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Psoriasis: HELP
Articles from Wake Forest University
Based on 140 articles published since 2008
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These are the 140 published articles about Psoriasis that originated from Wake Forest University during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6
1 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 --

2 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 --

3 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.

4 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:

5 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.

6 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.

7 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.

8 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.

9 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.

10 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.

11 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.

12 Review Interleukin-17 inhibition: role in psoriasis and inflammatory bowel disease. 2018

Hohenberger, Megan / Cardwell, Leah A / Oussedik, Elias / Feldman, Steven R. ·a Department of Dermatology, Wake Forest School of Medicine , Center for Dermatology Research , 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. ·J Dermatolog Treat · Pubmed #28521565.

ABSTRACT: INTRODUCTION: Interleukin 17 (IL-17) antagonism provides a highly effective approach for treating psoriasis. Exacerbations of inflammatory bowel disease have been reported in anti-IL-17 psoriasis trials. AIM: To characterize the relationship between IL-17 inhibition and inflammatory bowel disease. METHODS: A review of English-language articles was performed. Search terms included IL-17, psoriasis, inflammatory bowel disease, secukinumab, ixekizumab and brodalumab. RESULTS: IL-17 A inhibition, IL-17RA inhibition and IL-17 knockout led to induction or exacerbation of colitis in mouse models. The placebo groups fared better than the treatment group in controlled trials of anti-IL-17 antibody and anti-IL-17 receptor for Crohn's disease (CD). A brodalumab study (N = 1576) revealed one reported CD case. An ixekizumab study (N = 3736) evaluating moderate-to-severe psoriasis, four patients reported CD and seven reported UC while ixekizumab every 2 weeks led to a moderate exacerbation of UC in one patient and new-onset CD in one patient. A secukinumab study (N = 3430) revealed exposure adjusted incidence rates of 0.11 and 0.15 per 100 patient-years for CD and UC, respectively. DISCUSSION: Anti-IL-17 medications are associated with IBD exacerbation. Caution should be used in prescribing these medications in patients with diagnosed IBD or personal history suggestive of IBD.

13 Review Advances in treating psoriasis in the elderly with small molecule inhibitors. 2017

Cline, Abigail / Cardwell, Leah A / Feldman, Steven R. ·a Department of Internal Medicine , Augusta University Medical Center , Augusta , Georgia. · 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 Public Health Sciences , Wake Forest School of Medicine , Winston-Salem , NC , USA. ·Expert Opin Pharmacother · Pubmed #29171774.

ABSTRACT: INTRODUCTION: Due to the chronic nature of psoriasis, the population of elderly psoriasis patients is increasing. However, many elderly psoriatic patients are not adequately treated because management is challenging as a result of comorbidities, polypharmacy, and progressive impairment of organ systems. Physicians may hesitate to use systemic or biologic agents in elderly psoriasis patients because of an increased risk of adverse events in this patient population. Small molecule medications are emerging as promising options for elderly patients with psoriasis and other inflammatory conditions. Areas covered: Here we review the efficacy, safety and tolerability of small molecule inhibitors apremilast, tofacitinib, ruxolitinib, baricitinib, and peficitinib in the treatment of psoriasis, with focus on their use in the elderly population. Expert opinion: Although small molecule inhibitors demonstrate efficacy in elderly patients with psoriasis, they will require larger head-to-head studies and post-marketing registries to evaluate their effectiveness and safety in specific patient populations. Apremilast, ruxolitinib, and peficitinib are effective agents with favorable side effect profiles; however, physicians should exercise caution when prescribing tofacitinib or baricitinib in elderly populations due to adverse events. The high cost of these drugs in the U.S. is likely to limit their use.

14 Review Severe and acute complications of biologics in psoriasis. 2017

Oussedik, Elias / Patel, Nupur U / Cash, Devin R / Gupta, Angela S / Feldman, Steven R. ·Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA. · Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA - sfeldman@wakehealth.edu. · 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. ·G Ital Dermatol Venereol · Pubmed #28895664.

