This cohort study comprised 7,029,160 patients over 20 years old explored the relationship between psoriasis and chronic obstructive pulmonary disease (COPD) to determine whether patients with psoriasis are at increased risk for developing COPD.

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Background:
Understanding the relationship between psoriasis and chronic obstructive pulmonary disease (COPD) may enhance disease management.

Objectives:
We aimed to determine the prevalence and incidence and risk of COPD in psoriasis patients.

Results:
The COPD prevalence was 9.64 % in psoriasis patients and 6.94 % in psoriasis-free patients. The COPD incidence was 10.74 per 1000 person-years in psoriasis patients and 6.36 per 1000 person-years in psoriasis-free patients. Multivariable Cox regression showed no association between psoriasis and COPD development (HR 0.99, p = 0.271).

Conclusions:
Our findings suggest that psoriasis is not an independent risk factor for COPD development.

In this case-report, we describe an Human immunodeficiency virus positive patient with generalised pustular psoriasis (GPP) possible triggered by monkeypox vaccination and eventually successfully treated with spesolimab, an interleukin-36 inhibitor.

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A man in his thirties with well-controlled Human immunodeficiency virus (HIV) infection (CD4 cell count of 841 cells/mm3) and without previous skin disease developed a rash 7 days after monkeypox vaccination (Imvanex, Lot. No.: FDP00007). His regular medications (abacavir/dolutegravir/lamivudine, desloratadine and melatonin) were unchanged for years. The rash gradually worsened with pustules, fever and systemic symptoms, and he was admitted to the Infectious diseases department. Initially, Herpes simplex virus (HSV) type 2 was detected from the skin, and he was treated with intravenous acyclovir and dicloxacillin. Repeated blood cultures, viral and bacterial skin swabs were negative. After 1 week of treatment, there was no improvement in either the rash or his general condition and he was transferred to the department of Dermatology.

Upon admission, he presented with a generalised erythematous rash with widespread pustules. As the fever and leukocytosis were interpreted to be secondary to the skin inflammation, antibiotics and antiviral therapy were paused and he was treated with intravenous fluids, acetaminophen and topical hydrocortisone butyrate 0.1%. However, his condition rapidly declined with persistent fever above 39°C, tachycardia, hypotension, and an elevated respiratory rate.

Clinically, we first considered AGEP possibly triggered by monkeypox vaccination. The morphological picture could not distinguish between AGEP and GPP and as the rash did not improve, we considered GPP as a differential diagnosis. Treatment with acitretin 0.75 mg/kg was initiated but discontinued after 2 days due to a threefold elevation in liver enzymes.

A comprehensive reassessment for infections came out negative, also test for serum anti-HSV immunoglobulin (Ig) M. A chest & abdomen computer axial tomography revealed basal lung infiltrates and hepatomegaly. To cover Gram-negative bacteria causing a nosocomial pneumonia, he received intravenous treatment with a third-generation cephalosporin, and his condition improved rapidly concomitantly with resolution of the rash.

Due to a relapse, he was readmitted 10 days later. Recalcitrant AGEP was considered, and a second biopsy was taken. As soon as his liver enzymes were normalised, acitretin was re-initiated in a lower dose (0.35 mg/kg). In addition, he was given oral cyclosporin 4-5 mg/kg. His rash and overall condition responded well to this combined treatment. The second biopsy showed similar findings, but the number of eosinophils was substantially decreased. Four weeks later, his renal function deteriorated (serum creatinine 189 µmol/L, ref 60–105 µmol/L). His blood lipids also increased considerably (total cholesterol 10 mmol/L (ref 3.3-6.9 mmol/L) prompting an alternative treatment strategy.

Due to the lack of clinical improvement, as we would have expected with AGEP, we finally considered GPP as the most likely diagnosis. A third biopsy showed similar findings as the previous biopsies; the epidermis was acanthotic with increased basal proliferation, pronounced hypogranulosis and compact parakeratosis with small collections of neutrophilic granulocytes. In the dermal papillae small, tortuous capillaries were seen.

