Psoriasis: Which therapy for which patient: Psoriasis comorbidities and preferred systemic agents.

Psoriasis is a systemic inflammatory disease associated with increased risk of comorbidities, such as psoriatic arthritis, Crohn's disease, malignancy, obesity, and cardiovascular diseases. These factors have a significant impact on the decision to use one therapy over another. The past decade has seen a paradigm shift in our understanding of the pathogenesis of psoriasis that has led to identification of new therapeutic targets. Several new drugs have gained approval by the US Food and Drug Administration, expanding the psoriasis armamentarium, but still a large number of patients continue to be untreated or undertreated. Treatment regimens for psoriasis patients should be tailored to meet the specific needs based on disease severity, the impact on quality of life, the response to previous therapies, and the presence of comorbidities. The first article in this continuing medical education series focuses on specific comorbidities and provides insights to choose appropriate systemic treatment in patients with moderate to severe psoriasis.

Psoriasis: Which therapy for which patient: Focus on special populations and chronic infections.

Despite the availability of several new systemic agents for psoriasis treatment, choosing the right therapy in certain patient populations can be challenging. There are few up-to-date reviews on systemic drugs for moderate to severe psoriasis in pregnant and pediatric patients and in patients with concomitant chronic infections, such as hepatitis, HIV, and latent tuberculosis. These groups are usually excluded from clinical trials, and much of the available evidence is based on anecdotal case reports and case series. As a chronic disease, psoriasis requires long-term treatment, and there are concerns of adverse maternal-fetal outcomes, long-term side effects in children, and the reactivation of latent infections with the use of systemic agents in these patients. The second article in this continuing medical education series provides insights for choosing appropriate systemic agents for treating moderate to severe psoriasis in pregnant and pediatric patients and in the setting of chronic infections, such as hepatitis, HIV, and latent tuberculosis.

Review of safety and efficacy of approved systemic psoriasis therapies.

Psoriasis is a chronic inflammatory disease which affects nearly 3% of the adult US population. Due to the chronic nature of the disease and need for long-term treatment, psoriasis is associated with substantial disease burden and negative impact on patients' quality of life. In the past, systemic agents such as methotrexate, cyclosporine, and acitretin have been the mainstay treatment for moderate to severe psoriasis. Multiple new molecular targets have been recently identified, and novel biologic therapies directed at these targets have been approved leading to a paradigm shift in psoriasis management. However, despite the availability of several treatment options and continued introduction of highly efficacious biologics, undertreatment of psoriasis patients remains a huge problem. This can be largely attributed to several causes including high cost of biologics, lack of experience, and reluctance of practitioners to initiate or switch to systemic treatment regimens in moderate to severe psoriasis patients. In this article, we aim to provide a concise review of mechanism, safety, and efficacy of the approved systemic treatments for psoriasis.

Nonablative Fractional Laser Resurfacing in Skin of Color: Evidence-based Review.

Background: Nonablative laser resurfacing represents one of the major advances in procedural dermatology over the past decade. However, its use in darker skin types is limited by safety concerns and a relative lack of available data. Aim: To provide evidence-based recommendations for the use of fractional lasers in darker skin types. Evidence review: A broad literature search of PubMed/Medline database was conducted in April 2016 using the term fractional lasers. A free text search of keywords including fractional resurfacing, nonablative lasers, skin type, skin of color, ethnic skin, Fitzpatrick skin type, Asian skin, African Americans, Afro-Caribbean, and Hispanics was also executed. An in-depth review of all the relevant articles fitting the authors' inclusion/exclusion criteria was performed. Thereafter, each study was assigned levels of evidence per the Modified Criteria by Oxford Center of Evidence Based Medicine. A recommendation was made for a specific treatment based on the presence of at least one Level 1 study or more than three Level 2 or 3 studies that had concordant results. Findings: The available evidence strongly suggests that fractional lasers are a favorable treatment option for a variety of dermatological diseases in Fitzpatrick skin phototypes IV to VI. Level 1 evidence was found for the use of fractional lasers for treating acne, striae and skin rejuvenation. Level 2 evidence was found for their use in acne scars, melasma, and surgical/traumatic scars. Conclusion: Fractional resurfacing is a safe and efficacious treatment option for various dermatological disorders in darker skin types; however, there is a paucity of high-quality studies involving skin types V and VI.

