1
|
Cordingley L, Nelson PA, Davies L, Ashcroft D, Bundy C, Chew-Graham C, Chisholm A, Elvidge J, Hamilton M, Hilton R, Kane K, Keyworth C, Littlewood A, Lovell K, Lunt M, McAteer H, Ntais D, Parisi R, Pearce C, Rutter M, Symmons D, Young H, Griffiths CEM. Identifying and managing psoriasis-associated comorbidities: the IMPACT research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2022. [DOI: 10.3310/lvuq5853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Psoriasis is a common, lifelong inflammatory skin disease, the severity of which can range from limited disease involving a small body surface area to extensive skin involvement. It is associated with high levels of physical and psychosocial disability and a range of comorbidities, including cardiovascular disease, and it is currently incurable.
Objectives
To (1) confirm which patients with psoriasis are at highest risk of developing additional long-term conditions and identify service use and costs to patient, (2) apply knowledge about risk of comorbid disease to the development of targeted screening services to reduce risk of further disease, (3) learn how patients with psoriasis cope with their condition and about their views of service provision, (4) identify the barriers to provision of best care for patients with psoriasis and (5) develop patient self-management resources and staff training packages to improve the lives of people with psoriasis.
Design
Mixed methods including two systematic reviews, one population cohort study, one primary care screening study, one discrete choice study, four qualitative studies and three mixed-methodology studies.
Setting
Primary care, secondary care and online surveys.
Participants
People with psoriasis and health-care professionals who manage patients with psoriasis.
Results
Prevalence rates for psoriasis vary by geographical location. Incidence in the UK was estimated to be between 1.30% and 2.60%. Knowledge about the cost-effectiveness of therapies is limited because high-quality clinical comparisons of interventions have not been done or involve short-term follow-up. After adjusting for known cardiovascular risk factors, psoriasis (including severe forms) was not found to be an independent risk factor for major cardiovascular events; however, co-occurrence of inflammatory arthritis was a risk factor. Traditional risk factors were high in patients with psoriasis. Large numbers of patients with suboptimal management of known risk factors were found by screening patients in primary care. Risk information was seldom discussed with patients as part of screening consultations, meaning that a traditional screening approach may not be effective in reducing comorbidities associated with psoriasis. Gaps in training of health-care practitioners to manage psoriasis effectively were identified, including knowledge about risk factors for comorbidities and methods of facilitating behavioural change. Theory-based, high-design-quality patient materials broadened patient understanding of psoriasis and self-management. A 1-day training course based on motivational interviewing principles was effective in increasing practitioner knowledge and changing consultation styles. The primary economic analysis indicated a high level of uncertainty. Sensitivity analysis indicated some situations when the interventions may be cost-effective. The interventions need to be assessed for long-term (cost-)effectiveness.
Limitations
The duration of patient follow-up in the study of cardiovascular disease was relatively short; as a result, future studies with longer follow-up are recommended.
Conclusions
Recognition of the nature of the psoriasis and its impact, knowledge of best practice and guideline use are all limited in those most likely to provide care for the majority of patients. Patients and practitioners are likely to benefit from the provision of appropriate support and/or training that broadens understanding of psoriasis as a complex condition and incorporates support for appropriate health behaviour change. Both interventions were feasible and acceptable to patients and practitioners. Cost-effectiveness remains to be explored.
