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Buja A, Miatton A, Cozzolino C, Brazzale AR, Lo Bue R, Mercuri SR, Proft FN, Kridin K, Cohen AD, Damiani G. The Prevalent Comorbidome at the Onset of Psoriasis Diagnosis. Dermatol Ther (Heidelb) 2023; 13:2093-2105. [PMID: 37542678 PMCID: PMC10442308 DOI: 10.1007/s13555-023-00986-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 07/14/2023] [Indexed: 08/07/2023] Open
Abstract
INTRODUCTION Psoriasis (PsO) is currently regarded as a systemic inflammatory disease with a growing burden of post-diagnosis associated comorbidities. To determine the initial burden of comorbiditis we evaluated the comorbidome at PsO onset. METHODS In a matched case-control study, we extracted data on 57,228 patients and 125 morbidities from the Clalit Health Services Israeli insurance database. PsO cases were matched with control individuals by sex and age at enrolment. As pre-existing comorbidities, we considered all conditions already present in controls at the same age as the matched PsO case at the time of their diagnosis. To test for differences in the odds of comorbidities between the case and control groups, logistic regression analyses were run to calculate the odds ratio (OR) for each comorbidity, after which the comorbidome was graphically represented. RESULTS In this study we enrolled 28,614 PsO patients and 28,614 controls with an average age of 45.3 ± 19.6 years. At the time of diagnosis, PsO patients were more likely to be diagnosed with 2-4 comorbidities (28.8% vs 23.8%) and > 5 (19.6% vs 12.9%,). PsO patients' specific comorbidomes evidenced several pathological cores: autoimmune and inflammatory systemic diseases [i.e., hidradenitis suppurativa (OR 3.55, 95% CI 1.88-7.28) or polymyalgia rheumatica (OR 3.01 95% CI 1.96-4.77)], inflammatory bowel diseases [i.e., Crohn's disease (OR 2.99 95% CI 2.20-4.13)], pulmonary inflammatory diseases [i.e., chronic obstructive pulmonary disease (OR 1.81 95% CI 1.61-2.04)], hepatological diseases [i.e., cirrhosis (OR 2.00 95% CI 1.36-3.00)], endocrine diseases [dysthyroidisms (OR 1.82 95% CI 1.30-2.59)], mental disorders [i.e., depression (OR 1.72 95% CI 1.57-1.87)], and cardiovascular diseases (i.e., hypertension (OR 1.47 95% CI 1.41-1.53)]. CONCLUSION The PsO-onset comorbidome may help health professionals plan more comprehensive patient management. By screening for these common PsO-linked conditions, early diagnosis and treatment may become more frequent, thus greatly benefiting patients on their medical journey.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy.
| | - Andrea Miatton
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Claudia Cozzolino
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Roberta Lo Bue
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Santo Raffaele Mercuri
- Italian Center of Precision Medicine and Chronic Inflammation, University of Milan, Via Commenda 10, 20122, Milan, Italy
- Unit of Dermatology and Cosmetology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Fabian Nikolai Proft
- Department of Gastroenterology, Infectiology and Rheumatology (Including Nutrition Medicine), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Khalaf Kridin
- Unit of Dermatology and Skin Research Laboratory, Barch Padeh Medical Center, Tiberias, Israel
| | - Arnon Dov Cohen
- 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
| | - Giovanni Damiani
- Italian Center of Precision Medicine and Chronic Inflammation, University of Milan, Via Commenda 10, 20122, Milan, Italy.
- Unit of Dermatology and Cosmetology, IRCCS San Raffaele Hospital, Milan, Italy.
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy.
