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Psoriasis prevalence among adults in the United States
Abstract
Psoriasis is a chronic inflammatory disorder associated with significant morbidity and mortality. Up-to-date prevalence data on psoriasis provide the foundation for informing population research, education, and health policy.
We sought to determine the prevalence of psoriasis among US adults.
We performed a cross-sectional study using National Health and Nutrition Examination Survey 2009 through 2010 data to determine psoriasis prevalence rates.
From 6218 participants older than 20 years of age, 6216 respondents provided complete information regarding a psoriasis diagnosis. The prevalence of psoriasis among US adults ages 20 years and older is 3.2% (95% confidence interval [CI] 2.6%-3.7%). A total of 7.2 million US adults had psoriasis in 2010; an estimated 7.4 million US adults were affected in 2013. When stratifying the sample by race among those between ages 20 and 59 years, the psoriasis prevalence was highest in Caucasians at 3.6% (95% CI 2.7%-4.4%), followed by African Americans (1.9%; 95% CI 1.0%-2.8%), Hispanics (1.6%; 95% CI 0.5%-2.8%), and others (1.4%; 95% CI 0.3%-2.6%). The prevalence of psoriasis among US adults has not changed significantly since 2003 to 2004 (P > .05).
Dermatologist evaluation and skin photographs were unavailable for the 2009 through 2010 surveys.
In the United States, psoriasis remains a common, immune-mediated disease, affecting 7.4 million adults. Its prevalence has remained stable since the mid-2000s.
... Psoriasis is a chronic inflammatory disease with multiple skin manifestations and from epidemiological studies in the United States it is estimated that 3% of adult population shows signs of psoriatic disease [1]. 90% of patients with psoriasis have chronic plaque psoriasis, whereas less common psoriasis can affect the nails (23%-27%), face (49%) palms and soles (12%-16%), or intertriginous folds (21%-30%). ...
... Recently, the interleukin-23/T helper 17 (IL-23/Th17) pathway has been recognized as a key axis in the pathogenesis of psoriasis, which leads to the overexpression of the proinflammatory cytokine interleukin 17A (IL-17A). Secukinumab is a fully humanized immunoglobulin G1 kappa antagonist of IL-17A and is indicated for the treatment of moderateto-severe psoriasis, moderate-to-severe paediatric plaque psoriasis, psoriatic arthritis (PsA), axial spondyloarthritis, juvevile idiopathic arthritis (enthesitis-related arthritis and juvenile psoriatic arthritis) and hidradenitis suppurativa [1][2][3][4][5][6][7][8][9]. Namely for the treatment of moderate-to-severe plaque psoriasis in adults, secukinumab is indicated as first line treatment. ...
Introduction: Psoriasis is a chronic inflammatory disease with multiple skin manifestations, and in case of lesions affecting the genital area sexual health impairment and psychological distress can furthermore impair the quality of life of patients. Secukinumab is a fully humanized antagonist of IL-17A and is indicated for the treatment of moderate-to-severe psoriasis. Objectives: This study was conducted in order to gather retrospective real-world data regarding the efficacy of secukinumab in treating patients with moderate-to-severe plaque psoriasis in Greece. We included difficult-to-treat manifestations in our analysis, specifically regarding the efficacy in the genital area and on the skin folds. Methods: All adult patients receiving 300 mg of secukinumab and attending follow-up visits on a regular basis, according to routine medical practice, were included. The timeline of the study was from 2015 to 2020. Primary endpoint of the study was the percentage of patients who achieved a PASI75 response rate at week 16 and week 52 post baseline. Results: Ninety-nine patients were included in the study population. Regarding difficult-to-treat manifestations, we recorded scalp involvement in 74.74% (74/99) of our patients, genital psoriasis in 27.27% (27/99), and skin fold involvement (psoriasis inversa) in 17% (17/99). At week 16, PASI75/PASI90/PASI100 were observed in 87.5%/69.8%/49%, respectively. Treatment with secukinumab during the 208 weeks of observation did not reveal any major adverse event. Conclusion: According to our outcomes, secukinumab is an effective treatment choice for treating chronic plaque psoriasis, but additionally it can be efficacious in the subgroups of patients with difficult-to-treat manifestations.
... In 2016, the World Health Organization (WHO) highlighted the epidemiology of psoriasis as a priority area of research of the disease (World Health Organization 2016). Then, studies of various countries evaluated the distribution of this illness around the world (Rachakonda et al. 2014, Shalom et al. 2018, Springate et al. 2017, Danielsen et al. 2019. In general, psoriasis and psoriatic arthritis have a ranged prevalence in different localizations; also, they are considered diseases with a considerable impact on patients' quality of life (Menter 2016, Boehncke & Schön 2015, Langley et al. 2005. ...
... occur earlier in women(Griffiths et al. 2021). The age of the population was similar to other prevalence studies inBrazil (Romiti et al. 2017) and worldwide(Rachakonda et al. 2014, Shalom et al. 2018, Lebwohl et al. 2014. ...
The epidemiology of psoriasis and cutaneous mycoses is scarce in Brazil. Thus, this cross-sectional study aimed to characterize the distribution of these diseases in Paraná. Data was obtained from the Outpatient Information System (SIA - Sistema de Informações Ambulatoriais), between 2016 and 2020. The procedures were filtered by the International Classification of Diseases (ICD). A total of 201,161 outpatient procedures were registered for psoriasis and psoriatic arthritis. The distribution concerning gender was similar (50.93% feminine; 49.07% masculine). The mean age was 51.55 years. The most frequent procedure was methotrexate dispensing (23.17%), followed by acitretin (14.29%) and adalimumab (12.55%). Adjusting to total population, the prevalence of procedures was 0.35%. Regarding cutaneous mycoses, 1,756 procedures were registered. 65% of them referred to females. White race/color was predominant (82.97%). The mean age was 37.6 years. The distribution concerning age varied according to the type of mycosis. Medical appointments (48.92%) and surgical pathology exam/biopsy (38.71%) were the most frequent procedures. The prevalence of procedures was 0.004%. This is the first epidemiological study using SIA about the population affected by psoriasis, psoriatic arthritis, and cutaneous mycoses in a Brazilian state. We believe that these findings allow relevant contribution to science and public policies in Brazil.
... The sun's harmful UV rays, as well as exposure to screens, increase the risk of skin cancer, including basal cell carcinoma, squamous cell carcinoma, and melanoma. People who are older tend to have accumulated sun damage, making them more susceptible to skin cancer [1,[18][19][20]. ...
... Overcoming skin problems requires a comprehensive approach that includes proper skincare, healthy lifestyle habits, and, in some cases, professional guidance and the right choice of cosmetic products. Determine your skin type (oily, dry, sensitive, or normal) and identify any specific skin concerns you may have (acne, pigmentation, etc.) [1,2,16,19,20,29,31,32]. This understanding will guide one in selecting appropriate skincare products and treatments. ...
Introduction Human skin serves several important functions and is the largest organ in the body. It plays a role of barrier against external elements, regulates body temperature, and helps in the excretion of waste products. The condition of the skin can vary from person to person, and it is often classified into different types based on certain characteristics [1, 2]. Additionally, various skin problems can occur that may require attention and treatment. Skin is typically classified into four main types: normal, dry, oily, and sensitive. These classifications are based on factors such as sebum production, moisture levels, and sensitivity [2,3]. Normal Skin: Normal skin has a balanced sebum production, good moisture retention, and is generally free from major skin problems [2]. Dry Skin: Skin that is dry lacks proper moisture and feels tight, itchy, and rough. It may be caused by factors such as genetics, aging, weather conditions, or excessive use of harsh skincare products [1]. Oily Skin: As a result of excessive sebum production, oily skin looks shiny, has enlarged pores, and is prone to acne and other skin. Abstract Background: The current study survey aims to explore the impact of age groups and seasons on various skin types. A survey was performed by IncNut LifeStyle Pvt. Ltd., City, Country in 2021 and 2022. IncNut LifeStyle Pvt. Ltd. India is the 1st organization that designed customized products as per individual needs. To understand consumers' actual needs over 'wants', the consumer needs to answer the questionnaire, which is about various attributes like skin type, gender, age, food habits, skin issues, etc. For skin type categorization, four options were provided i.e. Oily, Dry, Normal and Sensitive Skin. Data mapping and analysis have been done with the aid of proprietary validated software DiabloTM.
... Psoriasis is a chronic autoimmune inflammatory disease that primarily affects skin, nails, and sometimes joints. It is characterized by chronic skin inflammation, excessive keratinocyte proliferation, and itchy, silvery scaly and erythematous lesions on the skin (Griffiths and Barker 2007;Rachakonda et al. 2014). Psoriasis is characterized by a key clinical feature, the hyperproliferation of keratinocytes, driven by T-cell activation. ...
Using a bioassay-guided fractionation approach, the most potent anti-psoriatic components of Aster squamatus herb, Aster chinensis stalks, and Aster chinensis flowers, cultivated in Egypt, were identified and evaluated against Imiquimod (IMQ)-induced psoriasis in female BALB/c mice and compared to standard drug, mometasone. The topical application of A. chinensis stalk methanolic extract exhibited the strongest anti-psoriatic effects against IMQ-induced psoriasis model, as evidenced by improvements in psoriasis area severity index (PASI) score, histopathological analysis, and spleen index. Further fractionation of A. chinensis stalk methanolic extract using petroleum ether, methylene chloride, ethyl acetate, and n-butanol revealed that the methylene chloride fraction (MCF) was the most potent. Indeed, MCF significantly reduced the PASI score, alleviated histopathological changes, and restored spleen index. Mechanistically, MCF exerted its anti-psoriatic effects by suppressing inflammation, evidenced by decreased TLR-4 gene expression and lower levels of HMGB1 and NFκBp65 protein contents. Additionally, MCF reduced serum levels of pro-inflammatory cytokines interleukin (IL)-1β, IL-6, IL-23, and IL-17 while mitigating oxidative stress through increased superoxide dismutase (SOD) activity and reduced malondialdehyde (MDA) content. Notably, the efficacy of MCF was comparable to that of mometasone, with no significant differences observed. In parallel, the chemical profile of the MCF was analyzed using UHPLC-MS/MS techniques in negative and positive ionization full scan modes. MCF of A. chinensis stalk could be used a potential therapeutic agent for psoriasis.
... To the Editor: Psoriasis is a chronic systemic inflammatory disease that affects 1% to 3% of the global population. 1,2 Due to dysregulation of the immune system, patients with HIV who have concurrent moderate to severe psoriasis present a clinical therapeutic challenge for dermatologists. Recent guidelines from the American Academy of Dermatology recommended avoiding certain systemic treatments (eg, methotrexate, cyclosporine) in patients who are HIV positive due to their immunosuppressive effects, as well as cautious use of certain biologics in populations with HIV. 3 Traditional therapies for managing psoriasis in patients with HIV have included topical agents, antiretroviral therapy (ART), phototherapy, and acitretin; however, phototherapy can be logistically cumbersome for patients, and in the setting of ART, acitretin has the potential to exacerbate hypertriglyceridemia as well as other undesirable adverse effects. ...
... Psoriasis is a chronic inflammatory skin disease that affects 1-3% of the world's population [25][26][27]. Its pathogenesis is complex and not fully understood. ...
... The association between psoriasis and depression is well-established in the population of the United States [51]. The incidence of psoriasis is significantly higher in the United States than in China, at 2-4% and 0.47%, respectively [52,53]. ...
Background: Patients with psoriasis often experience psychiatric comorbidities, such as depression and anxiety. These comorbidities can lead to poorer adherence to treatment regimens, reduced effectiveness of therapies, and a heightened disease burden. This study aims to explore the scientific output related to psoriasis, depression, and anxiety using a comprehensive analysis combining bibliometric statistical methods. Methods: The study performed a bibliometric analysis of publications related to psoriasis, depression, and anxiety between 1974 and December 2023. This study employed the Latent Dirichlet Allocation (LDA) algorithm to identify key research topics and used the HJ-Biplot technique to visualize the relationships between publications and research indicators. The inclusion criteria were limited to English-language research articles. Results: Over 49 years, the analysis identified 5059 documents published across 1151 sources. The annual growth rate for research was 12.26%. The Journal of the European Academy of Dermatology and Venereology and The British Journal of Dermatology were found to be the leading journals in this field. The United States emerged as the top contributor, followed by China, Italy, and Germany. The most prevalent research topics were inflammation and cellular function, with a significant focus on patient treatment and the impact of depression and anxiety. Conclusions: This bibliometric analysis underscores the increasing of studies on the comorbidities of depression and anxiety in patients with psoriasis. This study provides a comprehensive overview of research trends and emerging topics in this field, offering valuable insights for future investigations.
... There may be visible signs of inflammation such as raised plaques (plaques may look different for different skin types) and scales on the skin [1]. Psoriasis affects from 2-3% of people worldwide [2], and more than 3% of the United States adult population [1,3]. Psoriasis is most common in those with white European ancestry, with similar numbers between men and women. ...
... 30% or more of patients also have joint issues. The epidermis is home to a large number of activated T cells that appear to be able to promote the growth of keratinocytes (Rachakonda et al. 2014). Numerous problems, such as psoriatic arthritis, heart disease, metabolic syndrome, and obesity, are associated with psoriasis. ...
A neurodegenerative illness is a disorder in which the brain and/or spinal cord’s neurons, or nerve cells, gradually deteriorate and disappear. These illnesses often get worse with time and can seriously affect movement, cognition, and other neurological functions. Psoriasis is a long-term autoimmune skin condition marked by fast skin cell growth that results in red, elevated areas coated in silvery-white scales. It can affect several body parts, such as the elbows, knees, scalp, and lower back, and it is not communicable. The build-up of amyloid beta [Aβ] protein is linked to elevated levels of reactive oxygen species (ROS) (Kim et al. 2020). These ROS can trigger multiple pathways, including MAPK, NFkB, JAK/STAT, and interleukin 1 beta (IL-1β), ultimately playing a role in the development of neurodegenerative illnesses like Alzheimer’s disease (AD) and psoriasis. People who have psoriasis are more likely to acquire AD, as psoriasis is a chronic inflammatory skin condition that is genetically connected. Because of the antioxidants and anti-inflammatory properties of citrus fruits neurodegenerative and psoriasis disease may be prevented. The neuroprotective action of bioactives in citrus fruits involves the inhibition of inflammation through the control of p38 mitogen-activated protein kinase (MAPK) and the activation of nuclear factor erythroid 2-related factor 2 (Nrf2). Due to their immunomodulatory and anti-inflammatory qualities, polyphenols may be able to control the immune response in psoriasis. We performed a thorough review in order to investigate for the first time to understand the role of citrus fruits in comorbid neurodegenerative disorders associated with psoriasis. For better understanding into the possible applications of citrus fruits in treating psoriasis and neurodegenerative disease would require additional studies focusing directly on the relationship between citrus fruits consumption in managing neurodegenerative and psoriasis disease.
... [1][2][3][4] It has an estimated prevalence of 2%-3% of the world's population, varying according to ethnicity and geographic location. [5][6][7] In Brazil, it is estimated to occur in 1.3% of the general population. 8,9 Its etiopathogenesis is complex, multifactorial, and not completely understood to the present day. ...
