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Yeh YT, Tsai TF. Drug- or Vaccine-Induced/Aggravated Psoriatic Arthritis: A Systematic Review. Dermatol Ther (Heidelb) 2024; 14:59-81. [PMID: 38183617 PMCID: PMC10828154 DOI: 10.1007/s13555-023-01082-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: 10/23/2023] [Accepted: 12/05/2023] [Indexed: 01/08/2024] Open
Abstract
INTRODUCTION Drugs and vaccines have been less studied as inducing or aggravating factors for psoriatic arthritis (PsA) compared with psoriasis. Thus, the present study collected and summarized the publications to date about this issue. METHODS We conducted a systematic literature search through the PubMed, Embase, and Cochrane databases to identify all reports on potential drug- and vaccine-related PsA events until 28 February 2023. RESULTS In total, 179 cases from 79 studies were eligible for study. Drugs commonly reported include coronavirus disease 2019 (COVID-19) mRNA vaccines (6 cases), bacillus Calmette-Guerin (BCG) vaccine (3 cases), interferon (18 cases), immune-checkpoint inhibitors (ICI) (19 cases), and biologic disease-modifying antirheumatic drugs (bDMARDs) (127 cases). Drugs causing psoriasis may also induce or aggravate PsA (6 cases). BDMARD-related PsA mostly occurred in a "paradoxical" setting, in which the bDMARDs approved for the treatment of psoriasis induce or aggravate PsA. The reported latency may be delayed up to 2 years. Peripheral arthritis (82.3%) was the most common manifestation of drug- and vaccine-related PsA, followed by dactylitis (29.1%), enthesitis (23.4%), and spondyloarthritis (17.7%). CONCLUSIONS Drugs and vaccines may be implicated in the aggravation of PsA. Possible mechanisms include cytokine imbalance, immune dysregulation, or inadequate PsA treatment response compared with psoriasis. Most reports are case based without controls, so more studies are needed to further prove the causality. However, early recognition of factors causing or aggravating PsA is important to prevent the irreversible joint damage.
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Affiliation(s)
- Yao-Tsung Yeh
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital, No. 7, Chung Shan South Road (Zhongshan S. Rd.), Zhongzheng Dist., Taipei City, 100225, Taiwan, ROC.
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2
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Leung AKC, Barankin B, Lam JM, Leong KF. Childhood guttate psoriasis: an updated review. Drugs Context 2023; 12:2023-8-2. [PMID: 37908643 PMCID: PMC10615329 DOI: 10.7573/dic.2023-8-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 09/25/2023] [Indexed: 11/02/2023] Open
Abstract
Background Guttate psoriasis is common and affects 0.5-2% of individuals in the paediatric age group. This review aims to familiarize physicians with the clinical manifestations, evaluation, diagnosis and proper management of guttate psoriasis. Methods A search was conducted in July 2023 in PubMed Clinical Queries using the key term "guttate psoriasis". The search strategy included all observational studies, clinical trials and reviews published within the past 10 years. The information retrieved from the search was used in the compilation of the present article. Results Guttate psoriasis typically presents with an abrupt onset of numerous, small, scattered, tear-drop-shaped, scaly, erythematous, pruritic papules and plaques. Sites of predilection include the trunk and proximal extremities. There may be a history of preceding streptococcal infection. Koebner phenomenon is characteristic. Guttate psoriasis may spontaneously remit within 3-4 months with no residual scarring, may intermittently recur and, in 40-50% of cases, may persist and progress to chronic plaque psoriasis. Given the possibility for spontaneous remission within several months, active treatment may not be necessary except for cosmetic purposes or because of pruritus. On the other hand, given the high rates of persistence of guttate psoriasis and progression to chronic plaque psoriasis, some authors suggest active treatment of this condition. Conclusion Various treatment options are available for guttate psoriasis. Triggering and exacerbating factors should be avoided if possible. Topical corticosteroids alone or in combination with other topical agents (e.g. tazarotene and vitamin D analogues) are the most rapid and efficient treatment for guttate psoriasis and are therefore the first-line treatment for mild cases. Other topical therapies include vitamin D analogues, calcineurin inhibitors, anthralin, coal tar and tazarotene. Ultraviolet phototherapy is the first-line therapy for moderate-to-severe guttate psoriasis, as it is more practical than topical therapy when treating widespread or numerous small lesions. Systemic immunosuppressive and immunomodulatory therapies (e.g. methotrexate, cyclosporine, retinoids, fumaric acid esters and biologics) may be considered for patients with moderate-to-severe guttate psoriasis who fail to respond to phototherapy and topical therapies.
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Affiliation(s)
- Alexander KC Leung
- Department of Pediatrics, The University of Calgary, Calgary, Alberta, Canada
- The Alberta Children’s Hospital, Calgary, Alberta, Canada
| | | | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
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3
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Szlasa W, Ślusarczyk S, Nawrot-Hadzik I, Abel R, Zalesińska A, Szewczyk A, Sauer N, Preissner R, Saczko J, Drąg M, Poręba M, Daczewska M, Kulbacka J, Drąg-Zalesińska M. Betulin and Its Derivatives Reduce Inflammation and COX-2 Activity in Macrophages. Inflammation 2023; 46:573-583. [PMID: 36282372 PMCID: PMC10024662 DOI: 10.1007/s10753-022-01756-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/01/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022]
Abstract
Betulin is a heavily studied natural compound for its use as an anticancer or pro-regenerative agent. The structural similarity between betulin to steroids gives rise to the idea that the substance may as well act as an anti-inflammatory drug. This study is the first to describe the anti-inflammatory properties of betulinic acid, betulin, and its derivatives with amino acids 1,4-diaminebutane (Dab), 1,3-diaminepropane (Dap), Ornithine (Orn), and lysine (Lys) on murine macrophages from lymphoma site. The compounds were compared to dexamethasone. To establish the response of the macrophages to the natural compounds, we tested the viability as well as sensitivity to the inflammatory signaling (IFNγR). IL-6 secretory properties and HSP-70 content in the cells were examined. Furthermore, we characterized the effects of compounds on the inhibition of cyclooxygenase-2 (COX-2) activity both in the enzymatic assays and molecular docking studies. Then, the changes in COX-2 expression after betulin treatment were assessed. Betulin and betulinic acid are the low-cytotoxicity compounds with the highest potential to decrease inflammation via reduced IL-6 secretion. To some extent, they induce the reorganization of IFNγR with nearly no effect on COX-2 activity. Conversely, Bet-Orn and Bet-Lys are highly cytotoxic and induce the aggregation of IFNγR. Besides, Bet-Lys reduces the activity of COX-2 to a higher degree than dexamethasone. Bet-Orn is the only one to increase the HSP-70 content in the macrophages. In case of IL-6 reduction, all compounds were more potent than dexamethasone.
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Affiliation(s)
- Wojciech Szlasa
- Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland.
| | - Sylwester Ślusarczyk
- Department of Pharmaceutical Biology and Biotechnology, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
| | - Izabela Nawrot-Hadzik
- Department of Pharmaceutical Biology and Biotechnology, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
| | - Renata Abel
- Department of Pharmaceutical Biology and Biotechnology, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
- Institute of Physiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany, Philippstrasse 12, 10115, Berlin, Germany
| | | | - Anna Szewczyk
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
| | - Natalia Sauer
- Faculty of Pharmacy, Wrocław Medical University, Wroclaw, Poland
| | - Robert Preissner
- Science-IT and Institute of Physiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Philippstrasse 12, 10115, Berlin, Germany
| | - Jolanta Saczko
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
| | - Marcin Drąg
- Department of Chemical Biology and Bioimaging, Faculty of Chemistry, Wrocław University of Science and Technology, Wybrzeże Wyspiańskiego 27, 50-370, Wroclaw, Poland
| | - Marcin Poręba
- Department of Chemical Biology and Bioimaging, Faculty of Chemistry, Wrocław University of Science and Technology, Wybrzeże Wyspiańskiego 27, 50-370, Wroclaw, Poland
| | - Małgorzata Daczewska
- Department of Animal Developmental Biology, Institute of Experimental Biology, University of Wroclaw, Wroclaw, Poland
| | - Julita Kulbacka
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland.
