Objective::To measure the prevalence of depression in patients with psoriasis and to evaluate the relationship between the severity of psoriasis and depression and its effect on patients’ quality of life.Methods::A total of 154 patients with a confirmed diagnosis of psoriasis were assessed to determine the severity of psoriasis based on the psoriasis area and severity index score, presence, and severity of depression using the patient health questionnaire 9, and quality of life using the dermatology life quality index 10. Pearson correlation coefficient was used to demonstrate the relationship between continuous variables with 95% confidence intervals (CIs); P < 0.00001 was taken to indicate statistical significance. Results::The severity of psoriasis was mild in 36.36% of patients, moderate in 25.97%, severe in 32.47%, and very severe in 5.20%. Of the 154 patients, 139 (90.3%) had depression; the severity of depression was mild in most affected patients (46.7%) and severe in 2.6% of patients. Psoriasis had a moderate effect on the quality of life in 37.01% of patients and a very large effect in 33.77% of patients. The severity of psoriasis was positively correlated with depression (Pearson correlation coefficient, r= 0.42, P < 0.00001, 95% CI: 0.28-0.54) and quality of life ( r= 0.43, P < 0.00001, 95% CI: 0.29-0.55). Conclusion::Depression is a common comorbidity in patients with psoriasis. The severity of psoriasis is positively correlated with the severity of depression and is associated with poor quality of life.

古塞奇尤单抗作为首个靶向白细胞介素23的抑制剂，在多项随机对照临床试验中对中重度银屑病患者的治疗显示出良好的疗效和安全性，能显著改善患者的生活质量。本文综述白细胞介素23和其抑制剂的作用机制及在银屑病治疗中的应用。

Psoriatic arthritis (PsA) is a chronic immune-mediated inflammatory disease related to psoriasis involving bone and cartilage. It is a heterogeneous disorder with a variety of clinical manifestations, which can include peripheral arthritis, axial spondylitis, enthesitis, skin and nail disease, dactylitis, uveitis, osteitis, inflammatory bowel disease. The distinctive feature of PsA is enthesitis. The characteristic bone erosion at the bone-pannus junction in PsA is mediated by osteoclasts, which are multinucleated giant cells derived from hematopoietic stem cells. Although the pathological mechanism of osteoclasts in PsA is mainly related to the destruction of the diseased joint, the exact pathogenesis of PsA is complex and the factors involved in initiation and termination of osteoclast need to be further explored. Much attention has been paid to the importance of osteoclast in psoriasis arthritis for decades. Based on the role of osteoclasts in PsA, our review discusses the formation and characteristics of multinucleated osteoclasts in PsA, summarizes current developments in osteoclast-related pathways in PsA including classical receptor activator of nuclear factor-κB-receptor activator of nuclear factor-κB ligand-osteoprotegerin pathway and immunomodulatory factors, as well as their advances and corresponding treatment. At present, the molecular and signal pathway that interacts with osteoclasts in the pathogenesis of PSA has not been fully elucidated, therefore more detailed studies are expected in the near future.

Objective::Adalimumab (ADA) is expensive and rarely used among patients. However, its cost for moderate to severe chronic plaque psoriasis can now be reimbursed since its addition to the National Reimbursement Drug List (NRDL) in January 2020. Therefore, we conducted this study to estimate the medical cost of ADA and its influencing factors in patients with psoriasis using ADA and thus gain a better understanding of the effect of the NRDL adjustment in China.Methods::This retrospective study evaluated the medical cost of ADA before and after the addition of ADA to the NRDL (2018—2022) among 320 patients in a large professional dermatology specialty hospital. Descriptive analysis, Welch’s analysis of variance, and multiple regression analysis were used to evaluate the medical cost and influencing factors.Results::Before ADA was added to the NRDL, patients’ mean total cost and ADA cost were ￥24,243.56 ± 16,346.53 and ￥20,391.11 ± 14,440.69, respectively. After ADA became covered by the NRDL, the above 2 expenses decreased to ￥10,461.19 ± 7,554.66 and ￥8,775.27 ± 7,092.16, respectively. This significant decrease in the cost of ADA resulted in a significant 110.5-times increase in ADA use. Statistically significant differences were found in the total cost, patient type (outpatient/inpatient), insurance status (yes/no), reimbursement status (before/after), and age. Medical insurance reimbursement ( P < 0.001, β = -0.468, before reimbursement = 1, after reimbursement = 2) was the most significant influencing factor, followed by patient type ( P = 0.018, β = -0.215, outpatient = 1, inpatient = 2) and age ( P = 0.0046, β = -0.174). Conclusion::Medical insurance reimbursement is the most important factor affecting patients’ total cost of ADA by reducing the economic burden, enhancing the availability of ADA, and stimulating the need for treatment.

