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Mastorino L, Daniele R, Dapavo P, Frigatti G, Ponti R, Giunipero di Corteranzo I, Bongiovanni E, Quaglino P, Ribero S. Alcohol abuse and discretionary habits in psoriatic patients: impact on IL-17 and IL-23 inhibitor response. J Dtsch Dermatol Ges 2024. [PMID: 39037761 DOI: 10.1111/ddg.15441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/27/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Alcohol abuse is correlated with the onset and worsening of psoriasis, but its effects, as for smoking, on biological therapies are still poorly investigated. MATERIALS AND METHODS This study aimed to determine the prevalence of alcohol abuse and other discretionary habits (such as smoking and sedentary lifestyle) in patients with psoriasis treated with topicals, conventional systemic and biologic therapies. The second objective is to investigate the impact of discretionary habits, focusing on alcohol abuse, on the response to biological therapy. To identify alcohol dependence, the CAGE questionnaire was distributed among patients of our clinic. RESULTS 305 patients were included with 18% at high risk of alcohol abuse. Clinically, guttate psoriasis and psoriatic arthritis were more common in patients at higher risk of alcohol abuse. Furthermore, patients with an alcohol problem who started biological therapy reported a higher PASI than those who drank less. None of the considered variables seemed to correlate with discontinuation of medication or with lower achievement of the analyzed outcomes (PASI100, PASI90, and PASI≤3). There was a stronger association between alcohol dependence and patients receiving conventional therapy than with patients receiving biologics. CONCLUSIONS The efficacy of biologicals did not seem to be impacted by alcohol consumption, smoking, or sedentary lifestyle.
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Affiliation(s)
- Luca Mastorino
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Rebecca Daniele
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paolo Dapavo
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giada Frigatti
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Renata Ponti
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Eleonora Bongiovanni
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Simone Ribero
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
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2
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Krefting F, Hölsken S, Schedlowski M, Sondermann W. Discontinuation of Fumaric Acid Esters is Affected by Depressive Symptomatology: A Retrospective Analysis. Acta Derm Venereol 2024; 104:adv12326. [PMID: 38483082 PMCID: PMC10953706 DOI: 10.2340/actadv.v104.12326] [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: 04/13/2023] [Accepted: 02/22/2024] [Indexed: 03/22/2024] Open
Abstract
Fumaric acid esters (FAEs) remain a widespread therapy option for moderate-to-severe psoriasis. However, drug survival of FAEs is limited by adverse events (AEs) or inadequate treatment response. Depressive disturbances are highly prevalent in psoriasis patients and are hypothesized to be associated with the reporting of AEs and therapy discontinuation. This study's aim was to analyze whether psoriasis patients with comorbid depressive symptomatology are more likely to discontinue treatment with FAEs due to AEs and/or inadequate treatment response. Data were retrospectively extracted from the records of patients starting therapy with FAEs in the Department of Dermatology, University Hospital Essen, Germany between 2017 and 2022, covering the first 52 weeks of treatment. Psoriasis severity and depressive symptomatology, as well as AEs and therapy discontinuation, were analyzed. Psoriasis patients (N = 95, 47.37% female) with depressive symptomatology (42.11%) were more likely to discontinue therapy due to patient-reported AEs, while the total number of reported AEs was not associated with depression. The results support the hypothesis that among psoriasis patients with depressive symptoms, the associated introspection and somatization may result in increased sensitivity for AEs and thus in quicker therapy discontinuation. In these patients, the occurrence of nocebo effects should be minimized, e.g. by special communication techniques.
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Affiliation(s)
- Frederik Krefting
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
| | - Stefanie Hölsken
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Wiebke Sondermann
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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3
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Liu L, Cai XC, Sun XY, Zhou YQ, Jin MZ, Wang J, Ma T, Li B, Li X. Global prevalence of metabolic syndrome in patients with psoriasis in the past two decades: current evidence. J Eur Acad Dermatol Venereol 2022; 36:1969-1979. [PMID: 35666614 DOI: 10.1111/jdv.18296] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/18/2022] [Indexed: 01/05/2023]
Abstract
Patients with psoriasis are at an increased risk of metabolic syndrome (MetS); however, a systematic analysis of its global prevalence has not been performed to date. Here, we performed a systematic review and meta-analysis to assess the prevalence of MetS among patients with psoriasis. We searched five databases from inception through September 2021 and used the Agency for Healthcare Research and Quality (AHRQ) and Newcastle-Ottawa Scale (NOS) tools to assess observational study quality. Stata SE 15.1 was used to perform the data analysis. Subgroup, meta-regression and sensitivity analyses were used to evaluate interstudy heterogeneity. Publication bias was evaluated using Egger's and Begg's linear tests. The global prevalence of MetS in patients with psoriasis was 32% (95% confidence interval [CI], 0.26-0.38). The prevalence in adults was 32% (95% CI, 0.29-0.36), while that in children and adolescents was 9% (95% CI, 0.00-0.18). Latin America had the highest prevalence of 47% (95% CI, 0.43-0.51), whereas North America had the lowest prevalence of 26% (95% CI, 0.16-0.37). Patients with psoriasis vulgaris (29%; 95% CI, 0.23-0.35) or severe psoriasis (37%; 95% CI, 0.27-0.46) had a higher prevalence of MetS than those with other psoriasis types. These findings suggest that MetS should be appropriately recognized and managed in patients with psoriasis. More population-based prospective observational studies are required to elucidate the mechanisms underlying the coexistence of MetS in patients with psoriasis.
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Affiliation(s)
- L Liu
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - X-C Cai
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - X-Y Sun
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Y-Q Zhou
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - M-Z Jin
- Department of Dermatology, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - J Wang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - T Ma
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - B Li
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China.,Department of Dermatology, Shanghai Skin Disease Hospital, Shanghai, China
| | - X Li
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
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4
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Abstract
Psoriasis is a chronic inflammatory and immune-mediated condition, which is no longer considered as being limited to the skin, but may affect the entire body. Epidemiological studies have shown that certain disorders, including obesity, diabetes, liver abnormalities, elevated lipid levels in the blood and metabolic syndrome, may occur more frequently in patients with psoriasis compared with the general population. As psoriasis is a chronic disease, the frequently associated comorbidities must be identified early to ensure timely treatment and, possibly, their prevention. Comorbidities often manifest clinically 1-2 years after the onset of psoriasis and are commonly seen in patients with severe forms of the disease. The association between psoriasis and its comorbidities is not coincidental, but rather based on common pathophysiological mechanisms and risk factors that underlie the increased frequency of comorbidities in patients with psoriasis. The aim of the present review was to emphasize the important role of dermatologists in the early recognition of comorbidities in patients with psoriasis, with a focus on metabolic comorbidities, precisely because the dermatologists are usually the first medical contact due to the predominance of skin lesions. Therefore, these specialists have the responsibility to inform patients on the association between psoriasis and possible multiple comorbidities, devise prevention and treatment plans, or even redirect patients to other specialists.
