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Psoriasis: HELP
Articles from Kiel
Based on 136 articles published since 2008
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These are the 136 published articles about Psoriasis that originated from Kiel during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6
1 Guideline European S3-Guideline on the systemic treatment of psoriasis vulgaris - Update Apremilast and Secukinumab - EDF in cooperation with EADV and IPC. 2017

Nast, A / Spuls, P I / van der Kraaij, G / Gisondi, P / Paul, C / Ormerod, A D / Saiag, P / Smith, C H / Dauden, E / de Jong, E M / Feist, E / Jobling, R / Maccarone, M / Mrowietz, U / Papp, K A / Reich, K / Rosumeck, S / Talme, T / Thio, H B / van de Kerkhof, P / Werner, R N / Dressler, C. ·Division of Evidence-Based Medicine, Department of Dermatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. · Department of Dermatology, Academic Medical Center, Amsterdam, The Netherlands. · Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy. · Department of Dermatology, Paul Sabatier University, Toulouse, France. · Department of Dermatology, Aberdeen Royal Infirmary, Aberdeen, UK. · Service de Dermatologie, Hôpital Ambroise Paré Université Paris V, Boulogne, France. · St Johns Institute of Dermatology, Guys and St Thomas' Hospital Foundation Trust, London, UK. · Hospital Universitario de la Princesa, Madrid, Spain. · Radboud University medical center and Radboud University, Nijmegen, The Netherlands. · Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany. · Cambridge, UK. · Roma, Italy. · Department of Dermatology, Psoriasis-Center University Medical Center Schleswig Holstein, Kiel, Germany. · Waterloo, Canada. · Dermatologikum Hamburg, Hamburg, Germany. · Section of Dermatology and Venereology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden. ·J Eur Acad Dermatol Venereol · Pubmed #28895202.

ABSTRACT: -- No abstract --

2 Guideline European S3-Guidelines on the systemic treatment of psoriasis vulgaris--Update 2015--Short version--EDF in cooperation with EADV and IPC. 2015

Nast, A / Gisondi, P / Ormerod, A D / Saiag, P / Smith, C / Spuls, P I / Arenberger, P / Bachelez, H / Barker, J / Dauden, E / de Jong, E M / Feist, E / Jacobs, A / Jobling, R / Kemény, L / Maccarone, M / Mrowietz, U / Papp, K A / Paul, C / Reich, K / Rosumeck, S / Talme, T / Thio, H B / van de Kerkhof, P / Werner, R N / Yawalkar, N. ·Division of Evidence Based Medicine, Department of Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany. · Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy. · Department of Dermatology, Aberdeen Royal Infirmary, Aberdeen, UK. · Service de Dermatologie, Hôpital Ambroise Paré Université Paris V, Boulogne, France. · Clinical Lead for Dermatology, St Johns Institute of Dermatology, St Thomas' Hospital, London, UK. · Department of Dermatology, Academic Medical Center, Amsterdam, The Netherlands. · Third Faculty of Medicine, Department of Dermatology, Charles University, Prague, Czech Republic. · Department of Dermatology, Hôpital Saint-Louis, Paris, France. · St. Johns Institute of Dermatology, St. Thomas' Hospital, London, UK. · Hospital Universitario de la Princesa, Madrid, Spain. · University Medical Center Nijmegen St Radboud, Nijmegen, The Netherlands. · Medizinische Klinik mit Schwerpunkt Rheumatologie u. klinische Immonologie, Charité - Universitätsmedizin Berlin, Berlin, Germany. · Cambridge, UK. · SZTE Borgyogyaszati Klinika, Szeged, Hungary. · Roma, Italy. · Department of Dermatology, Psoriasis-Center University Medical Center Schleswig Holstein, Kiel, Germany. · Waterloo, Canada. · Department of Dermatology, Paul Sabatier University, Toulouse, France. · Dermatologikum Hamburg, Hamburg, Germany. · Section of Dermatology and Venereology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden. · Department of Dermatology, Erasmus University, Rotterdam, The Netherlands. · Department of Dermatology, University Hospital Nijmegen, Nijmegen, The Netherlands. · Department of Dermatology, Inselspital, Universitätsklinik für Dermatologie, Bern, Switzerland. ·J Eur Acad Dermatol Venereol · Pubmed #26481193.

ABSTRACT: -- No abstract --

3 Editorial Inflammation: Treatment Progress and Limitations. 2017

Cascorbi, Ingolf. ·Institute of Experimental and Clinical Pharmacology, University Hospital Schleswig-Holstein, Campus Kiel, Germany. ·Clin Pharmacol Ther · Pubmed #28895120.

ABSTRACT: There is an increasing understanding on the etiology of chronic immune-mediated inflammatory diseases such as inflammatory bowel disease (IBD), psoriasis, or rheumatoid arthritis. Large consortia contributed to the elucidation of the genetics, for instance, of IBD identifying a number of genes involved in innate mucosal defense and immune tolerance (most prominent, e.g., NOD2) and other related processes. For a number of such diseases, common genetic susceptibility loci were identified, suggesting overlapping immune response pathways, although there is no causality of single genetic traits.

