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Jia YJ, Liu P, Zhang J, Hu FH, Yu HR, Tang W, Zhang WQ, Ge MW, Shen LT, Du W, Shen WQ, Xu H, Cai B, Zhang WB, Chen HL. Prevalence of anxiety, depression, sleeping problems, cognitive impairment, and suicidal ideation in people with autoimmune skin diseases. J Psychiatr Res 2024; 176:311-324. [PMID: 38917722 DOI: 10.1016/j.jpsychires.2024.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 05/15/2024] [Accepted: 06/15/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Autoimmune skin diseases (ASDs) such as psoriasis and vitiligo, in addition to causing visible skin symptoms, are closely associated with psychological health issues. However, a comprehensive understanding of the prevalence of these psychological comorbidities in affected individuals is lacking. This study aims to identify the prevalence of anxiety, depression, sleeping problems, cognitive impairment, and suicidal ideation in people with ASDs. METHOD PubMed, MEDLINE, Web of Science, and Cochrane Library searches were conducted from 1993 to May 2024. Observational studies reporting prevalence data for anxiety, depression, sleeping problems, cognitive impairment, and suicidal ideation among people with ASDs were included in the analysis. The Newcastle-Ottawa scale was used to evaluate the quality of studies. RESULTS The study included 114 studies from 37 countries including 823,975 participants. The estimated pooled prevalence of anxiety in patients with ASDs was 33.3% (95% CI: 27.3-29.3%). The estimated pooled prevalence of depression was 33.7% (95% CI: 29.2-38.1%). The estimated pooled prevalence of sleeping problems was 45.0% (95% CI:31.6-58.4%). The estimated pooled prevalence of cognitive impairment and suicidal ideation was 30.8% (95% CI:15.0-46.7%) and 21.6% (95% CI:13.4-29.8%), respectively. The most common mental disorder in patients with systemic lupus erythematosus and psoriasis was sleeping problems at 55.9% (95% CI: 35.6-76.1%, I2 = 97%) and 39.0% (95% CI: 21.1-56.9%, I2 = 99%). CONCLUSION Among patients with ASDs, anxiety, depression, sleeping problems, cognitive impairment, and suicidal ideation were common. The most prevalent mental disorder among patients with systemic lupus erythematosus and psoriasis was sleeping problems. Those with ASDs may experience considerable psychological burdens, and integrated mental health support is necessary for their treatment.
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Affiliation(s)
- Yi-Jie Jia
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Peng Liu
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Jie Zhang
- Medical School, Nantong University, Nantong, Jiangsu, PR China
| | - Fei-Hong Hu
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Hai-Rong Yu
- Department of Nursing, The Affiliated Hospital of Nantong University, Nantong, Jiangsu, PR China
| | - Wen Tang
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Wan-Qing Zhang
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Meng-Wei Ge
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Lu-Ting Shen
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Wei Du
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Wang-Qin Shen
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Hong Xu
- Center for Disease Control and Prevention of Nantong, Nantong, Jiangsu, PR China
| | - Bo Cai
- Center for Disease Control and Prevention of Nantong, Nantong, Jiangsu, PR China
| | - Wei-Bing Zhang
- Center for Disease Control and Prevention of Nantong, Nantong, Jiangsu, PR China.
| | - Hong-Lin Chen
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China.
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Salari N, Heidarian P, Hosseinian-Far A, Babajani F, Mohammadi M. Global Prevalence of Anxiety, Depression, and Stress Among Patients with Skin Diseases: A Systematic Review and Meta-analysis. JOURNAL OF PREVENTION (2022) 2024:10.1007/s10935-024-00784-0. [PMID: 38822990 DOI: 10.1007/s10935-024-00784-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/03/2024]
Abstract
The changes in human lifestyle over the past few decades have impacted the prevalence of skin diseases within different societies. Skin diseases may result in various physical and mental disorders. The most common mental disorders observed among the patients are stress, anxiety, and depression. This study aims to investigate the global prevalence of anxiety, depression, and stress in patients with skin diseases. In this Systematic Review and Meta-Analysis study, the PubMed, Scopus, Science Direct, Embase, Web of science, and Google Scholar repositories were searched without a lower time limit. Heterogeneity among the identified studies was examined using the I2 index, and accordingly random effects model was adopted for analysis. Data analysis was conducted within the Comprehensive Meta-Analysis software (v. 2). In total, 113 studies were included for the final analysis. The overall pooled prevalence of stress, depression, and anxiety in skin disease patients was found to be 39.4%, 27.2% and 28.8%, respectively. Among patients with psoriasis, acne, vitiligo or atopic dermatitis diseases, the highest number of patients suffering from stress was related to patients with acne (75.7%). The highest prevalence of depression, and anxiety was reported in patients with vitiligo (38.3%) and acne (36.5%), respectively. Considering the high prevalence of mental disorders among patients with skin diseases and recognising the impacts of mental health challenges on patients' well-being, the findings of this study provide valuable insights for identifying specific populations that require targeted interventions for the diagnosis, treatment, and prevention of mental illnesses. Accordingly, healthcare policymakers should incorporate psychological treatment and support measures as integral components of comprehensive care strategies for patients with skin diseases.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Pegah Heidarian
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amin Hosseinian-Far
- Department of Business Analytics & Systems, University of Hertfordshire, Hatfield, AL10 9EU, UK
| | - Fateme Babajani
- Department of Clinical Psychology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran.
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Man S, Ma W, Jiang H, Haider A, Shi S, Li X, Wu Z, Song Y. Evaluating the efficacy and mechanisms of Hua-Zhuo-Ning-Fu-Decoction on psoriasis using integrated bioinformatics analysis and metabolomics. JOURNAL OF ETHNOPHARMACOLOGY 2024; 325:117856. [PMID: 38316220 DOI: 10.1016/j.jep.2024.117856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/18/2024] [Accepted: 02/02/2024] [Indexed: 02/07/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Hua Zhuo Ning Fu Decoction (HZD) is an empirical prescription from traditional Chinese medicine that shows excellent clinical results for psoriasis patients. Uncertainty lingered over HZD's potential anti-psoriasis mechanisms. AIM OF THE STUDY The study's objective is to investigate the pharmacological processes and therapeutic effects of HZD on psoriasis. MATERIALS AND METHODS In the initial phase of the study, an investigation was conducted to assess the effects of HZD on psoriasis-afflicted mice using an imiquimod (IMQ)-induced murine model. The experimental mice were randomly allocated to different groups, including the IMQ-induced model group, the control group, the HZD therapy groups with varying dosage levels (low, medium, and high), and Dexamethasone (DEX, the positive control medicine) group. Bioinformatics analysis and molecular docking were subsequently employed to identify the primary components and molecular targets associated with the therapeutic action of HZD in the context of psoriasis. Additionally, to find the impacts on metabolite regulation, plasma metabolomics based on ultra-high-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (UPLC-QTOF/MS) was used. It's interesting to note that the combined mechanisms from metabolomics were examined in tandem with the targets. In vivo tests were the last step in validating the potential mechanism. Throughout the trial, the following data were recorded: body weight, psoriasis area and severity index (PASI). The molecular targets connected to HZD's anti-psoriasis activities were revealed using histological examination, western blot (WB), and ELISA investigation. RESULTS In mice induced with IMQ, HZD shown good anti-psoriasis effects in terms of PASI score and epidermal acanthosis. 95 HZD targets and 77 bioactive chemicals connected to psoriasis were found by bioinformatics research; of these, 7 key targets (EPHX2, PLA2G2A, TBXAS1, MAOA, ALDH1A3, ADH1A, and ADH1B) were linked to the mechanisms of HZD, the combination degree of which was finally expressed by the score of docking. In addition, HZD regulated nine metabolites. In line with this, HZD modified three metabolic pathways. Additionally, a combined examination of 7 key targets and 9 metabolites suggested that the metabolism of arachidonic acid might be the key metabolic route, which was identified by ELISA analysis. The in vivo investigation shown that HZD could control cytokines associated to inflammation (IL-10, TGF-β, IL-17A, and IL-23), as well as important antioxidant system markers (ROS, GSH, and MDA). Moreover, HZD controlled iron levels and the expression of ferroptosis-related proteins (ACSL4 and GPX4), suggesting that ferroptosis played a crucial role in this process. CONCLUSIONS Our findings demonstrated the whole mechanism and anti-psoriasis effectiveness of HZD, which will promote its clinical application and aid in the investigation of new bioactive components of HZD against psoriasis.
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Affiliation(s)
- Shuai Man
- Experimental Center, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China; Key Laboratory of Traditional Chinese Medicine for Classical Theory, Ministry of Education, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Wenke Ma
- Innovation Research Institute of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Hao Jiang
- Pharmacy School, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Ali Haider
- Department of Allied Health Sciences, The University of Lahore, Gujrat Campus, 50700, Pakistan
| | - Shasha Shi
- Pharmacy School, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Xiao Li
- Innovation Research Institute of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China.
| | - Zhuzhu Wu
- Key Laboratory of Traditional Chinese Medicine for Classical Theory, Ministry of Education, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China.
| | - Yongmei Song
- Key Laboratory of Traditional Chinese Medicine for Classical Theory, Ministry of Education, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China; Institute for Literature and Culture of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China.
