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Psoriasis: HELP
Articles from Wake Forest University
Based on 222 articles published since 2009
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These are the 222 published articles about Psoriasis that originated from Wake Forest University during 2009-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9
1 Editorial Assessing Efficacy and the Speed of Response in Psoriasis Treatment. 2019

Light, Jeremy G / Haidari, Wasim / Feldman, Steven R. ·a Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine , Winston-Salem , NC , USA. · b Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine , Winston-Salem , NC , USA. · c Department of Pathology, Wake Forest School of Medicine , Winston-Salem , NC , USA. · d Department of Social Sciences & Health Policy, Wake Forest School of Medicine , Winston-Salem , NC , USA. · e Department of Dermatology, University of Southern Denmark , Odense , Denmark. ·J Dermatolog Treat · Pubmed #31339413.

ABSTRACT: -- No abstract --

2 Editorial Choice Overload in Systemic Psoriasis Therapy. 2019

Whitman, Patrick A / Cline, Abigail E / Feldman, Steven R. ·a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , North Carolina ; · b Department of Pathology , Wake Forest School of Medicine , Winston-Salem , North Carolina. · c Department of Social Sciences & Health Policy, Wake Forest School of Medicine , Winston-Salem , North Carolina and. · d Adjunct Professor of Dermatology, University of Southern Denmark. ·J Dermatolog Treat · Pubmed #30919721.

ABSTRACT: -- No abstract --

3 Editorial Comorbidities in patients with psoriasis: The role of the dermatologist. 2017

Saleem, Mohammed D / Feldman, Steven R. ·Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina. Electronic address: msaleem@g.clemson.edu. · Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina. ·J Am Acad Dermatol · Pubmed #28619566.

ABSTRACT: -- No abstract --

4 Editorial Impact and management of depression in psoriasis patients. 2016

Korman, Abraham M / Hill, Dane / Alikhan, Ali / Feldman, Steven R. ·a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA. · b Department of Dermatology , University of Cincinnati College of Medicine , Cincinnati , OH , USA. · c Department of Pathology , Wake Forest School of Medicine , Winston-Salem , NC , USA. · d Department of Public Health Sciences , Wake Forest School of Medicine , Winston-Salem , NC , USA. ·Expert Opin Pharmacother · Pubmed #26641936.

ABSTRACT: -- No abstract --

5 Editorial Are wash outs needed in clinical trials of topical agents? 2014

Sandoval, Laura F / Feldman, Steven R. ·Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC. ·J Dermatolog Treat · Pubmed #24328994.

ABSTRACT: -- No abstract --

6 Review Biologic Treatment Options for Pediatric Psoriasis and Atopic Dermatitis. 2019

Cline, Abigail / Bartos, Gregory J / Strowd, Lindsay C / Feldman, Steven R. ·Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, 475 Vine St, Winston-Salem, NC 27101, USA. aecline25@gmail.com. · Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, 475 Vine St, Winston-Salem, NC 27101, USA. · Department of Dermatology, Wake Forest School of Medicine, 475 Vine St, Winston-Salem, NC 27101, USA. · Department of Pathology, Wake Forest School of Medicine, 475 Vine St, Winston-Salem, NC 27101, USA. · Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA. · Department of Dermatology, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark. ·Children (Basel) · Pubmed #31514420.

ABSTRACT:

7 Review A safety review of recent advancements in the treatment of psoriasis: analysis of clinical trial safety data. 2019

Kolli, Sree S / Kepley, Anna L / Cline, Abigail / Feldman, Steven R. ·a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA. · b Department of Pathology , Wake Forest School of Medicine , Winston-Salem , NC , USA. · c Department of Public Health Sciences , Wake Forest School of Medicine , Winston-Salem , NC , USA. ·Expert Opin Drug Saf · Pubmed #31046481.