4 Review Dimethyl fumarate (DMF) vs. monoethyl fumarate (MEF) salts for the treatment of plaque psoriasis: a review of clinical data. 2018

Landeck, Lilla / Asadullah, Khusru / Amasuno, Adriana / Pau-Charles, Ignasi / Mrowietz, Ulrich. ·Department of Dermatology, Ernst von Bergmann General Hospital, Teaching Hospital Charité, Humboldt University, Charlottenstrasse 72, 14467, Potsdam, Germany. llandeck@klinikumevb.de. · Department of Dermatology, Venerology and Allergology, Charité Universitätsmedizin Berlin, Berlin, Germany. · Almirall S.A., Barcelona, Spain. · Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany. ·Arch Dermatol Res · Pubmed #29574575.

ABSTRACT: Fumarates (fumaric acid esters, FAEs) are orally administered systemic agents used for the treatment of psoriasis and multiple sclerosis. In 1994, a proprietary combination of FAEs was licensed for psoriasis by the German Drug Administration for use within Germany. Since then, fumarates have been established as one of the most commonly used treatments for moderate-to-severe psoriasis in Germany and other countries. The licensed FAE formulation contains dimethyl fumarate (DMF), as well as calcium, zinc, and magnesium salts of monoethyl fumarate (MEF). While the clinical efficacy of this FAE mixture is well established, the combination of esters on which it is based, and its dosing regimen, was determined empirically. Since the mid-1990s, the modes of action and contribution of the different FAEs to their overall therapeutic effect in psoriasis, as well as their adverse event profile, have been investigated in more detail. In this article, the available clinical data for DMF are reviewed and compared with data for the other FAEs. The current evidence substantiates that DMF is the main active compound, via its metabolic transformation to monomethyl fumarate (MMF). A recent phase III randomized and placebo-controlled trial including more than 700 patients demonstrated therapeutic equivalence when comparing the licensed FAE combination with DMF alone, in terms of psoriasis clearance according to the Psoriasis Area and Severity Index (PASI) and Physician's Global Assessment (PGA). Thus, DMF as monotherapy for the treatment of psoriasis is as efficacious as in combination with MEF, making the addition of such fumarate derivatives unnecessary.

5 Review European consensus statement on phenotypes of pustular psoriasis. 2017

Navarini, A A / Burden, A D / Capon, F / Mrowietz, U / Puig, L / Köks, S / Kingo, K / Smith, C / Barker, J N / Anonymous420909. ·Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland. · Institute of Infection Inflammation and Immunity, University of Glasgow, Glasgow, UK. · Division of Genetics and Molecular Medicine, King's College, London, UK. · Psoriasis Center at the Department of Dermatology, University Medical Center, Schleswig-Holstein, Campus Kiel, Kiel, Germany. · Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. · Department of Dermatology and Venerology, Tartu University Hospital, Tartu, Estonia. ·J Eur Acad Dermatol Venereol · Pubmed #28585342.

ABSTRACT: Pustular psoriasis (PP) is a group of inflammatory skin conditions characterized by infiltration of neutrophil granulocytes in the epidermis to such an extent that clinically visible sterile pustules develop. Because of clinical co-incidence, PP is currently grouped with psoriasis vulgaris (PV). However, PP and PV are phenotypically different, respond differently to treatments and seem to be distinct on the genetic level. In contrast to PV, the phenotypes of PP are not well defined. Descriptions of each form of PP are discordant among standard dermatology textbooks [Saurat Dermatologie 2016, Rook's Dermatology 2016, Fitzpatrick's 2012 and Braun-Falco 2012], encumbering the collection of phenotypically well-matched groups of patients as well as clinical trials. The European Rare and Severe Psoriasis Expert Network (ERASPEN) was founded to define consensus criteria for diagnosis, deeply phenotype large groups of PP patients, analyse the genetics and pathophysiology and prepare for prospective clinical trials. This work reviews historical aspects of these conditions, new genetic findings and presents our initial considerations on the phenotypes of PP and a consensus classification of clinical phenotypes that will be used as a baseline for further, prospective studies of PP. Generalized pustular psoriasis (GPP) is defined as primary, sterile, macroscopically visible pustules on non-acral skin (excluding cases where pustulation is restricted to psoriatic plaques). GPP can occur with or without systemic inflammation, with or without PV and can either be a relapsing (>1 episode) or persistent (>3 months) condition. Acrodermatitis continua of Hallopeau (ACH) is characterized by primary, persistent (>3 months), sterile, macroscopically visible pustules affecting the nail apparatus. Palmoplantar pustulosis (PPP) has primary, persistent (>3 months), sterile, macroscopically visible pustules on palms and/or soles and can occur with or without PV.

