1
|
Mitsiou E, Kyriakou A, Parlapani E, Trigoni A, Trakatelli M, Apalla Z, Sotiriadis D, Lazaridou E, Patsatsi A. Correlation of Specific Inflammatory Markers With the Occurrence of Depression in Patients With Psoriasis and Their Use as Biomarkers for the Diagnosis of Depression. Dermatol Pract Concept 2024; 14:dpc.1402a104. [PMID: 38810053 PMCID: PMC11135957 DOI: 10.5826/dpc.1402a104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION Psoriasis is a systemic disease of the skin and nails associated with a wide range of comorbidities such as depression, psoriatic arthritis and metabolic syndrome. OBJECTIVES The study aimed to examine a potential association between inflammatory markers (C- reactive protein [CRP] and erythrocyte sedimentation rate [ESR]) and depression in patients with psoriasis. METHODS A total of 80 individuals were enrolled in the study. Case participants included 28 patients diagnosed with Psoriasis (Beck Depression Inventory-II: :0-13) and 24 patients diagnosed with Psoriasis and Depression (Beck Depression Inventory-II:14-63). Twenty-eight (28) healthy participants comprised the control group.Psoriasis severity was evaluated by using Psoriasis Area and Severity Index, Physician Global Assessment, Body Surface Area and Dermatology Life Quality Index. Written approval was obtained for its use in this study: Cardiff University (09/2015). Other factors considered in the study were obesity using the Body Mass Index, the levels of stress using the Beck Anxiety Inventory, and the presence of insomnia using the Athens Insomnia Scale. Blood draws and inflammatory markers measurements were performed for all participants. RESULTS Both CRP and ESR levels were higher in the case group (ie Psoriasis and Depression and Psoriasis) compared to healthy controls. Furthermore, psoriatic patients with depression showed increased CRP and ESR levels compared to those of psoriatic patients without depression. CONCLUSIONS The evaluation of both CRP and ESR and their use to detect the presence of depression in patients with psoriasis can be an important tool for their holistic treatment of theirs.
Collapse
Affiliation(s)
- Eleni Mitsiou
- 2nd Dermatology Department, Aristotle University School of Medicine, Papageorgiou Hospital, Thessaloniki, Greece
| | - Aikaterini Kyriakou
- 2nd Dermatology Department, Aristotle University School of Medicine, Papageorgiou Hospital, Thessaloniki, Greece
| | - Eleni Parlapani
- 1st Department of Psychiatry, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Trigoni
- 2nd Dermatology Department, Aristotle University School of Medicine, Papageorgiou Hospital, Thessaloniki, Greece
| | - Myrto Trakatelli
- 2nd Dermatology Department, Aristotle University School of Medicine, Papageorgiou Hospital, Thessaloniki, Greece
| | - Zoe Apalla
- 2nd Dermatology Department, Aristotle University School of Medicine, Papageorgiou Hospital, Thessaloniki, Greece
| | - Dimitrios Sotiriadis
- 2nd Dermatology Department, Aristotle University School of Medicine, Papageorgiou Hospital, Thessaloniki, Greece
| | - Elizabeth Lazaridou
- 2nd Dermatology Department, Aristotle University School of Medicine, Papageorgiou Hospital, Thessaloniki, Greece
| | - Aikaterini Patsatsi
- 2nd Dermatology Department, Aristotle University School of Medicine, Papageorgiou Hospital, Thessaloniki, Greece
| |
Collapse
|
2
|
Toledano E, Hidalgo C, Gómez-Lechón L, Ibáñez M, Chacón CC, Martín-Vallejo J, Pastor S, Montilla C. SLEEP quality in patients with psoriatic arthritis and its relationship with disease activity and comorbidities: a cross-sectional study. Sci Rep 2023; 13:22927. [PMID: 38129461 PMCID: PMC10739913 DOI: 10.1038/s41598-023-48723-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
The assessment of psoriatic arthritis is complex and multidimensional. It is increasingly common to include the patient perspective using patient-reported outcomes. Although some research has explored sleep quality in patients with psoriatic arthritis, most studies have had small sample sizes, failed to assess sleep quality considering the inflammatory process together with the psychological well-being of patients, and have not described any use of sleep medication. Further, research to date has not provided data on the relationship of sleep quality with axial forms. In this context, the objective of this study was to assess sleep quality in patients with psoriatic arthritis and its relationship with clinical characteristics, disease activity, functioning, disease impact, fatigue and psychological status. A cross-sectional study was conducted including 247 consecutive patients with PsA recruited during 2021. Sleep quality was measured using the Pittsburgh Sleep Quality Index. We assessed correlations of Pittsburgh Sleep Quality Index score with peripheral disease activity (Disease Activity Index for PSoriatic Arthritis), axial disease activity (Ankylosing Spondylitis Disease Activity Score-C-reactive protein and Bath Ankylosing Spondylitis Disease Activity Index), functioning (Bath Ankylosing Spondylitis Functional Index and Health Assessment Questionnaire), impact (Psoriatic Arthritis Impact of Disease questionnaire), anxiety, depression (Hospital Anxiety and Depression Scale) and fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue) scores. A multiple linear regression model was constructed with PSQI as the dependent variable and as independent variables those that could influence sleep quality. Nearly two-thirds (63.15%) of patients had poor sleep quality. Poorer sleep quality was associated with being female, higher joint counts, greater peripheral and axial disease activity, fatigue, anxiety and depression, functioning and disease impact (p < 0.001). Multiple linear regression analysis found that pain (β: 0.3; p < 0.007) and fatigue β: - 0.1; p < 0.001 contributed 40% to the sleep quality model. Poor sleep quality was common among patients with psoriatic arthritis. Emotional factors (fatigue, anxiety) seemed more important than inflammatory factors in sleep quality.
Collapse
Affiliation(s)
- Esther Toledano
- Rheumatology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Cristina Hidalgo
- Rheumatology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Luis Gómez-Lechón
- Rheumatology Department, Hospital Francesc De Borja, Gandía, Valencia, Spain
| | - Marta Ibáñez
- Rheumatology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | | | - Sonia Pastor
- Rheumatology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Carlos Montilla
- Rheumatology Department, Hospital Universitario de Salamanca, Salamanca, Spain.
| |
Collapse
|
3
|
Zaky MS, Elgamal EEA, Abd Al Maksoud AA, Mohamed DH, Elsaie ML. Evaluation of sleep quality and pruritus severity in psoriatic patients and their impact on quality of life: a cross section correlational study. Sci Rep 2023; 13:17541. [PMID: 37845323 PMCID: PMC10579417 DOI: 10.1038/s41598-023-44757-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/11/2023] [Indexed: 10/18/2023] Open
Abstract
Psoriasis is a chronic inflammatory condition associated with genetic and immunological susceptibility. The objective of the study was to evaluate pruritus and sleep quality in correlation (r) to psoriasis severity and to detect their impact on quality of life. Two hundred (200) patients with psoriasis were included. Psoriasis severity was determined using the psoriasis area severity index (PASI), the quality of life (QoL) was assessed by the psoriasis disability index (PDI) questionnaire, and the sleep quality was evaluated by the Pittsburgh sleep quality index (PSQI). Finally, the severity of itching was evaluated using a 12-item pruritus severity scale (PSS). Poor sleep quality was found in 16.0% of patients in this study. Poor sleep was detected among 50.0% of cases with severe psoriasis. PASI scores correlated significantly with sleep quality, duration and sleep disturbances (p < 0.001). The global PSQI and PASI were also significantly correlated (p = 0.004). In conclusion patients complaining of psoriasis exacerbated by pruritus and sleep problems demonstrated lower quality of life in all domains. Sleep disturbances and depressive symptoms impairing quality of life should be taken into consideration when screening patients suffering from psoriasis.
Collapse
Affiliation(s)
- Mohamed S Zaky
- Department of Dermatology, Venereology and Andrology, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Emad Eldin A Elgamal
- Department of Dermatology, Venereology and Andrology, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Ayman A Abd Al Maksoud
- Department of Psychiatry, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Dina H Mohamed
- Department of Dermatology, Venereology and Andrology, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Mohamed L Elsaie
- Department of Dermatology, Venereology and Andrology, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt.
| |
Collapse
|
4
|
Costanzo A, Llamas-Velasco M, Fabbrocini G, Cuccia A, Rivera-Diaz R, Gaarn Du Jardin K, Kasujee I, Puig L, Carrascosa JM. Tildrakizumab improves high burden skin symptoms, impaired sleep and quality of life of moderate-to-severe plaque psoriasis patients in conditions close to clinical practice. J Eur Acad Dermatol Venereol 2023; 37:2004-2015. [PMID: 37246505 DOI: 10.1111/jdv.19229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/20/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Tildrakizumab (TIL) is an interleukin (IL)-23p19 inhibitor for the treatment of moderate-to-severe plaque psoriasis with long-term efficacy and safety demonstrated in Phase III trials. Studies conducted in conditions closer to clinical practice are needed. OBJECTIVES The TRIBUTE study (open-label, Phase IV) assessed the efficacy and impact on health-related quality of life (HRQoL) of TIL 100 mg in adult moderate-to-severe psoriasis patients (naïve to IL-23/Th17 pathway inhibitors) in conditions similar to clinical practice. METHODS Key efficacy measure was Psoriasis Area Severity Index (PASI). HRQoL was evaluated using the Dermatology Life Quality Index (DLQI) and Skindex-16. Additional patient-reported outcomes included Pain-, Pruritus- and Scaling-Numerical Rating Scale (NRS), Medical Outcome Study (MOS)-Sleep, Work Productivity and Activity Impairment (WPAI), Patient Benefit Index (PBI) and Treatment Satisfaction Questionnaire for Medication (TSQM). RESULTS One hundred and seventy-seven patients were enrolled (six patients did not complete the study). After 24 weeks, the proportion of patients achieving PASI scores ≤ 3, PASI 75, PASI 90 and DLQI 0/1 was 88.4%, 92.5%, 74.0% and 70.4%, respectively. Skindex-16 overall score improved (mean absolute change from baseline, MACB [95%CI]: -53.3 [-58.1, -48.5]). Significant benefits (MACB [95%CI]) were found on pruritus-, pain- and scaling-NRS scores (-5.7 [-6.1, -5.2], -3.5 [-4.1, -3.0] and -5.7 [-6.2, -5.2], respectively), MOS-Sleep (-10.4 [-13.3, -7.4] Sleep problems Index II) and WPAI (-36.4 [-42.6, -30.2] activity impairment, -28.2 [-34.7, -21.7] productivity loss, -27.0 [-32.9, -21.1] presenteeism and -6.8 [-12.1, -1.5] absenteeism). 82.7% of patients reported PBI ≥ 3 and the mean (SD) global TSQM score was high (80.5 [18.5]). Only one serious treatment-emergent adverse event was reported (not-related to TIL). CONCLUSIONS TIL 100 mg treatment after 24 weeks in conditions close to real clinical practice showed a quick and high improvement in psoriasis signs and HRQoL. Patient reported improvements in sleep outcomes and work productivity, relevant benefits and high treatment satisfaction. The safety profile was favourable and consistent with Phase III trials.
Collapse
Affiliation(s)
- Antonio Costanzo
- Section of Dermatology, Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Mar Llamas-Velasco
- Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Aldo Cuccia
- Unit of Dermatology, San Donato Hospital, Arezzo, Italy
| | - Raquel Rivera-Diaz
- Department of Dermatology, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | | | | | - Lluís Puig
- Department of Dermatology, IIB SANTPAU, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | |
Collapse
|
5
|
Duan GY, Silverberg JI. Sleep impairment in patients with chronic inflammatory skin diseases: A review of mechanisms and management. J Am Acad Dermatol 2023; 88:421-427. [PMID: 35700930 DOI: 10.1016/j.jaad.2022.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/02/2022] [Accepted: 06/05/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Chronic inflammatory skin diseases (CISD), such as atopic dermatitis and psoriasis, are associated with nocturnal sleep disturbances, which may in turn exacerbate inflammation. OBJECTIVE To summarize the complex factors that underlie the relationship between CISD and sleep impairment. METHODS We conducted a focused review of the published literature, including retrospective, prospective, and interventional studies, clinical trials, reviews, and consensus guidelines. RESULTS The results of our literature review identified a complex interplay among various physiological, psychosocial, and behavioral factors mediating the relationship between sleep loss and CISD alongside targeted management strategies. We highlight treatment strategies that target these pathways, providing a practical framework for clinicians managing sleep loss in patients with CISD. Current guidelines by dermatology societies on the management of sleep disturbances in patients with CISD are limited and largely focus mostly on atopic dermatitis and psoriasis. CONCLUSIONS We recommend that sleep problems must be regularly assessed and managed in patients with CISD. Updated clinician guidelines are needed to better recognize and address the multifactorial nature of sleep loss in patients with CISD.