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Masson L, Saillard C, Ping Man SL, Baggio R, Kammerer-Jacquet SF, Adamski H, Dupuy A. A pustular psoriasis flare treated with calcium supplementation. JAAD Case Rep 2021; 12:40-45. [PMID: 34026993 PMCID: PMC8122144 DOI: 10.1016/j.jdcr.2021.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Laure Masson
- University of Rennes 1, Rennes, France.,Department of Dermatology, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Clémence Saillard
- Department of Dermatology, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Sarah Law Ping Man
- Department of Dermatology, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Raphaelle Baggio
- Department of Dermatology, Centre Hospitalier Universitaire Rennes, Rennes, France
| | | | - Henri Adamski
- Department of Dermatology, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Alain Dupuy
- University of Rennes 1, Rennes, France.,Department of Dermatology, Centre Hospitalier Universitaire Rennes, Rennes, France
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Abstract
BACKGROUND Hypoparathyroidism is a rare endocrine disorder characterized by hypocalcemia and low or undetectable levels of parathyroid hormone. METHODS This review is an evidence-based summary of hypoparathyroidism in terms of relevant pathophysiological, clinical, and therapeutic concepts. RESULTS Many clinical manifestations of hypoparathyroidism are due to the lack of the physiological actions of parathyroid hormone on its 2 major target organs: the skeleton and the kidney. The skeleton is inactive, accruing bone without remodeling it. The kidneys lose the calcium-conserving actions of parathyroid hormone and, thus, excrete a greater fraction of calcium. Biochemical manifestations, besides hypocalcemia and low or undetectable levels of parathyroid hormone, include hyperphosphatemia and low levels of 1,25-dihydroxyvitamin D. Calcifications in the kidney, brain, and other soft tissues are common. Removal of, or damage to, the parathyroid glands at the time of anterior neck surgery is, by far, the most likely etiology. Autoimmune destruction of the parathyroid glands and other genetic causes represent most of the other etiologies. Conventional treatment with calcium and active vitamin D can maintain the serum calcium level but high doses may be required, adding to the risk of long-term soft tissue calcifications. The advent of replacement therapy with recombinant human PTH(1-84) represents a major step in the therapeutics of this disease. CONCLUSIONS Advances in our knowledge of hypoparathyroidism have led to greater understanding of the disease itself and our approach to it.
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Affiliation(s)
- John P Bilezikian
- Department of Medicine, Division of Endocrinology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Correspondence and Reprint Requests: John P. Bilezikian, Vice-Chair, International Research and Education, Department of Medicine, Vagelos College of Physicians and Surgeons, 630 W. 168th Street, New York, NY 10032. E-mail:
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Marcucci G, Cianferotti L, Brandi ML. Clinical presentation and management of hypoparathyroidism. Best Pract Res Clin Endocrinol Metab 2018; 32:927-939. [PMID: 30665553 DOI: 10.1016/j.beem.2018.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The clinical manifestations of hypoparathyroidism are variable and can involve almost any organ system. The main clinical features of the hypoparathyroidism are typically signs or symptoms due to neuromuscular irritability owing to low serum calcium level. In addition to hypocalcemia, hyperphosphatemia can contribute to long-term complications, including extra-skeletal calcifications. Bone turnover markers are generally decreased, and bone mass density is usually normal-increased compared to age- and gender-matched controls. It is still unclear whether or not these bone features could have an impact on the risk of fracture. Impaired renal function is a common complication described in patients treated for hypoparathyroidism. Other complications include premature cataracts, seizures, basal ganglia calcifications, and cardiac arrhythmias. Lastly, some clinical studies have also reported a reduced quality of life of patients with hypoparathyroidism. Increased awareness of the clinical manifestations of this disease is important to improve its clinical management.
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Affiliation(s)
- Gemma Marcucci
- Department of Surgery and Translational Medicine, University of Florence, Bone Metabolic Diseases Unit, University Hospital of Florence, Italy.
| | - Luisella Cianferotti
- Department of Surgery and Translational Medicine, University of Florence, Bone Metabolic Diseases Unit, University Hospital of Florence, Italy.
| | - Maria Luisa Brandi
- Department of Surgery and Translational Medicine, University of Florence, Bone Metabolic Diseases Unit, University Hospital of Florence, Italy.