Intravenous treatment with spesolimab was administered approximately 4 months after onset of symptoms. Encouragingly, this led to rapid clearance of his rash and clinical improvement within the first few days. Clinical scorings revealed a GPP Physician Global Assessment (GPPGA) score of 3 and Dematology Life Quality Index (DLQI) of 30 before treatment. One week after treatment, GPPGA was reduced to 1 and DLQI to 4. The treatment had no impact on regular CD4 cell counts, or on HIV-, Cytomegalovirus- and EBV-DNA level quantification. He is still in remission 8 months after treatment, back to work with a GPPGA score and DLQI of 0.

Not sure it proves a lot as I would have thought some countries are happier than others but it's a study.

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Background:
Dermatological research has traditionally concentrated on evaluating mental comorbidities, neglecting positive concepts like happiness. Initial studies indicate that psoriasis and atopic dermatitis (AD) impair the happiness of those affected. Considering global happiness variations, this study aimed to explore the disease- and country-specific differences in disease-related quality of life and happiness, and potential influential factors on heuristic happiness among psoriasis and AD patients in Europe.

Methods:
A cross-sectional multicentre study was conducted in dermatology departments of university-affiliated hospitals in eight European countries (Austria, Germany, Italy, Malta, Poland, Portugal, Romania and Ukraine) between October 2021 and February 2023. Adult psoriasis and AD patients completed a standardized questionnaire in their native languages, providing data on demographics, disease-related characteristics, disease-related quality of life (Dermatology Life Quality Index, DLQI), heuristic happiness, positive affect (PA), negative affect (NA) and satisfaction with life (SWL). Descriptive analysis and quantile regression were performed.

Results:
Between psoriasis (n = 723) and AD (n = 316) patients almost no differences were observed in happiness, SWL and NA, except for DLQI and small differences in PA, with AD patients reporting greater impact than psoriasis patients. Country-wise variation emerged in DLQI, heuristic happiness, PA, NA and SWL with Austrian patients displaying the highest levels of happiness, satisfaction and positivity, coupled with higher treatment care and lower disease severity. Quantile regression revealed varying coefficients for predictor variables across quantiles, indicating, for example positive effects on heuristic happiness associated with current or previous receipt of systemic therapies at different quantiles.

Conclusion:
This study shows notable happiness differences across European countries and significant disease-related variations, particularly with AD patients being more impaired than psoriasis patients. The findings highlight the need for equality in treatment access and support the development of targeted positive psychological interventions to enhance happiness considering country-specific distinctions in future research and health policies for psoriasis and AD patients.

This study explored the role of early nutrition as a risk factor for the development of psoriasis.

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Background:
Psoriasis is a genetically determined systemic skin disease, although environmental trigger factors are required for disease manifestation. Some of these triggers, such as stress, infections and drug exposure, have been identified.

Objectives:
To explore the role of early nutrition as a risk factor for the development of psoriasis.

Methods:
Parents in the All Babies in Southeast Sweden (ABIS) prospective birth cohort (n = 16 415) answered questionnaires at birth and when their children were aged 1 and 3 years. A diagnosis of psoriasis was determined from the Swedish National Patient Register and National Drug Prescription Register. Statistical analyses were conducted using custom-written R scripts.

Results:
Individuals breastfed for < 4 months and who received infant formula before 4 months of age had a higher risk of psoriasis [odds ratio (OR) 1.84 (P = 0.02) and OR 1.88 (P = 0.02), respectively]. At the 3-year follow-up, the increased consumption of fish, especially from the Baltic Sea, increased the risk of psoriasis (OR 9.61; P = 0.003). In addition, the risk of psoriasis increased following the consumption of a large volume of milk (OR 2.53; P = 0.04).

Conclusions:
Our study underscores, for the first time, the impact of very early nutrition on the manifestation of psoriasis through early adulthood. Exclusive breastfeeding for 4 months appears to be protective.

Interim analysis results at Week 12 from the GULLIVER study.

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Background:
Facial (FP) and genital psoriasis (GP) significantly affect patients' quality of life. Despite the advances in treatments, limited data on efficacy and safety are available on these difficult-to-treat areas. Guselkumab is an interleukin (IL)-23 inhibitor which has been proven effective in treating patients with moderate-to-severe plaque psoriasis.