Future work
Patient support materials have been created for patients and NHS providers. A 1-day training programme with training materials for dermatologists, specialist nurses and primary care practitioners has been designed. Spin-off research projects include a national study of responses to psoriasis therapy and a global study of the prevalence and incidence of psoriasis. A new clinical service is being developed locally based on the key findings of the Identification and Management of Psoriasis Associated ComorbidiTy (IMPACT) programme.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 10, No. 3. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Lis Cordingley
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, UK
| | - Pauline A Nelson
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Linda Davies
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Darren Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, UK
| | - Christine Bundy
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | | | - Anna Chisholm
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Jamie Elvidge
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Matthew Hamilton
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Rachel Hilton
- Bridgewater Community Healthcare NHS Foundation Trust, Wigan, UK
| | - Karen Kane
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | | | - Alison Littlewood
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Mark Lunt
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | | | - Dionysios Ntais
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Rosa Parisi
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, UK
| | - Christina Pearce
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Martin Rutter
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Deborah Symmons
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - Helen Young
- Dermatology Research Centre, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Salford, UK
| | - Christopher EM Griffiths
- Dermatology Research Centre, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Salford, UK
| |
Collapse
|
2
|
Hajiebrahimi M, Song C, Hägg D, Andersson TML, Villacorta R, Linder M. The Occurrence of Metabolic Risk Factors Stratified by Psoriasis Severity: A Swedish Population-Based Matched Cohort Study. Clin Epidemiol 2020; 12:737-744. [PMID: 32765108 PMCID: PMC7368160 DOI: 10.2147/clep.s252410] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/22/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose To assess the relative risk of metabolic risk factors in patients stratified by psoriasis severity compared with population controls. Patients and Methods A retrospective cohort study was conducted using national Swedish registers. Adult patients with psoriasis were selected if they had a dispensing of anti-psoriasis prescription (2007–2013) and at least one diagnosis within five years before the dispensing date. The patients with psoriasis were matched 1:10 to controls from the general population on birth year, sex, and county. The cohort was further divided into three disease severity groups (mild, moderate, or severe) based on their dispensed anti-psoriasis medication. Subjects were followed from the index date until censoring. We applied flexible parametric modeling to understand the risks of the incident comorbidities hypertension, hypercholesterolemia, and diabetes mellitus among patients with psoriasis from 6 months through 10 years. Hazard ratios and predicted risk (ie, 1 minus the survival probability) of comorbidities were reported. Results The hazard of hypertension, hypercholesterolemia, and diabetes mellitus is higher among psoriasis patients compared with population controls, and the hazard ratio increases with psoriasis severity. For example, HRs of hypertension for patients with mild, moderate, and severe psoriasis are 1.29 (95% CI: 1.27–1.32), 1.35 (95% CI: 1.32–1.38), and 1.73 (95% CI: 1.64–1.82), respectively. The predicted risk of hypertension, hypercholesterolemia, and diabetes mellitus among patients with severe psoriasis at year ten was 0.58 (95% CI: 0.56, 0.59), 0.33 (95% CI: 0.32, 0.35), and 0.21 (95% CI: 0.20, 0.23), respectively, while it was 0.42 (0.41, 0.43), 0.23 (0.22, 0.23), 0.11 (0.10, 0.11) among controls, respectively. The predicted risk at year ten was similar among patients with mild or moderate psoriasis. Conclusion The HRs and predicted risks of metabolic risk factors are higher among patients with psoriasis compared with matched controls and are more prominent among the severe psoriasis group.
Collapse
Affiliation(s)
- Mohammadhossein Hajiebrahimi
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Statistics and Epidemiology, Public Health Faculty, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ci Song
- Janssen GCSO, Stockholm, Sweden
| | - David Hägg
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Therese M-L Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Marie Linder
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
3
|
Shahidi-Dadras M, Haghighatkhah HR, Abdollahimajd F, Younespour S, Partovi kia M, Zargari O. Correlation between vascular endothelial growth factor and subclinical atherosclerosis in patients with psoriasis. Int J Dermatol 2015; 55:52-9. [DOI: 10.1111/ijd.12842] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 08/10/2014] [Accepted: 08/14/2014] [Indexed: 01/22/2023]
Affiliation(s)
| | - Hamid Reza Haghighatkhah
- Department of Radiology and Medical Imaging Center; Shohada-e Tajrish Hospital; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | | | - Shima Younespour
- Skin Research Center; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Masoud Partovi kia
- Skin Research Center; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Omid Zargari
- Skin Research Center; Shahid Beheshti University of Medical Sciences; Tehran Iran
| |
Collapse
|
4
|
Duman N, Ersoy Evans S, Atakan N. Rosacea and cardiovascular risk factors: a case control study. J Eur Acad Dermatol Venereol 2013; 28:1165-9. [PMID: 23909954 DOI: 10.1111/jdv.12234] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 07/11/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Rosacea is an inflammatory skin disease with a chronic course. This study aimed to investigate the risk of cardiovascular disease (CVD) in rosacea patients. MATERIALS AND METHODS The study included 60 rosacea patients and 50 age- and gender-matched controls. Demographic data, medical history, presence of cardiovascular risk factors were recorded. Waist circumference, height, and weight were measured, and the body mass index was calculated for each participant. Laboratory investigations, including fasting blood glucose, C-reactive protein (CRP), very low-density lipoprotein, low-density lipoprotein (LDL), high-density lipoprotein, total cholesterol, triglyceride, lipoprotein(a) were performed. RESULTS In all, 66% of the rosacea patients were female (mean age: 44.65 ± 12.9 years) and 66% of the controls were female (mean age: 42.3 ± 12.3 years). Median disease duration in the rosacea group was 36 months. High total cholesterol (>200 mg/dL), LDL (>130 mg/dL) and CRP (>0.8 mg/L) levels, a family history of premature CVD, and a history of smoking and alcohol consumption were significantly more common in the rosacea patients compared to controls. CONCLUSION Rosacea patients may have a high risk of CVD. As such, we recommend close follow-up of rosacea patients because of the increased risk of CVD. The mechanism underlying this increased risk is unknown, and additional randomized and controlled studies are required for clarification.