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5
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Hölsken S, Krefting F, Schedlowski M, Sondermann W. Common Fundamentals of Psoriasis and Depression. Acta Derm Venereol 2021; 101:adv00609. [PMID: 34806760 PMCID: PMC9455336 DOI: 10.2340/actadv.v101.565] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Psoriasis is an inflammatory, immune-mediated disease that is frequently associated with psychological comorbidities such as depression. The stigma patients feel because of the appearance of their skin may contribute to the high psycho-social burden of psoriasis. However, there is emerging evidence that overlapping biological mechanisms are, to a substantial degree, responsible for the close interaction between psoriasis and depression. Increased proinflammatory mediators, such as C-reactive protein or interleukin-6, are present in both psoriasis and depression, indicating that inflammation may represent a pathophysiological link between the diseases. Anti-inflammatory biologic therapies treat the clinical manifestations of psoriasis, but might also play a significant role in reducing associated depressive symptoms in patients with psoriasis. Comparison between single studies focusing on the change in depressive symptoms in psoriasis is limited by inconsistency in the depression screening tools applied.
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Affiliation(s)
| | | | | | - Wiebke Sondermann
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, DE-45122 Essen, Germany.
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6
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Hölsken S, Krefting F, Schneider L, Benson S, Schedlowski M, Sondermann W. A brief screening tool for depression in psoriasis patients: The Two Questions Test in clinical practice. J Dermatol 2021; 49:341-348. [PMID: 34806209 DOI: 10.1111/1346-8138.16241] [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: 09/20/2021] [Revised: 10/22/2021] [Accepted: 11/08/2021] [Indexed: 11/28/2022]
Abstract
Patients suffering from chronic inflammatory diseases such as psoriasis are prone to develop depressive symptoms. However, within the time constraints of dermatological clinics, depressive symptoms in psoriasis patients are often overlooked and thus underdiagnosed. The Two Questions Test may serve as a quick screening tool for an initial assessment of depressive burden in these patients. We evaluated its usefulness in the clinical context analyzing the records of patients starting systemic treatment for psoriasis with a selective interleukin (IL)23- or IL17A-inhibitor. In a total sample of N = 139 patients, baseline Two Questions Test scores were analyzed together with measures of psoriatic and psychiatric symptoms. In addition, the development of the Two Questions Test scores over the course of the first 28 weeks of treatment was assessed. No association was found between the Two Questions Test scores and skin symptoms measured by the Psoriasis Area and Severity Index and the visibility of skin lesions. However, skin related quality of life analyzed with the Dermatology Life Quality Index was associated with the Two Questions Test scores. In addition, the longitudinal analysis revealed improvement in Two Questions Test outcomes over the course of patients' treatment. These results indicate the Two Questions Test's usefulness both as an initial screening tool of depressive symptoms, as well as in its use as a sensitive tool for the repeated assessment of depressive symptoms in psoriasis patients.
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Affiliation(s)
- Stefanie Hölsken
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Frederik Krefting
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lea Schneider
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sven Benson
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Wiebke Sondermann
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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7
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Körber A, Augustin M, Behrens F, Gerdes S, von Kiedrowski R, Schäkel K, Sticherling M, Wilsmann-Theis D, Wohlrab J, Simon JC. [Treatment of psoriasis with secukinumab : Practical guidance]. DER HAUTARZT 2021; 72:984-991. [PMID: 34417630 PMCID: PMC8378296 DOI: 10.1007/s00105-021-04871-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Moderate to severe plaque psoriasis can be treated effectively with immunomodulating biologicals such as the interleukin-17A inhibitor secukinumab. In practice, however, questions often arise as to how to proceed in special situations, such as infections, comorbidity, pregnancy, or surgery. OBJECTIVES To address frequent questions about the treatment of plaque psoriasis with secukinumab in a consensus document of German psoriasis experts that supplements current guidelines. METHODS In a virtual expert meeting in May 2020, practical aspects of the treatment of psoriasis were discussed based on the experience of the participants and on current literature. The results of this discussion were summarized in the present consensus document. RESULTS This article provides practical guidance on case history, documentation of previous therapies, severity of psoriasis, and comorbidities before starting therapy with secukinumab. For patients treated with secukinumab, the course of action in case of vaccinations, chronic or acute infections, surgical interventions, special manifestations of psoriasis, and comorbidities including history of cancer and autoimmune disorders is discussed. Questions regarding family planning and health policy regulations are also addressed. DISCUSSION The recommendations for the treatment of psoriasis with secukinumab summarized in this consensus document may contribute to achieve optimal therapy for patients and to improve their quality of life.
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Affiliation(s)
| | - Matthias Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Frank Behrens
- Rheumatologie, Medizinische Klinik 2, Universitätsklinikum Goethe-Universität, Frankfurt am Main, Deutschland
| | - Sascha Gerdes
- Psoriasis-Zentrum, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Deutschland
| | - Ralph von Kiedrowski
- Dermatologische Spezialpraxis für chronisch-entzündliche System-Dermatosen, Dermato-Onkologie und Allergologie, Selters (Westerwald), Deutschland
| | - Knut Schäkel
- Hautklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Michael Sticherling
- Hautklinik und Psoriasiszentrum, Universitätsklinikum Erlangen, Deutsches Zentrum Immuntherapie, Erlangen, Deutschland
| | - Dagmar Wilsmann-Theis
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Johannes Wohlrab
- Universitätsklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - Jan-Christoph Simon
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR, Philipp-Rosenthal-Str. 23, 04103, Leipzig, Deutschland.
