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Li SH, Cheng CY. Risks of glaucoma among individuals with psoriasis: a population-based cohort study. Clin Exp Dermatol 2024; 49:1007-1015. [PMID: 38469696 DOI: 10.1093/ced/llae073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 01/04/2024] [Accepted: 02/29/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Psoriasis is a chronic systemic disorder with ocular involvement. OBJECTIVES To evaluate the risk of glaucoma among patients with psoriasis. METHODS Participants in this cohort study were selected based on Chang Gung Research Database from 1 January 2003 to 31 December 2012. Follow-up ended on 31 December 2017. The participants in the control group were matched with the psoriasis group by sex, age and index date with a 4 : 1 ratio. The hazard ratios of glaucoma were estimated using Cox regression analysis. We also evaluated the relationship between the risk of glaucoma and systemic therapies as well as phototherapy and topical corticosteroid in patients with psoriasis. RESULTS In total, 6682 patients with psoriasis and 26 728 matched controls were enrolled. The study population was composed mainly of males accounting for 64.2% (21 445/33 410) of the study population. The psoriasis group had higher incidence rates than the control group for glaucoma (adjusted hazard ratio 1.405, 95% confidence interval, 1.051-1.879). Patients with psoriasis receiving psoralen-ultraviolet A (PUVA) therapy for > 200 sessions had an increased risk of glaucoma. CONCLUSIONS Patients with psoriasis had an increased risk of glaucoma. Long-term PUVA therapy raised the risk of glaucoma in people with psoriasis.
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Affiliation(s)
- Shu-Hao Li
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Yu Cheng
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Center of Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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2
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Duan K, Wang J, Chen S, Chen T, Wang J, Wang S, Chen X. Causal associations between both psoriasis and psoriatic arthritis and multiple autoimmune diseases: a bidirectional two-sample Mendelian randomization study. Front Immunol 2024; 15:1422626. [PMID: 39119335 PMCID: PMC11306030 DOI: 10.3389/fimmu.2024.1422626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/09/2024] [Indexed: 08/10/2024] Open
Abstract
Background Numerous observational studies have identified associations between both psoriasis (PsO) and psoriatic arthritis (PsA), and autoimmune diseases (AIDs); however, the causality of these associations remains undetermined. Methods We conducted a bidirectional two-sample Mendelian Randomization study to identify causal associations and directions between both PsO and PsA and AIDs, such as systemic lupus erythematosus (SLE), Crohn's disease (CD), ulcerative colitis (UC), multiple sclerosis (MS), uveitis, bullous pemphigoid (BP), Hashimoto's thyroiditis (HT), rheumatoid arthritis (RA), vitiligo, and ankylosing spondylitis (AS). The causal inferences were drawn by integrating results from four regression models: Inverse Variance Weighting (IVW), MR-Egger, Weighted Median, and Maximum Likelihood. Furthermore, we performed sensitivity analyses to confirm the reliability of our findings. Results The results showed that CD [IVW odds ratio (ORIVW), 1.11; 95% confidence interval (CI), 1.06-1.17; P = 8.40E-06], vitiligo (ORIVW, 1.16; 95% CI, 1.05-1.28; P = 2.45E-03) were risk factors for PsO, while BP may reduce the incidence of PsO (ORIVW, 0.91; 95% CI, 0.87-0.96; P = 1.26E-04). CD (ORIVW, 1.07; 95% CI, 1.02-1.12; P = 0.01), HT (ORIVW, 1.23; 95% CI, 1.08-1.40; P = 1.43E-03), RA (ORIVW, 1.11; 95% CI, 1.02-1.21, P = 2.05E-02), AS (ORIVW, 2.18; 95% CI, 1.46-3.27; P = 1.55E-04), SLE (ORIVW, 1.04; 95% CI, 1.01-1.08; P = 1.07E-02) and vitiligo (ORIVW, 1.27; 95% CI, 1.14-1.42; P = 2.67E-05) were risk factors for PsA. Sensitivity analyses had validated the reliability of the results. Conclusions Our study provides evidence for potential causal relationships between certain AIDs and both PsO and PsA. Specifically, CD and vitiligo may increase the risk of developing PsO, while CD, HT, SLE, RA, AS, and vitiligo may elevate the risk for PsA. Additionally, it is crucial to closely monitor the condition of PsO patients with specific AIDs, as they have a higher likelihood of developing PsA than those without AIDs. Moving forward, greater attention should be paid to PsA and further exploration of other PsO subtypes is warranted.
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Affiliation(s)
- Kexin Duan
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jingrui Wang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shaomin Chen
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Tong Chen
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiajue Wang
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shujing Wang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xinsheng Chen
- Department of Dermatology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
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Santos de Freitas RD, Feitosa AM, Bezerra de Sena E, Moreira PG, Silva JV, Posada MIP, Lima XTV. Ocular changes in patients with psoriasis. Indian J Dermatol Venereol Leprol 2024; 0:1-4. [PMID: 39152886 DOI: 10.25259/ijdvl_1129_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/02/2024] [Indexed: 08/19/2024]
Affiliation(s)
| | | | | | - Pedro Gomes Moreira
- Deparment of Ophthalmology, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Jailton Vieira Silva
- Deparment of Ophthalmology, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Marielos I Posada Posada
- Clinical Unit for Research Trials in Skin, Massachusetts General Hospital, Boston, Massachusetts, United States
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Oliveira RDC, Faneli AC, Amaral DC, Chagas JM, Guedes J, Follador I, de Oliveira MDFSP, Fernandes BF, Correia LCL. Ocular complications in adults with psoriasis: a cross-sectional study in a referral center in Brazil. Int Ophthalmol 2024; 44:215. [PMID: 38705919 PMCID: PMC11070383 DOI: 10.1007/s10792-024-03147-0] [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: 03/11/2024] [Accepted: 04/11/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE There is limited literature on the ocular manifestations in patients with psoriasis. Therefore, this study aimed to identify the prevalence of and factors associated with ocular manifestations in adults with psoriasis. METHODS This cross-sectional study included Brazilian adults with psoriasis. The dermatological evaluation included diagnosis, clinical form, Psoriasis Area and Severity Index (PASI) measurement, and location of the lesions. Patients underwent a full ophthalmological examination, including the Schirmer I test, Rose Bengala staining, and tear breakup time tests. The results were analyzed using chi-square and Pearson's linear correlation tests. RESULTS Of the 130 patients assessed, 118 (90.8%) exhibited ocular abnormalities, with meibomian gland dysfunction (MGD) being the most prevalent (59.2%), followed by dry eye disease (DED) (56.2%). A significant correlation was observed between MGD and PASI (p = 0.05), and between MGD and certain treatment modalities. DED was significantly associated with PASI (p < 0.05). Concurrent use of acitretin was identified as an independent predictor of MGD (odds ratio [OR] = 3.5, p < 0.05), whereas PASI was a protective factor against DED (OR = 0.39, p < 0.01). CONCLUSION Given the high prevalence of eye disease among individuals with psoriasis, routine ophthalmological assessments are recommended to prevent possible ocular complications.
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Affiliation(s)
| | - Adriano Cypriano Faneli
- Bahiana School of Medicine and Public Health, Rua Machado Neto, 129, Pituba, Salvador, Bahia, CEP 41830-510, Brazil.
| | - Dillan Cunha Amaral
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Jaime Guedes
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Ivonise Follador
- University Hospital Complex Professor Edgard Santos (HUPES) - Federal University of Bahia, Salvador, Brazil
| | | | | | - Luis Claudio Lemos Correia
- Bahiana School of Medicine and Public Health, Rua Machado Neto, 129, Pituba, Salvador, Bahia, CEP 41830-510, Brazil
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Esen Baris M, Kuscu Akdeniz F, Unal I, Guven Yilmaz S. Alterations in Retinal Vascularity in Severe Psoriasis. Ocul Immunol Inflamm 2024; 32:276-280. [PMID: 36731518 DOI: 10.1080/09273948.2023.2166536] [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: 09/15/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate the changes in retinal vascularity in patients with severe psoriasis. MATERIALS AND METHODS Patients with severe psoriasis [psoriasis area-severity index (PASI) >10] who did not get any systemic treatment in the last year and do not have any ocular diseases were included. All patients underwent detailed ophthalmological examination, including optical coherence tomography (OCT) and OCT angiography (OCTA). Vessel densities (VD) of Superficial (SCP) and deep (DCP) capillary plexus, foveal avascular zone (FAZ) diameter, central retinal thickness (CRT) were analyzed and compared with age-sex matched healthy adults. RESULTS Fifty-three patients (13 F, 40 M) and 56 controls (16 F, 40 M) were included in the study. VD of SCP (50.4%±3.9 vs. 51.4%±3.2) and DCP (52.6%±6.4 vs. 55.4%±5.7) were lower in psoriasis group compared to controls (p < .05). Presence of psoriatic arthritis was related with an increased CRT (p = .000), larger FAZ and decreased foveal VD in SCP (p = .01, p = .02, respectively). CONCLUSION Severe psoriasis causes a decrease in retinal blood flow and presence of psoriatic arthritis is related with decreased foveal VD.
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Affiliation(s)
- Mine Esen Baris
- Department of Ophthalmology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Funda Kuscu Akdeniz
- Department of Dermatology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Idil Unal
- Department of Dermatology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Suzan Guven Yilmaz
- Department of Ophthalmology, Ege University Faculty of Medicine, Izmir, Turkey
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6
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Randall DJ, Modersitzki NK, Vegunta S, Seay MD. Optic Disc Edema Associated With Ustekinumab Therapy. J Neuroophthalmol 2024; 44:e32-e33. [PMID: 35944121 DOI: 10.1097/wno.0000000000001685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Dustin J Randall
- Oakland University William Beaumont School of Medicine (DR), Rochester, Michigan; and John A. Moran Eye Center, University of Utah (NM, SV, MDS), Salt Lake City, Utah
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Zhang L, Wang J, Gao Y. Eyelid cleaning: Methods, tools, and clinical applications. Indian J Ophthalmol 2023; 71:3607-3614. [PMID: 37991291 PMCID: PMC10788755 DOI: 10.4103/ijo.ijo_1457_23] [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: 06/04/2023] [Accepted: 08/25/2023] [Indexed: 11/23/2023] Open
Abstract
Nowadays, people give more importance and pay closer attention to the condition of their eyelids and lid margins. This increased recognition of eyelid hygiene is due to the growing awareness that improper eyelid cleaning might lead to various ocular surface diseases such as blepharitis and meibomian gland dysfunction. These ocular surface diseases can greatly affect people's quality of life. This article reviews the latest procedures for proper eyelid cleaning, including indications, methods, tools, detergents, and clinical applications, to maintain a healthy ocular surface and assist in the treatment of dry eye and blepharitis.