Background
Gut dysbiosis may play a role in immune-mediated diseases, such as psoriasis. There is a growing interest in understanding microbiome influence, with speculations around the importance of an altered gut microbiome linked to the progression to psoriatic arthritis in psoriasis. The objective of this study is to study the gut microbiome in patients with severe psoriatic disease with or without psoriatic arthritis.
Methods
V3/V4 16S rRNA gene sequencing and bioinformatics analyses were performed with the total DNA extracted from the stool samples of 30 patients with psoriatic disease, 15 of whom had documented psoriatic arthritis.
Results
We found differences in gut microbiome composition in psoriatic arthritis patients when looking for relative and especially differential abundances. Bacteroidaceae family (P = .02), Bacteroides genus (P = .02), and Bacteroides uniformis (P = .03) were more abundant in psoriatic arthritis patients on differential abundance, adjusted for each taxonomic level. However, the present study did not show significant differences in alpha or beta diversity.
Conclusion
This study shows different patterns of gut microbiome composition in patients with psoriatic arthritis, with significant overexpression of the Bacteroides genus. This reinforces the microbiome as a field of interest in psoriasis. Nevertheless, it should be noted that some previously described findings related to lower diversity and different clustering between groups could not be demonstrated, probably due to the small number of patients. Additionally, it remains difficult to understand the magnitude of the gut microbiome influence. Is dysbiosis a cause or consequence of the disease? However, the microbiome deserves our attention, especially since it brings different opportunities for intervention through diet, prebiotics and probiotics, pretreatment analysis, prognosis, and even microbiome modulation and transplantation.
... In Brazil, a prevalence of 1.3% in the general population is estimated. Psoriatic disease, on the skin, manifests itself as erythematous and scaly lesions, which can affect the joints, in a heterogeneous way, but with erosive potential, including pain and permanent damage [17][18][19][20][21] The etiology of psoriasis is complex and not completely understood to this day. It appears to be determined primarily by an aberrant immune response, influenced by genetic factors involved with a pre-disposition for the development of the disease phenotype, associated with various environmental stimuli described as possible triggering and/or aggravating mechanisms of the disease [22] This immunological hyperactivation determines a persistent inflammatory state, not restricted to the skin. ...
Dear editor. Just over 30 years ago, the US National Center for Human Genome Research, today known as the National Human Genome Research Institute, was established in the United States, with the ambitious goal of sequencing all 3 million nitrogenous bases in the human genome. In simple terms, it represented the determination of the exact order of DNA bases, determining the segments of human genetic material from blood samples from healthy individuals [1]. More than 2000 researchers from many countries participated in the project in a global joint effort (Universities and Research Centers, mostly from the USA, United Kingdom, France, Germany, Japan, and China, which represented the International Human Genome Sequencing Consortium)
... Psoriasis is a chronic immune-mediated skin disease that affects roughly 3.6% of European ancestry groups, 2.5% of Asians, 1.9% of Hispanics, 1.5% of African Americans, and 3.1% of other/multiracial groups [1]. 90% of individuals with psoriasis experience it in the form of plaque psoriasis, also known as psoriasis vulgaris [2], and roughly 6-42% of psoriasis patients also experience psoriatic to psoriasis susceptibility. ...
Psoriasis is a chronic, immune-mediated inflammatory skin disease associated with a polygenic mode of inheritance. There are few studies that explore the association of a psoriasis Polygenic Risk Score (PRS) with patient clinical characteristics, and to our knowledge there are no studies examining psoriasis PRS associations across different ethnicities. In this study, we used a multi-racial psoriasis cohort to investigate PRS associations with clinical phenotypes including age of onset, psoriatic arthritis, other comorbidities, psoriasis body location, psoriasis subtype, environmental triggers, and response to therapies. We collected patient data and Affymetrix genome-wide SNP data from a cohort of 607 psoriasis patients and calculated an 88-loci PRS (PRS-ALL), also partitioned between genetic loci within the HLA region (PRS-HLA; 11 SNPS) and loci outside the HLA region (PRS-NoHLA; 77 SNPS). We used t-test and logistic regression to analyze the association of PRS with clinical phenotypes. We found that PRS-HLA and PRS-noHLA had differing effects on psoriasis age of onset, psoriatic arthritis, psoriasis located on the ears, genitals, nails, soles of feet, skin folds, and palms, skin injury as an environmental trigger, cardiovascular comorbidities, and response to phototherapy. In some cases these PRS associations were ethnicity specific. Overall, these results show that the genetic basis for clinical manifestations of psoriasis are driven by distinct HLA and non-HLA effects, and that these PRS associations can be dependent on ethnicity.
... It affects both men as well as women equally, as well as children, adults, and the elderly, and can strike at any age. According to the National Psoriasis Foundation, it is more common in individuals between the ages of 15 and 35 [2]. A grouping of hereditary and environmental causes causes psoriasis. ...
Psoriasis is a non-contagious, continuing, auto-immune disease that mostly affects the skin, and about 2%-3% of the world's population suffers from it. In this review article, the primary focus is on the strategies involved in conventional therapies and the latest advances that have been recorded in metallic nano, polymer-based, and lipid-based formulations in the spectrum of anti-psoriatic drugs. Liposomes, ethosomes, solid lipid nanoparticles, micelles, and dendrimers are only some of the nanocarrier systems that have been extensively researched in relation to their potential use in nano formulations. This study incorporates patent applications that illustrate the nanoparticle's function in treating psoriasis. Hence, on the basis of an extensive literature survey, it is concluded that nano-formulations are a promising medium to treat a disease like psoriasis as they offer enhanced penetration, target-specific delivery, and improved efficacy. When applied to the study of biological systems and the development of novel medical technologies, nanobiotechnology offers potentially promising possibilities for the efficient use of nanoscale materials and processes. In this approach, nanotechnology and biotechnology are combined in order to develop nanoscale devices, materials, and systems that can be used for the diagnosis, treatment, and prevention of psoriasis. The future of the therapeutic effect of antipsoriatic drugs is dependent on both the benefits they have the ability to bring and the progress being made in the mass production of these carriers. Researching novel carrier systems or combination therapies is essential, but so is working to scale up existing technologies so they may be commercialised and used to benefit society at large.
... Plaque psoriasis is a common inflammatory skin condition affecting about 3% of US adults (1), with approximately 80% of patients having mild-to-moderate disease (2). In the Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) survey of North American and European patients with psoriasis (N = 3,426), 22% of patients with <3% body surface area (BSA) involved reported a sizable impact on their life (i.e. ...
Background
Topical treatments are the foundation for patients with psoriasis; however, adherence can be limited by patient preferences and treatment burden.
Methods
The Harris Poll conducted an online survey of US patients with psoriasis who use prescription topical therapy to examine their preferences and perspectives on topical treatments.
Results
Among patients with psoriasis who use topical treatment (n = 507), most participants described their psoriasis symptoms as mild (31%) or moderate (59%). The body areas most often reported to be affected by psoriasis were the scalp, elbows, legs, intertriginous areas, arms, and knees. Participants reported psoriasis affecting the scalp (39%), elbows (20%), and legs (excluding knees; 19%) caused the greatest impact on quality of life. Most participants (76%) preferred topical therapies to treat their psoriasis, while 20% preferred pills, and 4% preferred injections. The most common product attributes that participants wanted in a topical psoriasis treatment and that would help them to continue to use the treatment were: improvement in plaques (68%), itch relief (68%), and easy to apply (63%).
Conclusion
The respondents to this survey reported that they prefer topical treatments to pills or injections (76%) and most (89%) reported they are interested in trying a new topical treatment.
... A systematic, worldwide review found the prevalence of psoriasis ranged from 0.5 to 11.4 percent in [4] adults and 0 to 1.4 percent in children. [5,6] There is no clear sex predilection for psoriasis. In addition, psoriasis can begin at any age, though it is less common in children than adults. ...
Background: Psoriasis and related disorders are a group of common, chronic, inammatory and proliferative conditions of the skin, associated with systemic manifestations. Psoriasiform dermatitis comprises of a wide variety of diseases that resemble psoriasis both at clinical and histological levels. This group includes Seborrheic Dermatitis, Pityriasis Rubra Pilaris, Allergic Dermatitis, Atopic Dermatitis, Nummular Eczema, Lichen Simplex Chronicus, Pityriasis Rosea, Dermatophytosis,Mycosis Fungoides,Psoriasiform Syphilide etc.These patients often prove to be a diagnostic dilemma for the clinician and warrant a histopathological conrmation. Materials and Methods: We conducted a retrospective study among patients who had attended our Dermatology OPD from March 2023 to January 2024. The records of patients who were clinically diagnosed as psoriasis and psoriasiform dermatitis were collected, data extracted and categorised into different groups. The clinical and pathological correlation of psoriasis and psoriasiform dermatitis were done. Descriptive statistics of the obtained data were calculated. Results: Out of the 50 patients included in the study, majority were females(52%) belonging to the age group of 40-50 years(60%). Psoriasis was the most common disease according to clinical as well as histological diagnosis. In this study, majority of patients (58%) had been clinically diagnosed as psoriasis and rest 42% patients were clinically diagnosed as psoriasiform dermatitis. Histological diagnosis of psoriasis had been made in 44% of patients. Conclusion: Psoriasis could be confused with other dermatological diseases having similar presentations (psoriasiform dermatitis), thus complicating the diagnosis. Hence, it is histopathological examination that eventually helps in aiding diagnosis and makes it imperative to perform a skin biopsy in suspected cases.
... It affects around 2 to 3% of the general population and causes a profound impact on quality of life, especially when present in its severe forms. [1][2][3][4][5][6][7][8][9][10] Classic studies indicate that approximately one third of patients with psoriasis will have associated psoriatic arthritis (PsA). And, in 70% of cases, joint disease follows cutaneous involvement, placing the dermatologist in a prominent position to suspect this diagnosis. ...
Psoriasis is a common chronic, immune-mediated, systemic inflammatory disease, with a special predilection for the skin and joints. Approximately one third of patients with psoriasis will have associated psoriatic arthritis and it usually begins with the skin lesions, evolving to articular manifestations. Since psoriatic arthritis could present with permanent articular damage with chronic pain and disability, it is important to seek for early diagnosis. We will talk about our recent experience with rheumatological ultrasound, studying a small and selected group of patients, along with an important literature review.
... Studies have shown that nail involvement is observed in 47.4% to 78.3% of the patients with psoriasis, more frequently in men. [1][2][3][4] The 4th finger and 1st toe are most commonly affected by the nail involvement of psoriasis. [4] While pitting and onycholysis are the most prevalent patterns in fingernails, onycholysis, and crumbling are the most frequent toenail changes. ...
Psoriasis is a common multisystem inflammatory disease, and arthritis is an essential component of the disorder, requiring early diagnosis and prompt treatment for successful management. In this study, we aimed to investigate the relationship between nail and scalp involvement and other covariates with psoriatic arthritis (PsA). This cross-sectional study, conducted from June 2021 through December 2021, included 763 patients from 11 different centers in Turkey. The severity of involvement was evaluated using psoriasis area severity index (PASI), nail psoriasis severity index (NAPSI), and psoriasis scalp severity index (PSSI) scores. Predictors for PsA were evaluated using univariate and multivariate logistic regression models. PsA (n = 155, 21.5%) was significantly more common in patients having a family history of psoriasis (43.2% vs 30.9%, P = .004), nail involvement (68.4% vs 52.3%, P < .001), and coexistence of nail and scalp involvement (53.7% vs 39.6%, P = .002). Furthermore, patients with PsA had considerably higher PASI (7 vs 5.6, P = .006), NAPSI (5 vs 2, P < .001), and PSSI scores (7 vs 4, P = .002) and longer disease duration (months) (126 vs 108, P = .009). In multivariate analysis, female gender [OR: 3.01, 95% CI (1.861–4.880), P < .001], nail involvement [OR: 2.06, 95% CI (1.293–3.302), P = .002)], and body mass index (BMI) [OR: 1.06, 95% CI (1.017–1.100), P = .005] were identified as independent predictors for PsA. Female gender, nail involvement, and high BMI are significant predictors for PsA and warrant detailed rheumatological assessment. Notably, being female is the strongest predictor of increased risk of PsA in our survey. Scalp involvement appears not to be associated with PsA. Also, the presence of PsA seems related to a more severe skin involvement phenotype.
... В другом американском исследовании по изучению предикторов смертности было установлено, что при ассоциированном тяжелом течении Пс отмечался повышенный уровень кардиоваскулярной смертности по сравнению с общей популяцией [13]. Некоторые эпидемиологические исследования продемонстрировали связь между вульгарным Пс и ИБС [14]. Японское исследование показало более высокий риск развития инфаркта миокарда у пациентов с Пс. ...
Introduction. Psoriatic disease is a genetically determined disease of a multifactorial nature that affects about 2% of the population. According to modern concepts of this pathology, there is a high level of comorbidities, especially those associated with damage to the cardiovascular system. The aim of the study is a comprehensive analysis of the features of epidemiological and clinical data linking psoriasis with cardiovascular risk factors and cardiovascular diseases. Material and Methods. A review and analysis of modern scientific data in the databases, such as eLibrary, PubMed/Medline, Web of Science, Google Scholar, and Cyberleninka for the period from 2000 to the present. Results and Discussion. Up-to-date information has been collected regarding comorbid cardiovascular pathology in psoriasis. We systematized the data related to the analysis of possible pathophysiological mechanisms that justify this relationship and analyzed the methods of cardiovascular risk stratification in patients with psoriasis. Conclusions. Various studies have shown that psoriasis is associated with a higher prevalence of cardiovascular diseases, including hypertension, diabetes mellitus, dyslipidemia, obesity, and metabolic syndrome. The relationship is discussed between psoriasis severity and the risk of developing cardiovascular diseases, as well as prognostic risks with mortality rates. The common pathogenetic mechanisms proposed include genetic factors, inflammatory pathways, adipokine secretion, insulin resistance, lipoprotein composition and function, angiogenesis, oxidative stress, and hypercoagulability.
... The disease has equal prevalence among genders and a bimodal onset distribution, peaking around the ages of 18-39 and 50-69 [5]. While psoriasis is rare in children-ranging from 0% in Taiwan to more than 2.1% in Italy [5]-the incidence rates are more variable in adults and have increased over time [6], with a higher prevalence in white people (3.6%) than in African Americans (1.5%) and Hispanics (1.9%) [7]. The clinical severity of such a skin ailment varies significantly over time, with cyclical periods of flares that are followed by subsidence or remission [2]. ...
Psoriasis is an autoimmune cutaneous condition that significantly impacts quality of life and represents a burden on society due to its prevalence. Genome-wide association studies (GWASs) have pinpointed several psoriasis-related risk loci, underlining the disease’s complexity. Functional genomics is paramount to unveiling the role of such loci in psoriasis and disentangling its complex nature. In this review, we aim to elucidate the main findings in this field and integrate our discussion with gold-standard techniques in molecular biology—i.e., Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)—and high-throughput technologies. These tools are vital to understanding how disease risk loci affect gene expression in psoriasis, which is crucial in identifying new targets for personalized treatments in advanced precision medicine.