ABSTRACT: INTRODUCTION: The management of psoriasis can include oral medications and injectable biologics. Safety data of these various treatment options are important to consider when choosing the right treatment for the patient. AREAS COVERED: This review evaluates the safety of newer treatments approved for psoriasis, including interleukin-(IL)-17 inhibitors, IL-23/p19 inhibitors, ustekinumab, certolizumab pegol and apremilast, using phases III and IV clinical trial data. EXPERT OPINION: Even as treatment of psoriasis becomes safer, it is important to recognize both common and uncommon adverse effects of treatment. Common adverse effects are similar across treatment options, including upper respiratory infection and injection-site reaction. Serious adverse effects occur less frequently and specific to the psoriasis treatment option, such as inflammatory bowel disease and candida infections with IL-17 inhibitors, tuberculosis with certolizumab pegol, and psychiatric events with apremilast. While IL-23/p19 inhibitors may have a slightly better safety profile than other biologics, long-term data are limited. The conclusions that can be drawn from clinical trial safety data are limited given that many clinical trials are not large enough to detect rare safety events. Data from registries provide important complementary information on long-term safety but there are limitations including a lack of randomized assignment between drug treatments.

8 Review Mechanisms of microbial pathogenesis and the role of the skin microbiome in psoriasis: A review. 2019

Lewis, Daniel J / Chan, Warren H / Hinojosa, Tiffany / Hsu, Sylvia / Feldman, Steven R. ·Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. Electronic address: dlew2191@gmail.com. · School of Medicine, Baylor College of Medicine, Houston, Texas, USA; Department of Dermatology, Stanford University School of Medicine, Redwood City, California, USA. · Center for Clinical Studies, Houston, Texas, USA. · Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA. · Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA; Departments of Pathology and Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA. ·Clin Dermatol · Pubmed #30981296.

ABSTRACT: The pathogenesis of psoriasis may involve a breakdown of immune tolerance to cutaneous microorganisms. Psoriasis is associated with a higher incidence of Crohn disease and periodontitis, two diseases involving impaired tolerance and abnormal immune activation in response to intestinal and oral microbiota, respectively. In addition, guttate and chronic plaque psoriasis are associated with Streptococcus pyogenes colonization. The aim of this review is to characterize the microorganisms implicated in psoriasis by examining results of major association studies and possible mechanisms of pathogenesis. Although studies show relative increases in Streptococcus and Staphylococcus and decreases in Malassezia and Cutibacterium, they differ in methods of sampling and methods of microbial analysis. As such, no definitive associations between microbes and psoriasis have been found to date. It also remains unclear if changes in the microbiomal composition have a causal association with psoriasis or are simply a consequence of the inflammatory microenvironment. Techniques enabling strain-level analysis rather than species-level analysis of the skin microbiome are likely necessary to determine microbiomal signatures of psoriasis. Future investigations may lead to new diagnostic tests and novel treatments, such as probiotics or bacterial transplantation.

9 Review Diet and psoriasis. 2019

Pona, Adrian / Haidari, Wasim / Kolli, Sree S / Feldman, Steven R. ·Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina. apona@wakehealth.edu. ·Dermatol Online J · Pubmed #30865402.

ABSTRACT: BACKGROUND: Patients with psoriasis have a growing interest in managing their disease through diet. OBJECTIVE: This review paper aims to analyze dietary interventions for psoriasis and their outcome. METHODS: Terms "psoriasis AND diet" were used to search PubMed database and 63 articles describing dietary changes influencing psoriasis were selected. RESULTS: Low calorie diet (LCD) improves Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) in conjunction with topical or systemic therapy, although LCD was unsuccessful in maintaining disease remission when patients discontinued concomitant cyclosporine or methotrexate therapy. A fish oil diet improved baseline PASI of 7.7 to 5.3 at three months and 2.6 at 6 months compared to control (PASI: 8.9, 7.8, and 7.8, respectively). A randomized, double-blind, placebo-controlled study investigating selenium supplementation in psoriasis provided no PASI improvement. Zinc supplementation with concomitant betamethasone valerate 0.0025% ointment in a randomized, double-blind, placebo-controlled study provided a mean PASI of 11.2 in the intervention group and 8.0 in the control group with no significant difference between both arms. Gluten free diet and vitamin D supplementation were also efficacious dietary changes although results were mixed. CONCLUSIONS: Dietary changes alone do not cause a large effect in psoriasis but may become an important adjunct to current first line treatments.

10 Review Pharmacotherapeutic strategies for standard treatment-resistant psoriasis. 2019

Heath, Michael S / Kolli, Sree S / Dowling, Jessica R / Cline, Abigail / Feldman, Steven R. ·a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA. · b Department of Pathology , Wake Forest School of Medicine , Winston-Salem , NC , USA. · c Department of Social Sciences & Health Policy , Wake Forest School of Medicine , Winston-Salem , NC , USA. ·Expert Opin Pharmacother · Pubmed #30589362.