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Affiliation(s)
- Ling Zhang
- Department of Ophthalmology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian Province, China
| | - Jingru Wang
- Department of Ophthalmology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian Province, China
| | - Yingying Gao
- Department of Ophthalmology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian Province, China
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Sedghi T, Torre K, Suchecki J, Rothe M. The ocular and periocular involvement of psoriasis. Clin Dermatol 2023; 41:515-522. [PMID: 37619649 DOI: 10.1016/j.clindermatol.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Ocular manifestations of psoriasis are generally underrepresented in the literature and can often be missed by clinicians. Appreciation of eye involvement in psoriasis is especially important for dermatologists and ophthalmologists who may be closely involved with treating afflicted patients. Depending on the involved site and severity of the condition, signs and symptoms of ocular psoriasis can vary from asymptomatic erythema to debilitating scarring and vision loss. Treatment is critical to prevent disease progression and to improve the quality of life for these patients. We discuss the various clinical manifestations and treatment options for ocular complications in patients with psoriasis, including specific circumstances that should trigger immediate referral to our ophthalmology colleagues.
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Affiliation(s)
- Tannaz Sedghi
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Kristin Torre
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Jeanine Suchecki
- Department of Surgery, Division of Ophthalmology, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Marti Rothe
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut, USA.
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9
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Evaluation of corneal topographic parameters in patients with psoriasis. Photodiagnosis Photodyn Ther 2023; 41:103280. [PMID: 36627067 DOI: 10.1016/j.pdpdt.2023.103280] [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: 08/29/2022] [Revised: 12/23/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND To evaluate corneal topographic parameters in patients with psoriasis. METHODS This prospective, cross-sectional study included 50 right eyes of 50 patients with psoriasis and 50 right eyes of 50 age- and sex-matched healthy individuals. Detailed dermatological and ophthalmological examinations were performed in all cases. Noninvasive tear break-up time (NIBUT), meibography, keratometry values, and high-order corneal aberrations (HOAs) were obtained using corneal topography and compared to healthy subjects. These values were also evaluated according to anti-tumor necrosis factor alpha (anti-TNF-α) use, the Psoriasis Area and Severity Index (PASI) score, psoriasis duration, and patient age. The chi-square test, Mann-Whitney U test, and Pearson correlation test were used for statistical assessment. RESULTS Lower NIBUT and higher meibomian gland loss (MGL) were detected in psoriasis patients compared to healthy controls. There were no significant differences between the groups in terms of corneal HOAs. Higher MGL was detected in patients using anti-TNF-α than in patients not using it. A positive correlation was found among topographic parameters, especially between PASI score and the patient's age. No correlations were found between the disease duration and the other parameters. CONCLUSION NIBUT and MGL are more common in psoriasis patients than in healthy subjects. The relationship between anti-TNF-α use, PASI score, patient age, and corneal parameters should be considered in the follow-up and treatment of ocular findings in psoriasis patients.
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10
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Aryanian Z, Shirzadian A, Hatami P, Roostayi GA, Najafi S, Goodarzi A. Ocular manifestations of psoriasis: An inflammatory disease beyond the skin. J Gen Fam Med 2023; 24:45-49. [PMID: 36605906 PMCID: PMC9808144 DOI: 10.1002/jgf2.576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/01/2022] [Accepted: 08/14/2022] [Indexed: 02/01/2023] Open
Abstract
Background Psoriasis is a chronic inflammatory disorder, mainly involves skin. Aims To evaluate the prevalence of ocular manifestations in Iranian patients with psoriasis, compared to healthy controls. Materials and methods Forty psoriasis patients and 40 age- and gender-matched healthy controls were enrolled in the study and underwent a comprehensive ophthalmologic assessment. Results Only meibomian gland dysfunction was significantly more common among patients with psoriasis, compared to control group (p value: 0.011). Regarding intraocular pressure (IOP), the mean values for both patients and healthy controls were within the normal range and mean IOP in patients was even lower than normal controls, although this difference was significant only for left eye (p value: 0.049). A strong positive correlation between PASI and tear meniscus height for both right and left eyes (p value: 0.005, r: 0.44 for OD and p value: 0.003, r: 0.46 for OS.) was noted. Meibomian gland dysfunction was also positively correlated with disease duration for right and left palpebras (p: 0.04, r: 0.31 for both). Conclusion Psoriasis can lead to meibomian gland dysfunction, especially in patients with long-lasting disease. Hence, dermatologists and general practitioners should be vigilant in this regard when visiting psoriasis patients, especially those who have higher PASI values or long-lasting disease.
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Affiliation(s)
- Zeinab Aryanian
- Autoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
- Department of DermatologyBabol University of Medical SciencesBabolIran
| | - Azar Shirzadian
- Department of DermatologyBabol University of Medical SciencesBabolIran
| | - Parvaneh Hatami
- Autoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
| | | | - Sadrollah Najafi
- Student Research CommitteeBabol University of Medical SciencesBabolIran
| | - Azadeh Goodarzi
- Department of Dermatology, School of Medicine, Rasool Akram Medical Complex Clinical Research Development CenterIran University of Medical SciencesTehranIran
- Skin and Stem Cell Research CenterTehran University of Medical SciencesTehranIran
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Pineda-Sierra JS, Peña-Pulgar LF, Cifuentes-González C, Rojas-Carabali W, de-la-Torre A. Uveitis and nail psoriasis in a patient without articular involvement: a case report. BMC Ophthalmol 2022; 22:384. [PMID: 36153505 PMCID: PMC9509638 DOI: 10.1186/s12886-022-02596-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to report a case of bilateral anterior non-granulomatous chronic non-infectious uveitis associated with isolated nail psoriasis without articular involvement. Case presentation A 55-year-old man with a history of open-angle glaucoma was referred to our uveitis and ocular immunology center with intraocular inflammation concordant with chronic non-infectious bilateral anterior non-granulomatous uveitis. At presentation, he had moderate inflammation in the anterior chamber bilaterally and lesions characteristic of nail psoriasis. Nail psoriasis was later confirmed by nail ultrasonography performed by a radiologist who specialized in psoriasis. Appropriate clinical and paraclinical assessments were conducted, ruling out all other possible causes of uveitis. The patient required dual systemic immunomodulatory therapy with methotrexate and adalimumab, topical anti-inflammatory drugs (steroidal and non-steroidal), and anti-glaucoma therapy to achieve satisfactory inflammatory and ocular pressure control. Discussion and conclusions This is the first report of non-infectious uveitis associated with nail compromise in a patient without other manifestations of psoriasis. Despite reports on the relationship between psoriatic disease and uveitis, there is insufficient information on clinical phenotypes associated with uveitis that could lead to later diagnosis and treatment of associated intraocular inflammation. Clinicians should be aware of all subtypes of psoriasis that increases a risk of developing uveitis in these patients.
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Bustamante-Arias A, Ruiz Lozano RE, Rodriguez-Garcia A. Dry eye disease, a prominent manifestation of systemic autoimmune disorders. Eur J Ophthalmol 2022; 32:3142-3162. [PMID: 35300528 DOI: 10.1177/11206721221088259] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Dry eye disease (DED) is arguably the most frequent ocular disease encountered in ophthalmic clinical practice. DED is frequently an underestimated condition causing a significant impact on visual function and quality of life. Many systemic autoimmune diseases (SAIDs) are related to moderate to severe DED. The main objective of this review is to enhance the awareness among ophthalmologists of the potential association of an underlying SAID in a high-risk patient with DED. METHODS An exhaustive literature search was performed in the National Library of Medicine's Pubmed, Scopus, Web of Science, and Google Scholar databases for all English language articles published until November 2021. The main keywords included "dry eye disease" associated with autoimmune, connective tissue, endocrine, gastrointestinal, hematopoietic, vascular, and pulmonary diseases. Case reports, series, letters to the editor, reviews, and original articles were included. RESULTS Although DED is frequently associated with SAIDs, its diagnosis is commonly delayed or missed, producing significant complications, including corneal ulceration, melting, scleritis, uveitis, and optic neuritis resulting in severe complications detrimental to visual function and quality of life. SAID should be suspected in a woman, 30 to 60 years old with a family history of autoimmunity, presenting with DED symptoms and extraocular manifestations including arthralgias, dry mouth, unexplained weight and hair loss, chronic fatigue, heat or cold intolerance, insomnia, and mood disorders. CONCLUSIONS Establishing the correct diagnosis and treatment of DED associated with SAIDs is crucial to avoid its significant burden and severe ocular complications.