6 Review Reformulations of well-known active ingredients in the topical treatment of psoriasis vulgaris can improve clinical outcomes for patients. 2017

Iversen, L / Dauden, E / Segaert, S / Freeman, K / Magina, S / Rigopoulos, D / Thaci, D. ·Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark. · Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain. · Department of Dermatology, University Hospital Leuven, Leuven, Belgium. · Bunny Hill Primary Care Centre, County Durham and Darlington NHS Foundation Trust & Sunderland Teaching Primary Care Trust, Sunderland, UK. · Department of Dermatology, CHSJoão, Porto, Portugal. · Department of Pharmacology and Therapeutics, Faculty of Medicine, Porto University, Porto, Portugal. · 2nd Department of Dermatology, University of Athens Medical School, Attikon Hospital, Athens, Greece. · Comprehensive Centre for Inflammation Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany. ·J Eur Acad Dermatol Venereol · Pubmed #28419600.

ABSTRACT: Although the majority of patients with psoriasis vulgaris are treated exclusively with topical therapies, research to develop more effective topical therapies that are associated with higher patient satisfaction has lagged behind the development of systemic agents. The aim of this literature review was to determine whether there is documented evidence that applying an innovative approach to improving the formulation of active ingredients commonly used in the topical treatment of psoriasis can have a positive effect on clinical outcomes and patient-reported outcomes (PROs). The Embase and PubMed databases were searched for articles published between 2001 and 2016 that made direct head-to-head comparisons of different formulations of an active pharmaceutical ingredient (API), focusing on clinical outcomes and PROs. In total, 22 publications on APIs or API combinations met the eligibility criteria (19 head-to-head clinical trials, one pooled analysis, one health-economic modelling study and one systematic review). Significant clinical benefit associated with the use of a reformulated API over an older formulation was reported in three trials of clobetasol propionate, one trial of calcipotriol, three trials of betamethasone and five trials/pooled analyses of calcipotriol/calcipotriene + betamethasone dipropionate (Cal/BD) formulations. Significantly improved PROs associated with the use of a reformulated API over an older formulation were reported in three trials of clobetasol propionate, one trial of betamethasone valerate and two trials of Cal/BD formulations. These results demonstrate that the innovative reformulation of APIs used in the treatment of psoriasis can produce therapies that attain significantly improved clinical outcomes and PROs. This suggests that improvement in topical therapy for psoriasis need not only to be achieved by the identification of new targets and the development of new APIs, but that improvement in the vehicle used to deliver existing APIs has the potential to result in significant clinical and patient benefits.

7 Review Candida infections in patients with psoriasis and psoriatic arthritis treated with interleukin-17 inhibitors and their practical management. 2017

Saunte, D M / Mrowietz, U / Puig, L / Zachariae, C. ·Department of Dermatology, Zealand University Hospital, Roskilde, Denmark. · Psoriasis Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany. · Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. · Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark. ·Br J Dermatol · Pubmed #27580411.

ABSTRACT: The recognition of the central role of interleukin (IL)-17A in the pathogenesis of psoriasis has led to the development of several monoclonal antibodies targeting this cytokine or its receptors for therapeutic purposes. IL-17A also plays an important role in immunological protection against infections, especially those due to Candida spp., as evidenced by findings in patients with genetic defects in IL-17-related immune responses. To assess the potential of anti-IL-17 treatment to promote Candida infections, here we have systematically reviewed published clinical trials of patients with psoriasis or psoriatic arthritis. Candida infections were reported in 4·0% of patients treated with brodalumab, 1·7% with secukinumab and 3·3% with ixekizumab vs. 0·3%, 2·3% and 0·8% of those assigned to placebo, ustekinumab or etanercept, respectively. Although the incidence of Candida infection was found to be increased by only a small degree during anti-IL-17 therapy, patients undergoing such treatment should be monitored for fungal infection and treated as necessary. We propose adoption of the recently updated recommendations for the practical management of Candida infection in patients administered IL-17 inhibitors.

8 Review [Comorbidity in psoriasis]. 2016

Gerdes, S / Mrowietz, U / Boehncke, W-H. ·Psoriasis-Zentrum, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 7, 24105, Kiel, Deutschland. sgerdes@dermatology.uni-kiel.de. · Psoriasis-Zentrum, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 7, 24105, Kiel, Deutschland. · Service de Dermatologie et Vénéréologie, Hôpitaux Universitaires de Genève und Département de Pathologie et Immunologie, Université de Genève, Genf, Schweiz. ·Hautarzt · Pubmed #27221798.

ABSTRACT: Psoriasis is a systemic chronic inflammatory disease associated with comorbidity. Many epidemiological studies have shown that psoriasis is associated with psoriatic arthritis as well as cardiovascular and metabolic diseases. Furthermore, obesity and psychological diseases such as depression and anxiety disorders are linked with psoriasis and play a central role in its management. The association of psoriasis and its comorbidity can be partly explained by genetic and pathophysiological mechanisms. Approximately 40 psoriasis susceptibility loci have been described with the majority linked to the innate and adaptive immune system. In some associated diseases, such as psoriatic arthritis, an overlap of their genetic susceptibility exists. Pathophysiologically the "psoriatic march" is a model that describes the development of metabolic and cardiovascular diseases due to the presence of underlying systemic inflammation. Dermatologists are the gatekeepers to treatment for patients with psoriasis. The early detection and the management of comorbidity is part of their responsibility. Concepts for the management of psoriasis and tools to screen for psoriatic comorbidity have been developed in order to support dermatologists in daily practice.

