Patient perspectives on treating psoriasis with classic inpatient dithranol therapy: a retrospective patient survey

Painsi, Clemens; Patscheider, Michael; Inzinger, Martin; Lange‐Asschenfeldt, Bernhard; Quehenberger, Franz; Wolf, Peter

doi:10.1111/ddg.12820

Cited by 7 publications

(4 citation statements)

References 41 publications

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“…However, the use of dithranol as a second‐line treatment in our cohort should be taken into consideration. In accordance with the Dutch guidelines for paediatric psoriasis, many patients who do not respond to classical topical treatments (corticosteroids, vitamin D analogues, calcineurin inhibitors) are treated with dithranol before commencing phototherapy or systemic treatment 1,4,23 . As dithranol is a safe and effective therapy and is often given in rotation with other topical treatments, many children stay on topical treatments (including dithranol) for a considerable time 4 .…”

Section: Discussionmentioning

confidence: 99%

“…In accordance with the Dutch guidelines for paediatric psoriasis, many patients who do not respond to classical topical treatments (corticosteroids, vitamin D analogues, calcineurin inhibitors) are treated with dithranol before commencing phototherapy or systemic treatment. 1,4,23 As dithranol is a safe and effective therapy and is often given in rotation with other topical treatments, many children stay on topical treatments (including dithranol) for a considerable time. 4 However, we realize that this is not common practice in many other countries, where the availability or practicality of dithranol might be problematic.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Treatment persistence in paediatric and adolescent patients with psoriasis followed into young adulthood. From topical to systemic treatment: a prospective, longitudinal, observational cohort study of 448 patients*

Bruins

Bronckers

Cai³

et al. 2020

Br J Dermatol

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Summary Background Although solely topical treatment often suffices, patients with psoriasis may require more intensive treatment (phototherapy and/or systemic treatments) to control their disease. However, in paediatric, adolescent and young adult patients, little is known about persistence of topical treatment and time until switch to systemic treatment. Objectives To determine the median time from psoriasis onset until (i) discontinuation of solely topical agents and (ii) switch to systemic treatment, and to identify patient characteristics associated with switching to systemic treatments. Methods Data were extracted from the Child‐CAPTURE registry, a prospective, observational cohort of patients with paediatric‐onset psoriasis followed into young adulthood from 2008 to 2018. Data prior to inclusion in the registry were collected retrospectively. Median times were determined through Kaplan–Meier survival analyses. Cox regression analysis was used to identify patient characteristics associated with switch to systemic treatment. Results Of 448 patients, 62·3% stayed on solely topical treatment until data lock; 14·3% switched from topicals to phototherapy, but not to systemic treatment; and 23·4% switched to systemic treatment. The median time from psoriasis onset until discontinuation of solely topical treatment was 7·3 years, and until switch to systemics was 10·8 years. Higher Psoriasis Area and Severity Index and (Children’s) Dermatology Life Quality Index > 5 were independently associated with switching to systemic treatment. Conclusions In a population of paediatric and adolescent patients with mild‐to‐severe psoriasis, one‐third needed more intensive treatment than solely topical therapy to control their disease. We consider the median time until switching to systemics to be long.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Treatment persistence in paediatric and adolescent patients with psoriasis followed into young adulthood. From topical to systemic treatment: a prospective, longitudinal, observational cohort study of 448 patients*

Bruins

Bronckers

Cai³

et al. 2020

Br J Dermatol

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“…Psoriasis characteristics, extracted from the PsoRA [9,10,11], were available from 72 patients and are depicted in Table 1. These patients had no psoriasis arthritis and were scheduled to receive classical topical inpatient dithranol treatment in combination with local steroids and/or UVB phototherapy [12,13]. Overall in 50 of 209 (23.9%) psoriasis and 7 of 91 (7.7%) CSU patients, periodontitis was documented in the DCU (for further details, see the study flowchart of Fig.…”

Section: Resultsmentioning

confidence: 99%

The Prevalence of Periodontitis Is Increased in Psoriasis and Linked to Its Inverse Subtype

Painsi

Hirtenfelder²,

Lange‐Asschenfeldt³

et al. 2017

Skin Pharmacol Physiol

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Periodontitis and psoriasis are suggested to be co-occurring, chronic inflammatory conditions with overlapping characteristics. However, respective evidence is rare and data on risk factors of periodontitis in psoriasis patients are minimal. The aim of this study was to expand the evidence of psoriasis-associated periodontitis and establish a potential risk profile for periodontitis. In total, data from 209 exacerbated psoriasis patients were retrospectively analyzed on recordings of periodontitis and compared with those of 91 patients with chronic spontaneous urticaria (CSU). Analysis showed a significantly increased prevalence of periodontitis in psoriasis compared to CSU patients with an odds ratio of 3.76 (95% CI = 1.60-10.27, p = 0.001). Within the psoriatic subtypes, the presence of the inverse type (affecting intertriginous body areas) was strongly linked to periodontitis with an odds ratio of 5.11 (95% CI = 1.36-20.38, p = 0.006). These results are enlarging the evidence for psoriasis-associated periodontitis and identify a link between the inverse type of psoriasis and periodontitis.

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“…We speculate that a dual effect of anti-IL-17 or anti-IL-23 antibody treatment on keratinocytes and immunocytes may also be responsible for the long-lasting, sustained response seen after treatment cessation. In contrast, other anti-psoriatic treatments such as topical steroids, vitamin D 3 analogs, or anthralin [55][56][57], systemic traditional treatments such as cyclosporine or methotrexate, and even firstgeneration biologics (i.e., TNF antagonists) are usually associated with rather quick relapses within several weeks after treatment is stopped.…”

Section: Treatments Leading To Long-lasting Clearance Of Psoriasismentioning

confidence: 99%

Resolution of plaque-type psoriasis: what is left behind (and reinitiates the disease)

Benezeder

Wolf

2019

Semin Immunopathol

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Psoriasis is a chronic inflammatory skin disease that involves numerous types of immune cells and cytokines resulting in an inflammatory feedback loop and hyperproliferation of the epidermis. A more detailed understanding of the underlying pathophysiology has revolutionized anti-psoriatic treatment and led to the development of various new drugs targeting key inflammatory cytokines such as IL-17A and IL-23. Successfully treated psoriatic lesions often resolve completely, leaving nothing visible to the naked eye. However, such lesions tend to recur within months at the exact same body sites. What is left behind at the cellular and molecular levels that potentially reinitiates psoriasis? Here, we elucidate the cellular and molecular "scar" and its imprints left after clinical resolution of psoriasis treated with anti-TNFα, anti-IL-17, or anti-IL-23 antibodies or phototherapy. Hidden cytokine stores and remaining tissue-resident memory T cells (TRMs) might hold the clue for disease recurrence.

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Patient perspectives on treating psoriasis with classic inpatient dithranol therapy: a retrospective patient survey

Cited by 7 publications

References 41 publications

Treatment persistence in paediatric and adolescent patients with psoriasis followed into young adulthood. From topical to systemic treatment: a prospective, longitudinal, observational cohort study of 448 patients*

Treatment persistence in paediatric and adolescent patients with psoriasis followed into young adulthood. From topical to systemic treatment: a prospective, longitudinal, observational cohort study of 448 patients*

The Prevalence of Periodontitis Is Increased in Psoriasis and Linked to Its Inverse Subtype

Resolution of plaque-type psoriasis: what is left behind (and reinitiates the disease)

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