... 3 Additionally, environmental factors such as stress, infection, and certain medications can exacerbate symptoms. 4 When immune cells activate abnormally, this can lead to rapid skin cell production, resulting in the formation of thickened patches on the skin that eventually become scaly and inflamed. 5 Individuals with psoriasis are at an increased risk of comorbidities, including psoriatic arthritis, cardiovascular diseases, and metabolic syndrome. ...
Psoriasis is a chronic skin condition that can significantly impact the quality of life of those affected. As an autoimmune disease, it can lead to itchy, painful, and scaly patches on the skin. Although various treatments, including topical creams, phototherapy, and systemic medications, are currently available, they may not always offer effective relief and can have side effects. Researchers have thus been exploring the potential benefits of non-psychoactive compounds such as CBD, found in Cannabis sativa plants, for treating psoriasis. CBD treatment may reduce inflammation, oxidative stress, itching, abnormal proliferation of keratinocytes, and may increase hydration. This review aims to provide an overview of the existing literature on the potential uses of CBD for psoriasis treatment.
... Psoriasis is a chronic dermatological condition characterized by a complex pathogenesis and impacts approximately 3% of adults 20 years or older in the United States (1,2). Research findings suggest that the prevalence of psoriasis among adults in the United States has remained relatively stable since 2003, showing no significant differences (2). ...
Background
Psoriasis is a chronic dermatological condition characterized by a complex pathogenesis that impacts approximately 3% of adults in the United States and brings enormous social burdens. For many diseases, the systemic immune-inflammatory index (SII), defined as neutrophils × platelets/lymphocytes, has been recognized as a prognostic indicator. Therefore, we conducted a cross-sectional study to assess the association between SII and psoriasis among outpatient US adults.
Methods
In this cross-sectional study, we used data on the US adults 20 to 59 years of age from the National Health and Nutrition Examination Survey (NHANES) spanning 2003–2006 and 2009–2014. Sample-weighted logistic regression and stratified analysis of subgroups were used.
Results
Among the 16,831 adults, there were 8,801 women and 8,030 men, with a psoriasis prevalence rate of 3.0%. A fully adjusted model revealed a positive association between a SII higher than 479.15 × 10⁹/L and a high risk of psoriasis. According to subgroup analysis and interaction testing (p for interaction > 0.05), age, sex, alcohol drinking status, marital status, and body mass index (BMI) were not significantly correlated with this positive association.
Conclusion
Our findings suggested that SII higher than 479.15 × 10⁹/L was positively associated with a high risk of psoriasis among outpatient US adults. To the best of our knowledge, this is the first cross-sectional study using NHANES data focused on the risk of higher SII on psoriasis among outpatient US adults. The outcomes of this cross-sectional serve to supplement previous research, indicating a need for larger-scale prospective cohorts for further validation.
... In the United States of America, the prevalence of psoriasis among adults is about 3.0-3.2% [24,26]. The age distribution shows that the increase in the incidence of psoriasis begins at the age of 20, reaching a peak at 55-60 years. ...
b>Aim: This study aimed to conduct a literature review on the prevalence, incidence, gender and age distribution of psoriasis, as well as the economic burden of psoriasis worldwide, including Kazakhstan.
Material and methods: A literature review was conducted using keywords in PubMed, Scopus, Web of Science, eLibrary.ru databases, and Google Scholar to identify relevant articles.
Results: The prevalence of psoriasis varies by geographic location and race. However, psoriasis is predominantly common in Western countries and among people of European descent: in Norway (4.6%), France (4.42%), Portugal (4.4%), and the United States of America (3.0%). Significant differences in the prevalence of this disease were identified in Kazakhstan, ranging from 0.86% to 2.5%. In many Western countries, the incidence rate of psoriasis is significantly higher than the global incidence rate (57.8 cases per 100,000 population): in Denmark (199.5), Italy (230.62), and Israel (280), respectively. In Kazakhstan, the incidence rate is 35.0 per 100,000 population, which is almost 1.7 times lower than the global rate. Psoriasis affects both genders. There is a bimodal pattern of manifestation of psoriasis with early (type I) and late (type II) onset, which occurs in the age range of 30–40 years, and about 60 years. In addition, treating and providing medications to patients with psoriasis represents a significant economic burden for both the government and the patients themselves.
Conclusion: The study made it possible to determine the current epidemiological situation of psoriasis worldwide, including Kazakhstan, as well as to assess the economic burden of this disease.
... Psoriasis (PsO) is an immune-mediated chronic inflammatory disease that affects approximately 0.91% to 8.5% of the world's population and results in a severe disease burden for psoriasis patients, which impacts their quality of life as well as work productivity [1][2][3]. Although psoriasis is not contagious, because of its disfiguring and incapacitating symptoms, those who have it frequently struggle socially and psychologically. ...
Introduction
Psoriasis (PsO) is an immune-mediated chronic inflammatory disease that results in severe outcomes that impact the patient’s quality of life and work productivity. We investigated the effectiveness of secukinumab in patients with chronic plaque psoriasis and psoriatic arthritis (PsA) over a 12-month period.
Methods
This was a longitudinal, retrospective study of the medical records of 81 patients with psoriasis and/or psoriatic arthritis who had been treated with secukinumab for at least 12 weeks.
Results
The Psoriasis Area Severity Index (PASI), Body Surface Area (BSA) percentage, and Dermatology Quality of Life Index (DLQI) among patients with PsO and PsO-PsA showed a statistically significant decrease from baseline over 12 months by approximately 9.86, 19.3%, and 9.7, respectively ( p values < 0.001 for each). Moreover, there was a statistically significant decrease in the overall Disease Activity in Psoriatic Arthritis score (DAPSA) by approximately 22.35 from baseline over 12 months of treatment ( p < 0.001). Considering the patients who started secukinumab 12 months or more prior to the study cutoff date, the 12-month retention rate was 85%.
Conclusion
In a Saudi real-world setting, secukinumab proved to be an efficient medication with high efficacy and retention rates.
... [5]. The prevalence of PsA is higher in people with psoriasis; of the 3.2% (95% CI 2.6-3.7%) of US adults who have psoriasis [6], 19.0% (95% CI 16.3-21.8%) also have PsA [7]. ...
The aim of this work is to evaluate secukinumab vs. placebo in a challenging-to-treat and smaller US patient subpopulation of the international FUTURE 2–5 studies in patients with psoriatic arthritis (PsA).
Data were pooled from US patients enrolled in the phase 3 FUTURE 2–5 studies (NCT01752634, NCT01989468, NCT02294227, and NCT02404350). Patients received secukinumab 300 or 150 mg with subcutaneous loading dose, secukinumab 150 mg without subcutaneous loading dose, or placebo. Categorical efficacy and health-related quality-of-life (QoL) outcomes and safety were evaluated at week 16. Subgroup analyses were performed based on tumor necrosis factor inhibitor (TNFi) status and body mass index (BMI). For hypothesis generation, odds ratios (ORs) for American College of Rheumatology (ACR) 20/50/70 and Psoriasis Area and Severity Index (PASI) 75/90/100 responses by treatment were estimated using logistic regression without adjustment for multiple comparisons.
Of 2148 international patients originally randomized, 279 US patients were included in this pooled analysis. Mean BMI was > 30 kg/m2 and 55.2% had prior TNFi treatment. ORs for ACR20/50/70 significantly favored patients receiving secukinumab 300 mg and 150 mg with loading dose vs. placebo (P < 0.05), but not those receiving secukinumab 150 mg without loading dose vs. placebo. For PASI75, ORs favored all secukinumab groups over placebo (P < 0.05); for PASI90 and PASI100, only the secukinumab 300-mg group was significantly favored over placebo (P < 0.05).
In this challenging sub-population of US patients with PsA, secukinumab provided rapid improvements in disease activity and QoL. Patients with PsA and active psoriasis might benefit more from secukinumab 300 mg than 150 mg.
... BAPC, Bayesian ageperiod-cohort; SDI, sociodemographic index prevalence, emphasizing tailored healthcare strategies for varying development levels in managing this chronic skin condition's evolving burden. The BAPC model predicts a future rise in global psoriasis cases per 10,000 individuals by 2030, aligning with previous findings [37,38]. Despite this increase, ASIRs per 100,000 are expected to decrease. ...
Background
Millions of people worldwide are affected by psoriasis, one of the most prevalent skin conditions. Currently, there is a lack of high-quality epidemiological reports on psoriasis.
Objective
This study aimed to reveal trends in psoriasis epidemiology in 1990–2019.
Methods
Using data from the GBD study 2019, we examined psoriasis epidemiology globally and across regions defined by the social-demographic index (SDI). Trends in incidence, prevalence, and disability-adjusted life year (DALY) rates were assessed using estimated annual percentage changes (EAPC)s. Age-period-cohort analysis examined risk variations, and decomposition analysis identified factors impacting the psoriasis burden. A Bayesian Age-Period-Cohort model predicted future incidence. Frontier analysis associated psoriasis outcomes with socio-demographic development.
Results
In 2019, the global psoriasis burden included 4,622,594 incidence, 40,805,386 prevalence, and 3,505,736 DALY cases. Despite variations in SDI regions, the overall trend showed a decline in psoriasis rates from 1990 to 2019 (EAPC = − 0.76). The age-specific analysis indicated that the highest incidence of psoriasis was observed among individuals aged 40–64 years (global, 1,606,429). Epidemiological shifts contributed negatively to global incidence and DALYs by − 80.52% and − 103.06%, respectively. Countries like San Marino and Spain displayed the highest effective differences in the decomposition analysis. By 2030, while incidence cases per 10,000 might rise (487.36, 423.62 to 551.10), age-standardized incidence rates per 100,000 were predicted to decline (53.67, 0.00 to 259.99).
Conclusion
This research revealed a global decline in psoriasis incidence rate from 1990 to 2019, with predictions suggesting this trend continues through 2030. Geographic disparities underscore the importance of tailored healthcare policies.
The aim of the study: to evaluate the dynamics of cytokine status biomarkers and oxidative stress during the treatment of psoriatic onychodystrophy using the complex use of darsonvalization and pulsed dye laser. Material and methods. A prospective, controlled, comparative, and randomized study was performed involving 110 patients with psoriatic onychodystrophy, who were divided into 4 groups using simple fixed randomization. The first group (control, 27 patients) received only basic therapy (BT), consisting of local application of ointment with calcipotriol. In the second group (comparison group 1, n = 28), patients in addition to BT received 3 courses of darsonvalization. In the third group (comparison group 2, n = 28), BT was supplemented with 5–6 ILC procedures, carried out after 1 month. Patients of the 4th group (main, n = 27) along with BT received darsonvalization in combination with ILC. In all patients, markers of oxidative stress and the level of proinflammatory cytokines were determined in the blood before and after treatment. The effectiveness of the therapy was assessed by the dynamics of the nail psoriasis severity index (NAPSI). Results. The development of psoriatic onychodystrophy is accompanied by a pronounced imbalance between oxidants and antioxidants in favor of oxidants, which indicates the development of oxidative stress. Increased levels of proinflammatory cytokines (IL-1β, IL-17, and TNF-α) confirm the dominant concept of immune inflammation, the pathogenetic axis of which implements effector functions through IL-17. The course of therapy was accompanied by the development of a corrective effect in relation to clinical and laboratory parameters in all the groups under consideration, but its severity was different. Insignificant dynamics were noted in the control group, while in the groups with additional use of physical factors, an increase in clinical efficacy according to the NAPSI index was recorded against the background of a decrease in peroxidation manifestations and cytokine levels. At the same time, the maximum severity of positive changes was noted with the complex use of darsonvalization and a pulsed dye laser. Conclusion. Additional use of therapeutic physical factors helps to reduce pathogenetic effects from immune mechanisms of inflammation and oxidative stress. The complex nature of the use of a pulsed dye laser and darsonvalization allows achieving the implementation of a synergistic interaction of physical factors, which determines the maximum implementation of the clinical effect.
La psoriasis es una enfermedad inflamatoria crónica de la piel que puede presentar formas refractarias de difícil control con terapias convencionales (1,2). En los últimos años, el desarrollo de terapias biológicas —dirigidas contra dianas inmunológicas específicas— ha revolucionado el panorama de tratamiento, ofreciendo mayores tasas de respuesta y mejoría sostenida en la calidad de vida (3). Sin embargo, su uso en psoriasis refractaria plantea desafíos en términos de selección del paciente, manejo de efectos adversos y optimización del seguimiento clínico (4). Esta revisión sistemática analiza la evidencia sobre la efectividad y seguridad de las terapias biológicas en la psoriasis refractaria, abarcando inhibidores del factor de necrosis tumoral (TNF), bloqueadores de interleucinas (IL-12/23, IL-17, IL-23) y moduladores de otras vías inmunes. Además, se discuten las experiencias clínicas actuales y las perspectivas futuras, enfatizando la necesidad de una aproximación multidisciplinaria en el manejo integral de esta enfermedad compleja.
Background and hypothesis:
Psoriasis is a common immune-mediated skin disorder with additional manifestations due to systemic inflammation. Patients with psoriasis have an increased risk of end-stage renal disease (ESRD) requiring either dialysis or renal transplant; however, the relationship between psoriasis and renal allograft failure has not been established.
Methods:
We conducted a retrospective cohort study using the United States Renal Data System to analyze the association between psoriasis and graft failure (occurring more than 2 weeks after the transplant). We compared transplant failure rates in ESRD patients with a psoriasis diagnosis prior to the initial transplant versus transplanted ESRD patients without a psoriasis diagnosis. From 2004-2019, a total of 151 272 renal transplant patients aged 18-100 and meeting exclusion and inclusion criteria were identified; in this cohort, 1 105 ESRD patients had International Classification of Disease (ICD)-9 and -10 claim codes for psoriasis prior to their renal transplant.
Results:
Logistic regression modeling was used to examine possible confounders of psoriasis on graft failure. Kaplan-Meier estimates indicated that renal transplant patients with psoriasis had reduced graft survival over time than those without psoriasis. In addition, Cox Proportional Hazard analysis, controlling for demographics and clinical risk factors, showed a significantly increased hazard ratio for renal allograft failure for patients with a diagnosis of psoriasis.
Conclusion:
The systemic inflammation and immune-mediated pathophysiology underlying psoriasis could underlie the association between psoriasis and the increased risk of renal transplant failure.