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Affiliation(s)
- Andres Bustamante-Arias
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences. Monterrey, Mexico
| | - Raul E Ruiz Lozano
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences. Monterrey, Mexico
| | - Alejandro Rodriguez-Garcia
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences. Monterrey, Mexico
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Wu PC, Ma SH, Huang YY, Chang JY, Chang YT, Dai YX. Psoriasis and Dry Eye Disease: A Systematic Review and Meta-Analysis. Dermatology 2022; 238:876-885. [PMID: 35299172 DOI: 10.1159/000522167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/23/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Psoriasis is a chronic inflammatory skin disease with potential systemic involvement. Some evidence suggests an increased risk of dry eye in patients with psoriasis. However, the relationship between these two conditions remains unclear. The aim of our study is to investigate the association between psoriasis and dry eye disease. METHODS This meta-analysis was registered in PROSPERO (CRD42020199445) and adhered to MOOSE checklist and PRISMA guidance for all processes. PubMed, Embase, Web of Science, and Cochrane databases were searched for studies examining the association between psoriasis and dry eye disease from inception to December 13, 2020. The primary outcome was the prevalence of dry eye disease in patients with psoriasis relative to controls. The secondary outcomes were the Schirmer I test score, tear film breakup time (TBUT), and ocular surface disease index (OSDI). The risk of bias of the selected studies was assessed using the Newcastle-Ottawa Scale. RESULTS The meta-analysis showed a significant association between dry eye disease and psoriasis (OR, 8.49; 95% CI, 3.34-21.58). Moreover, patients with psoriasis had a significantly lower Schirmer I test score (MD, -2.80; 95% CI, -4.07 to -1.52), shorter TBUT (MD, -4.12; 95% CI, -5.22 to -3.02), and higher OSDI (MD, 20.15; 95% CI, 6.24-34.05; p < 0.01), compared to controls. CONCLUSIONS The current evidence supports an association between dry eye disease and psoriasis. These results suggest ophthalmologic assessment for the early recognition and management of dry eye in patients with psoriasis.
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Affiliation(s)
- Po-Chien Wu
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, .,School of Medicine, Taipei Medical University, Taipei, Taiwan,
| | - Sheng-Hsiang Ma
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Ya-Yun Huang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jin-Yu Chang
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.,Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yun-Ting Chang
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Ying-Xiu Dai
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
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14
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Köse B, Uzlu D, Erdöl H. Psoriasis and uveitis. Int Ophthalmol 2022; 42:2303-2310. [DOI: 10.1007/s10792-022-02225-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 01/09/2022] [Indexed: 02/08/2023]
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Identifying and Treating Ocular Manifestations in Psoriasis. Am J Clin Dermatol 2022; 23:51-60. [PMID: 34731450 DOI: 10.1007/s40257-021-00648-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 01/04/2023]
Abstract
Psoriasis is a chronic immune-mediated inflammatory skin condition that commonly presents with red, thickened, and scaling plaques. Given the prominent cutaneous manifestations of psoriasis, more subtle ophthalmic findings of the disease may initially go undetected, with the potential for significant ocular morbidity. Associated ocular disease can involve nearly any structure of the eye, with the eyelids most commonly being affected, resulting in relatively common signs and symptoms of ocular surface discomfort. The presence of intraocular inflammation (i.e., uveitis) or retinal involvement carry a heightened risk of vision loss, and are often more difficult to diagnose outside of the ophthalmology clinic. Early detection and treatment of ocular disease can limit morbidity and are critical to the management of these patients, which requires coordination of care between dermatologists and ophthalmologists. The objective of this article was to review the most common ocular conditions that affect psoriatic patients, when to consider referral to an ophthalmologist, and to summarize the adverse ocular effects of current psoriasis treatments.
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Role of Janus Kinase (JAK) Inhibitor in Autoimmune Ocular Inflammation: A Systematic Review. J Immunol Res 2021; 2021:2324400. [PMID: 34966823 PMCID: PMC8712175 DOI: 10.1155/2021/2324400] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/09/2021] [Accepted: 11/19/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose To evaluate the effectiveness of Janus kinase (JAK) inhibitors for the treatment of patients with autoimmune disease and associated inflammatory ocular diseases. Methods We identified relevant literature by screening the MEDLINE, PubMed, and Cochrane databases for randomized controlled trials, cohort studies, case controls, and case reports. Results Seven studies, including 11 patients, were included in the final systematic analysis. Of the 11 patients, there were 5 cases of juvenile idiopathic arthritis- (JIA-) associated uveitis, 1 case of rheumatoid arthritis- (RA-) associated keratitis, 1 case of RA-associated scleritis, 1 case of psoriasis-associated conjunctivitis, 2 cases of noninfectious scleritis, and 1 case of uveitis with suspected autoimmune disease. None of these 11 patients responded adequately to conventional treatments, including biological agents; these were all refractory cases and switched to JAK inhibitor therapy. Irrespective of whether they were suffering from uveitis, scleritis, or other types of ocular inflammation, all 11 patients showed an improvement to JAK inhibitors without significant side effects. Different types of JAK inhibitors might be associated with different responses when used to treat ocular inflammation. Conclusions JAK inhibitors may represent an alternative treatment option for patients with autoimmune ocular inflammation.
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Kemeriz F, Tugrul B, Yasar E. Evaluation of ocular psoriasis with meibography. An Bras Dermatol 2021; 97:22-27. [PMID: 34785066 PMCID: PMC8799865 DOI: 10.1016/j.abd.2021.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/24/2021] [Accepted: 05/04/2021] [Indexed: 11/23/2022] Open
Abstract
Background Previous studies has shown that dry eye test abnormalities, meibomian gland dysfunction (MGD), may occur in psoriasis. Objectives The authors aimed to evaluate the dry eye disease (DED), MGD, in psoriasis patients with meibography which is a current, objective, noninvasive method for patients with meibomian gland diseases, to investigate the relationship between disease severity and ocular involvement. Methods This study included 50 participants with psoriasis and 50 healthy individuals. All subjects were examined by the same dermatologist and referred for ophthalmological examination including meibomian gland obstruction, lid margin alterations assessment, ocular surface disease index assessment, tear film break-up time test, Schirmer test, corneal conjunctival fluorescein staining assessment. Additionally, upper and lower lids were evaluated for meibomian gland loss with meibography. Results MGD (28%), meibomian gland loss (MGL) (29.5%), upper meiboscore (0.61 ± 0.81), lower meiboscore (0.46 ± 0.61), DED (22%) were significantly higher in the psoriasis group compared with the control group (p = 0.008, p < 0.001, p = 0.027, p = 0.041, p = 0.044, respectively). There was a significant relationship between MGD and psoriasis area severity index (PASI) (p = 0.015, Odds Ratio = 1.211). There was a significant positive relationship between MGL with PASI (p < 0.001, r = 608) and psoriasis duration (p < 0.001, r = 0.547). Study limitations Smaller study group and inability to detect quality changes of meibum with meibography were limitations of the study. Conclusions Psoriasis may affect the meibomian gland morphology, may cause structural changes in meibomian glands, and as a result of these may cause MGD and DED. Therefore, ophthalmologists and dermatologists should be aware of this situation and co-evaluate the patients in this respect.
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Affiliation(s)
- Funda Kemeriz
- Department of Dermatology, Aksaray University Faculty of Medicine, Aksaray, Turkey.
| | - Burcu Tugrul
- Department of Dermatology, Health Science University Ankara City Hospital, Ankara, Turkey
| | - Erdogan Yasar
- Department of Ophthalmology, Aksaray University Faculty of Medicine, Aksaray, Turkey
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18
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Ocular manifestations of skin diseases with pathological keratinization abnormalities. Postepy Dermatol Alergol 2021; 38:14-20. [PMID: 34408561 PMCID: PMC8362792 DOI: 10.5114/ada.2021.104272] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 08/29/2019] [Indexed: 11/17/2022] Open
Abstract
Keratinization means cytodifferentiation of keratinocytes turning into corneocytes in the stratum corneum. Disorders of keratinization (hyperkeratosis, parakeratosis and dyskeratosis) are causing many dermatological diseases, including various types of ichthyoses, pachyonychia congenita, pityriasis rubra pilaris, all subtypes of psoriasis, pityriasis lichenoides, dyskeratosis congenita, leukoplakia and keratosis follicularis, which apart from skin lesions may affect the eye’s adnexae causing ectropion, entropion, blepharitis, madarosis, and trichiasis, the ocular surface causing keratitis, conjunctivitis, corneal ulceration and episcleritis, which in turn cause uveitis and various fundoscopic changes (proliferative retinopathy, retinal vasculopathy, macular oedema and birdshot chorioretinopathy). Knowledge of ocular symtoms associated with pathological keratinization is crucial, preventing sight-threatening complications such as corneal perforation, lagophthalmus, phthisis bulbi, retinal neovascularization, retinal vasculopathy and optic nerve atrophy. This review encourages dermatologists to monitor patients for ocular symptoms and encourage ophthalmologists to monitor patients for dermatological symptoms.
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19
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Constantin MM, Ciurduc MD, Bucur S, Olteanu R, Ionescu RA, Constantin T, Furtunescu F. Psoriasis beyond the skin: Ophthalmological changes (Review). Exp Ther Med 2021; 22:981. [PMID: 34345263 DOI: 10.3892/etm.2021.10413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 06/03/2021] [Indexed: 12/31/2022] Open
Abstract
Psoriasis is a chronic, immune-mediated inflammatory disease of unknown etiology that may be associated with abnormal T-lymphocyte function. Ocular manifestations associated with psoriasis, particularly artropathic or pustular psoriasis, usually affect men, often during exacerbations of the disease. It has been reported that eye damage tends to occur later compared with cutaneous or joint manifestations, blindness being the most disabling complication. Previous studies have focused on ophthalmic manifestations and identified several etiopathogenic mechanisms. Psoriasis may be associated with eye complications such as lesions of the eyelids, conjunctiva and others, with systemic inflammation being the main contributor. In addition, the treatment used for psoriasis may cause ocular changes. The main ophthalmic manifestations associated with psoriasis are keratoconjunctivitis sicca, blepharitis, conjunctivitis and uveitis. The treatment of uveitis, perceived as one of the most serious eye conditions, is controversial and has yet to be clearly determined. Thus, the aim of the present review was to emphasize the importance of regular eye examination for patients with psoriasis, either those receiving biological treatment or those not receiving treatment, in order to diagnose and manage the disease appropriately.
