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Xiao Y, Yi Y, Jing D, Yang S, Guo Y, Xiao H, Kuang Y, Zhu W, Zhao J, Li Y, Liu H, Li J, Chen X, Shen M. Age at Natural Menopause, Reproductive Lifespan, and the Risk of Late-Onset Psoriasis and Psoriatic Arthritis in Women: A Prospective Cohort Study. J Invest Dermatol 2024; 144:1273-1281.e5. [PMID: 38081449 DOI: 10.1016/j.jid.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/01/2023] [Accepted: 11/17/2023] [Indexed: 01/12/2024]
Abstract
Although a peak incidence of psoriasis in women aged around 60 years has been observed, the link between reproductive lifespan and late-onset psoriatic diseases is underexplored. This study aims to elucidate the association between reproductive lifespan and the risk of late-onset psoriasis and psoriatic arthritis (PsA). Utilizing the UK Biobank data, we conducted a prospective cohort study in postmenopausal women without baseline psoriatic diseases. The exposure variables included age at natural menopause (ANM) and duration from menarche to menopause, termed reproductive years. The outcome variables were incident psoriasis and PsA. We employed Cox regression analysis, factoring in polygenic risk scores for psoriatic diseases and recognized risk factors. We found that later ANM and longer reproductive years were significantly associated with decreased risks of late-onset psoriasis and PsA in a dose-dependent manner (P<.05). ANM after age 55 years led to a 34 and 46% risk reduction in late-onset psoriasis and PsA, respectively, compared with ANM before age 45 years (P<.001). The population-attributable risks of ANM were 17.4% for late-onset psoriasis and 21.6% for PsA. In conclusion, reproductive lifespan, with its inherent homeostasis, plays a pivotal yet overlooked role in late-onset psoriatic diseases. Investigations into estrogen-centric causes and sex-specific interventions are imperative.
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Affiliation(s)
- Yi Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Furong Laboratory, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China; National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, China
| | - Yan Yi
- Reproductive Medicine Center, Xiangya Hospital, Central South University, Changsha, China
| | - Danrong Jing
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Furong Laboratory, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China
| | - Songchun Yang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Furong Laboratory, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China
| | - Yeye Guo
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Furong Laboratory, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China
| | - Hui Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Furong Laboratory, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China
| | - Yehong Kuang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Furong Laboratory, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China
| | - Wu Zhu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Furong Laboratory, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China
| | - Jing Zhao
- Reproductive Medicine Center, Xiangya Hospital, Central South University, Changsha, China
| | - Yanping Li
- Reproductive Medicine Center, Xiangya Hospital, Central South University, Changsha, China
| | - Hong Liu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Furong Laboratory, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China; National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, China
| | - Jinchen Li
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, China; Bioinformatics Center, Xiangya Hospital, Central South University, Changsha, China; Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Furong Laboratory, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China; National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, China.
| | - Minxue Shen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Furong Laboratory, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, China; Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.
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Braun H, Thompson EC, Zhang Q, Tangpricha V, Goodman M, Yeung H. Prevalence of Psoriasis and Perceived Association with Hormone Therapy in Transgender Adults. Transgend Health 2023; 8:396-399. [PMID: 37525834 PMCID: PMC10387154 DOI: 10.1089/trgh.2021.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose The role of hormone therapy (HT) in the etiology and progression of psoriasis in the transgender population is unclear. Methods The prevalence of psoriasis in transmasculine (TM) and transfeminine (TF) adults and perceived links between psoriasis and gender-affirming HT is examined using a cross-sectional survey of 696 transgender individuals. Results Ever diagnosis of psoriasis was reported by 17 TM persons (4.9%; 95% confidence interval [CI]: 2.6-7.2) and 13 TF persons (3.7%; 95% CI: 1.7-5.7). Prevalence of current psoriasis in TM persons was 2.6% (95% CI: 0.9-4.3) and 1.1% (95% CI: 0.03-2.3) among TF persons. Notably, among participants who had ever had psoriasis, 17% perceived a link between their psoriasis and gender-affirming HT. Conclusions Prevalence of psoriasis among transgender persons resembled estimates in the general population. Potential associations between psoriasis and its severity with gender-affirming HT warrant further longitudinal research.