Objective: evaluation of the effectiveness of laser phoresis of the balm «Placentol 100 %”, transcranial magnetic therapy and oxygen barotherapy, used both as a single effect and in the mode of complex use, for the correction of involutional changes in the skin of the face in patients suffering from metabolic syndrome. Materials and methods. The study was conducted at the Clinic of Expert Cosmetology and Aesthetic Medicine «Love Clinic» with the participation of 120 women with involutional changes in the facial skin, suffering from metabolic syndrome. Using the method of simple fixed randomization, all patients were divided into 4 equal groups of 30 people. The first group (comparison group 1) received laserphoresis of the balm «Placentol 100 %”. The second group (comparison group 2) received a course of transcranial magnetic therapy using the «Amo-Atos» device with the «Headband» attachment. The third group (comparison group 3) received a course of oxygen barotherapy. The fourth group (main group) received a course of complex treatment, including laser phoresis of Placentol 100 % balm, transcranial magnetic therapy and oxygen barotherapy. Evaluation of clinical efficacy in the selected groups was based on the dynamics of the dermatological quality of life index; visual analogue scale of facial skin condition (VAS); international aesthetic improvement scale (GAIS), objective parameters of facial skin (hydration, elasticity, oiliness, skin pH), cutometry and corneometry. Additionally, the insulin resistance index, body mass index, atherogenicity coefficient, oxidative stress patterns and proinflammatory cytokines were determined. Results. A pronounced advantage of combined physiotherapy over the monofactorial use of therapeutic physical factors was established. It was shown that laserphoresis of Placentol 100 % balm had a greater effect on the clinical manifestations of involutional processes, transcranial magnetic therapy — on metabolic parameters, oxidative stress and inflammatory reactions, oxygen barotherapy — only on the lipid peroxidation system and systemic inflammation parameters. Analysis of the types of interaction of therapeutic physical factors in combined use made it possible to establish that 26 % of the variables used reflected the supra-additive (potentiating) nature of the implementation of the therapeutic effect of complex physiotherapy. Conclusion. An integrated approach to the correction of involutional changes in the facial skin in patients with metabolic syndrome allows for therapy taking into account the systemic mechanisms of comorbidity that determine the mutual additive nature of the clinical manifestations of the underlying disease and the pathological condition associated with it. The results of the study confirm the feasibility of developing complex methods of therapy in the field of dermatology and cosmetology based on physiotherapeutic technologies that are easy to use, accessible to the general population and have virtually no side effects.
Skin diseases are in the middle of the most prevalent conditions, arising from a myriad of factors including viral infections, bacteria, allergies, and fungal pathogens. Appropriate detection of these conditions is essential for effective treatment and management. Further, Deep learning methods are employed to enable early-stage detection, with a particular emphasis on the pivotal role of feature extraction in the classification process. This research emphasizes the significance of a patient-centered approach, aiming to provide responsible and effective solutions for skin diagnoses. In pursuing more accurate and timely skin condition diagnoses, we turn to deep learning techniques, leveraging the HAM10000 dataset. Initially, we perform different prepossessing techniques on selected datasets to handle class imbalance and a Convolutional Neural Network and fine-tune hyperparameters such as with or without Dropout, CW, FL, and Using Global Average Pooling. Our technique excels in distinguishing diverse skin, Gender, localization, and Cell types with reliable evaluation metrics such as precision, recall, FI Score, and specificity. Our technique not only subsidizes the healthcare field but also underscores the potential of advanced technologies in enhancing early skin disease detection and medical decision-making.
Psoriasis is an incurable chronic inflammatory disease that requires new interventions. Here, we found that fibroblasts exacerbate psoriasis progression by promoting macrophage recruitment via CCL2 secretion by single-cell multi-omics analysis. The natural small molecule celastrol was screened to interfere with the secretion of CCL2 by fibroblasts and improve the psoriasis-like symptoms in both murine and cynomolgus monkey models. Mechanistically, celastrol directly bound to the low-density lipoprotein receptor-related protein 1 (LRP1) β-chain and abolished its binding to the transcription factor c-Jun in the nucleus, which in turn inhibited CCL2 production by skin fibroblasts, blocked fibroblast–macrophage crosstalk, and ameliorated psoriasis progression. Notably, fibroblast-specific LRP1 knockout mice exhibited a significant reduction in psoriasis like inflammation. Taken together, from clinical samples and combined with various mouse models, we revealed the pathogenesis of psoriasis from the perspective of fibroblast-macrophage crosstalk, and provided a foundation for LRP1 as a novel potential target for psoriasis treatment.
Cur-CNEs/Gel combines the superior skin penetration efficiency of cell-penetrating peptide modified curcumin-loaded nanoemulsions and the prolonged skin retention ability of the oligopeptide hydrogel.
The atherogenic index of plasma (AIP) is a significant indicator of lipid levels. This study aimed to investigate the association between psoriasis and AIP in adults. The association between AIP and psoriasis was investigated using multivariate logistic regression, and smoothing curve fitting utilizing data from the National Health and Nutrition Examination Survey 2009 to 2014. Subgroup analysis and interaction tests were employed to investigate whether this relationship was stable across populations. The final sample included 8177 participants, representing approximately 60 million people in the US. Psoriasis among the AIP groups (quartile, Q1–Q4) was statistically significant ( P < .05). In the minimally adjusted model, each 1-unit increase in AIP was associated with a 44% increase in the risk of developing psoriasis [1.44 (1.01, 2.20)]. Participants in the highest quartile of AIP had a 40% higher risk of developing psoriasis than those in the lowest quartile [1.40 (1.05, 2.10)]. In the male group, the risk of developing psoriasis increased by 0.86 points per 1 unit increase in AIP. AIP is positively associated with psoriasis in US adults. Our findings imply that AIP improves psoriasis prevention in the general population.
Importance
Diverse racial and ethnic representation in clinical trials has been limited, not representative of the US population, and the subject of pending US Food and Drug Administration guidance. Psoriasis presentation and disease burden can vary by skin pigmentation, race and ethnicity, and socioeconomic differences. Overall, there are limited primary data on clinical response, genetics, and quality of life in populations with psoriasis and skin of color (SoC). The Varying Skin Tones in Body and Scalp Psoriasis: Guselkumab Efficacy and Safety trial (VISIBLE) is underway and uses strategies aimed at addressing this persistent gap.
Objective
To assess the innovative strategies used in the VISIBLE trial to recruit and retain diverse participants in a randomized clinical trial of psoriasis in participants with SoC.
Design, Setting, and Participants
This was an ad hoc quality improvement assessment of participant recruitment and retention approaches used by the VISIBLE trial. VISIBLE enrolled and randomized 211 participants (mean [SD] age, 43 [13] years; 75 females [36%] and 136 males [64%]) with SoC and moderate to severe plaque psoriasis from August 2022 to March 2023 to evaluate guselkumab treatment. The self-identified race and ethnicity of the participants was: 1 American Indian/Alaska Native (0.5%), 63 Asian (29.9%), 24 Black (11.4%), 94 Hispanic/Latino (44.5%), 13 Middle Eastern (6.2%), 1 Pacific Islander/Native Hawaiian (0.5%), 12 multiracial (5.7%), and 3 of other race and/or ethnicity (1.4%). Using a combination of objective (colorimetry to determine Fitzpatrick skin type) and self-reported (race and ethnicity consistent with SoC) parameters, VISIBLE sought to broaden inclusion of participants from various backgrounds.
Results
Observed improvements were that participant enrollment occurred approximately 7 times faster than anticipated (vs historical recruitment data for psoriasis studies); 211 participants (100%) self-identified themselves as a race or ethnicity other than White; and more than 50% had skin tone in the darker half of the Fitzpatrick skin type spectrum (type IV-VI). Innovations implemented by VISIBLE were (1) assessment of the natural history of postinflammatory pigment alteration and improvements over time using combined objective colorimetry and clinician- and patient-reported outcomes; (2) evaluation of genetic and comorbidity biomarkers relevant to participants with SoC; (3) a diverse demographic-driven approach to site selection (emphasizing investigator and staff diversity and experience with populations with SoC); (4) provision of cultural competency training to enhance participant enrollment and retention; (5) collection of patient-reported outcomes data in participants’ primary language; and (6) periodic, blinded central review and feedback on investigator efficacy scoring to promote consistency and accuracy in evaluating psoriasis in participants with SoC.
Conclusions and Relevance
VISIBLE is a unique study focused on addressing important knowledge and data gaps in populations of patients with psoriasis and SoC, with the goal of generating data to help improve clinical care and inform future best practices in diversity within dermatology research. The rapid study enrollment demonstrates that intentional and strategic approaches to clinical trial design and conduct can speed recruitment and bolster participation and retention of diverse populations in a dermatologic setting.
Trial Registration
ClinicalTrials.gov Identifier: NCT05272150
Sought in this manner, psoriasis is an old-standing skin condition that is precipitated by immune system of the bodies attacking skin cells and causing them to reproduce more than required, leading to formations of scales on skin surface. However, traditional medications can encounter some issues leading to poor patients’ compliance and appearance of side effects topping at the body systems. The above challenges have been well managed through in – situ gelling systems which is used in a sustained and localized drug delivery near or at the site of affected tissue through the topical route. The discussions of in-situ gel formation, mechanism of action, polymers and excipients, and choice of drugs in formulating treatment for psoriasis will be made in this review. Concerning the understanding of effectiveness of in-situ gels for the purpose of improving the therapeutic values, it is possible to explain the effectiveness through use of techniques such as gelation temperature, drug release profiles skin permeation and stability assessments. In addition, the review claims the advantages and disadvantages of the in-situ gel systems and offers the information for the further study of the approach to the treatment of psoriasis. In conclusion, In-Situ gels provide motivation for the delivery of the anti-psoriatic agents, enhances patient compliance and reduces the side effects hence making In-situ gels a useful tool in servicing Psoriasis patients.
The advent of telemedicine has revolutionized healthcare delivery across various specialties, and dermatology is no exception. With the integration of technology and medical expertise, telemedicine has emerged as a powerful tool in providing remote dermatologic care. Telemedicine has the ability to break down geographical barriers, offering dermatological care to individuals who may have limited access to specialized healthcare. Rural areas, underserved communities, and regions with a shortage of dermatologists can now benefit from expert consultations through telemedicine. Patients are now able to circumvent the costs associated with transportation and time spent away from work by scheduling virtual consultations. Moreover, telemedicine allows patients to connect with dermatologists who may be in a different city or even a different country, expanding the pool of available specialists.
Introduction:
Risankizumab is an interleukin 23p19 inhibitor, approved by the USA Food and Drug Administration (FDA) for the management of moderate to severe plaque psoriasis. Apart from its utility in psoriasis, there are a number of other dermatologic conditions where risankizumab has demonstrated value. The aim of this narrative review is to describe the utility of risankizumab in psoriasis, as well as its implication in off-label dermatologic disorders.
Evidence acquisition:
PubMed, Google Scholar, Scopus and ResearchGate were searched for scholarly articles related to risankizumab and its utility in dermatology using the search terms "Risankizumab" AND "Psoriasis" AND "other dermatological disorders."
Evidence synthesis:
Risankizumab is a valuable biologic agent for the management of psoriasis and psoriatic arthropathy. It has also been used successfully for other dermatologic disorders like hidradenitis suppurativa, pityriasis rubra pilaris and pyoderma gangrenosum.
Conclusions:
Risankizumab's usage is not limited to psoriasis. Its benefit extends to many more dermatologic conditions. Besides, it has an acceptable safety profile.
Psoriasis is a chronic inflammatory immune-dependent genodermatosis, mainly affecting the skin, with a prevalence in the population from 1 to 5%. The pathogenesis of psoriasis is based on Th1-dependent autoimmune inflammation, which leads to a change in the aggregation properties of platelets, increased excretion of thromboxane-A2, which worsens microcirculation processes and causes the development of endothelial dysfunction. Psoriasis is associated with a number of concomitant nosologies, such as psoriatic arthritis, depression, inflammatory bowel disease and cardiometabolic syndrome. Platelets play an important role in the development of cardiovascular diseases, as mediators of hemostasis. However, the number of publications on their pathophysiological contribution to the development of cardiovascular risks in patients with psoriasis is insignificant. Understanding the role of platelet activation in psoriasis and the correct choice of laboratory methods for their assessment will allow the timely prevention of vascular platelet disorders and prognosis.
Men often presented with higher severity of psoriasis than women, but the underlying reasons are still unclear. In this study, we evaluate proteomic differences in psoriatic lesions between men and women with moderate-to-severe psoriasis and explore possible protective and risk proteins using data-independent acquisition mass spectrometry (DIA-MS) and verified by 4D-parallel reaction monitoring (4D-PRM). 416 differentially expressed proteins (DEPs) were identified between two groups. Among them, 94 proteins were upregulated, while 322 were down-regulated. Some DEPs were enriched to pathways associated with psoriasis, such as the IL − 17 signalling pathway, T cell receptor signalling pathway, Th17 cell differentiation, Oxidative phosphorylation, PI3K − Akt signalling pathway, and MAPK signalling pathway; meanwhile, numerous pathways associated with infection. Nine DEPs (KRT36, KRT13, KRT15, SHC1, GNAI1, SRC, HSPA6, HSPA1L, and HSP90AB4P) were involved in the estrogen pathway, which was predicted to be activated in males. Through Ingenuity pathway Analysis (IPA), our data also identified three upstream regulators (TNF, KRAS, TGFB1). 4D-PRM suggested that HMGB2 and PML were upregulated, while LAMTOR3 was downregulated in male group compared to female one. Our study suggests that sex may influence protein changes in psoriasis, pathogenesis and disease severity. Targeting these molecules may improve the severity and therapeutic efficacy of psoriasis.
Objective
Psoricatic disease remains underdiagnosed and undertreated. We developed and validated a suite of novel, smartphone sensor-based assessments that can be self-administered to measure cutaneous and musculoskeletal signs and symptoms of psoriatic disease.
Methods
Participants with psoriasis, psoriatic arthritis, or healthy controls were recruited between June 5, 2019, and November 10, 2021, at two academic medical centers. Concordance and accuracy of digital measures and image-based machine learning models were compared to their analogous clinical measures from trained rheumatologists and dermatologists.
Results
Of 104 study participants, 51 (49%) were female and 53 (51%) were male, with a mean age of 42.3 years (SD: 12.6). Seventy-nine (76%) participants had psoriatic arthritis, 16 (15.4%) had psoriasis and 9 (8.7%) were healthy controls. Digital patient assessment of percent body surface area (BSA) affected with psoriasis demonstrated very strong concordance (CCC = 0.94, [95%CI = 0.91–0.96]) with physician-assessed BSA. The in-clinic and remote target-lesion Physician Global Assessments showed fair to moderate concordance (CCC erythema =0.72 [0.59–0.85]; CCC induration =0.72 [0.62–0.82]; CCC scaling =0.60 [0.48–0.72]). Machine learning models of hand photos taken by patients accurately identified clinically-diagnosed nail psoriasis with an accuracy of 0.76. The Digital Jar Open assessment categorized physician-assessed upper extremity involvement, considering joint tenderness or enthesitis (AUROC = 0.68 (0.47–0.85)).
