This months poll asks: How embarrassing do you find psoriasis

*Thank you to Jim for the suggestion

Members and guests can vote in the poll above, and our members are welcome to post in this thread too if they wish.

*Members usernames will not be shown in the poll.

This might be a silly question, but I'm going to ask it anyway  
Hopefuly users of Methotrexate can tell me more.

If you use Methotrexate, it has an effect on your immune system, the chance of contracting viruses and bacteria and resulting infections is greater.
But what about saying hello to people? Do you have to take this into account? I mean shaking hands and kissing? 

Unfortunately, here in the Netherlands we give eachother three kisses when we see eachother and also when we leave... 
For me thats on a weekend with friends, and there are always around 30 men, it will be 90 kisses when i see them and then usually also 90 when I leave. .. I also try to sneak out ... but thats not always possible  

But have you received any advice about this when using Methotrexate? I can't find anything about this form of contact.

I've been reading on this Forum for a while now, it was Caroline who told me about this Forum, so thanks Caroline!  And now I'll introduce myself. My name is Yvon and I come from the Netherlands.

I have psoriasis since I was a child and I got physical complaints when I was 38, I am now 48 years old.
Complaints like back pain, terrible fatigue, painful knees, all my joints hurt, at least the attachments/tendons.

Hospital in and out. I got diagnoses like fibromyalgia, osteoarthritis and the worst "it must be psychological go see the psychiatrist".
Last year the pain became so bad, that I once again went to visit the general pratitioner, who wanted to send me away again, she said that it would be muscle overload. At my insistence, I was referred to the rheumatologist (the fourth), this time a rheumatologist who specializes in psoriatic arthritis.

During the first conversation he immediately confirmed my own suspicion, I also have psoriatic arthritis. He found it unimaginable that I was sent away so much in those 10 years because the signals for PsA were obvious.

Because here in the Netherlands it has to be demonstrated on the basis of redness and swelling and possibly confirmation via an ultrasound and this was all absent with me, I could only get the nsaids/painkillers.
This didn't work and I kept calling the rheumatologist, also because I got an unbearable nerve compression in my neck. Then they did an MRI of my neck and pelvis. It showed that the vertebrae were inflamed, deformities on my vertebrae and there were many spots on my pelvis and sacrum that indicated that there had been inflammation in the past.

In a week I will start with Methodextrate by injection, which I am not looking forward to. But Mtx is also the first choice in the Netherlands for treating PsA, only if that does not work well or you get too many side effects, you can switch to biologicals such as Humira. That's an insurance story here. While research here in the Netherlands indicates that MTX does not work sufficiently for PsA.

Anyway, I hope it will work, because the pain is driving me crazy. And in the meantime, I enjoy reading this Forum, to read your experiences. It's nice for me to see so much recognition, then you're not alone.

Bimzelx (bimekizumab) gets a positive recommendation for psoriasis in the EU.

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UCB, announced today that the European Medicines Agency’s (EMA) Committee for Medicinal Products for Human Use (CHMP) has adopted a positive opinion recommending granting a marketing authorization for BIMZELX®* (bimekizumab), an investigational IL-17A and IL-17F inhibitor, for the treatment of moderate to severe plaque psoriasis in adults who are candidates for systemic therapy.

“This positive CHMP opinion is a significant regulatory milestone towards approval of bimekizumab in Europe. We’re delighted by today’s decision which recognizes the strength of the psoriasis clinical development program. Bimekizumab is testament to our commitment to advancing science in immuno-dermatology, addressing unmet needs and improving patient outcomes,” said Emmanuel Caeymaex, Executive Vice President, Immunology Solutions and Head of U.S., UCB.

The positive CHMP opinion is supported by results from three Phase 3 studies – BE VIVID, BE READY and BE SURE – which evaluated the efficacy and safety of bimekizumab in adults with moderate to severe plaque psoriasis.  All studies met their co-primary and all ranked secondary endpoints. Patients treated with bimekizumab achieved superior levels of skin clearance (PASI 90 and IGA 0/1**) at week 16 compared to those who received adalimumab, placebo and ustekinumab.1,2,3 Clinical responses achieved with bimekizumab at week 16 were maintained up to one year in all studies. The most frequently reported treatment emergent adverse events in bimekizumab-treated patients were nasopharyngitis, oral candidiasis, and upper respiratory tract infection.