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Affiliation(s)
- Maria-Magdalena Constantin
- Third Department, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Second Department of Dermatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Maria-Diana Ciurduc
- Second Department of Dermatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Stefana Bucur
- Third Department, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Second Department of Dermatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Rodica Olteanu
- Second Department of Dermatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Razvan Adrian Ionescu
- Third Department, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Third Department of Internal Medicine and Rheumatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Traian Constantin
- Third Department, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Urology, 'Prof. Dr. Th. Burghele' Hospital, 050659 Bucharest, Romania
| | - Florentina Furtunescu
- Third Department, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Public Health and Management, National Institute of Public Health, 050463 Bucharest, Romania
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20
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Sahin AK, Etgü F, Uzun A. Assessment of central retinal thickness, choroidal thickness, and retinal nerve fiber layer in psoriasis: a spectral-domain optical coherence tomography study. BMC Ophthalmol 2021; 21:233. [PMID: 34039314 PMCID: PMC8152133 DOI: 10.1186/s12886-021-02000-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background This study aims to evaluate choroidal thickness (CT), retinal thickness, ganglion cell-inner plexiform layer (GCIPL), and retinal nerve fiber layer (RNFL) structures in psoriasis patients using optical coherence tomography (OCT). Methods This study included 33 psoriasis patients and 33 healthy individuals. Moreover, psoriasis patients who did not use any systemic anti-inflammatory treatment were evaluated. Retinal and choroidal images of the participants were obtained with spectral-domain OCT. Furthermore, CT was measured in the subfoveal, temporal, and nasal positions at 500-µm intervals to a distance of 1,500 μm from the foveal center. Results The mean psoriasis area and severity index (PASI) score was 5.70 (range, 2.40–9.00). No significant differences were found in subfoveal (p = 0.659), temporal, and nasal CT values in psoriasis patients compared with the control group (p > 0.05). Similarly, no statistically significant differences were found between the groups in terms of central retinal thickness, macular GCIPL, and RNFL (p > 0.05). Moreover, no significant correlation exists between the duration of psoriasis disease and PASI scores and OCT parameters (p > 0.05). Conclusions No significant changes in CT, ganglion cell layer, RNFL, and retinal thickness values were noted in psoriasis patients with mild to moderate mean PASI score.
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Affiliation(s)
- Asena Keles Sahin
- Department of Ophthalmology, Training and Research Hospital, Ordu University, 52000, Ordu, Turkey.
| | - Fatma Etgü
- Department of Dermatology, Training and Research Hospital, Ordu University, Ordu, Turkey
| | - Aslihan Uzun
- Department of Ophthalmology, Training and Research Hospital, Ordu University, 52000, Ordu, Turkey
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21
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Taheri AR, Allahyari E, Zeinaly M, Nikandish M. The study of dry eye and meibomian glands in psoriasis. Eur J Ophthalmol 2021; 32:11206721211007096. [PMID: 33832333 DOI: 10.1177/11206721211007096] [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: 01/14/2023]
Abstract
BACKGROUND To investigate aqueous and lipid layers of the tear film as well as meibomian gland structure by meibography in psoriatic patients in the Iranian population. METHODS This case-control study was conducted on 31 psoriasis patients and 31 controls in Birjand University of Medical Sciences in 2018. The sampling method was available from the date of approval of the proposal in the Ethics Committee until it reached the sample size. After entering the study, patients were examined individually with a slit lamp. Then, Ocular Surface Disease Index (OSDI) score assessment, Schirmer test 1, lacrimal measurement with SM tube, tear break-up time (TBUT), and meibomian glands imaging by SBM Sistemi were done. Finally, the obtained data were entered into SPSS 15 software and analyzed at a significant level of less than 0.05. RESULTS The two groups were matched according to age and gender (p = 0.39 and p = 0.80; respectively). With the exception of the SM Tube score, the mean of all tear film and meibomian glands functional and structural parameters including Schirmer test 1, TBUT, and meibography were significantly different between patients and control groups. Moreover, the proportion of abnormal OSDI (OSDI ⩾ 13) and the dry eye was significantly higher in psoriasis patients. CONCLUSIONS Psoriasis is associated with dry eye as well as meibomian glands atrophy and dysfunction.
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Affiliation(s)
- Ahmad Reza Taheri
- Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elahe Allahyari
- School of Health, Social Determinants of Health Research Center, Department of Epidemiology and Biostatistics, Birjand University of Medical Sciences, Birjand, Iran
| | - Mostafa Zeinaly
- Department of Ophthalmology, Valiasr Hospital, Birjand University of Medical Sciences, Birjand, Iran
| | - Malihe Nikandish
- Ophthalmology Department, Valiasr Hospital, Birjand University of Medical Sciences, Birjand, Iran
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22
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Goh Y, Kwan Z, Han WH, Iqbal T, Yahya F, Khang TF, Singh S. Ocular surface disease in psoriatic patients in a developing country. Int Ophthalmol 2021; 41:2139-2147. [PMID: 33788072 DOI: 10.1007/s10792-021-01771-8] [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] [Received: 07/01/2020] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate ocular surface changes among patients with psoriasis in Malaysia, a developing country in Southeast Asia. METHODS An interdisciplinary case-control study (60 psoriasis patients and 40 control subjects) to look at the differences in ocular surface manifestations between patients with psoriasis and a group of age-, gender- and ethnicity-matched healthy controls. RESULTS One hundred and twenty eyes of 60 patients with psoriasis and 80 eyes of 40 healthy controls without psoriasis were included in the study. Mild-to-moderate psoriasis was found in 42 patients (70%), while 18 patients (30%) had severe psoriasis. Psoriatic arthritis was found in 19 patients (32%). Of the 60 psoriatic patients, the prevalence of ocular involvement was 65% (39/60), in which 32% (19/60) had dry eyes, 27% (16/60) had lid margin abnormalities, 33% (20/60) had cataract, and one had history of anterior uveitis. Compared to controls, ocular surface of psoriatic patients showed more eyelid margin abnormalities, higher meibomian gland loss and lower tear film break-up time. The estimated odds ratio for dry eyes in the psoriasis group was 2.2 (95% CI: 0.8-6.9). CONCLUSION Ocular surface disorders encompassing eyelid margin abnormalities, meibomian gland loss and tear dysfunction occur at an earlier and higher rate among psoriatic patients.
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Affiliation(s)
- Yihui Goh
- Department of Ophthalmology, Faculty of Medicine, University of Malaya Eye Research Centre, University of Malaya, Lembah Pantai, 59100, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia
| | - Zhenli Kwan
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Winn Hui Han
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Tajunisah Iqbal
- Department of Ophthalmology, Faculty of Medicine, University of Malaya Eye Research Centre, University of Malaya, Lembah Pantai, 59100, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia
| | - Fariz Yahya
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Tsung Fei Khang
- Department of Ophthalmology, Faculty of Medicine, University of Malaya Eye Research Centre, University of Malaya, Lembah Pantai, 59100, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia.,Institute of Mathematical Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Sujaya Singh
- Department of Ophthalmology, Faculty of Medicine, University of Malaya Eye Research Centre, University of Malaya, Lembah Pantai, 59100, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia.
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23
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Schwade MJ, Tien L, Waller JL, Davis LS, Baer SL, Mohammed A, Young L, Kheda MF, Bollag WB. Treatment of psoriasis in end-stage renal disease patients is associated with decreased mortality: A retrospective cohort study. Am J Med Sci 2021; 362:24-33. [PMID: 33798461 DOI: 10.1016/j.amjms.2021.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/18/2021] [Accepted: 03/25/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Psoriasis impairs the quality of life of approximately 7.5 million Americans and is associated with serious comorbidities. Because of chronic vascular access and epidermal dysfunction, end-stage renal disease (ESRD) patients with psoriasis may be at greater risk for infection, and psoriasis treatment could affect this risk. METHODS A retrospective cohort analysis was performed using the United States Renal Data System from 2004-2011 to investigate the association of psoriasis with infections common to ESRD patients, as well as the effect of psoriasis treatment on infection risk as well as mortality. RESULTS A total of 8,911 psoriasis patients were identified. Psoriasis was associated with a significantly increased risk for all queried infections, especially cellulitis (adjusted relative risk = 1.55), conjunctivitis (1.47), and onychomycosis (1.36). Psoriasis treatment (systemic, local, and light) was associated with a significantly decreased risk of some infections. Psoriasis treatment was also correlated with a significantly decreased risk of mortality, with systemic therapies (biologics and other immunosuppressants) showing the greatest reduction (adjusted hazard ratio = 0.55). CONCLUSIONS These results suggest that psoriasis-ESRD patients may have an increased risk of infection and treatment of psoriasis is associated with a reduced risk of some infections and improved survival.
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Affiliation(s)
- Mark J Schwade
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Lillie Tien
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Jennifer L Waller
- Division of Biostatistics and Data Science, Department of Population Health Sciences, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Loretta S Davis
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia; Department of Dermatology, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Stephanie L Baer
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia; Charlie Norwood VA Medical Center, Augusta, Georgia
| | - Azeem Mohammed
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Lufei Young
- Department of Physiological and Technological Nursing, Augusta University, Augusta, Georgia
| | | | - Wendy B Bollag
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia; Department of Dermatology, Medical College of Georgia at Augusta University, Augusta, Georgia; Charlie Norwood VA Medical Center, Augusta, Georgia; Department of Physiology, Medical College of Georgia at Augusta University, Augusta, Georgia.
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24
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Ruggiero A, Fabbrocini G, Cacciapuoti S, Cinelli E, Gallo L, Megna M. Ocular Manifestations in Psoriasis Screening (OcMaPS) Questionnaire: A Useful Tool to Reveal Misdiagnosed Ocular Involvement in Psoriasis. J Clin Med 2021; 10:1031. [PMID: 33802255 PMCID: PMC7958956 DOI: 10.3390/jcm10051031] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/18/2021] [Accepted: 02/25/2021] [Indexed: 02/07/2023] Open
Abstract
Psoriasis is an immune-mediated, chronic inflammatory disease, which mainly affects the skin, although it has systemic pathological effects. Comorbidities of psoriasis include ocular disorders, which are often nonspecific or mildly symptomatic. The aim of this study was to show the importance of ocular-disease screening in psoriatic patients using the Ocular Manifestations in Psoriasis Screening (OcMaPS) questionnaire. Patients suffering from moderate-to-severe psoriasis referring at our outpatient-clinic were consecutively enrolled. Each patient was asked to complete a screening questionnaire (OcMaPS). Patients reporting ocular symptoms were referred for an ophthalmological examination. A total of 372 patients were enrolled in the study. Ocular symptoms were detected in 39 patients (10.5%), and 37 patients were referred to ophthalmological examination which confirmed the presence of ocular manifestation in 30 patients. There were three cases (10%) of uveitis, 14 (46.6%) of dry eye and 13 (43.3%) of cataract, in progress or already treated with surgery. In the remaining seven patients, no ocular manifestations were found. Ocular manifestations in psoriatic patients are not rare. It is important to be aware of ocular symptoms in psoriatic patients, screening patients (with a consultation or OcMaPS questionnaire), which leads to earlier diagnosis and treatment.