Objective::The histopathologic diagnosis of psoriasis remains challenging. This study aimed to uncover clues for the histopathologic diagnosis of psoriasis in patients whose lesions required differentiation from other inflammatory skin disorders.Methods::A retrospective analysis was conducted between psoriasis biopsy sections and other inflammatory skin diseases sections. The psoriasis and control groups were compared regarding the pathological characteristics, including the ? sign, hypogranulosis, and neutrophilic infiltration or pustules within the epidermis. We also summarized the clinical information and the classic and non-classic histologic features of psoriasis. Comparisons between psoriasis and control groups were performed using the c-square test.Results::Biopsy sections from 190 patients were analyzed. Of these patients, 100 had a confirmed clinicopathological diagnosis of psoriasis, while 90 were diagnosed with an inflammatory skin disorder other than psoriasis (control group). The classic histologic features included the mound of parakeratosis (68.0%), confluent parakera tosis (42.0%), hypogranulosis (86.0%), regular psoriasiform hyperplasia (79.0%), Munro microabscess (85.0%), spongiform pustule of Kogoj (43.0%), suprapapillary plate thinning (87.0%), and dermal papilla capillary ectasia (98.0%). The ? sign was present in 79.0% and 21.1 %, respectively, of the lesional biopsy samples from the psoriasis and control groups ( P < 0.001). The combination of the ? sign and neutrophil infiltration in the upper epidermis was present in 74.0% and 10.0%, respectively, of the lesional biopsy samples from the psoriasis and control groups ( P < 0.001). The combination of these 2 features had a sensitivity of 0.89 and specificity of 0.76 in distinguishing between the psoriasis and control groups. Conclusion::The ? sign is a useful visual clue for the histopathologic diagnosis of psoriasis. However, for some inflammatory skin disorders that are very similar to psoriasis, such as pityriasis rubra pilaris, the combination of the ? sign and neutrophil infiltration in the upper epidermis is needed to distinguish the condition from psoriasis.

1例34岁男性因银屑病自行使用司库奇尤单抗300 mg皮下注射、1次/周，共5次；随后300 mg皮下注射、1次/4周，共3次；之后出现脓血便。电子肠镜检查发现乙状结肠距肛门25 cm处弥漫性粘膜充血水肿，组织活检病理报告为乙状结肠重度慢性炎、糜烂及浅溃疡形成，考虑为司库奇尤单抗所致炎性肠病。立即停用该药，予美沙拉嗪灌肠液60 g、1次/d，半个月后脓血便明显改善，2个月后脓血便消失。复查电子肠镜发现乙状结肠距肛门20~25 cm处粘膜粗糙，呈颗粒状，有散在小片状出血，诊断为溃疡性结肠炎（缓解期）。停用美沙拉嗪灌肠液，改为美沙拉嗪栓0.5 g、1次/d。