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4
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Stenger S, Grasshoff H, Hundt JE, Lange T. Potential effects of shift work on skin autoimmune diseases. Front Immunol 2022; 13:1000951. [PMID: 36865523 PMCID: PMC9972893 DOI: 10.3389/fimmu.2022.1000951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/29/2022] [Indexed: 02/16/2023] Open
Abstract
Shift work is associated with systemic chronic inflammation, impaired host and tumor defense and dysregulated immune responses to harmless antigens such as allergens or auto-antigens. Thus, shift workers are at higher risk to develop a systemic autoimmune disease and circadian disruption with sleep impairment seem to be the key underlying mechanisms. Presumably, disturbances of the sleep-wake cycle also drive skin-specific autoimmune diseases, but epidemiological and experimental evidence so far is scarce. This review summarizes the effects of shift work, circadian misalignment, poor sleep, and the effect of potential hormonal mediators such as stress mediators or melatonin on skin barrier functions and on innate and adaptive skin immunity. Human studies as well as animal models were considered. We will also address advantages and potential pitfalls in animal models of shift work, and possible confounders that could drive skin autoimmune diseases in shift workers such as adverse lifestyle habits and psychosocial influences. Finally, we will outline feasible countermeasures that may reduce the risk of systemic and skin autoimmunity in shift workers, as well as treatment options and highlight outstanding questions that should be addressed in future studies.
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Affiliation(s)
- Sarah Stenger
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Hanna Grasshoff
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Jennifer Elisabeth Hundt
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Tanja Lange
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany.,Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
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5
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Yu K, Syed MN, Bernardis E, Gelfand JM. Machine Learning Applications in the Evaluation and Management of Psoriasis: A Systematic Review. ACTA ACUST UNITED AC 2021; 5:147-159. [PMID: 33733038 PMCID: PMC7963214 DOI: 10.1177/2475530320950267] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Machine learning (ML), a subset of artificial intelligence (AI) that aims to teach machines to automatically learn tasks by inferring patterns from data, holds significant promise to aid psoriasis care. Applications include evaluation of skin images for screening and diagnosis as well as clinical management including treatment and complication prediction. Objective To summarize literature on ML applications to psoriasis evaluation and management and to discuss challenges and opportunities for future advances. Methods We searched MEDLINE, Google Scholar, ACM Digital Library, and IEEE Xplore for peer-reviewed publications published in English through December 1, 2019. Our search queries identified publications with any of the 10 computing-related keywords and "psoriasis" in the title and/or abstract. Results Thirty-three studies were identified. Articles were organized by topic and synthesized as evaluation- or management-focused articles covering 5 content categories: (A) Evaluation using skin images: (1) identification and differential diagnosis of psoriasis lesions, (2) lesion segmentation, and (3) lesion severity and area scoring; (B) clinical management: (1) prediction of complications and (2) treatment. Conclusion Machine learning has significant potential to aid psoriasis evaluation and management. Current topics popular in ML research on psoriasis are the evaluation of medical images, prediction of complications, and treatment discovery. For patients to derive the greatest benefit from ML advancements, it is helpful for dermatologists to have an understanding of ML and how it can effectively aid their assessments and decision-making.
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Affiliation(s)
- Kimberley Yu
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Maha N Syed
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Elena Bernardis
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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6
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Use of beta-blockers for rosacea-associated facial erythema and flushing: A systematic review and update on proposed mode of action. J Am Acad Dermatol 2020; 83:1088-1097. [DOI: 10.1016/j.jaad.2020.04.129] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 01/30/2023]
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7
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The role of xenobiotics in triggering psoriasis. Arch Toxicol 2020; 94:3959-3982. [PMID: 32833044 DOI: 10.1007/s00204-020-02870-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
Psoriasis is a common inflammatory skin disease affecting approximately 2% of the world population. A complex interplay of genetic predisposition and risk factors contributes to the risk of its onset. Several xenobiotics have been implicated in the pathogenesis of psoriasis. Drugs are among the most investigated trigger factors; strong association with disease induction or exacerbation has been reported for β-blockers, lithium, NSAIDs and ACE inhibitors, all of which are commonly used in the management of various comorbidities in psoriasis patients. Furthermore, inhibitors of TNF have a well-documented potential for triggering new-onset psoriasis when used for other indications (e.g. Crohn's disease or rheumatoid arthritis), while post-marketing data have revealed the same association for ustekinumab. Several other drugs have been connected with psoriasis, but the evidence is less compelling. Smoking and alcohol have been reported to increase the risk for occurrence of psoriasis, but can also affect unfavorably the course of the disease and its response to treatment. Furthermore, exposure to secondhand smoke, especially in childhood, also mediates the risk. Emerging data now suggest that air pollution also has a detrimental effect on skin disease, including psoriasis, but this association needs further investigation. Understanding of the toxic effect of xenobiotics on the initiation and clinical course of psoriasis can contribute to its better control, as it can help with the avoidance of triggering factors and, in some cases, influence the success of pharmacological treatment. It, therefore, has an important place in the comprehensive management of psoriasis.
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8
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Bakshi H, Nagpal M, Singh M, Dhingra GA, Aggarwal G. Treatment of Psoriasis: A Comprehensive Review of Entire Therapies. Curr Drug Saf 2020; 15:82-104. [DOI: 10.2174/1574886315666200128095958] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 12/19/2022]
Abstract
Background:
Psoriasis is an autoimmune disease that ingeminates itself with the repeated
proliferation of keratinocytes. It globally strikes a 2-5 % population on an average. Management
of psoriasis remains a daunting task with various challenges influencing treatment, such as patient
conformity and adherence to therapy, delicate patient profiles, psychological aspects, and skin as a
barrier to topical delivery. The first part reviewed pathophysiology, triggering factors, and clinical
classification. The second part reviewed all the therapies, such as topical, oral, biological, parenteral
therapy, phototherapy, and the phyto-pharmaceuticals.
Methods:
The research data related to the existing and upcoming therapies for psoriasis treatment,
several nanocarriers, existing marketed formulations, and detailed description of phytopharmaceuticals
with their mechanism.
Results:
Topical therapy is the mainstay treatment option with limited adverse effects. Biological therapy
has reformed conventional psoriasis treatment by being more efficacious and has increased patient
acceptance due to decreased adverse events. Nanoformulations present an edge over conventional
therapy due to improved anti-psoriatic effect and decreased side effects. Phyto-pharmaceuticals act as
a complementary and alternative therapy for diminishing psoriasis symptoms.
Conclusion:
A rationalized cost-effective patient compliant therapy is required for effective management
and complete cure of psoriasis.
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Affiliation(s)
- Harman Bakshi
- Chitkara College of Pharmacy, Chitkara University, Chandigarh-Patiala, NH 7, 64, Tehsil, Rajpura, Punjab, India
| | - Manju Nagpal
- Chitkara College of Pharmacy, Chitkara University, Chandigarh-Patiala, NH 7, 64, Tehsil, Rajpura, Punjab, India
| | - Manjinder Singh
- Chitkara College of Pharmacy, Chitkara University, Chandigarh-Patiala, NH 7, 64, Tehsil, Rajpura, Punjab, India
| | | | - Geeta Aggarwal
- Delhi Pharmaceutical Sciences and Research University, New Delhi-110017, India
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9
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Grän F, Kerstan A, Serfling E, Goebeler M, Muhammad K. Current Developments in the Immunology of Psoriasis. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2020; 93:97-110. [PMID: 32226340 PMCID: PMC7087066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Psoriasis is a frequent inflammatory skin disease. Fundamental research on the pathogenesis of psoriasis has substantially increased our understanding of skin immunology, which has helped to introduce innovative and highly effective therapies. Psoriasis is a largely T lymphocyte-mediated disease in which activation of innate immune cells and pathogenic T cells result in skin inflammation and hyperproliferation of keratinocytes. B cells have thus far largely been neglected regarding their role for the pathogenesis of psoriasis. However, recent data shed light on their role in inflammatory skin diseases. Interestingly, interleukin (IL)-10-producing regulatory B cells have been assumed to ameliorate psoriasis. In this review, we will discuss the development of disease, pathogenicity, and current developments in therapeutic options. We describe different roles of T cells, B cells, and cytokines for the immunopathology and disease course of psoriasis.