If marketing authorization is granted by the European Commission, bimekizumab will become the first approved treatment for patients with moderate to severe plaque psoriasis in the European Union that is designed to selectively and directly inhibit both IL-17A and IL-17F, two key cytokines driving inflammatory processes. The positive CHMP opinion is a scientific recommendation which is shared with the European Commission for the adoption of a decision on an EU-wide marketing authorization. A European Commission marketing authorization through the centralized procedure is valid in all European Union Member States, as well as the European Economic Area countries Iceland, Liechtenstein and Norway.

UCB is committed to bringing bimekizumab to patients worldwide. Bimekizumab is currently under review by the U.S. Food and Drug Administration for the treatment of adults with moderate to severe plaque psoriasis. Regulatory reviews are also underway in Japan, Australia and Canada. The efficacy and safety of bimekizumab are also being evaluated in Phase 3 trials in psoriatic arthritis,  ankylosing spondylitis, non-radiographic axial spondyloarthritis, and hidradenitis suppurativa.

Following on from this thread Could covid vaccine affect efficacy of psoriasis treatments I thought this may be of interest.

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A 46-year-old Caucasian man presented with psoriasis flare-up, which occurred a day after second dose of COVID-19 Pfizer-BioNTech BNT16B2b2 mRNA vaccine. The patient had been suffering from plaque psoriasis for 24 years. During the last 21 months, his psoriasis was completely clear (PASI 0 points) due to deucravacitinib treatment in the clinical trial. Before entering the clinical trial two years ago, the severity of his psoriasis was assessed as PASI 18 points. For the last 48 weeks, he has been in the open-label phase of above-mentioned trial receiving deucravacitinib 6 mg orally once daily.

Regarding COVID-19 vaccination, the patient received his first dose of Pfizer-BioNTech BNT16B2b2 mRNA vaccine and experienced only pain at the site of vaccine injection lasting for 24 hours. Five days after the second dose (administered 3 weeks after the first shot), he noticed psoriatic lesions on his lower legs, which quickly spread with time extending to the whole lower extremities and trunk. He presented again with pain at the injection site accompanied with fever up to 39°C and malaise lasting for 48 hours. On admission, one week after the disease exacerbation, physical examination revealed highly inflammatory, psoriatic plaques with gross, silver scaling localized mostly on patient’s lower legs. Moreover, multiple, smaller lesions were visible on patient’s back and chest. The patient did not complain of neither associated itch nor pain. The PASI score was 18.5 points.

Treatment of chronic inflammatory disorders changed drastically during COVID-19 pandemic. Problems with drugs availability and irregular consultations with dermatologist caused many patients to suffer from exacerbations. Moreover, the pandemic triggered insecurity about the use of novel treatment modalities. Yet, it is important to emphasize that psoriatic patients may present higher risk of respiratory diseases because of systemic inflammation. Therefore, and due to the lack of data on safety of novel, mRNA COVID-19 vaccines, concern on its impact on patients suffering from inflammatory diseases has been raised.

Vaccination, in general, is an uncommon factor triggering psoriasis flares; nevertheless, the association of vaccination with the new development or exacerbation of this skin disease has been reported. The available reports include mostly cases of psoriasis flare-ups after vaccination for influenza (H1N1), pneumococcal pneumonia and yellow fever. However, until now, there was no well-described association with novel mRNA COVID-19 vaccines. Possible cutaneous reactions after COVID-19 vaccination were characterized recently in a registry-based study of 414 cases by McMahon et al.

Among others, authors described cases of local site reactions, swelling, erythema, urticaria, erythromelalgia and flares of existing dermatologic disorders. Regarding the prevalence of psoriasis flare-ups, amid 414 cutaneous reactions, authors stated that it occurred only in two patients, which seems to be very rare. Moreover, there was no explicit description of skin lesions, nor its association with particular vaccination.6 Therefore, to the best of our knowledge, our case is the first, well-described example of psoriatic flare-up after COVID-19 Pfizer-BioNTech BNT16B2b2 mRNA vaccine. The mechanisms responsible for psoriasis exacerbation after vaccination are yet to be understood. It is possible that similarly to influenza vaccines, it may be caused by both dysregulation of immune system due to viral components and vaccine adjuvants.