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8
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Kromer C, Mohr J, Celis D, Poortinga S, Gerdes S, Mössner R, Wilsmann-Theis D. Screening auf Depression bei Psoriasis‐Patienten während einer dermatologischen Konsultation: ein erster Schritt in Richtung Behandlung. J Dtsch Dermatol Ges 2021; 19:1451-1462. [PMID: 34661361 DOI: 10.1111/ddg.14532_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 03/29/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Christian Kromer
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Johannes Mohr
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Daniel Celis
- Wirtschaftswissenschaftliche Fakultät, Georg-August-Universität Göttingen, Göttingen, Deutschland
| | - Sietske Poortinga
- Klinik und Poliklinik für Dermatologie und Allergologie, Universität Bonn, Bonn, Deutschland
| | - Sascha Gerdes
- Psoriasis-Zentrum, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - Rotraut Mössner
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Dagmar Wilsmann-Theis
- Klinik und Poliklinik für Dermatologie und Allergologie, Universität Bonn, Bonn, Deutschland
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9
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Kromer C, Mohr J, Celis D, Poortinga S, Gerdes S, Mössner R, Wilsmann-Theis D. Screening for depression in psoriasis patients during a dermatological consultation: A first step towards treatment. J Dtsch Dermatol Ges 2021; 19:1451-1461. [PMID: 34467650 DOI: 10.1111/ddg.14532] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 03/29/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Depression is a highly prevalent comorbidity in psoriatic patients. The aim of this prospective study was to follow up psoriasis patients at risk for depression and to evaluate individual pathways to mental health care and the efficacy of depression screening in a real-life setting. PATIENTS AND METHODS In this prospective multicenter study, 355 patients with psoriasis were screened for depressive symptoms with the revised Beck Depression Inventory (BDI-II). General practitioners of patients at risk for depression were asked for further evaluation. One year later, information on mental health care provision was gathered. RESULTS 130 patients were screened positive for depressive symptoms, and 71 patients were followed-up (follow-up rate: 54.6 %). Psychiatric treatment was recommended for 28.2 % and accepted by 23.9 % of patients. Parameters of disease activity of psoriasis (PASI: 3.1, ∆: -1.7, P = 0.018), quality of life (Dermatology Life Quality Index [DLQI]: 6.5, ∆: -2.8, P = 0.005), and depressive symptoms (BDI-II: 13.2, ∆: -8.3, P < 0.001) improved significantly. Decrease of the BDI-II score was more pronounced in patients with higher PASI decrease. CONCLUSIONS Screening for depressive symptoms led to increased utilization of mental health care and improvement of psoriasis, depressive symptoms, and quality of life. Thus, such screening should be implemented in routine care to optimize patient management.
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Affiliation(s)
- Christian Kromer
- Department of Dermatology, Georg-August-University Göttingen, Göttingen, Germany
| | - Johannes Mohr
- Department of Dermatology, Georg-August-University Göttingen, Göttingen, Germany
| | - Daniel Celis
- Faculty of Economic Sciences, Georg-August-University Göttingen, Göttingen, Germany
| | - Sietske Poortinga
- Department of Dermatology and Allergy, University Bonn, Bonn, Germany
| | - Sascha Gerdes
- Psoriasis-Center, Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Rotraut Mössner
- Department of Dermatology, Georg-August-University Göttingen, Göttingen, Germany
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10
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11
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Schön MP. Psoriasis und nichtalkoholische Fettleber. J Dtsch Dermatol Ges 2021; 19:503-504. [PMID: 33860996 DOI: 10.1111/ddg.14469_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Xie X, Wang Y, Yao S, Xia Y, Luo H, Li L, Lu C. Biologics recommendations for patients with psoriasis: a critical appraisal of clinical practice guidelines for psoriasis. J DERMATOL TREAT 2021; 33:2038-2050. [PMID: 33849360 DOI: 10.1080/09546634.2021.1914306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE This review article serves to assess the consistency of recommendations from guidelines on biologic agents for psoriasis, based on the quality evaluation of psoriasis Clinical Practice Guidelines (CPGs). METHODS We conducted a systematic literature search to identify CPGs that provide recommendations on diagnosis and treatment for psoriasis. Four reviewers performed a quality assessment of the included CPGs with the Appraisal of Guidelines Research and Evaluation II (AGREE II) Instrument. RESULTS A total of 51 sets of CPGs from 22 medical societies or separate working groups fulfilled the inclusion criteria. The overall quality of the eligible sets of guidelines was moderate to high, with an overall average score of 55%The highest domain scores were Score and Purpose (70%) and Clarity of Presentation (68%). A total of 95 biologic agent recommendations were extracted from the 18 recommended CPGs.Three biologic agents (Etanercept, Adalimumab, Ustekinumab) were recommended for pediatric patients. Three biologic agents (Adalimumab, Ustekinumab, Secukinumab) were recommended as first-line biologic agents for adults with psoriasis. CONCLUSION The overall methodological quality of CPGs for psoriasis is medium to high. More attention should be paid to applicability in guideline development. The recommendations and the basis for them among various sets guidelines were almost consistent.
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Affiliation(s)
- Xiuli Xie
- Department of Standardization of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Department of Standardization of Traditional Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China.,Engineering and Technology Research Center of Standardization of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Yangyang Wang
- Department of Standardization of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Department of Standardization of Traditional Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China.,Engineering and Technology Research Center of Standardization of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Sha Yao
- Department of Standardization of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yun Xia
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hao Luo
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lui Li
- Department of Standardization of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Department of Standardization of Traditional Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China.,Engineering and Technology Research Center of Standardization of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Chuanjian Lu
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Dermatology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Dermatology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
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13
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Köster FW, Kohlmann S, Loeper S, Löwe B, Schneider SW. [Screening for mental comorbidities in dermatology : Successful implementation of a screening for mental comorbidities in the field of inpatient dermatological treatment]. Hautarzt 2021; 72:244-248. [PMID: 33180179 PMCID: PMC7935736 DOI: 10.1007/s00105-020-04723-y] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND Anxiety and depression are common in the field of inpatient somatic treatment. Especially in dermatology in which the treatment of chronic diseases is very common and the risk of stigmatization by society is particularly high, mental disorders appear in every third patient. Dermatological diseases and mental disorders often negatively interact with each other leading to increased morbidity. Dermatological guidelines recommend early detection, but this is often not adequately done in practice. MATERIALS AND METHODS We present the implementation of an easy screening for mental comorbidities in the field of inpatient dermatological treatment by using a short questionnaire. This so-called Patient Health Questionnaire‑4 (PHQ-4) consists of four questions regarding anxiety disorders and depression. Upon reaching a certain number of points, a psychosomatic consult is automatically requested. As a result the patient's stress is relieved and the necessary holistic treatment becomes possible. RESULTS In 2019, 83% of inpatients in our clinic were screened using the PHQ‑4; 98 psychosomatic consults were performed. CONCLUSION Our findings so far have shown the benefit of the screening with a minimal investment of time. We recommend its comprehensive use in the field of inpatient dermatological treatment.
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Affiliation(s)
- Felix-Wilhelm Köster
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Sebastian Kohlmann
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Deutschland
| | - Siobhan Loeper
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Deutschland
| | - Bernd Löwe
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Deutschland
| | - Stefan W Schneider
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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14
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Adibi N, Robati RM. Skin and metabolic syndrome: A review of the possible associations. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2021; 26:16. [PMID: 34084195 PMCID: PMC8106409 DOI: 10.4103/jrms.jrms_585_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/14/2020] [Accepted: 08/26/2020] [Indexed: 12/28/2022]
Abstract
Metabolic syndrome (MeTS) is a well-known health-related problem with several end-organ damages and the resulted side effects such as rising in the blood glucose and lipid and blood pressure. Although MeTS might show several skin symptoms such as acanthosis nigricans, skin tags, acne, and androgenic alopecia, it could also be implicated in the pathophysiology of numerous dermatologic disorders. Furthermore, some dermatologic drugs might be implicated in the incidence or exacerbation of MeTS. Consequently, MeTS and skin problem could interfere closely with each other and each one could predispose the patient to the other one and vice versa. Remembering these close relationships help us to have better therapeutic choices regarding each inflammatory skin conditions. Moreover, some of the skin symptoms should be followed cautiously to define the underlying MeTS.