Collapse
Affiliation(s)
- Grace Y Duan
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
| |
Collapse
|
6
|
Lada G, Talbot PS, Chinoy H, Warren RB, Mcfarquhar M, Kleyn CE. Brain structure and connectivity in psoriasis and associations with depression and inflammation; findings from the UK biobank. Brain Behav Immun Health 2022; 26:100565. [PMID: 36471870 PMCID: PMC9719019 DOI: 10.1016/j.bbih.2022.100565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 11/02/2022] [Accepted: 11/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Psoriasis is a chronic systemic inflammatory skin disease, coexisting with depression in up to 25% of patients. Little is known about the drivers of comorbidity, including shared neurobiology and depression brain imaging patterns in patients. An immune-mediated crosstalk between the brain and skin has been hypothesized in psoriasis. With the aim of investigating brain structure and connectivity in psoriasis in relation to depression comorbidity, we conducted a brain imaging study including the largest psoriasis patient sample to date (to our knowledge) and the first to investigate the role of depression and systemic inflammation in brain measures. Effects of coexisting psoriatic arthritis (PsA), which represents joint involvement in psoriasis and a higher putative inflammatory state, were further explored. Methods Brain magnetic resonance imaging (MRI) data of 1,048 UK Biobank participants were used (131 comorbid patients with psoriasis and depression, age-and sex-matched to: 131 non-depressed psoriasis patients; 393 depressed controls; and 393 non-depressed controls). Interaction effects of psoriasis and depression on volume, thickness and surface of a-priori defined regions of interest (ROIs), white matter tracts and 55x55 partial correlation resting-state connectivity matrices were investigated using general linear models. Linear regression was employed to test associations of brain measures with C-reactive protein (CRP) and neutrophil counts. Results No differences in regional or global brain volumes or white matter integrity were found in patients with psoriasis compared to controls without psoriasis or PsA. Thickness in right precuneus was increased in psoriasis patients compared to controls, only when depression was present (β = 0.26, 95% CI [Confidence Intervals] 0.08, 0.44; p = 0.02). In further analysis, psoriasis patients who had PsA exhibited fronto-occipital decoupling in resting-state connectivity compared to patients without joint involvement (β = 0.39, 95% CI 0.13, 0.64; p = 0.005) and controls (β = 0.49, 95% CI 0.25, 0.74; p < 0.001), which was unrelated to depression comorbidity. Precuneus thickness and fronto-occipital connectivity were not predicted by CRP or neutrophil counts. Precuneus thickening among depressed psoriasis patients showed a marginal correlation with recurrent lifetime suicidality. Conclusions Our findings provide evidence for a combined effect of psoriasis and depression on the precuneus, which is not directly linked to systemic inflammation, and may relate to suicidality or altered somatosensory processing. The use of the UK Biobank may limit generalizability of results in populations with severe disease.
Collapse
|
7
|
Controne I, Scoditti E, Buja A, Pacifico A, Kridin K, Fabbro MD, Garbarino S, Damiani G. Do Sleep Disorders and Western Diet Influence Psoriasis? A Scoping Review. Nutrients 2022; 14:nu14204324. [PMID: 36297008 PMCID: PMC9608488 DOI: 10.3390/nu14204324] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022] Open
Abstract
Western diet may trigger sleep disorders and vice versa, but their single and mutual effects on systemic inflammatory diseases (i.e., psoriasis) are far from being fully elucidated. At the same time, psoriatic patients display a great burden of sleep disorders and dysmetabolisms related to an unhealthy lifestyle (i.e., diet). These patients are also affected by a chronic disorder deeply modulated by environmental factors (i.e., sleep and diet) capable to influence drug-response and disease progression. Thus, we aimed to summarize the evidence in the literature that may highlight a potential link among psoriasis–diet–sleep in order to further promote a multidisciplinary approach to psoriatic patients in the scientific community.
Collapse
Affiliation(s)
- Ilaria Controne
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | - Egeria Scoditti
- Institute of Clinical Physiology, National Research Council (CNR), 73100 Lecce, Italy
| | - Alessandra Buja
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padova, 35128 Padova, Italy
| | - Alessia Pacifico
- Clinical Dermatology Department, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, 23562 Lübeck, Germany
| | - Massimo Del Fabbro
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- IRCCS Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal/Child Sciences (DINOGMI), University of Genoa, 16132 Genoa, Italy
| | - Giovanni Damiani
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-02-662141
| |
Collapse
|
8
|
Matching-Adjusted Indirect Comparison of Long-Term Efficacy and Safety Outcomes for Calcipotriol Plus Betamethasone Dipropionate Foam Versus Halobetasol Proprionate Plus Tazarotene Lotion in the Treatment of Plaque Psoriasis. Dermatol Ther (Heidelb) 2022; 12:2589-2600. [PMID: 36223060 PMCID: PMC9588120 DOI: 10.1007/s13555-022-00824-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/26/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction To date, there have been no head-to-head clinical studies comparing calcipotriol 0.005% plus betamethasone dipropionate 0.064% (Cal/BD) aerosol foam and halobetasol propionate 0.01% plus tazarotene 0.045% (HP/Taz) lotion for the treatment of plaque psoriasis. However, the efficacy of 4 weeks of Cal/BD foam and 8 weeks of HP/Taz lotion has been compared using a matching-adjusted indirect comparison (MAIC) approach. Here, we compare the efficacy and safety of Cal/BD foam and HP/Taz lotion for up to 52 weeks. Methods An unanchored MAIC was conducted using individual patient data from the PSO-LONG Cal/BD foam trial and a 52-week, open-label phase 3 study of HP/Taz lotion (NCT02462083). Key outcomes of interest were Physician’s Global Assessment (PGA) success (PGA 0/1 with ≥ 2-point improvement) after 4 or 8 weeks of open-label therapy; the proportion of patients who had body surface area affected (BSA) ≤ 3 after open-label therapy who maintained BSA ≤ 3 to week 52; and adverse events (AEs). Results After matching, patients were statistically significantly more likely to have PGA success after 4 weeks of Cal/BD foam than after 8 weeks of HP/Taz lotion (84.5% versus 54.4%; p < 0.01). At week 52, 92.5% and 92.4% of patients receiving proactive and reactive Cal/BD foam, respectively, maintained BSA ≤ 3, compared with 49.3% of those treated with HP/Taz lotion (both p < 0.01). Treatment-related AEs, AEs leading to withdrawal, and AEs associated with drug application (dermatitis, application site pain, and pruritus) were significantly rarer with Cal/BD foam than with HP/Taz lotion (all p < 0.01). Conclusions Cal/BD aerosol foam demonstrated significantly greater efficacy than HP/Taz lotion, and had a more favorable safety profile, compared with HP/Taz lotion, for up to 52 weeks. Proactive Cal/BD foam maintenance therapy and reactive use of Cal/BD foam following relapse both had significant advantages over HP/Taz lotion. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-022-00824-9.
Collapse
|
9
|
Huang J, Choo YJ, Smith HE, Apfelbacher C. Quality of life in atopic dermatitis in Asian countries: a systematic review. Arch Dermatol Res 2022; 314:445-462. [PMID: 34086064 PMCID: PMC9162971 DOI: 10.1007/s00403-021-02246-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/22/2021] [Indexed: 11/28/2022]
Abstract
Atopic dermatitis (AD) is a common chronic inflammatory skin condition which impacts psychological wellbeing and social relationships. There have been studies of AD's impact on quality of life (QoL) in Western countries, but these findings cannot be directly extrapolated to Asian populations with genetic, environmental and cultural differences. Therefore, we aimed to systematically review the literature pertaining to QoL impairment in AD in East and Southeast Asia to characterize the impact of AD on patients and their families, and to identify the factors affecting the degree of QoL impairment. A search of English language papers was conducted on MEDLINE, EMBASE, PSYCInfo, Global Health and Web of Science. Observational studies measuring QoL using single or multi-item instruments in people with self-reported or physician diagnosed atopic dermatitis were included. 27 studies from 29 articles were included and synthesized. There is data documenting QoL impairment in AD sufferers and their families, across a wide range of Asian countries, healthcare settings and ages. Aspects of QoL impacted to a greater extent included symptoms of itch, feelings of embarrassment, and sleep disturbance. Severity of disease affects the degree of impairment of QoL, but there is no apparent link between QoL impairment and patient demographic factors, or other medical factors such as age at diagnosis or duration of illness. Our findings also highlighted the need for clinicians to actively explore the impact of patient's symptoms, especially in an Asian context where healthcare communications are traditionally doctor-centric.
Collapse
Affiliation(s)
- Jinghui Huang
- Department of Family Medicine and Primary Care, Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Yue Jia Choo
- Department of Family Medicine and Primary Care, Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Helen Elizabeth Smith
- Department of Family Medicine and Primary Care, Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Christian Apfelbacher
- Department of Family Medicine and Primary Care, Nanyang Technological University, Lee Kong Chian School of Medicine, Singapore, Singapore.
- Institute of Social Medicine and Health Systems Research, Otto Von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| |
Collapse
|
10
|
Chicharro P, Llamas-Velasco M, Armesto S, Herrera-Acosta E, Vidal D, Vilarrasa E, Rivera R, De la Cueva P, Martorell A, Ballescà F, Belinchón I, Carretero G, Rodríguez L, Romero-Maté A, Pujol-Montcusí J, Salgado L, Sahuquillo-Torralba A, Coto-Segura P, Baniandrés O, Feltes R, Alsina M, Daudén E. Fast and sustained Improvement of Patient-reported outcomes in psoriatic patients treated with secukinumab in a daily practice setting. Dermatol Ther 2022; 35:e15653. [PMID: 35731640 DOI: 10.1111/dth.15653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Abstract
Psoriasis is a chronic dermatological disease with great impact on patients' quality of life (QoL). The main objective of this study was to assess the impact of secukinumab treatment on different patient-reported outcomes (PROs) during a long-term follow-up in Spanish patients with moderate-to-severe psoriasis under real-world conditions. Retrospective, observational, open-label, nationwide multicenter cohort study that included patients who initiated treatment with secukinumab in daily clinical practice conditions. PROs assessing disease impact and QoL included Dermatology Life Quality Index (DLQI), Patient's Global Psoriasis Assessment, Itch Numerical Rating Scale and EuroQoL Thermometer Visual Analogue Scale. Outcomes, including PROs and Psoriasis Area and Severity Index (PASI), were assessed at months 3, 6, 12, 18 and 24 during treatment. A total of 238 patients were enrolled in the study. Patients had a mean DLQI score of 14.9 at baseline; 78.3%, 73.7% and 71.7% of them achieved a DLQI 0/1 response at months 6, 12 and 24, respectively. DLQI score was lower in the long term for naïve patients. A sharp decrease in mean DLQI was observed during the first three months, reaching a plateau that was maintained until the end of follow-up. Similar findings were observed for the rest of QoL assessments. There was a close association between improvement in QoL and skin clearance (PASI), which progressively increased during follow-up. In this study, secukinumab sustainably improved patient's QoL during a 24-month follow-up, with strongest effects in patients naïve to biological therapies and with a direct correlation with PASI improvement. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Pablo Chicharro
- Department of Dermatology, Hospital Universitario de la Princesa, Madrid
| | - Mar Llamas-Velasco
- Department of Dermatology, Hospital Universitario de la Princesa, Madrid
| | - Susana Armesto
- Department of Dermatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - David Vidal
- Department of Dermatology, Hospital de Sant Joan Despí Moisés Broggi, Barcelona
| | - Eva Vilarrasa
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona
| | - Raquel Rivera
- Department of Dermatology, Hospital Universitario 12 de Octubre, Madrid
| | - Pablo De la Cueva
- Department of Dermatology, Hospital Universitario Infanta Leonor, Madrid
| | | | - Ferran Ballescà
- Department of Dermatology, Hospital Universitario Germans Trias i Pujol, Barcelona
| | - Isabel Belinchón
- Department of Dermatology, Hospital General Universitario de Alicante - ISABIAL, Alicante, Spain
| | - Gregorio Carretero
- Department of Dermatology, Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Lourdes Rodríguez
- Department of Dermatology, Hospital Universitario Virgen del Rocío, Sevilla
| | | | - Josep Pujol-Montcusí
- Department of Dermatology, Hospital Universitario de Tarragona "Joan XXIII", Tarragona, Spain
| | - Laura Salgado
- Department of Dermatology, Complejo Hospitalario Universitario, Pontevedra, Spain
| | - Antonio Sahuquillo-Torralba
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Instituto de Investigación Sanitária La Fe, Valencia
| | - Pablo Coto-Segura
- Department of Dermatology, Hospital Vital Alvarez-Buylla de Mieres, Asturias, Spain
| | - Ofelia Baniandrés
- Department of Dermatology, Hospital General Universitario Gregorio Marañón, Madrid
| | - Rosa Feltes
- Department of Dermatology, Hospital Universitario la Paz, Madrid
| | - Mercè Alsina
- Department of Dermatology, Hospital Clínic i Provincial, Barcelona
| | - Esteban Daudén
- Department of Dermatology, Hospital Universitario de la Princesa, Madrid
| |
Collapse
|
11
|
Halioua B, Chelli C, Misery L, Taieb J, Taieb C. Sleep Disorders and Psoriasis: An Update. Acta Derm Venereol 2022; 102:adv00699. [PMID: 35191513 PMCID: PMC9574693 DOI: 10.2340/actadv.v102.1991] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Psoriasis alters patients’ quality of life. Among the disorders associated with psoriasis, sleep disorders are common, although they are not directly assessed by most quality-of-life scores. Thus, the specific evaluation of sleep disorders using dedicated scores is necessary, especially because such disorders alter patients;’ physical and psychological health. The relationship between psoriasis and sleep disorders has been shown in numerous studies, but has not yet been fully elucidated. The aim of this study was to update knowledge of sleep disorders in patients with psoriasis, through a review of the scientific literature since 1980. This work covers several topics of interest, such as sleep assessment methods, the prevalence of sleep disorders in patients with psoriasis, factors predictive of sleep disorders in patients with psoriasis, the impact of sleep disorders on comorbidities and quality of life, pathogenic mechanisms, obstructive sleep apnoea and restless leg syndromes, and the impact of biotherapy treatments on sleep disorders in patients with psoriasis.