ABSTRACT: Biologic therapies have revolutionized the approach to immune-mediated diseases such as psoriasis. Due to their favorable safety profiles and excellent efficacy, biologic agents are considered the gold standard for moderate-to-severe psoriasis. The aim of this paper is to saliently review the severe and acute complications of the Food and Drug Administration (FDA) approved biologic agents for psoriasis. Reviewed agents include tumor necrosis factor alpha inhibitors (etanercept, infliximab, and adalimumab), interleukin 12/23 inhibitors (ustekinumab), and interleukin 17 (IL-17) inhibitors (secukinumab and ixekizumab). While malignancies, serious infections, and major adverse cardiovascular events have been reported, their association with biologic therapy are not hypothesized as causal. However, IL-17 inhibitors appear to cause exacerbations and new cases of inflammatory bowel disease. While more long-term studies are warranted in understanding the biologic's long-term side effect profile, short-term studies have confirmed that the biologics are some of the safest treatment options for psoriasis. Nevertheless, certain populations yield higher risk to acute complications with the biologics than others - physicians must use their judgement and vigilance when monitoring and treating patients undergoing therapy with biological agents.

15 Review Psoriasis, Depression, and Inflammatory Overlap: A Review. 2017

Patel, Nupur / Nadkarni, Anish / Cardwell, Leah A / Vera, Nora / Frey, Casey / Patel, Nikhil / Feldman, Steven R. ·Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA. · Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA. lcardwell06@gmail.com. · 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. ·Am J Clin Dermatol · Pubmed #28432649.

ABSTRACT: Psoriasis has an enormous impact on patients' lives and is frequently associated with depression. Depression in psoriasis may be attributed, at least in part, to elevated proinflammatory cytokines rather than the psychosocial impact of psoriasis itself. Biologics that target inflammatory cytokines treat the clinical manifestations of psoriasis, but may also play a role in reducing associated depression. Multiple biologics have decreased symptoms of depression during clinical trials in psoriasis; however, these studies used a variety of depression screening tools, which limits comparison. Furthermore, it is difficult to distinguish whether improved depression is the result of the direct anti-inflammatory effect of the biologic, or the indirect effect of improved psoriasis leading to better psychological status. Future studies evaluating depression in patients with psoriasis could benefit from a standardized depression screening tool to mitigate discrepancies and facilitate comparison across treatment types. Here, we highlight the inflammatory overlap between psoriasis and depression by examining the pathophysiology of depression, and reviewing psoriasis clinical studies that assessed depression as an outcome measure.

16 Review Biologic Therapies for Autoimmune and Connective Tissue Diseases. 2017

Wolfe, Rachel M / Ang, Dennis C. ·Section on Rheumatology and Immunology, Wake Forest Baptist Health, Medical Center Boulevard, Winston Salem, NC 27157, USA. · Section on Rheumatology and Immunology, Wake Forest Baptist Health, Medical Center Boulevard, Winston Salem, NC 27157, USA. Electronic address: dang@wakehealth.edu. ·Immunol Allergy Clin North Am · Pubmed #28366477.

ABSTRACT: Biologic therapy continues to revolutionize the treatment of autoimmune disease, especially in rheumatology as the pathophysiology of both inflammation and autoimmune disease becomes better understood. These therapies are designed to dampen the response of the inflammatory cascades. Although the first biologic therapies were approved many years ago, expanding indications and new agents continue to challenge the traditional treatment strategies for rheumatic diseases. This article reviews the data supporting the current use of biologic therapies, including off-label indications, in a subset of rheumatic diseases including rheumatoid arthritis, lupus, inflammatory myositis, ankylosing spondylitis, psoriatic arthritis, vasculitis, and gout.

17 Review Recent Advances in Small Molecule and Biological Therapeutic Approaches in the Treatment of Psoriasis. 2017

Turbeville, J G / Patel, N U / Cardwell, L A / Oussedik, E / Feldman, S R. ·Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. · Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. · Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. ·Clin Pharmacol Ther · Pubmed #28317101.