Collapse
Affiliation(s)
- N Duman
- Department of Dermatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | | |
Collapse
|
5
|
Tseng HW, Lin HS, Lam HC. Co-morbidities in psoriasis: a hospital-based case-control study. J Eur Acad Dermatol Venereol 2012; 27:1417-25. [PMID: 23134418 DOI: 10.1111/jdv.12028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Recent researches show that psoriasis is frequently associated with systemic co-morbidities. OBJECTIVES This study aimed to identify possible associated co-morbidities in psoriatic patients stratified by age and sex. METHODS In this retrospective hospital-based case-control study, patients diagnosed as psoriasis at the Kaohsiung Veterans General Hospital in Taiwan between January 2008 and December 2009 were enrolled as cases and classified into severe and mild based on their use of systemic therapy. The controls were the patients without psoriasis matched the cases in 1 : 1 ratio with same birth year, sex and calendar date. Odds ratios (ORs) and 95% confidence intervals (CIs) from the conditional logistic regression method were used to assess the risk of co-morbidities between psoriatic and non-psoriatic patients. RESULTS A total of 447 cases and 447 matched controls, with mean age of 51.3 ± 18.3 years and male-to-female ratio of 2.17 : 1 were enrolled. The ratio of mild-to-severe was 3.5 : 1. Compared with non-psoriatic patients, psoriatic patients had significantly higher OR of hypertension (1.85), diabetes mellitus (2.88) and obesity (1.66). Among those aged ≥51 years old, there was significant risk in male psoriatic patients with ischaemic and hypertensive heart disease (IHHD) (OR = 2.167) after eliminating female IHHD psoriatic patients (OR = 0.125). Psoriasis was significantly negatively associated with cancers (OR = 0.267). Psoriasis patients often had the usual drinking habit (OR = 2.23) and seldom had an occasional drinking habit (OR = 0.25). CONCLUSIONS Psoriasis is strongly associated with hypertension, diabetes mellitus and obesity. The association between psoriasis and IHHD, stroke, cancers, smoking and alcohol habits warrant more investigation.
Collapse
Affiliation(s)
- H W Tseng
- Department of Dermatology, Kaohsiung Veterans General Hospital, KaohsiungDepartment of Nursing, College of Health and Nursing, Meiho University, PingtungSchool of Nursing, Fooyin University, KaohsiungDivision of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Veterans General Hospital, KaohsiungFaculty of Nursing, Yuh-Ing Junior College of Health Care and Management, Kaohsiung, Taiwan
| | | | | |
Collapse
|
6
|
Abuabara K, Lee H, Kimball AB. The effect of systemic psoriasis therapies on the incidence of myocardial infarction: a cohort study. Br J Dermatol 2012; 165:1066-73. [PMID: 21777216 DOI: 10.1111/j.1365-2133.2011.10525.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Psoriasis confers an independent risk of cardiovascular disease that is likely to be related to systemic inflammation. Anti-inflammatory treatment could theoretically reduce the risk of cardiovascular disease, and initial data suggest that treatment may reduce the incidence of cardiovascular risk factors. OBJECTIVES To determine the impact of anti-inflammatory therapy on the risk of acute myocardial infarction (MI) in patients with moderate-to-severe psoriasis. METHODS Cohort study using administrative and pharmacy claims data from a large U.S. insurer comparing patients with psoriasis aged ≥ 18 years receiving systemic immunomodulatory therapies (methotrexate, ciclosporin, alefacept, efalizumab, adalimumab, etancercept and infliximab) with a control group treated with ultraviolet B phototherapy that has limited systemic anti-inflammatory effects. The risk of acute MI was calculated using a proportional hazards model while controlling for sex, age, hypertension, hyperlipidaemia, diabetes and depression. Significant interaction terms were included in the final model. RESULTS The study group included 25,554 patients with psoriasis receiving systemic treatment or phototherapy. There was a trend towards an increased risk of MI in the systemic treatment group but not a significant difference in overall MI risk [hazard ratio (HR) 1·33, 95% confidence interval (CI) 0·90-1·96]. Additionally, there was a significant interaction with age: in patients under 50 years the HR for MI if receiving systemic therapy was 0·65 (95% CI 0·32-1·34), and in patients aged 50-70 years it was 1·37 (95% CI 0·79-2·38). CONCLUSIONS Overall, there does not appear to be a reduced risk of MI in patients with psoriasis receiving systemic therapy compared with a group undergoing phototherapy. The risk of MI may vary by age.
