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Wang B, Wang Z, Yang W, Han L, Huang Q, Yawalkar N, Zhang Z, Yao Y, Yan K. Unlocking the role of the B7-H4 polymorphism in psoriasis: Insights into methotrexate treatment outcomes: A prospective cohort study. Immunology 2024; 171:104-116. [PMID: 37814391 DOI: 10.1111/imm.13704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023] Open
Abstract
B7-H4 is a recently discovered member of B7 family that negatively regulates T-cell immunity, specifically Th1 and Th17 cell responses. However, its role in the pathogenesis of psoriasis has yet to be determined. This study aims to investigate the effect of B7-H4 polymorphism on the efficacy of methotrexate (MTX) and its mechanism in psoriasis. Four single nucleotide polymorphisms of B7-H4 were genotyped in 310 psoriatic patients who received 12-week MTX. The protein expression of B7-H4 in platelets was characterized using immunofluorescence staining, confocal laser scanning microscopy, and flow cytometry techniques. We found that GG genotype carriers of B7-H4 rs1935780 had a lower Psoriasis Area and Severity Index (PASI) 75 response rate and higher weight (p = 0.0245) and body mass index (p = 0.0185) than AA and AG genotype carriers. Multiple regression analysis showed that the PASI score at baseline (p = 0.01) and age at disease onset (p = 0.003) were positively correlated with PASI 75 response rate, while weight (p = 0.005) and the rs1935780 genotype (p = 0.003) were negatively associated with PASI 75 response rate. B7-H4 was expressed in the platelet plasma membrane and cytoplasm. Furthermore, the expression of B7-H4 protein in platelets was lower in good responders than in non-responders and was upregulated considerably after 12-week MTX or in vitro MTX stimulation in good responders. Collectively, these results demonstrate that psoriatic patients with GG genotype of B7-H4 rs1935780 had a poorer response to MTX. Low expression of B7-H4 protein in platelets correlated with better clinical outcomes of MTX in psoriasis.
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Affiliation(s)
- Bing Wang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai Institute of Dermatology, Shanghai, China
| | - Zhicheng Wang
- Department of Transfusion Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenjing Yang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai Institute of Dermatology, Shanghai, China
| | - Ling Han
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai Institute of Dermatology, Shanghai, China
| | - Qiong Huang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai Institute of Dermatology, Shanghai, China
| | - Nikhil Yawalkar
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Zhenghua Zhang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai Institute of Dermatology, Shanghai, China
| | - Yu Yao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Kexiang Yan
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai Institute of Dermatology, Shanghai, China
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2
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Leung AKC, Barankin B, Lam JM, Leong KF. Childhood guttate psoriasis: an updated review. Drugs Context 2023; 12:2023-8-2. [PMID: 37908643 PMCID: PMC10615329 DOI: 10.7573/dic.2023-8-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 09/25/2023] [Indexed: 11/02/2023] Open
Abstract
Background Guttate psoriasis is common and affects 0.5-2% of individuals in the paediatric age group. This review aims to familiarize physicians with the clinical manifestations, evaluation, diagnosis and proper management of guttate psoriasis. Methods A search was conducted in July 2023 in PubMed Clinical Queries using the key term "guttate psoriasis". The search strategy included all observational studies, clinical trials and reviews published within the past 10 years. The information retrieved from the search was used in the compilation of the present article. Results Guttate psoriasis typically presents with an abrupt onset of numerous, small, scattered, tear-drop-shaped, scaly, erythematous, pruritic papules and plaques. Sites of predilection include the trunk and proximal extremities. There may be a history of preceding streptococcal infection. Koebner phenomenon is characteristic. Guttate psoriasis may spontaneously remit within 3-4 months with no residual scarring, may intermittently recur and, in 40-50% of cases, may persist and progress to chronic plaque psoriasis. Given the possibility for spontaneous remission within several months, active treatment may not be necessary except for cosmetic purposes or because of pruritus. On the other hand, given the high rates of persistence of guttate psoriasis and progression to chronic plaque psoriasis, some authors suggest active treatment of this condition. Conclusion Various treatment options are available for guttate psoriasis. Triggering and exacerbating factors should be avoided if possible. Topical corticosteroids alone or in combination with other topical agents (e.g. tazarotene and vitamin D analogues) are the most rapid and efficient treatment for guttate psoriasis and are therefore the first-line treatment for mild cases. Other topical therapies include vitamin D analogues, calcineurin inhibitors, anthralin, coal tar and tazarotene. Ultraviolet phototherapy is the first-line therapy for moderate-to-severe guttate psoriasis, as it is more practical than topical therapy when treating widespread or numerous small lesions. Systemic immunosuppressive and immunomodulatory therapies (e.g. methotrexate, cyclosporine, retinoids, fumaric acid esters and biologics) may be considered for patients with moderate-to-severe guttate psoriasis who fail to respond to phototherapy and topical therapies.