Collapse
|
12
|
Wren GH, Humby T, Thompson AR, Davies W. Mood symptoms, neurodevelopmental traits, and their contributory factors in X-linked ichthyosis, ichthyosis vulgaris and psoriasis. Clin Exp Dermatol 2022; 47:1097-1108. [PMID: 35104372 PMCID: PMC9314151 DOI: 10.1111/ced.15116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 11/28/2022]
Abstract
Background High rates of adverse mood/neurodevelopmental traits are seen in multiple dermatological conditions, and can significantly affect patient quality of life. Understanding the sex‐specific nature, magnitude, impact and basis of such traits in lesser‐studied conditions like ichthyosis, is important for developing effective interventions. Aim To quantify and compare relevant psychological traits in men with X‐linked ichthyosis (XLI, n = 54) or in XLI carrier women (n = 83) and in patients with ichthyosis vulgaris (IV, men n = 23, women n = 59) or psoriasis (men n = 30, women n = 122), and to identify factors self‐reported to contribute most towards depressive, anxious and irritable phenotypes. Methods Participants recruited via relevant charities or social media completed an online survey of established questionnaires. Data were analysed by sex and skin condition, and compared with general population data. Results Compared with the general population, there was a higher rate of lifetime prevalence of mood disorder diagnoses across all groups and of neurodevelopmental disorder diagnoses in the XLI groups. The groups exhibited similarly significant elevations in recent mood symptoms (Cohen d statistic 0.95–1.28, P < 0.001) and neurodevelopmental traits (d = 0.31–0.91, P < 0.05) compared with general population controls, and self‐reported moderate effects on quality of life and stigmatization. There were strong positive associations between neurodevelopmental traits and recent mood symptoms (r > 0.47, P < 0.01), and between feelings of stigmatization and quality of life, particularly in men. Numerous factors were identified as contributing significantly to mood symptoms in a condition or sex‐specific, or condition or sex‐independent, manner. Conclusion We found that individuals with XLI, IV or psoriasis show higher levels of mood disorder diagnoses and symptoms than matched general population controls, and that the prevalence and severity of these is similar across conditions. We also identified a number of factors potentially conferring either general or condition‐specific risk of adverse mood symptoms in the three skin conditions, which could be targeted clinically and/or through education programmes. In clinical practice, recognizing mood/neurodevelopmental problems in ichthyosis and psoriasis, and addressing the predisposing factors identified by this study should benefit the mental health of affected individuals.
Collapse
Affiliation(s)
| | - Trevor Humby
- School of Psychology, Cardiff University, Cardiff, UK
| | - Andrew R Thompson
- School of Psychology, Cardiff University, Cardiff, UK.,South Wales Clinical Psychology Doctoral Programme, Cardiff, Vale University Health Board, Cardiff, UK
| | - William Davies
- School of Psychology, Cardiff University, Cardiff, UK.,Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK.,MRC Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| |
Collapse
|
13
|
Khatoon F, Husain N, Jabeen A, Uddin Q, Azahar M, Qureshi A, Khan AA. Psoriasis with special reference to Unani medicine – A review. OPEN HEALTH 2022; 3:124-140. [DOI: 10.1515/openhe-2022-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Abstract
Background. Psoriasis is a chronic and recurrent inflammatory skin disorder that affects about 125 million people worldwide. Patients with psoriasis are more likely to develop inflammatory arthritis, cardiometabolic disease, and mental health issues. Psoriasis remains incurable and recurrent despite the availability of contemporary treatments. Unani (Greco-Arabic) medicine has its unique concept of psoriasis; numerous treatments and formulations are prescribed by renowned Unani scholars.
Objective. This study sought to provide an understanding of psoriasis in conventional medicine, as well as clinically equivalent conditions documented by ancient Unani academics in their writings, such as Rūfas, Jālinūs, Rāzī, Ibn Sīna, Majūsi, Ibn-i Zuhr, Ibn al- Quf, and Ibn-i Hubal Baghdādi.
Methods. The Unani classical literature was researched manually and online for this purpose. PubMed, Science Direct, and Google Scholar were utilized to assemble all the classic and contemporary psoriasis disease-related literature.
Results. Since antiquity, Unani scholars have advocated ‘Ilāj bi’l Ghiḍhā (diet therapy), ‘Ilāj bi’l- Tadbīr (regimenal therapy), ‘Ilāj bi’l Dawā (drug therapy) to treat disorders clinically comparable to psoriasis.
Conclusion. This study provided a comprehensive evaluation of existing psoriasis knowledge, with an emphasis on Unani medicine, which may be valuable for generating integrated hypotheses to treat the psoriasis challenge.
Collapse
Affiliation(s)
- Faiza Khatoon
- Department of Moalajat (Medicine), National Research Institute of Unani Medicine, for Skin Disorders (NRIUMSD) Hyderabad - , India
| | - Nazim Husain
- Department of Moalajat (Medicine) , Luqman Unani Medical College Hospital and Research Center , Bijapur, Karnataka- 586101 , India
| | - Arzeena Jabeen
- Department of Moalajat (Medicine), National Research Institute of Unani Medicine, for Skin Disorders (NRIUMSD) Hyderabad - , India
| | - Qamar Uddin
- Department of Moalajat (Medicine), National Research Institute of Unani Medicine, for Skin Disorders (NRIUMSD) Hyderabad - , India
| | - Mohd Azahar
- Rajasthan Unani Medical College and Hospital , Jaipur , Rajasthan , , India
| | - Arshad Qureshi
- Department of Ilmul Advia (Pharmacology) National Research Institute of Unani Medicine, for Skin Disorders (NRIUMSD) Hyderabad - , India
| | - Asif Ahmad Khan
- Department of Moalajat (Medicine), National Research Institute of Unani Medicine, for Skin Disorders (NRIUMSD) Hyderabad - , India
| |
Collapse
|
14
|
Huet F, Taieb C, Corgibet F, Brenaut E, Richard MA, Misery L. Pruritus, Pain, and Depression Associated with the Most Common Skin Diseases: Data from the French Study "Objectifs Peau". Dermatology 2021; 238:448-453. [PMID: 34515100 DOI: 10.1159/000518220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/26/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The prevalence and impact of pruritus, pain, and other sensory symptoms in skin diseases are poorly known. OBJECTIVE To assess the frequency of these symptoms with dermatoses and their association with depression using data from the "Objectifs Peau" survey. METHODS A representative sample of 20,012 French individuals was created using the usual quota method. RESULTS When patients suffered from both pruritus and skin pain, they had a higher relative risk of psychological suffering (2.9) than those who suffered only from pruritus (1.4) or skin pain (1.2). Pruritus was reported in 48.55% of patients with acne, 43.24% with mycoses, 44.35% with warts, and 36.51% with rosacea. For skin pain, the results were 11.22%, 27.59%, and 16.13% for atopic dermatitis, acne, and warts, respectively. Other unpleasant sensations, such as tingling or burning, were also frequently reported. CONCLUSION Pruritus, pain, or other sensory symptoms were found to be common not only in classic pruritic skin diseases but also in acne, rosacea, or warts. The association of pruritus and pain dramatically increased psychological suffering. These symptoms must be systematically searched for in patients, especially since new therapeutic possibilities are emerging for the symptomatic treatment of pruritus.
Collapse
Affiliation(s)
- Flavien Huet
- Société Française de Dermatologie (SFD), Paris, France.,Service de Dermatologie, CHRU de Brest, Brest, France.,Univ Brest, LIEN, Brest, France
| | - Charles Taieb
- Société Française de Dermatologie (SFD), Paris, France
| | - Florence Corgibet
- Société Française de Dermatologie (SFD), Paris, France.,Fédération Française de Formation Continue et d'Evaluation en Dermatologie-Vénéréologie (FFFCED), Paris, France
| | - Emilie Brenaut
- Société Française de Dermatologie (SFD), Paris, France.,Service de Dermatologie, CHRU de Brest, Brest, France.,Univ Brest, LIEN, Brest, France.,Collège des Enseignants en Dermatologie de France (CEDEF), Paris, France
| | - Marie-Aleth Richard
- Société Française de Dermatologie (SFD), Paris, France.,Collège des Enseignants en Dermatologie de France (CEDEF), Paris, France.,Service de Dermatologie, CHU Timone, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Laurent Misery
- Société Française de Dermatologie (SFD), Paris, France.,Service de Dermatologie, CHRU de Brest, Brest, France.,Univ Brest, LIEN, Brest, France.,Collège des Enseignants en Dermatologie de France (CEDEF), Paris, France
| |
Collapse
|
15
|
Pan KT, Li IH, Kao HH, Chen YH, Zhong PX, Kao LT. Association of Benzodiazepine Receptor Agonist Use With Changes in Psoriasis Severity in Adult Population: A Population-Based Study. Front Pharmacol 2021; 12:596375. [PMID: 34290604 PMCID: PMC8287000 DOI: 10.3389/fphar.2021.596375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
To date, it remains uncertain whether benzodiazepine receptor agonists (BZRAs) are aggravating factors even though these drugs can elevate the levels of biomarkers associated with the development of psoriasis. Therefore, this study aimed to investigate the association of BZRA use with changes in psoriasis severity. All data were sourced from the National Health Insurance system in Taiwan. We conducted a population-based retrospective cross-sectional study of 15,727 psoriasis patients who received BZRAs (BZRA users), and 18,856 psoriasis patients who did not receive BZRAs (nonusers). At least a 1-year washout period without any BZRA prescriptions was required. The main outcome was the change in psoriasis severity between before and after BZRA exposure. This study detected the exacerbation of psoriasis severity in mild psoriasis population by using a logistic model. Then, this study carried another logistic model among those patients who had severe psoriasis to calculate the odds ratios (ORs) for the improvement of the psoriasis severity. Among patients with mild psoriasis, BZRA users had a significantly higher probability of psoriasis severity exacerbation (IPTW-adjusted OR = 1.46). Mild psoriasis patients who received high and low doses of BZRAs had 1.70- and 1.39-fold higher probabilities of psoriasis severity exacerbation, respectively, than the non-users. Furthermore, in the severe psoriasis population, more low-dose BZRA users improved psoriasis severity than non-users. In conclusion, this study provided clinical evidence of the effects of BZRA use on patients with psoriasis severity. Among patients with mild psoriasis, high-dose BZRA users may be associated with the changes in psoriasis severity. However, low-dose BZRA exposure only slightly exacerbated disease severity among patients with mild psoriasis. Accordingly, clinicians should evaluate the risks and benefits of the BZRA usage.
Collapse
Affiliation(s)
- Ke-Ting Pan
- Institute of Environmental Design and Engineering, Bartlett School, UCL, London, United Kingdom.,Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Centre, Taipei, Taiwan
| | - I-Hsun Li
- Department of Pharmacy Practice, Tri-Service General Hospital, Taipei, Taiwan.,School of Pharmacy, National Defense Medical Center, Taipei, Taiwan.,Department of Pharmacology, National Defense Medical Center, Taipei, Taiwan
| | - Hui-Han Kao
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.,Science and Technology Policy Research and Information Center, National Applied Research Laboratories, Taipei, Taiwan
| | - Yi-Hsien Chen
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Pei-Xun Zhong
- Department of Pharmacy Practice, Tri-Service General Hospital, Taipei, Taiwan.,School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
| | - Li-Ting Kao
- Department of Pharmacy Practice, Tri-Service General Hospital, Taipei, Taiwan.,School of Pharmacy, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan
| |
Collapse
|
16
|
Jaworecka K, Kwiatkowska D, Marek L, Tamer F, Stefaniak A, Szczegielniak M, Chojnacka-Purpurowicz J, Matławska M, Gulekon A, Szepietowski JC, Narbutt J, Owczarczyk-Saczonek A, Reich A. Characteristics of Pruritus in Various Clinical Variants of Psoriasis: Results of the Multinational, Multicenter, Cross-Sectional Study. Life (Basel) 2021; 11:life11070623. [PMID: 34199131 PMCID: PMC8304988 DOI: 10.3390/life11070623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/20/2021] [Accepted: 06/24/2021] [Indexed: 12/16/2022] Open
Abstract
Psoriasis is a chronic, inflammatory skin disease present in about 3% of the world’s population. The clinical symptoms manifest diversely, therefore one can distinguish several subtypes of psoriasis. The majority of patients with psoriasis experience pruritus, which is an unpleasant sensation that decreases patients’ quality of life. The knowledge on pruritus in different subtypes of psoriasis is limited. We have performed a cross-sectional, prospective, and multicenter study to evaluate the relationship between clinical subtypes of psoriasis (large-plaque, nummular, guttate, palmoplantar, inverse, erythrodermic, palmoplantar pustular, generalized pustular psoriasis, and psoriasis of the scalp) and the prevalence, intensity, and clinical manifestation of itch. We introduced a questionnaire assessing various aspects of pruritus to a total of 254 patients. Out of these, 42 were excluded. Pruritus was present in 92.9% of the remaining patients and its prevalence did not depend on the clinical subtype. A correlation between the severity of psoriasis and the intensity of itch was explicitly noticeable in palmoplantar pustular psoriasis and scalp psoriasis (p < 0.05). The itch sensation was individual and differed among subtypes of psoriasis. In conclusion, pruritus is a frequent phenomenon, and its presentation is different in various subtypes of psoriasis.