Conclusion
The Psorcast digital assessments achieved significant clinical validity, although they require further validation in larger cohorts before use in evidence-based medicine or clinical trial settings. The smartphone software and analysis pipelines from the Psorcast suite are open source and freely available.
background - comparative assessment of the effect of different options for spa treatment: balneotherapy and balneotherapy in combination with intravenous laser blood irradiation in patients with psoriasis vulgaris on the level of IL-6 and IL-17, dermatological and psycho-emotional status, assessment of quality of life. Materials and methods. The naturalistic comparative study involved 108 patients with ordinary psoriasis, stationary stage (men – 57.4%, women – 42.6%; the average age was 36.2 [24.5;47.9] years) who underwent spa treatment, which were subsequently divided into 2 groups: 52 patients who received balneotherapy along with the traditional complex of SCL were included in the 1st group, 56 patients who received complex treatment were included in the 2nd group. balneotherapy in combination with VLOK along with traditional ... The effectiveness of SCL was evaluated using the PASI index, the HARS and HDRS scale, the SF-36 questionnaire. The dynamics of IL-6 and IL-10 levels in blood plasma were evaluated. The total duration of the study was 6 months and 48 weeks: the treatment phase was 14 days and the follow–up phase was 3 and 6 months after the completion of SCL. Results. After 14 days of SCL in the group in which balneotherapy was performed in combination with VLOK, a statistically significant decrease in the PASI index was more pronounced compared to the group in which balneotherapy was performed (p). Balneotherapy did not have a pronounced effect on psychoemotional status. On the contrary, balneotherapy in combination with VLOK contributed to a statistically significant decrease in the final indicators on the HARS and HDRS scales. The decrease in IL-6 and IL-17 levels was statistically significant in both groups and there were no differences between them. The complex use of balneotherapy and VLOK in comparison with the group of balneotherapy was accompanied by a more pronounced improvement in QOL. The combined use of balneotherapy and VLOK in the follow-up phase showed a long-term positive effect: 6 months after the completion of SCL, the number of patients who had clinical remission was statistically significantly higher compared to the group in which balneotherapy was performed (87.4% vs. 44.7%). Conclusions:The advantage of the combined use of balneotherapy and ILBI compared with balneotherapy in patients with psoriasis vulgaris on CL was shown. The complex use of balneotherapy and ILBI of significant indicators of inflammatory biomarkers, improvement of the dermatological and psycho-emotional state, quality of life parameters and good overpopulation. More pronounced effectiveness of the complex use of balneotherapy and ILBI compared to balneotherapy of the quality, diversity of pathophysiological mechanisms of psoriasis and the presence of several targets for pathogenetic therapy.
New potential applications for botulinum neurotoxin (BoNT) therapy are constantly emerging through the expanding literature in the field of clinical toxicology. In this chapter, we discuss potential indications for botulinum neurotoxin treatment in five major fields of medicine: Psychiatry (depression), cardiology (irregular heartbeats, atrial fibrillation), cancer related disorders (cancer related pain, prevention of post-surgical and post radiation pain, prevention of esophageal narrowing after surgery for esophagal cancer, prevention of parotid gland fistula and cyst formation after parotid cancer surgery and alleviating excessive face sweating and severe jaw pain after first bite following parotid gland surgery). In dermatology, there is evidence that local botulinum toxin injections can help psoriasis and recalcitrant itch as well as palm pain and vascular palm problems associated with Raynaud syndrome. In pain medicine, botulinum toxin injections can help to reduce teeth grinding and associated pain, jaw pain from temporomandibular disorder, pain and discomfort of anal fissure.
Itolizumab is a humanized monoclonal antibody that selectively targets the CD6-ALCAM pathway. This article reports on the safety and efficacy of itolizumab in the treatment of moderate-to-severe plaque psoriasis in a clinical study conducted in Cuba in the setting of an expanded-access program (EAP). The study included 84 patients who had previously received conventional anti-psoriatic systemic therapies but were either intolerant, had an inadequate response, or had contraindications to these therapies. It consisted of multiple phases, including a 12-week induction phase, a 40-week maintenance phase, and a 24-week off-treatment follow-up phase, using either a 0.4 or 1.6 mg/Kg dose. The results showed that itolizumab monotherapy was safe and effective during 52 weeks of continuous treatment and the subsequent 24 follow-up weeks. Itolizumab treatment resulted in a significant improvement (PASI 75) in 80 % of patients at the end of the induction phase, and this effect was sustained till week 52 during the maintenance phase. Moreover, 24 weeks after treatment stopped nearly two-thirds of patients still showed a PASI ≥75. The observed effects were dose-dependent, with 1.6 mg/kg being the most convenient dose. This study further supports the strategy of targeting the CD6-ALCAM signaling pathway for the treatment of psoriasis and the use of itolizumab as a valuable asset in the armamentarium of anti-psoriasis drugs.
Curcumin is a naturally occurring polyphenolic compound extracted from the rhizomes of Curcuma longa, commonly known as turmeric. It has been used for centuries in traditional medicine and is gaining increasing attention in modern medicine owing to its potential therapeutic benefits. Psoriasis is a chronic inflammatory disease characterized by red scaly patches on the skin. Curcumin has been found to be effective in treating psoriasis by inhibiting the activity of various enzymes and proteins involved in the inflammation and proliferation of psoriatic skin cells. Nanogel preparation of curcumin has been found to be a promising approach for the delivery of compounds to treat psoriasis. Nanogels are composed of biocompatible and biodegradable crosslinked hydrogels. The nanogel formulation of curcumin increases its solubility, stability, and bioavailability, indicating that a lower dose is needed to achieve the same therapeutic effect. This review article suggests that the nanogel preparation of curcumin can be a better alternative for psoriasis treatment as it increases the bioavailability and stability of curcumin and also reduces the required dosage. This study suggests that curcumin nanogel preparations are promising alternatives to traditional psoriasis treatments and could potentially be used as a more effective and safe treatment option. This article highlights the need for further research to fully understand the potential of curcumin nanogel preparations for psoriasis treatment in humans.
Psoriasis is a chronic, immune-mediated inflammatory skin disease associated with a polygenic mode of inheritance. There are few studies that explore the association of a psoriasis Polygenic Risk Score (PRS) with patient clinical characteristics, and to our knowledge there are no studies examining psoriasis PRS associations across different races. In this study, we used a multi-racial psoriasis cohort to investigate PRS associations with clinical phenotypes including age of onset, psoriatic arthritis, other comorbidities, psoriasis body location, psoriasis subtype, environmental triggers, and response to therapies. We collected patient data and Affymetrix genome-wide SNP data from a cohort of 607 psoriasis patients and calculated an 88-loci PRS (PRS-ALL), also partitioned between genetic loci within the HLA region (PRS-HLA; 11 SNPS) and loci outside the HLA region (PRS-NoHLA; 77 SNPS). We used t-test and logistic regression to analyze the association of PRS with clinical phenotypes. We found that PRS-HLA and PRS-noHLA had differing effects on psoriasis age of onset, psoriatic arthritis, psoriasis located on the ears, genitals, nails, soles of feet, skin folds, and palms, skin injury as an environmental trigger, cardiovascular comorbidities, and response to phototherapy. In some cases these PRS associations were race specific. Overall, these results show that the genetic basis for clinical manifestations of psoriasis are driven by distinct HLA and non-HLA effects, and that these PRS associations can be dependent on race.
Search of new rational ways to increase the effectiveness of treatment and rehabilitation measures for patients with psoriasis vulgaris continues to be one of the urgent problems in modern clinical dermatology. Objective. To carry out a comparative analysis of the impact of different variants of sanatorium-resort treatment (SRT) — pelotherapy and pelotherapy in combination with intravenous laser blood irradiation (ILBI) — on the level of IL-17 and TNF-a, dermatological status, psychoemotional state and quality of life (QL) assessment of patients with psoriasis vulgaris. Material and methods. A naturalistic comparative study included 120 patients with psoriasis vulgaris, who were undergoing SRT: 57 patients in the pelotherapy group and 63 in the group of pelotherapy in combination with ILBI. The SRT effectiveness was assessed using the PASI index, the HARS and HDRS scales and the DLQI questionnaire. The dynamics of IL-17 and TNF-a plasma levels in blood plasma was studied. The study duration was 6 months 14 days. Results. After 14 days of SRT, a decrease in IL-17 and TNF-a levels in blood plasma was statistically significant both in the pelotherapy group and in the group of pelotherapy in combination with ILBI, no statistically significant differences between the groups were found. Furthermore, the comprehensive use of pelotherapy in combination with ILBI has contributed to a more pronounced statistically significant decrease in the PASI index, the HARS and HDRS scales’ total scores and an increase in the level of QL. The number of patients with clinical remission was statistically higher in the group of pelotherapy combined with ILBI compared to the pelotherapy group (87.3% versus 42.1%) six months after SRT. Conclusion. The advantage of comprehensive application of pelotherapy and ILBI in comparison with pelotherapy in patients with psoriasis vulgaris in SRT has been shown. The comprehensive application of pelotherapy and ILBI reduces the level of inflammatory biomarkers, improves dermatological and psychoemotional status, improves QL and is well tolerated by patients.
Objective
Many studies have emphasized the possible role of probiotics in psoriasis, probiotic supplementation might be helpful to treat psoriasis. This study systematically evaluated the efficacy of probiotic supplementation for the treatment of psoriasis.
Methods
We searched some databases with keywords until November 10, 2023, including PubMed, Cochrane Library, Embase, and Web of Science. These keywords included probiotics, psoriasis RCT, and so on. After rigorous literature screening by two authors, five studies were identified. Eventually, the required data were independently extracted by another author.
Results
A total of five studies with 286 patients were included. The pooled results showed that the efficacy of probiotic supplementation was superior to placebo in the treatment of psoriasis. The Psoriasis Area and Severity Index (SMD = −1.40, 95% Cl = −2.63 to −0.17, p < 0.00001) and Dermatology Life Quality Index (SMD = −0.92, 95% Cl = −1.86 to 0.01, p < 0.00001). Score decreased after probiotic supplementation.
Conclusions
The meta‐analysis showed that probiotic supplementation could be a new treatment option for psoriasis.
Kelly C Pearson1, April W Armstrong21Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, 2Department of Dermatology, University of California, Davis, Sacramento, CA, USAAbstract: Psoriasis is a systemic inflammatory disorder, which has been reported to be associated with adverse cardiovascular (CV) risks. CV comorbidities, such as diabetes, dyslipidemia, hypertension, and obesity appear to be increased in psoriasis patients compared with the general population. Psoriasis may contribute independently to adverse cardiac outcomes after accounting for traditional CV risk factors. In this article, it was aimed to summarize large population studies that examine the relationship between psoriasis and CV risk factors and major adverse cardiac outcomes, and highlight proposed mechanisms for the observed epidemiologic link. Specifically, large population-based studies with over 1000 total subjects from 1975 to September 2008 in the English literature are highlighted. The relevant search terms in the Ovid Medline database were applied. The majority of the studies presented evidence for an increased incidence of CV risk factors and an increased risk for major adverse cardiac outcomes in patients with severe psoriasis. The increased risk in severe psoriasis necessitates regular screening for other comorbidities. Current guidelines for screening CV risk factors among psoriasis patients are discussed. Also reviewed is the scarce literature in therapeutic strategies to reduce CV risk factors and major adverse cardiac outcomes in psoriasis patients. Specifically, an emerging area of research on the effects of biologic agents on CV risk factors and CV adverse outcomes in psoriasis is discussed.Keywords: cardiovascular disease, cardiovascular risk factors, psoriasis, diabetes mellitus, myocardial infarction, major adverse cardiovascular events, MACE, hypertension
At the 2012 annual meeting of the Group for Research and Assessment of Psoriasis and PsA (GRAPPA) in Stockholm, Sweden, members addressed the infectious, oncologic, and autoimmune comorbidities of psoriasis and psoriatic arthritis (PsA). Members discussing infectious comorbidities asked whether patients with psoriasis or PsA are predisposed to particular types of infections, and whether the use of biologic agents is advisable in patients with certain preexisting infections. Regarding the oncologic comorbidities of psoriasis and PsA, members addressed cutaneous malignancy screening, lymphoproliferative malignancy risk and the need for screening, and treatment of patients with preexisting oncologic history requiring systemic therapy. Finally, GRAPPA members discussed autoimmune comorbidities associated with psoriasis and PsA; they agreed that research is nascent in this field and larger studies are necessary to determine the precise magnitude of these associations.
Although prevalence and incidence of type 2 diabetes mellitus (T2DM) are reportedly increasing among adolescents, national data are lacking, particularly in regard to undiagnosed T2DM. To estimate the prevalence of diagnosed and undiagnosed T2DM among US adolescents, we analyzed a nationally representative cross-section of 11,888 adolescents aged 12-19 years who received a diabetes interview in the Continuous National Health and Nutrition Examination Survey during 1999-2010. Among them, a random subsample of 4,661 adolescents also had fasting blood samples collected. Persons who reported a previous diabetes diagnosis and were either taking no medication or taking an oral hypoglycemic agent (with or without insulin) were classified as having T2DM; persons who reported using insulin alone were classified as having type 1 diabetes. Undiagnosed diabetes was defined as a fasting plasma glucose concentration of ≥126 mg/dL and was assumed to be type 2. In the fasting subsample, 31 diabetes cases (types 1 and 2) were identified, representing a prevalence of 0.84% (weighted 95% confidence interval (CI): 0.51, 1.40) (276,638 cases; 95% CI: 134,255, 419,020). Estimates of the prevalences of type 1 and type 2 diabetes were 0.48% (95% CI: 0.23, 1.02) and 0.36% (95% CI: 0.20, 0.67), respectively, indicating that T2DM accounted for 43% of all cases. Further, undiagnosed T2DM prevalence was 0.12% (95% CI: 0.05, 0.31), representing 34% of T2DM cases (40,611 cases; 95% CI: 2,850, 78,373). T2DM accounts for approximately half of adolescent diabetes in the United States, and one-Third of these cases are undiagnosed. © 2013 © The Author 2013. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: [email protected]
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To ascertain impairment in quality of life and work productivity among patients with psoriasis and psoriatic arthritis.
From 2003 through 2011, the National Psoriasis Foundation collected survey data from patients with psoriasis and psoriatic arthritis via email and telephone correspondences.
Survey data were collected from psoriasis and psoriatic arthritis patients in the general community in the U.S.
Quality of life focusing on emotional impact (anger, frustration, helplessness, etc.) and physical impact (pain, pruritus, physical irritation, etc.); employment status.
The surveys were performed through random sampling of participants from a database of over 75,000 patients.
From 2003 to 2011, 5,604 patients completed the surveys. Psoriasis and psoriatic arthritis affected overall emotional wellbeing in 88% of patients, and they interfered with enjoyment of life in 82%. Most patients reported experiencing anger (89%), frustration (89%), helplessness (87%), embarrassment (87%), and self-consciousness (89%). Many patients also actively concealed physical manifestations of their diseases (83%), and experienced pain (83%) and pruritus (93%) regularly. Of note, 12% of patients were unemployed, and 11% worked part-time. Among unemployed patients, 92% cited psoriasis and/or psoriatic arthritis as the sole reasons for not working. Among working patients, 49% missed work days regularly due to psoriasis. Compared to patients with mild psoriasis, patients with severe psoriasis have 1.8 times greater odds to be unemployed after adjusting for age and gender (Adjusted OR = 1.7, 95% CI 1.4-2.3).
Patients with psoriasis and psoriatic arthritis continue to experience significant impairment of quality of life and work productivity.
Objectives:
The objectives of this study were to determine the prevalence of PsA in The Health Improvement Network (THIN), a large population-based medical records database in the UK, to examine factors associated with prevalent PsA among patients with psoriasis and to describe the use of DMARDs in patients with PsA.
Methods:
Two cohorts were derived from THIN to examine the prevalence of PsA in a cross-sectional study among all patients aged 18-90 years and among a subcohort of 4900 psoriasis patients aged 45-65 years. Prescription codes were used to describe therapies after the diagnosis of PsA. Associations for prevalent PsA among psoriasis patients were assessed using logistic regression analysis.