ABSTRACT: INTRODUCTION: Psoriasis management includes a variety of treatments including localized therapies and systemic treatments; however, many patients report inadequate clinical response and resistance to therapy. Currently there is no treatment algorithm that incorporates effective strategies to tackle the various barriers leading to resistance. AREAS COVERED: The authors evaluate the scope of resistance, the reasons it occurs, and provide the reader with strategies for overcoming resistance in both localized and systemic therapies for psoriasis. EXPERT OPINION: Refractory psoriasis involves modifiable and non-modifiable factors that warrant different approaches to maximize clinical response. Treatment-resistance to topical therapies may be due to poor adherence. Improving adherence involves incorporating patients' treatment preferences, improving the physician-patient relationship, and simplifying treatment regimens. Treatment-resistance to systemic therapies can be due to non-adherence but can also be due to ineffective dosing, development of anti-drug antibodies, and severe disease that necessitates multiple drugs. After addressing non-adherence, strategies to maximize systemic therapies include increasing the dosage, combining treatments, drug switching and incorporating pharmacogenetics.

11 Review Heterogeneity and variation of innovator biologics. 2019

Sahni, D R / Feldman, S R. ·School of Medicine, Virginia Commonwealth University, Richmond, VA, USA. · Center for Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA. · Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA. · Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA. ·J Eur Acad Dermatol Venereol · Pubmed #30451328.

ABSTRACT: -- No abstract --

12 Review Current biological therapies for use in HIV-positive patients with psoriasis: case report of gesulkumab used and review. 2018

Bartos, Gregory / Cline, Abigail / Beroukhim, Kourosh / Burrall, Barbara A / Feldman, Steven R. ·Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina. aecline@wakehealth.edu. ·Dermatol Online J · Pubmed #30695971.

ABSTRACT: BACKGROUND: Psoriasis in human immunodeficiency virus (HIV)-positive patients may be severe. Physicians may be tentative to use biologics in HIV-infected patients. OBJECTIVE: We present an HIV-positive patient with psoriasis who was treated with guselkumab. This paper aims to investigate the safety, efficacy, and tolerability of biologic therapies for HIV-positive patients with psoriasis. METHODS: A systematic PubMed review of articles dating between 2000-2018 containing key words psoriasis AND HIV, and psoriatic AND HIV combined with several approved biologic therapies. The review generated 15 articles containing 27 cases of HIV-positive patients treated with etanercept, infliximab, adalimumab, or ustekinumab for their psoriasis. RESULTS: The majority of cases reported excellent clinical responses, limited adverse events, and well tolerated treatment. CD4 count and viral loads were stable throughout treatment. Similar safety and efficacy were seen in the illustrative case report. Available literature is limited to case reports or case series and could be subject to publication bias of successful cases. Many reports lack quantifiable data and report results based on clinical judgement. No randomized, controlled trials evaluate biologic treatment for psoriasis in HIV-positive patients. CONCLUSIONS: The findings suggest that biologic therapy is an efficacious, safe, and tolerable treatment for most patients with moderate-to-severe psoriasis in HIV-positive patients.

13 Review Psychosocial impact of psoriasis: a review for dermatology residents. 2018

Kolli, Sree S / Amin, Sima D / Pona, Adrian / Cline, Abigail / Feldman, Steven R. ·Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. · Departments of Pathology and Public Health Sciences, Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. ·Cutis · Pubmed #30566553.

ABSTRACT: Psoriasis is a chronic inflammatory disease with both a physical and psychosocial burden. To offer strategies for dermatology residents to assess and manage psychosocial aspects of psoriasis, a PubMed search of articles indexed for MEDLINE was performed using the following terms:

14 Review Current pharmacological treatment guidelines for psoriasis and psoriatic arthritis. 2018

Stiff, Katherine M / Glines, Katelyn R / Porter, Caroline L / Cline, Abigail / Feldman, Steven R. ·a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA. · b Department of Pathology , Wake Forest School of Medicine , Winston-Salem , NC , USA. · c Department of Social Sciences & Health Policy , Wake Forest School of Medicine , Winston-Salem , NC , USA. ·Expert Rev Clin Pharmacol · Pubmed #30449211.