ABSTRACT: New treatments continue to be developed for psoriasis. In this review, we aim to summarize the results of the major published studies on biologic and small molecule drugs for the treatment of psoriasis. We emphasize the safety, efficacy, and tolerability of these treatment options. A review of the MEDLINE database was conducted for each class of medication. Randomized controlled trials were identified for each medication; data on efficacy, safety, and tolerability were reviewed. Biologic and small molecule treatment options are more effective than placebo, although there were few head-to-head trials to assess relative efficacy between biologics and small molecule treatments. These drugs offer favorable safety profiles with only rare serious adverse events reported. Biologic and small molecule drugs offer diverse therapeutic regimens, particularly in patients with recalcitrant disease.

18 Review Advances in Psoriasis. 2017

Smith, Jaclyn / Cline, Abigail / Feldman, Steven R. ·From the Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina. ·South Med J · Pubmed #28052180.

ABSTRACT: Psoriasis treatments range from topical treatments and phototherapy to oral systemic medications and injections. Despite good control of the disease when applying appropriate treatments (according to disease severity, insurance parameters, patient preference, and patients' ability to adhere), continued advancements will allow even better symptomatic control, reduced adverse effects, and patient satisfaction. This review aims to assess traditional and new psoriasis treatments and how to apply them in clinical practice. A literature review on psoriasis treatments and clinical applications was performed using PubMed. Mild-to-moderate psoriasis treatments include topicals, localized phototherapy, and newer therapies combining two types of topicals, phototherapy with topicals, and easy-to-use foam and spray vehicles. Moderate-to-severe psoriasis therapies include monotherapy or various combinations of generalized phototherapy, oral treatments, and biologic agents, with new oral and biologic agents on the horizon. Dermatologists and primary care providers share roles in screening for associated comorbidities (including cardiovascular disorders, chronic kidney disease, Crohn disease, dyslipidemia, diabetes mellitus/insulin resistance, depression, metabolic syndrome, obesity, and psoriatic arthritis), managing patients' treatments, and reevaluating treatment needs as new therapies are approved. Continued advancements in psoriasis treatment and improvement in coordinated care will allow better overall care of patients with psoriasis.

19 Review Relative versus absolute risk of comorbidities in patients with psoriasis. 2017

Saleem, Mohammed D / Kesty, Chelsea / 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. · Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Public Health Science, Wake Forest School of Medicine, Winston-Salem, North Carolina. ·J Am Acad Dermatol · Pubmed #27986396.

ABSTRACT: BACKGROUND: Psoriasis is associated with numerous comorbidities, often reported in terms of relative risk. Both doctors and the general population tend to overestimate the effects of exposures when presented in relative terms, leading to anxiety and potentially poor treatment decisions. Absolute risks might provide a better basis for risk assessment. OBJECTIVE: To characterize and compare relative and absolute risks of comorbidities in patients with psoriasis. METHODS: A systematic review using Medline identified comorbidities associated with psoriasis, their relative risks, and information for calculating absolute risks. RESULTS: The comorbidities associated with psoriasis with the highest relative risk were nonmelanoma skin cancer, melanoma, and lymphoma, with relative risks of 7.5, 6.12, and 3.61, respectively; the attributable risk for these 3 conditions were 0.64, 0.05, and 0.17 per 1000 person-years, respectively. To attribute 1 event of these conditions to psoriasis would require seeing 1551; 20,135; and 5823 patients, respectively. LIMITATIONS: Database studies might not fully account for confounders, resulting in overestimates of the risk impact of comorbidities. CONCLUSIONS: Presenting attributable risk in the form of the number needed to harm provides a clearer picture of the magnitude of risk and a basis for wiser medical decision making and patient education.