Collapse
Affiliation(s)
- Kamila Jaworecka
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland; (K.J.); (D.K.)
| | - Dominika Kwiatkowska
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland; (K.J.); (D.K.)
| | - Luiza Marek
- Department of Dermatology and Venerology, Faculty of Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland;
| | - Funda Tamer
- Department of Dermatology, Gazi University School of Medicine, 06560 Ankara, Turkey; (F.T.); (A.G.)
| | - Aleksandra Stefaniak
- Department of Dermatology, Venerology and Allergology, Wroclaw Medical University, 50-368 Wrocław, Poland; (A.S.); (J.C.S.)
| | - Magdalena Szczegielniak
- Department of Dermatology, Pediatric Dermatology and Oncology, Lodz Medical University, 91-347 Łódź, Poland; (M.S.); (J.N.)
| | - Joanna Chojnacka-Purpurowicz
- Department and Clinic of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-959 Olsztyn, Poland; (J.C.-P.); (M.M.); (A.O.-S.)
| | - Monika Matławska
- Department and Clinic of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-959 Olsztyn, Poland; (J.C.-P.); (M.M.); (A.O.-S.)
| | - Ayla Gulekon
- Department of Dermatology, Gazi University School of Medicine, 06560 Ankara, Turkey; (F.T.); (A.G.)
| | - Jacek C. Szepietowski
- Department of Dermatology, Venerology and Allergology, Wroclaw Medical University, 50-368 Wrocław, Poland; (A.S.); (J.C.S.)
| | - Joanna Narbutt
- Department of Dermatology, Pediatric Dermatology and Oncology, Lodz Medical University, 91-347 Łódź, Poland; (M.S.); (J.N.)
| | - Agnieszka Owczarczyk-Saczonek
- Department and Clinic of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-959 Olsztyn, Poland; (J.C.-P.); (M.M.); (A.O.-S.)
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland; (K.J.); (D.K.)
- Correspondence:
| |
Collapse
|
17
|
Vucemilovic AS, Puljak L. Outcome domains and measures for pain in psoriasis used in registered trials: analysis of studies on ClinicalTrials.gov. J Comp Eff Res 2021; 10:909-915. [PMID: 34111965 DOI: 10.2217/cer-2021-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Psoriasis includes unpleasant symptoms such as pain. This study aimed to investigate whether clinical trials have domains related to pain in their study designs. Materials and methods: We analyzed all clinical trials about interventions for psoriasis treatment registered on ClinicalTrials.gov and the frequency of pain-related outcomes. Results: Our analysis included 1033 registered clinical trials. They had 1329 primary outcomes and 5457 secondary outcomes. The pain was used in six (0.6%) protocols as a primary outcome and 68 (6.5%) protocols as a secondary outcome. Conclusion: Pain as an outcome was used in few registered clinical trial protocols for the treatment of psoriatic conditions. Future studies should investigate why the trialists do not include pain among primary or secondary outcomes.
Collapse
Affiliation(s)
| | - Livia Puljak
- Center for Evidence-Based Medicine & Health Care, Catholic University of Croatia, Zagreb, Croatia
| |
Collapse
|
18
|
Tas B, Kabeloglu V. Prevalence of Metabolic Syndrome and Its Parameters and Their Correlations With Psoriasis Duration, Severity, and Sleep Quality In Psoriasis Patients: A Cross-Sectional Study. Dermatol Pract Concept 2021; 11:e2021049. [PMID: 34123557 DOI: 10.5826/dpc.1103a49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 12/23/2022] Open
Abstract
Background Psoriasis is an inflammatory skin disease that may lead to comorbidities, including metabolic syndrome (MS). Objective We determined the prevalence of MS and its correlation with psoriasis duration, severity, and sleep quality in psoriasis patients. Methods A total of 112 subjects with chronic plaque psoriasis were studied. Demographics, MS parameters, disease duration, severity, and sleep quality were examined. The Psoriasis Area and Severity Index (PASI) and the Pittsburgh Sleep Quality Index (PSQI) were used to assess psoriasis severity and sleep quality, respectively. Presence of MS and its correlations with psoriasis duration, severity and sleep quality were investigated. Results Of 112 patients, 76 (67.8%) were diagnosed with MS. Of all patients, 74.1% had a high PASI, and 84.8% had a high PSQI. The mean values of psoriasis duration, body mass index, waist circumference, fasting glucose, HOMA-IR, triglyceride levels, blood pressure, PSQI, sleep latency, and daytime sleep dysfunction were significantly higher in the MS group than non-MS group, whereas the mean HDL level was lower. The prevalences of MS, high fasting glucose, and low HDL were significantly higher among female, but not male, patients with severe psoriasis (PASI >10) than those without severe psoriasis. Disease duration, high body mass index, waist circumference, blood pressure, fasting glucose, HOMA-IR, triglyceride levels, low HDL, and poor sleep quality were significantly correlated with the presence of MS. However, only waist circumference, fasting glucose, blood pressure, and low HDL were predictive of the development of MS. Conclusions MS is common among psoriasis patients, and especially in females with advanced psoriasis, high fasting glucose, and low HDL levels. Besides diagnostic criteria of MS, a long duration of psoriasis, poor sleep quality and high-HOMA-IR correlate with the development of MS. High fasting glucose and low HDL levels may facilitate MS development in association with psoriasis severity in females.
Collapse
Affiliation(s)
- Betul Tas
- Department of Dermatology and Venereology, University of Health Sciences, Istanbul Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - Vasfiye Kabeloglu
- Department of Neurology, University of Health Sciences, Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital, Istanbul, Turkey
| |
Collapse
|
19
|
Kodumudi V, Rajput K. Pain Management in Painful Psoriasis and Psoriatic Arthropathy: Challenging and Intricately Intertwined Issues Involving Several Systems. Curr Pain Headache Rep 2021; 25:36. [PMID: 33821380 DOI: 10.1007/s11916-021-00952-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Psoriasis and psoriatic arthropathy are inflammatory autoimmune conditions that can lead to profound emotional distress, social stigmatization, isolation, disfigurement, pain, disability, unemployment, and decreased quality of life. Thus, this disease has immense psychological, social, and economic implications as the pain experienced is closely associated with the primary disease burden. This review focuses on discussing the primary disease burden of psoriasis and psoriatic arthropathy, as well as management of different types of pain in these patients. RECENT FINDINGS Pain affects over 40% of patients with psoriasis, ranging from neuropathic to nociceptive. Treatment of pain largely focuses on treating the underlying disease with mild topical steroids and non-steroidal medications including vitamin D analogs followed by systemic immunomodulatory agents for more severe disease. Interventional options such as corticosteroid injections are available for select cases (conditional recommendation). Psoriasis and psoriatic arthropathy have been associated with underreporting and resultant undertreatment of pain. Pain control in these conditions is complex and requires a multidisciplinary approach. More research and guidelines are needed in the areas of reporting of psoriatic disease, associated pain, psoriatic nociception, and optimal clinical management.
Collapse
Affiliation(s)
- Vijay Kodumudi
- Yale University School of Medicine, 333 Cedar St, TMP3, CT, 06510, New Haven, USA
| | - Kanishka Rajput
- Yale University School of Medicine, 333 Cedar St, TMP3, CT, 06510, New Haven, USA.
| |
Collapse
|
20
|
Halioua B, Misery L, Seite S, Delvigne V, Chelli C, Taieb J, Taieb C. Influence of Skin Subjective Symptoms on Sleep Quality in Patients with Cutaneous Disorders: A Study of 2871 Subjects. Clin Cosmet Investig Dermatol 2021; 14:143-152. [PMID: 33603431 PMCID: PMC7886096 DOI: 10.2147/ccid.s288557] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/31/2020] [Indexed: 01/16/2023]
Abstract
Introduction Previous studies showed more sleep disturbance (SD) in patients with cutaneous disorders (CD). During CD, unpleasant subjective symptoms [USS], such as itch, pain and others (tingling, burning, or tightness) have a negative influence on sleep quality. This study aims to evaluate the prevalence of SD in CD patients and to identify the influence of itch, pain and other unpleasant sensations on SD. Materials and Methods An international, anonymized real-life survey was conducted with individuals [18−75 years], with physician-confirmed CD, or without CD. The 25 items covered sociodemographic characteristics, feeling of overall sleep quality and skin unpleasant sensations. Severity of SD and unpleasant sensations were assessed using a 10-cm Visual Analogue Scale (VAS). Results From 3834 analyzed questionnaires, 2871 (67.3%) were in the CD group and 863 (32.7%) in the control group. Patients with CD had significantly more SD (71.2% vs 32.7% in the control group, p<0.0001). CD patients without any reported unpleasant sensation were at higher risk for SD than control subjects (OR 1,362 [95% CI 1.975–2.405] p=0.0013). SS were highly associated with SD (OR 1.641 [95% CI 1.393–1.933] p<0.0001). Pruritus, pain and intermediate sensations were significant predictors of SD, with odds ratios of 1.670, 1.625 and 1.326, respectively. VAS sleep scores were strongly associated with pruritus (r: 0.25, p<0.0001) and pain (r: 0.25 p<0.0001) severity ratings. Discussion SD is a common problem for patients with CD. Patients with subjective symptoms suffer more from SD, suggesting that they are aggravating factors, but are likely not the only reason for SD in CD patients. We found that during CD, intermediate sensations also contribute to SD. Despite some limitations and the potential bias due to the study design, our results confirm for the first time on an international level the influence of subjective symptoms on sleep quality in patients with CD.
Collapse
Affiliation(s)
| | - Laurent Misery
- Univ Brest, LIEN, F-29200, Brest, France.,Department of Dermatologie, University Hospital of Brest, Brest, France
| | - Sophie Seite
- La Roche-Posay Laboratoire Dermatologique, Levallois-Perret, France
| | | | - Clara Chelli
- Department of Dermatology-Venereology, Robert-Debré Hospital, Reims, France
| | - Jonathan Taieb
- APHP, Hôtel Dieu, Centre du Sommeil et de la Vigilance, Paris, France
| | - Charles Taieb
- European Market Maintenance, Assessment, Patients Priority Department, Fontenay-sous-Bois, France.,Hôpital Necker Enfants Malades, Paris, France
| |
Collapse
|
21
|
Srivastava AK, Chand Yadav T, Khera HK, Mishra P, Raghuwanshi N, Pruthi V, Prasad R. Insights into interplay of immunopathophysiological events and molecular mechanistic cascades in psoriasis and its associated comorbidities. J Autoimmun 2021; 118:102614. [PMID: 33578119 DOI: 10.1016/j.jaut.2021.102614] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 02/07/2023]
Abstract
Psoriasis is an inflammatory skin disease with complex pathogenesis and multiple etiological factors. Besides the essential role of autoreactive T cells and constellation of cytokines, the discovery of IL-23/Th17 axis as a central signaling pathway has unraveled the mechanism of accelerated inflammation in psoriasis. This has provided insights into psoriasis pathogenesis and revolutionized the development of effective biological therapies. Moreover, genome-wide association studies have identified several candidate genes and susceptibility loci associated with this disease. Although involvement of cellular innate and adaptive immune responses and dysregulation of immune cells have been implicated in psoriasis initiation and maintenance, there is still a lack of unifying mechanism for understanding the pathogenesis of this disease. Emerging evidence suggests that psoriasis is a high-mortality disease with additional burden of comorbidities, which adversely affects the treatment response and overall quality of life of patients. Furthermore, changing trends of psoriasis-associated comorbidities and shared patterns of genetic susceptibility, risk factors and pathophysiological mechanisms manifest psoriasis as a multifactorial systemic disease. This review highlights the recent progress in understanding the crucial role of different immune cells, proinflammatory cytokines and microRNAs in psoriasis pathogenesis. In addition, we comprehensively discuss the involvement of various complex signaling pathways and their interplay with immune cell markers to comprehend the underlying pathophysiological mechanism, which may lead to exploration of new therapeutic targets and development of novel treatment strategies to reduce the disastrous nature of psoriasis and associated comorbidities.