9 Review The German National Program on Psoriasis Health Care 2005-2015: results and experiences. 2016

Augustin, M / Eissing, L / Langenbruch, A / Enk, A / Luger, T / Maaßen, D / Mrowietz, U / Reich, K / Reusch, M / Strömer, K / Thaçi, D / von Kiedrowski, R / Radtke, M A. ·Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany. m.augustin@uke.de. · Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany. · Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany. · Department of Dermatology, University Hospital Muenster (UKM), Münster, Germany. · Dermatological Practice Maxdorf, Maxdorf, Germany. · Department for Dermatology, Venereology and Allergology, University Hospital Kiel, Kiel, Germany. · Dermatological Practice Dermatologikum Hamburg, Hamburg, Germany. · Dermatological Practice Tibarg, Hamburg, Germany. · Dermatological Practice Mönchengladbach, Mönchengladbach, Germany. · Department for Dermatology, Allergology and Venereology, University of Lübeck, Lübeck, Germany. · Dermatological Practice Selters, Selters, Germany. ·Arch Dermatol Res · Pubmed #27048503.

ABSTRACT: In 2005, the first national psoriasis survey in Germany revealed large deficits in health care particularly in patients with moderate to severe disease. The consecutive goal was to improve health care for psoriasis countrywide. For this, a large-scale national program was initiated starting with a comprehensive analysis of structures and processes of care for psoriasis. Patient burden, economic impact and barriers to care were systematically analyzed. In order to optimize routine care, a S3 guideline, a set of outcomes measures and treatment goals, were developed. Implementation was enforced by the German Psoriasis Networks (PsoNet) connecting the most dedicated dermatologists. The annual National Conference on Health Care in Psoriasis established in 2009 consented National Health Care Goals in Psoriasis 2010-2015 and defined a set of quality indicators, which are monitored on a regular basis. Currently 28 regional networks including more than 800 dermatologists are active. Between 2005 and 2014 7 out of 8 quality indicators have markedly improved, and regional disparities were resolved. e.g., mean PASI (Psoriasis Area Severity Index) dropped from 11.4 to 8.1 and DLQI (Dermatology Life Quality Index) from 8.6 to 5.9. A decade of experience indicates that a coordinated nationwide psoriasis program based on goal orientation can contribute to better quality of care and optimized outcomes.

10 Review A Systematic Review of Factors Associated with Non-Adherence to Treatment for Immune-Mediated Inflammatory Diseases. 2015

Vangeli, Eleni / Bakhshi, Savita / Baker, Anna / Fisher, Abigail / Bucknor, Delaney / Mrowietz, Ulrich / Östör, Andrew J K / Peyrin-Biroulet, Laurent / Lacerda, Ana P / Weinman, John. ·Department of Psychology, London South Bank University, London, UK. · Psychological Medicine, King's College London, London, UK. · Atlantis Healthcare, London, UK. · University College London, London, UK. · London Metropolitan University, London, UK. · Psoriasis-Center at the Department of Dermatology, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany. · School of Clinical Medicine, University of Cambridge, Cambridge, UK. · Inserm U954 and Department of Gastroenterology, Université de Lorraine, Vandoeuvre-les-Nancy, France. · AbbVie Inc, North Chicago, IL, USA. · Institute of Pharmaceutical Science, King's College London, 5th Floor, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK. John.weinman@kcl.ac.uk. ·Adv Ther · Pubmed #26547912.

ABSTRACT: BACKGROUND: Non-adherence impacts negatively on patient health outcomes and has associated economic costs. Understanding drivers of treatment adherence in immune-mediated inflammatory diseases is key for the development of effective strategies to tackle non-adherence. OBJECTIVE: To identify factors associated with treatment non-adherence across diseases in three clinical areas: rheumatology, gastroenterology, and dermatology. DESIGN: Systematic review. DATA SOURCES: Articles published in PubMed, Science Direct, PsychINFO and the Cochrane Library from January 1, 1980 to February 14, 2014. STUDY SELECTION: Studies were eligible if they included patients with a diagnosis of rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease, or psoriasis and included statistics to examine associations of factors with non-adherence. DATA EXTRACTION: Data were extracted by the first reviewer using a standardized 23-item form and verified by a second/third reviewer. Quality assessment was carried out for each study using a 16-item quality checklist. RESULTS: 73 studies were identified for inclusion in the review. Demographic or clinical factors were not consistently associated with non-adherence. Limited evidence was found for an association between non-adherence and treatment factors such as dosing frequency. Consistent associations with adherence were found for psychosocial factors, with the strongest evidence for the impact of the healthcare professional-patient relationship, perceptions of treatment concerns and depression, lower treatment self-efficacy and necessity beliefs, and practical barriers to treatment. CONCLUSIONS: While examined in only a minority of studies, the strongest evidence found for non-adherence were psychosocial factors. Interventions designed to address these factors may be most effective in tackling treatment non-adherence.