Collapse
Affiliation(s)
- K Abuabara
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA.
| | | | | |
Collapse
|
7
|
Ahlehoff O, Gislason GH, Charlot M, Jørgensen CH, Lindhardsen J, Olesen JB, Abildstrøm SZ, Skov L, Torp-Pedersen C, Hansen PR. Psoriasis is associated with clinically significant cardiovascular risk: a Danish nationwide cohort study. J Intern Med 2011; 270:147-57. [PMID: 21114692 DOI: 10.1111/j.1365-2796.2010.02310.x] [Citation(s) in RCA: 335] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The magnitude of the cardiovascular risk from psoriasis and psoriatic arthritis is debated. We therefore investigated the psoriasis-related risk of adverse cardiovascular events and mortality. DESIGN, SETTING AND SUBJECTS We conducted a cohort study of the entire Danish population aged ≥18 years followed from 1997 to 2006 by individual-level linkage of nationwide registers. Psoriasis was defined by prescription claims and classified as severe if patients received hospital-based treatment. Time-dependent Poisson regression models were applied to assess cardiovascular risk in patients with psoriasis and psoriatic arthritis. MAIN OUTCOME MEASURES All-cause mortality, cardiovascular mortality and hospitalizations for myocardial infarction (MI), stroke and coronary revascularization were recorded. RESULTS A total of 34 371 patients with mild psoriasis and 2621 with severe psoriasis, including 607 with psoriatic arthritis, were identified and compared with 4 003 265 controls. The event rates and rate ratios (RRs) of all-cause mortality, cardiovascular death, MI, coronary revascularization, stroke and a composite of MI, stroke and cardiovascular death were increased in patients with psoriasis. The rate ratio increased with disease severity and decreased with age of onset. The overall RRs for the composite endpoint were 1.20 (95% confidence interval [CI] 1.14-1.25) and 1.58 (95% CI 1.36-1.82) for mild and severe psoriasis, respectively. The corresponding RRs for cardiovascular death were 1.14 (95% CI 1.06-1.22) and 1.57 (95% CI1.27-1.94). The risk was similar in patients with severe skin affection alone and those with psoriatic arthritis. CONCLUSIONS Psoriasis is associated with increased risk of adverse cardiovascular events and all-cause mortality. Young age, severe skin affection and/or psoriatic arthritis carry the most risk. Patients with psoriasis may be candidates for early cardiovascular risk factor modification.