Moreover, mRNA vaccines, like BCG or diphtheria, may cause a significant increase in IL-6 production and recruitment of Th17 cells, which play an important role in pathomechanism of psoriasis. Nevertheless, even though psoriasis flares are rare, because of extensive and rapid vaccination, medical professionals should pay close attention to possible adverse effects and counteract the worsening of patient’s clinical condition.

What are your thoughts on the covid vaccine having an affect on the efficacy of your psoriasis treatment. ?

I'm on Tremfya and have noticed the psoriatic arthritis isn't doing so well with my last two shots, and as usual I always try to understand why. But apart from thinking the Tremfya isn't working as well as it did, I'm stumped for an answer.

But I started looking at when I took my Tremfya in comparison with the dates of the Pfizer covid vaccine to see if there could be a link.

Tremfya:

24 April
19 June

Pfizer

05 May
14 June

When I look back at my journal it's 15 May that I said the psoriatic arthritis score had shot up from 7 to 12, since then my score has slowly gone up and it's now on 16.

Here is what I'm wondering.

Tremfya is slowing things down and doing it's job, but then along comes Pfizer which wants to create antibodies. So there is a boxing match going on in my system and both drugs are knocking hell out of each other.

The psoriatic arthritis is getting worse because Tremfya is now having to punch away at Pfizer whilst at the same time fight off psoriasis and psoriatic arthritis.

If this is the case its going to go on for a while as I have my third Pfizer jab on 15 July less than 4 weeks after my Tremfya. 

Thoughts ?

I was wondering what the worst area has been for people for psoriasis.  Not necessarily the longest, but either the area that has been most resistant to clearing or just the area that you feel has bothered you the most.

Mine, definitely ears, scalp area.

The ActiPso tool was used in a prospective study in psoriasis patients.

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Background:
Assessment of psoriasis is exclusively done measuring severity using somatic scores such as the psoriasis area and severity index (PASI) or patient-reported outcomes such as the dermatology life quality index (DLQI). There is no established tool to measure a patient’s individual psoriasis activity over time.

Objectives:
Development of a new tool to classify psoriasis activity types.

Methods:
Open patient interviews were performed and adapted in several steps and by using different groups of patients. Wording of the tool’s axis and description how to use it was optimized with the input of patients. The final ActiPso tool was used in a prospective study in psoriasis patients.

Results:
Four activity types could be identified describing psoriasis intensity (eg. severity, itch, pain) over one typical year and an event/trigger type describing flares.
In the study in 586 psoriasis patients of the 536 patients eligible for analysis 40.9% self-classified as type 1 (“stable”), 22.6 % as type 2 (“unstable”), 30.6 % as type 3 (“winter-type”), and 6.0 % as type 4 (“summer-type”), respectively. Flares of psoriasis as identified by the event/trigger type were reported in 36.1 % of patients with activity type 1, 67.8 % with type 2, 73.8 % of type 3, and 59.4 % of type 4, respectively.

Limitations:
In regions with no seasonal variations ActiPso types 3 and 4 may not apply.

Conclusions:
Interviewed patients were able to describe their course of psoriasis disease and to name potential triggering factors. By doing so activity types of psoriasis were defined for the first time and the importance of events/triggers for flares described and integrated into ActiPso types as a basis for advanced patient-centric management.

This study suggests Siliq / Kyntheum (brodalumab) was associated with higher levels of complete clearance and greater cumulative benefit over time compared with Stelara (ustekinumab)

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Background:
The pathway for treatment of psoriasis is partly dependent upon disease severity and patients may experience inadequate response at any point along the treatment pathway. Patients who repeatedly fail therapy represent a population in whom effective and well-tolerated treatment options are limited.

Objectives:
To investigate and describe patients achieving Psoriasis Area and Severity Index (PASI) 100 and cumulative treatment benefit over time in patients with moderate-to-severe psoriasis receiving brodalumab or ustekinumab by prior treatment.