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Choi J, Han I, Min J, Yun J, Kim BS, Shin K, Kim K, Kim YH. Dosis‐Wirkungs‐Beziehung zwischen Alkoholkonsum und Psoriasis: Systematische Übersicht und Metaanalyse. J Dtsch Dermatol Ges 2024; 22:641-653. [PMID: 38730521 DOI: 10.1111/ddg.15380_g] [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: 06/07/2023] [Accepted: 01/11/2024] [Indexed: 05/13/2024]
Abstract
The association between psoriasis and alcohol consumption has been inconsistent across various studies. However, to the best of our knowledge, no dose-response meta-analysis has been performed to date. This study aims to investigate the association between alcohol consumption and psoriasis. The search was performed on July 27, 2021, using Embase and MEDLINE. The restricted cubic spline analysis was used to perform a dose-response analysis. We identified 3,904 studies, of which 48 studies with 1,702,847 individuals across 24 countries were included. Alcohol consumption was positively associated with psoriasis (odds ratio [OR], 1.47; 95% confidence interval [CI], 1.27-1.70). In addition, a significantly increased OR for psoriasis was observed in males (OR, 1.84; 95% CI, 1.13-3.01) but not in females (OR, 1.22; 95% CI, 0.97-1.54). Based on eight studies, including three cohort and five case-control studies, the analysis revealed that with each additional gram of daily alcohol intake, the OR for psoriasis increased by 4%. We found a positive association between alcohol consumption and psoriasis. The association is more prominent in the group drinking more than 45 g of alcohol per day (3.2 alcoholic drink equivalent).
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Affiliation(s)
- Jeeyu Choi
- School of Dentistry, Pusan National University, Yangsan, Republic of Korea
| | - Ikjoon Han
- School of Dentistry, Pusan National University, Yangsan, Republic of Korea
| | - Joohong Min
- School of Dentistry, Pusan National University, Yangsan, Republic of Korea
| | - Jisang Yun
- Department of Dermatology, College of Medicine, Pusan National University, Busan, Republic of Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Byung-Soo Kim
- Department of Dermatology, College of Medicine, Pusan National University, Busan, Republic of Korea
| | - Kihyuk Shin
- Department of Dermatology, College of Medicine, Pusan National University, Busan, Republic of Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Kihun Kim
- Department of Biomedical Informatics, School of Medicine, Pusan National University, Yangsan, Republic of Korea
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Yun Hak Kim
- Department of Biomedical Informatics, School of Medicine, Pusan National University, Yangsan, Republic of Korea
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan, Republic of Korea
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Choi J, Han I, Min J, Yun J, Kim BS, Shin K, Kim K, Kim YH. Dose-response analysis between alcohol consumption and psoriasis: A systematic review and meta-analysis. J Dtsch Dermatol Ges 2024; 22:641-652. [PMID: 38679782 DOI: 10.1111/ddg.15380] [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: 06/07/2023] [Accepted: 01/11/2024] [Indexed: 05/01/2024]
Abstract
The association between psoriasis and alcohol consumption has been inconsistent across various studies. However, to the best of our knowledge, no dose-response meta-analysis has been performed to date. This study aims to investigate the association between alcohol consumption and psoriasis. The search was performed on July 27, 2021, using Embase and MEDLINE. The restricted cubic spline analysis was used to perform a dose-response analysis. We identified 3,904 studies, of which 48 studies with 1,702,847 individuals across 24 countries were included. Alcohol consumption was positively associated with psoriasis (odds ratio [OR], 1.47; 95% confidence interval [CI], 1.27-1.70). In addition, a significantly increased OR for psoriasis was observed in males (OR, 1.84; 95% CI, 1.13-3.01) but not in females (OR, 1.22; 95% CI, 0.97-1.54). Based on eight studies, including three cohort and five case-control studies, the analysis revealed that with each additional gram of daily alcohol intake, the OR for psoriasis increased by 4%. We found a positive association between alcohol consumption and psoriasis. The association is more prominent in the group drinking more than 45 g of alcohol per day (3.2 alcoholic drink equivalent).
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Affiliation(s)
- Jeeyu Choi
- School of Dentistry, Pusan National University, Yangsan, Republic of Korea
| | - Ikjoon Han
- School of Dentistry, Pusan National University, Yangsan, Republic of Korea
| | - Joohong Min
- School of Dentistry, Pusan National University, Yangsan, Republic of Korea
| | - Jisang Yun
- Department of Dermatology, College of Medicine, Pusan National University, Busan, Republic of Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Byung-Soo Kim
- Department of Dermatology, College of Medicine, Pusan National University, Busan, Republic of Korea
| | - Kihyuk Shin
- Department of Dermatology, College of Medicine, Pusan National University, Busan, Republic of Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Kihun Kim
- Department of Biomedical Informatics, School of Medicine, Pusan National University, Yangsan, Republic of Korea
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Yun Hak Kim
- Department of Biomedical Informatics, School of Medicine, Pusan National University, Yangsan, Republic of Korea
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan, Republic of Korea
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Iocca F, Burlando M, Angelo NL, Ragucci F, Pugi D, Parodi A, Dèttore D, Pozza A. Sexual functioning in patients with psoriasis: the role of body dissatisfaction and cognitive biases toward sexuality. JOURNAL OF SEX & MARITAL THERAPY 2024; 50:439-455. [PMID: 38288968 DOI: 10.1080/0092623x.2024.2302959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Psoriasis is a chronic disease, involving skin and joints, characterized by inflamed lesions. Psoriasis negatively impacts the patients' quality of life due to the physical, emotional, and social burden that accompanies this condition. Also, psoriasis is associated with a number of psychiatric comorbidities, including sexual dysfunctions. The present study investigates the variables associated with sexual functioning in psoriasis patients. One-hundred-three psoriasis patients and 101 matched control subjects took part in the present study. Each participant completed five self-report measures investigating the presence of depression, anxiety and stress symptoms, body image, quality of life, and sexual experience. Our results show that differences in sexual activity, but not in sexual functioning, emerged between groups. In men with psoriasis, more sexual difficulties were associated with more negative automatic thoughts about sexuality. In women, more sexual difficulties were associated with more negative automatic thoughts; anxiety, depression, and stress; severity of symptoms; comorbid disease; age; quality of life. Our findings expand the current knowledge about sexual functioning in psoriasis and shed light on specific cognitive, psychological, and demographic variables associated with sexual impairment in men and women with psoriasis.
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Affiliation(s)
- Francesco Iocca
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Martina Burlando
- Department of Dermatology, Dipartimento di Scienze della Salute- DISSAL, University of Genoa, Genova, Italy
- UO Clinica Dermatologica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Nicole Loren Angelo
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Federica Ragucci
- Neuromotor and Rehabilitation Department, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Daniele Pugi
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Aurora Parodi
- Department of Dermatology, Dipartimento di Scienze della Salute- DISSAL, University of Genoa, Genova, Italy
- UO Clinica Dermatologica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Andrea Pozza
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
- Psychology Unit, Department of Mental Health, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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Menicucci D, Bastiani L, Malloggi E, Denoth F, Gemignani A, Molinaro S. Impaired Well-Being and Insomnia as Residuals of Resolved Medical Conditions: Survey in the Italian Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:129. [PMID: 38397620 PMCID: PMC10888320 DOI: 10.3390/ijerph21020129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Well-being encompasses physical, mental, social, and cultural aspects. Sleep quality and pathologies are among the objective conditions jeopardising it. Chronic insomnia, inflammatory-based diseases, and mood disorders often occur in a single cluster, and inflammation can negatively impact sleep, potentially harming well-being. Some evidence from specific clinical populations suggests that also some resolved past diseases could still have an impact on present sleep quality and well-being. The aim of the present study is to investigate, in the general population, whether and to what degree well-being and insomnia are associated with resolved pathologies. METHODS A cross-sectional survey (IPSAD®) was carried out using anonymous postal questionnaires that investigated past and present general health, well-being, and insomnia. A total of 10,467 subjects answered the questionnaire. RESULTS Several classes of both current and resolved pathologies resulted in increased odds ratios for current insomnia (odds ratios = 1.90; 1.43, respectively) and impaired well-being (odds ratios = 1.75; 1.33, respectively), proportional to the number of the displayed pathologies. Notably, both current and resolved past psychiatric disorders were strongly associated with both current impaired well-being (odds ratios = 5.38; 1.70, respectively) and insomnia (odds ratios = 4.99; 2.15, respectively). CONCLUSIONS To explain these associations, we suggest that systemic inflammation conveyed by several medical conditions disrupts homeostatic processes, with final effects on sleep quality and behaviour.
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Affiliation(s)
- Danilo Menicucci
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (D.M.); (E.M.); (A.G.)
| | - Luca Bastiani
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy; (L.B.); (F.D.)
| | - Eleonora Malloggi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (D.M.); (E.M.); (A.G.)
| | - Francesca Denoth
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy; (L.B.); (F.D.)
| | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (D.M.); (E.M.); (A.G.)
- Clinical Psychology Branch, Azienda Ospedaliero-Universitaria Pisana, 56100 Pisa, Italy
| | - Sabrina Molinaro
- Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy; (L.B.); (F.D.)
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Zhang XJ, Lin JR, Ou MX, Yan HW, Liu SN, Dai L, Gong FQ. Factors associated with quality of life in Chinese people with psoriasis: a cross-sectional study. BMC Public Health 2023; 23:1860. [PMID: 37749489 PMCID: PMC10521450 DOI: 10.1186/s12889-023-16758-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/13/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND The ultimate goal of medical care is to eradicate disease and restore normality to a person's life. Quality of life (QOL) is a concern as dermatologists and researchers strive to find better drug treatments. However, there have been few reports on the factors associated with QOL among Chinese people with psoriasis. METHODS A total of 185 people with psoriasis were surveyed to assess their sociodemographic status, disease-related information, psychosocial status, and QOL. The questionnaires included a sociodemographic questionnaire, the Athens Insomnia Scale, the Hospital Anxiety and Depression Scale, the Perceived Social Support Scale, the Psychosocial Adaptation Questionnaire of Chronic Skin Disease and the Dermatology Life Quality Index. Multiple stepwise regression and path analysis were used to study the factors associated with QOL among Chinese people with psoriasis and to analyse the relationship between them. RESULTS The results showed that the presence of anxiety/depression, lesion area, sleep disorders, psychosocial adaptation, and sex could jointly predict 62.1% of the variance in QOL among Chinese people with psoriasis. According to previous theories and the literature, a path model was established for five variables. Four internal variables could be effectively explained. The values of the explanatory variables were 62.1% (F(1056) = 61.020, p = 0.000) for QOL, 71.8% (F(2433) = 117.370, p = 0.000) for anxiety/depression, 44.0% (F(660) = 36.935, p = 0.000) for sleep disorders, and 66.9% (F(6886) = 93.556, p = 0.000) for psychosocial adaptation. The path analysis confirmed that 9 paths were consistent with the predicted path, and 3 paths were not confirmed. CONCLUSION To improve QOL among Chinese people with psoriasis, attention should be given to the presence of anxiety/depression, lesion area, sleep disorders, psychosocial adaptation and sex differences. Therefore, health care programs for psoriasis should include physical, psychological and social aspects.
