Psoriasis: Hsu S

Doherty SD, Van Voorhees A, Lebwohl MG, Korman NJ, Young MS, Hsu S, National Psoriasis Foundation. · Department of Dermatology, Baylor College of Medicine, Houston, Texas 77030, USA. · J Am Acad Dermatol. · Pubmed #18485527 No free full text.

Abstract: BACKGROUND: Chronic immunosuppression is a known risk factor for allowing latent tuberculosis (TB) infection to transform into active TB. Immunosuppressive/immunomodulatory therapies, while highly efficacious in the treatment of psoriasis and psoriatic arthritis, may be associated with an increased rate of active TB in patients receiving some of these therapies. OBJECTIVE: Our aim was to arrive at a consensus on screening for latent TB infection in psoriasis patient treated with systemic and biologic agents. METHODS: Reports in the literature were reviewed regarding immunosuppressive therapies and risk of TB. RESULTS: Screening patients for latent TB infection before commencement of treatment is of utmost importance when beginning treatment with the tumor necrosis factor-alpha inhibitors, T-cell blockers, cyclosporine, or methotrexate. The currently recommended method for screening is the tuberculin skin test. It is preferable that positively screened patients be treated with a full course of latent TB infection prophylaxis before immunosuppressive/immunomodulatory therapy is initiated. However, in the opinion of many experts, patients may be started on the immunosuppressive/immunomodulatory therapy after 1 to 2 months, if their clinical condition requires, as long as they are strictly adhering to and tolerating their prophylactic regimen. LIMITATIONS: There are few evidence-based studies on screening for latent TB infection in psoriasis patients treated with systemic and biologic agents. CONCLUSIONS: The biologic TNF-alpha inhibitors are very promising in the treatment of psoriasis. However, because TNF-alpha is also an important cytokine in preventing TB infection and in keeping latent TB infection from becoming active disease, the use of TNF-alpha inhibitors has been associated with an increased risk of developing active TB. A higher incidence of TB has also been reported with other immunosuppressive/immunomodulatory treatments for psoriasis. It is, therefore, of utmost importance to appropriately screen all patients for latent TB infection prior to initiating any immunologic therapy. Delaying immunologic therapy until latent TB infection prophylaxis is completed is preferable. However, if the patient is adhering to his prophylactic regimen and is appropriately tolerating the regimen, therapy may be started after 1 to 2 months if the clinical condition requires.

Rivera AM, Hsu S. · Department of Dermatology, Baylor College of Medicine, Houston, Texas 77030, USA. · Am J Clin Dermatol. · Pubmed #16252930 No free full text.

Abstract: Halobetasol propionate (HP) 0.5% ointment and cream are class I topical corticosteroids. We review the efficacy and tolerability of HP for treatment of plaque psoriasis in the English language literature. The efficacy of HP ointment and cream is consistently superior to other super-potent topical corticosteroids. Local adverse events associated with topical HP are similar to those experienced with other super-potent corticosteroids. Combination therapy with calcipotriene (calcipotriol) and tazarotene appears to be superior to monotherapy with topical HP.

Chan CS, Van Voorhees AS, Lebwohl MG, Korman NJ, Young M, Bebo BF, Kalb RE, Hsu S. · Department of Dermatology, Baylor College of Medicine, Houston, Texas 77030, USA. · J Am Acad Dermatol. · Pubmed #19375191 No free full text.

Abstract: BACKGROUND: The scalp is the most commonly affected part of the body in patients with psoriasis. Signs and symptoms of scalp psoriasis vary significantly for individual patients. OBJECTIVE: A task force of the National Psoriasis Foundation was convened to evaluate treatment options. Our aim was to achieve a consensus for scalp psoriasis therapy. METHODS: Reports in the medical literature were reviewed regarding scalp psoriasis therapy. LIMITATIONS: There is a paucity of evidence-based and double-blind studies in the treatment of scalp psoriasis particularly for long-term therapy. Many of the studies in scalp psoriasis were designed to attain Food and Drug Administration approval for a medication and not to provide treatment guidance. CONCLUSIONS: The recommended short-term or intermittent therapy for scalp psoriasis is topical corticosteroids. The primary alternatives are topical retinoids, vitamin D analogues, and salicylic acid. Combination therapy has many advantages. The choice of an appropriate vehicle is crucial to increase patient compliance. While scalp psoriasis can often be adequately treated with topical therapy, recalcitrant disease may require more aggressive approaches, including systemic agents.

Kao CL, Krathen RA, Wolf JE, Fuerst JF, Hsu S. · Department of Dermatology, Baylor College of Medicine, Houston, TX 77030, USA. · J Drugs Dermatol. · Pubmed #18664166 No free full text.

This publication has no abstract.

Van L, Modi SV, Yang DJ, Hsu S. · Department of DermatologyBaylor College of Medicine, 6620 Main St, Ste 1425, Houston, TX 77030, USA. · Arch Dermatol. · Pubmed #18559778 No free full text.

This publication has no abstract.