Methods:
We conducted a post hoc analysis of data from two phase 3, randomized, controlled, 52-week AMAGINE trials of brodalumab to describe patients who achieved complete clearance as measured by PASI 100 by prior treatment subgroup (naïve to systemic and biologic treatment, systemic-treated but biologic-naïve, biologic-treated without failure, and biologic-treated with failure). A competing risk model was used to assess cumulative incidence over a 52-week period with outcomes of PASI 100 or inadequate response. Cumulative clinical benefit of treatment was determined with an area under the curve analysis.

Results:
The 52-week cumulative incidence of patients achieving PASI 100 were consistently higher for brodalumab vs. ustekinumab across treatment pathway subgroups (76% vs. 58% in systemic/biologic-naïve patients, 78% vs. 55% in systemic-treated/biologic-naïve patients, 75% vs. 41% in biologic-treated patients without failure, and 70% vs. 30% in biologic-treated patients with failure). Rates of inadequate response were lower with brodalumab compared with ustekinumab across all subgroups. Cumulative treatment benefit was also higher for all subgroups treated with brodalumab compared with those treated with ustekinumab.

Conclusion:
Treatment with brodalumab was associated with higher levels of complete clearance and greater cumulative benefit over time compared with ustekinumab, in patients with moderate-to-severe psoriasis, regardless of prior treatment experience.

Cosentyx has received U.S. Food and Drug Administration (FDA) approval for treatment of children with psoriasis.

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Novartis today announced the U.S. Food and Drug Administration (FDA) has approved Cosentyx® (secukinumab) for the treatment of moderate to severe plaque psoriasis in pediatric patients six years and older who are candidates for systemic therapy or phototherapy. This is the first approval for Cosentyx in a pediatric population in the US. The Cosentyx clinical profile is supported by five years of adult data showing long-lasting efficacy and a consistent safety profile across moderate to severe plaque psoriasis, psoriatic arthritis and ankylosing spondylitis.

The approved pediatric dosing for Cosentyx is 75 mg or 150 mg depending on the child’s weight at the time of dosing and is administered by subcutaneous injection every four weeks after an initial loading regimen. After initial counseling and proper training in injection technique, Cosentyx can be administered by an adult caregiver outside of a healthcare provider’s office via a single-dose prefilled syringe or Sensoready® pen.

This Cosentyx approval is based on two Phase III studies evaluating the use of Cosentyx in children aged 6 to 18 years with plaque psoriasis. The safety profile reported in these trials was consistent with the safety profile reported in adult plaque psoriasis trials. No new safety signals were observed.

The first study, which evaluated efficacy and safety, was a 52-week (236 weeks total), randomized, double-blind, placebo- and active-controlled study which included 162 children six years of age and older with severe plaque psoriasis. The data showed Cosentyx reduced psoriasis severity at Week 12 compared with placebo as demonstrated by the following efficacy results by baseline weight strata for the approved doses (75mg for <50kg and 150mg for ≥50kg): Psoriasis Area Severity Index (PASI) 75 response (55% 75 mg vs 10% placebo (N=22 and N=20, respectively), 86% 150 mg vs 19% placebo (N=21 and N=21, respectively), 70% total Cosentyx vs 15% total placebo (N=43 and N=41, respectively) and Investigator’s Global Assessment modified 2011 (IGA) “clear” or “almost clear” skin response (32% 75 mg vs 5% placebo, 81% 150 mg vs 5% placebo, 56% total Cosentyx vs 5% total placebo), co-primary endpoints of the study.

The second Phase III study, which assessed safety, was a randomized open-label, 208-week trial of 84 subjects six years of age and older with moderate to severe plaque psoriasis.

This months poll asks: Have you ever achieved psoriasis remission

*Thank you to Turnedlight for the suggestion

Members and guests can vote in the poll above, and our members are welcome to post in this thread too if they wish.

*Members usernames will not be shown in the poll.

I thought I would share this as I have been told I need three covid jabs.

France have recently reviewed their covid jab strategy and have put patients receiving an Immunosuppressant on three jabs of covid vaccine.

Today Mrs Fred went for her first jab this morning and met our old retired GP, he told her that I should ask about the third jab. As it happened I also had an appointment with my new GP this afternoon and she confirmed that it is being rolled out that anyone taking an Immunosuppressant is to have three shots.

#1 First shot

#2 Second shot 6 - 8 weeks later

#3 Third shot 4 weeks after the second.

