Background The first phase of the Psoriasis Longitudinal Assessment and Registry (PSOLAR) provided safety, demographic, and other outcomes data from >12,000 patients (>75,000 patient-years) eligible to receive biologics for psoriasis. In 2018, PSOLAR enrollment criteria were updated to specifically include patients receiving either guselkumab or an interleukin-17 inhibitor (IL-17i). Methods Baseline characteristics are described for patients included in PSOLAR after adoption of Protocol Amendment 6 (March 26, 2018), which updated enrollment criteria to include patients exposed to guselkumab or an IL-17i. Results As of July 12, 2025, 3501 patients (guselkumab, n = 2213; IL-17i, n = 1288) were enrolled at sites in 17 countries. Baseline characteristics were generally balanced between the guselkumab and IL-17i cohorts. The majority of patients were male (59.9%), white (74.3%), and overweight/obese (78.5%; mean [SD] BMI = 30.2 [7.2] kg/m 2 ). Mean (SD) age was 50.3 (13.9) years. On average, patients had longstanding psoriasis at baseline (mean [SD] duration of psoriasis = 19.0 [13.7] years; mean [SD] body surface area = 8.6% [12.7]). Most patients reported current or prior history of alcohol use (77.3%) and smoking (54.1%). Prior to enrollment, most patients (76.9%) reported exposure to ≥1 biologic. Self-reported psoriatic arthritis was less common in the guselkumab vs the IL-17i group (25.0% vs 38.1%). Conclusion Patients with psoriasis treated with guselkumab or an IL-17i in this real-world cohort had similar baseline characteristics, although psoriatic arthritis was more common in the IL-17i group. Findings from PSOLAR may help clinicians better understand characteristics of patients who may be prescribed guselkumab or an IL-17i for psoriasis in a real-world setting. Clinicaltrials.gov Identifier NCT00508547.
Background:Psoriasis is a chronic immune-mediated inflammatory disease associated with heightened cardiovascular risk. Platelets are increasingly implicated in this link through their capacity to amplify vascular inflammation and interact with leukocytes. Circulating leukocyte-platelet aggregates are elevated in psoriasis, although the biological significance of these aggregates remains incompletely understood. We investigated whether increased leukocyte-platelet aggregates is associated with alterations in the platelet transcriptomic profile in psoriasis. Methods:Leukocyte-platelet aggregate levels were compared between psoriasis patients (n = 42) and healthy controls (n = 29). Psoriasis patients were stratified by the cohort median lymphocyte-platelet aggregate (LyPA) or neutrophil-platelet aggregate (NPA) levels into high vs low aggregate groups. Platelet RNA sequencing was then performed to define transcriptomic differences in high-vs low-aggregate psoriasis. Results:Psoriasis patients (mean age 46; 60% male; 81% Caucasian) had higher LyPA (P = 0.001) and NPA (P = 0.04) compared with healthy controls (mean age 42; 55% male; 69% Caucasian). Platelet RNA sequencing revealed that psoriasis patients with high LyPA or high NPA had downregulation of platelet inflammatory pathways, including interferon, tumor necrosis factor (TNF), IL-8, and IL-6 signaling. Conclusion:These findings identify inflammatory platelet transcriptomic alterations associated with elevated lymphocyte-platelet and neutrophil-platelet aggregates in psoriasis and motivate further work to define the functional consequences of leukocyte-platelet aggregates in psoriasis.
Introduction:Psoriasis (PsO) and psoriatic arthritis (PsA) are chronic inflammatory conditions treated with primarily immune-modulating medication. However, interest is growing in gut microbiome therapies. Studies have reported altered gut microbiota in PsO/PsA and explored probiotics and fecal microbiota transplantation (FMT) as potential therapies. This review synthesizes global studies on the microbiome's associations in PsO/PsA. Methods:We conducted a scoping literature review to understand the association between gut microbiota in PsO and PsA patients. Pubmed was used to identify 4,126 published manuscripts between 2015-2025. Thirty studies were included, encompassing 749,275 participants, with balanced gender representation and ages ranging from 18 to 76 years. These studies included 21 case-control studies, 1 case-series, 2 genome-wide analyses, 5 clinical trials, and 1 retrospective review. Results:Eighteen studies reported significant gut microbiome differences in PsO/PsA vs healthy controls. Variation in the Firmicutes/Bacteroides (F/B) ratio was of interest, with one study suggesting a low F/B ratio and five studies suggesting an elevated F/B ratio in PsO. A higher F/B ratio was linked to increased acetate production. Acetate and propionate, key short-chain fatty acids (SCFAs), were associated with modulation of the IL-23/Th17 axis in psoriasis and activation of keratinocytes. The role of therapeutics targeting the gut microbiome was explored. Ustekinumab and tofacitinib altered gut microbiome composition. Probiotic and FMT interventions showed mixed outcomes. Six of eight probiotic studies reported increased SCFA producing species and/or reduced inflammatory markers. FMT improved immune markers in mice but had no significant benefit in human trials. Conclusion:Alterations in the microbiome linked to inflammation and immune response, suggest the microbiome as a potential therapeutic target for PsO/PsA.
