This study has been supported by the Discovery Research Grant (B.-J.F.) and the PsA Diagnostic Test Grant (B.-J.F. and J.A.W.) from the National Psoriasis Foundation, and the Utah Genome Project Partnership Grant (B.-J.F. and J.A.W.) and the Immunology, Inflammation, &#38; Infectious Disease (3i) Initiative Seed Grant (B.-J.F. and J.A.W.) from the University of Utah. The author would like to thank Tyler S. Nelson (Physician Assistant, University of Utah Department of Dermatology) and Angela Contreras (Study Coordinator, University of Utah Department of Dermatology) for recruiting patients for the study.

This study was approved by the University of Utah Institutional Review Board (IRB_00137694). Twenty-seven psoriasis patients at the University of Utah dermatology clinic were enlisted to complete a questionnaire about psoriasis severity at the time of the questionnaire&#39;s administration. All patients provided informed consent and completed the questionnaire without instructions from research or medical personnel, either before or immediately after the dermatologist&#39;s assessment.
1. Procedure for making a Psoriasis Thickness Reference Card
<ol>
	<li>Print the Psoriasis Thickness Reference Card template (Supplemental Figure S1) on a standard piece of printer paper. If a printer is not accessible, manually write down the numbers as in the template on any paper and follow the subsequent steps.</li>
	<li>Place sticky notes.
	<ol>
		<li>Purchase a package of sticky notes. The smallest-sized sticky notes (5.08 cm height x 5.08 cm width or 5.08 cm height x 3.81 cm width) will work. The thickness of each sticky note should be between 0.09 and 0.1 mm. 
		NOTE: The authors have tested multiple brands of sticky notes (see Table of Materials) in the market and found that they all fulfill this requirement. If in doubt, one can calculate the thickness of each page by dividing the total thickness of a stack of sticky notes by the number of pages in the stack.</li>
		<li>Place a stack of three sticky notes on the box labeled &#34;3.&#34;</li>
		<li>Place a stack of 5 sticky notes on the box labeled &#34;5.&#34;</li>
		<li>Place a stack of 8 sticky notes on the box labeled &#34;8.&#34;</li>
		<li>Place a stack of 10 sticky notes on the box labeled &#34;10.&#34;</li>
		<li>Place a stack of 13 sticky notes on the box labeled &#34;13.&#34;</li>
	</ol>
	</li>
	<li>Align the adhesive side of the sticky notes on the left side of each corresponding box and press them down to adhere each stack firmly to the sheet of paper.</li>
	<li>Apply a strip of tape along the right side of each stack of sticky notes (Figure 1). Ensure the tape adheres smoothly, creating a gentle slope between the top of the stack and the paper. 
	NOTE: If the left side of each stack is not adhered securely to the paper via the sticky note adhesive, tape the left side in the same way as the right side.</li>
</ol>
2. Usage of the Psoriasis Thickness Reference Card
<ol>
	<li>Slide a finger across the taped side of each stack of sticky notes to get a sense of its thickness or elevation from the paper it is adhered to.</li>
	<li>In a similar manner, slide a finger across the edge of one&#39;s thickest psoriasis patch, feeling its elevation from the surrounding, unaffected skin.</li>
	<li>Identify the stack that is most similar in elevation to one&#39;s thickest psoriasis patch and record the corresponding score of 0 to 13.</li>
</ol>