When you book here you book your first and second jab dates together, that is about to change and there will soon be an option for those using an Immunosuppressant to book 3 dates. I have had my first jab so I have to phone my GP two days after my second jab and if I have had no problems she will talk to my dermatologist and write a prescription for my third jab 4 weeks later.

Any other countries doing three jabs for patients on an Immunosuppressant ?

It's not big but I thought it my be worth publishing for those using Methotrexate.

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Up to a third of patients taking methotrexate – a common treatment for immune mediated inflammatory conditions such as rheumatoid arthritis and psoriasis/psoriatic arthritis – failed to achieve an adequate immune response to mRNA COVID-19 vaccines in a small study accepted for publication in the journal Annals of the Rheumatic Diseases.

While mRNA COVID-19 vaccines have been shown to produce an effective immune response in over 90% of healthy adults in clinical trials, it is unknown whether the immune response is as robust in patients with immune-mediated inflammatory diseases (IMID) who may also be taking immunomodulatory medications.

The authors assessed the immune response to the mRNA Pfizer-BioNTech COVID-19 vaccine in 82 patients with immune-mediated inflammatory diseases (mainly psoriasis/psoriatic arthritis and rheumatoid arthritis) receiving methotrexate or an alternative immunomodulator (mainly TNF inhibitors and other biologics) at two centres – New York University Langone Health (New York, USA) and FAU Erlangen-Nuremberg and Universitatsklinikum Erlangen (Erlangen, Germany).

The study found that the Pfizer-BioNTech vaccine induced adequate antibody levels in up to a third fewer patients on methotrexate, when compared with healthy participants and patients with IMIDs on the other immunomodulatory drugs.

Adequate antibody levels were produced in over 90% of the 208 healthy participants and 37 patients on biologic or non-methotrexate oral treatments, but in only 62% of the 45 patients taking methotrexate.

Furthermore, while the vaccination induced activated CD8+ T cell responses in healthy participants and patients with immune-mediated inflammatory diseases not on methotrexate, this same induction was not seen in those patients on methotrexate. T cells are another part of the body’s immune defence system.

This is an observational study, and as such, can’t establish causality. The authors also acknowledge that the study had a small sample size, only assessed one type of mRNA COVID-19 vaccine, and could have included patients with previously asymptomatic COVID-19 infections.

They also point out that IMID patients on methotrexate were generally older than the comparison group (average age 63 vs 49) which may potentially explain some differences in immunogenicity.

Additionally, the authors emphasize that “it is not yet clear what level of immunogenicity is representative of vaccine efficacy.”

They go on to note that “although precise cut offs for immunogenicity that correlate with vaccine efficacy are yet to be established, our findings suggest that different strategies may need to be explored in patients with immune-mediated inflammatory diseases taking methotrexate to increase the chances of immunization efficacy against SARS-CoV-2 as has been demonstrated for augmenting immunogenicity to other viral vaccines.”

Methotrexate, for example, has previously been shown to reduce the immune response to the influenza vaccine.

The authors add: “Our results suggest that the optimal protection of patients with IMID against COVID-19 will require further studies to determine whether additional doses of vaccine, dose modification of methotrexate, or even temporary discontinuation of this drug can boost immune response as has been demonstrated for other viral vaccines in this patient population.”

This study in Greece looked at the effectiveness and safety of Otezla (apremilast) in biologic-naïve patients with moderate psoriasis.

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Background:
Apremilast is an oral phosphodiesterase-4 inhibitor indicated for patients with moderate-to-severe chronic plaque psoriasis and active psoriatic arthritis.

Objectives:
To examine the effectiveness of apremilast on Dermatology Life Quality Index (DLQI), Psoriasis Area and Severity Index (PASI), and nail, scalp, and palmoplantar involvement, when administered prior to biologics.

Methods:
This 52-week real-world study included biologic-naive adults with moderate psoriasis (psoriasis-involved body surface area 10% to <20%, or PASI 10 to <20 and DLQI 10 to <20). Apremilast was initiated ≤7 days before enrolment. Data from the first 100 eligible patients who completed 24 weeks (W24) of observation (or were prematurely withdrawn) are presented in this interim analysis using the last-observation-carried-forward imputation method.