Objectives:
The aim of this interim analysis was to report the efficacy and safety of guselkumab in the treatment of patients with FP and/or GP.

Materials and Methods:
GULLIVER is a 52-week Italian observational study to evaluate the effectiveness and safety of guselkumab in a real-life setting in patients with FP and/or GP. Adult patients with facial and/or genital moderate-to-severe psoriasis (sPGA score ≥ 3) were included. The primary endpoint of this analysis was the percentage of patients achieving a facial or genital sPGA score of 0 (clear) or 1 (almost clear), at Week 12. The change in the score of the facial or genital sPGA components in patients with a score ≥3 for each sPGA component was assessed. PASI score in patients with a baseline PASI above or below 10 was evaluated.

Results:
Overall, 351 patients were included in the study; 83.3% of FP and 76.5% of GP patients achieved the primary endpoint. Similar response rates were observed for the facial or genital sPGA components in patients with a baseline facial or genital sPGA score ≥3 in each component. Among patients with a baseline PASI score >10, mean PASI score improved from 19.0 (SD 8.3) to 2.2 (SD 4.8). Forty-four AEs were observed in 32 patients; two mild and transient AEs (fatigue and nausea) were considered treatment related. No SAEs were observed.

Conclusions:
Guselkumab, showing to be effective and safe in treating FP and GP, may be a valid therapeutic option for patients with psoriasis localized in these difficult-to-treat areas.

Exploratory multi-omics analysis reveals host-microbe interactions associated with disease severity in psoriatic skin

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Background:
Psoriasis (Pso) is a chronic inflammatory skin disease that poses both physical and psychological challenges. Dysbiosis of the skin microbiome has been implicated in Pso, yet a comprehensive multi-omics analysis of host-microbe interactions is still lacking. To bridge this gap, we conducted an exploratory study by adopting the integrated approach that combines whole metagenomic shotgun sequencing with skin transcriptomics.

Methods:
This was a cross-sectional study, adult patients with plaque-type Psoriasis (Pso) and healthy volunteers were included. Skin microbiota samples and biopsies were collected from both lesional and non-lesional skin areas on the lower back. Weighted Gene Correlation Network Analysis (WGCNA) was employed for co-expression network analysis, and cell deconvolution was conducted to estimate cell fractions. Taxonomic and functional features of the microbiome were identified using whole metagenomic shotgun sequencing. Association between host genes and microbes was analyzed using Spearman correlation.

Findings:
Host anti-viral responses and interferon-related networks were identified and correlated with the severity of psoriasis. The skin microbiome showed a greater prevalence of Corynebacterium simulans in the PASI severe-moderate groups, which correlated with interferon-induced host genes. Two distinct psoriatic clusters with varying disease severities were identified. Variations in the expression of cell apoptosis-associated antimicrobial peptides (AMPs) and microbial aerobic respiration I pathway may partly account for these differences in disease severity.

Interpretation:
Our multi-omics analysis revealed for the first time anti-viral responses and the presence of C. simulans associated with psoriasis severity. It also identified two psoriatic subtypes with distinct AMP and metabolic pathway expression. Our study provides new insights into understanding the host-microbe interaction in psoriasis and lays the groundwork for developing subtype-specific strategies for managing this chronic skin disease.

Results from a retrospective, multicentric, multi-country, cohort study of drug survival rates of interleukin IL-17 and IL-23 inhibitors in elderly psoriasis patients.

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Background:
Scarce data related to the drug survival of biologic agents in psoriasis patients aged ≥65 years is available.

Objectives:
To evaluate the drug survival of interleukin (IL)-23 or the IL-17 inhibitors approved for the treatment of moderate-to-severe psoriasis in elderly patients (aged ≥65 years), compared with younger adult patients (aged <65 years), and to identify clinical predictors that can influence the drug survival.

Methods:
This retrospective multicentric cohort study included adult patients with moderate-to-severe psoriasis, dissecting two-patient subcohorts based on age: elderly versus younger adults. Kaplan–Meier estimator and proportional hazard Cox regression models were used for drug survival analysis.