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Nayak PB, Girisha BS, Noronha TM, Sripathi H. Low Vitamin D in Psoriasis: Reality or Myth? Indian J Dermatol 2018; 63:255-260. [PMID: 29937564 PMCID: PMC5996630 DOI: 10.4103/ijd.ijd_35_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Context: Psoriasis is a chronic, systemic disease with the beneficial effect of topical vitamin D3 analogs, known for a long time. Low levels of vitamin D are increasingly found to be associated with the initial development of some autoimmune diseases. There are contradictory reports of low serum levels of vitamin D3 in the pathogenesis of psoriasis. Aims: (1) To determine the serum levels of vitamin D, calcium and C-reactive protein (CRP) in patients with psoriasis vulgaris, (2) To compare these levels with the serum levels of controls, and (3) To correlate them with the severity of the disease. Subjects and Methods: A hospital-based case–control study with 61 patients of psoriasis and 61 age- and sex-matched controls was undertaken. A detailed history was taken and examination including body mass index, Psoriasis Area and Severity Index (PASI) was done. Estimations of serum vitamin D, serum calcium, and CRP levels were done. Results: Mean 25(OH) vitamin D level was not significantly different between persons with and without psoriasis. Mean vitamin D level in cases was 18.41±9.41 and that in controls was 17.24±13.03 (P =0.63). However, vitamin D level were significantly lower in females than in males in both cases (P =0.02) and controls (P =0.006). There was no significant correlation between the severity of psoriasis and serum levels of vitamin D, serum calcium, and CRP. Conclusions: Serum level of vitamin D did not correlate with the severity of psoriasis in our study.
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Affiliation(s)
- Preethi B Nayak
- Department of Dermatology Venereology and Leprosy, K. S. Hegde Medical Academy, NITTE (Deemed to be university), Mangalore, Karnataka, India
| | - Banavasi Shanmukha Girisha
- Department of Dermatology Venereology and Leprosy, K. S. Hegde Medical Academy, NITTE (Deemed to be university), Mangalore, Karnataka, India
| | - Tonita Mariola Noronha
- Department of Dermatology Venereology and Leprosy, K. S. Hegde Medical Academy, NITTE (Deemed to be university), Mangalore, Karnataka, India
| | - Handattu Sripathi
- Department of Dermatology Venereology and Leprosy, K. S. Hegde Medical Academy, NITTE (Deemed to be university), Mangalore, Karnataka, India
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Abstract
Hypoparathyroidism is a disease characterized by inadequately low circulating concentrations of parathyroid hormone (PTH) resulting in low calcium levels and increased phosphate levels in the blood. Symptoms of the disease result from increased neuromuscular irritability caused by hypocalcaemia and include tingling, muscle cramps and seizures. The most common cause of the disease is inadvertent removal of, or injury to, the parathyroid glands during neck surgery, followed by genetic, idiopathic and autoimmune aetiologies. Conventional treatment includes activated vitamin D and/or calcium supplements, but this treatment does not fully replace the functions of PTH and can lead to short-term problems (such as hypocalcaemia, hypercalcaemia and increased urinary calcium excretion) and long-term complications (which include nephrocalcinosis, kidney stones and brain calcifications). PTH replacement has emerged as a new treatment option. Clinical trials using human PTH(1-34) and PTH(1-84) showed that this treatment was safe and effective in studies lasting up to 6 years. Recombinant human PTH(1-84) has been approved in the United States and Europe for the management of hypoparathyroidism; however, its effect on long-term complications is still being evaluated. Clinical practice guidelines, which describe the consensus of experts in the field, have been published and recognize the need for more research to optimize care. In this Primer, we summarize current knowledge of the prevalence, pathophysiology, clinical presentation and management of hypoparathyroidism.