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Affiliation(s)
- Franziska Grän
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Andreas Kerstan
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Edgar Serfling
- Department of Molecular Pathology, Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Khalid Muhammad
- Department of Molecular Pathology, Institute of Pathology, University of Würzburg, Würzburg, Germany,Department of Biology, College of Science, United Arab Emirates University, Al Ain, United Arab Emirates,To whom all correspondence should be addressed: K. Muhammad, Tel: +971 3 713 6517, Fax: +971 3 713 4927;
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10
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Li IH, Pan KT, Wang WM, Chien WC, Shih JH, Kao LT. Digoxin use and following risk of psoriasis: A population-based cohort study in Taiwan. J Dermatol 2020; 47:458-463. [PMID: 32141100 DOI: 10.1111/1346-8138.15281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/03/2020] [Indexed: 11/29/2022]
Abstract
This study examined the association between digoxin use and subsequent psoriasis risk using a population-based database in Taiwan. This cohort study enrolled 15 545 digoxin users and 15 545 propensity score-matched non-users from the Taiwan National Health Insurance Research Database. Each patient was independently followed up for 5 years to confirm whether they had been diagnosed with psoriasis. Cox proportional hazard regression was used to estimate psoriasis risk among digoxin users. Subgroup and sensitivity analyses were also performed. The psoriasis incidence rates were 3.02 and 2.27 per 1000 person-years among digoxin users and non-users, respectively. After adjustment for confounders, psoriasis risk was significantly higher among digoxin users than among non-users. Notably, in most subgroup analyses, digoxin use tended to increase psoriasis risk, particularly among patients with heart failure, diabetes, hypertension and hyperlipidaemia. Moreover, significantly increased psoriasis risk was noted over 2, 3, 4 and 5 years of digoxin use. In conclusion, our findings confirm that digoxin use increases subsequent psoriasis risk. Thus, physicians should be aware of this association and accordingly estimate the risks and benefits of digoxin use. Nevertheless, some patient variables, such as body mass index and obesity, were unavailable in this study. The findings in this study should be elucidated carefully because the potential effects of these factors could not be considered.
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Affiliation(s)
- I-Hsun Li
- Department of Pharmacy Practice, Tri-Service General Hospital, Taipei, Taiwan.,Department of Pharmacology, National Defense Medical Center, Taipei, Taiwan.,School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
| | - Ke-Ting Pan
- Institute of Environmental Design and Engineering, Bartlett School, UCL, London, UK.,Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Ming Wang
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jui-Hu Shih
- Department of Pharmacy Practice, Tri-Service General Hospital, Taipei, Taiwan.,Department of Pharmacology, National Defense Medical Center, Taipei, Taiwan
| | - Li-Ting Kao
- Department of Pharmacy Practice, Tri-Service General Hospital, Taipei, Taiwan.,Department of Pharmacology, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan
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11
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Keeling SO, Bowker SL, Savu A, Kaul P. A Population-level Analysis of the Differing Effects of Rheumatoid Arthritis and Spondyloarthritis on Peripartum Outcomes. J Rheumatol 2019; 47:197-203. [PMID: 31043549 DOI: 10.3899/jrheum.181320] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The effects of rheumatoid arthritis (RA) and spondyloarthritis (SpA) on maternal and neonatal outcomes at a population level have not previously been well compared. METHODS A contemporary pregnancy cohort of 312,081 women and corresponding birth events was assembled for the province of Alberta from the random selection of 1 live birth event per woman. We identified 3 groups: (1) no inflammatory arthritis (no IA, n = 308,989), (2) RA (n = 631), and (3) SpA (n = 2461). We compared maternal and neonatal outcomes, comorbid conditions, and medication use among the 3 groups. Multivariable logistic regression models evaluated the independent association between RA and SpA, relative to no IA, and the outcomes of small for gestation age (SGA) and hypertensive disorders during pregnancy. RESULTS Pregnant women with RA were significantly more likely to have preterm delivery (13.5%), cesarean delivery (33.9%), hypertensive disorders in pregnancy (10.5%), and SGA babies (15.6%), compared to pregnant women with either SpA or no IA. Nonsteroidal antiinflammatory drugs and corticosteroid use were significantly higher in pregnant women with RA compared to the other groups. Women with RA were significantly more likely to have an SGA baby (OR 1.51, 95% CI 1.21-1.88; p < 0.01), and hypertensive disorder in pregnancy (OR 1.51, 95% CI 1.16-1.97; p < 0.01), compared to women with no IA, while no difference was found between women with SpA and those with no IA. CONCLUSION Women with RA have a higher risk of worse maternal and neonatal outcomes, whereas the risk of these events is similar between women with and without SpA.
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Affiliation(s)
- Stephanie O Keeling
- From the Division of Rheumatology, Department of Medicine, University of Alberta; Faculty of Medicine and Dentistry, University of Alberta; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada. .,S.O. Keeling, MD, MSc, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; S.L. Bowker, PhD, Research Associate, Faculty of Medicine and Dentistry, University of Alberta; A. Savu, PhD, Biostatistician, Faculty of Medicine and Dentistry, University of Alberta; P. Kaul, PhD, Professor of Medicine, Faculty of Medicine and Dentistry, University of Alberta.
| | - Samantha L Bowker
- From the Division of Rheumatology, Department of Medicine, University of Alberta; Faculty of Medicine and Dentistry, University of Alberta; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.,S.O. Keeling, MD, MSc, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; S.L. Bowker, PhD, Research Associate, Faculty of Medicine and Dentistry, University of Alberta; A. Savu, PhD, Biostatistician, Faculty of Medicine and Dentistry, University of Alberta; P. Kaul, PhD, Professor of Medicine, Faculty of Medicine and Dentistry, University of Alberta
| | - Anamaria Savu
- From the Division of Rheumatology, Department of Medicine, University of Alberta; Faculty of Medicine and Dentistry, University of Alberta; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.,S.O. Keeling, MD, MSc, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; S.L. Bowker, PhD, Research Associate, Faculty of Medicine and Dentistry, University of Alberta; A. Savu, PhD, Biostatistician, Faculty of Medicine and Dentistry, University of Alberta; P. Kaul, PhD, Professor of Medicine, Faculty of Medicine and Dentistry, University of Alberta
| | - Padma Kaul
- From the Division of Rheumatology, Department of Medicine, University of Alberta; Faculty of Medicine and Dentistry, University of Alberta; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.,S.O. Keeling, MD, MSc, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; S.L. Bowker, PhD, Research Associate, Faculty of Medicine and Dentistry, University of Alberta; A. Savu, PhD, Biostatistician, Faculty of Medicine and Dentistry, University of Alberta; P. Kaul, PhD, Professor of Medicine, Faculty of Medicine and Dentistry, University of Alberta
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12
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Abstract
Background Psoriasis is a common disorder of the skin, immune system, and joints that is influenced by genetic and environmental factors. It can be aggravated or induced by drugs. Objectives To identify the major drugs implicated in inducing or exacerbating psoriasis and to discuss their characteristics. Methods We performed a PubMed literature search for reviews and case reports on drugs that exacerbate or induce psoriasis. Articles were screened by title and abstract and then examined for their findings and references. Results Drugs most often reported to exacerbate or induce psoriasis were β-blockers, lithium, synthetic antimalarials, nonsteroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, interferons, tetracyclines, tumor necrosis factor-α inhibitors, and steroid withdrawal. Conclusions Characterizing drugs that induce or exacerbate psoriasis by latency and type of psoriatic eruption can help guide clinical reasoning. Although a relatively uncommon occurrence, psoriatic lesions can be caused by drugs, allowing astute physicians to recognize and change their management plans accordingly.
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Affiliation(s)
- Julie Hong
- Mount Sinai School of Medicine, New York, New York
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13
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Abstract
Inflammatory dermatoses encompass a variety of histologic patterns that affect different portions of the skin. In spongiotic, psoriasiform, lichenoid, pityriasiform, and blistering disorders, there are predominately epidermal and junctional activities with variable superficial dermal inflammation. Hypersensitivity reactions can show either epidermal or mostly dermal changes depending on whether the exposure of the exogenous allergen occurs through an external or internal route, respectively. Exceptions include erythema multiforme and Stevens-Johnson syndrome/toxic epidermal necrolysis, where the etiology is often due to infection or ingested medications, but the histologic features are almost exclusively confined to the epidermis and dermoepidermal junction. Autoimmune disorders are unique in that lesions typically incorporate a mixture of epidermal and dermal inflammatory patterns with periadnexal inflammation, while the vast majority of vasculitis/vasculopathy and alopecia have changes limited to only the vessels and hair follicles, respectively. It is critical to recognize that a relatively limited number of histologic patterns are seen in a large array of clinical entities. Therefore, clinicopathologic correlation and careful examination of histologic details are of the utmost importance when evaluating skin biopsies for inflammatory disorders.
