Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients.

Psoriasis is a chronic, multisystem, inflammatory disease that affects approximately 1% of children, with onset most common during adolescence. This guideline addresses important clinical questions that arise in psoriasis management […]

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Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with phototherapy.

Psoriasis is a chronic inflammatory disease involving multiple organ systems and affecting approximately 3.2% of the world’s population. In this section of the guidelines of care for psoriasis, we will focus the discussion on ultraviolet light-based therapies, which include narrowband and broadband UVB, UVA in conjunction with photosensitizing agents (PUVA), targeted UVB treatments like excimer laser, and several other modalities and variations of these core phototherapies, including newer applications of pulsed dye laser, intense pulse light, and light emitting electrodes. We will provide an in-depth, evidence-based discussion of efficacy and safety for each treatment modality and provide recommendations and guidance for the use of these therapies alone or in conjunction with other topical and/or systemic psoriasis treatments.

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Complete Skin Clearance and PASI response rates in clinical practice- Predictors, Health Related Quality of Life improvements and implications for treatment goals.

PASI90 is suggested to be the new standard endpoint RCTs of biologics for psoriasis, whereas treatment guidelines often still refer to PASI75.To analyse in a real-world setting: Firstly, what factors are associated with higher levels of treatment response to biologics. Secondly, the Health-Related Quality of Life gains associated with different response levels in clinical practice.Biologically-naïve patients with PASI, DLQI and EQ-5D outcomes before (maximum 6 months) and after (3-12 months) switch to biologics during registration in the Swedish Register for systemic treatment of psoriasis, PsoReg, were included (n=515). Patient characteristics associated with higher treatment response were analysed by regression analyses. Improvements in absolute PASI, DLQI and EQ-5D were assessed in different PASI percent response levels.High PASI percentage response was associated with higher PASI before switch and lower BMI. DLQI and EQ-5D improved within all responder groups (p<0·001). The magnitude of improvements in DLQI (p=0·02) differed between responder groups. The mean (SD) DLQI improvement for PASI75-<90, PASI90-<100 responders and patients achieving Complete Skin Clearance (PASI100) were 9·9 (7·4), 11·5 (7·0) and 8·0 (6·1), respectively.PASI percentage change is largely dependent on absolute PASI before switch. Patients in clinical practice lack "baseline" PASI values as they may switch directly from one treatment to another or stay successfully treated for a longer time period. Treatment goals such as PASI90 are thus not suitable for treatment guidelines or for follow-up in clinical practice. This article is protected by copyright. All rights reserved.

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Grading immunohistochemical markers p16INK4a and HPV E4 identifies productive and transforming lesions caused by low- and high-risk HPV within high-grade anal squamous intraepithelial lesions.

Current LAST guidelines recognise high- and low-grade anal squamous intraepithelial lesions (HSIL, LSIL) and recommend treatment of all HSIL, but not all HSIL progress to cancer. This study aims to distinguish transforming and productive HSIL by grading immunohistochemical (IHC) biomarkers p16 and E4 in lr- and hr-HPV- associated SIL as a potential basis for more selective treatment.Immunostaining for p16 and HPV E4 was performed and graded in 183 biopsies from 108 HIV+ MSM. Causative HPV genotype of the worst lesion was identified using SPF10-PCR-DEIA-LiPA25v1, with laser capture microdissection (LCM) for multiple infections. Worst lesions were scored for p16 (0-4) to identify activity of hrHPV E7 gene, and panHPV E4 (0-2) marking HPV production and life-cycle completion. There were 37 normal, 60 LSIL and 86 HSIL with 85% LSIL caused by lrHPV and 93% HSIL by hrHPV. No normal biopsy showed E4 but 43% of LSIL and 37% of HSIL were E4 positive. No differences in E4 positivity rates were found between lrHPV and hrHPV lesions. Most (90%) lesions caused by lrHPV showed very extensive patchy p16 staining. p16 grade in HSIL was variable with frequency of productive HPV infection dropping with increasing p16 grade.Combined p16/E4 IHC identifies productive and non-productive HSIL associated with hrHPV within the group of HSIL defined by the Lower Anogenital Squamous Terminology recommendations. This opens the possibility of investigating selective treatment of hrHPV-caused advanced transforming HSIL and a “wait and see” policy for productive HSIL.

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Latin American Clinical Practice Guidelines on the Systemic Treatment of Psoriasis SOLAPSO – Sociedad Latinoamericana de Psoriasis (Latin American Psoriasis Society).

This Clinical Practice Guideline on the systemic treatment of Psoriasis includes the recommendations elaborated by a panel of experts from the Latin American Psoriasis Society SOLAPSO, who assessed the quality of the available evidence using the GRADE system and the PICO process to guide the literature search. To answer each question, the experts discussed the results of randomized controlled trials, observational studies and metanalysis evaluating the interventions identified (non-biologics, biologics and phototherapy) in different populations of patients with moderate to severe plaque-psoriasis, which was summarized in Tables ad-hoc. The main end-points considered to assess efficacy were PASI 50, 75, 90 and 100, PGA 0-1 and significant improvement of health-related quality of life. Specific adverse events, either severe or leading to treatment interruption, were also evaluated. The 31 recommendations included in this CPG follow the structure proposed by GRADE: direction (for or against) and strength (strong or weak). The goal of this CPG is to improve the management of patients with psoriasis by recommending interventions of proved benefit and providing a reference standard for the treating physician. Adhering to the contents of this CPG does not guarantee therapeutic success. The final decision on the specific treatment is the responsibility of the physician based on the individual circumstances and considering the values, the preferences and the opinions of the patient or caregivers.

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Topical treatments in atopic dermatitis: unexpectedly low use of emollients; use of topical corticosteroid is higher in juvenile patients, higher in male vs females, and shows independent associations with asthma and depression.

Abstract: Despite decades of use,the actual amounts of topical corticosteroids (TCS) and emollients used in moderate-to-severe atopic dermatitis (AD) under real-world conditions are unknown. Thus, it remains unclear if inadequate […]

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Mammalian target of rapamycin (mTOR) inhibitors and skin cancer risk in nonrenal solid organ transplant recipients: systematic review and meta-analysis.

Abstract: Solid organ transplant recipients have an increased risk of malignancy compared with the general population. Mammalian target of rapamycin (mTOR) inhibitors have been used as immunosuppressants in transplant recipients. […]

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