Results:
Among 4.8 million patients in THIN between the ages of 18 and 90 years, 9045 patients had at least one medical code for PsA, giving an overall prevalence of 0.19% (95% CI 0.19%, 0.19%). Of those patients, 45.9% with PsA have been prescribed DMARDs. Among the 4064 confirmed psoriasis patients, the prevalence of PsA was 8.6% (95% CI 7.7%, 9.5%). PsA was more prevalent among patients with severe psoriasis [odds ratio (OR) 3.34; 95% CI 2.40, 4.65], obesity (OR 1.77; 95% CI 1.30, 2.41) and duration of psoriasis for ≥10 years (OR 7.42; 95% CI 3.86, 14.25) in the fully adjusted model.
Conclusion:
The prevalence of PsA in THIN is consistent with previous population-based estimates. Limitations include a definition of PsA based on a diagnostic code rather than Classification Criteria for Psoriatic Arthritis (CASPAR) criteria. Given the large population of PsA patients, THIN is an important resource for the study of PsA.
The aim of this study was to determine the prevalence, treatment modalities and comorbidity of psoriasis in Taiwan. A nationally representative cohort of 1,000,000 individuals from the National Health Insurance database was followed up for the years 2000 to 2006. Their claims data was used for an epidemiological study. The mean one-year prevalence of psoriasis was 0.23% for men and 0.16% for women, respectively. The prevalence of psoriasis increased more rapidly in male patients aged 30 years and over and reached its peak in patients aged 70 years and over, regardless of sex. Overall, 98.4% of patients received treatment with topical corticosteroids, while 13.1% used Chinese herbal medicines and 13.6% received systemic treatment. Patients with psoriasis had a higher comorbidity of diabetes, hyperlipidaemia, and hypertension. In conclusion, in contrast to Caucasians, the prevalence of psoriasis in Taiwanese people is high er in men than in women and the prevalence increases significantly in patients over 70 years of age.
Psoriasis is a chronic Th-1 and Th-17 inflammatory disease. Chronic inflammation has also been associated with atherosclerosis and thrombosis. The purpose of this study was to determine the risk of stroke in patients with psoriasis. We conducted a population-based cohort study of patients seen by general practitioners participating in the General Practice Research Database in the United Kingdom, 1987–2002. Mild psoriasis was defined as any patient with a diagnostic code of psoriasis, but no history of systemic therapy. Severe psoriasis was defined as any patient with a diagnostic code of psoriasis and a history of systemic therapy consistent with severe psoriasis. The unexposed (control) population was composed of patients with no history of a psoriasis diagnostic code. When adjusting for major risk factors for stroke, both mild (hazard ratio (HR) 1.06, 95% confidence interval (CI) 1.0–1.1) and severe (1.43, 95% CI 1.1–1.9) psoriasis were independent risk factors for stroke. The excess risk of stroke attributable to psoriasis in patients with mild and severe disease was 1 in 4,115 per year and 1 in 530 per year, respectively. Patients with psoriasis, particularly if severe, have an increased risk of stroke that is not explained by major stroke risk factors identified in routine medical care.
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In a survey for coronary risk factors 14 667 adult men and women answered a questionnaire on lifestyle, diet, and health, including whether they had psoriasis. The overall prevalence of psoriasis was 4.79% in men and 4.85% in women. The data showed an increasing incidence of psoriasis. The association with family history, lifestyle, diet, and health was explored by multiple regression analysis. The occurrence of psoriasis in first degree relatives contributed to more than 90% of the explained variance for both sexes. Of the other variables, only the positive association with rheumatoid arthritis was significant in both sexes. It is concluded that the examined environmental factors have only minor effects on the prevalence of psoriasis.
During 1999, a survey of dermatological outpatients was undertaken in the five academic hospitals serving the public sector in the Johannesburg area. The relative frequency of dermatological diseases was calculated as the percentage of new dermatological outpatients. A total of 7029 patients was surveyed of whom 5355 (76.1%) were black, 770 (10.9%) white, 474 (6.7%) Indian and 430 (6.1%) coloured (mixed race). Eczema was the commonest disease accounting for one-third of all diagnoses in the total population surveyed. In black patients the commonest skin diseases were eczema (32.7%), acne (17.5%) and superficial fungal infections (5.7%). In white patients the commonest skin diseases were benign skin tumours (29.7%), eczema (17.8%) and malignant tumours (15%). In Indian patients the commonest skin diseases were eczema (30.4%), superficial fungal infections (11.8%) and psoriasis (9.6%) and in coloured patients the commonest skin diseases were eczema (34.5%), acne (13.9%) and warts (8.1%). The prevalence of seborrhoeic dermatitis, Kaposi's sarcoma and herpes zoster has increased markedly since the last South African survey in 1982. This increase may be ascribed to the epidemic of HIV infection, first diagnosed in South Africa in 1982.
Importance:
Despite the growing literature on comorbidity risks in psoriasis, there remains a critical knowledge gap on the degree to which objectively measured psoriasis severity may affect the prevalence of major medical comorbidity.
Objective:
To examine the prevalence of major medical comorbidity in patients with mild, moderate, or severe psoriasis, classified objectively based on body surface area involvement, compared with that in patients without psoriasis.
Design, setting, and participants:
Population-based cross-sectional study of patient data from United Kingdom-based electronic medical records; analysis included 9035 patients aged 25 to 64 years with psoriasis and 90,350 age- and practice-matched patients without psoriasis.
Main outcomes and measures:
Prevalence of major medical comorbidity included in the Charlson comorbidity index.
Results:
Among patients with psoriasis, 51.8%, 35.8%, and 12.4%, respectively, had mild, moderate, or severe disease based on body surface area criteria. The mean Charlson comorbidity index was increasingly higher in patients with mild (0.375 vs 0.347), moderate (0.398 vs 0.342), or severe psoriasis (0.450 vs 0.348) (each P < .05). Psoriasis overall was associated with higher prevalence of chronic pulmonary disease (adjusted odds ratio, 1.08; 95% CI, 1.02-1.15), diabetes mellitus (1.22; 1.11-1.35), diabetes with systemic complications (1.34; 1.11-1.62), mild liver disease (1.41; 1.12-1.76), myocardial infarction (1.34; 1.07-1.69), peptic ulcer disease (1.27; 1.03-1.58), peripheral vascular disease (1.38; 1.07-1.77), renal disease (1.28; 1.11-1.48), and rheumatologic disease (2.04; 1.71-2.42). Trend analysis revealed significant associations between psoriasis severity and each of the above comorbid diseases (each P < .05).
Conclusions and relevance:
The burdens of overall medical comorbidity and of specific comorbid diseases increase with increasing disease severity among patients with psoriasis. Physicians should be aware of these associations in providing comprehensive care to patients with psoriasis, especially those presenting with more severe disease.
At the 2012 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) in Stockholm, Sweden, several GRAPPA members led a panel discussion on cardiovascular (CV) comorbidities of psoriasis and psoriatic arthritis (PsA). The panelists discussed the role of insulin resistance in the pathophysiology of psoriasis, the possible effect of tumor necrosis factor inhibitors on CV comorbidities, and the effect of 12/23 monoclonal antibodies on CV outcomes. The panelists also addressed how lessons from CV comorbidity research could be applied to other areas of comorbidity research in psoriasis and PsA and identified future research directions in this area.
To characterize the prevalence of metabolic syndrome (MetS), its five components and their pharmacological treatment in US adults by gender and race over time.
MetS is a constellation of clinical risk factors for cardiovascular disease, stroke, kidney disease and type 2 diabetes mellitus.
Prevalence estimates were estimated in adults (≥20 years) from the National Health and Nutrition Examination Survey (NHANES) from 1999-2010 (in 2-year survey waves). The biological thresholds, defined by the 2009 Joint Scientific Statement, were: (1) waist circumference ≥ 102 cm (males), and≥ 88 cm (females) (2) fasting plasma glucose ≥100 mg/dl (3) blood pressure of ≥130/85 mm Hg (4) triglycerides ≥150 mg/dl (5) high-density lipoprotein-cholesterol (HDL-C) <40 mg/dl (males) and <50 mg/dl (females). Prescription drug use was estimated for lipid-modifying agents, anti-hypertensives, and anti-hyperglycemic medications.
From 1999/2000 to 2009/10, the age-adjusted prevalence of MetS (based on biologic thresholds) decreased from 25.5% (95%CI: 22.5-28.6) to 22.9% (20.3-25.5). During this period, hypertriglyceridemia prevalence decreased (33.5% to 24.3%), as did elevated blood pressure (32.3% to 24.0%). The prevalence of hyperglycemia increased (12.9% to 19.9%), as did elevated waist circumference (45.4% to 56.1%). These trends varied considerably by gender and race/ethnicity groups. Decreases in elevated blood pressure, suboptimal triglycerides and HDL-C prevalence have corresponded with increases in anti-hypertensive and lipid-modifying drugs, respectively.
The increasing prevalence of abdominal obesity, particularly among females, highlights the urgency of addressing abdominal obesity as a healthcare priority. The use of therapies for MetS components aligns with favorable trends in their prevalence.
Objective To characterize the prevalence of metabolic syndrome (MetS), its five components and their pharmacological treatment in US adults by gender and race over time.
Background MetS is a constellation of clinical risk factors for cardiovascular disease, stroke, kidney disease and type 2 diabetes mellitus.
Methods Prevalence estimates were estimated in adults (≥20 years) from the National Health and Nutrition Examination Survey (NHANES) from 1999-2010 (in 2-year survey waves). The biological thresholds, defined by the 2009 Joint Scientific Statement, were: (1) waist circumference ≥ 102 cm (males), and≥ 88 cm (females) (2) fasting plasma glucose ≥100 mg/dl (3) blood pressure of ≥130/85 mm Hg (4) triglycerides ≥150 mg/dl (5) high-density lipoprotein-cholesterol (HDL-C) <40 mg/dl (males) and <50 mg/dl (females). Prescription drug use was estimated for lipid-modifying agents, anti-hypertensives, and anti-hyperglycemic medications.
Results From 1999/2000 to 2009/10, the age-adjusted prevalence of MetS (based on biologic thresholds) decreased from 25.5% (95%CI: 22.5-28.6) to 22.9% (20.3-25.5). During this period, hypertriglyceridemia prevalence decreased (33.5% to 24.3%), as did elevated blood pressure (32.3% to 24.0%). The prevalence of hyperglycemia increased (12.9% to 19.9%), as did elevated waist circumference (45.4% to 56.1%). These trends varied considerably by gender and race/ethnicity groups. Decreases in elevated blood pressure, suboptimal triglycerides and HDL-C prevalence have corresponded with increases in anti-hypertensive and lipid-modifying drugs, respectively.
Conclusion The increasing prevalence of abdominal obesity, particularly among females, highlights the urgency of addressing abdominal obesity as a healthcare priority. The use of therapies for MetS components aligns with favorable trends in their prevalence.
Introduction
Epidemiologic data on sexual behavior in psoriasis patients are lacking.
Aim
We aim to examine and compare the sexual behaviors between men with and without psoriasis in the United States.
Methods
We analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2006 and 2009 to 2010. Responses from male participants to the dermatology and sexual behavior questionnaires of the NHANES were collated and analyzed.
Main Outcome Measures
Outcome measures included sexual orientation, age of first sexual encounter, number of oral and non‐oral sexual partners, and frequency of unprotected sex.
Results
Among 6,444 U.S. men that responded to the psoriasis question, 170 (2.6%) reported a physician‐given diagnosis of psoriasis. Heterosexual men accounted for 95.5% and nonheterosexual men 4.5% of the overall study population. On multivariate analysis, psoriasis was not associated with differences in sexual orientation (odds ratio 1.78, 95% confidence interval [CI] 0.75–4.15). Heterosexual men with psoriasis experienced first sexual encounter at an earlier age than those without psoriasis (weighted difference −0.9 years, P = 0.002). Heterosexual men with psoriasis had significantly fewer female oral sexual partners compared with heterosexual men without psoriasis on multivariate analysis (lifetime partner number: rate ratio [RR] 0.65, 95% CI 0.45–0.95; past‐year partner number: RR 0.64, 95% CI 0.42–0.97). No significant differences existed between heterosexual men with and without psoriasis regarding frequency of unprotected sex (RR 0.96, 95% CI 0.85–1.09). Among nonheterosexual men with and without psoriasis, no significant differences existed in age first had sex, number of sexual partners, or frequency of unprotected sex.
Conclusion
Heterosexual men with psoriasis have significantly fewer lifetime female oral sexual partners compared with those without psoriasis. Dermatologists and other healthcare providers need to examine the genital region routinely and initiate appropriate therapy to improve patients' sexual health. Armstrong AW, Harskamp CT, and Schupp CW. Psoriasis and sexual behavior in men: Examination of the National Health and Nutrition Examination Survey (NHANES) in the United States. J Sex Med 2014;11:394–400.
Psoriasis is a common chronic dermatological disease whose prevalence varies among different populations worldwide. In epidemiological studies, the factors that potentially account for this variability include climate, genetic susceptibility, and environmental antigen exposure. In this issue, Parisi et al. performed a systematic review to explore the global prevalence and incidence of psoriasis.
Introduction:
Although sexual behavior is an integral part of most adults' overall well-being, this aspect of psoriasis patients' quality of life is rarely explored.
Aim:
The aim of this study is to assess the relationship between psoriasis and sexual behavior in U.S. women.
Methods:
We analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2006. Our study focuses on responses to the dermatology and sexual behavior questionnaires of the NHANES.
Main outcome measures:
This study examines the association between psoriasis and sexual behavior in U.S. women with regard to sexual orientation, age of first sexual encounter, number of sexual partners, and frequency of unprotected sex.
Results:
A total of 3,462 women provided responses to their psoriasis status: 2,753 (80%) women were heterosexual and 709 (20%) were nonheterosexual. Among them, 2.7% reported a physician-given diagnosis of psoriasis. On multivariate analyses, psoriasis was not associated with differences in sexual orientation (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.62-2.01). Among nonheterosexual women, multivariate analysis revealed a lower number of lifetime female sexual partners in women with psoriasis (rate ratio [RR] 0.11, 95% CI 0.04-0.33, P = 0.001). Among heterosexual women, no significant differences existed between those with and without psoriasis in age of first sexual encounter (weighted difference -0.54 years, 95% CI -1.27 to 0.19), number of lifetime male sexual partners (RR 1.19, 95% CI 0.69-2.06), or number of lifetime male oral sex partners (RR 0.72, 95% CI 0.40-1.29). Heterosexual women with psoriasis had 1.13 times more unprotected sex (RR 1.13, 95% CI 1.02-1.24, P = 0.03) compared with those without psoriasis.
Conclusion:
Psoriasis is associated with a significantly reduced number of sexual partners in nonheterosexual women. Psoriasis may differentially impact sexual behavior based on sexual orientation in women.