We appreciate the interest of Joaquin et al in our recent study on the treatment persistence of ixekizumab in psoriatic arthritis. In response, we clarify that our study utilized prospectively collected real-world clinical data from a multicenter observational cohort, rather than administrative databases. We emphasize the importance of persistence, as assessed through the Drug Retention Rate (DRR), a validated measure in observational studies of biologic therapies. The DRR reflects a complex interplay of factors, including efficacy, safety, and patient choice, making it a valuable indicator of therapeutic performance. We agree that adherence is an interesting topic, but argue that its absence does not invalidate persistence data. Our study was designed to evaluate treatment persistence, not behavioural pharmacology. We believe that our methodological rigor, real-world design, and consistency with international literature make our data a reliable reference for understanding ixekizumab persistence in routine clinical pratice.
Background: Enthesitis, a key feature of psoriatic arthritis (PsA), can be detected subclinically by ultrasound (US) in patients with psoriasis (PsO), where it may signal an increased risk of future articular involvement. Purpose: This observational study aimed to investigate the prevalence of subclinical enthesitis in PsO patients without musculoskeletal symptoms, analyze the differences between patients with enthesis alterations (i.e. active enthesitis - AE, inactive enthesitis - En, enthesopathy - Ep or none - wE, per OMERACT criteria) and evaluate the 1 year PsA incidence. Research design: All consecutive PsO patients ≥18 years attending a dermatology outpatient clinic were screened. A rheumatologist and a radiologist experienced in US performed greyscale and Power Doppler (PD) examination on six bilateral enthesal sites (Achilles, quadriceps, distal/proximal patellar, plantar fascia, and triceps enthesis). The chi-square test or Kruskall-Wallis test detected the differences between the groups. After 1 year, rheumatologists reassessed En and AE patients for PsA onset. A P-value ≤0.05 was considered statistically significant. Results: Among 211 enrolled subjects, AE, En, and Ep prevalences were 6.6%, 35.6%, and 31.8%, respectively. There were no alterations in 23.2% while 2.8% showed only PD signal. BMI was higher in En than in wE and Ep (28, 24 and 25 kg/m^2 respectively) (P < 0.05). Female were less prevalent in En than in Ep (52% vs 25%, P < 0.01). None developed PsA during the 1-year follow-up. Conclusion: Subclinical enthesitis is common in PsO patients (about 40%), with inactive enthesitis more frequent in higher-BMI individuals. Active enthesitis was rare (<7%), and no cases progressed to PsA.
Despite advancements in psoriasis therapeutics, biologic discontinuation and switching still happen frequently, with the most common reasons being lack of efficacy or treatment intolerance. Conventional teaching has been to switch out of the class (inter-class switching) for primary non-responders and to stay in the class (intra-class switching) for secondary non-responders. Previous real-world studies have reported success with intra-class switching within the IL-17 inhibitor class, but data have been limited to secukinumab, ixekizumab, and brodalumab. Using retrospective data from cases selected for moderate-to-severe psoriasis who failed prior IL-17 therapy, we report our real-world experience using bimekizumab in 50 patients who failed a prior IL-17 inhibitor, in which 82% achieved an IGA 0/1. By demonstrating achievement of stringent benchmarks, such as IGA 0/1 and sPGAxBSA 100 in these selected patients, we challenge the conventional teaching of primary vs secondary non-responders class switching, and have found bimekizumab to be a viable option in those who have failed IL-17 inhibitor therapy in the past.