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Affiliation(s)
- Andy C Hsi
- 1 Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Ilana S Rosman
- 1 Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri.,2 Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri
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Galili E, Barzilai A, Shreberk‐Hassidim R, Merdler I, Caspi T, Astman N. Neuropsychiatric comorbidity among adolescents with psoriasis. Br J Dermatol 2018; 178:910-916. [DOI: 10.1111/bjd.16031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2017] [Indexed: 01/02/2023]
Affiliation(s)
- E. Galili
- Department of Dermatology Sheba Medical Center, Tel‐Hashomer Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Medical Corps Israel Defense Force Ramat Gan Israel
| | - A. Barzilai
- Department of Dermatology Sheba Medical Center, Tel‐Hashomer Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - R. Shreberk‐Hassidim
- Department of Dermatology Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - I. Merdler
- Department of Internal Medicine “H” Tel‐Aviv Sourasky Medical Center Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - T. Caspi
- Medical Corps Israel Defense Force Ramat Gan Israel
| | - N. Astman
- Department of Dermatology Sheba Medical Center, Tel‐Hashomer Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Medical Corps Israel Defense Force Ramat Gan Israel
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Gisondi P, Altomare G, Ayala F, Conti A, Dapavo P, De Simone C, Foti C, Idolazzi L, Lubrano E, Malara G, Marchesoni A, Olivieri I, Parodi A, Peris K, Piaserico S, Salvarani C, Scarpa R, Girolomoni G. Consensus on the management of patients with psoriatic arthritis in a dermatology setting. J Eur Acad Dermatol Venereol 2018; 32:515-528. [PMID: 29220551 DOI: 10.1111/jdv.14741] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 11/22/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with psoriasis (PsO). Early diagnosis and prompt therapeutic intervention are crucial for limiting PsA progression and prevention of disability. Dermatologists are in a privileged position to detect early PsA. The management of patients with PsA in the dermatology setting is widely variable. OBJECTIVE To provide practical recommendations for the management of patients with PsA in the dermatology setting including early diagnosis and treatment. METHODS A consensus document was written by an expert panel composed by dermatologists (n = 12) and rheumatologists (n = 6). Eleven highly relevant questions were selected and elaborated with answers/statements based on a narrative literature review. The resulting document was discussed in a face-to-face meeting adopting a nominal group technique to reach consensus (i.e. 100% agreement) using the Delphi method. RESULTS A consensus was achieved in defining the following: the clinical characteristics differentiating inflammatory and non-inflammatory signs and symptoms of joint disease; the most important differential diagnoses of PsA in clinical practice; the most useful screening questionnaires, serum laboratory tests and imaging techniques for the detection of early PsA; the criteria for dermatologist to refer patients with PsO to rheumatologist; the criteria for the diagnosis of PsA; the selection of the indices that the dermatologist could use for measuring the activity and severity of PsA in clinical practice; when systemic steroids and/or intra-articular steroid injections are indicated in the treatment of PsA. Finally, systemic treatments including synthetic and biologic disease-modifying antirheumatic drugs to be considered for the treatment of PsA have been reported. CONCLUSIONS The implementations of these practical recommendations could be very helpful for the management of patients with PsA in the dermatology setting including early diagnosis and treatment.
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Affiliation(s)
- P Gisondi
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - G Altomare
- I.R.C.C.S Istituto Ortopedico Galeazzi, Division of Dermatology and Venereology, University of Milan, Milan, Italy
| | - F Ayala
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - A Conti
- Department of Head and Neck Surgery, Section of Dermatology, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena, Italy
| | - P Dapavo
- Department of Biomedical Science and Human Oncology, Second Dermatologic Clinic, University of Turin, Turin, Italy
| | - C De Simone
- Dermatology Department, Catholic University of the Sacred Heart, Rome, Italy
| | - C Foti
- Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - L Idolazzi
- Department of Medicine, Section of Rheumatology, University of Verona, Verona, Italy
| | - E Lubrano
- Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy
| | - G Malara
- Unit of Dermatology, Azienda Ospedaliera Papardo, Messina, Italy
| | - A Marchesoni
- Department of Rheumatology, ASST Gaetano Pini-CTO, Milano, Italy
| | - I Olivieri
- Division of Rheumatology, Azienda Ospedaliera San Carlo, Potenza, Italy
| | - A Parodi
- Section of Dermatology, University of Genoa, Genoa, Italy
| | - K Peris
- Dermatology Department, Catholic University of the Sacred Heart, Rome, Italy
| | - S Piaserico
- Department of Medicine, Section of Dermatology, University of Padua, Padua, Italy
| | - C Salvarani
- Division of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, University of Modena and Reggio Emilia, Modena, Reggio Emilia, Italy
| | - R Scarpa
- Department of Medicine, Section of Rheumatology, University of Naples Federico II, Naples, Italy
| | - G Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
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Balak DM, Hajdarbegovic E. Drug-induced psoriasis: clinical perspectives. PSORIASIS-TARGETS AND THERAPY 2017; 7:87-94. [PMID: 29387611 PMCID: PMC5774610 DOI: 10.2147/ptt.s126727] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Exposure to certain drugs can elicit an induction or exacerbation of psoriasis. Although well-conducted systematic studies on drug-related psoriasis are mostly lacking, traditionally strong associations have been documented for beta-blockers, lithium, antimalarial drugs such as (hydroxy)chloroquine, interferons, imiquimod, and terbinafine. More recently, new associations have been reported for monoclonal antibody- and small-molecule-based targeted therapies used for oncological and immunological indications, such as tumor necrosis factor-alpha antagonists and anti-programmed cell death protein 1 immune checkpoint inhibitors. Recognizing potential drug-related psoriasis is of clinical relevance to allow an optimal management of psoriasis. However, in clinical practice, identifying medication-related exacerbations and induction of psoriasis can be challenging. The clinical and histopathological features of drug-provoked psoriasis may differ little from that of “classical” nondrug-related forms of psoriasis. In addition, the latency period between start of the medication and onset of psoriasis can be significantly long for some drugs. Assessment of the Naranjo adverse drug reaction probability scale could be used as a practical tool to better differentiate drug-related psoriasis. The first step in the management of drug-related psoriasis is cessation and replacement of the offending drug when deemed clinically possible. However, the induced psoriasis skin lesions may persist after treatment withdrawal. Additional skin-directed treatment options for drug-related psoriasis follows the conventional psoriasis treatment guidelines and includes topical steroids and vitamin D analogs, ultraviolet phototherapy, systemic treatments, such as acitretin, methotrexate, and fumaric acid esters, and biological treatments.
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Affiliation(s)
- Deepak Mw Balak
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Enes Hajdarbegovic
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Matos-Pires E, Campos S, Mendes-Bastos P, João A, Fernandes C. Erythrodermic psoriasis induced by bupropion. J Eur Acad Dermatol Venereol 2016; 31:e129-e130. [DOI: 10.1111/jdv.13876] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E. Matos-Pires
- Department of Dermatology and Venereology; Hospital de Santo António dos Capuchos - Centro Hospitalar de Lisboa Central; Lisboa Portugal
| | - S. Campos
- Department of Dermatology and Venereology; Hospital de Santo António dos Capuchos - Centro Hospitalar de Lisboa Central; Lisboa Portugal
| | - P. Mendes-Bastos
- Department of Dermatology and Venereology; Hospital de Santo António dos Capuchos - Centro Hospitalar de Lisboa Central; Lisboa Portugal
| | - A. João
- Department of Dermatology and Venereology; Hospital de Santo António dos Capuchos - Centro Hospitalar de Lisboa Central; Lisboa Portugal
| | - C. Fernandes
- Department of Dermatology and Venereology; Hospital de Santo António dos Capuchos - Centro Hospitalar de Lisboa Central; Lisboa Portugal