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Affiliation(s)
- Xiu-Jie Zhang
- School of Public Health, China Medical University, Shenyang, China
- Department of Dermatology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jing-Rong Lin
- Department of Dermatology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Min-Xing Ou
- Department of Dermatology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hong-Wei Yan
- Department of Dermatology, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Sheng-Nan Liu
- Department of Dermatology, Dalian Dermatology Hospital, Dalian, China
| | - Lu Dai
- Department of Dermatology, Shenyang Dermatology Hospital, Shenyang, China
| | - Fu-Qing Gong
- School of Public Health, China Medical University, Shenyang, China.
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Effectiveness of Long-Term Treatment with Brodalumab on Anxiety or Depressive Symptoms in Japanese Patients with Psoriasis: The ProLOGUE Study. Dermatol Ther (Heidelb) 2023; 13:1039-1052. [PMID: 36877438 DOI: 10.1007/s13555-023-00909-z] [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: 12/11/2022] [Accepted: 02/20/2023] [Indexed: 03/07/2023] Open
Abstract
INTRODUCTION Evidence on treatment effectiveness in patients with psoriasis having anxiety or depressive symptoms helps shared decision-making. This single-arm, open-label, prospective study-ProLOGUE-was conducted to assess the effectiveness of brodalumab on self-assessed anxiety and depressive symptoms in Japanese patients with psoriasis. METHODS Patients aged ≥ 18 years with plaque psoriasis without peripheral arthritis symptoms who had responded inadequately to current therapies were enrolled at 15 Japanese facilities and received brodalumab 210 mg subcutaneously. RESULTS A total of 73 patients were enrolled (male, 82%; median age, 54 years). The proportion of patients without anxiety symptoms changed significantly from baseline (72.6%) to weeks 12 (88.9%, p = 0.008) and 48 (87.7%, p = 0.02); the proportion of patients without depressive symptoms did not change significantly. The Generalized Anxiety Disorder-7 score (median [quartile(Q)1-Q3], 1.0 [0.0-5.0] at baseline; 0.0 [0.0-2.0] at week 12, p = 0.008; and 0.0 [0.0-1.0] at week 48, p = 0.007) and Patient Health Questionnaire-8 score (median [Q1-Q3], 2.0 [0.0-4.0] at baseline; 1.0 [0.0-4.0] at week 12, p = 0.03; and 0.0 [0.0-2.0] at week 48, p = 0.004) significantly decreased after treatment. The median Psoriasis Area and Severity Index scores after treatment were < 1, irrespective of the presence of baseline anxiety or depressive symptoms. At week 12, the health-related quality of life was more impaired in patients with versus without baseline depressive symptoms, which largely resolved at week 48. CONCLUSIONS Brodalumab treatment resulted in the reduction of the levels of self-assessed anxiety and depressive symptoms in Japanese patients with psoriasis. Unlike anxiety symptoms, depressive symptoms did not resolve completely with brodalumab treatment. Patients with psoriasis having depressive symptoms may require long-term treatment. TRIAL REGISTRATION UMIN Clinical Trials Registry identifier: UMIN000027783, Japan Registry of Clinical Trials identifier: jRCTs031180037.
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10
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Armstrong AW, Fitzgerald T, McLean RR, Teeple A, Uy JP, Olurinde M, Rowland K, Guo L, Shan Y, Callis Duffin K. Effectiveness of Guselkumab Therapy among Patients with Plaque Psoriasis with Baseline IGA Score ≥ 2 in the CorEvitas Psoriasis Registry. Dermatol Ther (Heidelb) 2023; 13:487-504. [PMID: 36484917 PMCID: PMC9884726 DOI: 10.1007/s13555-022-00865-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION In clinical trials, treatment with the interleukin-23 inhibitor guselkumab was associated with significantly improved disease severity and patient-reported outcome measures (PROMs) among patients with moderate-to-severe plaque psoriasis. However, limited information is available regarding the real-world effectiveness of guselkumab among patients with psoriasis of mild, moderate, and severe Investigator's Global Assessment (IGA) severities living in the USA and Canada. METHODS Patients participating in the CorEvitas Psoriasis Registry between 18 July 2017 and 10 July 2019 who met the following criteria were included: IGA ≥ 2 (mild or greater disease severity), initiated guselkumab at a registry (index) visit, and had a registry follow-up visit after persistent guselkumab treatment for 9 to 12 months. Data were collected for patient demographics, disease characteristics, treatment history, disease activity, and PROMs. At follow-up, outcome measure response rates and mean changes from the index visit were calculated. RESULTS Among 130 patients, the mean age was 50.2 years, 39.2% were female, and 56.9% had a body mass index ≥ 30 kg/m2. Mean psoriasis duration was 17.5 years and 79.2% of patients had previously received one or more biologic therapy. At the index visit, mean IGA, Psoriasis Area Severity Index (PASI), and Dermatology Life Quality Index (DLQI) scores were 3.0, 9.9, and 8.0, respectively. At follow-up, IGA 0/1 and IGA 0 were achieved by 64.6% and 36.2% of patients, respectively. PASI 75, 90, and 100 were achieved by 61.5%, 46.9%, and 36.9% of patients; 55.4% had maintained or achieved DLQI 0/1. Mean improvements were observed in all evaluated disease activity outcomes and PROMs, with all differing significantly from zero except for the percent of work hours missed due to psoriasis. CONCLUSION In this real-world study, patients with a baseline IGA score ≥ 2 experienced improvements in disease activity and PROMs after 9-12 months of persistent guselkumab treatment.
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Affiliation(s)
- April W Armstrong
- University of Southern California, Los Angeles, CA, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | - Amanda Teeple
- Janssen Scientific Affairs, LLC, Horsham, PA, 19044, USA
| | - Jonathan P Uy
- Janssen Scientific Affairs, LLC, Horsham, PA, 19044, USA
| | | | | | - Lin Guo
- CorEvitas, LLC, Waltham, MA, USA
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11
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Quality of Life and Body Region Affected by Psoriasis: A Systematic Review. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T33-T38. [PMID: 36368576 DOI: 10.1016/j.ad.2022.07.025] [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: 07/06/2021] [Accepted: 07/28/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Psoriasis is a chronic skin condition that affects approximately 1-3% of the world's population and is known to decrease patients' quality of life. However, it is yet to be ascertained whether the specific location of psoriatic lesions on the body influences one's quality of life. METHODS A systematic review was conducted with a search of MEDLINE, EMBASE, and Web of Science databases. Only non-case report and non-review studies with explicitly stated body regions affected by psoriasis were included in the review. FINDINGS Psoriatic patches and plaques in different areas of the body were not found to influence patients' quality of life to differing extents. CONCLUSIONS While the body of evidence is limited and presents unstandardized results, the results of this review point to the fact that all psoriatic patches and plaques decrease patients' quality of life, with neither one region doing so to a significantly greater extent than another.
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12
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Kim SM, Ahn J, Cho YA, Sung JY, Kim CY, Yu DA, Lee YW, Won S, Choe YB. Increased risk of suicidality in patients with psoriasis: A Nationwide cohort study in Korea. J Eur Acad Dermatol Venereol 2023; 37:75-84. [PMID: 36028994 DOI: 10.1111/jdv.18565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/27/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Psoriasis has a devastating psychological impact on patients' quality of life. However, the relationship between suicidality and psoriasis remains unclear. OBJECTIVE This study analysed and compared the risk of suicidality (suicidal ideation, suicide attempt and completed suicide) between patients with psoriasis and the general population. METHODS This nationwide, population-based, retrospective, cohort study analysed the Korean National Health Insurance Service claim data from 2005 to 2018. RESULTS The study included 348,439 patients with psoriasis aged over 18 years and with age- and sex-matched controls. The risk of suicidality was higher in the psoriasis group than in the control group [adjusted hazard ratio (aHR) 1.21; 95% confidence interval (CI), 1.18-1.24]. The aHR of suicidality was higher in the psoriatic arthritis group (aHR, 1.46; 95% CI, 1.39-1.54) than in the psoriasis-alone group (aHR, 1.17; 95% CI, 1.13-1.20). However, the severity of psoriasis and suicidality showed no correlation (mild psoriasis group: aHR, 1.22; 95% CI, 1.18-1.25; moderate-to-severe psoriasis group: aHR, 1.16; 95% CI, 1.10-1.23). CONCLUSION Patients with psoriasis have an increased risk of suicidality. In particular, the presence of arthritis in patients had a more significant effect on the risk of suicidality.