Development and Evaluation of a Self-Assessment Tool for Psoriasis Severity

<ol><li>Merola, J. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Incidence+and+prevalence+of+psoriatic+arthritis+in+patients+with+psoriasis+stratified+by+psoriasis+disease+severity%3A+Retrospective+analysis+of+an+electronic+health+records+database+in+the+United+States%5BTitle%5D)+AND+%22Journal+of+the+American+Academy+of+Dermatology%22%5BJournal%5D)">Incidence and prevalence of psoriatic arthritis in patients with psoriasis stratified by psoriasis disease severity: Retrospective analysis of an electronic health records database in the United States.</a> Journal of the American Academy of Dermatology. 86 (4), 748-757 (2022).</li>
<li>Eder, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+incidence+and+risk+factors+for+psoriatic+arthritis+in+patients+with+psoriasis%3A+a+prospective+cohort+study%5BTitle%5D)+AND+%22Arthritis+%26+Rheumatology%22%5BJournal%5D)">The incidence and risk factors for psoriatic arthritis in patients with psoriasis: a prospective cohort study.</a> Arthritis & Rheumatology. 68 (4), 915-923 (2016).</li>
<li>Haroon, M., Gallagher, P., FitzGerald, O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Diagnostic+delay+of+more+than+6+months+contributes+to+poor+radiographic+and+functional+outcome+in+psoriatic+arthritis%5BTitle%5D)+AND+%22Annals+of+the+Rheumatic+Diseases%22%5BJournal%5D)">Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis.</a> Annals of the Rheumatic Diseases. 74 (6), 1045-1050 (2015).</li>
<li>Belman, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Psoriasis+characteristics+for+the+early+detection+of+psoriatic+arthritis%5BTitle%5D)+AND+%22The+Journal+of+Rheumatology%22%5BJournal%5D)">Psoriasis characteristics for the early detection of psoriatic arthritis.</a> The Journal of Rheumatology. 48 (10), 1559-1565 (2021).</li>
<li>Tey, H. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Risk+factors+associated+with+having+psoriatic+arthritis+in+patients+with+cutaneous+psoriasis%5BTitle%5D)+AND+%22The+Journal+of+Dermatology%22%5BJournal%5D)">Risk factors associated with having psoriatic arthritis in patients with cutaneous psoriasis.</a> The Journal of Dermatology. 37 (5), 426-430 (2010).</li>
<li>Rouzaud, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Is+there+a+psoriasis+skin+phenotype+associated+with+psoriatic+arthritis%3F+Systematic+literature+review%5BTitle%5D)+AND+%22Journal+of+the+European+Academy+of+Dermatology+and+Venereology+JEADV%22%5BJournal%5D)">Is there a psoriasis skin phenotype associated with psoriatic arthritis? Systematic literature review.</a> Journal of the European Academy of Dermatology and Venereology JEADV. 28, 17-26 (2014).</li>
<li>Gladman, D. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Development+and+initial+validation+of+a+screening+questionnaire+for+psoriatic+arthritis%3A+the+Toronto+Psoriatic+Arthritis+Screen+%28ToPAS%29%5BTitle%5D)+AND+%22Annals+of+the+Rheumatic+Diseases%22%5BJournal%5D)">Development and initial validation of a screening questionnaire for psoriatic arthritis: the Toronto Psoriatic Arthritis Screen (ToPAS).</a> Annals of the Rheumatic Diseases. 68 (4), 497-501 (2009).</li>
<li>Tom, B. D. M., Chandran, V., Farewell, V. T., Rosen, C. F., Gladman, D. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Validation+of+the+Toronto+Psoriatic+Arthritis+Screen+Version+2+%28ToPAS+2%29%5BTitle%5D)+AND+%22The+Journal+of+Rheumatology%22%5BJournal%5D)">Validation of the Toronto Psoriatic Arthritis Screen Version 2 (ToPAS 2).</a> The Journal of Rheumatology. 42 (5), 841-846 (2015).</li>
<li>Husni, M. E., Meyer, K. H., Cohen, D. S., Mody, E., Qureshi, A. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+PASE+questionnaire%3A+pilot-testing+a+psoriatic+arthritis+screening+and+evaluation+tool%5BTitle%5D)+AND+%22Journal+of+the+American+Academy+of+Dermatology%22%5BJournal%5D)">The PASE questionnaire: pilot-testing a psoriatic arthritis screening and evaluation tool.</a> Journal of the American Academy of Dermatology. 57 (4), 581-587 (2007).</li>
<li>Ibrahim, G. H., Buch, M. H., Lawson, C., Waxman, R., Helliwell, P. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Evaluation+of+an+existing+screening+tool+for+psoriatic+arthritis+in+people+with+psoriasis+and+the+development+of+a+new+instrument%3A+the+Psoriasis+Epidemiology+Screening+Tool+%28PEST%29+questionnaire%5BTitle%5D)+AND+%22Clinical+and+Experimental+Rheumatology%22%5BJournal%5D)">Evaluation of an existing screening tool for psoriatic arthritis in people with psoriasis and the development of a new instrument: the Psoriasis Epidemiology Screening Tool (PEST) questionnaire.</a> Clinical and Experimental Rheumatology. 27 (3), 469-474 (2009).</li>
<li>Walsh, J. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((PAPRIKA%3A+A+question+bank+for+assessing+psoriatic+arthritis+risk+in+individuals+of+diverse+ancestries%5BTitle%5D)+AND+%22Arthritis+Care+%26+Research%22%5BJournal%5D)">PAPRIKA: A question bank for assessing psoriatic arthritis risk in individuals of diverse ancestries.</a> Arthritis Care & Research. , (2023).</li>
<li>Feldman, S. R., Krueger, G. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Psoriasis+assessment+tools+in+clinical+trials%5BTitle%5D)+AND+%22Annals+of+the+Rheumatic+Diseases%22%5BJournal%5D)">Psoriasis assessment tools in clinical trials.</a> Annals of the Rheumatic Diseases. 64, 65-68 (2005).</li>
<li>McHugh, M. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Interrater+reliability%3A+the+kappa+statistic%5BTitle%5D)+AND+%22Biochemia+Medica%22%5BJournal%5D)">Interrater reliability: the kappa statistic.</a> Biochemia Medica. 22 (3), 276-282 (2012).</li>
<li>Montes de Oca Pedrosa, A., Oakley, A., Rogers, J., Rangaitaha Epiha, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((PASI+vs+PO-PASI%3A+Patient-Oriented+PASI+%28PO-PASI%29+is+comparable+to+clinician+score+PASI%5BTitle%5D)+AND+%22The+Australasian+Journal+of+Dermatology%22%5BJournal%5D)">PASI vs PO-PASI: Patient-Oriented PASI (PO-PASI) is comparable to clinician score PASI.</a> The Australasian Journal of Dermatology. 63 (1), e67-e70 (2022).</li>
</ol>