ABSTRACT: INTRODUCTION: Psoriasis is a common chronic skin condition that is prevalent worldwide. Despite the numerous treatment options available, discrepancies exist between international guidelines. Areas covered: This review aims to evaluate the current international guidelines for the systemic treatment of psoriasis and psoriatic arthritis. Expert commentary: Most guidelines are unanimous on medication dosing and laboratory monitoring. However, even the most up-to-date guidelines do not include many of the new biologic medications. Guidelines will require frequent updates to include the newer treatments and will soon need to state a recommendation on the use of biosimilars.

15 Review Investigational drugs in phase II clinical trials for moderate to severe plaque psoriasis - potential new treatments on the horizon. 2018

Guda, Anisha / Feldman, Steven R / Strowd, Lindsay. ·a UT Health San Antonio Long School of Medicine , San Antonio , TX , USA. · b Departments of Dermatology, Pathology and Department of Social Sciences & Health Policy Wake Forest School of Medicine , Center for Dermatology Research , Winston-Salem. · c Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , North Carolina , USA. ·Expert Opin Investig Drugs · Pubmed #30293437.

ABSTRACT: INTRODUCTION: Psoriasis is a common immune disorder for which there are many FDA-approved therapies. Older oral drugs had limited efficacy and considerable side effects. Biologics have been a major advance but require self-administered injections, and many patients prefer oral options. Because many patients fear needles, oral drugs are a welcome option. This review provides an update on oral drugs in Phase II development for psoriasis. AREAS COVERED: A literature review was performed to identify these drugs by using search terms such as 'psoriasis', 'agents', 'drugs', and 'phase 2 development'. Baricitinib and KDO 25 are the oral drugs that appear to hold the most promise due to the balance they maintain between efficacy and adverse effects. If a RORγt inhibitor can be identified that has no hepatotoxicity, then that may be the most promising new oral treatment. EXPERT OPINION: Several new oral psoriasis medications are currently being investigated. One major challenge remains medication cost and insurance coverage. Phase III studies are needed to determine efficacy and safety in large cohorts of psoriasis patients. An increase in the number of approved oral medications for psoriasis would mean more choice for psoriasis patients.

16 Review Targeting p19 as a treatment option for psoriasis: an evidence-based review of guselkumab. 2018

Wechter, Todd / Cline, Abigail / Feldman, Steven R. ·Stony Brook Medicine, Stony Brook, NY, USA, todd.wechter@stonybrookmedicine.edu. · Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA. · Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA. · Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA. ·Ther Clin Risk Manag · Pubmed #30174431.

ABSTRACT: Further understanding of psoriasis pathogenesis has led to the development of effective biologic medications. Guselkumab (GUS) is a subcutaneously administered monoclonal antibody that targets the p19 cytokine subunit in IL-23 and IL-39 and is US Food and Drug Administration (FDA) approved for the treatment of moderate-to-severe psoriasis in adult patients. This review evaluates the pharmacology, safety and efficacy of GUS in patients with psoriasis. We performed a literature review by searching online databases including PubMed and Google Scholar. In clinical trials, GUS improved diseases including psoriatic arthritis (PsA) and specific areas of disease (scalp, feet, hands and fingernails). In the Phase III trials VOYAGE 1 and 2, more GUS than adalimumab (ADM) patients experienced a ≥90% reduction in Psoriasis Area and Severity Index (PASI) score (PASI90) (VOYAGE 1: 80.2% vs 53.0%; VOYAGE 2: 75.2% vs 54.8%;

17 Review Medication adherence and persistence in patients with rheumatoid arthritis, psoriasis, and psoriatic arthritis: a systematic literature review. 2018

Murage, Mwangi J / Tongbram, Vanita / Feldman, Steven R / Malatestinic, William N / Larmore, Cynthia J / Muram, Talia M / Burge, Russel T / Bay, Charles / Johnson, Nicole / Clifford, Sarah / Araujo, Andre B. ·Eli Lilly and Company, Indianapolis, IN, USA, murage_mwangi_james@lilly.com. · ICON Plc, New York, NY, USA. · Wake Forest University School of Medicine, Winston-Salem, NC, USA. · University of Cincinnati, Division of Pharmaceutical Sciences, Winkle College of Pharmacy, Cincinnati, OH, USA. · ICON Plc, San Francisco, CA, USA. ·Patient Prefer Adherence · Pubmed #30174415.