Results:
We included 4178 patients and 4866 treatment courses; 934 were elderly (1072 treatment courses), and 3244 were younger patients (3794 treatment courses). Drug survival, considering all causes of interruption, was higher in patients aged <65 years than in elderly patients overall (log-rank p < 0.006). This difference was significant for treatment courses involving IL-23 inhibitors (p < 0.001) but not for those with IL-17 inhibitors (p = 0.2). According to both uni- and multi-variable models, elder age was associated with an increased risk of treatment discontinuation (univariable analysis: HR: 1.229, 95% CI 1.062–1.422; p < 0.006; multivariable analysis: HR: 1.199, 95% CI 1.010–1.422; p = 0.0377). Anti-IL-23 agents were associated with a reduced likelihood of treatment discontinuation after adjusting for other variables (HR: 0.520, 95% CI 0.368–0.735; p < 0.001). Being previously treated with IL-17 inhibitors increased the probability of discontinuation.

Conclusion:
Elderly patients with psoriasis have an increased risk of biologic treatment discontinuation compared with younger adult patients, particularly, if being treated with IL-23 inhibitors. However, in stratified analyses conducted in elderly patients, IL-23 inhibitors showed higher drug survival rates than IL-17 inhibitors.

Class 4 Medicines Defect Information: Manx Healthcare Ltd., Betamethasone Valerate 0.1% Ointment, EL(24)A/18

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MDR number: 142-05/24

Company name: Manx Healthcare Ltd.

Product name: Betamethasone Valerate 0.1% Ointment, PL 14251/0010

SNOMED Code: 41207211000001102

Batch Number: G0039

Expiry Date: Feb-2027

Pack Size: 30g

First Distributed: April 2024

Active Pharmaceutical Ingredient: Betamethasone valerate

Brief description of the problem
Manx Healthcare Ltd. has informed MHRA that they have identified a problem with the product packaging of the batch indicated in the table. The tamper-evident seal on the outer carton may be missing or deformed on some packs. This is due to an intermittent equipment fault during secondary packaging.

Advice for healthcare professionals
The quality of the ointment is not impacted by the defect. Any packs from this batch of product with missing or deformed seals may be dispensed. Healthcare professionals dispensing this medication may wish to advise patients that the seal on the outer carton may be broken but this will not affect product quality.

Advice for patients
The quality of the ointment is not impacted by the manufacturing issue as it only affects the outer carton. The tube of ointment that the patient receives will be sealed. Patients should continue to take medicines from this batch as prescribed by your healthcare professional.

Source: gov.uk

UChicago Chemistry Prof. Bozhi Tian’s lab has been working on a patch to monitor and improve psoriasis.

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Living bioelectronics is a combination of living cells, gel, and electronics that can integrate with living tissue.

The patches are made of sensors, bacterial cells, and a gel made from starch and gelatin. Tests in mice found that the devices could continuously monitor and improve psoriasis-like symptoms, without irritating skin.

Typically, bioelectronics consist of the electronics themselves, plus a soft layer to make them less irritating to the body. But Tian’s group wondered if they could add new capabilities by integrating a third component: living cells themselves. The group was intrigued with the healing properties of certain bacteria such as S. epidermidis, a microbe that naturally lives on human skin and has been shown to reduce inflammation.

They created a device with three components. The framework is a thin, flexible electronic circuit with sensors. It is overlaid with a gel created from tapioca starch and gelatin, which is ultrasoft and mimics the makeup of tissue itself. Lastly, S. epidermidis microbes are tucked into the gel.

When the device is placed on skin, the bacteria secrete compounds that reduce inflammation, and the sensor monitors the skin for signals like skin temperature and humidity.

In tests with mice prone to psoriasis-like skin conditions, there was a significant reduction in symptoms.

“We’re very excited because it’s been a decade and a half in the making,” said Tian.

The British government will be bringing in new labelling for topical steroids.