Collapse
Affiliation(s)
- Amit Kumar Srivastava
- Department of Biotechnology, Indian Institute of Technology Roorkee, Roorkee, 247667, Uttarakhand, India
| | - Tara Chand Yadav
- Department of Biotechnology, Indian Institute of Technology Roorkee, Roorkee, 247667, Uttarakhand, India
| | - Harvinder Kour Khera
- Tata Institute for Genetics and Society, Centre at InStem, Bangalore, 560065, Karnataka, India; Division of Biological Sciences, University of California, San Diego, La Jolla, CA, 92093, United States
| | - Purusottam Mishra
- Department of Biotechnology, Indian Institute of Technology Roorkee, Roorkee, 247667, Uttarakhand, India
| | - Navdeep Raghuwanshi
- Vaccine Formulation & Research Center, Gennova (Emcure) Biopharmaceuticals Limited, Pune, 411057, Maharashtra, India
| | - Vikas Pruthi
- Department of Biotechnology, Indian Institute of Technology Roorkee, Roorkee, 247667, Uttarakhand, India
| | - Ramasare Prasad
- Department of Biotechnology, Indian Institute of Technology Roorkee, Roorkee, 247667, Uttarakhand, India.
| |
Collapse
|
22
|
Reich K, DeLozier AM, Nunes FP, Thyssen JP, Eichenfield LF, Wollenberg A, Ross Terres JA, Watts SD, Chen YF, Simpson EL, Silverberg JI. Baricitinib improves symptoms in patients with moderate-to-severe atopic dermatitis and inadequate response to topical corticosteroids: patient-reported outcomes from two randomized monotherapy phase III trials. J DERMATOL TREAT 2020; 33:1521-1530. [DOI: 10.1080/09546634.2020.1839008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- K. Reich
- Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Skinflammation® Center, Hamburg and Dermatologikum Berlin, Berlin, Germany
| | | | - F. P. Nunes
- Eli Lilly and Company, Indianapolis, IN, USA
| | - J. P. Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital and University of Copenhagen, Copenhagen, Denmark
| | - L. F. Eichenfield
- Departments of Dermatology and Pediatrics, University of California, San Diego and Rady Children’s Hospital, San Diego, CA, USA
| | - A. Wollenberg
- Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany
| | | | - S. D. Watts
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Y.-F. Chen
- Eli Lilly and Company, Indianapolis, IN, USA
| | - E. L. Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - J. I. Silverberg
- Department of Dermatology, George Washington University School of Medicine, Washington, DC, USA
| |
Collapse
|
23
|
Abstract
Purpose of the Review Skin disease is associated with obstructive sleep apnea (OSA) both epidemiologically and mechanistically. In this review we highlight conditions which have a well-established link to obstructive sleep apnea, such as psoriasis and atopic dermatitis. Recent findings We describe putative mechanistic links between OSA and skin disease involving inflammatory pathways, obesity, mechanical upper airways obstruction, and hypoxia. In the context of these mechanisms we describe specific skin conditions, and other conditions which are associated with both skin manifestations (including hair/nail findings) and OSA. The risks/ benefits of CPAP in the context of skin disease are also reviewed. Summary We conclude that further research is needed to understand the mechanisms behind the associations between OSA and skin disease. Given the frequent co-occurrence of OSA and skin conditions, there would be great benefit for OSA clinical trials to consider improvement in skin disease as an outcome measure.
Collapse
Affiliation(s)
- Vinaya Soundararajan
- University of Illinois at Chicago, Department of Internal Medicine, Chicago, IL USA
| | - Jennifer Lor
- University of Illinois at Chicago, Department of Internal Medicine, Chicago, IL USA
- Ann & Robert H. Lurie Children's Hospital Department of Allergy, Division of Pediatric Allergy & Immunology, Chicago IL, USA
| | - Anna B Fishbein
- Ann & Robert H. Lurie Children's Hospital Department of Allergy, Division of Pediatric Allergy & Immunology, Chicago IL, USA
| |
Collapse
|
24
|
Association Between Patient- and Physician-Reported Outcomes in Patients with Moderate-To-Severe Plaque Psoriasis Treated with Biologics in Real Life (PSO-BIO-REAL). Dermatol Ther (Heidelb) 2020; 10:1099-1109. [PMID: 32761560 PMCID: PMC7477065 DOI: 10.1007/s13555-020-00428-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Clinical trials have shown that psoriasis patients who achieve complete skin clearance are more likely to report no impairment in health-related quality of life (HRQoL) and no psoriasis symptoms versus patients who achieve almost complete skin clearance. However, real-world data are lacking. The objective of this study was to estimate the real-world proportion of moderate-to-severe psoriasis patients on biologic treatment who achieved a Psoriasis Symptom Inventory (PSI) total score of 0 (PSI 0; no symptoms) and a Dermatology Life Quality Index (DLQI) score of 0/1 (DLQI 0/1; no impact on HRQoL), and to study the relationship between patient-reported symptoms and HRQoL versus physician-reported psoriasis severity (Psoriasis Area and Severity Index [PASI]). Methods The PSO-BIO-REAL study was a multinational, prospective, real-world, non-interventional study that included patients aged ≥ 18 years with moderate-to-severe plaque psoriasis who had initiated biologic therapy (either biologic-naïve or had switched biologics [biologic-experienced]). Psoriasis symptoms were evaluated using the PSI, and HRQoL was assessed using the DLQI. Assessments were conducted at baseline and at 6 and 12 months after initiating biologic treatment. Associations between PSI and DLQI with PASI were evaluated using Spearman correlation coefficients. Post-hoc analyses evaluated individual PSI items and the association to PASI response, DLQI and PSI by index biologic. Results At 12 months, 25.5% of patients achieved PSI 0, and 51.2% achieved DLQI 0/1, with greater proportions achieving these scores among biologic-naïve than among biologic-experienced patients. There was a moderate-to-strong correlation between PSI and DLQI scores and PASI scores, with 64.8% of patients with absolute PASI 0 and 19.4% with absolute PASI > 0 ≤ 2 achieving PSI 0 (6 and 12 months pooled). Achievement of response varied by index biologic. Conclusion This study demonstrates that in a real-world setting patients’ QoL improves with skin clearance. The results also demonstrate that the correlation between skin clearance and improvements in HRQoL (DLQI) and psoriasis symptoms (PSI) is not complete, which highlights the importance of considering both patient- and physician-reported outcomes in the assessment of psoriasis treatment outcomes.
Collapse
|
25
|
Abstract
INTRODUCTION Psoriasis is a common chronic skin inflammatory disease. Its presentation, apart from affected skin areas, involves other unpleasant symptoms, such as pain. Pain deteriorates the patient's quality of life, impairing their daily behaviour and functioning. Therefore, the alleviation of pain in patients with psoriasis should be one of the most desired outcomes of successful treatment. The aim of this study is to summarise available evidence about pain in patients with psoriasis using systematic scoping review methodology in order to map the relevant literature. METHODS AND ANALYSES Our scoping systematic review will provide evidence synthesis of the literature, both quantitative and qualitative, about the pain associated with psoriasis, including pain associated with psoriatic arthritis. Any types of studies will be eligible for inclusion, and we will not have any time, language or publication status restrictions. We will search MEDLINE, Embase and PsycINFO via OVID, as well as Cochrane Central Register of Clinical Trials, Cochrane Database of Systematic Reviews via Cochrane Library, CINAHL via EBSCO, OpenGrey and ProQuest Dissertations and Theses Global. All databases will be searched from the date of their inception. Retrieved bibliographic records and potentially relevant full texts will be screened by two authors independently. Two researchers will extract data independently. Any discrepancies will be resolved via discussion or consultation of the third author, if necessary. To appraise studies, we will use a Mixed Methods Appraisal Tool, AMSTAR 2, Cochrane risk of bias tool and ROBINS. Our findings will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. ETHICS AND DISSEMINATION The proposed study will not be conducted with human participants. We will only use published data and therefore ethics approval is not required. Our findings will be disseminated via peer-reviewed manuscript and conference reports.
Collapse
Affiliation(s)
| | - Danijela Nujic
- Department of Public Health, Josip Juraj Strossmayer University of Osijek School of Medicine, Osijek, Osijek-Baranja, Croatia
| | - Livia Puljak
- Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Zagreb, Croatia
| |
Collapse
|
26
|
Tas B, Kabeloglu V, Soysal A, Atakli D. Sleep Quality in Psoriasis Patients and its Relations with Possible Affecting Factors. SISLI ETFAL HASTANESI TIP BULTENI 2020; 54:181-187. [PMID: 32617055 PMCID: PMC7326668 DOI: 10.14744/semb.2018.53189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 09/12/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Psoriasis (PS) is a chronic, immune-mediated inflammatory skin disease. PS may lead to significant effects on health-related quality of life (HRQoL) and other outcomes. In the present study, an investigation into sleep quality (SQ), and its possible relations with factors which may affect SQ were aimed. METHODS A total of 74 subjects from both sexes were enrolled in this study, between January and July 2017. Patients were evaluated with their demographics, body mass index (BMI), Psoriasis Area Severity Index (PASI), Pittsburgh Sleep Quality Index (PSQI), Psoriasis Quality of Life Index (PQLI), Self Perception Scale (SPS). Additionally, accompanying chronic diseases, disease duration and severity of pruritus were recorded. Obtained PSQI values were compared with the mentioned parameters concerning the significance of their relations with it. SPSS version 24, 2016 was used to analyse the data, and significance was evaluated with p-values of <0.05, 0.01, and 0.001, and rho (r) values of <0.2, =0.2-0.4, =0.4-0.6, =0.6-0.8 and >0.8. RESULTS Thirty-seven female and 37 male were studied. The mean age of total of the study population was 47.21±13.91. Mean BMI and mean duration were 30.09± 4.68 kg/m2, and 10.58±9.1 months. Mean values of PASI, PSQI, SPS, and PQLI of the study group were 19.79±16.99, 9.14±5.09, 142.12±23.83, and 21.94±16.31, respectively. Approximately thirty-one percent of them had at least one chronic disease. Alcohol and smoking rates were 17.56%, 50%. PASI was positive/strongly correlated with PQLI and negative/weakly correlated with SPS. No correlation was detected between PSQI values and age, gender, BMI, and SPS values. PSQI was moderately correlated with PQLI, diabetes mellitus (DM), and pruritus severity, whereas it was weak correlated with PASI, hypertension (HT), thyroid diseases and disease duration. PASI and DM showed a predictive effect on SQ. CONCLUSION SQ is affected by certain factors, such as QoL, disease severity, disease duration, pruritus severity, accompanying disorders, such as HT, DM and thyroid diseases, in which disease severity and DM have predictive effects on SQ in PS patients. Controls of disease activation and prevention of progression in DM may provide to keep SQ in PS.
Collapse
Affiliation(s)
- Betul Tas
- Departments of Dermatology and Venereology, University of Health Sciences, Istanbul Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Vasfiye Kabeloglu
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Istanbul, Turkey
| | - Aysun Soysal
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Istanbul, Turkey
| | - Dilek Atakli
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Istanbul, Turkey
| |
Collapse
|
27
|
Heckman CJ, Riley M, Valdes-Rodriguez R, Yosipovitch G. Development and Initial Psychometric Properties of Two Itch-Related Measures: Scratch Intensity and Impact, Sleep-Related Itch and Scratch. J Invest Dermatol 2020; 140:2138-2145.e1. [PMID: 32298670 DOI: 10.1016/j.jid.2020.03.961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/23/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Abstract
Self-report measures are needed to better understand the relationships among sleep, itching, scratching, and chronic itch conditions and their associations with disease severity, QOL, health, and functioning. Two scales related to sleep and/or scratch were recently developed and assessed in 137 patients with chronic itch and atopic dermatitis or psoriasis. The Scratch Intensity and Impact Scale consisted of two factors (scratching intensity and impact of scratching on QOL) that accounted for 64.59% of the variance with a total of 13 items, overall Cronbach's α of 0.93, and test-retest reliability of 0.66. The Sleep-Related Itch and Scratch Scale consisted of one factor that accounted for 63.01% of the variance with a total of 16 items, overall Cronbach's α of 0.98, and test-retest reliability of 0.66. Both measures demonstrated significant correlations with each other as well as other itch-related measures and nonsignificant correlations with scales hypothesized to be unrelated. The final measures demonstrated adequate preliminary psychometric characteristics. It is hoped that these scales will be used for future research and clinical purposes to help fill recognized gaps in understanding about sleep, itch, scratching, atopic dermatitis, and psoriasis.
Collapse
Affiliation(s)
- Carolyn J Heckman
- Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
| | - Mary Riley
- Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | | | - Gil Yosipovitch
- Department of Dermatology, University of Miami, Miami, Florida, USA
| |
Collapse
|
28
|
Nagarajan P, Thappa DM. Clinical Profile of Patients with Psoriasis and their Attitude Towards the Illness. EUROPEAN MEDICAL JOURNAL 2020. [DOI: 10.33590/emj/19-00176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: Psoriasis is a chronic inflammatory hyperproliferative disease of the skin and affects 0.6–4.8% of the world’s population. In addition to the skin and joint manifestations, psoriasis impairs many aspects of individual wellbeing, including emotional, physical, sexual, and financial status. Skin diseases such as psoriasis can profoundly influence a patient’s self-image, self-esteem, and sense of wellbeing. This study aimed to assess the clinical profile of patients with psoriasis and their attitude towards living with the disease.
Methods: A cross-sectional descriptive design was used. Two hundred subjects diagnosed with psoriasis were recruited through purposive sampling. A structured proforma was used to assess the clinical profile and attitude was assessed by Psoriasis Attitude Assessment Questionnaire (PSAQ).