20 Review Current status and future prospects for biologic treatments of psoriasis. 2016

Cline, Abigail / Hill, Dane / Lewallen, Robin / Feldman, Steven R. ·a Medical College of Georgia , Augusta University , Augusta , Georgia. · 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 Public Health Sciences , Wake Forest School of Medicine , Winston-Salem , NC , USA. ·Expert Rev Clin Immunol · Pubmed #27327580.

ABSTRACT: INTRODUCTION: Biological agents have transformed psoriasis treatment by selectively targeting immune signaling molecules involved in psoriasis pathogenesis. While biologics offer the most effective treatment of moderate to severe psoriasis, they are not without complications. Some patients treated with biologics have poor clinical responses, form anti-drug antibodies, or develop adverse events. Additionally, there is growing need for head-to-head studies comparing biologic treatment regimens, efficacy, and safety. Areas covered: Here we review the literature surrounding biologics already in clinical use and those undergoing development and clinical trials. We also investigate the development and approval of small molecules inhibitors and biosimilars used to treat psoriasis. Expert commentary: As the psoriasis treatment armamentarium continues to expand, it is important to follow the safety profile of these drugs both in clinical trials and in post-marketing registries to ensure their long-term safety. Physicians must be aware of the limitations of existing safety data of a drug and the potential risk for rare adverse events when selecting appropriate treatments and monitoring patient outcomes.

21 Review Current challenges and emerging drug delivery strategies for the treatment of psoriasis. 2016

Hoffman, Melissa B / Hill, Dane / 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 Deliv · Pubmed #27164301.

ABSTRACT: INTRODUCTION: Psoriasis is a common skin disorder associated with physical, social, psychological and financial burden. Over the past two decades, advances in our understanding of pathogenesis and increased appreciation for the multifaceted burden of psoriasis has led to new treatment development and better patient outcomes. Yet, surveys demonstrate that many psoriasis patients are either undertreated or are dissatisfied with treatment. There are many barriers that need be overcome to optimize patient outcomes and satisfaction. AREAS COVERED: This review covers the current challenges associated with each major psoriasis treatment strategy (topical, phototherapy, oral medications and biologics). It also reviews the challenges associated with the psychosocial aspects of the disease and how they affect treatment outcomes. Patient adherence, inconvenience, high costs, and drug toxicities are all discussed. Then, we review the emerging drug delivery strategies in topical, oral, and biologic therapy. EXPERT OPINION: By outlining current treatment challenges and emerging drug delivery strategies, we hope to highlight the deficits in psoriasis treatment and strategies for how to overcome them. Regardless of disease severity, clinicians should use a patient-centered approach. In all cases, we need to balance patients' psychosocial needs, treatment costs, convenience, and effectiveness with patients' preferences in order to optimize treatment outcomes.

22 Review Calcipotriene and betamethasone dipropionate for the topical treatment of plaque psoriasis. 2016

Kin, Kevin C / Hill, Dane / Feldman, Steven R. ·a College of Osteopathic Medicine , Touro University Nevada , Henderson , NV , 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 Public Health Sciences , Wake Forest School of Medicine , Winston-Salem , NC , USA. ·Expert Rev Clin Pharmacol · Pubmed #27089906.

ABSTRACT: INTRODUCTION: Psoriasis affects an estimated 2% of the world's population, with higher rates in developed countries. 80% have mild-to-moderate disease and 50 to 80% have scalp involvement. Topical treatments are the mainstay of treatment. AREAS COVERED: Two-compound calcipotriene and betamethasone dipropionate (BD) is a common topical combination therapy consisting of a vitamin D analogue and a corticosteroid. It comes in ointment, gel/suspension, and foam formulations. Phase II and III clinical trials have consistently shown the two-compound formulation to be effective and safe, with no clinically significant skin atrophy, calcium level changes, or adrenal suppression were seen. Topical scalp solution was also safe and effective in treating scalp psoriasis in pediatric populations. Expert commentary: Calcipotriene plus BD is more effective and safer than the individual ingredients in the same vehicle for treating body and scalp psoriasis. It should be considered a first line therapy for mild-to-moderate plaque psoriasis.