The PERCH software, for which B.-J.F. is the inventor, has been non-exclusively licensed to Ambry Genetics Corporation for its clinical genetic testing services and research. B-J.F. also reports funding and sponsorship to his institution on his behalf from Pfizer Inc., Regeneron Genetics Center LLC., and AstraZeneca. K.C.D. has consulted for Amgen/Celgene, Abbvie, Lilly, Novartis, Leo, Boehringer-Ingelheim, Janssen, UCB, CorEvitas, and Bristol-Myers Squib. The remaining authors declare no potential conflicts of interest relevant to this article.

Protocol step 1.4 is a crucial aspect of the proper construction of the Psoriasis Thickness Reference Card. To achieve an accurate representation of plaque thickness, it is imperative to avoid placing the tape vertically or flush against the vertical edge of the stack of sticky notes. If the tape is positioned in such a manner, the sharp edge of each stack will not mimic the feel of a psoriasis plaque. The tape should be applied in a way that creates a smooth slope connecting the stack to the paper.
<p class="jove_co...

Psoriatic arthritis (PsA) is an inflammatory arthritis that develops in approximately 2.9% of patients with psoriasis each year1,2. Early prediction of which patients will develop PsA is crucial for a patient&#39;s quality of life as a diagnostic delay of as little as six months may cause irreversible damage to the joints3. A previous study had identified features associated with early-stage PsA. The three components of the Investigator&#39;s Global Assessment (IGA)-induration (thickness), erythema (redness), and desquamation (scaliness)-were highly correlated with each other and were nominally associated with subsequent PsA development. Multivariate analysis showed that a history of fingernail psoriasis and untreated induration of psoriasis lesions were independent PsA predictors4. Other studies have also identified psoriasis severity as associated with psoriatic arthritis2,5,6. The collection of these clinical factors is likely to be important in future PsA screening.
Several PsA screening tests exist7,8,9,10, but they require physicians to conduct them. A questionnaire-based screening test that can be completed by patients without physician assistance is an ideal format because it will not burden the dermatology and primary care clinics. Previously, the authors described a questionnaire with images that depict different severities of erythema and desquamation in multiple skin tones11. However, the measurement of induration requires a reference card corresponding to various plaque severities, such as that developed by the National Psoriasis Foundation12. The reference card is characterized by multiple raised areas of varying elevations, each corresponding to a number representing induration severity. To assess a patient&#39;s psoriasis severity in terms of induration, the card user compares the thickest psoriasis patch on a patient&#39;s body to the elevated areas on the card.
However, distributing a reference card to psoriasis patients may not be the most efficient approach for reaching a broad audience, especially for patients located outside the USA and for online survey studies. For researchers and clinicians gathering induration self-assessments from numerous patients, an alternative option could involve creating a homemade induration card using inexpensive office supplies. For patients, creating a homemade device from inexpensive office supplies can be more cost-effective than purchasing commercially available alternatives. This protocol describes how to create the Psoriasis Thickness Reference Card, an induration reference card that psoriasis patients can feel to assess the severity of their psoriasis induration. The Card can be made with standard office supplies and is inexpensive to make.