Background:Psoriatic arthritis (PsA) exhibits heterogeneity across different populations. Given the limited research on PsA in Africa, this study aims to characterize disease features and various cardiovascular disease risk factors (CVRFs) in a cohort of patients with PsA. Methods:We enrolled 110 patients fulfilling the CASPAR criteria. PsA. PsA-related parameters and various CVRFs were recorded. Radiographs of hands and feet assessed peripheral joint damages. Results:The study population included 48 males and 62 females, with a mean age of 49.8 ± 12.5 years and a mean disease duration of 9 ± 7 years. The most common disease pattern was polyarthritis, followed by oligoarthritis, spondyloarthritis, and enthesitis. Dactylitis was reported in 33.9% of patients, while 7.6% carried the HLA-B27 gene. Psoriasis was observed in 74.5% of patients, with nail involvement in 30% of cases. Inflammatory bowel disease and uveitis were present in 4.5% and 1.8% of patients, respectively. 77% of patients had active disease. Radiographic joint damage was detected in 47.2% of patients and was significantly associated with disease duration, dactylitis, and biologic therapy use. In this cohort, 23.6% were obese, and 30% were smokers. Comorbidities such as diabetes, hypertension, hyperlipidemia, and gout were present in 22.7%, 19.1%, 29.1%, and 8.1%, respectively. Moreover, 57.3% of patients had two or more CVRFs and 9.1% had a cardiovascular disease. Conclusion:This cohort suggested a female predominance, a lower prevalence of the HLA-B27 gene, a reduced frequency of extra-musculoskeletal manifestations, and a high prevalence of radiographic joint damage and CVRFs.
Background Generalized pustular psoriasis (GPP) is a rare, serious, chronic, neutrophilic skin disease, distinct from plaque psoriasis, characterized by recurrent flares of cutaneous erythema and widespread sterile pustules. Patient-centric data on the quality of life (QoL) impacts of GPP remain limited. Objective To evaluate the physical and emotional QoL impacts of GPP. Methods We used a web-based survey and 90-minute telephone interviews with open-ended questions to evaluate the experiences of adults with GPP across China, Japan, the UK, and the USA. Quantitative measures included the Dermatology Life Quality Index (DLQI), Psoriasis Symptom Scale (PSS), and Worst GPP Pain Numeric Rating Scale (NRS). Results 21 participants completed the survey; 9 completed telephone interviews. The journey to diagnosis was complicated, with 48% of participants seeing ≥4 physicians before the diagnosis. Impacts of GPP on participants physical and mental QoL were substantial, such as the anxiety of not being able to plan life and work with confidence, both in general and during flares. The mean DLQI was 10.2, and the PSS and Worst GPP Pain NRS were highest in participants experiencing recent flares. Participants’ biggest worries included risk of flares, distress from symptoms, inadequate treatment, and passing on the disease to their children. Limitations included a small sample size and short recall timeframe. Conclusion Participants reported multiple impacts of GPP on their daily lives even in the absence of acute flares, highlighting the need for greater disease awareness and understanding among healthcare professionals.
Objective:To assess the contributing factors and clinical characteristics of difficult-to-treat (D2T) psoriatic arthritis (PsA). Patients and methods:This retrospective cross-sectional study included PsA patients from a tertiary care center. D2T PsA was defined as failure of at least 1 conventional synthetic DMARD (csDMARD) and 2 or more biologic/targeted synthetic DMARDs (b/tsDMARDs) with different mechanisms of action. Baseline demographics, disease duration, and domain involvement were compared across groups. Results:A total of 150 PsA patients were included, with an equal gender distribution and a mean age of 55.9 ± 13.7 years. Patients with D2T PsA had a significantly younger age of onset for both psoriasis and PsA (both P < 0.001), and a higher prevalence of obesity (P = 0.018). Multidomain involvement was prominent, with 93.5% of D2T patients having 3 or more domains affected (P < 0.001). Axial disease, dactylitis, enthesitis, and nail involvement were all significantly more frequent in the D2T group (all P < 0.001). Multivariate analysis identified age, age of psoriasis onset, axial involvement, enthesitis, and nail dystrophy as independent predictors of D2T PsA. Conclusion:D2T PsA is associated with early disease onset, obesity, and extensive multi-domain involvement, particularly axial disease, enthesitis, and nail changes. These findings suggest that specific clinical features and comorbidities may help identify patients at risk of developing D2T PsA. Early recognition of these factors may guide more personalized and aggressive treatment strategies to improve long-term outcomes.
