Paradoxical reactions following treatment with biologics are well-documented adverse effects. The risks of paradoxical plaque and pustular psoriasis among patients with various other immune-mediated inflammatory diseases following treatment with tumour necrosis factor α inhibitors (TNFi) have been studied. Although case reports describe the emergence of pustular psoriasis in patients treated with all class of biologics for plaque psoriasis, population-level studies assessing risks between biologics are needed.

BACKGROUND:Psoriasis is linked to an increased risk of cardiovascular disease, but the impact of psoriasis on cardiac structure and function has been less clear. OBJECTIVES:To assess cardiac structure, function and cardiometabolic risk factors in individuals with psoriasis compared with matched controls and across psoriasis severity. METHODS:Cross-sectional analysis of 1010 adults with psoriasis from the prospective PSOCADIA cohort and 1010 age- and sex-matched controls without inflammatory skin disease. Participants underwent clinical assessment and transthoracic echocardiography. Cardiac abnormalities assessed included hypertrophy, valvular disease, systolic and diastolic dysfunction, and myocardial dysfunction defined by global longitudinal strain (GLS) <16%. RESULTS:Despite well-managed skin disease, individuals with psoriasis had more prevalent myocardial dysfunction by abnormal GLS (16.7% vs. 6.0%, p < 0.001) compared with controls. This association persisted after adjustment for cardiometabolic risk factors and atherosclerotic cardiovascular disease. Cardiac structure and function were largely similar across psoriasis severity. Higher body mass index and diabetes were independently associated with myocardial dysfunction in psoriasis. CONCLUSIONS:Individuals with psoriasis, even with well-managed skin disease, exhibit a higher burden of myocardial dysfunction compared with controls, independent of cardiometabolic comorbidity. The prevalence was similar across psoriasis severity, highlighting the importance of cardiovascular assessment in all patients with psoriasis. CLINICALTRIALS:GOV: NCT04950218 (Prevalence and risk factors asSOciated with CArdiac comorbiDIty in psoriAsis, registered on 6 July 2021).

Palmoplantar inflammatory dermatoses, including hyperkeratotic palmoplantar eczema (HPE), palmoplantar psoriasis (PP) and palmoplantar pustulosis (PPP), present overlapping clinical features that complicate diagnosis and limit targeted therapy. This prospective observational study evaluated whether minimally invasive tape strip sampling, combined with targeted proteomics, can distinguish these conditions at a molecular level. Adults with HPE (n = 14), PP (n = 10), and PPP (n = 12) were enrolled, and tape strips from esional and non-lesional skin were analysed using the Olink Reveal panel (1034 proteins) with validation by MSD multiplex immunoassays. Differentially expressed proteins, pathway enrichment analysis, and protein-protein interaction analyses were conducted across the three diseases, and longitudinal analyses were conducted in a subset of patients with PP. Protein expression patterns showed partial separation of PPP from PP and HPE, whereas PP and HPE overlapped. Lesional samples across all three diagnoses exhibited increased expression of inflammatory proteins compared with non-lesional skin. PPP showed a distinct molecular profile from PP and HPE, with enriched pathways related to neutrophil degranulation, innate immune activation, and Th17-associated signalling networks centred on IL-17A and CXCL8. No proteins were significantly differentially expressed between PP and HPE lesions. PP and HPE showed overlapping interferon-associated chemokines CXCL10-11, consistent with a shared inflammatory module. Inflammatory protein levels decline with clinical improvement in longitudinal PP samples. Overall, tape strip-based targeted proteomics is a feasible approach for palmoplantar diseases, revealing a distinct inflammatory signature that differentiates PPP from PP and HPE, although discrimination between PP and HPE remains limited.