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Affiliation(s)
- Alexander KC Leung
- Department of Pediatrics, The University of Calgary, Calgary, Alberta, Canada
- The Alberta Children’s Hospital, Calgary, Alberta, Canada
| | | | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
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Chen C, Che K, Guo Y, Huang Q, Hu X, Yu B. Effect of the age of onset on epidemiology, clinical features, and comorbidity of geriatric psoriasis. J Dermatol 2023; 50:1156-1161. [PMID: 37350010 DOI: 10.1111/1346-8138.16856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/08/2023] [Accepted: 05/22/2023] [Indexed: 06/24/2023]
Abstract
Psoriasis is an immune-mediated chronic, relapsing, inflammatory, systemic disease induced by a combination of genetics and environment. Currently, there are limited reports on the epidemiological and clinical characteristics of geriatric psoriatic patients in mainland China. This study analyzed the epidemiological characteristics, clinical features, and comorbidity rates of geriatric patients with psoriasis and evaluated the influence of age of onset on disease characteristics. This retrospective study enrolled 1259 geriatric patients with psoriasis in hospitals affiliated with the National Standardized Psoriasis Diagnosis and Treatment Center in China from September 2011 to July 2020 to analyze the epidemiological characteristics, clinical features, and prevalence of comorbidity in geriatric psoriasis. The cases were classified according to the age of onset into two groups to compare differences: early-onset psoriasis (EOP) and late-onset psoriasis (LOP). The mean age of geriatric patients with psoriasis was 67, with a 1.8:1 male-to-female ratio and 10.7% positive family history. The clinical manifestations of plaque psoriasis accounted for a high proportion (82.0%) and 85.1% of patients had moderate to severe disease. Overweight (27.8%), hypertension (18.0%), joint involvement (15.8%), diabetes (13.7%), and coronary heart disease (4.0%) were the first five common comorbidities. The LOP group had significantly more patients (79.9%) than the EOP group (20.1%). Positive family history was significantly associated with the EOP group (21.7%) than the LOP group (7.9%). The scalp (60.2%) was the most affected area, followed by the nails (25.3%), palmoplantar region (25.0%), and genitals (12.7%). This study analyzed the epidemiological and clinical characteristics of geriatric psoriasis in China and found that age of onset had no effect on disease characteristics or other comorbidities, except for toenail involvement, diabetes, and joint damage.
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Affiliation(s)
- Chaofeng Chen
- Peking University Shenzhen Hospital, Shenzhen, China
| | - Keying Che
- Peking University Shenzhen Hospital, Shenzhen, China
| | - Yang Guo
- Peking University Shenzhen Hospital, Shenzhen, China
| | - Qiufeng Huang
- Peking University Shenzhen Hospital, Shenzhen, China
| | - Xiaoping Hu
- Peking University Shenzhen Hospital, Shenzhen, China
| | - Bo Yu
- Peking University Shenzhen Hospital, Shenzhen, China
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Erazo Luna EV, Echavarría Sierra CJ, Cornejo-Sánchez DM, Sanclemente G, Pineda Trujillo NG. Protective association exhibited by a single nucleotide polymorphism of the IFIH1 gene in patients with psoriasis: A case-control study. Medwave 2021; 21:e8492. [PMID: 34882124 DOI: 10.5867/medwave.2021.11.002099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 08/31/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction Psoriasis is a chronic inflammatory dermatosis, a with variable clinical presentation and whose multifactorial etiology carries an essential genetic component. Multiple genetic variations associated with psoriasis have been described around the world. However, these variants are unknown among the Colombian population. This study aimed to evaluate the single nucleotide polymorphism rs10930046 (His460Arg) in the IFIH1 gene and its ssociation with the development of psoriasis in a Colombian population. Methods An observational, unmatched, case-control study was performed, including 51 patients with psoriasis and 151 population controls, all with self-reported Paisa ancestry (from the Antioquia region). All individuals were genotyped for the single nucleotide polymorphism rs10930046 (His460Arg) in the IFIH1 gene, and its association with psoriasis was pursued. Both groups were demographically characterized, and cases were also assessed for clinical variables. Results Through the allelic association analysis, cases were found to have a lower frequency of the single nucleotide polymorphism rs10930046 (His460Arg) in the IFIH1 gene than controls; 5% versus 22.67%, respectively. There were no significant differences in age or sex. We also found that psoriasis vulgaris was the most common variant (78%), that about half of the cases had nail psoriasis (56%), 19.6% had psoriatic arthritis, and that 45% had some comorbidity. Conclusions The results obtained from this study confirm that carriers of the single nucleotide polymorphism rs10930046 (His460Arg) in the IFIH1 gene have a decreased risk of developing psoriasis.