ABSTRACT: Purpose: Proper adherence and persistence to medications are crucial for better quality of life and improved outcomes in rheumatoid arthritis (RA), psoriasis (PsO), and psoriatic arthritis (PsA). We systematically describe current adherence and persistence patterns for RA, PsO, and PsA, with a focus on biologics and identifying factors associated with adherence and persistence. Patients and methods: Using various databases, a systematic literature review of US-based studies published from 2000 to 2015 on medication adherence and persistence to biologics and associated factors was conducted among patients with RA, PsO, and PsA. Results: Using the medication possession ratio or the percentage of days covered >80%, RA and PsO adherence rates for etanercept, adalimumab, and infliximab ranged from 16% to 73%, 21% to 70%, and 38% to 81%, respectively. Using the criteria of a ≥45-day gap, RA persistence rates for etanercept, adalimumab, and infliximab ranged from 46% to 89%, 42% to 94%, and 41% to 76%, respectively. In PsO, persistence rates for etanercept and adalimumab ranged from 34% to 50% and 50% to 62%, respectively. Similar persistence rates were observed in PsA. Experienced biologics users showed better adherence and persistence. Younger age, female gender, higher out-of-pocket costs, greater disease severity, and more comorbidities were associated with lower adherence and persistence rates. Qualitative surveys revealed that nonpersistence was partly due to perceived ineffectiveness and safety/tolerability concerns. Conclusion: Biologic adherence and persistence rates in RA, PsO, and PsA in the United States were low, with significant opportunity for improvement. Various factors - including decrease in disease severity; reduction of comorbidities; lower out-of-pocket costs; refilling at specialty pharmacies; and awareness of drug effectiveness, safety, and tolerability - can inform targeted approaches to improve these rates.

18 Review Adherence and resource use among psoriasis patients treated with biologics. 2018

Aleshaki, Joseph S / Cardwell, Leah A / Muse, Mikél E / Feldman, Steven R. ·a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA. · b Department of Pathology , Wake Forest School of Medicine , Winston-Salem , NC , USA. · c Department of Social Sciences & Health Policy , Wake Forest School of Medicine , Winston-Salem , NC , USA. ·Expert Rev Pharmacoecon Outcomes Res · Pubmed #30142007.

ABSTRACT: INTRODUCTION: The emergence of immune-modulating drugs such as biologics has altered the treatment landscape for psoriasis. However, their use presents high financial costs to patients and healthcare systems. Patient demographic and socioeconomic status may influence adherence to biologic medications and usage of healthcare resources. AREAS COVERED: We performed a systematic literature review to summarize the available evidence pertaining to biologic medication adherence and resource use. PubMed was searched using the terms 'psoriasis and adherence' and 'psoriasis biologics resource use.' EXPERT COMMENTARY: Psoriasis patients utilize many healthcare resources. Adherence rates are typically higher for biologics than for other psoriasis treatment categories. However, adherence rates are still suboptimal.

19 Review Pharmacokinetics of tazarotene and acitretin in psoriasis. 2018

Heath, Michael S / Sahni, Dev R / Curry, Zachary A / Feldman, Steven R. ·a Department of Dermatology, Center for Dermatology Research , Wake Forest School of Medicine , Winston-Salem , NC , USA. · b Department of Pathology , Wake Forest School of Medicine , Winston-Salem , NC , USA. · c Department of Social Sciences & Health Policy , Wake Forest School of Medicine , Winston-Salem , NC , USA. ·Expert Opin Drug Metab Toxicol · Pubmed #30134735.

ABSTRACT: INTRODUCTION: Psoriasis is a prevalent cutaneous condition with severe physical and psychological manifestations. Since the advent of biologics, clinical outcomes in psoriasis have improved. However, retinoids are useful in the correct clinical context. Tazarotene and acitretin are currently the only US Food and Drug Administration approved retinoids for treatment of psoriasis. Both topical tazarotene and oral acitretin act on retinoic acid receptors and retinoid-X-receptors, resulting in altered gene expression of inflammatory cytokines and inhibition of keratinocyte proliferation. Areas covered: This article provides an in-depth pharmacologic and clinical review on the use of tazarotene and acitretin in psoriasis. The PubMed database was searched using combinations of keywords: acitretin, bioavailability, dosing, efficacy, etretinate, interactions, mechanism, pharmacodynamics, pharmacokinetics, pharmacogenetics, psoriasis, safety, tazarotene, tolerability, and toxicity. Expert opinion: Tazarotene and acitretin are effective treatments for psoriasis. Benefits include lack of immunosuppression and success treating inflammatory psoriasis. When combined with other topical and systemic agents, both retinoids improve clinical efficacy while lowering the treatment threshold. However, topical adherence and bothersome side effects can limit retinoid use. Acitretin and tazarotene both improve outcomes through a unique mechanism that especially benefits subsets of patients, despite side effects and limitations.