Importance:Smoking and obesity are associated with risk of hidradenitis suppurativa, and both are considered important environmental risk factors. However, a causal relationship remains unproven. Objective:To primarily investigate the relationship between body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) and smoking and HS, and secondarily to investigate potential relationships between 3 inflammatory diseases (psoriasis, inflammatory bowel disease [IBD], and systemic sclerosis [SSc]) and HS. Design, Setting, and Participants:A mendelian randomization (MR) study conducted in 2024 on 5 exposure phenotypes (BMI, smoking, psoriasis, IBD, and SSc) on the outcome of phenotype HS was conducted. The MR analyses used large genetic White European cohorts from genome-wide association studies (GWAS) of each of the 6 phenotypes. Initial analyses were conducted May, 2024, and were updated in May, 2025. Exposure:The 5 exposure phenotypes using predetermined genome-wide significant single-nucleotide variants as proxies for each particular exposure. Results:The GWAS on HS included 4814 case patients and more than 1.2 million controls from Denmark, Iceland, Finland, the UK, and the US. The BMI GWAS involved 700 000 individuals from the UK Biobank and GIANT consortium. Smoking data were obtained from 1.23 million participants in an international consortium. The psoriasis GWAS analyzed 39 498 case patients and 286 769 controls from White European populations and a DNA genetic testing company. The IBD GWAS meta-analysis included 38 155 case patients and 48 485 controls from the International Inflammatory Bowel Disease (IBD) Genetics Consortium. The SSc GWAS included 9095 case patients and 17 584 controls from White European populations. Genetic correlations (rg) were found between HS and all exposure phenotypes except SSc (BMI: rg = 0.36, P < .001; smoking: rg = 0.33, P < .001; IBD: rg = 0.25, P < .001; psoriasis: rg = 0.34, P < .001; SSc: rg = 0.33, P = .22). MR analyses supported an effect of BMI on HS (β = 0.87; odds ratio [OR] per BMI unit, 1.20; 95% CI, 1.17-1.23; P < .001) without signs of pleiotropy (slope: β = 0.91, P < .001, P for intercept = .76). Smoking showed a significant causal estimate (β = 0.59, P < .001), but results became inconclusive in subsequent sensitivity analyses. Among IBD, psoriasis, and SSc, results supported a causal effect of IBD on HS (β = 0.18, OR = 1.20; 95% CI, 1.15-1.24; P < .001), without signs of pleiotropy. Conclusions and Relevance:These findings indicate causal effects of IBD and increased BMI on the risk of HS. This information may help physicians inform patients about disease risk contributed by modifiable lifestyle behaviors, which can be beneficial for planning lifestyle interventions.

BACKGROUND AND OBJECTIVES:Rosacea is a common chronic disease of the facial region characterized by erythema, flushing, papules, pustules, phymatous changes, and ocular symptoms. Despite its prevalence, the inflammatory pathways underlying rosacea remain poorly understood, and reliable biomarkers for assessing disease severity have not been established. METHODS:In this study, we employed a noninvasive skin tape stripping technique to evaluate levels of certain cutaneous biomarkers in patients with rosacea compared with skin-healthy individuals. RESULTS:Levels of the following biomarkers were increased in patients with rosacea compared with skin-healthy controls: interleukin (IL)-1RA, IL-8, IL12p70, IL-17A, IL-17E, IL-17F, IL-18, IL-22, interferon-gamma inducible protein (IP)-10, vascular endothelial growth factor (VEGF)-a and interferon gamma (IFN-γ). Increasing severity of rosacea (measured by the Rosacea Area and Severity Index) was positively correlated with higher concentrations of IFN-γ, IL-18, IP-10, VEGF-α and IL-17F. CONCLUSIONS:Our data suggest that dysregulation of both innate and adaptive immune responses, particularly involving T-helper (Th)1 and Th17 pathways, plays a critical role in rosacea pathogenesis and severity.