<table><tbody><tr><td>Post-it Notes, 1 3/8 in x 1 7/8 in, Canary Yellow, 6 Pads/Pack</td><td>3M</td><td>00021200569029</td><td>The smallest sized sticky notes (5.08 cm height x 5.08 cm width or 5.08 cm height x 3.81 cm width) work best with the printed template. The thickness of each sticky note should be between 0.09 and 0.1 mm; sticky notes from the brands Post-it, Pen+Gear, and Office Works meet these requirements.</td></tr><tr><td>Printworks Printer and Copy Paper - 500 Pack - White</td><td>Paris Corporation</td><td>0009014600006</td><td>Any brand of printer paper is acceptable; if recreating the template manually rather than printing, any brand of paper is acceptable.</td></tr><tr><td>R</td><td>http://www.r-project.org</td><td></td><td>The R programming language version 4.3.1 was used to analyze the data in this study.&amp;nbsp;</td></tr><tr><td>Scotch Magic Tape Dispensered Rolls</td><td>3M</td><td>00021200000041</td><td>Any brand of smooth adhesive tape is acceptable; do not use tape with a coarse texture.</td></tr></tbody></table>

measuring psoriasis severity at home

Psoriasis plaque severity metrics, such as induration (thickness), erythema (redness), and desquamation (scaliness), are associated with the subsequent development of psoriatic arthritis (PsA) among cutaneous-only psoriasis patients (patients with skin or nail psoriasis but no psoriatic arthritis). These metrics can be used for PsA screening. However, a key challenge in PsA screening is to optimize accessibility and minimize costs for patients, while also reducing the burden on healthcare systems. Therefore, an ideal screening tool consists of questions that patients can answer without a physician's assistance. Although reference images can be used to help a patient self-assess erythema and desquamation severity, a patient would need a tactile induration reference card to self-assess induration severity. This protocol describes how to create an induration reference card, the Psoriasis Thickness Reference Card, as well as how to use it to assess lesion induration severity. Administration of reference images for erythema and desquamation and a Psoriasis Thickness Reference Card for induration to 27 psoriasis patients showed that patients were moderately successful at self-assessing the severity of these three metrics. These findings support the feasibility of a future PsA screening test that patients can complete without the need for physician assistance.

To validate whether patient assessments of desquamation, erythema, and induration are comparable to those of a dermatologist, 27 psoriasis patients at the University of Utah dermatology clinic were enlisted to complete a questionnaire about psoriasis severity at the time of the questionnaire&#39;s administration. Each participant was provided with a Psoriasis Thickness Reference Card along with the questionnaire. The dermatologist provided their independent assessment of the current status of each patient using the same ...

Read this Scientific Article Protocol about Measuring Psoriasis Severity at Home at JoVE.com

Author Spotlight: Self-Assessment Protocol for Predicting Psoriatic Arthritis in Psoriasis Patients

This paper details the creation of a Psoriasis Thickness Reference Card, enabling psoriasis patients to self-assess their psoriasis plaque thickness without the need for physician assistance. Additionally, the precision of self-assessment for psoriasis redness and scaliness by employing reference images depicting various skin tones is assessed.

Measuring Psoriasis Severity at Home

Psoriasis plaque severity metrics, such as induration (thickness), erythema (redness), and desquamation (scaliness), are associated with the subsequent ...

Research

JoVE Journal

Medicine

339 Views.  University of Utah School of Medicine. Ons onderzoek richt zich op de gezondheidszorg van patiënten met psoriasis en artritis psoriatica. Een van de vragen die we proberen te beantwoorden, is hoe we artritis psoriatica bij psoriasispatiënten kunnen voorspellen met behulp van een kostenefficiënte aanpak die toegankelijk is voor afgelegen locaties. Ons protocol stelt patiënten in staat om de ernst van hun psoriasislaesies te meten zonder dat er een arts nodig is.Ze kunnen deze beoordeling...