Non-coding RNAs in skin cancers: An update.

Skin cancers are the most common form of cancer in humans. They can largely be categorized into Melanoma and Non-melanoma skin cancers. The latter mainly includes Squamous Cell Carcinoma (SCC) and Basal Cell Carcinoma (BCC), and have a higher incidence than melanomas. There has been a recent emergence of interest in the role of non-coding RNA's in pathogenesis of skin cancers. The transcripts which lack any protein coding capacity are called non-coding RNA. These non-coding RNA are further classified based on their length; small non-coding RNA (<200 nucleotides) and long non-coding RNA (>200 nucleotides). ncRNA They are involved at multiple transcriptional, post transcriptional and epigenetic levels, modulating cell proliferation, angiogenesis, senescence and apoptosis. Their expression pattern has also been linked to metastases, drug resistance and long term prognosis. They have both diagnostic and prognostic significance for skin cancers, and can also be a target for future therapies for cutaneous malignancies. More research is needed to further utilize their potential as therapeutic targets.

Chronic pruritus in HIV-positive patients in the southeastern United States: its prevalence and effect on quality of life.

BACKGROUND: Prevalence of chronic pruritus in HIV-positive patients is an underevaluated topic in the United States. The characteristics, severity, and quality of life (QOL) in patients with HIV and chronic pruritus have not been well documented using validated tools. OBJECTIVES: We sought to assess the prevalence and intensity of chronic pruritus and its effect on QOL in HIV-positive patients in a US population. METHODS: HIV-positive patients (n = 201) were asked to complete a sociodemographic data form and 2 itch questionnaires. Patients with itching rated their itch intensity on a numeric visual analog scale. Laboratory parameters were obtained from patients' medical records. RESULTS: The prevalence of chronic itch in the study group was 45% with an average visual analog scale score of 5.93 during an itch episode. Patients with high visual analog scale score had significantly decreased QOL. Patients with HIV reported greater negative impact of pruritus on daily lives. LIMITATIONS: Because of the cross-sectional design, this study demonstrates an association between HIV and pruritus but cannot prove causation. CONCLUSION: Patients with HIV surveyed in a large clinic in the southeastern United States have a high prevalence of pruritus; HIV pruritus has a significant effect on QOL and itch is the most common skin manifestation found in this population.

Transient receptor potential channels and dermatological disorders.

Transient receptor potential (TRP) cation channels are an emerging field of research in dermatology. Beyond their classical role in skin sensory perception, TRPs are involved in various cutaneous functions that include keratinocyte differentiation, apoptosis and melanocyte pigmentation. In addition, they have a role as pharmacological targets in many inflammatory skin diseases including psoriasis, chronic itch, hair disorders and skin cancers. Moreover, mutations in TRPs have recently been related to rare skin conditions such as Olmsted syndrome. This review will cover the role of TRPs in dermatologic conditions with special emphasis on itch and skin inflammatory diseases.

Segmental ulcerated perineal hemangioma of infancy: a complex case of PELVIS syndrome successfully treated using a multidisciplinary approach.

We report a case of PELVIS (perineal hemangioma, external genital malformations, lipomyelomeningocele, vesicorenal abnormalities, imperforate anus and skin tag) syndrome in which hemangioma in the perineal area was misdiagnosed at birth as diaper rash. Investigations revealed associated vesicorenal and spinal abnormalities. We emphasize careful diagnosis of suspicious lesions at birth and confirm the successful use of propranolol in treating ulcerated segmental hemangiomas.