11 Review Progressive neurologic dysfunction in a psoriasis patient treated with dimethyl fumarate. 2015

Bartsch, Thorsten / Rempe, Torge / Wrede, Arne / Leypoldt, Frank / Brück, Wolfgang / Adams, Ortwin / Rohr, Axel / Jansen, Olav / Wüthrich, Christian / Deuschl, Günther / Koralnik, Igor J. ·Department of Neurology, University Hospital of Schleswig-Holstein, Kiel, Germany. · Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany. · Neuroimmunology Unit Institute of Clinical Chemistry, University Hospital of Schleswig-Holstein, Kiel, Germany. · Institute for Virology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany. · Department of Radiology and Neuroradiology, University Hospital of Schleswig-Holstein, Kiel, Germany. · Division of Neuroimmunology, Department of Neurology, Center for Virology and Vaccine Research, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. ·Ann Neurol · Pubmed #26150206.

ABSTRACT: Progressive multifocal leukoencephalopathy (PML) has recently been described in psoriasis or multiple sclerosis patients treated with fumaric acid esters (fumarates), who had developed severe and long-standing lymphocytopenia (<500/mm(3) ). We report a psoriasis patient who presented with progressive neurologic dysfunction and seizures after 2.5 years of fumarate therapy. Despite absolute lymphocyte counts remaining between 500-1000/mm(3) , his CD4(+) and CD8(+) T-cell counts were markedly low. MRI showed right hemispheric and brainstem lesions and JC virus DNA was undetectable in his cerebrospinal fluid. Brain biopsy revealed typical features of PML as well as JC virus-infected neurons. Clinicians should consider PML in the differential diagnosis of fumarate-treated patients presenting with brain lesions or seizures even in the absence of severe lymphocytopenia.

12 Review Importance of basic therapy in psoriasis. 2015

Thaçi, Diamant / Augustin, Matthias / Krutmann, Jean / Luger, Thomas. ·Comprehensive Center Inflammation Medicine, University zu Lübeck University Hospital Schleswig- Holstein, Campus Lübeck. ·J Dtsch Dermatol Ges · Pubmed #25918082.

ABSTRACT: Basic therapy plays an important role in the management of psoriasis, regardless of disease severity or the therapeutic concept used. It helps reduce symptoms such as pruritus and scaling, decreases exacerbations, and may therefore prolong the remission period after successful antipsoriatic treatment. Accordingly, adequate basic therapy can also have a positive effect on patients' severely impaired quality of life. Unfortunately, the importance of basic therapy in psoriasis is still underestimated. Based on clinical trial data, the present review highlights the efficacy and potential of basic therapy, and focuses on new data and developments in this field.

13 Review Psoriasis: to treat or to manage? 2014

Mrowietz, Ulrich / Steinz, Kirsten / Gerdes, Sascha. ·Psoriasis-Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany. ·Exp Dermatol · Pubmed #24815425.

ABSTRACT: The recognition of psoriasis as a systemic disorder with characteristic skin symptoms and associated diseases has changed treatment concepts substantially. The complexity of psoriasis disease not only requires appropriate therapy but also weight-loss and smoking cessation programmes as well as trigger factor elimination. The term 'management' may better reflect the aim for a holistic approach of disease control. Comorbidity and the presence of psoriatic arthritis are important denominators for drug selection. However, there is a lack of prospective data substantiating a benefit of associated diseases by antipsoriatic therapy. Securing success using treatment goals helps to establish an efficacious therapy and to control inflammation. A regular scoring of disease severity, patients' quality of life and assessment of other clinically relevant conditions are mandatory to closely follow the disease course. There is debate whether an early treatment may modulate the future course of psoriasis. Concepts of minimal disease activity have not been implemented in psoriasis yet. There is a lack of evidence how long any treatment should be given and when and how to terminate. Finally, outcome tools should specifically be tailored for psoriasis to evaluate disease-related items as well as the benefit of management from the patient's perspective.

14 Review Bimodal immune activation in psoriasis. 2014

Christophers, E / Metzler, G / Röcken, M. ·Department of Dermatology, University Clinics, Kiel, Germany. ·Br J Dermatol · Pubmed #24117368.

ABSTRACT: Psoriasis is an immune-regulated skin disease with various clinical subtypes and disease activities. The majority of patients present with predominantly stable plaques. At the onset of new lesions, plaque-type psoriasis frequently demonstrates pin-sized and highly inflammatory papules sometimes with an inflammatory border. The histopathology of initial psoriasis differs from stable plaque-type psoriasis. Early lesions demonstrate innate immune cells with neutrophils, degranulating mast cells and macrophages. These are followed by interleukin (IL)-1-dependent T helper (Th)17 cells, finally resulting in the Th1-dominated immunopathology of stable plaque-type psoriasis, where mononuclear cells predominate with interspersed neutrophilic (Munro) microabscesses. These features suggest a bimodal immune pathway where alternate activation of either innate (autoinflammatory) or adaptive (autoimmune) immunity predominates. Neutrophilic infiltrations appear during early psoriasis with Munro abscesses. They are time limited and occur periodically, clinically best seen in linear nail pitting. These features strongly suggest a critical role for an IL-1-Th17-dominated autoinflammation in the initiation of psoriasis, followed by a Th1-dominated late-phase reaction. The concept of bimodal immune activation helps to explain results from therapeutic interventions that are variable and previously only partly understood.