Plaque psoriasis is a chronic skin disorder involving dysregulated inflammation. While numerous biologic therapies targeting inflammatory mediators have been approved for moderate-to-severe psoriasis, their safety profiles may include an increased risk of adverse events (AEs), such as infections, cardiovascular diseases, and malignancies. Because patients with psoriasis also have increased incidence of comorbidities, long-term real-world AE monitoring is critical to further evaluate the safety of biologic therapies postapproval. Brodalumab is a recombinant, fully human interleukin-17 receptor A antagonist indicated for the treatment of moderate-to-severe plaque psoriasis in adult patients who are candidates for systemic therapy or phototherapy and have failed to respond or have lost response to other systemic therapies. The safety profile of brodalumab has been established in clinical trials and industry-sponsored US pharmacovigilance reports. Herein, we summarize AEs reported in nonsponsored open-label and real-world studies of brodalumab. Across all studies, most common AEs were similar to those listed in the brodalumab package insert. While AEs of special interest were not reported comprehensively, their rates were generally low, with 3 cases of major adverse cardiac events, 2 cases of malignancy, 11 cases of depression, and no completed suicides in the overall safety population (N = 1701). There were 6 cases of serious infection and no serious fungal infections. Studies evaluating AEs of interest for brodalumab showed no causal link to suicide and no increase in risk of cardiac events or serious infection compared with other biologics. Together, these studies support a consistent safety profile of brodalumab in real-world use.
Background: Managing psoriasis in patients with a history of lymphoma presents a unique clinical challenge. Psoriasis is associated with significant comorbidities such as cardiovascular disease and inflammatory arthritis, making optimal treatment vital. Systemic treatments like biologic agents may help mitigate these sequelae of systemic inflammation. However, concerns about immunosuppression in the context of lymphoma recurrence and progression complicate therapeutic decisions. Purpose: This review aims to examine the role of IL-12, IL-17, IL-23, and TNF-α in psoriasis and explores the safety of biologic therapies in this population, with a focus on impact on lymphoma recurrence and progression. Research Design: A narrative review of the current medical literature was conducted. Study Sample: The analysis synthesizes evidence from preclinical studies, clinical trials, post-marketing surveillance registries, retrospetive cohort studies, and case reports concerning the use of biologic agents in psoriasis. Data Collection: Relevant literature was identified an analyzed to compare the mechanisms of action, degree of immunosuppression, and available safety data of different biologic agent classes. Results: Based on current evidence, we propose that IL-17 and IL-23 inhibitors as preferred options due to their targeted mechanisms and favorable safety profiles. In contrast, TNF-α inhibitors are less favored due to their comparatively greater immunosuppressive effects and potential association with lymphoma risk. IL-12/23 inhibitors are questionable given their potential impact on tumor immunosurveillance. Conclusion: For psoriasis patients with a history of lymphoma, IL-17 and IL-23 inhibitors represent the most suitable biologic options, while TNF-α inhibitors and IL-12/23 inhibitors should be used with caution. Clinical data overall remains limited, however, as lymphoma patients are routinely excluded from clinical trials. Further research is needed to clarify long-term safety and optimize treatment strategies for this high-risk population.
In this commentary, we discuss the role of pharmacy benefit managers (PBMs) on access to biologics for patients with psoriasis. We highlight structural and system level barriers to biologics access, as well as how PBMs work as intermediaries between insurers, pharmacies, and drug manufactures to influence prescription formularies and generate health savings. We also discuss how controversial PBM practices such as step therapy, prior authorizations, and spread pricing may limit access to biologics and potentially increase cost for patients. Finally, we highlight how dermatologists and national organizations such as the National Psoriasis Foundation can collaborate and advocate for legislative reforms to increase transparency among PBMs.