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Topical steroids are highly effective for the treatment of inflammatory skin conditions such as eczema and psoriasis, when prescribed and used appropriately. They are available in different potencies:

• mildly potent (for example, hydrocortisone)
  
• moderately potent (for example, clobetasone)
  
• potent (for example, betamethasone)
  
• very potent (for example, clobetasol)
  

The lowest potency topical steroid for effective treatment should be used and this may mean using different potency products for different body areas.

Over the coming year, topical steroids will be labelled with their potencies to aid correct selection and to simplify the advice to patients requiring multiple steroid products of differing potencies. These will be labelled ‘mild steroid’, ‘moderate steroid’, ‘strong steroid’, and ‘very strong steroid’.

Adverse reactions have been reported following long-term (generally 6 months or more) use of moderate or stronger potency topical steroids.

In psoriasis, use of large quantities of topical steroids is associated with a risk of more severe disease such as generalised pustular psoriasis.

Hi, I found this thread through a search on ppp. I have had this increasingly debilitating condition for about 4 years. Started on one foot as a small patch and is now covering most of the soles of both feet and now seems to be creeping up the sides and tops of my feet, maybe even my ankles. I have been doing light therapy for 6 months and it has helped a tiny bit on my soles. It is so painful, sore, itchy that I can’t wear socks or shoes and I have become isolated to the point of rarely leaving my house. I am on disability due to other conditions. I think it started as an autoimmune reaction to having cancer which was treated, now 3 years since last treatment. Doctors tell me to go live my best life now that cancer is gone but they don’t understand how painful this psoriasis is. I can make it to the grocery store once in a while. After about 20 mins on my feet they are painful, sore, like someone is sticking hot pokers in me. I also have neuropathy from cancer treatment so it feels like bugs are crawling up my legs most of the time. I gained a lot of weight during cancer and can’t walk to exercise which also helps other pain. I am so frustrated so I am hoping I can find some help or support or ideas here. Hoping not to be judged too harshly as I do still smoke. I don’t drink much alcohol. I don’t have much energy for cooking these days so that has been awful. My stress is through the roof and I am not sure what to do anymore as I am often so depressed that I don’t even get dressed and lose myself in tv or video games. My life has gotten so small. Hoping that I can gain some motivation and find some ideas to try and at least get back on my feet.

Just wondered how many of you on here who suffer with psoriasis, also suffer, or
Have suffered, with sinus problems at some point in your life?

This Swedish study looked at compulsory military service in men and psoriasis.

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Background:
Although stress is considered to be a negative factor for psoriasis, no convincing scientific evidence of this association exists, largely because of difficulties in measuring stress. Stress resilience is the ability to cope with and adapt to stressful events. Stress resilience can be measured in a standardized way and used as a marker for chronic stress.

Objectives:
The objective of this study is to investigate whether low stress resilience in adolescence increases the risk for onset of psoriasis and psoriatic arthritis later in life.

Methods:
A cohort of Swedish men (mean age 18.3 years), enrolled in compulsory military service between 1968 and 2005, was created using data from the Swedish Military Service Conscription Register (n = 1,669,422). Stress resilience at conscription was estimated using standardized semi-structured interviews, and was divided into three categories: low, medium and high. The men were followed from conscription until new-onset psoriasis or psoriatic arthritis, death or emigration or at the latest until 31 December 2019. Cox regression models adjusted for confounders at conscription were used to obtain hazard ratios (HRs) with 95% confidence intervals (CIs) for incident psoriasis and psoriatic arthritis.

Results:
Men in the lowest stress resilience category had an increased risk of psoriasis and psoriatic arthritis (HR 1.31 (95% CI 1.26–1.36) and 1.23 (95% CI 1.15–1.32), respectively), compared with those in the highest stress resilience category. When including only hospitalized patients the HRs for psoriasis and psoriatic arthritis in the lowest stress resilience group were 1.79 (1.63–1.98) and 1.53 (1.32–1.77), respectively.

Conclusions:
This large, prospective register study suggests that low stress resilience in adolescence is associated with an increased risk of incident psoriasis among men. The results indicate that patients with psoriasis have an inherent psychological vulnerability, and highlight the importance of addressing psychological well-being in the management of psoriasis.