15 Review Cyclosporine as maintenance therapy in patients with severe psoriasis. 2013

Mrowietz, Ulrich. ·Psoriasis-Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany. umrowietz@dermatology.uni-kiel.de ·J Am Acad Dermatol · Pubmed #23866863.

ABSTRACT: -- No abstract --

16 Review [Comorbidities and psoriasis. Impact on clinical practice]. 2012

Gerdes, S / Mrowietz, U. ·Psoriasis-Zentrum an der Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 7, 24105, Kiel, Deutschland. sgerdes@dermatology.uni-kiel.de ·Hautarzt · Pubmed #22373901.

ABSTRACT: Psoriasis is a genetically determined, chronic inflammatory systemic disease. Besides skin symptoms, patients with moderate to severe forms of psoriasis show an association with other diseases, referred to as comorbidities. Metabolic disorders (e.g. diabetes mellitus, insulin resistance, dyslipidemia mainly in obese patients) and cardiovascular diseases (e.g. arterial hypertension, coronary artery disease, myocardial infarction and stroke) are of importance as they can increase patients' mortality. In addition, psychiatric diseases are more frequent in psoriasis patients and influence the therapeutic approach. The dermatologist in most cases is the primarily consulted physician for patients with psoriasis and therefore plays the role as a gatekeeper managing therapy. He is responsible for the early diagnosis of comorbidities and insuring their appropriate management. The anti-psoriatic treatment has to be adapted to existing comorbidities and their systemic treatments. The following article provides information on psoriatic comorbidities and their consequences for daily practice.

17 Review Implementing treatment goals for successful long-term management of psoriasis. 2012

Mrowietz, U. ·Psoriasis-Center, Department of Dermatology, University Medical Centre Schleswig-Holstein, Campus Kiel, Germany. umrowietz@dermatology.uni-kiel.de ·J Eur Acad Dermatol Venereol · Pubmed #22356631.

ABSTRACT: Treatment goals are commonly used throughout medicine to ensure efficacious therapy of diseases and to prevent complications related to uncontrolled disease activity, such as the management of hypertension and diabetes. Psoriasis is a systemic immune-mediated inflammatory disease comprising characteristic skin manifestations. A range of co-morbidities has been associated with it, including diabetes and cardiovascular diseases such as myocardial infarction (MI) and stroke. There is good evidence that the severity of skin symptoms is related to mortality associated with MI. Therefore, long-term efficacious control of skin inflammation is the treatment paradigm of choice, particularly in patients with severe skin involvement. Surveys in a number of countries have revealed a substantial under-treatment of patients with moderate-to-severe psoriasis, leaving a considerable proportion without adequate disease control. In addition, a high number of patients were not satisfied with their treatment, including the time they needed to allocate for skin therapy and the number of visits to physicians. Therefore, the use of effective therapies is necessary to achieve appropriate control of inflammation and to improve patient satisfaction. The definition of treatment goals is an appropriate instrument for raising the quality of care and sets therapeutic standards in addition to evidence-based guidelines. Consensus treatment goals for moderate-to-severe psoriasis were recently defined, and a treatment goal algorithm was developed through a Delphi process by a group of experts from 19 European countries. These have since been adopted into the update of the German S3 guidelines for treatment of psoriasis. Furthermore, a novel analysis was carried out on published Phase 3 clinical trial data from three studies of adalimumab therapy in psoriasis, which used the consented definition of moderate-to-severe disease and the proposed treatment goal algorithm. The data showed that the 'treatment goal' was achieved in 68.2-79.3% of the patients treated with adalimumab by week 16, with >93% achieving 'treatment success' (a ≥75 reduction in psoriasis area and severity index compared with baseline). These results were similar to those achieved using the protocol-specified definitions of disease severity. Regular assessment of treatment goals during maintenance phase at intervals recommended by the published guidelines, such as 16 weeks for adalimumab, will ensure efficacious therapy over time. This may, consequently, represent progress towards establishing a standard of care for psoriasis.

18 Review Triptolide in the treatment of psoriasis and other immune-mediated inflammatory diseases. 2012

Han, Rui / Rostami-Yazdi, Martin / Gerdes, Sascha / Mrowietz, Ulrich. ·Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany. rhan@dermatology.uni-kiel.de ·Br J Clin Pharmacol · Pubmed #22348323.