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Affiliation(s)
- Neda Adibi
- Skin Disease and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza M Robati
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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15
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Voigt TP, Bause L, Tsianakas A. Inhalte und Stellenwert der Rehabilitation in der Dermatologie. J Dtsch Dermatol Ges 2021; 19:248-263. [PMID: 33586884 DOI: 10.1111/ddg.14428_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/10/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Tilmann Peter Voigt
- Klinik für Dermatologie und Allergologie, Fachklinik Bad Bentheim, Bad Bentheim
| | - Leonie Bause
- Klinik für Dermatologie und Allergologie, Fachklinik Bad Bentheim, Bad Bentheim
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16
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Voigt TP, Bause L, Tsianakas A. Content and value of rehabilitation in dermatology. J Dtsch Dermatol Ges 2021; 19:248-262. [PMID: 33533573 DOI: 10.1111/ddg.14428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/10/2020] [Indexed: 11/30/2022]
Abstract
The therapy of chronic skin diseases is challenging for both the dermatologist and the patient. Current standards of therapy and individual circumstances of the patient have to be considered. Furthermore, chronic skin diseases are often associated with comorbidities that require treatment adapted to the individual. Therefore, optimal education of the patient and a holistic concept of therapy are needed, in many cases in collaboration with various medical disciplines. In this case, rehabilitation provides an opportunity to address important aspects such as comorbidities, psychosocial burden and limitations at work, in addition to treating the underlying disease. This article describes the differences between acute and rehabilitation health care in dermatology, and illustrates the importance of rehabilitation in dermatology, based on examples of chronic inflammatory skin diseases, chronic pruritus and dermato-oncological diseases.
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Affiliation(s)
- Tilmann Peter Voigt
- Department of Dermatology and Allergology, Specialized Hospital Bad Bentheim, Bad Bentheim, Germany
| | - Leonie Bause
- Department of Dermatology and Allergology, Specialized Hospital Bad Bentheim, Bad Bentheim, Germany
| | - Athanasios Tsianakas
- Department of Dermatology and Allergology, Specialized Hospital Bad Bentheim, Bad Bentheim, Germany
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17
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Aalemi AK, Bahain MB, Hamdard AG. Metabolic Syndrome and Psoriasis: A Case-Control Study in Kabul, Afghanistan. Diabetes Metab Syndr Obes 2021; 14:1465-1471. [PMID: 33833537 PMCID: PMC8019617 DOI: 10.2147/dmso.s305806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/11/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Psoriasis is a chronic inflammatory disease that is not limited to the skin. Recently, numerous studies have shown a positive association between metabolic syndrome and psoriasis. OBJECTIVE The current study aimed to examine the association of metabolic syndrome with psoriasis in an Afghan population. METHODS This was a case- control study including 114 patients with psoriasis and 114 controls aged ≥18 years admitted to the dermatology department of Maiwand Teaching Hospital in Kabul, Afghanistan. Height, weight, blood pressure, and waist circumference were measured in all subjects. Blood glucose, triglyceride, cholesterol, and high-density lipoprotein cholesterol levels were tested following overnight fasting. The modified National Cholesterol Education Program - Adult Treatment Panel III criteria were used for the diagnosis of metabolic syndrome. RESULTS In total, 51.8% of the cases and 44.7% of the controls were male. The average age of participants was 33.4±13.1 years in the case group and 41.1±15.4 years in the control group. The average duration of disease for psoriasis was 4.2 years with 5.6 years SD. The average PASI was 10.8 with 5.1 SD. More than half of the cases (62.3%) had moderate to severe psoriasis and 37.7% had mild psoriasis. The prevalence of metabolic syndrome was higher among patients with psoriasis compared to controls (36.8% vs 21.1%) with OR of 2.18 (p=0.009). In addition, overweight/obesity was more prevalent among cases compared to controls (65.8% vs 41.2%) with OR of 2.74 (p<0.001), whereas the waist circumference was not significantly different between the two groups. Furthermore, the mean levels of total cholesterol, triglyceride, and fasting blood glucose were also higher among patients with psoriasis compared to controls. CONCLUSION The results of the study confirm the association between psoriasis and metabolic syndrome. Hence, screening psoriatic patients for metabolic syndrome should be considered.
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Affiliation(s)
- Ahmad Khalid Aalemi
- Department of Epidemiology, Kabul University of Medical Sciences, Kabul, Afghanistan
- Department of Dermatology, Maiwand Teaching Hospital, Kabul University of Medical Sciences, Kabul, Afghanistan
- Correspondence: Ahmad Khalid Aalemi Department of Epidemiology, Kabul University of Medical Sciences, Kabul, 1001, AfghanistanTel +93747947581 Email
| | - Mohammad Barin Bahain
- Department of Pharmacology, Kabul University of Medical Sciences, Kabul, Afghanistan
| | - Abdul Ghafar Hamdard
- Department of Dermatology, Maiwand Teaching Hospital, Kabul University of Medical Sciences, Kabul, Afghanistan
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Sondermann W, Fiege O, Körber A, Scherbaum N. Psychological burden of psoriatic patients in a German university hospital dermatology department. J Dermatol 2020; 48:794-806. [DOI: 10.1111/1346-8138.15721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/29/2020] [Accepted: 11/16/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Wiebke Sondermann
- Department of Dermatology, Venereology and Allergology University Hospital Essen University of Duisburg‐Essen Essen Germany
| | - Oliver Fiege
- Department of Psychiatry and Psychotherapy Medical Faculty LVR‐Hospital Essen University of Duisburg‐Essen Essen Germany
| | | | - Norbert Scherbaum
- Department of Psychiatry and Psychotherapy Medical Faculty LVR‐Hospital Essen University of Duisburg‐Essen Essen Germany
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Conti A, Giovannini L, Mandel VD, Odorici G, Lasagni C, Bigi L, Pellacani G, Cappelli G. Chronische Nierenerkrankung bei Psoriasis: eine Kohortenstudie. J Dtsch Dermatol Ges 2020; 18:438-446. [DOI: 10.1111/ddg.14087_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/20/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Andrea Conti
- Dermatology Unit Surgical Medical and Dental Department of Morphological Sciences related to Transplant Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - Lisa Giovannini
- Nephrology Unit Surgical Medical and Dental Department of Morphological Sciences related to Transplant Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - Victor Desmond Mandel
- Dermatology Unit Surgical Medical and Dental Department of Morphological Sciences related to Transplant Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
- Dermatology Unit Department of Clinical and Experimental Medicine University of Parma Parma Italy