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Schlager JG, Rosumeck S, Werner RN, Jacobs A, Schmitt J, Schlager C, Nast A. Topical treatments for scalp psoriasis. Cochrane Database Syst Rev 2016; 2:CD009687. [PMID: 26915340 PMCID: PMC8697570 DOI: 10.1002/14651858.cd009687.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND People with chronic plaque psoriasis often have lesions on the scalp. Hair makes the scalp difficult to treat and the adjacent facial skin is particularly sensitive to topical treatments. OBJECTIVES To assess the efficacy and safety of topical treatments for scalp psoriasis. SEARCH METHODS We searched the following databases up to August 2015: the Cochrane Skin Group Specialised Register, CENTRAL (2015, Issue 7), MEDLINE (from 1946), EMBASE (from 1974) and LILACS (from 1982). We also searched five trials registers, screened abstracts of six psoriasis-specific conferences and checked the reference lists of included studies for further references to relevant randomised controlled trials. SELECTION CRITERIA Randomised controlled trials (RCTs) with a parallel-group, cross-over or within-patient design of topical treatments for people of all ages with scalp psoriasis. DATA COLLECTION AND ANALYSIS Two authors independently carried out study selection, data extraction and 'Risk of bias' assessment. Disagreements were settled by reference to a third author.To assess the quality of evidence, we focused on the following outcomes: 'clearance' or 'response' as assessed by the investigator global assessment (IGA), improvement in quality of life, adverse events requiring withdrawal of treatment and 'response' as assessed by the patient global assessment (PGA).We expressed the results of the single studies as risk ratios (RR) with 95% confidence intervals (CI) for dichotomous outcomes, and mean differences (MD) with 95% CI for continuous outcomes. If studies were sufficiently homogeneous, we meta-analysed the data by using the random-effects model. Where it was not possible to calculate a point estimate for a single study, we described the data qualitatively. We also presented the number needed to treat to benefit (NNTB).We categorised topical corticosteroids according to the German classification of corticosteroid potency as mild, moderate, high and very high. MAIN RESULTS We included 59 RCTs with a total of 11,561 participants. Thirty studies were either conducted or sponsored by the manufacturer of the study medication. The risk of bias varied considerably among the included studies. For instance, most authors did not state the randomisation method and few addressed allocation concealment. Most findings were limited to short-term treatments, since most studies were conducted for less than six months. Only one trial investigated long-term therapy (12 months). Although we found a wide variety of different interventions, we limited the grading of the quality of evidence to three major comparisons: steroid versus vitamin D, two-compound combination of steroid and vitamin D versus steroid monotherapy and versus vitamin D.In terms of clearance, as assessed by the IGA, steroids were better than vitamin D (RR 1.82; 95% CI 1.52 to 2.18; four studies, 2180 participants, NNTB = 8; 95% CI 7 to 11; moderate quality evidence). Statistically, the two-compound combination was superior to steroid monotherapy, however the additional benefit was small (RR 1.22; 95% CI 1.08 to 1.36; four studies, 2474 participants, NNTB = 17; 95% CI 11 to 41; moderate quality evidence). The two-compound combination was more effective than vitamin D alone (RR 2.28; 95% CI 1.87 to 2.78; four studies, 2008 participants, NNTB = 6; 95% CI 5 to 7; high quality evidence).In terms of treatment response, as assessed by the IGA, corticosteroids were more effective than vitamin D (RR 2.09; 95% CI 1.80 to 2.41; three studies, 1827 participants; NNTB = 4; 95% CI 4 to 5; high quality evidence). The two-compound combination was better than steroid monotherapy, but the additional benefit was small (RR 1.15; 95% CI 1.06 to 1.25; three studies, 2444 participants, NNTB = 13; 95% CI 9 to 24; moderate quality evidence). It was also more effective than vitamin D alone (RR 2.31; 95% CI 1.75 to 3.04; four studies, 2222 participants, NNTB = 3; 95% CI 3 to 4; moderate quality evidence).Reporting of quality of life data was poor and data were insufficient to be included for meta-analysis.Steroids caused fewer withdrawals due to adverse events than vitamin D (RR 0.22; 95% CI 0.11 to 0.42; four studies, 2291 participants; moderate quality evidence). The two-compound combination and steroid monotherapy did not differ in the number of adverse events leading withdrawal (RR 0.88; 95% CI 0.42 to 1.88; three studies, 2433 participants; moderate quality evidence). The two-compound combination led to fewer withdrawals due to adverse events than vitamin D (RR 0.19; 95% CI 0.11 to 0.36; three studies, 1970 participants; high quality evidence). No study reported the type of adverse event requiring withdrawal.In terms of treatment response, as assessed by the PGA, steroids were more effective than vitamin D (RR 1.48; 95% CI 1.28 to 1.72; three studies, 1827 participants; NNTB = 5; 95% CI 5 to 7; moderate quality evidence). Statistically, the two-compound combination was better than steroid monotherapy, however the benefit was not clinically important (RR 1.13; 95% CI 1.06 to 1.20; two studies, 2226 participants; NNTB = 13; 95% CI 9 to 26; high quality evidence). The two-compound combination was more effective than vitamin D (RR 1.76; 95% CI 1.46 to 2.12; four studies, 2222 participants; NNTB = 4; 95% CI 3 to 6; moderate quality evidence).Common adverse events with these three interventions were local irritation, skin pain and folliculitis. Systemic adverse events were rare and probably not drug-related.In addition to the results of the major three comparisons we found that the two-compound combination, steroids and vitamin D monotherapy were more effective than the vehicle. Steroids of moderate, high and very high potency tended to be similarly effective and well tolerated. There are inherent limitations in this review concerning the evaluation of salicylic acid, tar, dithranol or other topical treatments. AUTHORS' CONCLUSIONS The two-compound combination as well as corticosteroid monotherapy were more effective and safer than vitamin D monotherapy. Given the similar safety profile and only slim benefit of the two-compound combination over the steroid alone, monotherapy with generic topical steroids may be fully acceptable for short-term therapy.Future RCTs should investigate how specific therapies improve the participants' quality of life. Long-term assessments are needed (i.e. 6 to 12 months).
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Affiliation(s)
- Justin Gabriel Schlager
- Charité ‐ Universitätsmedizin BerlinDivision of Evidence Based Medicine, Department of Dermatology, Venerology and AllergologyCharitéplatz 1BerlinGermany10117
| | - Stefanie Rosumeck
- Charité ‐ Universitätsmedizin BerlinDivision of Evidence Based Medicine, Department of Dermatology, Venerology and AllergologyCharitéplatz 1BerlinGermany10117
| | - Ricardo Niklas Werner
- Charité ‐ Universitätsmedizin BerlinDivision of Evidence Based Medicine, Department of Dermatology, Venerology and AllergologyCharitéplatz 1BerlinGermany10117
| | - Anja Jacobs
- Federal Joint Committee (G‐BA, Gemeinsamer Bundesausschuss)Department of Medical ConsultingWegelystrasse 8BerlinGermany10623
| | - Jochen Schmitt
- Faculty of Medicine Carl Gustav Carus, Technischen Universität (TU) DresdenCenter for Evidence‐Based HealthcareFetscherstr. 74DresdenGermany01307
| | - Christoph Schlager
- The University of Nottinghamc/o Cochrane Skin GroupA103, King's Meadow CampusLenton LaneNottinghamUKNG7 2NR
| | - Alexander Nast
- Charité ‐ Universitätsmedizin BerlinDivision of Evidence Based Medicine, Department of Dermatology, Venerology and AllergologyCharitéplatz 1BerlinGermany10117
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Karakurt A, Yildiz C, Yildiz A, Başbuğ HS. Amiodarone-induced exudative bullous lesion and hepatotoxicity in a patient with ventricular tachycardia. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2015. [DOI: 10.1016/j.ijcac.2015.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Gisondi P, Galvan A, Idolazzi L, Girolomoni G. Management of moderate to severe psoriasis in patients with metabolic comorbidities. Front Med (Lausanne) 2015; 2:1. [PMID: 25654080 PMCID: PMC4300999 DOI: 10.3389/fmed.2015.00001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 01/01/2015] [Indexed: 12/11/2022] Open
Abstract
Psoriasis is a chronic inflammatory skin disease affecting 2–3% of worldwide population. The extent of skin involvement is variable, ranging from a few localized plaques to generalized involvement. Moderate to severe psoriasis (>10% of body surface area) is frequently associated with psoriatic arthritis and metabolic diseases, like abdominal obesity, diabetes, non-alcoholic fatty liver disease, dyslipidemia, metabolic syndrome, and chronic kidney disease. A common genetic background as well as several acquired risk factors links psoriasis to comorbidities. From a clinical prespective, the understanding of the patients in the context of these comorbidities is very important to ensure that treatment is tailored to meet the individual patient needs. Indeed, some pharmacological treatments may negatively affect cardio-metabolic comorbidities, and have important interactions with drugs that are commonly used to treat them. Non-pharmacological intervention such as diet, smoking cessation, and physical exercise could both improve the response to treatments for psoriasis and reduce the cardiovascular risk.
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Affiliation(s)
- Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona , Verona , Italy
| | - Arturo Galvan
- Section of Dermatology and Venereology, Department of Medicine, University of Verona , Verona , Italy
| | - Luca Idolazzi
- Section of Rheumatology, University of Verona , Verona , Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona , Verona , Italy
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Jaworski K, Walecka I, Rudnicka L, Gnatowski M, Kosior DA. Cutaneous adverse reactions of amiodarone. Med Sci Monit 2014; 20:2369-72. [PMID: 25413691 PMCID: PMC4250032 DOI: 10.12659/msm.890881] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Dermatological complications of amiodarone are commonly encountered problems in therapy. The incidence in the population of patients with prolonged use of amiodarone reaches nearly 75% according to various sources. Nevertheless, they are often misdiagnosed or overlooked. The aim of this review is to present the current state of knowledge about skin changes induced by amiodarone, including phototoxic and photoallergic reactions, as well as hyperpigmentation. In most cases, the adverse effects are reversible and disappear after discontinuation of the drug. Although the dermatological complications usually do not influence the outcome of the therapy and rarely cause discontinuation of treatment, they have a great impact on patient quality of life.