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Affiliation(s)
| | | | | | | | | | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Napoli, Italy; (A.R.); (G.F.); (S.C.); (E.C.); (L.G.)
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25
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Castellino N, Longo A, Fallico M, Russo A, Bonfiglio V, Cennamo G, Fossataro F, Fabbrocini G, Balato A, Parisi G, D'urso RM, Lacarrubba F, Musumeci ML, Alosi P, Petrillo F, Micali G, Avitabile T, Reibaldi M. Retinal Vascular Assessment in Psoriasis: A Multicenter Study. Front Neurosci 2021; 15:629401. [PMID: 33568971 PMCID: PMC7868328 DOI: 10.3389/fnins.2021.629401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 01/06/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose To investigate the vascular status of the macula in psoriasis patients without history of ocular inflammation by Optical Coherence Tomography Angiography (OCTA). Methods This prospective cross-sectional multicenter study included 55 psoriasis patients and 55 control healthy subjects. A complete eye examination and 6 mm × 6 mm OCTA imaging were performed. Retinal vascular status was evaluated by analyzing vascular density (VD) of superficial vascular plexus (superficial wVD) and deep vascular plexuses (deep wVD) in a 6 mm × 6 mm area and in foveal (superficial fVD and deep fVD) and parafoveal sectors (superficial pVD and deep pVD). In addition, foveal thickness (FT) and foveal avascular zone (FAZ) and clinical variables, including best corrected visual acuity (BCVA), intraocular pressure and refractive condition, were collected. Results BCVA, intraocular pressure and refractive condition were comparable between cases and controls. OCTA imaging showed that superficial wVD and superficial pVD were lower in the psoriasis group in comparison with controls (p = 0.009 and p = 0.01, respectively). Similarly, deep wVD and pVD were lower in the psoriasis group in comparison with control subjects (p = 0.03 and p = 0.01, respectively). In a sub-analysis of 47 patients affected by psoriasis without psoriatic arthritis, lower values of wVD and pVD in both superficial and deep capillary plexuses were registered. Conclusion OCTA is a useful tool which provides data on vascular status of the retina in psoriasis with no ocular involvement. VD data may suggest that vascular changes may occur earlier than clinical onset of posterior inflammation.
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Affiliation(s)
| | - Antonio Longo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Matteo Fallico
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Andrea Russo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Vincenza Bonfiglio
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, Palermo, Italy
| | - Gilda Cennamo
- Public Health Department, University of Naples Federico II, Naples, Italy
| | - Federica Fossataro
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Anna Balato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Guglielmo Parisi
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Rosa Maria D'urso
- Department of Surgical Science, Dermatology Clinic, University of Catania, Catania, Italy
| | - Francesco Lacarrubba
- Department of Surgical Science, Dermatology Clinic, University of Catania, Catania, Italy
| | - Maria Letizia Musumeci
- Department of Surgical Science, Dermatology Clinic, University of Catania, Catania, Italy
| | - Pietro Alosi
- Department of Ophthalmology, University of Catania, Catania, Italy
| | | | - Giuseppe Micali
- Department of Surgical Science, Dermatology Clinic, University of Catania, Catania, Italy
| | | | - Michele Reibaldi
- Department of Surgical Science, Eye Clinic, University of Turin, Turin, Italy
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Lam M, Steen J, Lu JD, Vender R. The Incidence and Prevalence of Uveitis in Psoriasis: A Systematic Review and Meta-Analysis. J Cutan Med Surg 2020; 24:601-607. [PMID: 32866042 DOI: 10.1177/1203475420952420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The systemic effects and comorbidities of psoriasis include ocular disorders, such as uveitis. Patients with psoriatic arthritis in particular have been demonstrated to have an elevated risk for developing uveitis. Presently, the risk of uveitis in psoriasis has yet to be fully elucidated and this systematic review seeks to address this gap. OBJECTIVE To examine the prevalence and incidence of uveitis in psoriasis patients compared to non-psoriasis patients. METHODS We conducted a systematic review search on MEDLINE, Embase, and CENTRAL electronic databases with no lower limit on year of publication. RESULTS Fourteen articles met our inclusion criteria, with a total of 234 143 psoriasis subjects. Two studies found that participants with severe psoriasis were at a greater risk of uveitis than those with mild psoriasis. A random-effects meta-analysis of the 3 studies, which reported risk of incidence of uveitis in psoriasis patients compared to non-psoriasis controls, found a pooled risk ratio of 1.29 (95% CI, 1.10-1.51), indicating an increased risk of uveitis in psoriasis. Three studies compared risk of uveitis in psoriatic arthritis with psoriasis-only participants, all finding that psoriatic arthritis was associated with a greater risk of uveitis. CONCLUSIONS In summary, our findings suggest that psoriasis is associated with an increased risk of uveitis, with or without psoriatic arthritis.
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Affiliation(s)
- Megan Lam
- 12362 Michael G. DeGroote School of Medicine, Hamilton, ON, Canada
| | - Jeremy Steen
- 62703 Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Justin Di Lu
- 12362 Michael G. DeGroote School of Medicine, Hamilton, ON, Canada
| | - Ronald Vender
- 3710 Department of Dermatology, McMaster University, Hamilton, ON, Canada
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Psoriasis and Risk of Uveitis: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9308341. [PMID: 32724820 PMCID: PMC7381949 DOI: 10.1155/2020/9308341] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/28/2020] [Accepted: 06/27/2020] [Indexed: 12/14/2022]
Abstract
Background Uveitis is a known ophthalmologic manifestation of seronegative spondyloarthropathy, including psoriatic arthritis. However, the data is less clear among patients with psoriasis due to the limited number of published studies. Aims To investigate whether the risk of incident and prevalent uveitis is elevated among patients with psoriasis using systematic review and meta-analysis technique. Methods The MEDLINE and EMBASE databases were searched from their inception to May 2019. Eligible studies must have included a psoriasis group and a nonpsoriasis group. Eligible studies must also have investigated for prevalent or incident uveitis, and the magnitude of difference between the study groups must have been reported. Pooled risk ratio and 95% confidence interval (CI) were calculated using random-effect generic inverse variance methods. Results Of 7,107 potentially eligible articles from the EMBASE and MEDLINE databases, 7 studies were included in the meta-analysis. Two of those studies compared the incidence, and 5 studies compared the prevalence of uveitis between the psoriasis and nonpsoriasis groups. For incident uveitis, a total of 5,865,801 patients (222,083 with psoriasis and 5,643,718 without psoriasis) were analyzed. For prevalent uveitis, a total of 1,343,436 patients (37,891 with psoriasis and 1,305,545 without psoriasis) were studied. The risk of incident uveitis was significantly higher among patients with psoriasis with a pooled risk ratio of 1.23 (95% CI: 1.05-1.45, I 2 = 55%). The risk of prevalent uveitis was also significantly higher among patients with psoriasis with a pooled risk ratio of 1.97 (95% CI: 1.68-2.31, I 2 = 0%). Conclusions The results of this study revealed significantly increased risk of both prevalent and incident uveitis among patients with psoriasis.
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Schargus M, Langhorst CA, Joachim S, Frings A, Krause K, Reifenberger J, Geerling G, Frings VG. Hidradenitis Suppurativa is Associated with Symptoms of Keratoconjunctivitis Sicca. Curr Eye Res 2020; 46:23-30. [PMID: 32506959 DOI: 10.1080/02713683.2020.1775259] [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: 10/24/2022]
Abstract
AIM OF THE STUDY Hidradenitis suppurativa (HS) and psoriasis vulgaris (PSO) are chronic inflammatory dermatoses in which proinflammatory cytokines, such as IL-17, play a central role. The prevalence of keratoconjunctivitis sicca (KCS) is commonly higher in PSO than in healthy individuals. This study was thus set up to investigate the prevalence of KCS among patients with HS. MATERIALS AND METHODS In a cross-sectional study standardized tear film parameters and symptom-oriented questionnaires (OSDI, SPEED) were analyzed in a total of 71 subjects (HS n = 20, PSO n = 20, healthy controls n = 31). Additionally, IL-17 and MMP-9 in the tear film were analyzed. These parameters were correlated to the clinical severity of the skin disease. PSO patients served as inflammatory control group. RESULTS There were statistically significant differences in OSDI (p = .003) and SPEED (p ≤ 0.001) between HS and the control group, but not between PSO and controls. For HS, there was a statistically significant correlation between symptoms (OSDI) and the severity of HS according to Hurley stage (p = .023). Tear film concentrations showed significantly increased levels of IL-17 (p = .018), but not MMP-9, in PSO alone compared to the control group. CONCLUSION Data show that subjective complaints of KCS may be associated with HS and correlate with the severity of the respective Hurley stage, but do not involve alterations of tear film MMP-9 and IL-17. Clinicians should remain mindful that ocular complications in HS are often more vague than in psoriatic patients, but dry eye symptoms might be detrimental for the patients' quality of life.