20 Review Female Genital Itch. 2018

Savas, Jessica A / Pichardo, Rita O. ·Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA. · Department of Dermatology, Wake Forest University School of Medicine, 4618 Country Club Road, Winston-Salem, NC 27104, USA. Electronic address: rpichard@wakehealth.edu. ·Dermatol Clin · Pubmed #29929595.

ABSTRACT: Vulvar pruritus is a common complaint among young girls and women presenting to primary care physicians, gynecologists, and dermatologists. Female genital itch is especially disruptive because of its interference with sexual function and intimacy. Causes of vulvar itch are vast and may be inflammatory, environmental, neoplastic, or infectious, often with several causes coexisting simultaneously. Diagnosis may be difficult because of the unique anatomy and inherent properties of genital and perianal skin. Treatment is aimed at eliminating outside irritants, restoring epidermal barrier function, and suppressing inflammation.

21 Review Biosimilars for Immune-Mediated Chronic Diseases in Primary Care: What a Practicing Physician Needs to Know. 2018

Feldman, Steven R / Bagel, Jerry / Namak, Shahla. ·Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina. · Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina; Windsor Dermatology/Psoriasis Treatment Center of Central New Jersey (PTCCNJ), East Windsor, New Jersey. · Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina. Electronic address: snamak@wakehealth.edu. ·Am J Med Sci · Pubmed #29753369.

ABSTRACT: The introduction of biologics has revolutionized the treatment of immune-mediated diseases, but high cost and limited patient access remain hurdles, and some physicians are concerned that biosimilars are not similar enough. The purpose of this narrative review is to describe biosimilar safety, efficacy, nomenclature, extrapolation and interchangeability. In the United States, the Biologics Price Competition and Innovation Act created an abbreviated pathway for licensing of a biologic that is biosimilar to another licensed product (i.e., the reference product). This approval pathway differs from that of generic small-molecule drugs because biologics are too complex to be perfectly duplicated, and follows a process designed to demonstrate that any differences between the biosimilar and its reference product have no significant impact on safety and efficacy. The US approval process requires extensive analytical assessments, animal studies and clinical trials, assuring that biosimilar products provide clinical results similar to those of the reference product.

22 Review Molluscum contagiosum in immunocompromised patients: AIDS presenting as molluscum contagiosum in a patient with psoriasis on biologic therapy. 2018

Kaufman, William S / Ahn, Christine S / Huang, William W. ·Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. ·Cutis · Pubmed #29554156.

ABSTRACT: Molluscum contagiosum (MC) is a common, self-limited cutaneous infection in immunocompetent individuals. However, in immunocompromised individuals the infection often has an atypical presentation and can be difficult to eradicate, making both the diagnosis and treatment challenging. Due to advancements in the management of patients with human immunodeficiency virus (HIV) and cancer, there is a growing population of immunosuppressed individuals, signaling the need for dermatologists to recognize and manage related skin diseases. We present a case of an atypical MC eruption in a patient on biologic therapy for psoriasis and an unrecognized underlying HIV infection, followed by a current review of the presentation and treatment of MC in various immunosuppressed states. With a growing population of immunosuppressed patients, it is important to recognize MC as a potential indicator of underlying immunosuppression. Testing for HIV should be offered to any patient starting immunosuppressive therapy such as biologic agents.

23 Review Treating Moderate-to-Severe Plaque Psoriasis With Guselkumab: A Review of Phase II and Phase III Trials. 2018

Howell, Seth T / Cardwell, Leah A / Feldman, Steven R. ·1 Wake Forest School of Medicine, Winston-Salem, NC, USA. ·Ann Pharmacother · Pubmed #29134822.