ABSTRACT: Apart from cancer chronic (auto)immune-mediated diseases are a major threat for patients and a challenge for physicians. These conditions include classic autoimmune diseases like systemic lupus erythematosus, systemic sclerosis and dermatomyositis and also immune-mediated inflammatory diseases such as rheumatoid arthritis and psoriasis. Traditional therapies for these conditions include unspecific immunosuppressants including steroids and cyclophosphamide, more specific compounds such as ciclosporin or other drugs which are thought to act as immunomodulators (fumarates and intravenous immunoglobulins). With increasing knowledge about the underlying pathomechanisms of the diseases, targeted biologic therapies mainly consisting of anti-cytokine or anti-cytokine receptor agents have been developed. The latter have led to a substantial improvement of the induction of long term remission but drug costs are high and are not affordable in all countries. In China an extract of the herb Tripterygium wilfordii Hook F. (TwHF) is frequently used to treat autoimmune and/or inflammatory diseases due to its favourable cost-benefit ratio. Triptolide has turned out to be the active substance of TwHF extracts and has been shown to exert potent anti-inflammatory and immunosuppressive effects in vitro and in vivo. There is increasing evidence for an immunomodulatory and partly immunosuppressive mechanism of action of triptolide. Thus, compounds such as triptolide or triptolide derivatives may have the potential to be developed as a new class of drugs for these diseases. In this review we summarize the published knowledge regarding clinical use, pharmacokinetics and the possible mode of action of triptolide in the treatment of inflammatory diseases with a particular focus on psoriasis.

19 Review Psoriasin: key molecule of the cutaneous barrier? 2011

Gläser, Regine / Köten, Bente / Wittersheim, Maike / Harder, Jürgen. ·Department of Dermatology, Venereology and Allergy, University Clinic Schleswig-Holstein, Campus Kiel, Germany. rglaeser@dermatology.uni-kiel.de ·J Dtsch Dermatol Ges · Pubmed #21501383.

ABSTRACT: Psoriasin (S100 A7) was discovered two decades ago as a protein abundantly expressed in psoriatic keratinocytes. Even though much scientific research has been carried out on the characterization of psoriasin, only recent studies point to an important role of psoriasin as an antimicrobial and immunomodulatory protein in skin and other epithelia. In this review, we provide an overview of the major findings in psoriasin research and discuss novel studies highlighting the role of psoriasin as an important effector molecule of the cutaneous barrier.

20 Review Strategies for improving the quality of care in psoriasis with the use of treatment goals--a report on an implementation meeting. 2011

Mrowietz, U / Kragballe, K / Nast, A / Reich, K. ·Department of Dermatology, Psoriasis-Center, University Medical Center Schleswig-Holstein, Kiel, Germany. umrowietz@dermatology.uni-kiel.de ·J Eur Acad Dermatol Venereol · Pubmed #21470314.

ABSTRACT: Targeted treatment, early intervention and the use of treatment goals is a new approach in medicine that has been implemented across several disciplines (e.g. diabetes, pulmonary arterial hypertension and rheumatoid arthritis) over the last 5-10 years. As in other chronic diseases, well-defined treatment goals may be helpful in guiding physicians in their care of patients with psoriasis, thereby obviating poor outcomes. Individual treatment goals were recently developed for the first time in psoriasis by a European Consensus group of experts from 19 European countries to supplement guidelines and promote the consistent use of available therapies to improve patient care. Goal-oriented therapy involves treating according to a treatment algorithm, regularly monitoring therapeutic response and prompt modification of therapy if goals are not met. In the absence of hard outcomes in psoriasis (e.g. biomarkers or biomedical predictors of clinical response), the European Consensus group based their treatment goals on changes in Psoriasis Area Severity Index and Dermatology Life Quality Index scores. Further evidence generation is important to determine whether surrogate markers for disease progression (e.g. co-morbidities) or predictors of clinical response can be identified for psoriasis. Furthermore, psoriasis may have a potential cumulative effect on the life course of patients, the understanding of which is likely to provide the rationale for earlier treatment strategies in psoriasis. For the work of the European Consensus group to have an impact on clinical care, transmission of treatment goals into guidelines, along with implementation of treatment goals at both the regional and national level is needed. Thus, dermatology experts from Europe, the Middle East, Australia and Canada gathered in Frankfurt, 2010, for a 1.5 day educational meeting run by the Progressive Psoriasis Initiative to discuss how treatment goals in psoriasis might best be implemented in clinical practice. The meeting conclusions are presented here.

21 Review Management of palmoplantar pustulosis: do we need to change? 2011

Mrowietz, U / van de Kerkhof, P C M. ·Psoriasis-Center at Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 7, 24105 Kiel, Germany. umrowietz@dermatology.uni-kiel.de ·Br J Dermatol · Pubmed #21275942.

ABSTRACT: Palmoplantar pustulosis (PPP) is difficult to treat. There is little hard evidence for the efficacy of any treatment and no published guidelines for its management. A number of exacerbating factors are well documented and there is some evidence for the importance of others. Smoking is the most recognized environmental trigger and recent research has concentrated on the role of eccrine sweat glands in this regard. Other factors, including tonsillar streptococcal infection and gluten sensitivity, may be important in selected cases. The aim of this review is to challenge dermatologists to consider alternative management strategies for PPP and design clinical trials that will enable the development of useful therapeutic guidelines.