| | - Giulia Odorici
- Dermatology Unit Surgical Medical and Dental Department of Morphological Sciences related to Transplant Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - Claudia Lasagni
- Dermatology Unit Surgical Medical and Dental Department of Morphological Sciences related to Transplant Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - Laura Bigi
- Dermatology Unit Surgical Medical and Dental Department of Morphological Sciences related to Transplant Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - Giovanni Pellacani
- Dermatology Unit Surgical Medical and Dental Department of Morphological Sciences related to Transplant Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - Gianni Cappelli
- Nephrology Unit Surgical Medical and Dental Department of Morphological Sciences related to Transplant Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
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Conti A, Giovannini L, Mandel VD, Odorici G, Lasagni C, Bigi L, Pellacani G, Cappelli G. Chronic kidney disease in psoriasis: a cohort study. J Dtsch Dermatol Ges 2020; 18:438-445. [DOI: 10.1111/ddg.14087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/20/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Andrea Conti
- Dermatology Unit Surgical Medical and Dental Department of Morphological Sciences related to Transplant Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - Lisa Giovannini
- Nephrology Unit Surgical Medical and Dental Department of Morphological Sciences related to Transplant Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - Victor Desmond Mandel
- Dermatology Unit Surgical Medical and Dental Department of Morphological Sciences related to Transplant Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
- Dermatology Unit Department of Clinical and Experimental Medicine University of Parma Parma Italy
| | - Giulia Odorici
- Dermatology Unit Surgical Medical and Dental Department of Morphological Sciences related to Transplant Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - Claudia Lasagni
- Dermatology Unit Surgical Medical and Dental Department of Morphological Sciences related to Transplant Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - Laura Bigi
- Dermatology Unit Surgical Medical and Dental Department of Morphological Sciences related to Transplant Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - Giovanni Pellacani
- Dermatology Unit Surgical Medical and Dental Department of Morphological Sciences related to Transplant Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - Gianni Cappelli
- Nephrology Unit Surgical Medical and Dental Department of Morphological Sciences related to Transplant Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
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21
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Grine L, de la Brassinne M, Ghislain P, Hillary T, Lambert J, Segaert S, Willaert F, Lambert J. A Belgian consensus on the definition of a treat-to-target outcome set in psoriasis management. J Eur Acad Dermatol Venereol 2020; 34:676-684. [PMID: 31749264 PMCID: PMC7154521 DOI: 10.1111/jdv.16104] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/31/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Treat-to-target (T2T) is an algorithm to reach a predefined outcome. Here, we define a T2T outcome for moderate-to-severe psoriasis vulgaris. METHODS Briefly, the study included a literature review, discussions with key opinion leaders, recruitment of additional dermatologists with experience in managing moderate-to-severe psoriasis, 3 eDelphi survey rounds and a patient focus group. Relevant topics were selected during discussions prior to the survey for the statements. Surveys were based on the eDelphi methodology for consensus-building using a series of statements. Consensus was defined as at least 80% of participants agreeing. A psoriasis patient focus group provided feedback on topic selection and outcome. RESULTS A total of 5 discussions were held, and 3 eDelphi rounds were conducted with an average of 19 participants per round. The T2T outcome was set assuming shared decision between patient and dermatologist, awareness and referral for comorbidities by the dermatologist and appropriate treatment adherence by the patient. We defined 'ideal' and 'acceptable' targets; the latter referring to conditions restricting certain drugs. The T2T outcome was multidimensional, including ≥ ΔPASI90/75 or PGA ≤ 1, itch VAS score ≤ 1, absence of disturbing lesions, DLQI ≤ 1/3, incapacity daily functioning VAS score ≤ 1, safety ≤ mild side-effects and full/mild tolerability of treatment for the ideal and acceptable target, respectively. Finally, time to achieve the T2T outcome was set at 12 weeks after initiation for all treatments. At all times, safety should not exceed the presence of mild side-effects. CONCLUSION With this novel T2T composite outcome for psoriasis, clinicians and patients can make shared decisions on the treatment goals they envisage, as a guidance for future treatment steps - leading to a tight control management of the disease.
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Affiliation(s)
- L. Grine
- DermatologyGhent University HospitalGhentBelgium
- Head & SkinGhent UniversityGhentBelgium
| | | | - P.‐D. Ghislain
- DermatologyCliniques Saint‐LucUniversité Catholique de LouvainBrusselsBelgium
| | - T. Hillary
- DermatologyUniversity Hospital LeuvenLeuvenBelgium
| | - J. Lambert
- DermatologyUniversity Hospital of AntwerpAntwerpBelgium
| | | | - F. Willaert
- DermatologyErasme HospitalUniversité Libre de BruxellesBrusselsBelgium
| | | | - J. Lambert
- DermatologyGhent University HospitalGhentBelgium
- Head & SkinGhent UniversityGhentBelgium
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Abstract
Piplartine is an alkamide found in different Piper species and possesses several biological activities, including antiparasitic properties. Thus, the aim of the present study was to evaluate a series of 32 synthetic piplartine analogues against the Leishmania amazonensis promastigote forms and establish the structure-activity relationship and 3D-QSAR of these compounds. The antileishmanial effect of the compounds was determined using the MTT method. Most compounds were found to be active against L. amazonensis. Among 32 assayed derivatives, compound (E)-(−)-bornyl 3-(3,4,5-trimethoxyphenyl)-acrylate exhibited the most potent antileishmanial activity (IC50 = 0.007 ± 0.008 μM, SI > 10), followed by benzyl 3,4,5-trimethoxybenzoate (IC50 = 0.025 ± 0.009 μM, SI > 3.205) and (E)-furfuryl 3-(3,4,5-trimethoxyphenyl)-acrylate (IC50 = 0.029 ± 0.007 μM, SI > 2.688). It was found that the rigid substituents contribute to increasing antiparasitic activity against L. amazonensis promastigotes. The presence of the unsaturated heterocyclic substituent in the phenylpropanoid chemical structure (furfuryl group) resulted in a bioactive derivative. Molecular simplification of benzyl 3,4,5-trimethoxybenzoate by omitting the spacer group contributed to the bioactivity of this compound. Furthermore, bornyl radical appears to be important for antileishmanial activity, since (E)-(−)-bornyl 3-(3,4,5-trimethoxyphenyl)-acrylate exhibited the most potent antileishmanial activity. These results show that some derivatives studied would be useful as prototype molecules for the planning of new derivatives with profile of antileishmanial drugs.