Video: Auteur in de schijnwerpers: zelfbeoordelingsprotocol voor het voorspellen van artritis psoriatica bij psoriasispatiënten

Minimal Erythema Dose (MED) Testing

Ultraviolet radiation (UV) therapy is sometimes used as a treatment for various common skin conditions, including psoriasis, acne, and eczema. The dosage of UV light is prescribed according to an individual's skin sensitivity. Thus, to establish the proper dosage of UV light to administer to a patient, the patient is sometimes screened to determine a minimal erythema dose (MED), which is the amount of UV radiation that will produce minimal erythema (sunburn or redness caused by engorgement of capillaries) of an individual's skin within a few hours following exposure. This article describes how to conduct minimal erythema dose (MED) testing. There is currently no easy way to determine an appropriate UV dose for clinical or research purposes without conducting formal MED testing, requiring observation hours after testing, or informal trial and error testing with the risks of under- or over-dosing. However, some alternative methods are discussed.

Minimal Erythema Dose MED Testing

This article describes how to conduct minimal erythema dose (MED) testing in order to determine the lowest dose of ultraviolet radiation that will cause erythema (burning) when administered to an individual.

Ultraviolet radiation (UV) therapy is  sometimes used as a treatment for various common skin conditions, including  psoriasis, acne, and eczema. The ...

The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis

Psoriasis is a chronic, immune-mediated inflammatory skin disease affecting approximately 2-3% of the population. The Goeckerman regimen consists of exposure to ultraviolet B (UVB) light and application of crude coal tar (CCT). Goeckerman therapy is extremely effective and relatively safe for the treatment of psoriasis and for improving a patient's quality of life. In the following article, we present our protocol for the Goeckerman therapy that is utilized specifically at the University of California, San Francisco. This protocol details the preparation of supplies, administration of phototherapy and application of topical tar. This protocol also describes how to assess the patient daily, monitor for adverse effects (including pruritus and burning), and adjust the treatment based on the patient's response. Though it is one of the oldest therapies available for psoriasis, there is an absence of any published videos demonstrating the process in detail. The video is beneficial for healthcare providers who want to administer the therapy, for trainees who want to learn more about the process, and for prospective patients who want to undergo treatment for their cutaneous disease.

Psoriasis is a chronic, immune-mediated inflammatory skin disease. The Goeckerman regimen, formulated for the treatment of psoriasis, consists of exposure to ultraviolet B (UVB) light and application of crude coal tar (CCT). The following protocol is for the administration of Goeckerman therapy for the treatment of moderate-to-severe psoriasis.

Psoriasis is a  chronic, immune-mediated inflammatory skin disease affecting approximately 2-3%  of the population. The Goeckerman regimen consists of ...

The Multiple Sclerosis Performance Test (MSPT): An iPad-Based Disability Assessment Tool

Precise measurement of neurological and neuropsychological impairment and disability in multiple sclerosis is challenging. We report a new test, the Multiple Sclerosis Performance Test (MSPT), which represents a new approach to quantifying MS related disability. The MSPT takes advantage of advances in computer technology, information technology, biomechanics, and clinical measurement science. The resulting MSPT represents a computer-based platform for precise, valid measurement of MS severity. Based on, but extending the Multiple Sclerosis Functional Composite (MSFC), the MSPT provides precise, quantitative data on walking speed, balance, manual dexterity, visual function, and cognitive processing speed. The MSPT was tested by 51 MS patients and 49 healthy controls (HC). MSPT scores were highly reproducible, correlated strongly with technician-administered test scores, discriminated MS from HC and severe from mild MS, and correlated with patient reported outcomes. Measures of reliability, sensitivity, and clinical meaning for MSPT scores were favorable compared with technician-based testing. The MSPT is a potentially transformative approach for collecting MS disability outcome data for patient care and research. Because the testing is computer-based, test performance can be analyzed in traditional or novel ways and data can be directly entered into research or clinical databases. The MSPT could be widely disseminated to clinicians in practice settings who are not connected to clinical trial performance sites or who are practicing in rural settings, drastically improving access to clinical trials for clinicians and patients. The MSPT could be adapted to out of clinic settings, like the patient&#8217;s home, thereby providing more meaningful real world data. The MSPT represents a new paradigm for neuroperformance testing. This method could have the same transformative effect on clinical care and research in MS as standardized computer-adapted testing has had in the education field, with clear potential to accelerate progress in clinical care and research.