22 Review Adipokines and psoriasis. 2011

Gerdes, Sascha / Rostami-Yazdi, Martin / Mrowietz, Ulrich. ·Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany. sgerdes@dermatology.uni-kiel.de ·Exp Dermatol · Pubmed #21255085.

ABSTRACT: Adipose tissue is an active endocrine organ contributing to the regulation of multiple metabolic pathways via self-produced bioactive products called adipokines. These adipokines are key players in the pathogenesis of metabolic syndrome and cardiovascular diseases. Co-occurrence of obesity and psoriasis could lead to interactions of both diseases in which adipokines, at least in part, are involved and may contribute to associated comorbidities of psoriasis. Until today numerous adipokines have been identified of which the most important ones are discussed in the following within the context of obesity, chronic inflammation and their possible role in the pathogenesis of psoriasis. Adipokines could serve as a missing link in the causal relationship between psoriasis and comorbidities and may provide a biomarker for disease severity, risk of comorbidities and treatment success.

23 Review Combination therapy in the treatment of psoriasis. 2011

Domm, Silja / Mrowietz, Ulrich. ·Psoriasis Center, Department of Dermatology, Venerology and Allergology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany. sdomm@dermatology.uni-kiel.de ·J Dtsch Dermatol Ges · Pubmed #20868376.

ABSTRACT: In addition to topical monotherapy for mild and systemic monotherapy for moderate to severe psoriasis, combination therapy plays an important role in daily practice. Although clinical trials almost exclusively evaluate monotherapy regimens, in real life psoriasis patients are usually treated with combination therapies. All combinations are used, topical/topical, topical/UV-light, topical/systemic or UV-light/systemic. Often not only two but more drugs/therapies are combined. Not every combination provides additive or synergistic effects. Some combinations are not possible and may be regarded as contraindications. Data on a benefit-risk-assessment are much more sparse in medical literature as compared to monotherapies. We summarize current knowledge about the use of combination therapies in psoriasis on the basis of published literature in the form of a table to show which combinations are possible, useful or which can not be recommended. This provides a quick overview of available options.

24 Review Ten years of infliximab: its role in dermatology. 2009

Mrowietz, Ulrich / Reich, Kristian. ·Psoriasis-Center, Dept. of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany. umrowietz@dermatology.uni-kiel.de ·Eur J Pharmacol · Pubmed #19837058.

ABSTRACT: Psoriasis is a common chronic inflammatory disease of the skin. Psoriatic arthritis may develop in about 20% of psoriasis patients while metabolic syndrome is a frequent comorbidity, and risk of cardiovascular disease is increased in psoriasis patients. Classical systemic treatments have not evolved much during the last decades; biological therapies on the contrary have added most significant progress in systemic treatment during the last 10 years. In particular tumor necrosis factor (TNF) blockade has changed the treatment outcomes in moderate to severe psoriasis patients. With drugs such as infliximab treatment goals of 75% improvement of psoriasis lesions together with significant improvement of quality of life can be achieved. Furthermore, skin clearance is possible in many patients with continued maintenance treatment with infliximab. More recent pivotal studies have shown that associated nail psoriasis responds well to infliximab, an outcome that was difficult to reach with classical therapies. There is good evidence that infliximab may be useful in other dermatological conditions such as pyoderma gangrenosum and hidradenitis suppurativa. Infliximab is an intravenous administration over a 2-hour period. Some patients may develop infusion reactions, and dermatologists need to be well aware of any possible adverse events that may be associated with anti-TNF treatment. Today, dermatologists have collected a broad experience with infliximab treatment of psoriasis and they have thus advanced their clinical practice accordingly.

25 Review Impact of comorbidities on the management of psoriasis. 2009

Gerdes, S / Mrowietz, U. ·Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany. sgerdes@dermatology.uni-kiel.de ·Curr Probl Dermatol · Pubmed #19710548.

ABSTRACT: Psoriasis is associated with numerous comorbidities that have a major impact on severely affected patients. Besides psoriatic arthritis, other diseases such as metabolic syndrome and cardiovascular diseases are becoming of major importance. In particular, patients with severe forms of psoriasis are at a higher risk of developing cardiovascular diseases and myocardial infarction. In a recent study, a reduction in life expectancy was shown for this subgroup of patients. An increased prevalence of concomitant diseases leads to an increased intake of concomitant medication; thus, it is easy for comorbidities and their treatments to interact with routinely used antipsoriatic therapies and complicate the management of severely affected patients. This patient subgroup has a strong need of sufficient treatment not only for their severe skin symptoms, but also for preventing the possible development of comorbidities and their long-term complications. As dermatologists are often one of the first and most often consulted health care specialists for patients with psoriasis, advanced knowledge of the comorbid state of these patients should influence clinical management and lead to new standards of care. This article will summarize the current knowledge on comorbidities in psoriasis and their impact on patient management.

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