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Affiliation(s)
- Sung Min Kim
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Juhee Ahn
- Department of Public Health Sciences, Seoul National University, Seoul, Republic of Korea
| | - Young Ah Cho
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jae Young Sung
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Chang Yong Kim
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Da-Ae Yu
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Republic of Korea.,Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Yang Won Lee
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Republic of Korea.,Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sungho Won
- Department of Public Health Sciences, Seoul National University, Seoul, Republic of Korea.,Interdisciplinary Program of Bioinformatics, Seoul National University, Seoul, Republic of Korea.,RexSoft Inc, Seoul, Republic of Korea
| | - Yong Beom Choe
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Republic of Korea.,Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
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13
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Nabieva K, Vender R. Quality of Life and Body Region Affected by Psoriasis: A Systematic Review. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:33-38. [PMID: 36030828 DOI: 10.1016/j.ad.2022.07.021] [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: 07/06/2021] [Revised: 03/20/2022] [Accepted: 07/28/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Psoriasis is a chronic skin condition that affects approximately 1-3% of the world's population and is known to decrease patients' quality of life. However, it is yet to be ascertained whether the specific location of psoriatic lesions on the body influences one's quality of life. METHODS A systematic review was conducted with a search of MEDLINE, EMBASE, and Web of Science databases. Only non-case report and non-review studies with explicitly stated body regions affected by psoriasis were included in the review. FINDINGS Psoriatic patches and plaques in different areas of the body were not found to influence patients' quality of life to differing extents. CONCLUSIONS While the body of evidence is limited and presents unstandardized results, the results of this review point to the fact that all psoriatic patches and plaques decrease patients' quality of life, with neither one region doing so to a significantly greater extent than another.
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Affiliation(s)
- K Nabieva
- University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - R Vender
- Dermatrials Research Inc., Hamilton, Canada.
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14
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Pavlova NT, Moss‐Morris R, Smith C, Carr E, Rayner L, Picariello F. The importance of illness severity and multimorbidity in the association between mental health and body weight in psoriasis: Cross-sectional and longitudinal analysis. SKIN HEALTH AND DISEASE 2022; 2:e117. [PMID: 36479273 PMCID: PMC9720224 DOI: 10.1002/ski2.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND High body weight is common in psoriasis and is associated with depression and anxiety. Past studies are mostly cross-sectional and may underestimate the role of demographic and illness-related factors in the association between mental health and body weight in psoriasis. OBJECTIVES This study explored the association between depression and anxiety with waist circumference and body mass index (BMI) cross-sectionally and at 12 months follow-up, adjusting for demographic and illness-related factors in people with psoriasis. METHOD Routine psoriasis care data were combined with data on depression and anxiety from a large specialist psoriasis centre. The analytical samples consisted of patients with complete data on either waist circumference (N = 326 at time 1; N = 191 at follow-up) or BMI (N = 399 at time 1; N = 233 at follow-up) and corresponding mental health, demographic, and illness-related information. Associations between weight-related outcomes and mental health variables were assessed at time one and at 12 months follow-up, after adjusting for demographic and illness-related factors. RESULTS We found no evidence of associations between mental health and waist circumference or BMI, after adjusting for age, gender and illness-related factors. Higher age, male gender and illness-related factors, specifically multimorbidity and psoriasis severity, were positively associated with waist circumference and BMI at both time points. CONCLUSION This study revealed the important role of factors related to illness severity in body weight in psoriasis. The contribution of depression and anxiety to weight was not observed here likely due to the sample and methodology used. Future work should explore other psychosocial factors such as weight-related attitudes and emotional eating in the context of weight in psoriasis, to help inform the development of successful weight-management treatments.
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Affiliation(s)
- Neli T. Pavlova
- Health Psychology SectionPsychology DepartmentInstitute of Psychiatry Psychology and NeuroscienceKing's College LondonLondonUK
| | - Rona Moss‐Morris
- Health Psychology SectionPsychology DepartmentInstitute of Psychiatry Psychology and NeuroscienceKing's College LondonLondonUK
| | - Catherine Smith
- Health Psychology SectionPsychology DepartmentInstitute of Psychiatry Psychology and NeuroscienceKing's College LondonLondonUK
- Guy's and St Thomas' NHS Foundation TrustSt John's Institute of DermatologyLondonUK
| | - Ewan Carr
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry Psychology and NeuroscienceKing's College LondonLondonUK
| | - Lauren Rayner
- Department of Psychological MedicineInstitute of Psychiatry Psychology and NeuroscienceKing's College LondonLondonUK
| | - Federica Picariello
- Health Psychology SectionPsychology DepartmentInstitute of Psychiatry Psychology and NeuroscienceKing's College LondonLondonUK
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15
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Asawanonda P, Pattamadilok B, Chularojanamontri L, Chuamanochan M, Choonhakarn C, Chakkavittumrong P, Sangob N, Rajatanavin N. Real-world experience of secukinumab in moderate to severe psoriasis patients in Thailand: Characteristics, effectiveness, and safety. Dermatol Ther 2022; 35:e15958. [PMID: 36279306 PMCID: PMC10078165 DOI: 10.1111/dth.15958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 11/28/2022]
Abstract
Secukinumab demonstrated high efficacy and favorable safety profile in patients with moderate-to-severe plaque psoriasis (PsO) in clinical trials. However, understanding of patient characteristics and clinical outcomes in real world in Thailand is still limited. To describe patient characteristics, effectiveness and safety of secukinumab in Thai PsO patients. This retrospective study analyzed data from medical records of adult PsO patients who initiated secukinumab at 7 dermatology centers from September 2017 to April 2021. Study outcomes included patient characteristics and changes in Psoriasis Area and Severity Index (PASI) score from baseline at weeks 4 and 16 after secukinumab initiation. Adverse events were recorded. Subgroup analyses by adherence rate and completeness of loading dose were performed. Of 163 patients, the mean (SD) age was 44.0 (14.0) years. Most patients (84.7%) were previously treated with topical therapy while 62.0% and 21.5% of patients had received systemic and biologic therapy, respectively. The mean baseline PASI score was 15.4 (9.3). Overall, the mean PASI score improved by 58.0% at week 4 and 78.4% at week 16. Statistically significant differences in PASI approvement were revealed among subgroups of patients with different loading dose and adherence rate. Adverse effects were reported in 8.0% of patients. The characteristics of patients in this study were slightly different from clinical trials in terms of demographic and clinical characteristics, as well as PsO treatment. Secukinumab was effective and safe in Thai patients with PsO, especially among those with complete loading dose and a higher adherence rate.
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Affiliation(s)
- Pravit Asawanonda
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Mati Chuamanochan
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Charoen Choonhakarn
- Division of Dermatology, Department of Medicine, Srinagarind Hospital Medical School, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Natta Rajatanavin
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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16
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da Silva N, Augustin M, Hilbring C, Braren-von Stülpnagel CC, Sommer R. Psychological (co)morbidity in patients with psoriasis: the impact of pruritus and anogenital involvement on symptoms of depression and anxiety and on body dysmorphic concerns - a cross-sectional study. BMJ Open 2022; 12:e055477. [PMID: 36153012 PMCID: PMC9511542 DOI: 10.1136/bmjopen-2021-055477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES While stress plays a paramount role on the onset/exacerbation of psoriasis, via overactivation of the hypothalamic-pituitary-adrenal axis and increased release of pro-inflammatory cytokines, cutaneous inflammatory response induces, in turn, anxiety/depression symptoms, via body disfigurement and stigmatisation. The intensity of pruritus and anogenital involvement are additional risk factors for psychological comorbidity.Aims were to (1) examine the effects of intensity of pruritus and anogenital psoriasis on disease burden and psychological comorbidity and (2) identify the variables associated with the presence of clinically significant depression, anxiety, and dysmorphic concerns. DESIGN Cross-sectional study. SETTING Conducted at the University Medical Center Hamburg-Eppendorf (UKE). PARTICIPANTS 107 patients with psoriasis (mean age = 46.3, SD = 14.6 years; 53.3% male): 64 with none/mild pruritus; 43 with moderate/severe pruritus; 31 with anogenital psoriasis; 76 not affected in the anogenital area. PRIMARY/SECONDARY OUTCOMES MEASURES Disease severity was assessed with Psoriasis Area and Severity Index and intensity of pruritus was rated by patients. Patient-reported outcomes included the Dermatology Life Quality Index, ItchyQoL, Patient Benefit Index, Perceived Stigmatisation Questionnaire, and Relationship and Sexuality Scale. Psychological morbidity was assessed with the Patient Health Questionnaire, Generalised Anxiety Disorder, and Dysmorphic Concern Questionnaire. RESULTS Patients with moderate/severe pruritus reported more quality of life impairments, depression, anxiety and dysmorphic concerns, and less treatment benefits than those with none/mild pruritus. Moderate/severe pruritus had a deleterious effect on depression and stigmatisation for patients without anogenital involvement. Less patient benefits were associated with a higher likelihood of clinically significant depression/anxiety. CONCLUSION Pruritus induces significant burden and psychological morbidity, particularly for patients without anogenital involvement. However, coping strategies used by patients with anogenital psoriasis might be dysfunctional for overall psychosocial adaptation. Patient-centred healthcare might be the best way to prevent psychological comorbidity. ETHICS APPROVAL Ethics Committee of the Medical Association of Hamburg (process number PV6083, 28 May 2019).
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Affiliation(s)
- Neuza da Silva
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Caroline Hilbring
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Catharina C Braren-von Stülpnagel
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Rachel Sommer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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17
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Bachelez H, Barker J, Burden AD, Navarini AA, Krueger JG. Generalized pustular psoriasis is a disease distinct from psoriasis vulgaris: evidence and expert opinion. Expert Rev Clin Immunol 2022; 18:1033-1047. [PMID: 36062811 DOI: 10.1080/1744666x.2022.2116003] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Generalized pustular psoriasis (GPP) is a rare, severe, clinically heterogeneous disease characterized by flares of widespread, non-infectious, macroscopically visible pustules that occur with or without systemic inflammation, and are associated with significant morbidity and mortality. Historically, GPP has been classified as a variant of psoriasis vulgaris (PV, or plaque psoriasis); however, accumulating evidence indicates that these are distinct conditions, requiring different treatment approaches. AREAS COVERED In this perspectives article we review evidence that supports the classification of GPP as distinct from PV. EXPERT OPINION The histopathologic and clinical appearance of GPP is distinct from that of PV and fundamental differences exist between the two conditions in terms of genetic causes and expression-related mechanisms of disease development. GPP results from dysregulation of the innate immune system, with disruption of the interleukin (IL)-36 inflammatory pathway, induction of inflammatory keratinocyte responses, and recruitment of neutrophils. PV is driven by the adaptive immune system, with a key role played by IL-17. Considering GPP as a separate disease will enable greater focus on its specific pathogenesis and the needs of patients. Many treatments for PV have insufficient efficacy in GPP and a therapeutic approach developed specifically for GPP might lead to better patient outcomes.