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Polic MV, Miskulin M, Smolic M, Kralik K, Miskulin I, Berkovic MC, Curcic IB. Psoriasis Severity-A Risk Factor of Insulin Resistance Independent of Metabolic Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071486. [PMID: 30011841 PMCID: PMC6069377 DOI: 10.3390/ijerph15071486] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 07/04/2018] [Accepted: 07/11/2018] [Indexed: 01/14/2023]
Abstract
Background: It is still debatable whether psoriasis increases cardiovascular risk indirectly since it is associated with metabolic syndrome or is an independent cardiovascular risk factor. The aim of this study was to evaluate psoriasis severity as an independent predictor of insulin resistance (IR) irrespective of the presence of metabolic syndrome (MetS). Methods: This was a case control study including 128 patients stratified into two groups: patients with psoriasis and metabolic syndrome vs. patients with psoriasis and no metabolic syndrome. MetS was diagnosed according to ATP III criteria with homeostatic model assessment of insulin resistance (HOMA-IR), as well as a homeostatic model assessment of beta cell function (HOMA-β) were calculated. Results: Compared to subjects without metabolic syndrome, patients with metabolic syndrome had a significantly higher Psoriasis Area Severity Index (PASI) values (p < 0.001). The strongest correlation was established for HOMA-IR and the PASI index (p < 0.001), even after adjustment for body mass index (BMI) in regression analysis model. In patients without MetS and severe forms of disease, the HOMA-IR and HOMA-β values were significantly higher compared to mild forms of disease (p < 0.001 for all) while in subjects with MetS no difference was established for HOMA-IR or HOMA-β based on disease severity. Conclusions: Psoriasis severity is an independent risk factor of HOMA-IR, the strongest association being present in the non-MetS group, who still had preserved beta cell function suggesting direct promotion of atherosclerosis via insulin resistance depending on the disease severity, but irrespective of the presence of metabolic syndrome.
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Affiliation(s)
- Melita Vuksic Polic
- Department of Dermatology, University Hospital Center Osijek, 31000 Osijek, Croatia.
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia.
| | - Maja Miskulin
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia.
| | - Martina Smolic
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia.
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Crkvena 21, 31000 Osijek, Croatia.
| | - Kristina Kralik
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia.
| | - Ivan Miskulin
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia.
| | - Maja Cigrovski Berkovic
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia.
| | - Ines Bilic Curcic
- Department of Dermatology, University Hospital Center Osijek, 31000 Osijek, Croatia.
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia.
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Boehncke WH. Systemic Inflammation and Cardiovascular Comorbidity in Psoriasis Patients: Causes and Consequences. Front Immunol 2018; 9:579. [PMID: 29675020 PMCID: PMC5895645 DOI: 10.3389/fimmu.2018.00579] [Citation(s) in RCA: 179] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 03/07/2018] [Indexed: 11/26/2022] Open
Abstract
Psoriasis is a common inflammatory skin disease characterized by the appearance of red scaly plaques that can affect any part of the body. High prevalence, chronicity, disfiguration, disability, and associated comorbidity make it a challenge for clinicians of multiple specialties. Likewise, its complex pathogenesis, comprising inflammation, hyperproliferation, and angioneogenesis, intrigues numerous scientific disciplines, namely, immunology. From a clinical perspective, the severity of psoriasis is highlighted by its increased mortality, with cardiovascular diseases contributing the highest excess risk. From a scientific point of view, psoriasis has to be considered a systemic inflammatory condition, as blood biomarkers of inflammation are elevated and imaging techniques document sites of inflammation beyond the skin. While the association of psoriasis with cardiovascular diseases is now widely accepted, causes and consequences of this association are controversially discussed. This review comments on epidemiologic, genetic, and mechanistic studies that analyzed the relation between psoriasis and cardiovascular comorbidity. The hypothesis of psoriasis potentially being an independent cardiovascular risk factor, driving atherosclerosis via inflammation-induced endothelial dysfunction, will be discussed. Finally, consequences for the management of psoriasis with the objective to reduce the patients’ excess cardiovascular risk will be pointed out.
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Affiliation(s)
- Wolf-Henning Boehncke
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland
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Rizzello F, Olivieri I, Armuzzi A, Ayala F, Bettoli V, Bianchi L, Cimino L, Costanzo A, Cristaudo A, D'Angelo S, Daperno M, Fostini AC, Galeazzi M, Gilio M, Gionchetti P, Gisondi P, Lubrano E, Marchesoni A, Offidani A, Orlando A, Pugliese D, Salvarani C, Scarpa R, Vecchi M, Girolomoni G. Multidisciplinary Management of Spondyloarthritis-Related Immune-Mediated Inflammatory Disease. Adv Ther 2018. [PMID: 29516409 PMCID: PMC5910456 DOI: 10.1007/s12325-018-0672-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction Immune-mediated inflammatory diseases (IMIDs) are chronic autoimmune conditions that share common pathophysiologic mechanisms. The optimal management of patients with IMIDs remains challenging because the coexistence of different conditions requires the intervention of several specialists. The aim of this study was to develop a series of statements defining overarching principles that guide the implementation of a multidisciplinary approach for the management of spondyloarthritis (SpA)-related IMIDs including SpA, psoriasis, psoriatic arthritis, Crohn’s disease, ulcerative colitis and uveitis. Methods A Delphi consensus-based approach was used to identify a core set of statements. The process included development of initial questions by a steering committee, an exhaustive search of the literature using complementary approaches to identify potential statements and two Delphi voting rounds for finalization of the statements. Results Consensus was achieved on the related nature of IMIDs, the existence of a high prevalence of multiple IMIDs in a single patient and the fact that a multidisciplinary approach can result in a more extensive evaluation and comprehensive approach to treatment. The goals of a multidisciplinary team should be to increase diagnosis of concomitant IMIDs, improve the decision-making process, and increase patient satisfaction and adherence. Early referral and diagnosis, early recognition of concomitant IMIDs and optimizing treatment to improve patient quality of life are some of the advantages of using multidisciplinary teams. To be effective, a multidisciplinary team should be equipped with the appropriate tools for diagnosis and follow-up, and at a minimum the multidisciplinary team should include a dermatologist, gastroenterologist and rheumatologist; providing psychologic support via a psychologist and involving an ophthalmologist, general practitioners and nurses in multidisciplinary care is also important. Conclusion The present Delphi consensus identified a set of overarching principles that may be useful for implementation of a multidisciplinary approach for the management of SpA-related IMIDs. Funding Aristea and Hippocrates.
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Affiliation(s)
- Fernando Rizzello
- IBD Unit, DIMEC, University of Bologna, S Orsola-Malpighi Hospital Bologna, Bologna, Italy
| | - Ignazio Olivieri
- Istituto Reumatologico Lucano (IReL), Potenza, Italy
- Dipartimento di Reumatologia della Regione Basilicata, Ospedale Madonna delle Grazie di Matera, Potenza, Italy
- Dipartimento di Reumatologia della Regione Basilicata, Ospedale San Carlo di Potenza, Potenza, Italy
- Fondazione BRB (Basilicata Ricerca Biomedica), Potenza, Italy
| | - Alessandro Armuzzi
- UOC di Medicina Interna e Malattie dell'Apparato Digerente, Presidio Columbus Fondazione Policlinico Gemelli Universita' Cattolica, Rome, Italy
| | - Fabio Ayala
- UOC di Dermatologia, Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Vincenzo Bettoli
- Department of Clinical and Experimental Dermatology, O.U. of Dermatology, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Luca Bianchi
- U.O.C. Dermatologia, Fondazione Policlinico Tor Vergata, Tor Vergata University of Rome, Rome, Italy
| | - Luca Cimino
- SSD di Immunologia Oculare, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Costanzo
- Unità Dermatologia Dipartimento di Scienze Biomediche Humanitas University, Rozzano, Milan, Italy
- UOC Dermatologia IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - Antonio Cristaudo
- UO Dermatologia, MST, Ambientale e Tropicale San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Salvatore D'Angelo
- Istituto Reumatologico Lucano (IReL), Potenza, Italy.