This study looked evaluated the potential of serum protein levels as predictive biomarker candidates whilst using Tremfya (guselkumab)

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Background:
Response to biologics in psoriasis varies in real-world settings. Serum biomarkers could aid biologic selection and dose modifications to improve patient outcomes while encouraging cost-effective care.

Objectives:
To explore the exposure–response relationship for guselkumab (GUS), to define a GUS concentration target for optimal response and to evaluate the potential of serum protein levels as predictive biomarker candidates.

Methods:
This is a prospective, multicentric, cohort study in psoriasis patients treated with GUS. Serum GUS trough concentrations (TCs) collected at multiple timepoints were measured using an in-house immunoassay. Next, proximity extension assay technology (Target 96 Inflammation Panel Olink®) was used to measure serum protein levels in a subcohort including 38 GUS patients (week 0 and week 4), six psoriasis patients naive for systemic treatment and four healthy controls.

Results:
Seventy-five patients participated and 400 samples were collected. Guselkumab TCs and clinical response were correlated at week 4, week 12 and in steady-state (≥20 weeks). Optimal responders (Psoriasis Area and Severity Index [PASI] ≤ 2) had significantly higher TCs than suboptimal responders from week 4 onwards in treatment. An optimal steady-state TC of 1.6 μg/mL was defined. Although TC and absolute PASI were lower and worse, respectively, in patients weighing ≥90 kg, clinical outcomes referred to desirable to excellent PASI ranges. Therefore, we do not recommend systematically higher GUS doses in obese patients. We could not reveal early differentially expressed proteins to distinguish future optimal from suboptimal responders.

Conclusions:
We demonstrated an exposure–response relationship for GUS and an optimal steady-state TC of 1.6 μg/mL in real-world psoriasis patients. Hereby, we deliver more evidence that therapeutic drug monitoring poses a promising strategy in optimizing GUS treatment. No biomarker candidates were identified through serum proteomics. We propose protein screening should be repeated in larger cohorts to continue the quest for predictive biomarkers.

This German study looked at effectiveness, safety and impact of Tremfya (guselkumab) on sexuality and perceived stigmatization in patients with psoriasis.

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Background:
G-EPOSS is a prospective, non-interventional, German multicentre study of patients with moderate-to-severe plaque psoriasis receiving guselkumab, a therapeutic monoclonal antibody targeting interleukin-23, in a real-world setting.

Objectives:
The objective of the study was to evaluate the effectiveness and safety of guselkumab, including its impact on skin, health-related quality of life (HRQoL), sexuality, and perceived stigmatization.

Methods:
Patients (≥18 years old) received guselkumab per routine clinical practice. The primary endpoint was the proportion of patients achieving absolute Psoriasis Area and Severity Index (PASI) ≤ 3 at Week (W)28. Secondary endpoint assessments over 28 weeks included the Nail Psoriasis Severity Index (NAPSI), anogenital Physician's Global Assessment (aPGA), and Dermatology Life Quality Index (DLQI). Sexuality and perceived stigmatization were assessed by patients using the Relationship and Sexuality Scale (RSS) and Perceived Stigmatization Questionnaire (PSQ), respectively.

Results:
Overall, 293 patients were included in the evaluable set population. Mean age and disease duration were 45.6 and 17.6 years, respectively. At baseline, mean PASI, aPGA and DLQI scores were 15.3, 2.7 and 11.3, respectively. In total, 25.9% of patients had received a prior biologic. Overall, 83.0% of patients achieved PASI ≤ 3, and 56.2%/35.1% achieved PASI ≤ 1/PASI = 0, respectively, at W28. Among those with NAPSI ≥ 1 and aPGA ≥ 1 at baseline, NAPSI = 0 and aPGA = 0 were achieved by 39.2% and 61.1% of patients, respectively, and 61.4% of patients achieved DLQI 0–1 at W28. Improvements were observed over 28 weeks across individual items of the DLQI, RSS and PSQ, indicating improved HRQoL and sex life, and decreased perceived stigmatization. Based on DLQI Question (Q)9, 53.6% of patients experienced sexual difficulties at baseline, which decreased to 12.1% at W28. DLQI Q9 responses were consistent with RSS item responses, highlighting DLQI Q9 as a sentinel for sexual impairment.