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Affiliation(s)
- Marc Schargus
- Department of Ophthalmology, Heinrich-Heine-University Düsseldorf , Düsseldorf, Germany.,Department of Ophthalmology, Asklepios Hospital Nord-Heidberg , Hamburg, Germany
| | | | - Stephanie Joachim
- Department of Ophthalmology, Experimental Eye Research Institute, Ruhr-University Bochum , Bochum, Germany
| | - Andreas Frings
- Department of Ophthalmology, Heinrich-Heine-University Düsseldorf , Düsseldorf, Germany.,UCL Institute of Ophthalmology , London, UK
| | - Kristina Krause
- Department of Dermatology, Heinrich-Heine-University Düsseldorf , Düsseldorf, Germany
| | - Julia Reifenberger
- Department of Dermatology, Heinrich-Heine-University Düsseldorf , Düsseldorf, Germany
| | - Gerd Geerling
- Department of Ophthalmology, Heinrich-Heine-University Düsseldorf , Düsseldorf, Germany
| | - Verena Gerlinde Frings
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg , Würzburg, Germany
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Li CR, Chen L, Wang LF, Yan B, Liang YL, Luo J. Association between uveitis and psoriatic disease: a systematic review and Meta-analysis based on the evidence from cohort studies. Int J Ophthalmol 2020; 13:650-659. [DOI: 10.18240/ijo.2020.04.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/10/2020] [Indexed: 01/22/2023] Open
Affiliation(s)
| | - Lang Chen
- General Surgery Department, the Third Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Long-Fei Wang
- Cardiovascular Department, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Bin Yan
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - You-Ling Liang
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Jing Luo
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
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Perez-Chada LM, Merola JF. Comorbidities associated with psoriatic arthritis: Review and update. Clin Immunol 2020; 214:108397. [PMID: 32229290 DOI: 10.1016/j.clim.2020.108397] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/25/2020] [Indexed: 02/07/2023]
Abstract
Psoriatic arthritis is an inflammatory arthropathy frequently associated with psoriasis and several other comorbidities. The goal of this review is to summarize the available evidence on the epidemiology, clinical implications, pathological mechanisms proposed, and screening and management recommendations for the comorbidities related with PsA. Reported comorbidities include cardiovascular disease, metabolic syndrome, obesity, diabetes mellitus, dyslipidemia, inflammatory bowel disease, fatty liver disease, uveitis, kidney disease, infections, osteoporosis, depression, central sensitization syndrome, and gout. Given that these comorbidities may affect both clinical outcomes and the management for these patients, their recognition and monitoring by all health-care providers caring for patients with psoriatic arthritis is of utmost importance.
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Affiliation(s)
- Lourdes M Perez-Chada
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph F Merola
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Rajguru JP, Maya D, Kumar D, Suri P, Bhardwaj S, Patel ND. Update on psoriasis: A review. J Family Med Prim Care 2020; 9:20-24. [PMID: 32110559 PMCID: PMC7014874 DOI: 10.4103/jfmpc.jfmpc_689_19] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/24/2019] [Accepted: 12/04/2019] [Indexed: 11/04/2022] Open
Abstract
Psoriasis is a disease characterized by the presence of papules and plaques over the surface of skin with variable morphology, distribution and severity. The lesions of psoriasis are distinct from these other entities and are classically very well circumscribed, circular, red papules or plaques with a grey or silvery-white, dry scale. In addition, the lesions are typically distributed symmetrically on the scalp, elbows, knees, lumbosacral area, and in the body folds. The oral manifestations of psoriasis may involve the oral mucosa or the tongue. The dorsal surface of the tongue shows characteristic red patches surrounded with a yellow white border. The relationship between eye lesions and psoriasis are the current findings in the literature. The ocular complications along with the several extracutaneous manifestations are common complications seen in psoriasis. The pathogenesis of exact relationship between these two is still controversial. Immunological studies have shown a positive relationship between T helper cells and uveitis. Various signs and symptoms of ocular psoriasis may be overlooked. Thus, a complete understanding of ophthalmic involvement is important to the comprehensive care of patients with psoriasis. Almost any part of the body can be affected in psoriasis, but the ophthalmic complications of psoriasis usually remain clinically subtle. This review highlights the various manifestations of psoriasis with their clinical sign and symptoms.
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Affiliation(s)
- Jagadish P. Rajguru
- Department of Oral and Maxillofacial Pathology, Hi-Tech Dental College and Hospital, Bhubaneswar, Odisha, India
| | - Deepthi Maya
- BDS, Private Practitioner, Gokhale Nagar, Ramanthapur, Hyderabad, Telangana, India
| | - Dinesh Kumar
- Department of Oral Medicine and Radiology, BRS Dental College, Panchkula, Haryana, India
| | - Prerna Suri
- MDS, Private Practitioner and Consultant Orthodontist, Mumbai, Maharashtra, India
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Fotiadou C, Lazaridou E. Psoriasis and uveitis: links and risks. PSORIASIS (AUCKLAND, N.Z.) 2019; 9:91-96. [PMID: 31696050 PMCID: PMC6717847 DOI: 10.2147/ptt.s179182] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 08/01/2019] [Indexed: 01/10/2023]
Abstract
Uveitis, an inflammatory disorder of the mid-portion of the eye, is considered a relatively rare but very serious ocular complication of psoriasis. Data on the specific characteristics of uveitis in the background of psoriasis are extremely limited. The presence of uveitis in the context of psoriasis has been estimated to occur in 7-20% of the psoriasis cases. This incidence tends to be higher in patients suffering from psoriasis and psoriatic arthritis (PsA) or PSA alone. Psoriatic uveitis is usually bilateral, chronic, and severe. In term of pathogenesis, both psoriasis and uveitis are considered as paradigms of T-helper 1/T-helper 17 (Th1/Th17) inflammatory reactions. Certain cytokines such as tumor necrosis factor-α (TNF- α), Interleukin-17 (IL-17), IL-23, and IL-6 play a significant role in the pathogenesis of both psoriasis and uveitis. As uveitis shares common pathogenetic mechanisms with psoriasis in certain circumstances, both diseases may benefit from the same targeted biologic therapies. Undiagnosed and under-treated cases of psoriatic uveitis may cause significant morbidity and even vision loss. Larger prospective studies are needed in order to further investigate the association between these two entities.
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Affiliation(s)
- Christina Fotiadou
- Second Department of Dermatology-Venereology, Aristotle University Medical School, Thessaloniki, Greece
| | - Elizabeth Lazaridou
- Second Department of Dermatology-Venereology, Aristotle University Medical School, Thessaloniki, Greece
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Abstract
Eye involvement in psoriasis is little known to many dermatologists, although psoriasis has been acknowledged as a systemic disease for decades. The ophthalmic complications of psoriasis are numerous and can affect almost any part of the eye. The most common ocular changes in patients with psoriasis, including blepharitis, conjunctivitis, keratitis, iridocyclitis, UV-induced cataracts, uveitis, and birdshot chorioretinitis, have been described in the literature. Recognition of the ocular complications of psoriasis is of significant clinical importance, because various pathogenic mechanisms may contribute to the development of ocular manifestations, including direct eye involvement with psoriatic plaques, psoriasis-related immune-mediated inflammatory processes, and complications of psoriasis treatments.
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Affiliation(s)
- Zdravka Demerdjieva
- Department of Dermatology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria.
| | - Iskra Mazhdrakova
- Department of Ophthalmology, Alexanders University Hospital, Sofia, Bulargia
| | - Nikolai Tsankov
- Department of Dermatology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
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Chimenti MS, Caso F, Alivernini S, De Martino E, Costa L, Tolusso B, Triggianese P, Conigliaro P, Gremese E, Scarpa R, Perricone R. Amplifying the concept of psoriatic arthritis: The role of autoimmunity in systemic psoriatic disease. Autoimmun Rev 2019; 18:565-575. [DOI: 10.1016/j.autrev.2018.11.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 11/30/2018] [Indexed: 02/08/2023]
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Ghalamkarpour F, Baradaran-Rafii A, Sadoughi MM, Abdollahimajd F, Younespour S, Zargari O, Rudolph RI. Ocular findings in patients with psoriasis: is it related to the side effects of treatment or to psoriasis itself? A case-control study. J DERMATOL TREAT 2019; 31:27-32. [PMID: 30704324 DOI: 10.1080/09546634.2019.1577947] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives: To assess ocular abnormalities in psoriatic patients (new-cases versus patients under treatment) in comparison with healthy controls.Methods: A total of 200 psoriatic patients and 100 healthy controls were enrolled in this prospective, observational study. The demographic data of the individuals were recorded. Dermatological and ophthalmologic examinations were conducted; ocular surface disease index (OSDI), Schirmer's and tear break-up time (TBUT) values were also measured.Results: The mean values of TBUT and Schirmer's tests in patients were significantly lower than the controls and significantly higher scores of OSDI were observed among patients compared to the controls (p < .0001); dry eye disease was more frequent in the patients than the healthy subjects (p = .001). Other ocular findings including cataract and uveitis were not significantly different between the groups. Although no significant differences were found between the ocular findings of new cases and patients under treatment, ocular findings in cases under treatment were associated with the type of treatment and more frequent in those treated with methotrexate, followed by acitretin and biologic drugs.Conclusions: Ocular surface problems in psoriatic patients are more common than previously thought; in addition to the role of treatment modalities, psoriasis itself and a probable systemic inflammation may play an important role.Key PointsThere are limited case-control studies about ocular manifestations in psoriasis and also its pathogenesis is not yet clear.This study shows that ocular surface problems in psoriatic patients are higher than healthy subjects; in addition to the role of treatment modalities, psoriasis itself and a probable systemic inflammation may play a pivotal role.Regular ophthalmological evaluations are recommended in psoriatic patients especially those with more severe and chronic form of the disease, to prevent any complications.