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Affiliation(s)
- Hervé Bachelez
- Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, Paris, France.,INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université Paris Cité, Paris, France
| | - Jonathan Barker
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - A David Burden
- Institute of Infection, Inflammation and Immunity, University of Glasgow, Glasgow, UK
| | | | - James G Krueger
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
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18
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Jalenques I, Bourlot F, Martinez E, Pereira B, D'Incan M, Lauron S, Rondepierre F. Prevalence and Odds of Anxiety Disorders and Anxiety Symptoms in Children and Adults with Psoriasis: Systematic Review and Meta-analysi. Acta Derm Venereol 2022; 102:adv00769. [DOI: 10.2340/actadv.v102.1386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The magnitude of the association between psoriasis and depression has been evaluated, but not that between psoriasis and anxiety. The aim of this systematic review and meta-analysis was to examine the prevalence and odds of anxiety disorders and symptoms in patients with psoriasis. Five medical databases (Cochrane Database, EMBASE, PubMed, PsychINFO, ScienceDirect) were searched for relevant literature. A total of 101 eligible articles were identified. Meta-analysis revealed different prevalence rates depending on the type of anxiety disorder: 15% [95% confidence interval [CI] 9–21] for social anxiety disorder, 11% [9–14] for generalized anxiety disorder, and 9% [95% CI 8–10] for unspecified anxiety disorder. There were insufficient studies assessing other anxiety disorders to be able to draw any conclusions on their true prevalence. Meta-analysis also showed a high prevalence of anxiety symptoms (34% [95% CI 32–37]). Case-control studies showed a positive association between psoriasis and unspecified anxiety disorder (odds ratio 1.48 [1.18; 1.85]) and between psoriasis and anxiety symptoms (odds ratio 2.51 [2.02; 3.12]). All meta-analyses revealed an important heterogeneity, which could be explained in each case by methodological factors. The results of this study raise the necessity of screening for the presence of anxiety disorders, as previously recommended for depressive disorders, in patients with psoriasis and, if necessary, to refer such patients for evaluation by a mental health professional and appropriate treatment.
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19
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The impact of genital lichen sclerosus and lichen planus on quality of life: A review. Int J Womens Dermatol 2022; 8:e042. [PMID: 36000015 PMCID: PMC9387966 DOI: 10.1097/jw9.0000000000000042] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022] Open
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20
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Abstract
Psoriatic arthritis (PsA) is an inflammatory musculoskeletal disease with a chronic, progressive course. Various aspects of PsA, including its clinical features, disease course and response to treatment, are influenced by sociodemographic characteristics of the patient. This includes patient sex, the biological attributes associated with being male or female, and gender, a sociocultural construct that comprises attitudes, traits and behaviours associated with being a man or a woman. An understanding of sex- and gender-related differences in PsA, as well as their underlying mechanisms, is therefore important for individualized care. In this narrative review, the influence of sex and gender on PsA manifestation and course, patient function and quality of life, and their association with comorbidities are described. Sex- and gender-related disparities in response to advanced therapies and their potential underlying mechanisms are delineated. Differences in pathophysiological mechanisms between male and female patients including genetics, immune and hormonal mechanisms are discussed. Finally, fertility and pregnancy outcomes in PsA are outlined. By adopting sex and gender lenses, this review is aimed at highlighting key differences between male and female patients with PsA and uncovering mechanisms underlying these differences, ultimately promoting individualized care of men and women with PsA and informing future research in this area.
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21
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Morin S, Simard M, Rioux G, Julien P, Pouliot R. Alpha-Linolenic Acid Modulates T Cell Incorporation in a 3D Tissue-Engineered Psoriatic Skin Model. Cells 2022; 11:cells11091513. [PMID: 35563819 PMCID: PMC9104007 DOI: 10.3390/cells11091513] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/27/2022] [Indexed: 12/18/2022] Open
Abstract
Psoriasis is an autoimmune skin disease with an increased number of leukocytes infiltrating the dermal and epidermal compartments compared with normal skin. N-3 polyunsaturated fatty acids (n-3 PUFAs) are frequently used in the clinic in order to attenuate the symptoms of psoriasis. For psoriatic patients, a supplementation of the diet with alpha-linolenic acid (ALA) reduces the activation of T cell signaling pathways, leading to a significant reduction in inflammatory cytokine secretion. However, the precise mechanism of action of n-3 PUFAs in psoriasis is still not understood. In the present study, we elucidated the bioaction of ALA on the adaptive immune component of psoriasis by using a psoriatic skin model produced with the addition of activated T cells. Healthy and psoriatic skin substitutes were produced according to the self-assembly method, using culture media supplemented with 10 μM of ALA. T cells were isolated from blood samples using a negative selection isolation method. ALA supplementation regulated the hyperproliferation and abnormal cell differentiation of psoriatic keratinocytes stimulated by T cells. Additionally, the exogenous ALA was correctly incorporated into the phospholipids of keratinocytes, which resulted in increased levels of ALA, eicosapentaenoic acid (EPA) and n-3 docosapentaenoic acid (n-3 DPA). The infiltration of T cells into the epidermis was reduced when ALA was added to the culture medium, and significant decreases in the levels of inflammatory cytokines and chemokines such as CXCL1, interleukin-6 (IL-6) and interleukin-8 (IL-8) were consequently measured in psoriatic substitutes supplemented with this n-3 PUFA. Altogether, our results showed that in this psoriatic skin model enriched with T cells, ALA exerted its beneficial effect by decreasing the quantities of inflammatory mediators released by T cells.
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Affiliation(s)
- Sophie Morin
- Centre de Recherche en Organogénèse Expérimentale de l’Université Laval/LOEX, Axe Médecine Régénératrice, Centre de Recherche du CHU de Québec-Université Laval, 1401 18e Rue, Québec City, QC G1J 2Z4, Canada; (S.M.); (M.S.); (G.R.)
- Faculté de Pharmacie, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Mélissa Simard
- Centre de Recherche en Organogénèse Expérimentale de l’Université Laval/LOEX, Axe Médecine Régénératrice, Centre de Recherche du CHU de Québec-Université Laval, 1401 18e Rue, Québec City, QC G1J 2Z4, Canada; (S.M.); (M.S.); (G.R.)
- Faculté de Pharmacie, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Geneviève Rioux
- Centre de Recherche en Organogénèse Expérimentale de l’Université Laval/LOEX, Axe Médecine Régénératrice, Centre de Recherche du CHU de Québec-Université Laval, 1401 18e Rue, Québec City, QC G1J 2Z4, Canada; (S.M.); (M.S.); (G.R.)
- Faculté de Pharmacie, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Pierre Julien
- Centre de Recherche du CHU de Québec-Université Laval, Axe Endocrinologie et Néphrologie, Université Laval, Québec City, QC G1V 4G2, Canada;
- Département de Médecine, Faculté de Médecine, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Roxane Pouliot
- Centre de Recherche en Organogénèse Expérimentale de l’Université Laval/LOEX, Axe Médecine Régénératrice, Centre de Recherche du CHU de Québec-Université Laval, 1401 18e Rue, Québec City, QC G1J 2Z4, Canada; (S.M.); (M.S.); (G.R.)
- Faculté de Pharmacie, Université Laval, Québec City, QC G1V 0A6, Canada
- Correspondence:
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22
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Yang Y, Xie S, Jiang W, Tang S, Shi Y. Discovering Novel Biomarkers Associated with the Pathogenesis of Psoriasis: Evidence from Bioinformatic Analysis. Int J Gen Med 2022; 15:2817-2833. [PMID: 35300136 PMCID: PMC8923704 DOI: 10.2147/ijgm.s354985] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/01/2022] [Indexed: 01/01/2023] Open
Affiliation(s)
- Yang Yang
- Department of Dermatology, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, 200443, People’s Republic of China
- Institute of Psoriasis, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
| | - Shaoqiong Xie
- Department of Dermatology, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, 200443, People’s Republic of China
| | - Wencheng Jiang
- Department of Dermatology, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, 200443, People’s Republic of China
| | - Suwei Tang
- Department of Dermatology, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, 200443, People’s Republic of China
- Institute of Psoriasis, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
| | - Yuling Shi
- Department of Dermatology, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, 200443, People’s Republic of China
- Institute of Psoriasis, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
- Correspondence: Yuling Shi; Suwei Tang, Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Jing-an District, Shanghai, 200443, People’s Republic of China, Tel +86-13816213884; +86-18017337631, Fax +63833136, Email ;
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Li M, Cheng H, Tian D, Yang L, Du X, Pan Y, Zhang D, Mei X. D-Mannose Suppresses γδ T Cells and Alleviates Murine Psoriasis. Front Immunol 2022; 13:840755. [PMID: 35296088 PMCID: PMC8918796 DOI: 10.3389/fimmu.2022.840755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/04/2022] [Indexed: 11/18/2022] Open
Abstract
Psoriasis is a chronic skin disorder associated with multiple sequelae, such as psoriatic arthritis and cardiovascular diseases. Increasing evidence has shown that γδ T cells, as sources of IL-17A, play critical roles in psoriatic inflammations. However, there still lack effective ways to manipulate these pathogenic γδ T cells, which are less well studied than αβ T cells. The present study aims to characterize the phenotype of γδ T cells and evaluate the impact of D-mannose (a C-2 epimer of glucose) on γδ T cell-mediated psoriasis. We found that skin-draining LN γδ T cells underwent robust proliferation and acquired an IL-17-producing phenotype during psoriasis. The transcriptomic profiles of these psoriatic γδ T cells had elevated glycolytic signatures. Importantly, D-mannose treatment suppressed the γδ T cell reaction and successfully alleviated the local and systematic inflammation induced by imiquimod. The decreased AKT/mTOR/HIF-1α signaling and glycolytic ability may contribute to the suppression of γδ T cells achieved by D-mannose. Our study increased understanding of γδ T cells in psoriasis and promoted D-mannose utilization as a potential clinical application for autoimmune diseases driven by γδ T cells.