Results: The most common type of psoriasis was chronic stable psoriasis (86.5%). A family history of psoriasis was present in 30 (15.0%) subjects. Stress was attributed to the exacerbation of disease in 90 (45.0%) subjects. Itching was reported by 124 (62.0%) subjects, and sleep disturbance was reported by 85 (42.5%) of the subjects. The majority of individuals (n: 187; 93.5%) had a moderately favourable attitude towards living with psoriasis.
Conclusion: Living with psoriasis can be difficult for patients because of the inconvenience caused by the disease in their daily life. Knowledge about the pathogenesis and treatment of psoriasis may increase the patient’s perception of control and attention to aggravating factors may increase patient’s compliance with treatment and positive lifestyle habits.
Collapse
Affiliation(s)
- Padmavathi Nagarajan
- Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Devinder Mohan Thappa
- North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India
| |
Collapse
|
29
|
Pruritus and sleep disturbances in patients with psoriasis. Arch Dermatol Res 2019; 312:103-111. [DOI: 10.1007/s00403-019-01998-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/27/2019] [Accepted: 10/03/2019] [Indexed: 02/06/2023]
|
30
|
Smith MP, Ly K, Thibodeaux Q, Weerasinghe T, Beck K, Shankle L, Armstrong AW, Boas M, Bridges A, Doris F, Gelfand JM, Lafoy B, Orbai AM, Takeshita J, Truman S, Wan MT, Wu JJ, Siegel MP, Bell SJ, Bhutani T, Liao W. Factors Influencing Sleep Difficulty and Sleep Quantity in the Citizen Pscientist Psoriatic Cohort. Dermatol Ther (Heidelb) 2019; 9:511-523. [PMID: 31177381 PMCID: PMC6704222 DOI: 10.1007/s13555-019-0306-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Sleep is essential for overall health and well-being, yet more than one-third of adults report inadequate sleep. The prevalence is higher among people with psoriasis, with up to 85.4% of the psoriatic population reporting sleep disruption. Poor sleep among psoriasis patients is particularly concerning because psoriasis is independently associated with many of the same comorbidities as sleep dysfunction, including cardiovascular disease, obesity, and depression. Given the high prevalence and serious consequences of disordered sleep in psoriasis, it is vital to understand the nature of sleep disturbance in this population. This study was designed to help meet this need by using survey data from Citizen Pscientist, an online patient portal developed by the National Psoriasis Foundation. METHODS Our analysis included 3118 participants who identified as having a diagnosis by a physician of psoriasis alone or psoriasis with psoriatic arthritis. Demographic information, psoriasis severity and duration, sleep apnea status, smoking and alcohol consumption, itch timing, and sleep characteristics were included. Two separate multivariate logistic regression models in STATA were used to determine whether the presence of psoriatic arthritis, age, gender, body mass index, comorbid sleep apnea, psoriasis severity, timing of worst itch, smoking status, or high-risk alcohol consumption were associated with sleep difficulty or low sleep quantity, defined by the American Academy of Sleep Medicine as less than 7 h of sleep per night on average. RESULTS Results from the multivariate logistic regressions found that sleep difficulty was associated with psoriatic arthritis (OR 2.15, 95% CI [1.79-2.58]), female gender (2.03 [1.67-2.46]), obese body mass index (BMI ≥ 30) (1.25 [1.00-1.56]), sleep apnea (1.41 [1.07-1.86]), psoriasis severity of moderate (1.59 [1.30-1.94]) or severe (2.40 [1.87-3.08]), and smoking (1.60 [1.26-2.02]). Low sleep quantity was associated with obese BMI (1.62 [1.29-2.03]), sleep apnea (1.30 [1.01-1.68]), psoriasis severity of moderate (1.41 [1.16-1.72]) or severe (1.40 [1.11-1.76]), and smoking (1.62 [1.31-2.00]). Sleep difficulty and low sleep quantity were not associated with age, alcohol consumption, or timing of worst itch. CONCLUSION These results are potentially meaningful in several aspects. We identify an important distinction between sleep difficulty and sleep quantity in psoriatic disease, whereby having psoriatic arthritis and being female are each associated with sleep difficulty despite no association with low sleep quantity. Furthermore, there is conflicting evidence from prior studies as to whether psoriasis severity is associated with sleep difficulty, but this well-powered, large study revealed a strong, graded relationship between psoriasis severity and both sleep difficulty and low sleep quantity. Overall, our results show that both sleep difficulty and low sleep quantity were associated with multiple factors in this analysis of a large psoriatic cohort. These findings suggest that dermatologists may gather clinically useful information by screening psoriatic patients for trouble sleeping and low sleep quantity to identify potential comorbidities and to more effectively guide disease management.
Collapse
Affiliation(s)
- Mary Patricia Smith
- Department of Dermatology, University of California, San Francisco, CA, USA.
| | - Karen Ly
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Quinn Thibodeaux
- Department of Dermatology, University of California, San Francisco, CA, USA
| | | | - Kristen Beck
- Department of Dermatology, University of California, San Francisco, CA, USA
| | | | - April W Armstrong
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, OR, USA
- Department of Dermatology, University of Southern California, Los Angeles, CA, USA
| | - Marc Boas
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, OR, USA
| | - Alisha Bridges
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, OR, USA
| | - Frank Doris
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, OR, USA
| | - Joel M Gelfand
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, OR, USA
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Brian Lafoy
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, OR, USA
| | - Ana-Maria Orbai
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, OR, USA
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Junko Takeshita
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, OR, USA
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah Truman
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, OR, USA
| | - Marilyn T Wan
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, OR, USA
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jashin J Wu
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, OR, USA
- Dermatology Research and Education Foundation, Irvine, CA, USA
| | | | | | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Wilson Liao
- Department of Dermatology, University of California, San Francisco, CA, USA
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, OR, USA
| |
Collapse
|
31
|
Mostaghimi L, Hetzel S. Insomnia and other sleep complaints in inflammatory versus noninflammatory skin disorders: An observational case‐control study. Int J Dermatol 2019; 58:976-981. [DOI: 10.1111/ijd.14488] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 04/11/2019] [Accepted: 04/24/2019] [Indexed: 12/31/2022]
Affiliation(s)
| | - Scott Hetzel
- Department of Biostatistics and Medical Informatics University of Wisconsin – Madison Madison WI USA
| |
Collapse
|
32
|
Affiliation(s)
- P Magin
- Discipline of General Practice, University of Newcastle, Callaghan, NSW, Australia
| |
Collapse
|
33
|
Sleep disorders in patients with psoriasis: a cross-sectional study using non-polysomnographical methods. Sleep Breath 2019; 23:893-898. [PMID: 30859369 DOI: 10.1007/s11325-019-01820-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 02/23/2019] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Psoriasis is a chronic inflammatory skin disease which can cause sleep disturbances due to the disease itself or due to its complications. In this study, we aimed to analyze the array of sleep disturbances caused by psoriasis and to evaluate the interaction between the quality of sleep and the duration and severity of psoriasis. METHODS Study subjects included 60 patients with plaque psoriasis and 60 sex- and age-matched controls. The Psoriasis Area and Severity Index (PASI) was used to evaluate severity of disease. Body mass index (BMI), medication usage, and duration of disease were recorded. All subjects completed the Epworth Sleepiness Scale (EES), Pittsburgh Sleep Quality Index (PSQI), insomnia severity index (ISI), Berlin-sleep apnea questionnaire, and questions based on criteria of the International Restless Legs Syndrome Study Group indicating the presence of restless legs syndrome (RLS). RESULTS There were statistically significant and clinically relevant differences between the patients and controls regarding day-time sleepiness (ESS 5.3 vs 4.1, p = 0.037), sleep quality (PSQI 14.4 vs 4.9, p < 0.001), insomnia (ISI 19.7 vs 14.4, p < 0.001), sleep apnea (high risk 30% vs 7%, p = 0.01), and RLS (high risk 32% vs 0%, p < 0.001). CONCLUSIONS Patients with psoriasis experience poor sleep quality and are at markedly increased risk for insomnia, obstructive sleep apnea, and restless legs syndrome. These findings suggest the importance of evaluating patients with psoriasis for conditions that affect sleep. The study results further suggest that simple screening tools may be useful for this task.
Collapse
|
34
|
Wade R, Grosso A, South E, Rothery C, Saramago P, Schmitt L, Wright K, Palmer S. Brodalumab for the Treatment of Moderate-to-Severe Plaque Psoriasis: An Evidence Review Group Evaluation of a NICE Single Technology Appraisal. PHARMACOECONOMICS 2019; 37:131-139. [PMID: 30112635 DOI: 10.1007/s40273-018-0698-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
As part of the National Institute for Health and Care Excellence single technology appraisal process, brodalumab was assessed to determine the clinical and cost effectiveness of its use in the treatment of moderate-to-severe plaque psoriasis. The Centre for Reviews and Dissemination and the Centre for Health Economics Technology Assessment Group at the University of York were commissioned to act as the independent Evidence Review Group. This article provides a summary of the Evidence Review Group's review of the company's submission, the Evidence Review Group report and the National Institute for Health and Care Excellence Appraisal Committee's subsequent guidance issued in March 2018. The main clinical effectiveness data were derived from three well-conducted, multicentre, double-blind randomised controlled trials. The trials demonstrated that brodalumab statistically significantly reduced the severity of psoriasis and its impact on health-related quality of life, compared with placebo, at 12 weeks. In comparison with ustekinumab, statistically significantly more patients taking brodalumab had reduced psoriasis severity at 12 weeks. Psoriasis severity and quality of life also appeared improved at 52 weeks, although statistical significance was not assessed. Withdrawal rates were comparable to drug survival rates of other biological therapies and rates of adverse events were similar between brodalumab and ustekinumab. A network meta-analysis was presented, comparing brodalumab with other therapies available at the same point in the treatment pathway (i.e. in patients for whom standard systemic therapy or phototherapy is inadequately effective, not tolerated or contraindicated). The network meta-analysis ranked treatments in order of effectiveness, in terms of achieving different levels of Psoriasis Area and Severity Index response. The results indicated that brodalumab had a similar probability of response to ixekizumab, secukinumab and infliximab and a higher probability of response than ustekinumab, adalimumab, etanercept, apremilast, dimethyl fumarate and placebo. The company's economic model compared nine treatment sequences that included three lines of active therapy, consisting of brodalumab and other comparators recommended by the National Institute for Health and Care Excellence, followed by best supportive care. The sequence with brodalumab in the first-line position dominated sequences that started with adalimumab, infliximab, secukinumab and ustekinumab. The incremental cost-effectiveness ratio of the brodalumab sequence compared to less effective and non-dominated sequences ranged from £7145 (vs. the etanercept sequence) to £13,353 (vs. the dimethyl fumarate sequence) per quality-adjusted life-year gained. The incremental cost-effectiveness ratio for the more costly and effective ixekizumab sequence was £894,010 per quality-adjusted life-year gained compared to the brodalumab sequence. At a threshold of £20,000 per quality-adjusted life-year gained, the brodalumab sequence had the highest probability of being cost effective (96%). The main limitation of the company's economic model was the restrictive nature of the sequences compared. Twelve separate scenarios based on key uncertainties were explored by the Evidence Review Group. The only scenarios where brodalumab was ranked lower than first were not considered to be more appropriate or plausible than the assumptions or scenarios included in the company's base case. The treatment rankings identified in the Evidence Review Group's alternative base case were identical to those derived from the company's base case model. At the first National Institute for Health and Care Excellence Appraisal Committee meeting, the Committee concluded that brodalumab appears to be as effective as other anti-interleukin-17 agents and is cost effective, based on the discount agreed in the patient access scheme. Brodalumab is recommended as an option for treating adults with severe plaque psoriasis (defined by a total Psoriasis Area and Severity Index score of 10 or more and a Dermatology Life Quality Index score of more than 10) who have not responded to other systemic non-biological therapies. Brodalumab should be stopped at 12 weeks if the psoriasis has not responded adequately.
Collapse
Affiliation(s)
- Ros Wade
- Centre for Reviews and Dissemination, University of York, York, UK.
| | | | - Emily South
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Claire Rothery
- Centre for Health Economics, University of York, York, UK
| | - Pedro Saramago
- Centre for Health Economics, University of York, York, UK
| | | | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
| |
Collapse
|
35
|
Amanat M, Salehi M, Rezaei N. Neurological and psychiatric disorders in psoriasis. Rev Neurosci 2018; 29:805-813. [PMID: 29509545 DOI: 10.1515/revneuro-2017-0108] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 01/26/2018] [Indexed: 12/26/2022]
Abstract
Psoriasis used to be known as a skin disorder; however, it can now be considered as a systemic disease with the involvement of multiple organs. Neurological and psychiatric disorders are some of the associated problems that can be observed in patients with psoriasis. Stroke, multiple sclerosis, seizure, migraine, restless leg syndrome, Parkinson's disease, Guillain-Barré syndrome, and myasthenia gravis are the reported neurological diseases, while depression, bipolar mood disorder, anxiety, psychosis, cognitive impairment, personality disorders, sexual disorders, sleep disturbance, and eating disorders are the recognized psychiatric presentations in patients with psoriasis. Herein, the neurological and psychiatric disorders of psoriasis are described.