Background:Psoriasis is associated with increased risk of depression. Although cognitive behavioral therapy (CBT) is an evidence-based treatment, access remains limited. Objectives:To evaluate the feasibility, acceptability, and preliminary efficacy of a smartphone-delivered, coach-led CBT program for depression among individuals with psoriasis. Methods:This single-arm, 8-week pilot study (Mindset trial, NCT06216691) enrolled adults with psoriasis and at least mild depressive symptoms (PHQ-9 ≥5). Participants engaged in a smartphone-based CBT program guided by bachelor's-level lay coaches. Primary outcomes were feasibility as evaluated by module completion and acceptability as evaluated by the Client Satisfaction Questionnaire-8 (CSQ-8]) and User Version of the Mobile Application Rating Scale (uMARS). Secondary outcomes included changes in the Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), Appearance Anxiety Inventory, Skindex-16, and Psoriasis Symptom Inventory. Results:Of 30 participants, 63.3% completed ≥4/8 modules and 43.3% completed ≥6/8 modules. Mean CSQ-8 and uMARS scores were 27.2 (SD 4.5) and 4.0 (SD 0.7), respectively, supporting high satisfaction. Statistically and clinically significant improvements were observed in PHQ-9 (mean change -4.4; Cohen's d = 0.92), GAD-7 (-2.8; d = 0.63), and Skindex-16 symptoms (5.0; d = 0.78), emotions (10.0; d = 0.95), and functioning (6.4; Cohen's d = 0.71) subscales as well as the Psoriasis Symptom Inventory (3.1; d = 0.43). Conclusions:This study supports the feasibility, acceptability, and preliminary efficacy of smartphone-delivered CBT for individuals with psoriasis and depressive symptoms. Given the scalability of this model, future randomized trials are warranted to assess broader effectiveness in dermatology care settings.
Background: There have been significant advances in psoriatic disease research in recent years, leading to better understanding of genes involved and increased treatment options. Purpose: To guide current research priorities for psoriatic disease, we held an interactive session on this topic consisting of a presentation and small group discussion with National Psoriasis Foundation (NPF) patient-volunteers, their family members, and NPF staff at the NPF 2025 IMPACT Volunteer Leadership Summit. Research design: We presented a list of 10 psoriatic research topics and asked attendees to rate the priority of each topic on a 9-point scale. The session also included breakout groups where attendees discussed research areas most important to them. Study Sample: National Psoriasis Foundation (NPF) patient-volunteers, their family members, and NPF staff at the NPF 2025 IMPACT Volunteer Leadership Summit. Data collection and/or Analysis: Attendees completed an online REDCap survey which was then analyzed by the study team. Results: "Improving treatment for psoriatic disease and achieving remission" was the research topic that received the highest overall rating. We also learned of research topics of high patient interest not included on our original list of 10 topics, including research exploring the relationship between psoriatic disease and hormones, infertility, and menopause. Increased research on pediatric psoriatic disease and research initiatives focused on increased patient and provider education were topics of importance to attendees as well. Conclusion: Overall, these findings may help guide future patient-centered research agendas in psoriatic disease.
Background:In order to apply current treatment recommendations for psoriatic arthritis (PsA), a complete assessment of psoriatic disease domains must be completed by the clinician. This includes a musculoskeletal examination (including tender and swollen joints, dactylitis, enthesitis, and axial disease) as well as skin and nail examination. Documentation in the clinician's note serves as a proxy for disease assessment. Objective:To explore differences in documentation of psoriatic domains between PsA specialist and general rheumatologists at 2 academic centers. Methods:We identified PsA patients seen by either general rheumatologists or by PsA combined clinic specialist providers at 2 established PPACMAN (Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network) sites. Records were assessed for the presence (and extent) of documentation for musculoskeletal and cutaneous PsA domains. We also examined accuracy of ICD coded diagnoses to understand the extent to which discrete data from the electronic medical record can be used to evaluate completeness of assessment. Results:PsA combined clinic specialist providers documented disease domains significantly more consistently compared to generalists, including tender and swollen joint counts (P < 0.001), assessment of spondyloarthritis (P = 0.017), and presence/extent of skin involvement (P < 0.001). Additionally, PsA specialists more consistently coded for both psoriasis (PsO) and PsA. Conclusions:In this multicenter, retrospective study, compared to generalists, PsA combined-clinic specialist providers more thoroughly documented both musculoskeletal and cutaneous psoriatic disease domains and ICD coding of PsO for patients, highlighting gaps in assessment and documentation. These findings underscore the need for improved training in psoriatic disease assessment and simplified modalities for documentation.