The Multiple Sclerosis Performance Test MSPT: An iPad-Based Disability Assessment Tool

Precise measurement of neurological and neuropsychological impairment and disability in multiple sclerosis is challenging. We report methodologic details on a new test, the Multiple Sclerosis Performance Test (MSPT). This new approach to the objective of quantification of MS related disability provides a computer-based platform for precise, valid measurement of MS severity.

Precise measurement of neurological and neuropsychological impairment and disability in multiple sclerosis is challenging. We report a new test, the ...

Resolving Water, Proteins, and Lipids from In Vivo Confocal Raman Spectra of Stratum Corneum through a Chemometric Approach

Development of this in vivo confocal Raman spectroscopic method enables the direct measurement of water, proteins, and lipids with depth resolution in human subjects. This information is very important for skin-related diseases and characterizing skin care product performance. This protocol illustrates a method for confocal Raman spectra collection and the subsequent analysis of the spectral dataset leveraging chemometrics. The goal of this method is to establish a standard protocol for data collection and provide general guidance for data analysis. Preprocessing (e.g., removal of outlier spectra) is a critical step when processing large datasets from clinical studies. As an example, we provide guidance based on prior knowledge of a dataset to identify the types of outliers and develop specific strategies to remove them. A principal component analysis is performed, and the loading spectra are compared with spectra from reference materials to select the number of components used in the final multivariate curve resolution (MCR) analysis. This approach is successful for extracting meaningful information from a large spectral dataset.

Here, we present a protocol for collection of confocal Raman spectra from human subjects in clinical studies combined with chemometric approaches for spectral outlier removal and the subsequent extraction of key features.

Development of this in vivo confocal Raman spectroscopic method enables the direct measurement of water, proteins, and lipids with depth resolution in ...

Chemistry

Lymphocyte Isolation from Human Skin for Phenotypic Analysis and Ex Vivo Cell Culture

Human skin has an important barrier function and contains various immune cells that contribute to tissue homeostasis and protection from pathogens. As the skin is relatively easy to access, it provides an ideal platform to study peripheral immune regulatory mechanisms. Immune resident cells in healthy skin conduct immunosurveillance, but also play an important role in the development of inflammatory skin disorders, such as psoriasis. Despite emerging insights, our understanding of the biology underlying various inflammatory skin diseases is still limited. There is a need for good quality (single) cell populations isolated from biopsied skin samples. So far, isolation procedures have been seriously hampered by a lack of obtaining a sufficient number of viable cells. Isolation and subsequent analysis have also been affected by the loss of immune cell lineage markers, due to the mechanical and chemical stress caused by the current dissociation procedures to obtain single cell suspension. Here, we describe a modified method to isolate T cells from both healthy and involved psoriatic human skin by combining mechanical skin dissociation using an automated tissue dissociator and collagenase treatment. This methodology preserves expression of most immune lineage markers such as CD4, CD8, Foxp3 and CD11c upon the preparation of single cell suspensions. Examples of successful CD4+ T cell isolation and subsequent phenotypic and functional analysis are shown.

Lymphocyte Isolation from Human Skin for Phenotypic Analysis and Ex Vivo Cell Culture

We describe a protocol to efficiently isolate skin resident T cells from human skin biopsies. This protocol yields sufficient numbers of viable human skin resident lymphocytes for flow cytometric analysis and ex vivo culture.

Human skin has an important barrier function and contains various immune cells that contribute to tissue homeostasis and protection from pathogens. As the ...