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Affiliation(s)
- Evelyn Vanesa Erazo Luna
- Grupo de Investigación Dermatológica (GRID), Instituto de Investigaciones Médicas, Universidad de Antioquia, Medellín, Colombia; Grupo de Mapeo Genético, Instituto de Investigaciones Médicas, Universidad de Antioquia, Medellín, Colombia. ORCID: 0000-0002-6116-3191
| | - Claudia Janeth Echavarría Sierra
- Grupo de Investigación Dermatológica (GRID), Instituto de Investigaciones Médicas, Universidad de Antioquia, Medellín, Colombia; Grupo de Mapeo Genético, Instituto de Investigaciones Médicas, Universidad de Antioquia, Medellín, Colombia. ORCID: 0000-0003-0373-2031
| | - Diana M Cornejo-Sánchez
- Grupo de Mapeo Genético, Instituto de Investigaciones Médicas, Universidad de Antioquia, Medellín, Colombia. ORCID: 0000-0002-2667-7592
| | - Gloria Sanclemente
- Grupo de Investigación Dermatológica (GRID), Instituto de Investigaciones Médicas, Universidad de Antioquia, Medellín, Colombia. Address: Carrera 25 A # 1 A Sur 45, Of 2026, Torre Médica El Tesoro, Medellín, Colombia. EMail: ; . ORCID: 0000-0002-1555-2751
| | - Nicolás Guillermo Pineda Trujillo
- Grupo de Mapeo Genético, Instituto de Investigaciones Médicas, Universidad de Antioquia, Medellín, Colombia: ORCID: 0000-0002-8342-2510
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Fatema F, Ghoshal L, Saha A, Agarwal S, Bandyopadhyay D. Early-Onset Versus Late-Onset Psoriasis: A Comparative Study of Clinical Variables, Comorbidities, and Association with HLA CW6 in a Tertiary Care Center. Indian J Dermatol 2021; 66:705. [PMID: 35283511 PMCID: PMC8906303 DOI: 10.4103/ijd.ijd_45_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Psoriasis is a chronic inflammatory diseaseresulting from a complex interplay of genetic and environmental factors affecting the skin, nail and joints. Two distinct types of psoriasis are said to exist (i) early onset psoriasis (EOP), beginning before the age of 40 years and (ii) late onset psoriasis (LOP), beginning ≥40 years; with the presence of Human lymphocyte antigen (HLA) Cw6, present in majority of patients with early onset. Several studies demonstrated clinical and genetic differences between EOP and LOPamong European and East Asian populations. Lack of similar study in the Indian population has prompted us to undertake the present work. Aims and Objectives: (i) To compare the clinical patterns of early onset and late onset psoriasisin patients attending the Dermatology outpatientdepartment (OPD) and admitted in the in-patient department (IPD). (ii) To analyze the association age of onset with presence of HLA Cw6. Materials and Methods: It was an institution-based, descriptive, cross-sectional study. Consecutive patients with psoriasis at the OPD and IPD of the department of Dermatology during the study period, were recruited in the study after obtaining informed consents. Detailed history was obtained regarding the disease, co-morbidities and complications. Through physical examination was carried out, PASI was calculated and blood samples were drawn fromconsenting adult patients (age>/=18 years) to study the presence of Cw6. Results: The study population (n=250) wasbroadly divided into “Early onset psoriasis(EOP)” (n=138) and Late onset psoriasis (LOP)” (n=112).Significant higher occurrence of positive family history, nail involvement and koebnerization were found in EOP, but such differences were absent considering the types, patterns, joint involvement, severity and HLACW6 positivity. Conclusion: This study supports the concept of two subtypes of psoriasis based on age of onset showing different clinical and evolutionary features.