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Affiliation(s)
- Mingyang Li
- Immunology Research Center for Oral and Systemic Health, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Tolerance Induction and Organ Protection in Transplantation Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Immunology Research Center, Beijing Clinical Research Institute, Beijing, China
- General Surgery Department, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Haiyan Cheng
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Dan Tian
- Immunology Research Center for Oral and Systemic Health, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Tolerance Induction and Organ Protection in Transplantation Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Immunology Research Center, Beijing Clinical Research Institute, Beijing, China
- General Surgery Department, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lu Yang
- Immunology Research Center for Oral and Systemic Health, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Tolerance Induction and Organ Protection in Transplantation Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Immunology Research Center, Beijing Clinical Research Institute, Beijing, China
| | - Xiaonan Du
- Immunology Research Center for Oral and Systemic Health, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Tolerance Induction and Organ Protection in Transplantation Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Immunology Research Center, Beijing Clinical Research Institute, Beijing, China
| | - Yuhualei Pan
- Immunology Research Center for Oral and Systemic Health, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Tolerance Induction and Organ Protection in Transplantation Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Immunology Research Center, Beijing Clinical Research Institute, Beijing, China
| | - Dong Zhang
- Immunology Research Center for Oral and Systemic Health, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Tolerance Induction and Organ Protection in Transplantation Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Immunology Research Center, Beijing Clinical Research Institute, Beijing, China
- General Surgery Department, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- *Correspondence: Xueling Mei, ; Dong Zhang,
| | - Xueling Mei
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- *Correspondence: Xueling Mei, ; Dong Zhang,
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Kowalewska B, Krajewska-Kułak E, Sobolewski M. The Impact of Stress-Coping Strategies and the Severity of Psoriasis on Self-Esteem, Illness Acceptance and Life Satisfaction. Dermatol Ther (Heidelb) 2022; 12:529-543. [PMID: 35041156 PMCID: PMC8764316 DOI: 10.1007/s13555-021-00669-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/16/2021] [Indexed: 12/21/2022] Open
Abstract
Introduction The visibility of skin lesions is a significant burden for patients with psoriasis, who experience social hostility as well as many emotional and psychological problems. The recurrent nature of cutaneous manifestations and their location are also a source of emotional distress, which in turn is one of the main factors that intensifies skin lesions in these patients. The aim of the study was to assess the impact of the severity of psoriasis and stress-coping strategies on general psychometric measures in the affected patients. Methods The study used a short demographic questionnaire, Psoriasis Area and Severity Index (PASI), and four standardised general psychometric tools: Rosenberg Self-Esteem Scale (SES), Satisfaction With Life Scale (SWLS), Coping Inventory for Stressful Situations (CISS) and Acceptance of Illness Scale (AIS). A total of 111 patients participated in the study. Results The mean PASI score was 14.0 (12.1–15.9). The mean SWLS score was below average, i.e., 18.5 (17.3–19.7), and the SES score—26.8 points (26.1–27.5)—indicated self-esteem slightly above average among patients with psoriasis. The mean stress-coping level measured with CISS was 53.6 (51.9–55.2) for the task-oriented strategy (TOS), 46.2 (43.8–48.6) for the emotion-oriented strategy (EOS) and 50.1 (48.5–51.8) for the avoidance-oriented strategy (AOS). Higher PASI was associated with lower illness acceptance among men (r = 0.48) and lower self-esteem among women (r = 0.44). The level of life satisfaction was lower in respondents with higher PASI scores (mainly in the group of women, r = 0.44). Conclusions Higher severity of psoriasis (PASI) and greater frequency of emotion-oriented stress-coping mechanisms (CISS) are factors that negatively affect the overall psychophysical condition of respondents.
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Affiliation(s)
- Beata Kowalewska
- The Department of Integrated Medical Care, Medical University in Białystok, 7A MC Skłodowskiej Str., 15-096, Białystok, Poland.
| | - Elżbieta Krajewska-Kułak
- The Department of Integrated Medical Care, Medical University in Białystok, 7A MC Skłodowskiej Str., 15-096, Białystok, Poland
| | - Marek Sobolewski
- Faculty of Management, Rzeszow University of Technology, Rzeszow, Poland
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25
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Lang Y, Wu B, Sun Z, Ye E, Dou G, Guan X. Patient Preference for Biologic Treatments of Psoriasis in the Chinese Setting. Patient Prefer Adherence 2022; 16:1071-1084. [PMID: 35479654 PMCID: PMC9038155 DOI: 10.2147/ppa.s357795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/09/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Assessments of patients' preferences can support in clinical decision-making regarding biologic therapies for psoriasis. Our objective was to investigate patient preference for biologic treatments in patients with psoriasis in China. METHODS From October 2020 to January 2021, psoriasis patients were recruited for a survey that included demographic and disease-related questions, as well as a discrete choice experiment to measure their preferences for biologic therapy. A discrete-choice experiment was used in which respondents selected psoriasis treatments based on benefits (ie, early onset of efficacy, long-term efficacy, sustained efficacy) and treatment costs. We analyzed choice data using conditional logit model. RESULTS This study included 236 patients with moderate-to-severe psoriasis. The relative importance of the cost of biologic treatments, probability of keeping PASI100 at 5 years, probability of achieving PASI100 at 3 months and time to achieve PASI50 after initiation the biologic treatment were 0.593, 0.137, 0.185 and 0.085. Over 50% of patients regarded the cost of biologic treatments as the most important attribute. High-income and low-income subgroups had higher preference weight in probability of achieving PASI100 at 3-month and monthly cost. CONCLUSION The cost of biologic treatments was found as the most important attribute for Chinese patients with psoriasis. Among efficacy attributes, the probability of achieving PASI100 at 3 months showed most sensitive. These results may be helpful to understand patient preference for biologic treatments used for psoriasis in China.
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Affiliation(s)
- Yitian Lang
- Department of Pharmacy, Huangpu Branch, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People’s Republic of China
| | - Bin Wu
- Medical Decision and Economic Group, Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 201100, People’s Republic of China
| | - Zhilin Sun
- Department of Dermatology, Peking University Third Hospital, Peking University, Haidian District, Beijing, People’s Republic of China
| | - Erjia Ye
- Lilly China Drug Development and Medical Affairs Center, Eli Lilly and Company, Shanghai, People’s Republic of China
| | - Guanshen Dou
- Lilly China Drug Development and Medical Affairs Center, Eli Lilly and Company, Shanghai, People’s Republic of China
| | - Xin Guan
- Department of Dermatology, Peking University Third Hospital, Peking University, Haidian District, Beijing, People’s Republic of China
- Correspondence: Xin Guan, Department of Dermatology, Peking University Third Hospital, Peking University, No. 49, Huayuan North Road, Haidian District, Beijing, People’s Republic of China, Email
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Nowowiejska J, Baran A, Grabowska P, Lewoc M, Kaminski TW, Flisiak I. Assessment of Life Quality, Stress and Physical Activity Among Patients with Psoriasis. Dermatol Ther (Heidelb) 2021; 12:395-406. [PMID: 34918196 PMCID: PMC8850505 DOI: 10.1007/s13555-021-00662-1] [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: 10/18/2021] [Accepted: 11/30/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Psoriasis is a chronic, autoimmune, inflammatory skin disease affecting 2–4% of the general population, which nowadays is even perceived as a systemic illness. The nature of this dermatosis may negatively influence patients’ general condition, life expectancy, and quality of life, which highlights the severity of the problem and the need to perform further investigation. We aimed to assess quality of life, stress severity, and physical activity of patients with psoriasis in relation to demographic and clinical data and comparison to the control group without dermatoses. Methods A set of surveys was conducted in 56 patients with psoriasis hospitalized at the Department of Dermatology, Medical University of Bialystok. Questionnaires used involved the Dermatology Life Quality Index, WHO Quality of Life questionnaire, International Questionnaire of Physical Activity, and a self-invented stress survey. Obtained data were compared to a sex- and age-matched control group without dermatoses. Statistical analysis was performed using GraphPad Prism. Results Patients with psoriasis were found to be significantly less satisfied with their health and had lower scores in WHO social, environmental, and psychological domains, comparing to controls. Patients reported higher stress severity and lower satisfaction with sex life and physical appearance than controls. Patients with psoriasis also tended to perform less intensive physical activity than controls. Conclusions This study highlights the perception of psoriasis as not only affecting skin but also having a multifactorial impact on psychological and internal condition. Described lifestyle abnormalities can be easily evaluated with validated questionnaires, which could be introduced to patients in order to raise their awareness of comorbidities and mobilize them to modify incorrect lifestyle habits. Screening for other disorders and introduction of a holistic approach to every patient could be beneficial because the improvement of patients’ life quality is one of the most important issues.
