to their strong efficacy and favourable safety profiles.

A case series from four Italian centres reported sustained effectiveness of these drugs, with no observed effects on viral replication or immune parameters in HIV-positive patients. Although the number of cases is limited, these therapies appear to be a compelling option for patients with extensive or treatment-resistant psoriasis.

Hi there , I hope you can assist me in some way please with some advice , I have had Pustular psoriasis since 2016 and my latest GPP is ongoing since 23rd January 2025 , I am glad it isn't as bad as it was but at its worst I was sent to hospital twice being told I needed IV but was sent home which surprised me given the state my skin was also had cellulitis in both legs and feet , the antibiotics (3) different types didn't do anything , I started reading about Metformin being a help with all psoriasis types , I have asked my diabetic nurse and she hadn't even heard of pustular psoriasis infact 2 out 3 doctors I have visited hadn't either , this is a concern that there clearly isn't enough of any knowledge on pustular psoriasis and/or GPP , I get that it is rare but that doesn't mean its any less dangerous!
I don't mean any disrespect but because there is such a lack of knowledge from medical professionals I have had to come on to this forum to find people that have knowledge first hand along the lines of what is the best medication available in UK because nobody in medical profession seems to be able to help or even heard know what GPP is ! 
I'm in my 10th week and still having outbreaks of new pustules daily on various parts of my body and would appreciate any advice you could offer please .

A real-world safety and effectiveness surveillance study of Tremfya (guselkumab) in Japanese patients with psoriasis.

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Guselkumab is a monoclonal antibody that binds to the p19 subunit of interleukin-23 and inhibits its downstream signaling. The safety profile of guselkumab and its superior efficacy over placebo and adalimumab for the treatment of patients with moderate-to-severe psoriasis were reported in phase 3 studies conducted within and outside Japan.

To assess the real-world safety and effectiveness of guselkumab in Japanese patients with psoriasis, we conducted a multicenter, single-arm, prospective, post-marketing surveillance study. Guselkumab was administered by subcutaneous injection at a dose of 100 mg at weeks 0 and 4, then every following 8 weeks.

The patient observation period was 52 weeks after the initial guselkumab dose or until treatment withdrawal. The safety analysis set consisted of 416 patients, including 310 patients with vulgaris (PsV); and the effectiveness analysis set consisted of 251 patients, including 236 patients with PsV or psoriatic arthritis (PsA). There were more men (71.3%, 221/310) than women among the PsV group. The median age among those with PsV was 58 years, the median disease duration was 11.50 years, 50.0% (155/310) had comorbidity, and 41.3% (128/310) had previously been treated with biologic agents.

During the observation period, 8.4% (35/416) of patients experienced 49 adverse drug reactions, 2.9% (12/416) experienced 13 serious adverse drug reactions, and 3.4% (14/416) experienced 16 adverse events leading to treatment discontinuation. In the effectiveness analysis set of 236 patients with PsV or PsA, the Psoriasis Area and Severity Index (PASI) 75, 90, and 100 response rates at week 52 were 69.9%, 54.5%, and 32.5%, respectively. Bio-naïve patients consistently had higher PASI 75 and 90 response rates than bio-experienced patients.

This post-marketing surveillance study demonstrated that guselkumab was well-tolerated and effective in a real-world setting in Japanese patients with psoriasis.

This study asked “If you could improve one thing about your psoriatic arthritis, what would it be?” and “What would an effective treatment change for you?”

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Objective:
The aim was to examine patient-reported treatment goals among individuals with psoriatic arthritis (PsA).

Methods:
Participants in the Psoriatic Arthritis Research Consortium (PARC) completed standardized assessments including patient-reported outcome (PROs) instruments between 2017-2020. Additionally, participants were asked two open-ended questions at enrollment or therapy initiation “If you could improve one thing about your disease, what would it be?” and “What would an effective treatment change for you?” to identify patients’ top improvement priority and their treatment impact goals, respectively. We categorized each response into a theme. The themes were matched to constructs measured by PRO items (i.e., pain, fatigue, skin, etc.). We describe themes and scores from matched PRO items.

Results:
Assessments were completed by 193 participants. Decreasing pain (56%) and improving skin (12%) were the most common improvement priorities. Impact goals were more diverse and included decreasing pain (24%), general improvement in life (18%), the ability to be more active (15%), participate in recreational activities (9%), function at work (11%) and exercise (5%). Of note, responses were often matched to more than one PRO item or instrument. The scores for PRO items that matched the patient's improvement priority, or the impact goal were higher than scores for the remainder of the population (i.e., fatigue item scores were higher among individuals identifying fatigue as their improvement priority).

Conclusions:
The heterogeneity of treatment goals underscores the importance of eliciting patient treatment goals to guide personalized management. Specific items within PROs may be helpful in identifying and following patient-specific treatment goals.

A one year quality of life and sexual health observational study in adult Asian psoriasis patients.

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Genital involvement and sexual dysfunction are common amongst patients with psoriasis. However, the effects of genital psoriasis on quality of life (QOL) and sexual health of psoriasis patients are not well understood.

We performed an observational study on adult Asian psoriasis patients attending psoriasis subspecialty clinics in a tertiary dermatology centre in Singapore over 1 year. Participants underwent clinical examination of the whole-body surface, with particular attention to the genitalia and questionnaires to evaluate QOL and psychosexual health were administered.

A total of 62 patients participated. Most participants were male (82.3%) with a mean age of 41.7 years (SD 12.5). The mean Psoriasis Area and Severity Index (PASI) score was 7.0 (SD 4.3) with a mean Dermatology Life Quality Index (DLQI) score of 9.8 (SD 6.7), indicating moderately impaired QOL. Higher PASI scores were associated with increasing QOL impairment on DLQI (p = 0.021). The commonest site involved was the suprapubic region (61.3%).

Males in whom genital psoriasis prevented sexual intercourse or diminished their libido reported more sexual dysfunction. Females reported a greater severity impact of genital psoriasis in terms of symptoms and embarrassment (p = 0.038) yet were less likely to be on treatment (37.5% vs. 45.0%).

Perceived efficacy of treatment was low, and younger patients fared poorly on the Patient Health Questionnaire-9 depression questionnaire (p = 0.047). Clinicians should proactively evaluate for and treat genital psoriasis, as patients may be reluctant to discuss their genital rashes if not prompted, leading to under-recognition and undertreatment.