目的:研究人脐带间充质干细胞（MSC）对咪喹莫特诱导的银屑病样皮炎小鼠模型的治疗作用及机制。方法:将18只C57BL/6小鼠按随机数字表等分为凡士林组、模型组和治疗组，每组6只。小鼠背部剃毛后，模型组和治疗组小鼠背部涂抹5%咪喹莫特乳膏62.5 mg每天1次，连续6 d，凡士林组小鼠涂抹等量的凡士林软膏；治疗组小鼠在第1、4天予尾静脉注射1.5 × 10 6个MSC。根据银屑病面积和严重程度指数（PASI），每日评估小鼠背部皮损严重程度。末次涂药24 h后（第7天）取血并处死小鼠，取背部皮肤行HE染色，切取脾脏并获取单细胞悬液，流式细胞仪检测脾脏中Th1、Th17细胞亚群。酶联免疫吸附试验检测血清中细胞因子白细胞介素（IL）-17A及肿瘤坏死因子（TNF）-α水平。多组间比较采用单因素方差分析，两两多重比较采用Tukey检验，PASI评分随时间变化的数据采用重复测量的方差分析。 结果:第7天，模型组小鼠背部出现明显的鳞屑性红斑，皮肤厚度为（78.73 ± 23.11）μm，凡士林组为（13.28 ± 4.57）μm，两组比较， q=19.25， P < 0.001，模型组炎性细胞浸润数亦显著增加（ q=7.21， P < 0.001）。治疗组小鼠PASI评分、表皮厚度、炎性细胞浸润数均显著低于模型组（均 P < 0.001）。治疗组小鼠脾脏Th17细胞亚群比例、血清TNF-α水平显著低于模型组（ P < 0.05）。治疗组与模型组之间脾脏重量、脾指数、脾脏细胞计数、Th1细胞亚群比例及血清IL-17A水平差异均无统计学意义（均 P>0.05）。 结论:人脐带MSC可减轻咪喹莫特诱导的银屑病样皮炎小鼠模型皮肤炎症，机制可能与抑制Th17细胞及TNF-α的生成有关。

目的:运用数据挖掘方法分析中药外用治疗寻常型银屑病（PV）用药规律。方法:检索中国知识资源总库（CNKI）、中文科技期刊数据库（重庆维普）、中国学术期刊数据库（万方数据）、中国生物医学文献服务系统（SinoMed）、PubMed、Cochrane Library，时间为建库至2022年5月23日，获取中药外治PV的临床对照试验文献，筛选并提取中药方剂。借助中医传承计算平台V3.0软件，探析药物药性、药味、归经、功效，中药频次、常用药对及核心组合。结果:纳入方剂186首，涉及中药190味，多为苦寒药，主要归肝、心经，以清热类为主，活血化瘀类、补虚类中药次之；使用频次较高的10味中药为苦参、白鲜皮、黄柏、地肤子、蛇床子、当归、丹参、土茯苓、生地黄、紫草；常用的3个药对是苦参-白鲜皮、苦参-蛇床子、苦参-地肤子；演化得到4个核心组合。结论:中药外治PV围绕“热毒”核心病机，以“从血论治”为主，治以凉血解毒、活血化瘀、养血润燥，并重视清热燥湿、祛风止痒，可为临床治疗提供参考。

目的:回顾性分析阿达木单抗联合阿维A治疗儿童泛发性脓疱型银屑病的临床疗效及安全性。方法:选取2019年10月至2020年8月就诊于天津市儿童医院皮肤科的5例泛发性脓疱型银屑病患儿，入院予口服0.5 mg·kg -1·d -1阿维A，待相关检查结果回报后，第0周（首剂）、第1周及此后每2周给予皮下注射阿达木单抗20/40 mg，日本皮肤科协会（JDA）评分改善50%后阿维A减量至0.3 mg·kg -1·d -1，改善75%后停用阿维A，于阿达木单抗治疗0、1、2、4、8、12、24周时观察并记录患者病情，治疗过程中监测不良反应。 结果:5例患者均接受至少40周疗程的药物治疗，2周时3例达JDA50；4周时4例达JDA75，1例JDA100；8周时5例均达到JDA100。至2021年6月，5例患儿均已接受至少40周随访，期间病情未见反复，均未出现感染或恶性肿瘤等严重不良反应。结论:阿达木单抗联合阿维A治疗儿童泛发性脓疱型银屑病起效较快，安全性较高。