The Surface by PSOLVE+, Issue #3, May 2021
Issue #3, May 2021

Welcome back to Issue #3 of The Surface, a monthly feature of the PSOLVE+ community where we summarize recent publications with high clinical relevance for Canadian dermatologists. View archived issues of The Surface at

Considerations for use of SARS-CoV-2 vaccines in psoriasis patients

In a letter to the editor, Diotallevi and colleagues summarize some important points regarding SARSCoV-2 vaccination in psoriasis (PsO) patients. In the letter, they only discuss vaccines available under emergency use authorization as of January 2, 2021, namely the two mRNA vaccines from PfizerBioNTech and Moderna. The key product characteristics, efficacy, and safety outcomes for the two vaccines are summarized, although the online-ahead-of-print version contains some typos and errors, including noting that the dosing interval of both products are “0.28 days”, when in fact the EUAs authorize 28 days for Moderna and 21 days for Pfizer-BioNTech.

Importantly, the authors highlight some specific COVID-19 risks for those with psoriasis, including higher serum ACE levels and potentially increased risk of cardiovascular events, making this population especially important to protect with vaccines. They also highlight that major international psoriasis societies recommend mRNA SARS-CoV-2 vaccines even in patients currently on biologic therapy. The authors do not address whether adenovirus-vector vaccines (e.g., AstraZeneca and J&J) are appropriate in this population.

Read More: [Sosido link] Diotallevi F, Campanati A, Radi G, et al. Vaccination against SARS-CoV-2 and psoriasis: the three things every dermatologist should know [published online ahead of print, 2021 Mar 29]. J Eur Acad Dermatol Venereol. 2021;10.1111/jdv.17256. doi:10.1111/jdv.17256


Retrospective analysis of oral methotrexate for alopecia areata

Alopecia areata (AA) is a common autoimmune hair disorder generally treated with topical, intralesional, or systemic corticosteroids, and topical immunotherapies. The management of severe cases is challenging. This analysis retrospectively reviewed 15 AA patients (7 adult, 8 pediatric) treated with oral methotrexate (MTX) therapy. Seven patients stopped due to patient choice or insufficient response. Best responses were as follows: Good response (≥70% improvement, n=2), partial response (≥30% to <70% improvement, n=6), and minimal response (<30% improvement, n=5). There were two complaints of nausea, but no patients discontinued due to side effects. The authors conclude that MTX monotherapy is a feasible option for severe AA cases, especially where corticosteroids are contraindicated or risky.

Read More: [Sosido link] Kinoshita-Ise M, Sachdeva M, Martinez-Cabriales SA, Shear NH, Lansang P. Oral Methotrexate Monotherapy for Severe Alopecia Areata: A Single Center Retrospective Case Series [published online ahead of print, 2021 Mar 9]. J Cutan Med Surg. 2021;1203475421995712. doi:10.1177/1203475421995712


Case series and literature review of pleural effusion in PsA patients

Pulmonary involvement in psoriatic arthritis (PsA) is relatively rare, but Venetsanopoulou describe four cases of pleural effusion in male patients with PsA, ranging in ages from 41 to 80. They conducted a systematic literature review to further investigate, finding six additional reports for a total of ten patients. Nine of the patients were male, and the mean age was 55.9 years. Three had been treated with MTX at the time of pleural effusion, and six patients had received prior anti-TNF, one patient was drug naïve for PsA therapies. Three patients had coincident pericarditis. The authors suggest increased pharmacovigilance may uncover cases of drug- inducted serositis.

Read More: [Sosido link] Venetsanopoulou AI, Markatseli TE, Iliou C, et al. Pleural effusion in psoriatic arthritis patients: a case series and review of the literature [published online ahead of print, 2021 Mar 29]. Clin Rheumatol. 2021;10.1007/s10067-021-05712-9. doi:10.1007/s10067-021-05712-9


Polymorphisms associated with methotrexate treatment outcomes

The aim of this study was to investigate the association of MTX treatment outcomes in moderate-tosevere PsO with selected polymorphisms in genes that encode enzymes of the folate and methionine pathways, as well as genes that encode the MTX transporters. Most previous reports investigated psoriasis susceptibility genes or isolated genes in the folate pathway. Patients were included if they had a diagnosis of plaque PsO, at least three months of treatment with MTX, and documented outcome of treatment. Those treated in combination with biologics were excluded. The study captured 199 patients with a mean age at inclusion of 53.7 years and a median age at diagnosis of 27 years. Sixteen singlenucleotide polymorphisms (SNPs) in fourteen genes were genotyped. The authors found that MTX efficacy is affected by genetic polymorphism in glycine N-methyltransferase (GNMT) and DNA (cytosine-5-)- ethyltransferase 3β (DNMT3b), while a polymorphism in betaine– homocysteine methyltransferase (BHMT) was associated with MTX-related hepatotoxicity. They note that the findings should be further investigated in prospective cohorts.

Read More: [Sosido link] Grželj J, Mlinarič-Raščan I, Marko PB, Marovt M, Gmeiner T, Šmid A. Polymorphisms in GNMT and DNMT3b are associated with methotrexate treatment outcome in plaque psoriasis [published online ahead of print, 2021 Mar 10]. Biomed Pharmacother. 2021;138:111456. doi:10.1016/j.biopha.2021.111456


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