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Affiliation(s)
- Farhat Fatema
- Department of Dermatology, M. R. Bangur Hospital, Kolkata, West Bengal, India
| | - Loknath Ghoshal
- Department of Dermatology, Maldah Medical College, Kolkata, West Bengal, India
| | - Abanti Saha
- Department of Dermatology, Medical College, Kolkata, West Bengal, India
| | - Sristi Agarwal
- Department of Dermatology, Imambara Sadar Hospital, Chinsurah, Hooghly, West Bengal, India
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Amer AS, Samaka RM, Moftah NH. Beclin1 in psoriasis: an immunohistochemical study. Clin Exp Dermatol 2021; 46:851-860. [PMID: 33405299 DOI: 10.1111/ced.14554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/22/2020] [Accepted: 01/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Abnormal autophagy is known to be associated with the pathogenesis of some skin disorders. The protein Beclin1 plays a central role in the machinery of autophagy. AIM To assess the expression of Beclin1 in psoriasis, using immunohistochemical study in lesional and perilesional skin in patients with psoriasis, and to compare the results with those of an apparently healthy control (HC) group. METHODS This case-control study enrolled a total of 40 participants: 20 patients with chronic plaque psoriasis and 20 age- and sex-matched, apparently HCs. Skin biopsies were taken from (i) lesional and (ii) perilesional skin of patients with psoriasis and from (iii) normal skin of HCs for immunohistochemical evaluation of Beclin1 expression. RESULTS Epidermal Beclin1 expression was positive in all three studied groups. There was a significant difference between the three studied groups regarding Beclin1 epidermal topographic distribution, epidermal staining intensity, H score and H-score category (P < 0.01 for all). Significant differences were found between the three studied groups regarding Beclin1 H score and H-score category for skin adnexal structures (P < 0.01 for both). For dermal inflammatory infiltrate, significant differences were found between lesional and perilesional skin regarding Beclin1 expression status, staining intensity, H score and H-score category (P < 0.01, P = 0.01, P < 0.01 and P < 0.03, respectively). CONCLUSION The increased expression of Beclin1 in psoriatic skin, both lesional and perilesional, reflects increased autophagy, which could be a consequence of the rapid keratinocyte proliferation in psoriasis, which would also ramp up all the cellular processes including autophagy. The cellular localization of Beclin1 was nucleocytoplasmic in psoriasis skin but cytoplasmic only in normal HC skin, which needs further study to allow its interpretation.
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Affiliation(s)
- A S Amer
- Dermatology and Venereology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - R M Samaka
- Pathology Department, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
| | - N H Moftah
- Dermatology and Venereology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
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7
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Tseng IL, Yang CC, Lai ECC, Lee CN. Psoriasis in the geriatric population: A retrospective study in Asians. J Dermatol 2021; 48:818-824. [PMID: 33458884 DOI: 10.1111/1346-8138.15737] [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] [Received: 10/09/2020] [Revised: 11/17/2020] [Accepted: 12/03/2020] [Indexed: 11/30/2022]
Abstract
There is a paucity of data focusing on geriatric psoriatic patients. The clinical features were different among those with early-onset psoriasis and elderly-onset psoriasis among the geriatric population. From 2014 to 2018, a total of 290 geriatric psoriatic patients were retrospectively enrolled in our study. They were subclassified into two groups, early-onset (aged <60 years, n = 154) and elderly-onset (aged ≥60 years, n = 136). The characteristics and treatment course of these two groups were reviewed. Psoriasis of the elderly-onset group was generally milder than the early-onset groups (P < 0.05). Less nail involvement and arthritis were noted among the elderly-onset group (P < 0.05). There were four cases of erythrodermic psoriasis in the early-onset group and three cases of palmoplantar psoriasis in the elderly-onset group. Oral medication and biologics for treatment of psoriasis appeared to be safe among the geriatric psoriatic patients. Elderly-onset psoriasis has features which are distinct from early-onset psoriasis and may be a particular subtype, which needs further evaluation.