Results:
Eligible patients (mean age: 49.9 years; 71.0% males; median disease duration: 8.0 years) were consecutively enrolled between April and October 2017, by 18 dermatology specialists practicing in hospital outpatient settings in Greece. Baseline DLQI (median: 12.0) and PASI (median: 11.7) scores improved (P<0.001) at all post-baseline timepoints (Weeks 6, 16, and 24; W24 median decreases: 9.0 and 9.4 points, respectively). At W24, DLQI ≤5, DLQI 0 or 1, and PASI-75 response rates were 63.0%, 25.0%, and 48.0%, respectively. The Nail Psoriasis Severity Index score in patients with baseline nail involvement (n=57) decreased at all post-baseline timepoints (P<0.001; W24 median decrease: 20.0 points). At W24, 50.0% and 51.7% of patients with baseline scalp (n=76) and palmoplantar (n=29) involvement, respectively, achieved post-baseline Physician’s Global Assessment (PGA) score 0 or 1 if baseline score was ≥3, or 0 if baseline score was 1 or 2. The adverse drug reaction rate was 21.0% (serious: 2.0%).

Conclusions:
These interim results indicate that through 24 weeks, apremilast improved quality of life and reduced disease severity in biologic-naive patients with moderate plaque psoriasis, while demonstrating safety consistent with the known safety profile.

Some of my fingernails are lifting off the nail bed. I am active and do yard work, repairs of all sorts etc. I wear nitril rubber gloves as much as possible but even then they split, and even when they don't somehow I seem to get dirt lodged down in the middle of my fingernail. I am looking for ways to remove the dirt that a nail file won't reach. I have read that it's not good to scrape the areas that the nail is supposed to be attached.

Any suggestions how to clean them once they get some dirt under them?

Any suggestions to help keep them clean when I am active?

Thanks

Here you will find the latest reliable news about psoriasis.

As most of you know I keep up to date with everything going on in the world of psoriasis and any information I get I make sure it's genuine and from a reliable source before publishing it on Psoriasis Club. This keeps us free from spammers and scammers, as well as avoiding free advertising for other websites.

Only myself (Fred) will be able to start new threads in this section but all our members are welcome to post their own views on a news item if they wish.

I don't miss much when it comes to good reliable psoriasis news, but if you feel I may have missed something our members with more than 5 posts can post in the [Group Specific] where we can go through it together and see if it is worthy of publication on Psoriasis Club.

The other health boards are still there for all members to use and by moving news here it should help our members find threads easier. If you want to get notification of a new thread in this new section our members can subscribe see here: Notification of new threads and posts

*This is a new board and there may be some teething troubles, so do let me know if you spot anything wrong.

I have a derm who is very helpful. I have Ps and maybe PsA. I would like to try a drug that will be good for both ailments. She has given me the option of requesting what drug I would like to try.

If you had your choice what would you choose?

The Physician’s Global Assessment of Fingernail Psoriasis (PGA-F) is a rapid, valid, and reliable clinician-rated severity scale.

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Background:
Several clinician-rated scoring systems are available to assess nail psoriasis severity, but only one has been partially validated.

Objective:
To develop and validate the Physician’s Global Assessment of Fingernail Psoriasis (PGA-F), a new clinician-rated severity scale.

Methods:
A literature review, concept elicitation, pilot cognitive debriefing, and clinical expert consultations informed development of the PGA-F. A multi-stage mixed methods analysis consisted of practicing dermatologist cognitive interviews (n=10) for instrument clarity, relevance, and comprehensiveness. Inter-rater reliability (IRR) of ratings from dermatologists (n=22) and clinical trial investigators (n=8) was tested using many-facet Rasch analysis. Concurrent validity between the PGA-F and modified Nail Psoriasis Severity Index (mNAPSI) at screening and baseline was assessed along with degree of discrimination. Intraclass correlation coefficient (ICC) for single raters at multiple assessments determined IRR.