- Dipartimento di Reumatologia della Regione Basilicata, Ospedale Madonna delle Grazie di Matera, Potenza, Italy.
- Dipartimento di Reumatologia della Regione Basilicata, Ospedale San Carlo di Potenza, Potenza, Italy.
- Fondazione BRB (Basilicata Ricerca Biomedica), Potenza, Italy.
| | - Marco Daperno
- Gastroenterology Unit, Mauriziano Hospital, Turin, Italy
| | - Anna Chiara Fostini
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Mauro Galeazzi
- Dipartimento di Scienze Mediche, Chirurgiche e Neuroscienze, Università degli Studi di Siena, Siena, Italy
| | - Michele Gilio
- Istituto Reumatologico Lucano (IReL), Potenza, Italy
- Dipartimento di Reumatologia della Regione Basilicata, Ospedale Madonna delle Grazie di Matera, Potenza, Italy
- Dipartimento di Reumatologia della Regione Basilicata, Ospedale San Carlo di Potenza, Potenza, Italy
- Department of Health Science, University "Magna Grecia", Catanzaro, Italy
| | - Paolo Gionchetti
- IBD Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Ennio Lubrano
- Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy
| | - Antonio Marchesoni
- U.O.C. Day Hospital di Reumatologia, ASST Gaetano Pini-CTO, Milan, Italy
| | | | - Ambrogio Orlando
- UOSD MICI-A.O. Ospedali Riuniti "Villa Sofia-Cervello" Palermo, Palermo, Italy
| | - Daniela Pugliese
- UOC di Medicina Interna e Malattie dell'Apparato Digerente, Presidio Columbus Fondazione Policlinico Gemelli Universita' Cattolica, Rome, Italy
| | - Carlo Salvarani
- Azienda USL-IRCCS e Università di Modena e Reggio Emilia, Reggio Emilia, Italy
| | | | - Maurizio Vecchi
- Department of Biomedical Science for the Health, University of Milan, Milan, Italy
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
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Stefanadi EC, Dimitrakakis G, Antoniou CK, Challoumas D, Punjabi N, Dimitrakaki IA, Punjabi S, Stefanadis CI. Metabolic syndrome and the skin: a more than superficial association. Reviewing the association between skin diseases and metabolic syndrome and a clinical decision algorithm for high risk patients. Diabetol Metab Syndr 2018; 10:9. [PMID: 29483947 PMCID: PMC5822485 DOI: 10.1186/s13098-018-0311-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 02/12/2018] [Indexed: 02/08/2023] Open
Abstract
There is ongoing scientific interest regarding comorbidities associated with the metabolic syndrome (MeTS). MeTS comprises a combination of parameters that predispose individuals to the development of type 2 diabetes and cardiovascular disease (CVD). Three or more of the following criteria are necessary: fasting glucose > 110 mg/dl (5.6 mmol/l), hypertriglyceridemia > 150 mg/dl (1.7 mmol/l), HDL levels < 40 mg/dl (men)/< 50 mg/dl (women), blood pressure > 130/85 mmHg, waist circumference (values for Mediterranean populations > 94 cm (men)/> 89 cm (women). In this review we attempted to summarize relevant data by searching dermatological literature regarding associations between various skin conditions and MeTS. A multitude of studies was retrieved and a further goal of the present article is to present plausible mechanistic connections. The severity of skin conditions like psoriasis has been linked with MeTS. Parameters of MeTS like insulin resistance are present in patients with early onset androgenic alopecia, hidradenitis suppurativa acne and rosacea. Since MeTS can lead to CVD and type 2 diabetes early detection of patients would be very important. Also therapeutic intervention on MeTS could lead to improvement on the severity of skin conditions. This reciprocal relationship between skin diseases and MeTS in our opinion holds great interest for further investigation.
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Affiliation(s)
- Ellie C. Stefanadi
- Dermatology Department, Athens Medical Centre, Athens, Greece
- National and Kapodistrian University of Athens and Athens Medical Center, Papadiamantopoulou 20, Ilisia, Athens, Greece
| | | | | | | | | | | | - Sangeeta Punjabi
- Dermatology Department, Northwick Park and Middlesex Hospitals, London, UK
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Evaluation of abdominal fat index by ultrasonography and its relationship with psoriasis and metabolic syndrome. Postepy Dermatol Alergol 2017; 34:453-456. [PMID: 29507560 PMCID: PMC5831280 DOI: 10.5114/ada.2017.71111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/22/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction Accumulating evidence indicates that psoriasis is associated with obesity and metabolic syndrome. Psoriasis and obesity share similar inflammatory mediators, and obesity may potentiate some inflammatory cytokines seen in psoriasis. Body fat distribution, particularly visceral adipose tissue (VAT), is an important factor in metabolic syndrome and atherosclerotic diseases. An association has been demonstrated between psoriasis and abdominal VAT measured by computed tomography (CT). Aim To measure abdominal VAT noninvasively by ultrasonography (USG) in patients with psoriasis and investigated its relation to psoriasis and metabolic syndrome. Material and methods The study population consisted of 41 psoriasis patients and 41 control subjects matched for age, sex, and body mass index. The maximal preperitoneal fat thickness (Pmax) at the anterior surface of the liver and the minimal subcutaneous fat thickness (Smin) of the abdomen were measured by USG. The abdominal fat index (AFI = Pmax/Smin ratio) was calculated and the results were compared between groups. Results The rate of metabolic syndrome was significantly higher in psoriasis patients (p = 0.0018). The mean AFI was similar in both groups. AFI was not associated with psoriasis in subjects with metabolic syndrome (p = 0.495) or with Psoriasis Area and Severity Index (r = 0.123, p = 0.443). Conclusions This is the first study to evaluate abdominal VAT by USG. Computed tomography may be more reliable than USG, but its high cost and radiation exposure are major disadvantages. Further studies are required to determine the relationships between psoriasis and VAT.