ABSTRACT: OBJECTIVE: Guselkumab, an anti-interleukin-23 monoclonal antibody was recently approved for the treatment of patients with moderate-to-severe plaque psoriasis. This article will review the available phase II and phase III guselkumab clinical trial data. DATA SOURCES: A PubMed search was conducted using the terms guselkumab, interleukin-23, psoriasis, adalimumab, and ustekinumab (January 2014 to August 2017). STUDY SELECTION AND DATA EXTRACTION: Articles detailing the results of phase II and phase III clinical trials were selected for review. DATA SYNTHESIS: In 1 phase II and 2 phase III clinical trials, guselkumab was more effective than adalimumab and placebo in reducing Physician's Global Assessment and Investigator Global Assessment (IGA) scores in those with moderate-to-severe plaque psoriasis. In a separate phase III trial, transitioning to guselkumab treatment was more effective than continued ustekinumab use in reducing IGA scores in those who were minimally responsive to ustekinumab ( P = 0.001). Trial results did not reveal specific patterns in adverse event (AE) incidence; the most commonly reported AEs were nasopharyngitis, headache, and upper-respiratory-tract infections. No increased incidence of malignancy, tuberculosis, or serious infections were observed with the use of guselkumab. CONCLUSIONS: Guselkumab appears to be a safe and effective option for the treatment of moderate-to-severe plaque psoriasis in patients who have been screened for susceptibility to infection and are candidates for systemic treatment or phototherapy. However, long-term safety data are lacking.

24 Review Chronic mucocutaneous candidiasis: what can we conclude about IL-17 antagonism? 2018

Veverka, Kevin K / Feldman, Steven R. ·a Department of Dermatology Wake Forest School of Medicine , Winston-Salem , NC , USA. ·J Dermatolog Treat · Pubmed #29076381.

ABSTRACT: PURPOSE: IL-17 antagonists are effective for psoriasis in clinical trials, but long-term safety is not fully characterized. Since chronic mucocutaneous candidiasis (CMC) is caused by defects in the IL-17 pathway, CMC risk data have been touted as providing reassurance about the safety of IL-17 antagonism. METHODS: We performed a literature review to identify patients with CMC and compared the prevalence of cancer in these patients to the reported 5-year prevalence. RESULTS: There was a higher prevalence of oropharyngeal (2.5% vs. 0.028%; p < .0001) and esophageal cancer (1.9% vs. 0.013%; p < .0001) in patients with CMC. There were no reports of cancer in 31 patients with CMC caused by an isolated IL-17 deficiency (IL-17F, IL-17RA, IL17RC); however, a study would need over 1000 patients to detect even a 10-fold increase in the most common malignancy of CMC patients. CONCLUSIONS: There is evidence that some forms of CMC are associated with an increase in cancer. While CMC is heterogeneous, our findings suggest that we cannot use CMC data to reassure patients on the long-term safety of IL-17 antagonists beyond the safety results from clinical trials, and perhaps caution should be taken with the development of candidiasis in patients taking these medications.

25 Review Epidemiology of mental health comorbidity in psoriasis. 2018

Wu, J J / Feldman, S R / Koo, J / Marangell, L B. ·a Kaiser Permanente Los Angeles Medical Center , Los Angeles , CA , USA. · b Wake Forest University School of Medicine , Winston-Salem , NC , USA. · c University of California San Francisco , San Francisco , CA , USA. · d The University of Texas McGovern School of Medicine , Houston , TX , USA. · e Brain Health Consultants , Houston , TX , USA. ·J Dermatolog Treat · Pubmed #29057684.

ABSTRACT: AIM: The occurrence of mental health comorbidities such as depression, anxiety, and suicidal ideation or behavior is not uncommon in the context of psoriasis. The negative influence of psoriatic disease on a patient's physical and mental well-being, in combination with overlapping pathophysiology, increase the risk for clinically significant psychiatric conditions. These psychiatric conditions, in turn, influence the patient's outlook and potentially, prognosis. Although the healthcare community increasingly recognizes the association of mental health comorbidities with psoriasis, the extent of the correlation is not fully appreciated. To better understand the relationship between mental health comorbidities and psoriasis, including prevalence, risk factors, and response of psychiatric comorbidities to psoriasis treatment, a narrative review of the published literature was conducted. METHODS: Data from epidemiologic, observational, and clinical studies demonstrate a substantially greater mental health comorbidity burden in patients with psoriasis compared with those without psoriasis or patients with other dermatologic conditions. RESULT: The influence of contemporary drug therapies on measures of depression and anxiety are predominantly positive, although further data are needed to better understand the effects of long-term therapy. CONCLUSION: Clinicians should consider the heightened potential for mental health comorbidities when determining an optimal management strategy for their patients with psoriasis.

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