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Affiliation(s)
- I-Lun Tseng
- Department of Dermatology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Chun Yang
- Department of Dermatology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.,International Center for Wound Repair and Regeneration, National Cheng Kung University, Tainan, Taiwan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, College of Medicine, Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan
| | - Chaw-Ning Lee
- Department of Dermatology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.,School of Pharmacy, College of Medicine, Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan
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8
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Schonmann Y, Ashcroft DM, Iskandar IYK, Parisi R, Sde-Or S, Comaneshter D, Batat E, Shani M, Vinker S, Griffiths CEM, Cohen AD. Incidence and prevalence of psoriasis in Israel between 2011 and 2017. J Eur Acad Dermatol Venereol 2019; 33:2075-2081. [PMID: 31237370 DOI: 10.1111/jdv.15762] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 06/06/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Psoriasis is a common chronic inflammatory skin disease associated with a heavy burden of morbidity, disability and cost. The occurrence of the disease in Israel has not been previously investigated. OBJECTIVES To provide standardized estimates of trends in psoriasis incidence, prevalence and mortality among patients in Israel between 2011 and 2017. METHODS Using electronic health records from Clalit Health Services, the largest nationwide public health provider in Israel, we conducted a population-based study investigating trends in the annual incidence and prevalence of psoriasis between the years 2011 and 2017. We report age- and sex-adjusted rates, using the standard European population as a reference. RESULTS We identified 71 094 incident psoriasis cases. The mean (SD) age of onset was 42.4 (21.0) years with a bimodal distribution, peaking in the early '30s and early '60s. Late-onset psoriasis, occurring after 40 years of age, accounted for 51.1% of incident cases. The annual psoriasis incidence rate was constant throughout the study period (280/100 000 person-years). Psoriasis prevalence rose from 2.5% in 2011 to 3.8% in 2017. CONCLUSIONS Psoriasis prevalence is increasing in Israel, although its incidence is stable. Clinicians and policymakers should plan to address the growing demands in the clinical, economic and societal burden of psoriasis.
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Affiliation(s)
- Y Schonmann
- Department of Family Medicine, Rabin Medical Center, Clalit Health Services, Petach Tikva, Israel.,Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel.,Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
| | - I Y K Iskandar
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
| | - R Parisi
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
| | - S Sde-Or
- Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
| | - D Comaneshter
- Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
| | - E Batat
- Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
| | - M Shani
- Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel.,Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - C E M Griffiths
- Dermatology Centre, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
| | - A D Cohen
- Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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9
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Psoriasis in Skin of Color: Insights into the Epidemiology, Clinical Presentation, Genetics, Quality-of-Life Impact, and Treatment of Psoriasis in Non-White Racial/Ethnic Groups. Am J Clin Dermatol 2018; 19:405-423. [PMID: 29209945 DOI: 10.1007/s40257-017-0332-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Psoriasis is a chronic inflammatory skin condition affecting diverse racial/ethnic groups throughout the world. Large population-based studies suggest that psoriasis occurs most often in individuals of European ancestry, followed by black and Hispanic individuals, although the true prevalence of psoriasis in non-white individuals is likely underestimated. Despite similarities in psoriasis between ethnic groups, there are notable differences in the presentation, quality-of-life impact, and treatment of psoriasis with important implications for the management of non-white individuals. Overall, heterogeneity in psoriasis susceptibility alleles, in combination with cultural and socioeconomic factors, may explain these differences. In this article, we review the epidemiology, clinical presentation, genetic polymorphisms, quality-of-life impact, and treatment nuances of psoriasis in patients with skin of color.