Conclusions:
Guselkumab improved overall skin symptoms and HRQoL in patients with psoriasis and decreased sexual impairment and perceived stigmatization. No new safety signals were observed.

This study was passed to me by afternoonfix

Scientists from The Australian National University (ANU) have discovered a gene mutation is responsible for causing psoriasis.

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According to ANU researcher Dr Chelisa Cardinez, if two copies of this mutated gene (known as IKBKB) are present, patients with psoriasis may go on to develop psoriatic arthritis, leaving them with joint pain, stiffness and swelling. Thanks to the world-first discovery from ANU, scientists now know what causes the progression from a skin-only disease to a skin and joint disease.

It’s hoped the findings will lead to improved diagnosis and treatment for patients with psoriasis and psoriatic arthritis – conditions that patients say carry stigma in the community.

“Using a mouse model, we identified that this mutation led to an abnormal function in a group of immune cells known as regulatory T cells,” Dr Cardinez, from the ANU John Curtin School of Medical Research (JCSMR), said.

“These cells are normally considered gatekeepers of the immune system. However, we found that this mutation alters the function of these cells, causing them to contribute to inflammation and promote the onset of disease.”

Dr Cardinez said: “Studies have shown that delays in psoriatic arthritis diagnosis is linked to worse clinical outcomes for patients. Therefore, earlier detection and treatment of these immune diseases is key to improving health outcomes.

"By developing a better understanding of the IKBKB gene and the role it plays in promoting the onset of these diseases, it could bring us a step closer to one day finding a cure.

Hi there,

I've been using Enstilar foam with good results for a while now, but ever since I started using it, I developed a red rash around my nose and chin. At first I though it was down to a milk allergy I have, but I stopped using Enstilar for 3 days and the rash went away. I then started using it again and the rash came back. From looking online, it seems that it's allergic contact dermatitis, caused by Butylated Hydroxytoluene.
Does anyone else have any experience with this? And does anyone know if there's a particular antihistamine that could combat this? I tried using a hydrocortisone directly on the rash, but that didn't do much.

Any help would be much appreciated. Thank you.

Well, after a seemingly endless wait I'm finally on Imraldi.

I've had three injections in the last two weeks and can already see an improvement in some patches on my arms and side, though my legs have yet to take notice.

My derm has yet to sort my blood tests out but hopefully they'll be fine. I'll try and keep you updated with progress and fingers crossed for good results.

This French population based real world cohort study looked at pustular psoriasis (GPP)

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Background:
GPP is a rare, chronic, neutrophilic skin disease, with limited real-world data characterizing patients with flares and the impact of flares on disease progression and morbidity.

Objective:
Describe the clinical characteristics of patients with GPP, comorbidities, disease epidemiology and frequency and severity of flares, and compare patients with GPP with a matched severe psoriasis population.

Methods:
In this population-based real-world cohort study an algorithm was developed to identify patients with GPP flares. Three cohorts were identified using the Système National des Données de Santé (SNDS) database covering almost the entire French population; a prevalent cohort (2010–2018), an incident cohort (2012–2015). A severe psoriasis cohort was compared with the GPP incident cohort using propensity score matching.

Results:
The prevalent and incident cohorts comprised 4195 and 1842 patients, respectively. In both cohorts, mean age was 58 years; 53% were male. Comorbidities were significantly more common in the incident cohort versus matched psoriasis cohort, respectively, including hypertension (44% vs. 26%), ischaemic heart disease (26% vs. 18%) and hyperlipidaemia (25% vs. 15%). In the incident cohort, the flare rate was 0.1 flares/person-year and 0.4 flares/person-year among the 569 out of 1842 patients hospitalized with flares. These patients had a mean (±SD) stay of 11.6 ± 10.4 days; 25% were admitted to the intensive care unit. In 2017, the cumulative incidence and cumulative GPP age–sex standardized prevalence were 7.1 and 45.2 per million, respectively.

Conclusions:
Patients with GPP had a distinct comorbidity profile compared to patients with severe psoriasis, and GPP flares were associated with long hospitalizations.