Background: Cleaners are affected by occupational contact dermatitis, with both allergic and irritant causes. More knowledge on contact allergy in cleaners is needed for better preventive measures.Objectives: To investigate which contact allergens from the European baseline series (EBS) are associated with the cleaning profession.Method: A matched cross-sectional study using data from the Allergen database at Gentofte Hospital, Copenhagen, Denmark, in the period 2003-2023 was conducted. Patch tested cleaners were matched with patch tested noncleaners (controls) at a 1:4 ratio based on age (±4 years), sex, and the year of patch test.Results: In total, 459 cleaners and 1836 matched controls were included in the study. Being a cleaner was significantly positively associated with hand dermatitis and occupational dermatitis and significantly negatively associated with facial dermatitis and atopic dermatitis. Among the allergens from the EBS, thiuram mix and nickel were significantly positively associated with being a cleaner.Conclusion: Future prevention programs for cleaners should have a focus on contact allergy, including information on rubber accelerators and correct use of gloves.

INTRODUCTION:Leather is a recognised source of contact allergy to chromium (Cr). Cobalt (Co) has also been identified as a potential leather-related allergen. OBJECTIVES:To assess the presence and release of Cr and Co in used leather items available on the Danish secondhand market. METHODS:Thirty-four used consumer leather items with expected direct skin contact during normal use were purchased from secondhand shops in Greater Copenhagen, Denmark. Cr and Co were measured using handheld X-ray fluorescence (XRF). Cr(VI) was measured according to International Organization for Standardization (ISO) standard 17 075-1 following pre-conditioning with ISO 10195. Extractable Co was analysed using ISO 17072-1 and inductively coupled plasma mass spectrometry. RESULTS:Cr(VI) was detected in 12/34 (35.3%) items, with an average concentration of 1.77 mg/kg (range: 0.52-4.16). Co was detected in 7/34 (20.6%) items, with an average concentration of 0.63 mg/kg (range: 0.33-1.44). Shoes accounted for most items with higher Cr(VI) concentrations. CONCLUSION:Used leather items may contain measurable levels of Cr(VI) and Co. Secondhand leather represents a relevant exposure scenario that should be considered in future exposure assessments and regulatory discussions.

In this nationwide Danish cohort study, mild-to-moderate chronic hand eczema (CHE) was not associated with major adverse cardiovascular events (MACE). Severe CHE showed a marginally increased risk of MACE, including ischaemic stroke and mainly in hyperkeratotic and dyshidrotic subtypes, most likely reflecting residual confounding.

Individuals with psoriasis have a high prevalence of metabolic dysfunction–associated steatotic liver disease (MASLD), yet the association between MASLD as a cardiometabolic risk factor and cardiac manifestations in this population remains unclear. We aimed to evaluate associations between MASLD, cardiometabolic risk factors, and cardiac structure and function in adults with psoriasis. We performed a cross-sectional analysis of 255 adults with psoriasis prospectively enrolled. Participants underwent transthoracic echocardiography and transient elastography. MASLD was defined by hepatic steatosis with a controlled attenuation parameter of ≥250 dB/m and the presence of ≥1 cardiometabolic risk factor(s), excluding other liver disease causes. Cardiac structure and function were compared between individuals with psoriasis and MASLD and those without MASLD. Associations between MASLD and myocardial dysfunction were assessed in uni- and multivariable regression models. MASLD was present in 92 participants (36.1%), of whom 5 (5.4%) had evidence of increased liver stiffness. Those with MASLD exhibited higher blood pressure, body mass index (BMI), and more adverse cardiometabolic profiles. MASLD was associated with cardiac structural changes and worse diastolic and systolic function. After adjusting for age, sex, and BMI, most associations were attenuated. In fully adjusted models, higher BMI and diabetes, but not MASLD, were independently associated with myocardial dysfunction. In adults with psoriasis, the association between MASLD and cardiac structural and functional changes was attenuated after adjusting for BMI and cardiometabolic risk factors, underscoring the importance of cardiometabolic risk factor control, in particular of obesity and diabetes, in psoriasis with concomitant MASLD.