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Osier E, Wang AS, Tollefson MM, Cordoro KM, Daniels SR, Eichenfield A, Gelfand JM, Gottlieb AB, Kimball AB, Lebwohl M, Mehta NN, Paller AS, Schwimmer JB, Styne DM, Van Voorhees AS, Tom WL, Eichenfield LF. Pediatric Psoriasis Comorbidity Screening Guidelines. JAMA Dermatol 2017; 153:698-704. [PMID: 28514463 PMCID: PMC5748031 DOI: 10.1001/jamadermatol.2017.0499] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance Psoriasis is a complex inflammatory skin condition associated with serious medical comorbidities in adults, including obesity, hypertension, dyslipidemia, type 2 diabetes mellitus, psoriatic arthritis, nonalcoholic fatty liver disease, depression, anxiety, and decreased quality of life. Because psoriasis begins in childhood in almost one-third of patients, early identification of risk may be critical to minimizing effects on future health. Objective To develop the first set of guidelines for comorbidity screening for patients with pediatric psoriasis based on current evidence. Evidence Review A literature review was performed using PubMed from January 1999 through December 2015. Limiting the search to human studies published in English and removing reviews and editorials produced 153 relevant manuscripts. An expert panel in psoriasis, pediatric dermatology, pediatric rheumatology, pediatric gastroenterology, pediatric endocrinology, and adult and pediatric cardiology used the patient-centered Strength of Recommendation Taxonomy (SORT) method to evaluate and grade the quality of evidence. Findings Because of the limited number of pediatric studies published on these topics, the strength of the panel's recommendations is classified as SORT level C expert consensus recommendations. The majority of recommendations coincide with those endorsed by the American Academy of Pediatrics for the general pediatric patient but with added attention to signs and symptoms of arthritis, depression, and anxiety. The panel also identified key areas for further investigation. Conclusions and Relevance Patients with pediatric psoriasis should receive routine screening and identification of risk factors for associated comorbidities. These guidelines are relevant for all health care providers caring for patients with pediatric psoriasis, including primary care clinicians, dermatologists, and pediatric specialists. Because these are the first pediatric guidelines, re-review and refinement will be necessary as studies further detail, and possibly stratify, risk in affected children.
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Affiliation(s)
- Emily Osier
- Department of Dermatology, Eastern Virginia Medical School, Norfolk
| | - Audrey S Wang
- Division of Dermatology, Sharp Rees-Stealy Medical Group, San Diego, California
| | - Megha M Tollefson
- Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota
| | - Kelly M Cordoro
- Division of Pediatric Dermatology, Department of Dermatology, University of California San Francisco, San Francisco
| | - Stephen R Daniels
- Section of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Andrew Eichenfield
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, College of Physicians and Surgeons of Columbia University, New York, New York
| | - Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Alexa B Kimball
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Mark Lebwohl
- Department of Dermatology, Mount Sinai Medical Center, New York, New York
| | - Nehal N Mehta
- Division of Intramural Research, Section of Inflammation and Cardiometabolic Diseases, National Institutes of Health/National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeffrey B Schwimmer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Rady Children's Hospital San Diego, University of California San Diego School of Medicine, San Diego
| | - Dennis M Styne
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | | | - Wynnis L Tom
- Departments of Dermatology and Pediatrics, Rady Children's Hospital San Diego and University of California, San Diego School of Medicine, San Diego
| | - Lawrence F Eichenfield
- Departments of Dermatology and Pediatrics, Rady Children's Hospital San Diego and University of California, San Diego School of Medicine, San Diego
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Augustin M, Eissing L, Langenbruch A, Enk A, Luger T, Maaßen D, Mrowietz U, Reich K, Reusch M, Strömer K, Thaçi D, von Kiedrowski R, Radtke MA. The German National Program on Psoriasis Health Care 2005-2015: results and experiences. Arch Dermatol Res 2016; 308:389-400. [PMID: 27048503 PMCID: PMC4940437 DOI: 10.1007/s00403-016-1637-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/03/2016] [Accepted: 02/24/2016] [Indexed: 02/08/2023]
Abstract
In 2005, the first national psoriasis survey in Germany revealed large deficits in health care particularly in patients with moderate to severe disease. The consecutive goal was to improve health care for psoriasis countrywide. For this, a large-scale national program was initiated starting with a comprehensive analysis of structures and processes of care for psoriasis. Patient burden, economic impact and barriers to care were systematically analyzed. In order to optimize routine care, a S3 guideline, a set of outcomes measures and treatment goals, were developed. Implementation was enforced by the German Psoriasis Networks (PsoNet) connecting the most dedicated dermatologists. The annual National Conference on Health Care in Psoriasis established in 2009 consented National Health Care Goals in Psoriasis 2010-2015 and defined a set of quality indicators, which are monitored on a regular basis. Currently 28 regional networks including more than 800 dermatologists are active. Between 2005 and 2014 7 out of 8 quality indicators have markedly improved, and regional disparities were resolved. e.g., mean PASI (Psoriasis Area Severity Index) dropped from 11.4 to 8.1 and DLQI (Dermatology Life Quality Index) from 8.6 to 5.9. A decade of experience indicates that a coordinated nationwide psoriasis program based on goal orientation can contribute to better quality of care and optimized outcomes.
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Affiliation(s)
- M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany.
| | - L Eissing
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - A Langenbruch
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - A Enk
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany
| | - T Luger
- Department of Dermatology, University Hospital Muenster (UKM), Münster, Germany
| | - D Maaßen
- Dermatological Practice Maxdorf, Maxdorf, Germany
| | - U Mrowietz
- Department for Dermatology, Venereology and Allergology, University Hospital Kiel, Kiel, Germany
| | - K Reich
- Dermatological Practice Dermatologikum Hamburg, Hamburg, Germany
| | - M Reusch
- Dermatological Practice Tibarg, Hamburg, Germany
| | - K Strömer
- Dermatological Practice Mönchengladbach, Mönchengladbach, Germany
| | - D Thaçi
- Department for Dermatology, Allergology and Venereology, University of Lübeck, Lübeck, Germany
| | | | - M A Radtke
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
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Roman II, Constantin AM, Marina ME, Orasan RI. The role of hormones in the pathogenesis of psoriasis vulgaris. ACTA ACUST UNITED AC 2016; 89:11-8. [PMID: 27004020 PMCID: PMC4777452 DOI: 10.15386/cjmed-505] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 07/30/2015] [Accepted: 08/07/2015] [Indexed: 12/22/2022]
Abstract
Psoriasis vulgaris is a chronic, common skin disease, which affects the patient’s quality of life to the highest degree. Several exogenous factors and endogenous hormonal changes may act as triggers for psoriasis. The skin possesses a true endocrine system, which is very important in multiple systemic diseases. A number of conditions are associated with psoriasis, and its severity can also be influenced by hormones. Even though the sex hormones and prolactin have a major role in psoriasis pathogenicity, there are a lot of other hormones which can influence the psoriasis clinical manifestations: glucocorticoids, epinephrine, thyroid hormones, and insulin.
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Affiliation(s)
- Iulia Ioana Roman
- Department of Physiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anne-Marie Constantin
- Department of Histology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihaela Elena Marina
- Department of Histology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Remus Ioan Orasan
- Department of Physiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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