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Skrok A, Bednarczuk T, Skwarek A, Popow M, Rudnicka L, Olszewska M. The effect of parathyroid hormones on hair follicle physiology: implications for treatment of chemotherapy-induced alopecia. Skin Pharmacol Physiol 2016; 28:213-225. [PMID: 25721772 DOI: 10.1159/000375319] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 01/15/2015] [Indexed: 11/19/2022]
Abstract
Parathyroid hormone (PTH) and parathyroid hormone-related protein (PTHrP) influence hair follicles through paracrine and intracrine routes. There is significant evidence that PTH and PTHrP influence the proliferation and differentiation of hair follicle cells. The PTH/PTHrP receptor signalling plays an important role in the hair follicle cycle and may induce premature catagen-telogen transition. Transgenic mice with an overexpression or blockade (PTH/PTHrP receptor knockout mice) of PTHrP activity revealed impaired or increased hair growth, respectively. Some findings also suggest that PTHrP may additionally influence the hair cycle by inhibiting angiogenesis. Antagonists of the PTH/PTHrP receptor have been shown to stimulate proliferation of hair follicle cells and hair growth. A hair-stimulating effect of a PTH/PTHrP receptor antagonist applied topically to the skin has been observed in hairless mice, as well as in mice treated with cyclophosphamide. These data indicate that the PTH/PTHrP receptor may serve as a potential target for new (topical) hair growth-stimulating drugs, especially for chemotherapy-induced alopecia.
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Guerreiro de Moura CAG, de Assis LH, Góes P, Rosa F, Nunes V, Gusmão ÍM, Cruz CMS. A Case of Acute Generalized Pustular Psoriasis of von Zumbusch Triggered by Hypocalcemia. Case Rep Dermatol 2015; 7:345-51. [PMID: 26955330 PMCID: PMC4777907 DOI: 10.1159/000442380] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Psoriasis is an autoimmune disease triggered by different conditions in genetically susceptible people. It is characterized by variable cutaneous manifestations including localized or disseminated pustules. Generalized pustular psoriasis (GPP) has two main clinical forms: von Zumbusch psoriasis, characterized by severe erythrodermia and scaling skin after the resolution of pustules, and the annular form. GPP may also present severe extracutaneous manifestations including pneumonitis, heart failure and hepatitis. Old reports showed a relationship between hypoparathyroidism and hypocalcemia as triggers for GPP highlighting the importance of adequate workup of the patient and possible therapeutic changes in acute situations. Here, we present a case of severe von Zumbusch psoriasis with life-threatening complications triggered by severe hypocalcemia secondary to hypoparathyroidism successfully treated with aggressive calcium reposition.
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Affiliation(s)
- Carlos Antônio Gusmão Guerreiro de Moura
- Programa de Residência de Clínica Médica do Hospital Santo Antônio, Obras Sociais Irmã Dulce, Brazil; Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Luiz Henrique de Assis
- Programa de Residência de Clínica Médica do Hospital Santo Antônio, Obras Sociais Irmã Dulce, Brazil
| | - Paulo Góes
- Programa de Residência de Clínica Médica do Hospital Santo Antônio, Obras Sociais Irmã Dulce, Brazil
| | - Fabiana Rosa
- Faculdade de Medicina da UNIFENAS, Alfenas, Brazil
| | - Victor Nunes
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | | | - Constança Margarida Sampaio Cruz
- Programa de Residência de Clínica Médica do Hospital Santo Antônio, Obras Sociais Irmã Dulce, Brazil; Curso de Pós-graduação em Medicina e Saúde Humana da Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
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D'Epiro S, Marocco C, Salvi M, Mattozzi C, Luci C, Macaluso L, Giancristoforo S, Campoli M, Scarnò M, Migliaccio S, Calvieri S, Richetta A. Psoriasis and bone mineral density: implications for long-term patients. J Dermatol 2014; 41:783-7. [PMID: 24990650 DOI: 10.1111/1346-8138.12546] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 05/19/2014] [Indexed: 01/16/2023]
Abstract