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Affiliation(s)
- Krzysztof Jaworski
- Department of Cardiology and Hypertension, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland
| | - Irena Walecka
- Department of Dermatology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Gnatowski
- Department of Traumaorthopedic Surgery, District Hospital, Wołomin, Poland
| | - Dariusz A Kosior
- Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
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Triggering drug use in patients with psoriasis: an investigative report from Turkey. Postepy Dermatol Alergol 2014; 31:294-8. [PMID: 25395925 PMCID: PMC4221355 DOI: 10.5114/pdia.2014.44019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 02/24/2014] [Accepted: 04/04/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The patients clinically diagnosed with psoriasis were investigated for drug use that may trigger psoriasis. AIM To minimize the triggering drug use and help the medical treatment of psoriasis patients. MATERIAL AND METHODS The study involved 289 psoriatic patients who attended our clinic in 2010-2012 and were asked to bring their drug lists of the last year, which they obtained from the pharmacy's record system. They were advised not to use the drugs that may trigger psoriasis. Data analyses were performed using SPSS program version 19.0. RESULTS A total of 289 patients were included in the study. Two hundred and twenty-one patients were using non-steroidal anti-inflammatory drugs; 133 patients were using anti-reflux drugs; 35 patients were using antidiabetic drugs; 31 patients were using calcium-channel blockers and 24 patients were using β-blockers. In our study group, there was no significantly difference between median PASI scores of the patients using a triggering drug and those of who are not using a triggering drug. However, there was a positive low correlation between PASI rates and numbers of drugs used (r = 0.180, p = 0.013). CONCLUSIONS Many other factors may trigger psoriasis, therefore the effect of stopping or minimizing the drug use on disease remission is not known. Because of the high triggering drug use rate, it is important to enlighten psoriasis patients about triggering drugs.
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Xhaja A, Shkodrani E, Frangaj S, Kuneshka L, Vasili E. An epidemiological study on trigger factors and quality of life in psoriatic patients. Mater Sociomed 2014; 26:168-71. [PMID: 25126009 PMCID: PMC4130688 DOI: 10.5455/msm.2014.26.168-171] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 06/15/2014] [Indexed: 12/19/2022] Open
Abstract
Objective: to evaluate the role of stress, tobacco, drugs, infections, allergies, heredity, alcohol, hormones and skin aggressions as trigger factors and the impact on quality of life in a sample of psoriasis patients. Methods: a transversal study performed in 90 patients affected by psoriasis between January and November 2012 at the “Nene Tereza” University Hospital, Tirane, Albania, based on two scored questionnaires. Results: more than 70 % of patients reported that stressful events caused a flare- up of their psoriasis (p< 0.05). More than 60% of males and 20% of females were smokers (p< 0.05). About 20% of our patients were taking one or more of the medications listed in the questionnaire (p> 0.05). About 20% of patients reported having had recurrent infections (p<0,05). About 80% of males patients consumed alcohol (p<0,05). More than 40% reported a relative with psoriasis. Statistical comparison of the group that reported skin aggressions with the group that did not revealed a significant difference (p<0,05). Only a few of them reported to have allergies (p>0,05). About 36% of females reported that hormonal changes (puberty and menopause) exacerbated their psoriasis (p<0,05). More than 40% of patients reported that psoriasis seriously affects their quality of life. Conclusion: stress, tobacco, infections, heredity, alcohol, hormonal changes and skin aggressions were confirmed as trigger factors for psoriasis in the present sample. Allergies and the investigated drugs seemed not to have any influence in flare-ups. We found that psoriasis had a serious impact in the quality of life in over of 40% of the patients interviewed.
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Affiliation(s)
- Alert Xhaja
- Department of Dermatology, UHC Nene Tereza, Tirane, Albania
| | | | - Silvan Frangaj
- Department of Dermatology, UHC Nene Tereza, Tirane, Albania
| | | | - Ermira Vasili
- Department of Dermatology, UHC Nene Tereza, Tirane, Albania
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Abstract
Psoriasis is increasing in both children and adults. The association of comorbidities, specifically obesity and other components of the metabolic syndrome, are also increasing. The precise cause is unknown but genetic and complex immunologic factors play a role in the development of the disease and its comorbidities. There are multiple clinical variants, and the severity of the disease can range from mild localized lesions in most patients to severe generalized involvement in some. Most patients with mild to moderate disease can be controlled with topical treatments.
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Coumbe AG, Pritzker MR, Duprez DA. Cardiovascular risk and psoriasis: beyond the traditional risk factors. Am J Med 2014; 127:12-8. [PMID: 24161194 DOI: 10.1016/j.amjmed.2013.08.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 08/04/2013] [Accepted: 08/05/2013] [Indexed: 12/29/2022]
Abstract
Psoriasis is an autoimmune disease resulting in plaques of the skin. Similar to atherosclerosis, inflammation is integral to the initiation and propagation of plaque development. Mounting evidence has emerged demonstrating that psoriasis not only is associated with increased prevalence of cardiovascular risk factors, but also is an independent risk factor for the development of cardiovascular disease. Systemic therapies for moderate to severe psoriasis can increase the cardiovascular risk. Despite the evidence that psoriasis is an independent risk factor for cardiovascular disease, current guidelines only address managing traditional risk factors. An interdisciplinary approach is needed to find the necessary steps beyond classic risk reduction and detection of early cardiovascular disease in patients with psoriasis, as well as to develop a cardiovascular disease preventive regimen.
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Affiliation(s)
- Ann G Coumbe
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis
| | - Marc R Pritzker
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis
| | - Daniel A Duprez
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis.
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Abstract
The treatment of psoriasis has been revolutionized since the introduction of biologic therapies. Prior to their introduction, it was unclear if psoriasis was primarily a keratinocyte signaling dysfunction or an autoimmune T-cell mediated pathway. Nonspecific T-cell targeting treatments had been used with some success, but they were limited by a narrow therapeutic index. The nonspecific nature of these agents was fraught with side effects, and the efficacy of these treatments pales in comparison to current treatments. The initial biologic molecules, alefacept and efalizumab, were not specific for any T-cell driven pathway, and neither are currently available in the USA. The successors to these early therapies have shown high efficacy and low side effects in psoriasis and other autoimmune diseases through the specific targeting of tumor necrosis factor-alpha (TNF-α). Since the initial use of antitumor necrosis factor agents, a renaissance in our understanding of psoriasis has been underway, leading to the elucidation of the T-helper 17 (Th17) from the Th1 pathway. With each new treatment, the pathogenesis for psoriasis continues to be more defined, allowing for improved targeted therapies and the ability to achieve new milestones in efficacy.
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Affiliation(s)
| | | | - Henry K Wong
- College of Medicine, Ohio State University, Columbus, OH, USA
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Jafferany M. Lithium and psoriasis: what primary care and family physicians should know. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2012; 10:435-9. [PMID: 19287551 DOI: 10.4088/pcc.v10n0602] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Accepted: 04/14/2008] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This review focuses on the association of lithium treatment and psoriasis. The mechanism of action of lithium in causing psoriasis and the clinical presentation of psoriasis secondary to lithium treatment are considered. DATA SOURCES A search of the literature from 1949 to 2007 was performed using MEDLINE, with the following search terms: lithium, psoriasis, skin, dermatology, and psychodermatology. DATA SYNTHESIS Lithium is involved in a variety of cutaneous reactions including psoriasis, which may present as exacerbation of preexisting psoriasis, induction of de novo psoriasis, pustular psoriasis, nail changes, and psoriatic arthropathy. The appearance of psoriatic lesions may occur at normal therapeutic serum lithium levels. The refractory period for the development of psoriatic lesions is variable and generally longer in induction and shorter in exacerbation of psoriasis. Lithium-induced psoriasis is often resistant to conventional treatment modalities, and some cases may require dose reduction or discontinuation of lithium treatment. CONCLUSION Lithium is the mainstay of treatment in bipolar disorder and is associated with a variety of cutaneous side effects including psoriasis. Primary care providers and family physicians should be knowledgeable about the association of lithium and its dermatologic side effects. Early recognition and management could be beneficial in avoiding the issues of noncompliance and further deterioration of mood symptoms secondary to obviously disfiguring skin appearance. Primary care, psychiatry, and dermatology liaison services will prove helpful in managing these patients.