Collapse
Affiliation(s)
- Man Amanat
- NeuroImmunology Research Association (NIRA), Universal Scientific Education and Research Network (USERN), Tehran 14194, Iran.,Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran 1417755331, Iran
| | - Mona Salehi
- NeuroImmunology Research Association (NIRA), Universal Scientific Education and Research Network (USERN), Tehran 14194, Iran.,Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran 1417755331, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Dr. Gharib St, Keshavarz Blvd, Tehran 14194, Iran.,Department of Immunology and Biology, School of Medicine, Tehran University of Medical Sciences, Tehran 14155-6447, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Boston, MA 1419733151, USA
| |
Collapse
|
36
|
Sleep disorders in patients with psoriatic arthritis and psoriasis. Reumatologia 2018; 56:301-306. [PMID: 30505012 PMCID: PMC6263298 DOI: 10.5114/reum.2018.79501] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 09/14/2018] [Indexed: 02/06/2023] Open
Abstract
Objectives To assess and measure occurrence of sleep disorders in patients with psoriatic arthritis (PsA) and psoriasis (Ps). Material and methods The study included 62 patients with psoriatic arthritis and 52 patients with psoriasis. The measurement of sleep quality was conducted using the Pittsburgh Sleep Quality Index (PSQI), the evaluation of fatigue by the fatigue subscale of the FACIT-F questionnaire and the patient's quality of life by the Health Assessment Questionnaire (HAQ). The psoriasis severity was determined using the Psoriasis Area Severity Index (PASI) and the activity of arthritis by the disease activity score of 28 joints (DAS 28). The Visual Analogue Scale (VAS) was used to assess the severity of pain. Results Poor sleep quality was found in 67.7% of PsA patients, 57.7% in Ps patients and 14.6% within the control group. Sleeping disorders in patients with PsA and Ps were related to worse quality of life and intense fatigue. Methotrexate treatment was not related to sleeping disorders, but an improvement in sleep quality was observed in both PsA and Ps patients who were treated with anti TNF-α antibodies (p < 0.001 and p = 0.032 respectively). Following the use of the linear regression model, the following factors worsen the sleep quality in PsA: pain (R2 = 0.462, p < 0.001), tender joint count (R2 = 0.434, p < 0.001), C-reactive protein (CRP) concentration (R2 = 0.391, p < 0.001), patient's age (R2 = 0.284, p = 0.003) and duration of psoriasis (R2 = 0.166, p = 0.006). In Ps patients the factors were: severity of skin lesions (R2 = 0.329, p < 0.001), duration of psoriasis (R2 = 0.290, p = 0.004) and patient's age (R2 = 0.282, p = 0.019). Conclusions Poor sleep quality in patients with PsA or Ps is a common symptom. Sleep disorders are more frequent in patients with PsA than in those with psoriasis.
Collapse
|
37
|
Chiu HY, Wang TS, Chen PH, Hsu SH, Tsai YC, Tsai TF. Psoriasis in Taiwan: From epidemiology to new treatments. DERMATOL SIN 2018. [DOI: 10.1016/j.dsi.2018.06.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
38
|
Jensen P, Zachariae C, Skov L, Zachariae R. Sleep disturbance in psoriasis: a case-controlled study. Br J Dermatol 2018; 179:1376-1384. [PMID: 29704428 DOI: 10.1111/bjd.16702] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Sleep is essential for daytime functioning and health. Given the physical symptoms of psoriasis, a higher prevalence of sleep disorders can be expected. So far, the studies examining sleep disturbance in psoriasis have been of less-than-optimal methodological quality and with mixed results. OBJECTIVES To examine the prevalence of sleep disturbance in patients with plaque psoriasis compared with a control group, to evaluate associations with health-related quality of life (HRQoL) and examine possible disease-related predictors of disturbed sleep. METHODS We used a cross-sectional, case-controlled design. Participants included 179 consecutively recruited patients with plaque psoriasis and 105 controls. Measures included psoriasis severity (Psoriasis Area and Severity Index); HRQoL (Dermatology Life Quality Index); insomnia severity [Insomnia Severity Index (ISI)]; sleep quality [Pittsburgh Sleep Quality Index (PSQI)]; stress (Perceived Stress Scale); itch (Itch Severity Scale); and depressive symptoms (Beck Depression Inventory). Analyses included group comparisons and regression analyses to identify predictors of sleep disturbance. RESULTS A total of 25% of patients with psoriasis reported clinical insomnia (ISI > 15), compared with 10·5% of controls. In all, 53·6% of patients with psoriasis were poor sleepers (PSQI > 5), compared with 21·9% of controls. Itch was statistically significantly associated with all sleep-related outcomes. CONCLUSIONS A higher proportion of patients with psoriasis experience poor sleep than controls from the general population. Itch was the main predictor of impaired sleep. Improved control of psoriasis with decreased itch may improve sleep disturbance in psoriasis.
Collapse
Affiliation(s)
- P Jensen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900, Hellerup, Denmark
| | - C Zachariae
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900, Hellerup, Denmark
| | - L Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900, Hellerup, Denmark
| | - R Zachariae
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, Barthsgade 5, 3, DK-8200, Aarhus N, Denmark.,Department of Psychology and Behavioural Science, Aarhus University, Bartholins Allé 9, Bld. 1340, DK-8000, Aarhus C, Denmark
| |
Collapse
|
39
|
Yang PL, Matthews SW, Ward TM. Sleep Deficiency and Psoriasis: Implications for Clinical Practice. J Nurse Pract 2018. [DOI: 10.1016/j.nurpra.2017.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
40
|
Théréné C, Brenaut E, Barnetche T, Misery L. Efficacy of Systemic Treatments of Psoriasis on Pruritus: A Systemic Literature Review and Meta-Analysis. J Invest Dermatol 2018; 138:38-45. [DOI: 10.1016/j.jid.2017.05.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/17/2017] [Accepted: 05/26/2017] [Indexed: 01/08/2023]
|
41
|
Wong ITY, Chandran V, Li S, Gladman DD. Sleep Disturbance in Psoriatic Disease: Prevalence and Associated Factors. J Rheumatol 2017; 44:1369-1374. [PMID: 28620064 DOI: 10.3899/jrheum.161330] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We aimed to determine the prevalence and quality of sleep in patients with psoriatic arthritis (PsA) and those with psoriasis without PsA (PsC) followed in the same center, to identify factors associated with sleep disturbance, and to compare findings to those of healthy controls (HC). METHODS The study included 113 PsA [ClASsification for Psoriatic ARthritis (CASPAR) criteria] and 62 PsC (PsA excluded by a rheumatologist) patients and 52 HC. Clinical variables were collected using a standard protocol. The sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Other patient-reported outcomes collected included the Health Assessment Questionnaire (HAQ), Dermatology Life Quality Index, EQ-5D, Medical Outcomes Study Short Form-36 survey, patient's global assessment, and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-fatigue) scale. Statistical analyses included descriptive statistics, Wilcoxon rank-sum test, and linear regression. RESULTS The prevalence of poor sleep quality was 84%, 69%, and 50% in PsA, PsC, and HC, respectively. Total PSQI score was higher in both patients with PsA and patients with PsC compared with HC (p < 0.01) and higher in patients with PsA compared to patients with PsC (p < 0.0001). EQ-5D anxiety component, EQ-5D final, and FACIT-fatigue were independently associated with worse PSQI in patients with PsC and those with PsA (p < 0.05). Actively inflamed (tender or swollen) joints are independently associated with worse PSQI in patients with PsA (p < 0.01). CONCLUSION Patients with psoriatic disease have poor sleep quality. Poor sleep is associated with fatigue, anxiety, and lower EQ-5D. In patients with PsA, poor sleep is associated with active joint inflammation.
Collapse
Affiliation(s)
- Ian T Y Wong
- From the University of British Columbia, Vancouver, British Columbia; the Department of Medicine, Division of Rheumatology, and Department of Laboratory Medicine and Pathobiology, and the Institute of Medical Science, University of Toronto; Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, and Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,I.T. Wong, BSc (Pharmacy), Medical Student, University of British Columbia; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine, Division of Rheumatology, and Department of Laboratory Medicine and Pathobiology, and Institute of Medical Science, University of Toronto, and Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network; S. Li, MMath, Biostatistician, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, and Toronto Western Hospital, University Health Network; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, and Director of the Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, and Toronto Western Hospital, University Health Network
| | - Vinod Chandran
- From the University of British Columbia, Vancouver, British Columbia; the Department of Medicine, Division of Rheumatology, and Department of Laboratory Medicine and Pathobiology, and the Institute of Medical Science, University of Toronto; Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, and Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,I.T. Wong, BSc (Pharmacy), Medical Student, University of British Columbia; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine, Division of Rheumatology, and Department of Laboratory Medicine and Pathobiology, and Institute of Medical Science, University of Toronto, and Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network; S. Li, MMath, Biostatistician, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, and Toronto Western Hospital, University Health Network; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, and Director of the Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, and Toronto Western Hospital, University Health Network
| | - Suzanne Li
- From the University of British Columbia, Vancouver, British Columbia; the Department of Medicine, Division of Rheumatology, and Department of Laboratory Medicine and Pathobiology, and the Institute of Medical Science, University of Toronto; Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, and Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,I.T. Wong, BSc (Pharmacy), Medical Student, University of British Columbia; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine, Division of Rheumatology, and Department of Laboratory Medicine and Pathobiology, and Institute of Medical Science, University of Toronto, and Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network; S. Li, MMath, Biostatistician, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, and Toronto Western Hospital, University Health Network; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, and Director of the Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, and Toronto Western Hospital, University Health Network
| | - Dafna D Gladman
- From the University of British Columbia, Vancouver, British Columbia; the Department of Medicine, Division of Rheumatology, and Department of Laboratory Medicine and Pathobiology, and the Institute of Medical Science, University of Toronto; Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, and Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. .,I.T. Wong, BSc (Pharmacy), Medical Student, University of British Columbia; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine, Division of Rheumatology, and Department of Laboratory Medicine and Pathobiology, and Institute of Medical Science, University of Toronto, and Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network; S. Li, MMath, Biostatistician, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, and Toronto Western Hospital, University Health Network; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Senior Scientist, Krembil Research Institute, and Director of the Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, and Toronto Western Hospital, University Health Network.
| |
Collapse
|
42
|
Abstract
OBJECTIVE The main purpose of this research was to crosscheck sleep quality in patients with psoriasis with that in healthy individuals and to evaluate a possible relationship between sleep quality and disease severity in these patients. MATERIALS AND METHODS Fifty-eight patients with plaque psoriasis and 58 age- and gender-matched healthy individuals were included. The Psoriasis Area and Severity Index (PASI) scoring method was used to assess the disease severity in patients with psoriasis. The sleep quality of the participants was evaluated by the Pittsburgh Sleep Quality Index (PSQI). The sleep quality scores of the patients with psoriasis were compared to those of healthy controls. Pearson's correlation test and independent samples t-test and were used to interpret the data. RESULTS The mean disease duration was 11.1±7.4 years (mean±standard deviation), and the mean PASI was 14.1±5.3. In total, 60% of the patients with psoriasis (n=35) experienced poor sleep quality, and this frequency was considerably higher in the patients with psoriasis than in the healthy controls (p<0.000). Further, the mean PSQI in the patients with psoriasis (7.01±41.4) was higher than that in the healthy controls (4.18±2.76, p=0.000). The scores of daytime dysfunction, habitual sleep efficiency, and subjective sleep quality, which are the three components of sleep quality, were considerably higher in the patients with psoriasis than in the healthy controls (p=0.007, p=0.032, and p=0.034, respectively). CONCLUSION Our results showing impaired sleep quality and its association with disease severity in patients with psoriasis may contribute to the management of psoriasis.
Collapse
Affiliation(s)
- Mehmet Melikoglu
- Department of Dermatalogy, Atatürk University School of Medicine, Erzurum, Turkey
| |
Collapse
|
43
|
Psoriasis is associated with risk of obstructive sleep apnea independently from metabolic parameters and other comorbidities: a large hospital-based case-control study. Sleep Breath 2017; 21:949-958. [PMID: 28484896 DOI: 10.1007/s11325-017-1507-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 04/03/2017] [Accepted: 04/26/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE Obstructive sleep apnea (OSA) represents a breathing disorder during sleep with significant health consequences. Few studies have examined the prevalence of OSA in psoriatic patients and whether OSA may be associated with psoriasis risk. We aimed to explore: (1) the inverse relationship, that is whether psoriasis might represent an independent predictor of OSA and its severity considering important predisposing factors and (2) the psoriatic phenotype related to severe OSA. METHODS In a large hospital-based case-control study, we examined a total of 253 patients with OSA and a control group of 104 subjects without OSA, who underwent full nocturnal polysomnography and dermatologic examination. RESULTS The prevalence of psoriasis was significantly greater in OSA patients than in controls (p = 0.03). Psoriasis was associated with OSA risk (p = 0.04) but not severity of OSA, sleepiness severity or sleep efficiency, independently from age, gender, anthropometric features, and significant comorbidities. The phenotype of a psoriatic patient suffering from severe OSA is not different from that of a patient with severe OSA and is not associated with psoriasis severity indexes. OSA psoriatic patients were not compliant with CPAP treatment in comparison with OSA patients without psoriasis. CONCLUSION Psoriasis may represent an independent risk factor for OSA above and beyond significant comorbidities, anthropometric and metabolic parameters. Physicians should be aware of the bi-directional association of psoriasis and OSA. Managing psoriasis may be a potential target for preventing OSA as well as the potential cardiovascular mortality related to OSA and psoriasis.