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10
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Song HJ, Park CJ, Kim TY, Choe YB, Lee SJ, Kim NI, Cho JW, Jeon JH, Jang MS, Youn JI, Kim MH, Park J, Kim KH, Kim BS, Youn SW, Lee JH, Lee MG, Ahn SK, Won YH, Yun SK, Shin BS, Seo SJ, Lee JY, Kim KJ, Ro YS, Kim Y, Yu DY, Choi JH. The Clinical Profile of Patients with Psoriasis in Korea: A Nationwide Cross-Sectional Study (EPI-PSODE). Ann Dermatol 2017; 29:462-470. [PMID: 28761295 PMCID: PMC5500712 DOI: 10.5021/ad.2017.29.4.462] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/15/2017] [Accepted: 03/02/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Psoriasis is an immune-mediated, chronic inflammatory disease affecting multiple aspects of patients' lives. Its epidemiology varies regionally; however, nationwide epidemiologic data on psoriasis depicting profile of Korean patients has not been available to date. OBJECTIVE To understand nationwide epidemiologic characteristics and clinical features of adult patients with psoriasis visited university hospitals in Korea. METHODS This multicenter, non-interventional, cross-sectional study recruited 1,278 adult patients with psoriasis across 25 centers in Korea in 2013. Various clinical data including PASI, BSA, DLQI, SF-36 and PASE were collected. RESULTS A total of 1,260 patients completed the study (male:female=1.47:1). The mean age was 47.0 years with a distribution mostly in the 50s (24.9%). Early onset (<40 years) of psoriasis accounted for 53.9% of patients. The mean disease duration was 109.2 months; mean body mass index was 23.9 kg/m2; and 12.7% of patients had a family history of psoriasis. Plaque and guttate types of psoriasis accounted for 85.8% and 8.4%, respectively. Patients with PASI ≥10 accounted for 24.9%; patients with body surface area ≥10 were 45.9%. Patients with DLQI ≥6 accounted for 78.8%. Between PASI <10 and PASI ≥10 groups, significant difference was noted in age at diagnosis, disease duration, blood pressure, waist circumference of female, and treatment experiences with phototherapy, systemic agents, and biologics. CONCLUSION This was the first nationwide epidemiologic study of patients with psoriasis in Korea and provides an overview of the epidemiologic characteristics and clinical profiles of this patient population.
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Affiliation(s)
- Hae Jun Song
- Department of Dermatology, Korea University Guro Hospital, Seoul, Korea
| | - Chul Jong Park
- Department of Dermatology, The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Korea
| | - Tae Yoon Kim
- Department of Dermatology, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Yong Beom Choe
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - Seok-Jong Lee
- Department of Dermatology, Kyungpook National University Hospital, Daegu, Korea
| | - Nack In Kim
- Department of Dermatology, Kyung Hee University Medical Center, Seoul, Korea
| | - Jae We Cho
- Department of Dermatology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jie Hyun Jeon
- Department of Dermatology, Korea University Guro Hospital, Seoul, Korea
| | - Min Soo Jang
- Department of Dermatology, Kosin University College of Medicine, Busan, Korea
| | - Jai Il Youn
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Myung Hwa Kim
- Department of Dermatology, Dankook University Hospital, Cheonan, Korea
| | - Joonsoo Park
- Department of Dermatology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Ki Ho Kim
- Department of Dermatology, Dong-A University Hospital, Busan, Korea
| | - Byung Soo Kim
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
| | - Sang Woong Youn
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Joo-Heung Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min-Geol Lee
- Department of Dermatology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Ku Ahn
- Department of Dermatology, Wonju Severance Christian Hospital, Wonju, Korea
| | - Young Ho Won
- Department of Dermatology, Chonnam National University Hospital, Gwangju, Korea
| | - Seok Kweon Yun
- Department of Dermatology, Chonbuk National University Hospital, Jeonju, Korea
| | - Bong Seok Shin
- Department of Dermatology, Chosun University Hospital, Gwangju, Korea
| | - Seong Jun Seo
- Department of Dermatology, Chung-Ang University Hospital, Seoul, Korea
| | - Ji Yeoun Lee
- Department of Dermatology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Kwang Joong Kim
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Young Suck Ro
- Department of Dermatology, Hanyang University Medical Center, Seoul, Korea
| | | | | | - Jee-Ho Choi
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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11
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Lee MS, Yeh YC, Chang YT, Lai MS. All-Cause and Cause-Specific Mortality in Patients with Psoriasis in Taiwan: A Nationwide Population-Based Study. J Invest Dermatol 2017; 137:1468-1473. [PMID: 28257796 DOI: 10.1016/j.jid.2017.01.036] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/06/2017] [Accepted: 01/13/2017] [Indexed: 11/18/2022]
Abstract
Asian population-based data evaluating all-cause mortality and cause-specific mortality in patients with psoriasis are limited. This study aimed to evaluate the risk of all-cause mortality (stratified according to onset status, disease severity, and concomitant psoriatic arthritis) and cause-specific mortality in patients with psoriasis. Our study cohort consisted of 80,167 patients with newly diagnosed psoriasis between 2001 and 2012 in the National Health Insurance Database. Vital status and cause of death were ascertained from the National Death Registry of Taiwan. All-cause and cause-specific crude mortality rates and standardized mortality ratios were estimated. A total of 7,198 deaths were identified during the follow-up period (508,505 person-years). The standardized mortality ratios were 1.53 for severe psoriasis (95% confidence interval = 1.45-1.60), 1.47 for early-onset psoriasis (95% confidence interval = 1.34-1.61), and 1.47 for patients with psoriatic arthritis (95% confidence interval = 1.36-1.58). In the cause-specific mortality analysis, the absolute and excess risks of death were highest for malignancies (3.6 and 1.57 deaths per 1,000 patient-years, respectively) and circulatory system diseases (3.0 and 1.44 deaths per 1,000 patient-years, respectively). Patients with severe psoriasis, early-onset psoriasis, and psoriatic arthritis had higher all-cause mortality risks. In particular, patients with psoriasis had higher excess risks of mortality from malignancies and circulatory system diseases.