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Affiliation(s)
- Fariba Ghalamkarpour
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | | | - Shima Younespour
- National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Robert I Rudolph
- Dermatology Department, University of Pennsylvania, Philadelphia, PA, USA
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Oon HH, Ho G, Sandar H, Chee SP. Acute unilateral red eye in a patient with psoriasis. Clin Exp Dermatol 2019; 44:924-926. [PMID: 30746729 DOI: 10.1111/ced.13916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2018] [Indexed: 11/25/2022]
Affiliation(s)
- H H Oon
- National Skin Centre, Singapore
| | - G Ho
- Concord Repatriation General Hospital, Sydney, Australia
| | - H Sandar
- Ocular Inflammation and Immunology Department, Singapore National Eye Centre, Singapore.,Mandalay Eye ENT Hospital, Mandalay, Myanmar
| | - S P Chee
- Ocular Inflammation and Immunology Department, Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Research Program, Duke-NUS Graduate Medical School, Singapore
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37
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Amer R, Levinger N. Psoriasis-associated progressive necrotizing posterior scleritis: A 6-year follow-up. Eur J Ophthalmol 2019; 30:NP7-NP10. [PMID: 30638053 DOI: 10.1177/1120672118823121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Posterior scleritis is the least frequent form of scleritis accounting for around 2%-8% of all scleritis cases. We aim to present the 6-year clinical course of a 62-year-old female patient with bilateral progressive necrotizing posterior scleritis who suffered from concurrent active psoriasis and psoriatic arthritis. METHODS Descriptive case report. RESULTS A middle-aged female patient was referred to our clinic because of left eye peripheral progressively enlarging white retinochoroidal lesions. Her previous work-up ruled out infectious and malignant etiologies. A second diagnostic vitrectomy was performed because of the slowly progressive and the atypical nature of the sectoral retinochoroidal patches in the retinal periphery. Again malignancy was ruled out. With the onset of cystoid macular edema and diffuse retinal vasculitis, which occurred concurrently with the reactivation of psoriasis and psoriatic arthritis, treatment was initiated with systemic immunosuppressants which initially included oral steroids and methotrexate and at the last follow-up 6 years after the first presentation included also cyclosporin and golimumab. Vision was preserved with quiescent uveitis and posterior scleritis. CONCLUSION Posterior scleritis is an uncommon condition and it is even rarer in the setting of psoriasis. The necrotizing inflammation observed in the present case and by others revealed sectoral progressive chorioretinitis as a clinical manifestation which may initially raise the suspicion of masquerade malignant and infectious etiologies. Detailed thorough history-taking remains the cornerstone in identifying the possible systemic associations even when occult or subclinical.
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Affiliation(s)
- Radgonde Amer
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
| | - Nadav Levinger
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
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38
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Li H, Lee DJ. Epidemiology and Immunopathogenesis of Psoriasis and Its Comorbidities. CURRENT DERMATOLOGY REPORTS 2018. [DOI: 10.1007/s13671-018-0243-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kwon CW, Fried RG, Nousari Y, Ritchlin C, Tausk F. Psoriasis: Psychosomatic, somatopsychic, or both? Clin Dermatol 2018; 36:698-703. [DOI: 10.1016/j.clindermatol.2018.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Bridging the Gaps in the Care of Psoriasis and Psoriatic Arthritis: the Role of Combined Clinics. Curr Rheumatol Rep 2018; 20:76. [DOI: 10.1007/s11926-018-0785-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Bilal J, Malik SU, Riaz IB, Kurtzman DJB. Psoriasis and Psoriatic Spectrum Disease: A Primer for the Primary Care Physician. Am J Med 2018; 131:1146-1154. [PMID: 29864415 DOI: 10.1016/j.amjmed.2018.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 05/04/2018] [Accepted: 05/08/2018] [Indexed: 01/18/2023]
Abstract
Psoriasis is a chronic, immune-mediated disorder that affects approximately 7.5 million people in the United States. Individuals with psoriasis may develop cutaneous, articular, and systemic manifestations, which are a source of significant morbidity and a heightened risk of mortality, and may adversely impact patient-reported quality of life measures. Psoriasis is now recognized as a risk factor for cardiovascular disease, metabolic syndrome, peripheral vascular disease, inflammatory bowel disease, certain malignancies, and chronic renal disease. Therefore, it has become increasingly relevant that primary care physicians have a basic working knowledge and an understanding of fundamental management principles of psoriasis. This review highlights the salient clinical features of psoriasis and psoriatic spectrum disease, emphasizing key updates with respect to systemic disease and associated conditions, and briefly outlines a therapeutic algorithm for the primary care physician.
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Affiliation(s)
- Jawad Bilal
- Department of Medicine, University of Arizona, Tucson.
| | | | | | - Drew J B Kurtzman
- Complex Medical Dermatology Clinic, St. Elizabeth Physicians, Florence, Ky
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Increased risk of keratopathy after psoriasis: A nationwide population-based study. PLoS One 2018; 13:e0201285. [PMID: 30044880 PMCID: PMC6059472 DOI: 10.1371/journal.pone.0201285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/12/2018] [Indexed: 11/24/2022] Open
Abstract
Background To evaluate whether the presence of psoriasis increases the risk of keratopathy incidence by using Taiwan’s National Health Insurance Research Database (NHIRD). Methodology/Principal findings This retrospective cohort study used data from the NHIRD for the 2009 to 2012 period. A total of 3,648 patients diagnosed with psoriasis were enrolled in the study group while another 14,592 individuals were selected as the control group. The study group was propensity score-matched with a group of controls who had not received a diagnosis of psoriasis. Multivariate Cox regression analysis was performed to estimate the adjusted hazard ratio (aHR) of keratopathy. For the events of keratopathy, 71 patients in the study group and 208 patients in the control group developed keratopathy with a attributable risk of 23.43 per 100,000 person-months (incidence rate ratio = 1.40; P = 0.01) which correlated to the elevated cumulative probability (P = 0.03). The multivariate analysis revealed that the risk of keratopathy was higher in patients who had psoriasis (aHR = 1.31, P = 0.04). In addition, age older than 60 years (aHR = 2.10, P<0.01) and dry eye disease (aHR = 2.79, P<0.01) would also increase the risk of developing keratopathy. Conclusions Psoriasis was associated with an increased risk of keratopathy in patients without preexisting prominent corneal disease. Moreover, the risk of incident keratopathy increases with exposure to psoriasis.
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Abstract
Psoriasis is a chronic inflammatory disease that affects approximately 7.5 million people in the United States. The disease results in significant suffering, morbidity, and economic impact. Psoriasis is a multifaceted disease with a strong genetic component. Genetic data has revealed the presence of particular risk alleles in patients with psoriasis. Triggers of the disease have been elucidated and include factors such as trauma, obesity, infection, stress, and medications. At its core, psoriasis is a result of a dysfunctional immune response with T-cells at the center of immunogenesis. Clinically, psoriasis is characterized by discrete, erythematous scaly plaques. These lesions are often found on extensor surfaces, especially the elbows and knees. Although extensor surfaces are the prototypical destination of lesions, psoriasis may affect any area of the skin including the scalp, intertriginous areas, nails, palms, and soles. Location of lesions are important in assessing the impact on quality of life for patients. Diagnosis of psoriasis can typically be made clinically based on characteristic history and physical examination findings. In rare cases, biopsy may be needed to rule out other papulosquamous disease. Histologic findings of psoriasis can be non-specific and include marked epidermal hyperplasia, dilated vessels within the dermal papilla, and elongated rete ridges. Importantly, psoriasis is a systemic disease and organ systems outside of the skin must be considered. Co-morbidities of psoriasis include psoriatic arthritis, type 2 diabetes mellitus, cardiovascular disease, psychiatric disease, inflammatory bowel disease, neoplasms, and ocular disease. Management of psoriasis depends on the severity of the disease. In mild to moderate cases, topical medications are the cornerstone of treatment. Topical corticosteroids are the most commonly used and have limited systemic effects due to the localized application of medication. In moderate to severe cases of psoriasis, topical medications are ineffective and not feasible. Phototherapy and non-biologic systemic medications have been useful treatments; however, phototherapy is time consuming and non-biologic systemics have only modest response rates. In the last decade, biologic medications have become an important component of care for treating moderate to severe psoriasis. These medications target various cytokines responsible for psoriasis manifestations such as tumor necrosis factor (TNF-α), interleukin-12, interleukin-23, and interleukin-17. In the past 15 years, numerous biologic medications have been granted FDA approval, with the majority approved in the past several years. Some of the commonly used biologics include etanercept, adalimumab, infliximab, ixekizumab, secukinumab, brodalumab, guselkumab, ustekinumab, and tildrakizumab. Given the wealth of new biologics, current treatment guidelines have rapidly become outdated. This review provides summarized information of landmark trials that led to the approval of these medications.
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Abbagani S, Kamath YS, Nayak S. A Study on Ocular Morbidity among Patients with Psoriasis Visiting a Tertiary Care Hospital in Karnataka, Southern India. Ocul Immunol Inflamm 2017; 27:531-534. [PMID: 29286864 DOI: 10.1080/09273948.2017.1414271] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Introduction: Psoriasis is a chronic immune-mediated disorder with predominantly dermatological manifestations and varying prevalence in different parts of the world. Data on the ocular features of this disease are limited. Hence, we aimed to estimate the burden of ocular disease in psoriatic patients in the Indian population. Materials and methods: An interdisciplinary cross-sectional hospital-based observational study was conducted in South India, wherein an ophthalmological evaluation was performed for the patients with Psoriasis. The ocular features were recorded and compared with the severity of psoriasis using the Psoriasis Area Severity Index (PASI) score. Results: Ocular morbidity was observed in 80% of the patients with psoriasis which increased with increasing duration (p = 0.004) and increasing PASI score (p < 0.001). Blepharitis and dry eye disease were common in our patients with psoriasis. Conclusion: It is important to screen patients with psoriasis for ocular comorbidities so as to prevent sight-threatening complications.