The worldwide incidence and prevalence of psoriasis is poorly understood. To better understand this, we performed a systematic review of published population-based studies on the incidence and prevalence of psoriasis. Three electronic databases were searched from their inception dates to July 2011. A total of 385 papers were critically appraised; 53 studies reported on the prevalence and incidence of psoriasis in the general population. The prevalence in children ranged from 0% (Taiwan) to 2.1% (Italy), and in adults it varied from 0.91% (United States) to 8.5% (Norway). In children, the incidence estimate reported (United States) was 40.8/100,000 person-years. In adults, it varied from 78.9/100,000 person-years (United States) to 230/100,000 person-years (Italy). The data indicated that the occurrence of psoriasis varied according to age and geographic region, being more frequent in countries more distant from the equator. Prevalence estimates also varied in relation to demographic characteristics in that studies confined to adults reported higher estimates of psoriasis compared with those involving all age groups. Studies on the prevalence and incidence of psoriasis have contributed to a better understanding of the burden of the disease. However, further research is required to fill existing gaps in understanding the epidemiology of psoriasis and trends in incidence over time.Journal of Investigative Dermatology advance online publication, 27 September 2012; doi:10.1038/jid.2012.339.
Background:
Although psoriasis occurs worldwide, the prevalence varies considerably between different peoples and regions. In China, a questionnaire-based study was carried out in 1987 and the prevalence of psoriasis was found to be 0.12%. Since then, no large-scale, population-based study has been reported.
Objectives:
To obtain the accurate figures for the prevalence of psoriasis in China.
Methods:
A population-based survey was conducted in 6 cities. The cluster sampling method was used to select communities in each city. The subjects were required to fill out self-reporting questionnaires during a face-to-face interview and also received physical examination by dermatologists.
Results:
19,974 subjects were visited and 17,345 completed the questionnaires and received dermatological examination. 102 subjects (0.59%) were found to have psoriasis. After standardization, the prevalence of psoriasis was 0.47%. The prevalence of psoriasis in males and females was 0.54% and 0.44% respectively. 97.06% of the patients had psoriasis vulgaris. 28.43% of the patients reported a family history of psoriasis. 59.80% of patients experienced a negative influence on the quality of life.
Conclusions:
This population-based and dermatologist-confirmed study showed that the prevalence of psoriasis in China is 0.47%, which is higher than that reported in 1987.
Knowledge of the societal costs of psoriasis is limited. This study estimated the cost of care, psoriasis area and severity index (PASI), and quality of life in a defined patient population in Sweden.
A prevalence-based prospective recruitment of patients visiting two Swedish dermatology clinics between September and December 2009 was performed, collecting resource utilization for health care contacts, treatment, travelling, and productivity loss during 1 month.
164 patients were included. Mean total cost per patient-month was 994€. Main cost drivers were outpatient visits and light therapy (49%), biological drugs (20%) and productivity loss (22%). Total cost for topical treatment only (TT; 34%) was 369€, light therapy (LT; 24%) 1,274€, traditional systemic treatment (TST; 26%) 1,085€ and biological systemic treatment (BST; 16%) 1,709€ per patient-month. Main cost drivers were: outpatient visits (56%) in TT as well as for LT (78%), productivity loss (40%) in TST, and biological drugs (71%) among BST patients. There was no clear relationship between clinical (PASI) or subjective (DLQI) severity estimations and costs.
The one-month cost-of-illness amounted to almost 1,000€/month, with great variations. Despite 1,190€ difference in drug cost for TST vs BST, total cost per month differed by 623€ because of offsets from improved productivity. A trend towards lower severity and reductions in outpatient and topical treatment costs was seen.
Patients with psoriasis may have an increased risk of cardiovascular disease and myocardial infarction. The aim of this study was to investigate whether psoriasis is associated with an increased prevalence of coronary artery disease (CAD) independent of established cardiovascular risk factors in patients undergoing coronary angiography. A retrospective cohort analysis was performed by linking records of all patients undergoing coronary angiography from 2004 through 2009 with dermatology medical records. From an overall cohort of 9,473 patients, we identified 204 patients (2.2%) with psoriasis before coronary angiography. Patients with psoriasis had higher body mass index (31.3 ± 8.1 vs 29.3 ± 7.1 kg/m(2), p <0.001) but the prevalence of other risk factors was similar. Median duration of psoriasis before cardiac catheterization was 8 years (interquartile range 2 to 24). Patients with psoriasis were more likely to have CAD (84.3% vs 75.7%, p = 0.005) at coronary angiography. After adjusting for established cardiovascular risk factors, psoriasis was independently associated with presence of angiographically confirmed CAD (adjusted odds ratio 1.8, 95% confidence interval 1.2 to 2.8, p = 0.006). In patients with psoriasis, duration of psoriasis >8 years was also independently associated with angiographically confirmed CAD after adjusting for established cardiovascular risk factors (adjusted odds ratio 3.5, 95% confidence interval 1.3 to 9.6, p = 0.02). In conclusion, patients with psoriasis and especially those with psoriasis for >8 years have a higher prevalence of CAD than patients without psoriasis undergoing coronary angiography.
BACKGROUND: Recent studies suggest that psoriasis, particularly if severe, may be a risk factor for major adverse cardiac events, such as myocardial infarction, stroke, and mortality from cardiovascular disease. We compared the risk of major adverse cardiac events between patients with psoriasis and the general population and estimated the attributable risk of severe psoriasis.
METHODS:
We performed a cohort study in the General Practice Research Database. Severe psoriasis was defined as receiving a psoriasis diagnosis and systemic therapy (N=3603). Up to 4 patients without psoriasis were selected from the same practices and start dates for each patient with psoriasis (N=14,330).
RESULTS:
Severe psoriasis was a risk factor for major adverse cardiac events (hazard ratio 1.53; 95% confidence interval, 1.26-1.85) after adjusting for age, gender, diabetes, hypertension, tobacco use, and hyperlipidemia. After fully adjusted analysis, severe psoriasis conferred an additional 6.2% absolute risk of 10-year major adverse cardiac events.
CONCLUSION:
Severe psoriasis confers an additional 6.2% absolute risk of a 10-year rate of major adverse cardiac events compared with the general population. This potentially has important therapeutic implications for cardiovascular risk stratification and prevention in patients with severe psoriasis. Future prospective studies are needed to validate these findings.
Psoriasis is a common disease frequently studied in large databases. To date the validity of psoriasis information has not been established in The Health Improvement Network (THIN).
To investigate the validity of THIN for identifying patients with psoriasis and to determine if the database can be used to determine the natural history of the disease.
First, we conducted a cross-sectional study to determine if psoriasis prevalence in THIN is similar to expected. Second, we created a cohort of 4900 patients, aged 45-64 years, with a psoriasis diagnostic Read Code and surveyed their general practitioners (GPs) to confirm the diagnosis clinically. Third, we created models to determine if psoriasis descriptors (extent, severity, duration and dermatologist confirmation) could be accurately captured from database records.
Psoriasis prevalence was 1·9%, and showed the characteristic age distribution expected. GP questionnaires were received for 4634 of 4900 cohort patients (95% response rate), and psoriasis diagnoses were confirmed in 90% of patients. Duration of disease in the database showed substantial agreement with physician query (κ = 0·69). GPs confirmed that the psoriasis diagnosis was corroborated by a dermatologist in 91% of patients whose database records contained a dermatology referral code associated with a psoriasis code. We achieved good discrimination between patients with and without extensive disease based on the number of psoriasis codes received per year (area under curve = 0·8).
THIN is a valid data resource for studying psoriasis and can be used to identify characteristics of the disease such as duration and confirmation by a dermatologist.
Psoriasis is frequently associated with comorbidities.
To estimate the incremental economic burden associated with comorbidities in patients with psoriasis, accounting for psoriasis severity.
Patients continuously enrolled ≥6 months after a randomly selected psoriasis diagnosis date were selected from the Ingenix Impact National Managed Care Database (1999-2004). Comorbidities identified during the 6-month study included: psoriatic arthritis, cardiovascular disease, depression, diabetes, hyperlipidemia, hypertension, obesity, cerebrovascular diseases and peripheral vascular disease. Resource utilization and costs during the 6-month follow-up period were compared for patients with ≥1 comorbidity vs. those without and for patients with a specific comorbidity vs. those without. Adjusted incidence rate ratios (IRRs) and odds ratios (ORs) were estimated for resource utilization using negative binomial and logistic regression models, respectively. Adjusted incremental costs associated with comorbidities were reported using general linear models with log-link and gamma distributions or two-part models. Models controlled for age, sex and psoriasis severity.
A total of 114,512 patients were included; 51% had ≥1 comorbidity. Hyperlipidemia (27%) and hypertension (25%) were most prevalent. Patients with comorbidities were more likely to experience urgent care [OR (95% confidence interval (CI))=1.58 (1.51-1.65)] than patients without comorbidities. They also had significantly greater hospitalization rates [IRR (95% CI)=2.27 (2.13-2.42)] and outpatient visits [IRR (95% CI)=1.53 (1.52-1.55)]. Compared with patients who did not have comorbidities, patients with comorbidities incurred $2184 (P<0.001) greater total costs.
Comorbidities present a significant economic burden in patients with psoriasis.
There are limited data available on the economical burden of psoriasis and its impact on everyday life.
The aim of this study was to evaluate the impact of psoriasis on personal and professional life, and to evaluate the cost of psoriasis for the patient.
We performed a cross-sectional study in psoriasis patients. All patients aged >or=18 years with a diagnosis of plaque-psoriasis confirmed by a physician were included. A self-administered questionnaire evaluating everyday life was constructed with members of the French association of psoriasis patients. In addition, the Dermatology Life Quality Index (DLQI), Working Productivity and Activity Impairment and individual costs were assessed.
A total of 590 patients completed the study. Mean age of the responders was 56 years. The mean DLQI score was 8.5 for patients with severe psoriasis vs. 6.4 for mild psoriasis. Global loss of productivity was 10.7% without significant difference according to the disease severity. Daily activities alteration was most important in patients with severe psoriasis. In this study, 36.8% of patients with severe psoriasis reported a negative impact on their professional life vs. 19.6% for patients with mild psoriasis (P = 0.002). Time devoted to phototherapy was on average 33 h/year/patient and the application of emollients took 25 h/year/patient; 47.3% of patients had a feeling to clean the house more often, in correlation with the severity of the disease. Mean out-of-pocket expenses for the disease was estimated to be 543 euro/year/patient. High impact of psoriasis on quality of life (DLQI >10), age <40 years and joint involvement were significantly associated with an increased risk of loss of work productivity.
Psoriasis, particularly severe psoriasis, is a true burden for patients and impacts significantly everyday life and patient's economical resources.
Risk factors for psoriasis have been identified.
To precisely define these associated factors.
A survey was conducted using a questionnaire on a representative sample of the French population. A case-control study was conducted. Cases were persons who declared having had psoriasis during the previous 12 months. For each case, 3 matched controls were selected. Cases and controls were compared using univariate and multivariate analyses.
The questionnaire was filled out and returned by 6,887 (68.9%) of 10,000 subjects aged 15 years and over; 356 cases were identified. In multivariate analysis, a higher body mass index, current and former smoking habits and beta-blocker intake were independently associated with a higher risk of psoriasis; intake of statins was associated with a decreased risk (p < 0.05).
We confirmed the association of overweight, smoking habits and beta-blocker intake with psoriasis and reported a decreased risk associated with statin intake.
Psoriasis is a predictor of morbidity. It is important to determine the extent to which psoriasis remains undiagnosed.
To determine the prevalence of psoriasis.
We conducted a cross-sectional study using the National Health and Nutrition Examination Survey 2003-2004.
The prevalence of diagnosed psoriasis was 3.15% (95% confidence interval [CI], 2.18-4.53), corresponding to 5 million adults. Approximately 17% of these patients have moderate to severe psoriasis based on body surface area report and 25% rate psoriasis a large problem in everyday life. The prevalence of undiagnosed active psoriasis by conservative estimate was 0.4% (95% CI, 0.19-0.82), corresponding to approximately 600,000 US adults, and 2.28% (95% CI, 1.47-3.50) by a broader definition, corresponding to 3.6 million US adults. Undiagnosed patients had a trend toward being more likely to be male, nonwhite, less educated, and unmarried compared with patients who had received a diagnosis.
The method for determining the presence of psoriasis had limited ability to detect mild disease and only fair interrater agreement.
More than 5 million adults have been diagnosed with psoriasis. A large number have undiagnosed psoriasis and there are important disparities which may be associated with not receiving medical attention.
The prevalence of psoriasis in Croatia was studied by the representative samples method. The total number of investigated persons was 8416. The authors detected 131 psoriatics (prevalence -1.55%).
Information on prevalence of psoriasis was obtained from a health interview survey conducted by Central Bureau of Statistics of Norway in 1985 of a representative sample of the Norwegian population. Altogether 149 cases of psoriasis were registered in the study population of 10,576 persons, giving an overall prevalence of 1.4%, with no difference between males and females. A peak prevalence was observed in the age group 30-49 years, and a significantly lower prevalence of 0.5% was found in Hedmark and Oppland counties, as compared with the country as a whole. A higher prevalence of psoriasis among females was found in urban vis-à-vis rural areas, and in urban areas, the prevalence was higher for females than for males. No difference in prevalence was found between various socio-economic groups.
A representative random sample comprising approximately 4000 Danes, 16-99 years old, were questioned as to present or previous psoriasis eruption by non-medical, professional interviewers. Based on the information obtained, the point prevalence for men was 4.2%, for women 3.3%. 88% of those who believed themselves to be suffering from psoriasis stated that they had been treated by doctors for psoriasis and 71% by dermatologists and/or dermatological departments. The difference found between men and women is not statistically significant. The actual prevalence has been adjusted according to an estimated overcalculation of some 25% based on the number of false-positive answers to questionnaires in a twin study. The prevalence for men is thus adjusted to 3.2% and for women to 2.5%. The number of adult psoriatics in Denmark is estimated at approximately 113,000, of whom 71,000 suffer from mild psoriasis and 42,000 from more severe psoriasis.
Statistics for psoriatic patients from the skin clinics of the Hong Kong Government and those from Sendai, Japan, are compared with statistics from five major cities in mainland China. These statistics were compiled since 1949, following the establishment of the People's Republic of China. Additional statistics from seven other surveys among the general population conducted in recent years (1974 to 1981), for a total of 670,000 persons examined, all showed a remarkably constant and uniformly low prevalence of psoriasis at around 0.3% in five of seven surveys. The overall statistics present the evidence of the prevalence of psoriasis to be well under 1% in the Mongoloid races of the Far East.
The occurrence of psoriasis in a Norwegian Lapp population was estimated by reviewing medical records in the local health centre of Kautokeino. Altogether 40 cases of psoriasis were registered in the study population comprising 99.6% of the total population of 2,963 individuals. Thirty-five cases of psoriasis belonged to the Lappish population of 2,508 people, giving a prevalence of 1.4%, with no difference between males and females. Five cases of psoriasis were found in the non-Lappish population of 442 individuals which gives a prevalence of 1.1% with no sex differences. A peak prevalence among Lapps was observed in the age groups 20-39 years (2.7%), equal for both sexes and in females aged 50-59 years (3.2%), whereas a lower prevalence of 0.6% was found in the age group 40-49 years. A seronegative psoriatic arthritis was recorded in 6 of the 35 Lappish compared to none of the non-Lappish cases. A familial association was confirmed in 11 of the 35 Lappish cases, in none of the non-Lappish.