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Affiliation(s)
- Mohammad Jafferany
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
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Carron P, Van Praet L, Jacques P, Elewaut D, Van den Bosch F. Therapy for Spondyloarthritis. Rheum Dis Clin North Am 2012; 38:583-600. [DOI: 10.1016/j.rdc.2012.08.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Cozzani E, Scaparro M, Parodi A. A case of psoriasis worsened by atorvastatin. J Dermatol Case Rep 2011; 3:60-1. [PMID: 21886735 DOI: 10.3315/jdcr.2009.1037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 12/23/2009] [Indexed: 12/11/2022]
Abstract
Statins are known to have a number of cutaneous adverse effects including the induction of autoimmune diseases like systemic and subacute lupus erythematosus, dermatomyositis, polymyositis, lichen planus pemphigoides and the drug reaction with eosinophilia and systemic symptoms (DRESS). Statins have been also reported as a triggering factor of psoriasis. We report a case of psoriasis vulgaris that worsened three months after atorvastatin was introduced and improved after its discontinuance.
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Abstract
Psoriasis is a common relapsing and remitting immune-mediated inflammatory disease that affects the skin and joints. This review focuses on current immunogenetic concepts, key cellular players, and axes of cytokines that are thought to contribute to disease pathogenesis. We highlight potential therapeutic targets and give an overview of the currently used immune-targeted therapies.
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Affiliation(s)
- Gayathri K Perera
- St. John's Institute of Dermatology, King's College London, London SE1 9RT, United Kingdom.
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Roberts C, Angus JE, Williams HC, Villanueva E, Saeterdal I, Jobling R. Ustekinumab for plaque psoriasis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2011. [DOI: 10.1002/14651858.cd008947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Sadowsky AE. Dermatologic Disorders and the Cornea. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00072-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Basavaraj KH, Ashok NM, Rashmi R, Praveen TK. The role of drugs in the induction and/or exacerbation of psoriasis. Int J Dermatol 2010; 49:1351-61. [DOI: 10.1111/j.1365-4632.2010.04570.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tan Pei Lin L, Kwek SK. Onset of psoriasis during therapy with fluoxetine. Gen Hosp Psychiatry 2010; 32:446.e9-446.e10. [PMID: 20633754 DOI: 10.1016/j.genhosppsych.2009.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2009] [Revised: 08/22/2009] [Accepted: 08/31/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Psoriasis is a commonly diagnosed skin disorder that requires a long-term management and can have a profound impact on the quality of life of patients. Drugs that have been associated with the precipitation or exacerbation of psoriasis include lithium, beta-adrenergic receptor blocking agents and antimalarials. Despite extensive use of selective serotonin reuptake inhibitors (SSRIs) in clinical practice, there have been very few reports of selective serotonin reuptake inhibitor-related psoriasis. The main purpose of this study was to report fluoxetine-induced psoriasis in two Chinese women. RESULTS AND CONCLUSION Although both patients had been taking fluoxetine for an extended period of time, the time scale of these two case studies suggests that fluoxetine played a causative role in these patients' psoriasis.
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Affiliation(s)
- Lynnette Tan Pei Lin
- Department of Psychological Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
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Mak RKH, Hundhausen C, Nestle FO. Progress in understanding the immunopathogenesis of psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2010; 100 Suppl 2:2-13. [PMID: 20096156 DOI: 10.1016/s0001-7310(09)73372-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
This review emphasizes how translation from bench research to clinical knowledge and vice versa has resulted in considerable progress in understanding the immunopathogenesis of psoriasis. First, the journey in understanding the pathogenic mechanisms behind psoriasis is described. The roles of different components of the adaptive and innate immune systems involved in driving the inflammatory response are explained. Discovery of new immune pathways i.e. the IL23/Th17 axis and its subsequent impact on the development of novel biological therapies is highlighted. Identification of potential targets warranting further research for future therapeutic development are also discussed.
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Affiliation(s)
- R K H Mak
- St. John's Institute of Dermatology. King's College London School of Medicine. London, United Kingdom.
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Mizuashi M, Kuramoto Y, Aiba S, Tagami H. Juvenile localized annular pustular psoriasis developing severe exacerbation after topical indomethacin application. Int J Dermatol 2010; 48:1262-4. [PMID: 20064190 DOI: 10.1111/j.1365-4632.2009.04100.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Anandarajah AP, Ritchlin CT. The diagnosis and treatment of early psoriatic arthritis. Nat Rev Rheumatol 2009; 5:634-41. [PMID: 19806150 DOI: 10.1038/nrrheum.2009.210] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory musculoskeletal disorder associated with a heterogeneous disease presentation, varied disease expression and an unpredictable but often chronically destructive clinical course. Joint damage can occur early in the disease; indeed, several imaging modalities have demonstrated subclinical joint involvement in psoriasis patients without musculoskeletal signs or symptoms. Efforts are underway to validate questionnaires that will enable dermatologists to screen patients with psoriasis for the presence of musculoskeletal disease. To date, the use of therapies in patients with early PsA has not been reported in randomized controlled trials. Moreover, conventional agents are partially effective in established PsA but, in general, trials with DMARDS have not included validated outcome measures for the different manifestations of PsA. Tumor necrosis factor antagonists can alleviate the signs and symptoms of established psoriatic arthritis and inhibit radiographic progression, but the therapeutic impact of early intervention with these agents requires further study. The extent of disease and the presence of comorbidities should be used to guide treatment decisions and to minimize adverse events.
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Affiliation(s)
- Allen P Anandarajah
- Clinical Immunology Research Center, Allergy, Immunology & Rheumatology Research Division, University of Rochester Medical Center, 601 Elmwood Avenue, P. O. Box 695, Rochester, NY 14642, USA.
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Abstract
Psoriasis has been associated with a number of behavioral and systemic comorbidities, including psoriatic arthritis, anxiety, depression, obesity, hypertension, diabetes mellitus, hyperlipidemia, metabolic syndrome, smoking, cardiovascular disease, alcoholism, Crohn's disease, lymphoma, and multiple sclerosis. Many of these conditions have a similar immunologic pathogeneses. Canadian and international studies have not only confirmed the presence of these comorbidities but also have demonstrated that patients with psoriasis have a significantly reduced life span. Given that patients with psoriasis are often unaware of their comorbidities, they should be screened for these conditions and treated if required by their dermatologist and/or primary care physician. It is important to keep in mind that the comorbidities and drugs used to treat them have an impact on the choice of anti-psoriatic treatment. In addition, comorbidities often preclude the use of traditional systemic agents. Recent studies have demonstrated that patients with preexisting comorbidities can be safely and effectively treated with biologic therapy. Furthermore, literature is evolving to suggest that better control of psoriasis might decrease cardiovascular mortality and prolong life.
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Affiliation(s)
- Lyn Guenther
- From The Guenther Dermatology Research Centre, London, ON
| | - Wayne Gulliver
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL
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41
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Trehan M. The use of antimalarials in dermatology. J DERMATOL TREAT 2009. [DOI: 10.1080/09546630050517351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Brauchli Y, Jick S, Miret M, Meier C. Psoriasis and risk of incident myocardial infarction, stroke or transient ischaemic attack: an inception cohort study with a nested case-control analysis. Br J Dermatol 2009; 160:1048-56. [DOI: 10.1111/j.1365-2133.2008.09020.x] [Citation(s) in RCA: 236] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gerdes S, Zahl VA, Knopf H, Weichenthal M, Mrowietz U. Comedication related to comorbidities: a study in 1203 hospitalized patients with severe psoriasis. Br J Dermatol 2009; 159:1116-23. [PMID: 18717681 DOI: 10.1111/j.1365-2133.2008.08786.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Psoriasis is a common dermatological disorder characterized by an immune-mediated chronic inflammation which is associated with a variety of other diseases commonly referred to as comorbidities. The treatments for these diseases may interfere with the course and the treatment of psoriasis. Little is known on the general drug intake of patients with psoriasis. OBJECTIVES To gain more insight into the general drug intake of patients with severe psoriasis. A correlation of comedication to respective diseases could lead to a better knowledge of comorbidities. METHODS Data on demographics, comedication and comorbidities from 1203 patients with severe psoriasis in Germany were analysed. As a control group data from 7099 subjects from the German National Health Survey 1998 were used. RESULTS Patients with severe psoriasis are receiving significantly more different systemic drugs on average than the general population, with the most prominent difference in multidrug treatment. Drugs used in the treatment of arterial hypertension, diabetes mellitus and other diseases of the metabolic syndrome as well as oral anticoagulants and anticonvulsant agents showed the greatest differences. Special characteristics of antihypertensive drug treatments could be determined. CONCLUSIONS The data obtained in this study provide the basis for an improved management of patients with psoriasis. Knowledge of existing comedication and comorbidities may lead to the ability to treat psoriasis and comorbidities at the same time more safely and to use possible synergistic effects.