Results:
The PGA-F synthesizes severity ratings across multiple disease features that classifies individuals into 1 of 5 levels (clear to severe). Cognitive interviews confirmed content validity: all (n=10, 100%) participants agreed clinical criteria were consistent with nail psoriasis; no mismatched severity levels; and training photographs were realistic representations. All PGA-F items were locally independent and targeted patients along the severity continuum with complementary precision (item fit statistics: < the 1.5 acceptability threshold; exact agreements amongst the dermatologists [44%] and trial investigators [61.5%] exceeded 40% acceptability threshold). Clinician reliability exceeded the threshold of acceptability for dermatologists and clinical trial investigators: 0.85 and 0.73, respectively. There was adequate correlation (>0.30) between mNAPSI and PGA-F at baseline and Week 26 with significant discrimination of severity and monotonic increases on the mNAPSI for each level of categorical severity on the PGA-F. ICC results for each type of IRR indicate that clinicians were consistent in individual patient ratings.

Conclusion:
The PGA-F is a rapid, valid, and reliable clinician-rated severity scale for use in clinical practice and research.

This study evaluated drug survival for methotrexate (MTX) monotherapy in patients with plaque psoriasis.

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Background:
Drug survival is useful to evaluate long-term drug performance in daily practice. The aim of this study was to evaluate drug survival for methotrexate (MTX) monotherapy in patients with plaque-type psoriasis.

Methods:
We reviewed 3,512 follow-up charts of patients with psoriasis at five tertiary referral centers between January 2012 and January 2020. We analyzed baseline data and treatment outcomes of patients under MTX monotherapy. Drug survival was analyzed using Kaplan-Meier and Cox regression analyses.

Results:
Patients with psoriasis who were treated with MTX monotherapy were enrolled (N = 649). The median duration of drug survival was 15 months (95% CI: 13.2–16.8). The overall drug survival rate was 54.7%, 17.4%, and 8% after 1, 3, and 5 years, respectively. The main reasons for discontinuation were adverse effects (n = 209, 32.2%) and inefficacy (n = 105, 15.6%). Based on multivariate Cox regression analysis, the presence of nausea/vomiting (HR: 2.01, 95% CI: 1.49–2.71; P < 0.001) was observed as a statistically significant risk factor for drug discontinuation. Age over 50 years (HR: 0.68, 95% CI: 0.48–0.97; P = 0.03) and using MTX dose ≥15 mg/weekly were positive predictors for drug survival (HR: 0.72, 95% CI: 0.54–0.95; P = 0.02).

Conclusions:
The average drug survival of MTX was 15 months. MTX is still the first-line treatment of moderate-to-severe plaque psoriasis, as highlighted in guidelines. To prevent premature discontinuation, physicians need to look at the response time of at least 16–24 weeks, especially when a stepwise dose increment is used. The presence of nausea/vomiting seemed to be associated with an approximately twofold risk of discontinuation.

This study looked at the various forms of scalp psoriasis.

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Background:
Scalp psoriasis is often undiagnosed or inadequately treated. The patient himself underestimates the seriousness of this hair disease and consults too late to a dermatologist.

Objectives:
The aim of our study was to create a correlation between the clinical patterns and trichoscopy of scalp psoriasis such in a way to help the clinician to make the diagnosis and select the appropriate therapy.

Material & Methods:
We gathered all patients affected of scalp psoriasis afferent to Outpatient’s hair consultation of the Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, from January 2012 to December 2018. All patients were evaluated through clinical, trichoscopic examination and a skin biopsy only in doubtful cases. We quantified the severity of the disease with several objective and subjective parameters every 4 months, up to 1 year. We recorded therapies, outcome data and quality of life.

Results:
We collected 156 patients affected by scalp psoriasis, identifying 7 clinical patterns with specific trichoscopical correlation. In order of frequency the clinical patterns were: plaque psoriasis (with a prevalence of erythema, silver-white scales and twisted red loops vessels and red dots); thin scales (with silvery-white scales, simple red lines and signet red ring vessels); sebopsoriasis (with greasy scales, erythema with red dots, globules and twisted and bushy red loops at high magnification); psoriatic cap (with silver-white scales, erythema and polymorphic vascular pattern); pityriasis amiantacea (with yellowish adherent scales, erythema and simple red loops capillaries); cicatricial psoriatic alopecia (with erythema associated with yellowish, silver-white scales with twisted and bushy red loops capillaries) and pustular psoriasis (with “flower shape” pustular lesions, erythema simple red loops capillaries).

Conclusions:
The description of different clinical patterns of scalp psoriasis and its trichoscopical correlations may help the clinician to make the diagnosis also in atypical presentations and to prescribe an adequate therapeutic regimen.