With the changing health care scene in the United States, it is important to have up-to-date epidemiological data with regard to the prevalence of psoriasis in the United States. It is also becoming more important to develop a psychometric instrument that is useful in assessing quality of life issues among psoriasis patients. The Psoriasis Disability Index, which was developed in England, may not be optimally applicable in assessing quality of life issues among psoriasis patients seen by American dermatologists. In this article, the latest nationwide population-based epidemiologic data on psoriasis are presented, along with the use of a new psychometric questionnaire that emphasizes the assessment of quality of life rather than disability.
Surveys of skin disorders have previously provided information about the prevalence and incidence of psoriasis in sub-Saharan Africa; however, the geographic and ethnic trends which may be drawn from these surveys have not been fully described in previous studies, which considered only a fraction of the available data.
A critical review of clinic-based surveys of psoriasis incidence and population-based studies of psoriasis prevalence is presented. The incidence of psoriasis is adjusted, wherever possible, to factor out the widely variable incidence of infectious skin conditions seen in African skin clinics. To distinguish between genetic and environmental factors that may be responsible for the variability of psoriasis incidence, attention is drawn to climate, human leukocyte antigen (HLA) frequencies, and language groups across the regions surveyed in sub-Saharan Africa.
Higher psoriasis incidence rates are consistently observed in eastern Africa than in western Africa, consistent with more limited data on the prevalence of psoriasis in western Africa. Neither rainfall/humidity levels nor HLA frequencies can simply account for these differences; however, the ethnicities of sub-Saharan African peoples may be observed to parallel roughly the trend in psoriasis incidence. Western African countries, such as Nigeria, Mali, Senegal, and Sierra Leone, where lower rates of psoriasis incidence have been reported (less than 1.0% of skin disorders), are populated mainly by non-Bantu-speaking ethnic groups. Bantu-speaking peoples constitute a majority in the populations of most countries in eastern and southern sub-Saharan Africa, where the incidence of psoriasis varies widely. African Americans, whose largely non-Bantu-speaking African ancestry is shared with modern western Africans, also have relatively low psoriasis incidence rates by comparison with North American Caucasians.
Ethnic correlations both within Africa and between North America and Africa suggest that unidentified genetic factors, which differ between eastern and western sub-Saharan Africans, may govern the differential incidence of psoriasis.
Although diseases of the skin have been studied in some African countries, the provision of dermatology services is as yet a relatively underdeveloped aspect of medicine in sub-Saharan Africa.
To determine the pattern of skin diseases seen in a sub-Saharan community and to compare it with that seen in a European community.
The diagnoses of the principal presenting complaint of 2254 consecutive new patients seen at the dermatology clinic of Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana, are presented and compared with those of 3383 consecutive new patients seen at the dermatology clinic of The William Harvey Hospital (WHH), Ashford, Kent, UK.
The most common conditions in Ghana were infections (46.3%; UK, 12%). In the UK, the most common conditions were malignant and premalignant diseases of the skin (22.2%; Ghana, 0.5%) and benign tumors (16.8%; Ghana, 0.5%). Dermatitis was common in both countries (Ghana, 18.4%; UK, 16.0%). Psoriasis was more common in the UK (6.2%) than in Ghana (0.4%). In Ghana, fixed drug eruption, mainly due to cotrimoxazole (Septrin), was not rare (27 cases), and complications from cosmetic skin lightening creams were a frequent problem among women (86 cases). No cases of rosacea were found in Ghana, but it was not uncommon in the UK (1.6%).
The patterns of skin diseases are different in the two countries. It is hoped that this study may help to catalyze the further development of dermatology services in Ghana.
To study the pattern of skin diseases in patients attending the skin clinic of the University College Hospital, Ibadan, Nigeria, and to compare our findings with studies performed earlier in the same clinic.
The study involved 1091 new patients who had attended the skin clinic of the University College Hospital, Ibadan, Nigeria, between January 1994 and December 1998. The patients were examined by the authors, and laboratory investigations were ordered when necessary to make a diagnosis.
An increased prevalence of eczema, idiopathic pruritus, urticaria, connective tissue diseases, and fixed drug eruptions was observed. Infections, such as scabies, candidiasis, and tinea versicolor, had also increased. Pyoderma, leprosy, onchocerciasis, and dermatophytoses showed a decline. Psoriasis was uncommon, although there was a slight increase in prevalence. Vitiligo and alopecia were stable. Cutaneous tuberculosis, such as lupus vulgaris, was rare.
Allergic conditions have increased; connective tissue disorders, such as systemic lupus erythematosus, scleroderma, and discoid lupus erythematosus, have also increased. Cutaneous disorders associated with human immunodeficiency virus infection, such as seborrheic dermatitis, have increased. Health workers need to be educated on the management and treatment of these conditions, and should be advised to refer patients to appropriate health facilities when necessary.
Few data are available on the prevalence of common skin disorders like actinic keratoses in the general population. Such data are mostly needed to better define health needs and to organize medical services. The Prevalence of Actinic Keratoses in the Italian Population Study (PraKtis) was designed to estimate the point prevalence of actinic keratoses and related disorders, e.g. photoaging, in a representative sample of the Italian population. Within the study, information on the history of relevant dermatological diagnoses was also collected.
The study was conducted in collaboration with DOXA, the Italian branch of the Gallup International Association. A representative sample of people aged 45 years or older was selected by picking them from the electoral rolls according to a stratified random sampling design involving a replacement procedure. A total of 180 interviewers specifically trained to collect data on skin diseases and to take photographs of representative lesions on the face and upper limbs, contacted and interviewed the sampled subjects and performed a face-to-face computer-assisted interview. A final sample of about 12000 subjects was foreseen.
The pilot phase of the study was conducted between January 1 and June 30, 2003. A total of 3660 subjects were recruited and interviewed. Overall, an estimated 37% of Italian people reported having ever undergone a dermatological consultation in the past. An estimated 29% reported having ever received a specific dermatological diagnosis by a physician. The frequency of specifically enquired diagnoses, weighted according to the distribution of the Italian population, was as follows: atopic dermatitis 4.7%, other eczematous dermatitides 4.3%, urticaria 4.3%, psoriasis 3.1%, skin tumors 1.6%, vitiligo 0.7% and actinic keratoses 0.3%.
Skin diseases are frequently reported. The prevalence of actinic keratoses according to self-reported diagnoses was lower than expected based on prevalence data obtained by directly examining people. These discrepancies may be due to underreporting and/or unawareness of lesions by affected people. More precise estimates will be obtained by direct examination of sampled people.
The impact of psoriasis on quality of life has been studied in select patient populations. Population-based data detailing the distribution of extent of disease, associated problems in everyday life, and treatment satisfaction for the US population have been lacking. Our population-based survey indicates that approximately 4.5 million adults have been diagnosed as having psoriasis. Most (59%) have little or no involvement, but 650,000 adults have at least three palms of body surface involved and more than 1,000,000 indicate substantial dissatisfaction with their treatment. Only 5% of patients (56,000) who report severe dissatisfaction with current therapy have extensive disease (10 palms). Many individuals with little psoriasis at the time of interview considered the disease to be a large problem in everyday life.
Psoriasis is a common disease with substantial effects on quality of life. The prevalence of psoriasis in African Americans has been previously reported as rare. However, there have been no population-based studies to assess the prevalence and burden of psoriasis in African Americans.
We sought to measure the prevalence and burden of psoriasis in African Americans compared with Caucasians.
Patients were randomly selected from the United States population and were asked standard demographic questions. Patients who reported a physician diagnosis of psoriasis were asked additional questions related to quality of life.
The total sample included 27,220 individuals of which 21,921 were Caucasian and 2443 were African American. The prevalence of psoriasis was 2.5% in Caucasian patients and was 1.3% in African American patients. African Americans had an approximately 52% reduction in the prevalence of psoriasis compared with Caucasians ( P < .0001). African Americans and Caucasians had similar impacts on quality of life and treatment satisfaction based on single global questions.
Although psoriasis is less common in African Americans than in Caucasians, it is not rare in either demographic and carries a substantial burden in both groups.
To measure the prevalence and treatment of psoriasis in the United Kingdom.
Cross-sectional study to determine prevalence and cohort study to determine treatment patterns.
Outpatient practices of general practitioners.
We included in the analysis all patients who were registered with a general practitioner in the General Practice Research Database from 1987 to 2002.
The prevalence and treatment of psoriasis.
We identified 114 521 patients with psoriasis of a total population of 7 533 475 patients, yielding a prevalence of 1.5%. The prevalence of psoriasis increases more rapidly in young female patients compared with young male patients and declines significantly in patients 70 years and older, regardless of sex. Overall, 91.8% of patients with a diagnosis of psoriasis received a prescription for psoriasis treatment on or after the date of their first diagnostic code of psoriasis in the General Practice Research Database. Most of the patients (55.2%) received only 1 or 2 prescriptions for psoriasis in the first year after psoriasis was documented in the General Practice Research Database.
The epidemiology of psoriasis in the General Practice Research Database population is similar to that of other epidemiologic studies of psoriasis performed in the United Kingdom, the United States, and other Western countries. Psoriasis carries a substantial burden given its high prevalence and its associated need for prescription therapy. Additional studies are necessary to determine why the prevalence of psoriasis increases more rapidly in female patients and to determine why the prevalence decreases in patients 70 years and older.
Research in immune-mediated inflammatory disorders (IMIDs) suggests that several diseases share disruptions in key cytokines. A common pathogenesis may present as similar patterns of disease co-occurrence and comorbidity, which could be observed through the analysis of healthcare claims datasets.
Adult patients continuously enrolled from 2001-2002 were identified in two US healthcare datasets containing medical and drug claims from health plans and self-insured employers. Patients with treatment records indicating an IMID were selected (e.g., rheumatoid arthritis, psoriasis, Crohn's disease); controls for each disorder were matched 3:1 based on age, gender, region, and previous insurance coverage. IMID cohorts and comorbidities were identified using International Classification of Diseases, 9th revision codes. Prevalence relative risk was used to assess co-occurrence and comorbidity rates in IMID cohorts and controls. Medical and drug utilization patterns were also explored.
Findings were similar across the two datasets. IMID patients represented about 4% of the population; specific IMID prevalence matched the epidemiology literature. Patients with at least one IMID had a higher risk for another IMID when compared to controls. The risk for infectious, renal, liver, and ulcerative comorbidities was also elevated. Selected drug utilization patterns confirmed comorbidity findings. IMID patients used more healthcare resources compared to controls; findings were robust under sensitivity analyses.
IMID patients were generally more likely than controls to have another IMID, supporting the concept that the diseases are related. These patients also had higher comorbidity rates. Findings may be limited by the nature of claims datasets and the confounding effect of current treatments. Prospective studies are needed to determine whether IMIDs have a common pathogenesis.
Many reports indicate that skin diseases are affected by lifestyle factors.
To examine the relationship between reported skin diagnoses, smoking and alcohol consumption in an urban population.
Cross-sectional questionnaire-based health study among 18,747 adults in Oslo.
For current smokers, odds ratio for reporting psoriasis was 1.49 (95% CI 1.11-2.00) for males, and 1.48 (95% CI 1.15-1.91) for females, as compared to never smokers. There was no association between reported atopic dermatitis or hand eczema and smoking. High consumption of cigarettes was associated with an increased reporting of psoriasis in men, but not women. Reporting drinking alcohol 4-7 times per week was crudely associated with reporting psoriasis in men, but not in the adjusted model.
Cigarette smoking was associated with reported psoriasis, but not with atopic dermatitis or hand eczema.
To determine the risk of mortality in patients with psoriasis.
Cohort study.
General practitioners participating in the General Practice Research Database in the United Kingdom, 1987-2002.
Mild psoriasis, defined as any patient with a diagnostic code of psoriasis but no history of systemic therapy; severe psoriasis, any patient with a diagnostic code of psoriasis and a history of systemic therapy consistent with severe psoriasis. The unexposed (control) population was composed of patients with no history of a psoriasis diagnostic code. Control patients were selected in a 5:1 ratio from the same practice and date in practice as the patients with psoriasis.
Hazard ratio (HR) of time to death using Cox proportional hazards models adjusted for age and sex.
There was no overall effect of mild psoriasis on mortality (HR, 1.0; 95% confidence interval [CI], 0.97-1.02), whereas patients with severe psoriasis demonstrated an increased overall mortality risk (HR, 1.5; 95% CI, 1.3-1.7). The association of severe psoriasis with mortality persisted after adjustment for risk factors for mortality (HR, 1.4; 95% CI, 1.3-1.6) and after exclusion of patients with inflammatory arthropathy (HR, 1.5; 95% CI, 1.3-1.8). Male and female patients with severe psoriasis died 3.5 (95% CI, 1.2-5.8) and 4.4 (95% CI, 2.2-6.6) years younger, respectively, than patients without psoriasis (P < .001).
Severe but not mild psoriasis is associated with an increased risk of death.
Previous reports have shown an association between psoriasis and the metabolic syndrome, but there are only a few studies on the association between psoriasis and diabetes.
To study the association between psoriasis and diabetes.
A cross-sectional study was performed utilizing the database of Clalit Health Services (CHS). Patients who were diagnosed with psoriasis were compared with CHS enrolees without psoriasis regarding the prevalence of diabetes. Patients with diabetes were identified using the CHS chronic diseases registry. Chi-squared tests were used to compare categorical parameters. Logistic regression models were used for multivariate analyses.
The study included 16 851 patients with psoriasis and 74 987 subjects without psoriasis (control patients). The proportion of diabetes was significantly higher in patients above 35 years (P < 0.05). The age-adjusted proportion of diabetes was significantly higher in psoriasis patients as compared to the control group [odds ratio (OR), 1.38, P < 0.05] and was similar in men and women (OR, 1.32, 1.45, respectively). A multivariate logistic regression model showed that psoriasis was significantly associated with diabetes, independently of age and gender (OR, 1.58, P < 0.001).
Our study supports previous reports of an association between psoriasis and diabetes. Dermatologists taking care of patients with psoriasis should be aware of this association and advise the patients to reduce additional risk factors such as smoking, hypertension or dyslipidemia.
Dr Armstrong serves as investigator and Dr Schupp has no conflicts of interest to declare Accepted for publication
- Abbvie Amgen
- Abbvie
- Amgen
- Janssen
- Pfizer
Funding sources: None. Disclosure: Dr Rachakonda has served as a subinvestigator for Amgen and Abbvie. Dr Armstrong serves as investigator and/or consultant to AbbVie, Amgen, Janssen, Pfizer, and Merck. Dr Schupp has no conflicts of interest to declare. Accepted for publication November 7, 2013. Correspondence to: April W. Armstrong, MD, MPH, Department of Dermatology, University of Colorado at Denver, Anschutz Medical Campus, 12801 E 17 Ave, Campus Mailbox 8127, Aurora, CO 80045. E-mail: aprilarmstrong@post.harvard.edu. Published online January 6, 2014. 0190-9622/$36.00 Ó 2013 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2013.11.013 REFERENCES
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