Sun G, Wasko CA, Hsu S. · Department of Dermatology, Baylor College of Medicine, Houston, TX 77030, USA. · J Drugs Dermatol. · Pubmed #18246701 No free full text.

Abstract: Tumor necrosis factor-alpha (TNF-alpha) antagonists are used to treat many autoimmune disorders including Crohn's disease, ulcerative colitis, rheumatoid arthritis, and more recently, psoriasis. The adverse effects of the treatment regimen for psoriasis are not as well documented as those for Crohn's disease and rheumatoid arthritis. We report the development of acne vulgaris in 3 patients with psoriasis after initiating anti-TNF-alpha therapy.

Lebwohl M, Bagel J, Gelfand JM, Gladman D, Gordon KB, Hsu S, Kalb RE, Kimball AB, Korman NJ, Krueger GG, Mease P, Morison WL, Paller A, Pariser DM, Ritchlin C, Strober B, Van Voorhees A, Weinstein GD, Young M, Horn L. · Department of Dermatology, Mount Sinai School of Medicine, New York, New York, USA. · J Am Acad Dermatol. · Pubmed #17980456 No free full text.

Abstract: BACKGROUND: Biologics are widely used in the treatment of psoriasis and psoriatic arthritis. OBJECTIVE: Our aim was to arrive at a consensus on the kind of monitoring and the vaccinations that should be performed before and during biologic therapy. METHODS: Medical literature and data presented at meetings were reviewed and a consensus conference was held by members of the Medical Board of the National Psoriasis Foundation. RESULTS: Consensus was established on monitoring and vaccination practices that included discussion and recognition of variations in those practices. History, physical examination, chemistry screen with liver function tests, complete blood cell count, and platelet count and tuberculosis testing are widely obtained at baseline and with variable frequencies thereafter. Patients treated with efalizumab have platelet counts checked more often; liver function tests are repeated more frequently in patients treated with infliximab; patients taking tumor necrosis factor blockers undergo tuberculosis testing more often; and patients treated with alefacept have CD4 counts checked approximately every 2 weeks. Avoidance of live vaccines during biologic therapy and administration of essential vaccines before biologic therapy were discussed, although vaccination is performed only to a variable degree. There was no consistency in the measurement of antinuclear antibodies among the experts. LIMITATIONS: There are few evidence-based studies on monitoring practices for patients with psoriasis taking biologic therapies. CONCLUSIONS: In patients taking biologic therapies for psoriasis, monitoring of blood chemistries, blood counts, CD4 counts, antinuclear antibodies, tuberculin skin tests, history, and physical examination may be warranted depending on the particular therapy and the particular patient. Vaccination practices are also addressed.

Hsu S, Dickinson D, Borke J, Walsh DS, Wood J, Qin H, Winger J, Pearl H, Schuster G, Bollag WB. · Department of Oral Biology and Maxillofacial Pathology, School of Dentistry, Medical College of Georgia, Augusta, GA 30912, USA. · Exp Dermatol. · Pubmed #17620095 No free full text.

Abstract: Psoriasiform lesions are characterized by hyperproliferation and aberrant differentiation of epidermal keratinocytes, accompanied by inflammation, leading to a disrupted skin barrier with an abnormal stratum corneum. The expression and proteolytic processing of caspase 14, a member of the caspase family which is associated with epithelial cell differentiation, planned cell death, and barrier formation, is altered in psoriatic epidermis. We recently reported that human psoriatic tissues lack normal expression of caspase 14 [J Dermatol Sci37 (2005) 61], and caspase 14 is induced by EGCG, a green tea polyphenol (GTP), in exponentially growing normal human epidermal keratinocytes (NHEK) [J Pharmacol Exp Ther315 (2005) 805]. This suggests that GTPs may have beneficial effects on psoriasiform lesions. The current study aimed to determine whether MAPK pathways are required for GTP-induced caspase 14 expression in NHEK and if GTPs can modulate the expression of pathological markers in the psoriasiform lesions that develop in the flaky skin mouse. The results indicate that the p38 and JNK MAPK pathways are required for EGCG-induced expression of caspase 14 in NHEK. Importantly, topical application of 0.5% GTPs significantly reduced the symptoms of epidermal pathology in the flaky skin mice, associated with efficient caspase 14 processing and reduction in proliferating cell nuclear antigen levels. This suggests that GTP-activated pathways may be potential targets for novel therapeutic approaches to the treatment of some psoriasiform skin disorders.

George SJ, Anderson HL, Hsu S. · Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA. · Dermatol Online J. · Pubmed #16638397 links to  free full text

This publication has no abstract.

Krathen RA, Berthelot CN, Hsu S. · Department of Dermatology, Baylor College of Medicine, Houston, TX 77030, USA. · J Drugs Dermatol. · Pubmed #16573258 No free full text.