INTRODUCTION:Psoriasis is associated with increased risks of cardiovascular disease (CVD) and psoriatic arthritis (PsA). In Denmark, general practitioners (GPs) are responsible for annual screening, but validated tools for PsA screening are not consistently endorsed. Therefore, we evaluated the awareness and screening practices for CVD and PsA among patients with psoriasis among Danish GPs. METHODS:In a nationwide cross-sectional survey, 490 randomly selected Danish GPs were invited to complete a questionnaire on awareness and screening practices related to CVD and PsA in patients with psoriasis. Responses were analysed descriptively. RESULTS:A total of 101 GPs responded (21%). Most were aware of increased CVD risk (84%), and 60% reported screening for CVD, primarily assessing blood pressure, BMI, smoking status, and cholesterol. In contrast, only 32% reported screening for PsA. CONCLUSIONS:CVD awareness and screening among Danish GPs are relatively high, whereas PsA screening is infrequent. Clearer guidance and simple screening tools may improve early detection of PsA.

The prevalence of steatotic liver disease (SLD) with fibrosis in patients with psoriasis is unknown and no consensus on screening exists. Therefore, patients from The Copenhagen Translational Skin Immunology Biobank and Research Programme (BIOSKIN) were examined. SLD was defined as controlled attenuation parameter (CAP) > 250 dB/m and fibrosis as median liver stiffness measurement (LSM) ≥ 8 kPa using transient elastography. Biomarkers included fibrosis-4 index (FIB-4), N-terminal propeptide of collagen (type III), and enhanced liver fibrosis (ELF) test. A total of 403 patients (median age 51 years, 54% men, median BMI 27), 80% with moderate-to-severe psoriasis were enrolled. Based on the transient elastography, 40% of the patients had steatosis (mean CAP 245, ± 55 dB/m) and 5% had fibrosis (median LSM 4.8 kPa, IQR 3.8–5.8). According to self-reported alcohol consumption, all patients with steatosis except for 2 were categorized as having metabolic dysfunction-associated steatotic liver disease (MASLD). With transient elastography as the reference, FIB-4 and ELF had better diagnostic accuracy than PIIINP with Area Under the Receiver Operating Characteristic Curve (AUROC) of 0.92 (95% confidence interval 0.87–0.97) for FIB-4, 0.90 (0.83–0.97) for ELF test, and 0.77 (0.66–0.87) for PIIINP.

Purpose:Accumulating evidence supports the association between altered salivary microbiota and inflammatory diseases. The existing literature on the salivary microbiota in patients with psoriasis is limited. However, differences in the prevalence of Candida species and abundance of several bacterial taxa in saliva have been found between patients and controls. This study aimed to investigate the differences in the composition and functional potential of salivary microbiota in patients with psoriasis compared to their cohabiting partners and healthy controls. Patients and Methods:Samples from 115 of 123 individuals qualified for statistical analysis: patients with psoriasis who did not receive systemic anti-psoriatic treatment (n=47); cohabiting partners (n=21); and age-, sex-, and BMI-matched healthy controls (n=47). One saliva sample was collected from each participant and analysed by shotgun metagenomic sequencing. Results:A difference in the α-diversity of bacterial species was observed exclusively between patients and controls, with a lower diversity in patients (p=0.041). Variation in bacterial composition (β-diversity) was influenced by smoking (p=0.001) and diet (p=0.025) but not by group status. Using a linear regression model adjusted for smoking and diet, we identified four bacterial classes and five species that were significantly different between the patient, partner, and control groups. One Kyoto Encyclopedia of Genes and Genomes module differed significantly between patients with psoriasis and their partners. No differences in Candida species or abundance were found among the three groups. Conclusion:Comparison of salivary microbiota at the levels of bacterial diversity, composition, and predicted function indicated that psoriasis cases are characterised by dysbiosis.