Immunology and Infection

Establishing Transcription Profile of Psoriasiform Cutaneous In Vitro using HaCaT Cells Stimulated with Combination of Cytokines

Psoriasis is a common chronic inflammatory skin disease mediated by innate and adaptive immune systems, characterized by abnormal proliferation and differentiation of epidermal keratinocytes and infiltration of inflammatory cells. Skin-specific keratinocytes are key participants in innate immunity, responding to immune cells and environmental stimulation, thereby serving an important role in the immunopathogenesis of psoriasis. Here, we present a method for inducing psoriasiform keratinocytes inflammation at transcription level with HaCaT cell line using five proinflammatory cytokines combination (M5 combination), including IL-17A, IL-22, IL-1&#945;, TNF-&#945;, and oncostatin M. Results demonstrate that M5 combination induced HaCaT cells showed increased levels of antimicrobial peptides (BD2, S100A7, S100A8, and S100A9), chemokines, and cytokines (CXCL1, CXCL2, CXCL8, CCL20, IL-1&#946;, IL-6 and, IL-18). The mRNA levels of keratinocytes differentiation markers (Keratin1, Keratin10, Filaggrin, and Loricrin) were down regulated, which was consistent with the transcriptome data derived from psoriasis-like keratinocytes. The method described here, therefore, establishes an in vitro psoriasiform cutaneous inflammation at transcription level and contributes to the research for molecular pathogenesis of psoriasis.

This paper presents a method of establishing an in vitro psoriasiform cutaneous inflammatory model at the transcription level using a combination of five cytokines (IL-17A, IL-22, IL-1&#945;, TNF-&#945;, OSM) on HaCaT cell line.

Psoriasis is a common chronic inflammatory skin disease mediated by innate and adaptive immune systems, characterized by abnormal proliferation and ...

Precision Implementation of Minimal Erythema Dose (MED) Testing to Assess Individual Variation in Human Inflammatory Response

Minimal erythema dose (MED) testing is frequently used in clinical settings for determining the smallest amount of ultraviolet (UV) irradiation necessary to produce erythema (inflammatory reddening) on the surface of the skin. In this context, the MED is regarded as a key factor in determining starting doses for UV phototherapy for common skin conditions such as psoriasis and eczema. In research settings, MED testing also has potential to be a powerful tool for assessing within- and between-persons variation in inflammatory responses. However, MED testing has not been widely adopted for use in research settings, likely owing to a lack of published guidelines, which is a barrier to obtaining reproducible results from this assay. Also, protocols and equipment for establishing MED vary widely, making it difficult to compare results across laboratories. Here, we describe a precise and reproducible method to induce and measure superficial erythema using newly designed protocols and methods that can easily be adapted to other equipment and laboratory environments. The method described here includes detail on procedures that will allow extrapolation of a standardized dosage schedule to other equipment so that this protocol can be adapted to any UV radiation source.

Precision Implementation of Minimal Erythema Dose MED Testing to Assess Individual Variation in Human Inflammatory Response

Minimal erythema dose (MED) testing is used to establish dosage schedules for ultraviolet radiation phototherapy. It can assess individual variation in inflammatory response but lacks methodology for achieving reproducible results. Here, we present a precision implementation of MED and demonstrate its ability to capture individual variation in inflammatory response.

Minimal erythema dose (MED) testing is frequently used in clinical settings for determining the smallest amount of ultraviolet (UV) irradiation necessary ...

Software-Assisted Quantitative Measurement of Osteoarthritic Subchondral Bone Thickness

Subchondral bone thickening and sclerosis are the major hallmarks of osteoarthritis (OA), both in animal models and in humans. Currently, the severity of the histologic subchondral bone thickening is mostly determined by visual estimation based semi-quantitative grading systems. This article presents a reproducible and easily executed protocol to quantitatively measure subchondral bone thickness in a mouse model of knee OA induced by destabilization of the medial meniscus (DMM). This protocol utilized ImageJ software to quantify subchondral bone thickness on histologic images after defining a region of interest in the medial femoral condyle and the medical tibial plateau where subchondral bone thickening usually occurs in DMM-induced knee OA. Histologic images from knee joints with a sham procedure were used as controls. Statistical analysis indicated that the newly developed quantitative subchondral bone measurement system was highly reproducible with low intra- and inter-observer variabilities. The results suggest that the new protocol is more sensitive to subtle or mild subchondral bone thickening than the widely used visual grading systems. This protocol is suitable for detecting both early and progressing osteoarthritic subchondral bone changes and for assessing in vivo efficacy of OA treatments in concert with OA cartilage grading.