Collapse
|
44
|
Abstract
Obstructive sleep apnea (OSA) is present in at least 2% of women and 4% of men, and its prevalence is increasing, because a major predisposing factor for OSA is a high body mass index. Psoriasis has the most strongly substantiated link with OSA, where the relationship may be bidirectional. Dermatologic disorders may be comorbid with OSA due to several factors: (i) the heightened proinflammatory state in OSA, which can occur independent of body mass index, and may exacerbate inflammatory dermatoses; (ii) intermittent hypoxemia may promote neovascularization and tumor growth in certain cancers, such as melanoma; (iii) obesity, present in majority of OSA patients, can be associated with a heightened proinflammatory state; (iv) upper airway obstruction due to local tumors or soft tissue swelling due to physical urticaria or angioedema; (v) acute nasal congestion in the atopic patient with allergic rhinitis; (vi) dermatologic disorders associated with other OSA risk factors (eg, acanthosis nigricans and metabolic syndrome); and (vii) a high sympathetic tone (eg, in atopic dermatitis) and resultant sleep fragmentation contributing to upper airway instability during sleep. In many instances, the dermatology patient with OSA may have other medical and psychiatric comorbidities that are also associated with increased OSA risk.
Collapse
Affiliation(s)
- Madhulika A Gupta
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, N6C 0A7, Canada; Psychmed Research, 585 Springbank Drive, Suite 101, London, Ontario, Canada, N6J 1H3.
| | - Fiona C Simpson
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, N6C 0A7, Canada; Psychmed Research, 585 Springbank Drive, Suite 101, London, Ontario, Canada, N6J 1H3
| | - Branka Vujcic
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, N6C 0A7, Canada; Psychmed Research, 585 Springbank Drive, Suite 101, London, Ontario, Canada, N6J 1H3
| | - Aditya K Gupta
- Department of Medicine, University of Toronto School of Medicine, 645 Windermere Road, London, Ontario, Canada, N5X 2P1
| |
Collapse
|
45
|
Abstract
Psoriasis is a common chronic inflammatory disease with an incidence of about 0.5-3 %. Previously psoriasis was not primarily regarded to be associated with pruritus; however, this perception has changed in recent years. Meanwhile data conclusively show that between 64 and 97 % of patients report about pruritus that can be severe in a number of cases. Apart from suffering from psoriasis, the presence of pruritus causes additional stress and leads to a significant impairment of health-related quality of life. Neurogenic inflammation at least in part contributes to the development of pruritus in psoriasis skin lesions. A number of neuropeptides including substance P and calcitonin gene related peptide can act as pro-inflammatory mediators. There is evidence for a dysbalance between κ‑ and µ‑opioid receptors in lesional skin favoring inflammation and pruritus. After clearing of psoriasis lesions, pruritus is relieved as well. Therefore, specific treatment of pruritus is not necessary in general. In cases where severe pruritus is a prominent symptom, targeted therapy with mirtazapin or doxepin or neuroleptic compounds such as pregabalin or gabapentin or drugs affecting the κ‑ und µ‑opioid receptor balance can be administered. Today the importance of pruritus as a prominent symptom of psoriasis lesions has been widely accepted. In recent and running clinical trials with new drugs, pruritus at baseline and the effect of these drugs on pruritus is always assessed. This awareness also fuels basic research about pruritus in psoriasis.
Collapse
|
46
|
Henry AL, Kyle SD, Bhandari S, Chisholm A, Griffiths CEM, Bundy C. Measurement, Classification and Evaluation of Sleep Disturbance in Psoriasis: A Systematic Review. PLoS One 2016; 11:e0157843. [PMID: 27327082 PMCID: PMC4915697 DOI: 10.1371/journal.pone.0157843] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 06/06/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Psoriasis is a long-term immune-mediated inflammatory disorder mainly, but not only, affecting skin, and is associated with significant medical and psychological morbidity. Evidence suggests that sleep is disrupted in psoriasis, however high quality empirical evidence is lacking. Given the importance of sleep for health, characterisation of sleep disruption in psoriasis is an important goal. We therefore conducted a systematic review of the sleep-psoriasis literature. METHODS Searches were conducted in Pubmed, SCOPUS and Web of Science from inception to May 2016. Studies were compared against inclusion/exclusion criteria and underwent a quality evaluation. Given the heterogeneity of studies, we conducted a narrative synthesis of the findings. RESULTS Searches revealed 32 studies which met our predetermined inclusion/exclusion criteria. Whilst 93.7% of studies reported sleep disruption in this population, ranging from 0.05% to 85.4%, many had important methodological shortcomings. Over half of all quantitative studies (54.8%; 17/31) relied on non-validated measures, contributing to heterogeneity in study findings. In those that employed valid measures, assessing sleep was often not the primary objective. We frequently found the absence of adequate sample size calculations and poor statistical reporting. CONCLUSION This review showed that in psoriasis, reported sleep rates of sleep disturbance varied substantially. Most studies lacked a hypothesis driven research question and/or failed to use validated measures of sleep. We were unable to draw firm conclusions about the precise prevalence and nature of sleep disturbance within the psoriasis population. We offer suggestions to help advance understanding of sleep disturbance in psoriasis.
Collapse
Affiliation(s)
- Alasdair L. Henry
- Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
- * E-mail:
| | - Simon D. Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Sahil Bhandari
- Manchester Medical School, University of Manchester, Manchester, United Kingdom
| | - Anna Chisholm
- Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
| | - Christopher E. M. Griffiths
- Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Christine Bundy
- Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
| |
Collapse
|
47
|
Chiu HY, Hsieh CF, Chiang YT, Tsai YW, Huang WF, Li CY, Wang TS, Tsai TF. Concomitant Sleep Disorders Significantly Increase the Risk of Cardiovascular Disease in Patients with Psoriasis. PLoS One 2016; 11:e0146462. [PMID: 26745869 PMCID: PMC4712908 DOI: 10.1371/journal.pone.0146462] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 12/17/2015] [Indexed: 01/08/2023] Open
Abstract
Background The increased rates of cardiovascular morbidity and mortality in patients with psoriasis are not adequately explained by traditional risk factors. Whether concomitant sleep disorders (SDs) modify the risk of cardiovascular disease (CVD) in patients with psoriasis remains unknown. Methods Using the Taiwan National Health Insurance Research Database (NHIRD), we conducted a cohort study to investigate the association between concomitant SDs and CVD risk in patients with psoriasis. Data from 99,628 adults who received a psoriasis diagnosis during the period from 2004 to 2010 were analyzed. Cox proportional hazards regression analysis models were used to compare the risks of ischemic heart disease (IHD) and stroke between patients with and without SDs. Results Psoriasis patients with a concomitant SD had significantly higher risks of IHD (adjusted hazard ratio [aHR], 1.25; 95% confidence interval [CI], 1.22–1.28) and stroke (aHR, 1.24; 95% CI, 1.16–1.33) as compared with psoriasis patients without SDs. All psoriasis patient subgroups, including those with mild and severe psoriasis and those with and without arthritis, had increased HRs for IHD and stroke. The increases in IHD and stroke risks conferred by SDs were proportional to the dose of hypnotics used. The effect of SDs on the risks of IHD and stroke was greater in young adults than in middle-aged and older adults. Conclusions The risks of IHD and stroke were higher for psoriasis patients with SDs than for those without SDs. Clinicians should carefully evaluate CVD risk, particularly in young patients with psoriasis.
Collapse
Affiliation(s)
- Hsien-Yi Chiu
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
- Department of Dermatology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chi-Feng Hsieh
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Ting Chiang
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Wen Tsai
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
| | - Weng-Foung Huang
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Yuan Li
- Department of Dermatology, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ting-Shun Wang
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Division of Dermatology, National Taiwan University Hospital, Yun-Lin Branch, Dou-Liou, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- * E-mail:
| |
Collapse
|
48
|
Abstract
Psoriasis is a chronic inflammatory disease associated with several comorbidities. A few decades ago, it was considered an exclusive skin disease but today it is considered a multisystem disease. It is believed that 73% of psoriasis patients have at least one comorbidity. Studies have demonstrated the association of psoriasis with inflammatory bowel disease, uveitis, psychiatric disorders, metabolic syndrome and its components and cardiovascular diseases. The systemic inflammatory state seems to be the common denominator for all these comorbidities. This work aims at presenting a review of the current literature on some new comorbidities that are associated with psoriasis as osteoporosis, obstructive sleep apnea and chronic obstructive pulmonary disease. While there is still controversy, many studies already point to a possible bone involvement in patients with psoriasis, especially in the male group, generally less affected by osteoporosis. Psoriasis and chronic obstructive pulmonary disease present some risk factors in common as obesity, smoking and physical inactivity. Besides, both diseases are associated with the metabolic syndrome. These factors could be potential confounders in the association of the two diseases. Further prospective studies with control of those potential confounders should be developed in an attempt to establish causality. Existing data in the literature suggest that there is an association between obstructive sleep apnea and psoriasis, but studies performed until now have involved few patients and had a short follow-up period. It is, therefore, premature to assert that there is indeed a correlation between these two diseases.
Collapse
Affiliation(s)
- Jackson Machado-Pinto
- Santa Casa de Belo Horizonte - Belo Horizonte (MG),
Brazil
- Faculdade de Ciências Medica de Minas Gerais
(FCMMG) - Belo Horizonte (MG), Brazil
| | - Michelle dos Santos Diniz
- Santa Casa de Belo Horizonte - Belo Horizonte (MG),
Brazil
- Universidade Federal de Minas Gerais (UFMG) - Belo
Horizonte (MG), Brazil
| | | |
Collapse
|
49
|
Geel M, Maatkamp M, Oostveen A, Jong E, Finlay A, Kerkhof P, Seyger M. Comparison of the Dermatology Life Quality Index and the Children's Dermatology Life Quality Index in assessment of quality of life in patients with psoriasis aged 16–17 years. Br J Dermatol 2015; 174:152-7. [DOI: 10.1111/bjd.14163] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2015] [Indexed: 12/21/2022]
Affiliation(s)
- M.J. Geel
- Department of Dermatology Radboud University Medical Center PO Box 9101 6500 HB Nijmegen the Netherlands
| | - M. Maatkamp
- Department of Dermatology Radboud University Medical Center PO Box 9101 6500 HB Nijmegen the Netherlands
| | - A.M. Oostveen
- Department of Dermatology Radboud University Medical Center PO Box 9101 6500 HB Nijmegen the Netherlands
| | - E.M.G.J. Jong
- Department of Dermatology Radboud University Medical Center PO Box 9101 6500 HB Nijmegen the Netherlands
| | - A.Y. Finlay
- Department of Dermatology and Wound Healing Institute of Infection and Immunity Cardiff University School of Medicine Cardiff U.K
| | - P.C.M. Kerkhof
- Department of Dermatology Radboud University Medical Center PO Box 9101 6500 HB Nijmegen the Netherlands
| | - M.M.B. Seyger
- Department of Dermatology Radboud University Medical Center PO Box 9101 6500 HB Nijmegen the Netherlands
| |
Collapse
|
50
|
Gupta MA, Simpson FC, Gupta AK. Psoriasis and sleep disorders: A systematic review. Sleep Med Rev 2015; 29:63-75. [PMID: 26624228 DOI: 10.1016/j.smrv.2015.09.003] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 09/08/2015] [Accepted: 09/09/2015] [Indexed: 01/14/2023]
Abstract
Psoriasis is an immune-mediated chronic inflammatory disorder which manifests as dermatologic lesions, and psoriatic arthritis (PsA) in about 30% of cases. Psoriasis is associated with multiple comorbidities including metabolic syndrome, hypertension, diabetes, cardiovascular events, obesity and psychiatric disorders, which can all affect the course of sleep disorders. A systematic review of the literature on the relationship between psoriasis, PsA, and formal sleep disorders identified 33 studies. There is an increased prevalence of obstructive sleep apnea (OSA) with 36%-81.8% prevalence in psoriasis versus 2%-4% in the general population. There was also an increase in the prevalence of restless legs syndrome of 15.1%-18% in psoriasis versus 5%-10% in European and North American samples. The wide variety of insomnia criteria used in studies resulted in an insomnia prevalence of 5.9%-44.8% in psoriasis, which is insufficient to show an elevated prevalence when the general population has a 10% prevalence of chronic insomnia and 30-35% prevalence of transient insomnia. There is evidence that symptoms of insomnia in psoriasis are directly mediated by pruritus and pain. Treatments that decrease the cutaneous symptoms in psoriasis were successful in mitigating insomnia, but did not show improvements in OSA where the relationship with psoriasis is multifactorial.
Collapse
Affiliation(s)
- Madhulika A Gupta
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
| | - Fiona C Simpson
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Mediprobe Research Inc., London, Ontario, Canada
| | - Aditya K Gupta
- Mediprobe Research Inc., London, Ontario, Canada; Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|