Plaque thickness and morphology in psoriasis vulgaris associated with therapeutic response.
BACKGROUND
The Utah Psoriasis Initiative (UPI) is an expanding database that is being used to identify and characterize phenotypic variants of psoriasis and explore genotype-phenotype relationships. We recently reported distinct morphological variants of psoriasis that are characterized by thickness of lesions (induration) in the untreated state.


OBJECTIVE
To explore the clinical relevance of these morphological variants.


METHODS
For these analyses, we used the phenotypic data from 282 additional subjects gathered at enrollment into the UPI and compared their phenotype with that of the original 500 patients reported previously. The analysis was further expanded via a longitudinal follow-up of 286 subjects from the original 500 case cohort.


RESULTS
Firstly, the initial findings were confirmed. Expansion of the cohort used for the original observation by about 50% and reanalysis showed that there was no alteration in the proportions of patients expressing thin- and thick-plaque disease phenotypes. Secondly, analysis of the larger cohort showed that this morphological phenotype had clinical relevance: those patients with thin-plaque disease were more likely to report a complete therapeutic response to topical corticosteroids and phototherapy. In contrast, plaque thickness did not appear to be a factor in response to systemic agents.


CONCLUSIONS
Using a patient's baseline plaque morphology to choose a primary treatment modality may result in earlier disease improvement and reduce the cost of therapy.
Rakkhit
T
T
Department of Dermatology, 4B54 School of Medicine 30 N 1900 E, University of Utah School of Medicine, Salt Lake City, UT 84132, USA. tina.rakkhit@gmail.com
Panko
J M
JM
Christensen
T E
TE
Wong
B
B
Nelson
T
T
Papenfuss
J
J
Hansen
C B
CB
Callis-Duffin
K
K
Krueger
G G
GG
D000328:Adult; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010641:Phenotype; D010789:Phototherapy; D011565:Psoriasis / Q000188:drug therapy / Q000473:pathology*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014589:Utah