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Affiliation(s)
- Meng-Sui Lee
- Department of Dermatology, Taipei City Hospital, Taipei, Taiwan; Department of Dermatology, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Chun Yeh
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yun-Ting Chang
- Department of Dermatology, National Yang-Ming University, Taipei, Taiwan; Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mei-Shu Lai
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
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12
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Gulliver WP, Randell S, Gulliver S, Connors S, Bachelez H, MacDonald D, Gladney N, Morrissey A, Fleming P. Do Biologics Protect Patients With Psoriasis From Myocardial Infarction? A Retrospective Cohort. J Cutan Med Surg 2016; 20:536-541. [PMID: 27207347 DOI: 10.1177/1203475416650430] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Psoriasis is a chronic immune-mediated inflammatory disorder that affects approximately 2% to 3% of the population, which translates to 17 million in North America and Europe and approximately 170 million people worldwide. Although psoriasis can occur at any age, most cases develop before age 40 years. Some larger studies have noted bimodal age at onset with the first peak occurring at approximately age 30 years and the second peak at around 55 to 60 years, but most patients have a younger age of onset (15-30 years). Psoriasis is associated with multiple comorbidities, decreased quality of life, and decreased longevity of life. Two recent systematic reviews and a meta-analysis concluded that psoriasis patients are at increased risk of major adverse cardiovascular events. Multiple studies confirm that many of the comorbidities found in patients with psoriasis are also important risk factors for cardiovascular disease, stroke, diabetes mellitus, hypertension, hyperlipidemia, obesity, and metabolic syndrome. METHODS We conducted a retrospective cohort study using charts from a dermatology clinic combined with an administrative database of patients with moderate to severe psoriasis in Newfoundland and Labrador, Canada. We examined the role of clinical predictors (age of onset of psoriasis, age, sex, biologic use) in predicting incident myocardial infarction (MI). RESULTS Logistic regression revealed that age of onset (odds ratio [OR], 8.85; P = .005), advancing age (OR, 1.07; P < .0001), and being male (OR, 3.64; P = .018) were significant risk factors for the development of MI. Neither biologic therapy nor duration of biologic therapy were statistically significant risk factors for the development of MI. Our study found that in patients with psoriasis treated with biologics, there was a nonsignificant trend in reduced MI by 78% (relative risk, 0.18; 95% confidence interval, 0.24-1.34; P = .056). CONCLUSION Our study demonstrated a trend toward decreased MI in patients with moderate to severe psoriasis on biologics. Patients with an early age of onset of psoriasis (<25 years) were nearly 9 times more likely to have an MI. Clinicians should consider appropriate cardiovascular risk reduction strategies in patients with psoriasis.
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Affiliation(s)
- Wayne P Gulliver
- Newlab Clinical Research, St John's, NL, Canada .,Department of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
| | - Shane Randell
- Newlab Clinical Research, St John's, NL, Canada.,Department of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
| | | | - Sean Connors
- Division of Cardiology, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
| | - Hervé Bachelez
- Paris VII Denis-Diderot University, Assistance Publique-Hôpitaux de Paris (AP-HP), Dermatology Department, Hôpital Saint-Louis, Paris, France
| | - Don MacDonald
- Newfoundland and Labrador Centre for Health Information, St John's, NL, Canada
| | - Neil Gladney
- Newfoundland and Labrador Centre for Health Information, St John's, NL, Canada
| | - Andrea Morrissey
- Newfoundland and Labrador Centre for Health Information, St John's, NL, Canada
| | - Patrick Fleming
- Division of Dermatology, University of Toronto, Toronto, ON, Canada
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