Psoriasis is a chronic inflammatory disease associated with several comorbidities. Osteoporosis is defined as a reduction in bone mineral density with impaired bone microarchitecture. Several mechanisms may be implicated as a possible cause for the association between psoriasis and osteoporosis, such as systemic inflammation, anti-psoriatic drug intake and joint dysfunction for psoriatic arthritis (PsA). The aim of the present study was to assess bone mineral density (BMD) in patients with psoriasis, correlating the prevalence of osteopenia/osteoporosis with Psoriasis Area and Severity Index (PASI) score, mean duration of psoriatic disease, PsA and previous treatments for psoriasis. Forty-three consecutive patients with psoriasis, 19 of whom were affected by the arthropathic form, were enrolled. We evaluated the severity of psoriasis as measured by PASI score, the CASPAR criteria and ultrasounds of the joints to verify the diagnosis of PsA and the age of psoriasis onset to estimate mean disease duration. Patients underwent a bone density scan of the lumbar spine and femoral neck by dual-energy X-ray absorptiometry to measure BMD. Patients with osteopenia/osteoporosis showed a statistically significant longer average duration of psoriatic disease (17 years), compared to patients affected by psoriasis with normal T-score (8.8 years) (P = 0.04). The linear logistic regression confirms a significant relation between mean psoriatic disease duration and BMD alterations (P = 0.04). Our results suggest the necessity of an early diagnostic evaluation of bone metabolism in patients with psoriasis, especially if characterized by longer disease duration.
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Affiliation(s)
- Sara D'Epiro
- Dermatology and Venereology Policlinico Umberto I of Rome, University of Rome "Sapienza"
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Wémeau JL, Ryndak A, Karrouz W, Balavoine AS, Baudoux F. [Hand and endocrine diseases]. Presse Med 2013; 42:1596-606. [PMID: 24148694 DOI: 10.1016/j.lpm.2013.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 03/11/2013] [Accepted: 03/14/2013] [Indexed: 11/28/2022] Open
Abstract
The whole of hormones likely influence state of hands, modifying colouring and trophicity of the skin and having influence on its muscular, tendineous, osseous, articular components. Thus state of the hands contributes to the recognition of the endocrine diseases: hot and moist hands of the Graves' disease, dry, cold and infiltrated hands in myxoedema, pale and fine hands of hypopituitarism, broad and thick hand of acromegaly, brachymetacarpia in the pseudohypoparathyroidism… Diabetes exposes particularly to tendineous and articular retractions, to whitlows and ungual mycosis.
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Affiliation(s)
- Jean-Louis Wémeau
- Clinique endocrinologique Marc-Linquette, hôpital Claude-Huriez, CHRU de Lille, 4(e) et 5(e) Ouest, 59037 Lille cedex, France.
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Abstract
Dermatologic manifestations of parathyroid-related disorders, although rare in sporadic cases, are not uncommon in familial syndromes. Patients with familial hyperparathyroidism have several types of skin lesions. In multiple endocrine neoplasia 1, patients commonly have angiofibromas (85%) and collagenomas (70%), lesions that show loss of one 11q13 allele, the molecular abnormality in multiple endocrine neoplasia 1. They can also present with lipomas or café-au-lait spots. Cutaneous amyloidosis, an entity that can occur sporadically, has been described in multiple endocrine neoplasia 2a and is usually localized to the interscapular area. Metastatic calcification is an entity commonly encountered in patients with hyperparathyroidism and renal failure. It can be complicated by infections and necrosis. It is best treated by controlling hypercalcemia, hyperphosphatemia, hyperparathyroidism, antibiotics, and analgesia. Parathyroidectomy is reserved for refractory cases. Hypoparathyroidism presenting in the context of polyglandular failure type 1 is characterized by mucocutaneous candidiasis. Pseudohypoparathyroidism, an inherited disorder with end-organ unresponsiveness to parathyroid hormone, is characterized by Albright hereditary osteodystrophy. Patients present with short stature, round facies, brachydactyly, and short fourth or fifth metacarpals.
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Affiliation(s)
- Ghada El-Hajj Fuleihan
- Division of Endocrinology, Department of Internal Medicine, American University of Beirut Medical Center, PO Box 11-0236, 4407 2020 Beirut, Lebanon.
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