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Affiliation(s)
- Julia Nowowiejska
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St, 15-540, Bialystok, Poland.
| | - Anna Baran
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St, 15-540, Bialystok, Poland
| | - Paulina Grabowska
- Department of Endocrinology, Diabetology and Internal Diseases, Medical University of Bialystok, Sklodowskiej 24a St., 15-276, Bialystok, Poland
| | - Marta Lewoc
- I Department of General and Endocrine Surgery, Medical University of Bialystok, Sklodowskiej 24a, 15-276, Bialystok, Poland
| | - Tomasz W Kaminski
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, 15260, USA
| | - Iwona Flisiak
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St, 15-540, Bialystok, Poland
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27
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Kowalewska B, Jankowiak B, Krajewska-Kułak E, Milewski R, Sobolewski M. Skin-Disease Specific and Generic Psychometric Measures in Patients with Psoriasis. Dermatol Ther (Heidelb) 2021; 11:1999-2015. [PMID: 34585342 PMCID: PMC8478271 DOI: 10.1007/s13555-021-00609-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/08/2021] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Psychosocial problems of patients with chronic dermatoses, such as psoriasis, add to their somatic ailments, which results in the lack of illness acceptance, lowered self-esteem, deteriorated quality of life, and an array of somatic comorbidities. The aim of this study was to analyze the effect of psoriasis on the quality of life, sense of stigmatization, self-esteem, and satisfaction with life in patients with psoriasis. METHODS The study was based on a short survey prepared by the authors and five validated scales: Dermatology Life Quality Index (DLQI), 6-Item Stigmatization Scale, 33-Item Feelings of Stigmatization Questionnaire, Rosenberg Self-Esteem Scale (SES), and Satisfaction With Life Scale (SWLS). The study included 111 patients with psoriasis (46.8% women and 53.2% men). The inclusion criteria of the study were the diagnosis of plaque psoriasis and written informed consent to participate. RESULTS DLQI scores ranged between 0 and 28 points (pts) (mean 10.8 pts). Mean stigmatization scores determined with the 33- and 6-Item Stigmatization Scale were 81.6 pts and 7.5 pts, respectively. The mean SWLS score for the study group (18.5 pts) was slightly below the average. The mean score SES of 27 pts implies that the study respondents' self-esteem level was slightly above the average. CONCLUSIONS Satisfaction with life turned out to be significantly modulated by overall stigmatization level on the 33-Item Stigmatization Scale (the stronger the sense of stigmatization, the lower the satisfaction with life) and education (respondents with higher education presented with higher satisfaction with life than those with non-higher education).
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Affiliation(s)
- Beata Kowalewska
- The Department of Integrated Medical Care, Medical University in Białystok, 7A MC Skłodowskiej Str., 15-096, Białystok, Poland.
| | - Barbara Jankowiak
- The Department of Integrated Medical Care, Medical University in Białystok, 7A MC Skłodowskiej Str., 15-096, Białystok, Poland
| | - Elżbieta Krajewska-Kułak
- The Department of Integrated Medical Care, Medical University in Białystok, 7A MC Skłodowskiej Str., 15-096, Białystok, Poland
| | - Rafał Milewski
- Doctoral Studies at Faculty of Health Sciences, Department of Primary Healthcare, Medical University of Bialystok, Białystok, Poland
| | - Marek Sobolewski
- Faculty of Management, Rzeszow University of Technology, Rzeszów, Poland
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28
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O'Connell G, Tobin AM. Realize that 'everything connects to everything else': an immigrant's experience of living with untreated psoriasis. Clin Exp Dermatol 2021; 47:468-469. [PMID: 34699625 DOI: 10.1111/ced.14997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Affiliation(s)
- G O'Connell
- Department of Dermatology, Tallaght University Hospital, Dublin, Ireland
| | - A M Tobin
- Department of Dermatology, Tallaght University Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
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Psychological Stress and Salivary Cortisol Levels in Patients with Plaque Psoriasis. J Pers Med 2021; 11:jpm11111069. [PMID: 34834421 PMCID: PMC8621977 DOI: 10.3390/jpm11111069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 01/17/2023] Open
Abstract
Psychological stress has long been recognized as a trigger for plaque psoriasis, and preliminary evidence suggests that psoriasis could be associated with alterations in the hypothalamic-pituitary-adrenal (HPA) axis, resulting in impaired cortisol response to stress. This study aimed to investigate psychological stress, anxiety, depression and salivary cortisol in psoriatic patients. A cross sectional study involving 126 adult patients with plaque psoriasis and 116 adult healthy controls was conducted. Demographic, clinical data, Perceived Stress Scale (PSS) and Hospital Anxiety and Depression Scale (HADS) were collected. Cases and controls were asked whether they felt stressed in the last month, whilst psoriatic patients were also interrogated whether they found that psoriasis could have been worsened by stress. Moreover, 54 randomly selected subjects (27 psoriasis patients and 27 controls) underwent salivary cortisol testing at 8 am. PSS, HADS depression and anxiety subscales were significantly higher in psoriatic patients than in controls (17.2 ± 0.6 vs. 15.1 ± 0.8 p = 0.0289), (9.5 ± 0.3 vs. 6.2 ± 0.3 p < 0.001) and (8.2 ± 0.4 vs. 4.2 ± 0.3 p < 0.001), respectively. A higher rate of psoriatic patients reported feeling stress over the last month (45% vs. 19%, p < 0.001), and stress was considered a potential trigger for psoriasis flare-ups in 69% of cases. Psoriasis was strongly associated with higher PSS and HADS scores independently of sex, body mass index, diabetes, hypertension, dyslipidemia, and occupational status. Salivary cortisol was significantly lower in psoriatic patients compared to controls (9.6 ± 0.5 vs. 14.0 ± 1.1 nmol/L, p < 0.001). In conclusion, psoriasis was associated with higher psychological stress, anxiety and depressive symptoms, and with impaired cortisol response to stress.
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Staubach P, Plavic-Radeka N, Peveling-Oberhag A, Sohn A, Zimmer S, Weyer-Elberich V, Lang BM. Hohe Prävalenz und geringes Bewusstsein bei Patienten mit chronisch‐entzündlichen Hauterkrankungen und genitaler Beteiligung. J Dtsch Dermatol Ges 2021; 19:1443-1450. [PMID: 34661344 DOI: 10.1111/ddg.14437_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/26/2020] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | - Anna Sohn
- Hautklinik, Universitätsmedizin Mainz
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31
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Staubach P, Plavic-Radeka N, Peveling-Oberhag A, Sohn A, Zimmer S, Weyer-Elberich V, Lang BM. High prevalence and little awareness in patients with chronic inflammatory skin diseases and genital involvement. J Dtsch Dermatol Ges 2021; 19:1443-1448. [PMID: 34396689 DOI: 10.1111/ddg.14437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Genital involvement in patients with chronic inflammatory skin diseases is frequent, yet insufficiently acknowledged. OBJECTIVE To evaluate the prevalence of genital symptoms in psoriasis and chronic urticaria patients, effects on quality of life, physician-patient relations and disease management. PATIENTS AND METHODS 100 patients with psoriasis and 100 with chronic urticaria from our outpatient clinic, as well as 50 healthy controls were included. Data was collected using questionnaires developed by dermatological experts. RESULTS Out of 250 subjects, 74 % had already experienced genital symptoms - 70 % of psoriasis patients and 58 % of urticaria patients. Seven out of ten even complained about recurrent genital involvement. 50 % of psoriasis and 41 % of urticaria patients reported an impact on quality of life. 41 % identified genital pruritus as the main symptom, with one out of three expecting a better management for this specific problem. Furthermore, 74 % complained about a lack of awareness among physicians: 79 % of urticaria patients and 58 % of psoriasis patients reported never having been questioned about genital symptoms by their physicians. CONCLUSIONS The majority of patients with psoriasis and chronic urticaria suffer from genital involvement and an impaired quality of life. Patient and physician reported outcomes should include genital symptoms as an influencing factor for quality of life.
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Affiliation(s)
- Petra Staubach
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | | | | | - Anna Sohn
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Sebastian Zimmer
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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Maqbool S, Ihtesham A, Langove MN, Jamal S, Jamal T, Safian HA. Neuro-dermatological association between psoriasis and depression: an immune-mediated inflammatory process validating skin-brain axis theory. AIMS Neurosci 2021; 8:340-354. [PMID: 34183985 PMCID: PMC8222770 DOI: 10.3934/neuroscience.2021018] [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: 01/26/2021] [Accepted: 03/08/2021] [Indexed: 12/26/2022] Open
Abstract
Objective Our study's motive was to recognize various immune-mediated inflammatory processes involved in the pathogenesis of depression and psoriasis and interlink between them based on inflammatory mediators. Methods A careful and comprehensive literature search was done through various databases like PubMed, Google Scholar, and EBSCO. A total of 56 studies were included in our study after careful screening. Results The immune-mediated inflammatory process was significantly associated with the pathogenesis of both depression and psoriasis. Most of the inflammatory markers involved in Psoriasis (TNF-α, IL-2, IL-6, IL-23, IL-1β, IL-10), and increased serotonin transporters (5-HTT) were also found in the pathogenesis of depression, showing the immune-inflammatory linkage between psoriasis and major depression. Based on immune chemistry, the levels of CD2+, CD4+, CD8+ T-lymphocytes were also found to be raised in both depression and psoriasis, validating their relationship. Hyperactivity of HPA-axis was also found another interlink between them along with reduced melatonin amount. Conclusions According to various studies, the neuro-dermatological association between psoriasis and depression is significant. Different immune markers involved in the pathogenesis of depression and psoriasis also show the bidirectional association between them. However, this association between psoriasis and depression is positively correlated, but more work is required to answer why all depressed patients fail to develop psoriasis and why all psoriatic patients fail to develop depression.