23 Review Ultraviolet phototherapy for cutaneous diseases: a concise review. 2016

Vangipuram, R / Feldman, S R. ·University of Cincinnati Medical Center, Cincinnati, OH, USA. · Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA. ·Oral Dis · Pubmed #26464123.

ABSTRACT: Phototherapy is the use of non-ionizing radiation, primarily in the ultraviolet spectrum, to treat disease. In dermatology, ultraviolet (UV) phototherapy remains an established, lower cost, and often preferred option for many common skin conditions, despite the introduction of newer potent biologics. This article introduces a principal therapeutic modality in the treatment of psoriasis, atopic dermatitis (eczema), vitiligo, and morphea among other diseases where oral manifestations may be present, providing basic information about the use of UVA, UVB, and PUVA. Practical considerations and side effects of phototherapy are described. Phototherapy is an effective treatment for many illnesses and carries a relatively benign side-effect profile.

24 Review The cost-effectiveness of ustekinumab for moderate-to-severe psoriasis. 2015

Rouse, Nicole C / Farhangian, Michael E / Wehausen, Brooke / Feldman, Steven R. ·a Department of Osteopathic and Neuromuscular Medicine, College of Osteopathic Medicine of the Pacific , Western University of Health Sciences , Pomona , CA , 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 Public Health Sciences , Wake Forest School of Medicine , Winston-Salem , NC , USA. ·Expert Rev Pharmacoecon Outcomes Res · Pubmed #26488186.

ABSTRACT: Given its chronicity and impact on quality of life, psoriasis is a costly disease. As new and better treatments are developed, the cost of treating psoriasis has risen. In this drug profile, the authors discuss ustekinumab, its pharmacokinetics, safety profile, and direct and indirect costs to determine its cost-efficacy. The authors searched PubMed with specific search phrases for clinical trials investigating this issue over 5 years. Eleven articles analyzed cost-effectiveness of ustekinumab, and the references of these articles were included. Studies limited to 12 weeks reported that ustekinumab may not be cost-effective as it has high cost per injection and is costly when loading doses are required. Studies that went beyond 12 weeks documented that, with ustekinumab's infrequent dosing, it is cost-effective during the maintenance period.

25 Review To test or not to test? An updated evidence-based assessment of the value of screening and monitoring tests when using systemic biologic agents to treat psoriasis and psoriatic arthritis. 2015

Ahn, Christine S / Dothard, Emily H / Garner, Michael L / Feldman, Steven R / Huang, William W. ·Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina. · University of North Carolina School of Medicine, Chapel Hill, North Carolina. · Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina. · Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina. Electronic address: whuang@wakehealth.edu. ·J Am Acad Dermatol · Pubmed #26184440.

ABSTRACT: BACKGROUND: Safety profiles of systemic biologic agents for the treatment of psoriasis and psoriatic arthritis (PsA) encompass a wide spectrum of adverse events. To date, no uniform evidence-based guidelines exist regarding screening and monitoring patients who are undergoing biologic therapy. OBJECTIVE: We sought to identify studies evaluating screening and monitoring tests in the treatment of psoriasis and PsA with systemic biologic agents, and to propose evidence-based practical guidelines. METHODS: The MEDLINE database was searched to identify data on risks associated with adalimumab, etanercept, infliximab, and ustekinumab. Articles were reviewed and graded according to methods developed by the US Preventative Services Task Force. RESULTS: Evidence was strongest (grade B) for tuberculosis screening. Interferon-gamma release assay was preferable to tuberculin skin testing. Among known hepatitis B virus carriers, the evidence grade was C for monitoring liver function tests and viral load. LIMITATIONS: This study was limited by the lack of high-quality controlled trials evaluating screening and monitoring tests in patients treated with biologic agents. CONCLUSIONS: Baseline tuberculosis testing remains the only screening test with strong evidence to support its practice. Other screening and monitoring tests commonly performed in patients who are taking biologic agents are supported only in certain clinical settings or lack evidence to support or recommend against their practice.

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