Collapse
Affiliation(s)
- O Ahlehoff
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Rosa D, Machado R, Matias F, Cedrim S, Noronha F, Gaburri D, Gamonal A. Influence of severity of the cutaneous manifestations and age on the prevalence of several cardiovascular risk factors in patients with psoriasis. J Eur Acad Dermatol Venereol 2011; 26:348-53. [DOI: 10.1111/j.1468-3083.2011.04076.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
9
|
Mansouri K, Motlagh HRM, Keshavarz M. Tranilast could has potential therapeutic value in the treatment of psoriasis. Med Hypotheses 2010; 76:217-9. [PMID: 21030156 DOI: 10.1016/j.mehy.2010.09.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2010] [Revised: 09/29/2010] [Accepted: 09/29/2010] [Indexed: 12/22/2022]
Abstract
Psoriasis is a common chronic skin disease characterized by recurrent erythromatous skin plaques that exhibit epidermal hyperplasia, variable inflammatory cell infiltrate, and abnormalities of the dermal vascularization. The involvement of angiogenic growth factors such as vascular endothelial growth factor (VEGF), matrix metalloproteinases (MMPs) and inflammatory cytokines such as IFNγ, IL-1, IL-2, TNFα, TGFα and β, IL-6, IL-8, amphiregulin and monocyte chemoattractant protein 1 (MCP-1) have been known to play pathogenic roles in traumatic psoriatic skin. However, anti-angiogenic and anti-inflammatory cytokines regimens might favorably affect the psoriasis disease process. Tranilast is an anti-allergic drug now emerging as anti-angiogenesis and anti-inflammatory effects. In vitro and in vivo experiments have also been strongly showed that tranilast would treat skin psoriasis by inhibition of involving factors. Herein, we hypothesize that local administration of tranilast may be potentially clinically useful in psoriasis.
Collapse
Affiliation(s)
- Kamran Mansouri
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | | | | |
Collapse
|
10
|
Cugno M, Tedeschi A, Crosti C, Marzano AV. Activation of blood coagulation in autoimmune skin disorders. Expert Rev Clin Immunol 2010; 5:605-13. [PMID: 20477646 DOI: 10.1586/eci.09.40] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The immune system and blood coagulation are simultaneously activated in several inflammatory systemic disorders, such as lupus erythematosus, rheumatoid arthritis and inflammatory bowel diseases. Proinflammatory cytokines, such as IL-6 and TNF-alpha, induce the expression of tissue factor, the main initiator of blood coagulation. Activated proteases of coagulation in turn act on protease-activated receptors, inducing the expression of various proinflammatory cytokines. This cross-talk between inflammation and coagulation amplifies and maintains the activation of both systems. This review focuses on three skin disorders: chronic urticaria (CU), which is considered autoimmune in approximately 50% of cases, bullous pemphigoid (BP), which is the prototype of autoimmune blistering disease, and psoriasis, which is an immune-mediated dermatitis. In CU, the activation of coagulation, which is due to the involvement of eosinophils and tissue factor pathways with the generation of thrombin, has local implications by increasing dermal vascular permeability. Preliminary data indicate that anticoagulant treatment with heparin and warfarin may be effective in reducing the symptoms of this disorder. In BP, the activation of coagulation seems to have both local and systemic implications. Locally, eosinophils and thrombin participate in bulla formation and tissue damage; systemically, the activation of coagulation may explain the increased thrombotic risk observed in these patients. In psoriasis, the activation of coagulation seems to be mainly systemic, potentially contributing to the increased cardiovascular risk associated with this disease.
Collapse
Affiliation(s)
- Massimo Cugno
- Department of Internal Medicine, University of Milan and IRCCS Foundation Maggiore Hospital, Policlinico, Mangiagalli and Regina Elena, Via Pace 9, 20122, Milan, Italy.
| | | | | | | |
Collapse
|
11
|
Pokes, papules, plaques. Am J Med 2010; 123:514-6. [PMID: 20569755 DOI: 10.1016/j.amjmed.2010.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 03/09/2010] [Accepted: 03/09/2010] [Indexed: 11/23/2022]
|
12
|
Affiliation(s)
- Tace Rico
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | | |
Collapse
|
13
|
Management of psoriasis. South Med J 2009; 102:631-6. [PMID: 19434023 DOI: 10.1097/smj.0b013e3181a59c4f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Psoriasis is common, affecting about 2-3% of the population, and has major effects on patients' quality of life. Psoriasis varies in its manifestations and in how patients perceive the condition. Successful treatment involves addressing the clinical, psychological, and social aspects of the disease. Treatment options include topical agents, phototherapy and systemic treatment. Topical treatments are only practical for a fairly limited area of involvement. Phototherapy is practical for larger areas of involvement, but office phototherapy treatments are inconvenient. Traditional systemic medications are limited by side effects. New biologic agents that target specific components of the immune system are the most recent addition to our list of medications and provide higher efficacy with an improved safety profile, albeit at a higher cost.
Collapse
|