Biologic dosing frequency is a key concern among psoriasis (PsO) patients and physicians, yet dosing optimization remains a challenge. This study evaluates patient dosing preferences for IL-17 and IL-23 inhibitors, risankizumab (RZB) every 12 weeks, guselkumab (GUS) every 8 weeks, and ixekizumab (IXE) every 4 weeks, in managing PsO. This phone survey study evaluated 87 adults on RZB (n = 29), GUS (n = 35), or IXE (n = 23) from 2019 onward at two clinical sites. Patients were assessed for baseline PsO bothersome severity, current dosing frequency satisfaction, frequency of PsO flares, and preferred dosing frequency. Most patients were males (57.5%) with an average age of 54.1 years and an average treatment duration of 19.0 months. At baseline before treatment, 87% were 'very bothered' by their PsO. After treatment, 86% were either '3-somewhat' or '4-very satisfied' with their current dosing schedule, with no significant differences between each drug (P = 0.7). Across all biologics the majority of participants (62% with RZB, 57% with GUS, and 48% with IXE) preferred maintaining their current dosing frequency. No statistically significant differences were observed in dosing frequency preference between treatment groups, suggesting dosing schedule is not a primary concern for most patients. This aligns with previous research demonstrating effective disease control is the most important factor for patient satisfaction; however, tailoring dosing regimens to individual patient needs can also strengthen long-term adherence, as demonstrated in recent studies.
Patients with psoriasis (PsO) and psoriatic arthritis (PsA) are at significantly increased risk for cardiovascular (CV) disease, attributed to chronic systemic inflammation and a high burden of cardiometabolic comorbidities. Despite this, CV risk factors in this population are frequently underdiagnosed and undertreated. This consensus document, developed by the Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network (PPACMAN), provides practical recommendations for dermatologists, rheumatologists, and primary care physicians to improve CV risk assessment and management in PsO and PsA. Key recommendations include conducting baseline CV risk assessments at diagnosis-particularly for patients with moderate-to-severe PsO, PsA, or those requiring biologic therapy-and routine screening for hypertension, diabetes, dyslipidemia, smoking, obesity, and metabolic syndrome. The use of biomarkers such as high-sensitivity C-reactive protein and lipoprotein(a) may help refine risk stratification. Patients at elevated risk should be referred to their primary care provider or a cardiologist for further evaluation and may require additional imaging, including coronary artery calcium scoring. Lifestyle counseling on diet, exercise, weight management, and smoking cessation is essential. Pharmacologic strategies, such as earlier initiation of statins and consideration of glucagon-like peptide-1 (GLP-1) receptor agonists, are encouraged when clinically appropriate. Systemic inflammation should be reduced using anti-inflammatory therapies, although outcome data remain mixed. Clinicians must carefully assess the risks and benefits of NSAIDs, corticosteroids, and Janus kinase (JAK) inhibitors. This document aims to bridge existing gaps in interdisciplinary care and facilitate earlier, more aggressive CV risk management in psoriatic disease, aligning with current cardiology and dermatology guidelines to reduce morbidity and mortality.
Importance:Dengue infection is an emerging global health concern. Understanding its impact on patients with a history of psoriasis is essential, particularly concerning its potential to trigger psoriasis flare-ups. Additionally, it is crucial to assess the influence of psoriasis treatments on the severity of dengue. Objectives:This study aims to describe the effects of dengue infection on psoriasis exacerbations, in patients with pre-existing psoriasis and to assess whether prior psoriasis treatment influences dengue severity. Design:A cross-sectional descriptive study. Main Outcomes and Measures:Demographic, clinical, and treatment data were systematically collected. Results:25 dermatologists reported psoriasis flare-ups in 52 patients (67.3% male; median age 48 years, IQR 23-81). Among these patients, 63.5% (33 patients) experienced plaque psoriasis flare-ups, 19.2% (10 patients) developed guttate psoriasis, 11.5% (6 patients) progressed to erythroderma, 3.8% (2 patients) presented with plaque psoriasis and pustules, and one patient (1.9%) had an acute generalized pustular psoriasis flare-up. Overall, 63.5% of patients experienced moderate dengue, 30.8% had mild dengue, and 5.8% had severe dengue. Among the 19 patients receiving biologic treatments, 84.2% experienced moderate dengue, while 15.8% had mild dengue. Importantly, none of these patients required hospitalization for severe dengue. In the methotrexate-treated group, comprising seven patients, four experienced mild dengue and three had moderate dengue. Psoriasis flare-ups in this group included two severe cases, five moderate cases, one erythroderma, and six cases of plaque psoriasis. Conclusions and Relevance:Dengue infection appears to trigger psoriasis flare-ups in affected individuals. The most commonly observed type was plaque psoriasis. Our findings suggest systemic therapies for psoriasis may not exacerbate dengue severity and could be considered safe. Further prospective studies are necessary to elucidate the relationship between psoriasis severity and dengue outcomes.