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Affiliation(s)
- Hayley Braun
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Elaine C. Thompson
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Qi Zhang
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Michael Goodman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA
- Regional Telehealth Service, Veterans Affairs Southeast Network Veterans Integrated Service Network 7, Decatur, Georgia, USA
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Li W, Chan AA, Han J, Chlebowski RT, Lee DJ. Alcohol and Smoking Cessation as Potential Modulators for Smoking-Associated Psoriasis Risk in Postmenopausal Women: The Women's Health Initiative. Am J Clin Dermatol 2023; 24:325-332. [PMID: 36662365 PMCID: PMC9968247 DOI: 10.1007/s40257-022-00750-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND The association of alcohol with psoriasis has been inconsistent among studies. OBJECTIVES We aimed (1) to determine whether alcohol consumption (by status, frequency, and subtype of alcohol) modulates smoking-related psoriasis risk in postmenopausal women while stratifying for smoking status and pack-years and (2) to evaluate the effect of smoking cessation on psoriasis risk in postmenopausal women. METHODS This prospective cohort study included 106,844 postmenopausal women enrolled in the Women's Health Initiative between 1993 and 1998. Patients diagnosed with psoriasis were identified using fee-for-service Medicare International Classification of Diseases, Ninth Revision, Clinical Modification codes assigned by dermatologists or rheumatologists. Self-administered questionnaires were used to obtain information on demographics, medical history, and smoking and alcohol habits. Hazard ratios from Cox regression models were adjusted for ethnicity, income, body mass index, and history of non-melanoma skin cancer and were stratified on age and on randomization status in the Women's Health Initiative study components. RESULTS In the initial statistical model, past and current alcohol drinkers had higher risks of psoriasis compared with never-drinkers (P-trend < 0.001). This association was not observed after adjusting for cigarette smoking (P-trend: 0.478). The effect of alcohol (by status, frequency, and alcohol subtype) isolated by stratifying the analysis by smoking status (i.e., among never smokers) showed no association with psoriasis. Smoking showed an increasing risk for psoriasis with greater pack-years compared with those who have never smoked (P-trend: < 0.001). Compared to smokers at baseline, past smokers had a lower risk of psoriasis across women who smoked 5-14 cigarettes per day (hazard ratio 0.67, 95% confidence interval 0.51-0.88) and across women who smoked for 5-24 years (hazard ratio 0.65, 95% confidence interval 0.46-0.90). CONCLUSIONS These findings indicate that alcohol consumption does not modulate smoking-related psoriasis risk. Cigarette smoking, but not alcohol consumption, is an independent risk factor for psoriasis in postmenopausal women. As greater pack-years was associated with a higher risk of psoriasis and smoking cessation was conversely associated with a lower risk of psoriasis for moderate smokers, a greater emphasis on smoking abstinence and cessation counseling may benefit patients who already have other risk factors for psoriasis.
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Affiliation(s)
- Wendy Li
- grid.239844.00000 0001 0157 6501Division of Dermatology, Department of Medicine, Harbor-UCLA Medical Center, 1000 W Carson St, Torrance, CA 90502 USA
| | - Alfred A. Chan
- grid.239844.00000 0001 0157 6501The Lundquist Research Institute at Harbor-UCLA Medical Center, Torrance, CA USA
| | - Jiali Han
- grid.257413.60000 0001 2287 3919Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN USA
| | - Rowan T. Chlebowski
- grid.239844.00000 0001 0157 6501The Lundquist Research Institute at Harbor-UCLA Medical Center, Torrance, CA USA
| | - Delphine J. Lee
- grid.239844.00000 0001 0157 6501Division of Dermatology, Department of Medicine, Harbor-UCLA Medical Center, 1000 W Carson St, Torrance, CA 90502 USA ,grid.239844.00000 0001 0157 6501The Lundquist Research Institute at Harbor-UCLA Medical Center, Torrance, CA USA ,grid.19006.3e0000 0000 9632 6718David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
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Association between baseline insulin resistance and psoriasis incidence: the Women's Health Initiative. Arch Dermatol Res 2021; 314:869-880. [PMID: 34816303 PMCID: PMC9512862 DOI: 10.1007/s00403-021-02298-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/26/2021] [Indexed: 11/02/2022]
Abstract
Small-scale studies offer conflicting evidence regarding the relationship/association between psoriasis and insulin resistance by HOMA-IR (homeostasis model assessment of insulin resistance). The purpose of this study was to assess the association between baseline HOMA-IR and psoriasis incidence in a large-scale longitudinal cohort of postmenopausal women. The analysis included 21,789 postmenopausal women from the Women's Health Initiative. Psoriasis diagnosis was defined by fee-for-service Medicare ICD-9-CM codes assigned by dermatologists or rheumatologists, and a 2-year lookback period to exclude prevalent cases. Baseline HOMA-IR was calculated using the updated HOMA2 model. Hazard rates from the Cox regression models were stratified by age (10-year intervals), on WHI component (Clinical Trial or Observational Study), and on randomization status within each of the WHI clinical trials. The complete model also adjusted for ethnicity, waist-hip-ratio, and smoking and alcohol habits. Among participants free of psoriasis at entry, those with high baseline HOMA-IR (≥ 2) compared to low (< 1.4) had significantly higher risk for psoriasis over 21-year cumulative follow-up (HR: 1.39, 95% CI 1.08-1.79, P-trend: 0.011). In postmenopausal women, higher baseline HOMA-IR levels were significantly associated with higher incidence of psoriasis over 21-year cumulative follow-up. Results from this time-to-event analysis indicate that insulin resistance can precede and is associated with an increased risk of psoriasis. Study is limited by Medicare diagnostic code accuracy and cohort age.
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