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Affiliation(s)
| | - Arham Ihtesham
- Department of Medicine, Rawalpindi Medical University, Pakistan
| | | | - Sara Jamal
- Department of Haematology, Resident Haematology atomic energy Islamabad, Pakistan
| | - Tabdar Jamal
- Department of Radiology, Resident Radiology Kahuta Research Laboratory (KRL) hospital, Pakistan
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33
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Nowowiejska J, Baran A, Lewoc M, Grabowska P, Kaminski TW, Flisiak I. The Assessment of Risk and Predictors of Sleep Disorders in Patients with Psoriasis-A Questionnaire-Based Cross-Sectional Analysis. J Clin Med 2021; 10:664. [PMID: 33572270 PMCID: PMC7916004 DOI: 10.3390/jcm10040664] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 02/06/2023] Open
Abstract
Psoriasis is a chronic, inflammatory skin disease affecting 2-4% of the general population. Accompanying subjective symptoms (pruritus or pain) may cause decreased life quality including sleep disorders (SD). Sixty psoriatic patients fulfilled the following questionnaires: Pittsburgh Sleep Quality Index (PSQI), STOP BANG for the obstructive sleep apnea syndrome (OSAS) assessment, and Restless Legs Syndrome (RLS) Severity Scale. Patients' laboratory and clinical data were also investigated. All data obtained were compared to 40 participants without dermatoses. Mean PSQI, risk of OSAS, and RLS severity of psoriatics were significantly higher than in controls (p < 0.0001, p < 0.05, p < 0.05 respectively). There was a positive correlation between the time of suffering from psoriasis and the risk of OSAS (R = 0.286, p < 0.05). We did not observe any significant relationship between PSQI, risk of OSAS, or RLS and psoriasis severity assessed with PASI (Psoriasis Area and Severity Index). We identified four possible predictors of RLS: glucose, CRP and total cholesterol concentrations, and PSQI. SD are significantly more frequent in psoriatics than in people without chronic dermatological diseases but surprisingly they are not correlated with psoriasis severity. SD decrease patients' life quality and may result in serious consequences. Therefore, establishing recommendations concerning screening for SD and their predictors should be considered.
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Affiliation(s)
- Julia Nowowiejska
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St, 15-540 Bialystok, Poland; (A.B.); (M.L.); (P.G.); (I.F.)
| | - Anna Baran
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St, 15-540 Bialystok, Poland; (A.B.); (M.L.); (P.G.); (I.F.)
| | - Marta Lewoc
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St, 15-540 Bialystok, Poland; (A.B.); (M.L.); (P.G.); (I.F.)
| | - Paulina Grabowska
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St, 15-540 Bialystok, Poland; (A.B.); (M.L.); (P.G.); (I.F.)
| | - Tomasz W. Kaminski
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA 15260, USA;
| | - Iwona Flisiak
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St, 15-540 Bialystok, Poland; (A.B.); (M.L.); (P.G.); (I.F.)
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Kowalewska B, Jankowiak B, Cybulski M, Krajewska-Kułak E, Khvorik DF. Effect of Disease Severity on the Quality of Life and Sense of Stigmatization in Psoriatics. Clin Cosmet Investig Dermatol 2021; 14:107-121. [PMID: 33564255 PMCID: PMC7866929 DOI: 10.2147/ccid.s286312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/05/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Psoriasis is a chronic inflammatory disease of the skin having a profound effect on the quality of life and contributing to the sense of stigmatization in the affected patients. The aim of this study was to analyze the effect of psoriasis severity on the quality of life and sense of stigmatization in psoriatics and to investigate relationships between these measures and sociodemographic variables. PATIENTS AND METHODS The study included 111 patients with psoriasis. The inclusion criteria of the study were the diagnosis of psoriasis and written informed consent to participate. The study was based on a short survey prepared by the authors and four validated scales: Dermatology Life Quality Index (DLQI), 6-item Stigmatization Scale, 33-item Feelings of Stigmatization Questionnaire, and Psoriasis Area and Severity Index (PASI). RESULTS Mean PASI score for the study group was 14 pts. Most respondents presented with low DLQI scores, with the mean value of 10.8 pts suggesting that the disease-related ailments were not extremely burdensome for the majority of the patients. Mean stigmatization scores for the 6- and 33-item scale were 7-8 and 81-82 pts, respectively. CONCLUSION The severity of psoriasis was the strongest determinant of the quality of life measured with the DLQI. Also, the levels of stigmatization determined with the 6- and 33-item scale correlated significantly with PASI scores.
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Affiliation(s)
- Beata Kowalewska
- Department of Integrated Medical Care, Medical University of Bialystok, Bialystok, Poland
| | - Barbara Jankowiak
- Department of Integrated Medical Care, Medical University of Bialystok, Bialystok, Poland
| | - Mateusz Cybulski
- Department of Integrated Medical Care, Medical University of Bialystok, Bialystok, Poland
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Kubanov AA, Bogdanova EV. Epidemiology of psoriasis in the Russian Federation according to the patient registry. VESTNIK DERMATOLOGII I VENEROLOGII 2021. [DOI: 10.25208/vdv1268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background. Psoriasis is a chronic skin disorder that impairs patients health-related quality of life. It is associated with patients need in specialized medical care and with essential medical costs. Psoriasis may be the reason for temporary or permanent disability. Patient registries are important sources of epidemiological and clinical data on patients with psoriasis and medical care provided.
Aims. To describe demographic characteristics, characteristics of the disease, prevalence of concomitant and past diseases in adult (18 years and older) patients with moderate and severe psoriasis included in the patient registry of the Russian Society of Dermatovenereologists and Cosmetologists.
Materials and methods. The data of 3,268 patients with psoriasis aged 18 years and older were analyzed as of inclusion in the registry. Data lock point was June 3, 2021. Descriptive statistics methods were applied in data analysis.
Results. The mean ( SD) age of adult patients at inclusion in the registry was 46.1 14.4 years. Male patients accounted for 60.5%. The mean age of onset of psoriasis is 31.1 16.1 years. Most of the patients (89.5%) have psoriasis vulgaris. The mean body surface area at inclusion was 43.3% 24.7%. 28.9% of patients had psoriatic arthritis at inclusion in the registry.
A high prevalence of cardiovascular diseases was revealed: arterial hypertension 28.5%, coronary heart disease 5.4%, myocardial infarction and acute cerebrovascular accident 0.9% each.
More than half of patients are pre-obese or obese according to the WHO body mass index classification. 2.2% of patients have impaired glucose tolerance, 6.7% of patients have type 2 diabetes mellitus. 3.8% of patients have diseases or dysfunction of the thyroid gland.
The prevalence of diseases of the digestive system is high: any disease of the esophagus, stomach and duodenum was noted in 10.2% of patients, any disease of the liver, gallbladder, biliary tract and pancreas in 11.8% of patients.
The prevalence of viral hepatitis C among patients with psoriasis was 2.6%.
Conclusions. The prevalence of comorbidities is high among Russian patients with moderate and severe psoriasis.
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Kowalewska B, Jankowiak B, Niedżwiecka B, Krajewska-Kułak E, Niczyporuk W, Khvorik DF. Relationships between the acceptance of illness, quality of life and satisfaction with life in psoriasis. Postepy Dermatol Alergol 2020; 37:948-955. [PMID: 33603615 PMCID: PMC7874872 DOI: 10.5114/ada.2020.92906] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/24/2019] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Since the skin plays a pivotal role in interpersonal relationships, a chronic dermatological condition (psoriasis), may have a profound effect on the psychological status of patients. AIM To analyse the effects of skin lesions on satisfaction with life, acceptance of illness and quality of life in psoriasis. MATERIAL AND METHODS The study included psoriatics recruited at the Dermatology Outpatient Unit of the Regional Hospital in Lomza, Dermatology Outpatient Clinic in Siemiatycze and Dermatology and Medical Cosmetology Centre in Bialystok. The study patients were examined with a demographic survey prepared by the authors, as well as with three validated scales: AIS, SWLS and DLQI. A total of 263 questionnaire sets were handed out to the participants of the study; this pool included 200 questionnaires with complete data that were eventually included in the analysis. RESULTS Acceptance of Illness Scale scores of the study participants ranged between 8 and 40 pts. Mean AIS scores for female and male psoriatics were similar, 23 and 25 pts, respectively. Based on the distribution of Satisfaction with Life Scale scores, 42 of the study patients presented with high levels of satisfaction with life, whereas 37 and 21 showed moderate and low satisfaction levels, respectively. Quality of life turned out to be the best among 20- to 30-year-old respondents as up to 74.19 of them had Dermatology Life Quality Index scores no greater than 10 pts. CONCLUSIONS Psoriatics with higher levels of illness acceptance also presented with greater satisfaction with life.
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Affiliation(s)
- Beata Kowalewska
- Department of Integrated Medical Care, Medical University of Bialystok, Bialystok, Poland
| | - Barbara Jankowiak
- Department of Integrated Medical Care, Medical University of Bialystok, Bialystok, Poland
| | | | | | - Wiaczesław Niczyporuk
- Faculty of Health Sciences, Lomza State University of Applied Sciences, Lomza, Poland
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Jafferany M, Ferreira BR, Abdelmaksoud A, Mkhoyan R. Management of psychocutaneous disorders: A practical approach for dermatologists. Dermatol Ther 2020; 33:e13969. [PMID: 32621633 DOI: 10.1111/dth.13969] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 01/09/2023]
Abstract
Psychodermatology is a growing specialty which is gaining momentum in different parts of the world. It focuses on the connection between skin and psyche. Psychocutaneous conditions are characterized by those disorders where stress is the key element in exacerbating skin conditions or flare ups of dermatoses like psoriasis and atopic dermatitis. There is a direct relationship of stress with the course, and prognosis of the skin disease. In some situations, there is no skin condition but the lesions are self-inflicted and such disorders are always associated with underlying psychopathology or psychological conflicts. Sometimes emotional problems are more prominent as a result of having skin disease, and the psychological consequences may be more severe than the physical symptoms. Management of these conditions require a combination of psychpharmacology, psychotherapy, and liaison clinics of psychiatry and dermatology. This review focuses on the common management approach which can be adopted by dermatologists in treating patients with psychodermatological disorders, improving doctor-patient relationship and therapeutic bond.
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Affiliation(s)
- Mohammad Jafferany
- Department of Psychodermatology and Psychiatry, Central Michigan University, Saginaw, Michigan, USA
| | | | - Ayman Abdelmaksoud
- Mansoura Dermatology, Venereology and Leprology Hospital, Mansoura, Egypt
| | - Ruzanna Mkhoyan
- Division of Dermatology, Nairi Medical Clinic, Yerevan, Armenia
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