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Affiliation(s)
- Surabhi Abbagani
- a Department of Ophthalmology , Kasturba Medical College-Manipal, Manipal Academy of Higher Education , Manipal , India
| | - Yogish Subraya Kamath
- a Department of Ophthalmology , Kasturba Medical College-Manipal, Manipal Academy of Higher Education , Manipal , India
| | - Sudhir Nayak
- b Department of Dermatology , Kasturba Medical College-Manipal, Manipal Academy of Higher Education , Manipal , India
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Aragona E, Rania L, Postorino EI, Interdonato A, Giuffrida R, Cannavò SP, Puzzolo D, Aragona P. Tear film and ocular surface assessment in psoriasis. Br J Ophthalmol 2017; 102:302-308. [PMID: 28689165 DOI: 10.1136/bjophthalmol-2017-310307] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/15/2017] [Accepted: 06/03/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Psoriasis is a skin disease with also systemic involvement: its impact on the eye is not well established and often clinically underestimated. Aim of this study was to investigate the presence of ocular discomfort symptoms and of ocular surface changes in a population of patients with psoriasis. METHODS For this cross-sectional, comparative study, 66 patients with psoriasis were subdivided according to the presence of arthritis and to the use of biological therapy. All patients underwent clinical evaluation with the following tests: Ocular Surface Disease Index Questionnaire, Tearscope examination, meibometry, tear film breakup time, corneal and conjunctival fluorescein staining, Schirmer I test, corneal aesthesiometry, meibomian gland dysfunction (MGD) assessment and conjunctival impression cytology. 28 healthy subjects were also enrolled and treated with the same clinical tests. A statistical analysis of the results was performed. RESULTS Patients with psoriasis showed a significant deterioration of the ocular surface tests, if compared with healthy subjects, demonstrated by tear film lipid layer alteration, tear film instability, corneal and conjunctival epithelial suffering and mild squamous metaplasia at impression cytology. No differences were found in ocular surface test results of the psoriatic group when patients were divided according to the presence of arthritis, whereas the anti-inflammatory treatment with biological drugs demonstrated a significant improvement of corneal stain and MGD. CONCLUSIONS Our findings suggest that the ocular surface involvement in patients with psoriasis indicates the need of periodic ophthalmological examinations to diagnose the condition and allow a proper treatment, so contributing to the amelioration of patients' quality of life.
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Affiliation(s)
- Emanuela Aragona
- Department of Biomedical Sciences, Regional Referral Center for the Ocular Surface Diseases, University of Messina, Messina, Italy
| | - Laura Rania
- Department of Biomedical Sciences, Regional Referral Center for the Ocular Surface Diseases, University of Messina, Messina, Italy
| | - Elisa Imelde Postorino
- Department of Biomedical Sciences, Regional Referral Center for the Ocular Surface Diseases, University of Messina, Messina, Italy
| | - Alberto Interdonato
- Department of Biomedical Sciences, Regional Referral Center for the Ocular Surface Diseases, University of Messina, Messina, Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy
| | | | - Domenico Puzzolo
- Department of Biomedical Sciences, Section of Histology and Embriology, University of Messina, Messina, Italy
| | - Pasquale Aragona
- Department of Biomedical Sciences, Regional Referral Center for the Ocular Surface Diseases, University of Messina, Messina, Italy
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The prevalence and characteristics of chronic ocular itch: a cross-sectional survey. ACTA ACUST UNITED AC 2017; 2:e4. [PMID: 29862322 PMCID: PMC5965304 DOI: 10.1097/itx.0000000000000004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 01/11/2017] [Indexed: 11/26/2022]
Abstract
Introduction In this cross-sectional study, we aimed to determine the prevalence and characteristics of chronic ocular itch in an outpatient ophthalmology and optometry clinic. Methods Four hundred patients from an outpatient ophthalmology and optometry clinic were enrolled. The presence and characteristics of chronic ocular itch were assessed by a questionnaire. Data regarding ophthalmologic, dermatologic, and systemic conditions as well as current medications were extracted from medical records. Results Chronic ocular itch was present in 118 (29.5%) of 400 participants. Chronic ocular pruritus was significantly more prevalent in females [P=0.015; odds ratio (OR)=1.8; 95% confidence interval (CI), 1.1-2.8] and was significantly associated with the presence of allergic conjunctivitis [51.8% (n=45); P<0.001; OR=5.0; 95% CI, 3.0-8.3], dry eye syndrome [40.1% (75); P<0.001; OR=2.6; 95% CI, 1.7-4.1], blepharitis [43.8% (n=21); P=0.021; OR=2.0; 95% CI, 1.1-3.8], and atopic dermatitis [50.0% (n=10); P=0.023; OR=2.6; 95% CI, 1.1-5.8]. Chronic ocular itch was not significantly associated with systemic conditions, or the use of prescribed ophthalmologic medications. Discussion Chronic ocular itch is common and may be related to ophthalmologic or dermatologic pathologies. The present findings highlight the importance of identifying and managing this uncomfortable symptom that may negatively impact the quality of life and sleep of affected patients.
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Murray PI, Rauz S. The eye and inflammatory rheumatic diseases: The eye and rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis. Best Pract Res Clin Rheumatol 2016; 30:802-825. [DOI: 10.1016/j.berh.2016.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 10/07/2016] [Accepted: 10/07/2016] [Indexed: 02/01/2023]
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Rodríguez-Ausín P, Antolín-Garcia D, Ruano Del Salado M, Hita-Antón C. Topical tacrolimus 0.03% for the treatment of ocular psoriasis. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2016; 91:505-507. [PMID: 27130870 DOI: 10.1016/j.oftal.2016.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 03/15/2016] [Accepted: 03/19/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE/METHODS Cases are presented of 4 patients suffering from severe symptoms due to ocular psoriasis and who were treated with off-label 0.03% tacrolimus once a day. RESULTS/CONCLUSIONS All four patients had a mixed blepharitis and keratitis. Pseudopterygium and corneal opacities were present in three of them. All of them experienced an improvement of their itching and ocular surface. They all referred to a marked improvement of their quality of life in a follow-up period ranging from six months to two years. Therefore, topical tacrolimus could be considered an option in the treatment of ocular psoriasis.
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Affiliation(s)
- P Rodríguez-Ausín
- Departamento de Oftalmología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España.
| | - D Antolín-Garcia
- Departamento de Oftalmología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España
| | - M Ruano Del Salado
- Departamento de Dermatología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España
| | - C Hita-Antón
- Departamento de Oftalmología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España
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Finet A, Viguier M, Chazouillères O, Amatore F, Paul C, Richard MA, Chosidow O, Bachelez H, Sbidian E. Liver test abnormalities in patients admitted for severe psoriasis: prevalence and associated risk factors. J Eur Acad Dermatol Venereol 2016; 30:1742-1748. [PMID: 27226222 DOI: 10.1111/jdv.13674] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/22/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Few epidemiologic data are available regarding biologic liver abnormalities during psoriasis flares. OBJECTIVES The aim of this study was to assess the prevalence of biological liver test abnormalities (LTA) in a psoriasis population and the risk factors associated with LTA. METHODS A retrospective cross-sectional study in four hospital dermatology tertiary care centres included patients admitted for severe psoriasis flare between 1st January 2010 and 31st December 2011. During the same period, a control population was selected comprising patients admitted for contact and/or atopic eczema. Data were collected on hospital records and biology software. LTA was defined as serum AST and/or ALT and/or ALP concentration above the upper normal limit (UNL) and/or GGT concentration above 2 UNL. Prevalence of LTA with 95% confidence intervals (95% CI) was compared between the psoriatic and control populations. Factors associated with LTA at P < 0.05 were considered for the final multivariate logistic regression model. RESULTS Two hundred and forty psoriasis patients and 96 eczema control patients were included. One hundred and fifty-five(64.6%) of the psoriasis patients were male, aged 55 years on average (±17.6); 192 (80.0%) had plaque-type psoriasis (PV) and 52 (21.6%) had localized (n = 32) or generalized (n = 20) pustular psoriasis (PP). Prevalence of LTA was 36% (95% CI, 30-42) in the psoriatic population, significantly higher than in controls (17%, 95% CI 9.5-25). Risk factors independently associated with LTA comprised PV (OR 3.79; 95% CI 1.48-9.65), PP (OR 3.80; 95% CI 1.40-10.25) and previously diagnosed liver disease (underlying hepatic steatosis, viral hepatitis or excessive alcohol consumption) (OR 3.88; 95% CI 2.02-7.45). No association was found with systemic antipsoriatic drug therapies. CONCLUSION In severe psoriasis, liver impacting comorbidities and/or specific psoriatic inflammation, the latter mostly in PP cases, more than drug-related liver toxicity, appears to predominantly account for LTA. Clinicians should be aware of this, to avoid unjustified withdrawal of useful systemic drugs.
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Affiliation(s)
- A Finet
- Sorbonne Paris Cité Université Paris Diderot, Paris, France
- Service de Dermatologie, AP-HP Hôpital Saint-Louis, Paris, France
| | - M Viguier
- Sorbonne Paris Cité Université Paris Diderot, Paris, France
- Service de Dermatologie, AP-HP Hôpital Saint-Louis, Paris, France
| | - O Chazouillères
- AP-HP, Hôpital Saint-Antoine, Service d'Hépatologie, Sorbonne Université, UPMC Univ Paris 06, INSERM, UMR_S 938/CDR Saint-Antoine, Paris, France
| | - F Amatore
- Département de Dermatologie, AP-HM, Hôpital La Timone, Marseille, France
| | - C Paul
- Département de Dermatologie, Hôpital Larrey, Toulouse, France
| | - M A Richard
- Département de Dermatologie, AP-HM, Hôpital La Timone, Marseille, France
| | - O Chosidow
- Inserm, Centre d'Investigation Clinique 1430, Créteil, France
- EA EpidermE 7379, Université Paris-Est Créteil, Créteil, France
- Département de Dermatologie, AP-HP, Hôpital Universitaire Henri Mondor, Créteil, France
| | - H Bachelez
- Sorbonne Paris Cité Université Paris Diderot, Paris, France
- Service de Dermatologie, AP-HP Hôpital Saint-Louis, Paris, France
- INSERMU1163, Institut Imagine, Necker Hospital, Paris, France
| | - E Sbidian
- Inserm, Centre d'Investigation Clinique 1430, Créteil, France.
- EA EpidermE 7379, Université Paris-Est Créteil, Créteil, France.
- Département de Dermatologie, AP-HP, Hôpital Universitaire Henri Mondor, Créteil, France.
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Kılıç R, Kurt A, Acer E, Öktem Ç, Kocamış Ö. Choroidal thickness in psoriasis. Int Ophthalmol 2016; 37:173-177. [DOI: 10.1007/s10792-016-0252-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/05/2016] [Indexed: 12/27/2022]
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