This methodology article presents a software-assisted quantitative measurement protocol to quantify histologic subchondral bone thickness in murine osteoarthritic knee joints and normal knee joints as controls. This protocol is highly sensitive to subtle thickening and is suitable for detecting early osteoarthritic subchondral bone changes.

Subchondral bone thickening and sclerosis are the major hallmarks of osteoarthritis (OA), both in animal models and in humans. Currently, the severity of ...

A Novel Approach for Pain Assessment from Pain Body Diagrams

Quantifying Pain Location and Intensity with Multimodal Pain Body Diagrams

To quantify an individual&#39;s subjective pain severity, standardized pain rating scales such as the numeric rating scale (NRS), visual analog scale (VAS), or McGill pain questionnaire (MPQ) are commonly used to assess pain on a numerical scale. However, these scales are often biased and fail to capture the complexity of pain experiences. In contrast, clinical practice often requires patients to report areas of pain by drawing on a body diagram, which is an effective but qualitative tool. The method presented here extracts quantifiable metrics from pain body diagrams (PBDs) which are validated against the NRS, VAS, and MPQ pain scales. By using a novel pressure-hue transformation on a digital tablet, different drawing pressures applied with a digital stylus can be represented as different hues on a PBD. This produces a visually intuitive diagram of hues ranging from green to blue to red, representing mild to moderate to most painful regions, respectively. To quantify each PBD, novel pain metrics were defined: (1) PBD mean intensity, which equals the sum of each pixel&#39;s hue value divided by the number of colored pixels, (2) PBD coverage, which equals the number of colored pixels divided by the total number of pixels on the body, and (3) PBD sum intensity, which equals the sum of all pixels&#39; hue values. Using correlation and information theory analyses, these PBD metrics were shown to have high concordance with standardized pain metrics, including NRS, VAS and MPQ. In conclusion, PBDs can provide novel spatial and quantitative information that can be repeatedly measured and tracked over time to comprehensively characterize a participant&#39;s pain experience.

Author Spotlight: Quantifying Pain Experience &#8211; An Illustrative Approach Using the Pain Body Diagram 

Current pain scales used to quantify pain severity, such as visual analog scales, fail to capture the complexity of subjective pain experiences. Pain body diagrams are qualitative but may be more informative. The goal of this method is to extract quantitative metrics from pain body diagrams using novel pressure-hue transformation.

To quantify an individual&#39;s subjective pain severity, standardized pain rating scales such as the numeric rating scale (NRS), visual analog scale ...

Neuroscience

Comparing Objective Conjunctival Hyperemia Grading and the Ocular Surface Disease Index Score in Dry Eye Syndrome During COVID-19

The incidence of dry eye syndrome (DES) has increased due to wearing masks, utilizing digital devices, and working remotely during the pandemic. A survey was conducted during the COVID-19 pandemic to determine the prevalence of dry eye syndrome. A cross-sectional study investigated how prevalent DES is during COVID-19 in healthy patients aged 20-45 in the United States. An Ocular Surface Disease Index (OSDI) questionnaire was given to 40 individuals remotely from October 31, 2021, to December 1, 2021. The AOS and the OSDI survey were used to evaluate DES. The subjects were 29 years old on average (SD 14.14), with 23 males (57.5%) and 17 females (42.5%). According to the OSDI survey, low DES, moderate DES, and severe DES had prevalence rates of 15%, 77.5%, and 7.5%, respectively. White (W) people represent 50% of the population, while African Americans (AA) represent 35%, Asians represent 7.5%, and Hispanics represent 7.5%. Mild DES affected 77.5% of subjects, with 64.50% males and 35.50% females. According to the AOS objective grading system, mild (M) DES, moderate (MO) DES, and severe (S) DES had prevalence rates of 40%, 12.5%, and 15%, respectively. Linear regression was used to compare the two grading systems, and it demonstrated a strong relationship between the two grading systems.

The present protocol describes the cross-sectional research performed on 40 healthy subjects between the ages of 20 and 45 to assess the prevalence of dry eye syndrome (DES) during COVID-19. The OSDI survey evaluated DES, and the advanced ophthalmic systems (AOS) software was used to assess limbal redness.

The incidence of dry eye syndrome (DES) has increased due to wearing masks, utilizing digital devices, and working remotely during the pandemic. A survey ...

Measuring Psoriasis Severity at Home

Samenvatting

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