Abstract: BACKGROUND: Infliximab inhibits T-cell activation by binding tumor necrosis factor-alpha (TNF-alpha). This medication is widely used in the US for treatment of psoriasis as an off-label indication. The durability of its effect is largely unknown. OBJECTIVE: To assess the proportion of patients still on infliximab 12 months after initiation of therapy for psoriasis. Methods: Retrospective chart review analysis of 73 patients with psoriasis treated with infliximab for at least 12 months or those who experienced treatment failure in less than 12 months. The point where infusions were deemed to no longer be efficacious was determined by physician's global assessment (PGA). RESULTS: Of 73 patients who started infliximab at least 12 months prior to this chart review, 22 (30.1%) had discontinued treatment secondary to loss of efficacy. Thirty seven patients (50.7%) had no loss of efficacy and continued to receive infusions. Two patients (2.7%) discontinued due to loss of efficacy after greater than 12 months. Of the 22 patients who discontinued treatment due to loss of efficacy, 2 were on concomitant methotrexate (5-7.5 mg/wk) therapy. Of the 37 patients still receiving treatment with no loss of efficacy at 12 months, 3 patients were on concomitant methotrexate therapy. Five patients (6.8%) discontinued secondary to minor adverse events: sinus infection (1), acne (1), fever (1), arthralgia (1), and transient rash (1). Three patients (4.1%) discontinued due to major adverse events: reactivation of tuberculosis (1), breast cancer (1), and gastrointestinal bleeding (1). One patient discontinued infliximab secondary to concerns of possible lymphoma risk (though there were no signs of symptoms of disease on examination), and 3 patients discontinued due to insurance concerns. CONCLUSION: Infliximab treatment resulted in significant improvement in psoriasis, with 37 out of 73 patients (50.7%) experiencing no loss of efficacy. This longitudinal retrospective chart review demonstrates continued benefit of infliximab infusions in about half of patients after 1 year, though a notable percentage (30.1%) experienced loss of efficacy as determined by physician's global assessment (PGA) and a number of others discontinued due to adverse events or insurance difficulty.

Farnsworth NN, George SJ, Hsu S. · Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA. · Dermatol Online J. · Pubmed #16409907 links to  free full text

This publication has no abstract.

Berthelot CN, George SJ, Hsu S. · University of Texas Medical School Southwestern, Dallas, Texas, USA. · J Am Acad Dermatol. · Pubmed #16227104 No free full text.

Abstract: The development of tumor necrosis factor inhibitor biologic therapy is arguably one of the most significant achievements in the treatment of rheumatic diseases to date. Neurologic events suggestive of demyelination have been reported for patients receiving treatment with the antitumor necrosis factor agents etanercept and infliximab. We describe the onset of lower extremity paresthesia and foot drop in a patient who was receiving adalimumab for the treatment of psoriasis and examine the relationship of tumor necrosis factor antagonism and demyelinating disease.

Krishnan RS, Hsu S. · Department of Dermatology, Baylor College of Medicine, One Baylor Plaza, FB800 Houston, Texas 77030, USA. · J Drugs Dermatol. · Pubmed #15176166 No free full text.

Abstract: Infliximab is a chimeric, murine-human, monoclonal antibody against tumor necrosis alpha which has shown great efficacy in the treatment of psoriasis. Serum sickness, which is an immune complex mediated syndrome consisting of a cutaneous eruption, fever, arthritis, edema, and lymphadenopathy, has been described in several patients receiving infliximab for the treatment of Crohn's disease. However, to our knowledge, this type of reaction has not been well described in a patient treated with infliximab for psoriasis. We describe a patient who developed serum sickness while receiving infliximab for psoriasis and discuss the pathogenesis, diagnosis, and treatment of serum sickness. We believe that with the increasing use of infliximab for psoriasis, more cases of serum sickness will occur. Therefore, awareness of this adverse effect is essential.

Angel TA, Hsu S, Kornbleuth SI, Kornbleuth J, Kramer EM. · Department of Dermatology, Baylor College of Medicine, Houston, TX 77030, USA. · J Am Acad Dermatol. · Pubmed #11807457 No free full text.

Abstract: Four siblings, products of a consanguineous marriage, had palmoplantar keratoderma and loss of teeth. In addition, 3 of the siblings had psoriasiform plaques on their elbows and/or knees and 1 had intracranial calcifications. To our knowledge, this is the second largest reported number of affected members in a family with Papillon-Lefevre syndrome, a rare genodermatosis.

Chan CY, Browning JC, Larsen F, Hsu S. · No affiliation provided · Dermatol Online J. · Pubmed #19061594 links to  free full text

Abstract: Infliximab is a chimeric monoclonal antibody that selectively blocks tumor necrosis factor-alpha (TNF-alpha). It is indicated for the treatment of numerous inflammatory diseases, including rheumatoid arthritis, Crohn disease, ulcerative colitis, ankylosing spondyilitis, and psoriatic arthritis. Infliximab has also been shown to be a well tolerated and highly effective treatment for psoriatic skin lesions. We report an interesting case of unexpected, new-onset psoriasis in a patient on infliximab for rheumatoid arthritis.