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Affiliation(s)
- S Gerdes
- Psoriasis Center at the Department of Dermatology, University Clinic of Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany.
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Abstract
BACKGROUND Observations in controlled trials and case reports have linked lithium exposure to induction or exacerbation of psoriasis. A causal relationship between lithium exposure and incident psoriasis has been questioned, and observational studies are lacking. METHODS We conducted a case-control analysis using the United Kingdom-based General Practice Research Database to study the association between the use of lithium or antipsychotics and the risk of developing an incident diagnosis of psoriasis. We identified cases with an incident diagnosis of psoriasis between 1994 and 2005, and controls were matched to the cases on age, sex, general practice, calendar time, and years of history in the database. We used conditional logistic regression to estimate the risk of developing a first-time diagnosis of psoriasis in relation to previous exposure to lithium and antipsychotic drugs, stratified by exposure timing and duration. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) adjusted for smoking, body mass index, and additional potential confounders. RESULTS We identified 36,702 incident cases of psoriasis and the same number of matched controls. Compared with nonuse, current use of 5 or more prescriptions for lithium and atypical antipsychotics yielded adjusted ORs of 1.68 (95% CI, 1.18-2.39; P < 0.01) and 0.76 (95% CI, 0.55-1.06; P = 0.11), respectively. The OR for olanzapine was 0.50 (95% CI, 0.28-0.89, P = 0.02). CONCLUSIONS Long-term use of lithium was associated with a small increase in risk of incident psoriasis. There was a suggestion of a possible reduced psoriasis risk associated with the use of atypical antipsychotics, mainly olanzapine, a finding that needs further evaluation.
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Abstract
Treating children with psoriasis represents one of the most rewarding yet constantly challenging endeavors in dermatology. These patients require time, energy, enthusiasm, empathy, and current, comprehensive knowledge of the unique clinical presentations in children and available therapies, including clinical action spectrum, mechanism of action, potential toxicity, and monitoring. Longitudinal trials examining the epidemiology and natural history of psoriasis, as well as the safety and efficacy of current and emerging treatments, are desperately needed in the pediatric population. Partner with the patient, family, and other multidisciplinary providers to form an educational and therapeutic alliance. Early in the course of disease, schedule frequent visits for reinforcement of the therapeutic plan, education, clinical and treatment monitoring, and support. As the disease and the patient's physical, psychosocial and emotional level of functioning evolve, so too will the requirement for follow-up and monitoring. Patient advocacy and education groups, such as the National Psoriasis Foundation (www.psoriasis.org; 800-723-9166) are excellent resources and can serve as an extension of your comprehensive care.
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Affiliation(s)
- Kelly M Cordoro
- University of California, San Francisco, 1701 Divisadero Street, Box 0316, San Francisco, CA 94115, USA.
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Trends in incidence of adult-onset psoriasis over three decades: a population-based study. J Am Acad Dermatol 2009; 60:394-401. [PMID: 19231638 DOI: 10.1016/j.jaad.2008.10.062] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Revised: 10/24/2008] [Accepted: 10/27/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND Incidence studies of psoriasis are rare, mainly due to lack of established epidemiological criteria and the variable disease course. The objective of this study is to determine time trends in incidence and survival of psoriasis patients over three decades. METHODS We identified a population-based incidence cohort of 1633 subjects aged > or = 18 years first diagnosed with psoriasis between January 1, 1970 and January 1, 2000. The complete medical records for each potential psoriasis subject were reviewed and diagnosis was validated by either a confirmatory diagnosis in the medical record by a dermatologist or medical record review by a dermatologist. Age- and sex-specific incidence rates were calculated and were age- and sex-adjusted to the 2000 US white population. RESULTS The overall age- and sex-adjusted annual incidence of psoriasis was 78.9 per 100,000 (95% confidence interval [CI]: 75.0-82.9). When psoriasis diagnosis was restricted to dermatologist-confirmed subjects, the incidence was 62.3 per 100,000 (95% CI: 58.8-65.8). Incidence of psoriasis increased significantly over time from 50.8 in the period 1970-1974 to reach 100.5 per 100,000 in the 1995-1999 time period (P = .001). Although the overall incidence was higher in males than in females (P = .003), incidence in females was highest in the sixth decade of life (90.7 per 100,000). Survival was similar to that found in the general population (P = .36). LIMITATIONS The study population was mostly white and limited to adult psoriasis patients. CONCLUSION The annual incidence of psoriasis almost doubled between the 1970s and 2000. The reasons for this increase in incidence are currently unknown, but could include a variety of factors, including a true change in incidence or changes in the diagnosing patterns over time.
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Affiliation(s)
- Mohammad Jafferany
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of Washington School of Medicine, Children's Hospital and Regional Medical Center, Seattle, Washington 98105, USA.
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Rallis E, Verros C, Karanikola E, Valaskatzi A, Papaconstantis M. Exacerbation of Psoriasis under Efalizumab Therapy. J Cutan Med Surg 2009; 13:106-9. [DOI: 10.2310/7750.2008.07087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Efalizumab is a recombinant humanized IgG1-κ isotype monoclonal antibody that binds to CD11a, inhibiting T-cell activation. It has been approved for the treatment of moderate to severe plaque psoriasis. Efalizumab has been associated with the development of skin eruptions during the administration period, and this probably represents the potential psoriasis events observed during its administration. Objective: We report a case of exacerbation of psoriasis under efalizumab administration. A reversible increase in lymphocyte count with normal total white blood cell count was also noticed. Conclusion: Larger series are probably needed to establish clinical and histopathologic criteria and to determine the terminology used regarding the psoriasis adverse events seen with efalizumab treatment.
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Affiliation(s)
- Efstathios Rallis
- From the Departments of Dermatology and Pathology, Army General Hospital, Athens, Greece; and private practice, Tripolis, Greece
| | - Constantinos Verros
- From the Departments of Dermatology and Pathology, Army General Hospital, Athens, Greece; and private practice, Tripolis, Greece
| | - Evmorfia Karanikola
- From the Departments of Dermatology and Pathology, Army General Hospital, Athens, Greece; and private practice, Tripolis, Greece
| | - Argyro Valaskatzi
- From the Departments of Dermatology and Pathology, Army General Hospital, Athens, Greece; and private practice, Tripolis, Greece
| | - Markos Papaconstantis
- From the Departments of Dermatology and Pathology, Army General Hospital, Athens, Greece; and private practice, Tripolis, Greece
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Späh F. Inflammation in atherosclerosis and psoriasis: common pathogenic mechanisms and the potential for an integrated treatment approach. Br J Dermatol 2008; 159 Suppl 2:10-7. [PMID: 18700910 DOI: 10.1111/j.1365-2133.2008.08780.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Inflammation plays a key role in the pathogenesis of a number of chronic inflammatory systemic diseases (CISDs), including psoriasis, rheumatoid arthritis, systemic lupus erythematosus and Crohn's disease, and also in the pathogenesis of atherosclerosis. CISDs and cardiovascular diseases, such as atherosclerosis, share common pathogenic features, and cardiovascular disease is an important cause of morbidity and mortality in patients with CISDs. Activated inflammatory cells and pro-inflammatory cytokines contribute to the development of psoriatic lesions and play an important role in the breakdown of atherosclerotic plaques. Psoriasis and atherosclerosis also have similar histological characteristics involving T cells, macrophages and monocytes. In particular, the extravasation of T cells through the epithelium is characteristic of both psoriatic and atherosclerotic plaques. Cardiovascular disease is an important cause of morbidity and mortality in patients with psoriasis, which is associated with an increased cardiovascular risk profile compared with the general population. Patients with psoriasis are at increased risk of arterial hypertension, coronary heart disease, hyperlipidaemia, obesity and type II diabetes, which are more prevalent than in control patients. This increased risk could be due to the effects of chronic inflammatory changes, particularly the infiltration of T cells and subsequent secretion of pro-inflammatory cytokines. Some drugs used in the treatment of cardiovascular disease, such as 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) and angiotensin-converting enzyme inhibitors have anti-inflammatory activity. In addition, systemic treatments for psoriasis may, by decreasing inflammation, reduce the risk of cardiovascular disease. It is suggested, therefore, that an integrated approach to the treatment of the inflammatory processes underlying both psoriasis and atherosclerosis may be beneficial in reducing cardiovascular risk in patients with psoriasis. The newer targeted biological therapies, such as efalizumab and infliximab, which offer the potential for long-term disease control in psoriasis, may be of particular use in this setting.
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Affiliation(s)
- F Späh
- HELIOS Klinikum Krefeld, Medizinische Klinik I, Lutherplatz 40, D-47805 Krefeld, Germany.
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