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Aixue W, Feng W, Huanhuan Z, Xixing M, Yanling L. Cosentyx alleviates psoriasis-induced podocyte injury by inhibiting the tlr/nf-κb signaling pathway. Skin Res Technol 2024; 30:e13562. [PMID: 38279604 PMCID: PMC10818124 DOI: 10.1111/srt.13562] [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: 10/30/2023] [Accepted: 12/19/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Pathological studies have shown an association between psoriasis and renal podocyte injury, and the specific mechanism of podocyte injury in psoriasis remains unclear, with no effective treatments currently available. This study aimed to investigate the underlying mechanisms of podocyte and epidermal cell injury in psoriasis and evaluate the therapeutic effect of Cosentyx. MATERIALS AND METHODS A psoriasis-like mouse model was established using BALB/C mice, and Cosentyx treatment was administered via intraperitoneal injection. Various parameters, including skin lesions, urinary protein, kidney/serum inflammatory cytokines, kidney function, podocyte membrane proteins, and Toll-like receptors/nuclear factor kappa-b (TLR/NF-κB) pathway-associated proteins, were analyzed to explore the mechanisms of podocyte and epidermal cell injury in psoriasis and the potential ameliorative effects of Cosentyx. RESULT Treatment with Cosentyx significantly reduced the increased levels of urinary protein, creatinine, and blood urea nitrogen caused by psoriasis. Cosentyx inhibited the upregulation of kidney/serum inflammatory factors (IL-17, IL-1β, IL-6, TNF-α, and IL-22) and TLR/NF-κB-related proteins (TLR2, TLR4, MyD88, and NF-κBp65) in both psoriatic skin and kidney tissues, while also reducing the accumulation of oxidative products. Moreover, Cosentyx treatment suppressed podocyte apoptosis and promoted epidermal cell apoptosis. The experimental data demonstrated that psoriasis-like inflammation impaired renal podocytes through the TLR/NF-κB signaling pathway. CONCLUSION Cosentyx treatment effectively inhibited the expression of TLR/NF-κB-related proteins, providing a therapeutic effect for psoriasis-induced kidney and skin injuries.
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Affiliation(s)
- Wang Aixue
- DermatologyThe Second Hospital of Hebei Medical UniversityShijiazhuang HebeiChina
| | - Wei Feng
- DermatologyThe Second Hospital of Hebei Medical UniversityShijiazhuang HebeiChina
| | - Zhang Huanhuan
- DermatologyThe Second Hospital of Hebei Medical UniversityShijiazhuang HebeiChina
| | - M Xixing
- DermatologyThe Second Hospital of Hebei Medical UniversityShijiazhuang HebeiChina
| | - L Yanling
- DermatologyThe Second Hospital of Hebei Medical UniversityShijiazhuang HebeiChina
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Czarnecka A, Zabłotna M, Purzycka-Bohdan D, Nowicki RJ, Szczerkowska-Dobosz A. An Observational Study of 147 Psoriasis Patients: Overweightness and Obesity as a Significant Clinical Factors Correlated with Psoriasis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2006. [PMID: 38004054 PMCID: PMC10673501 DOI: 10.3390/medicina59112006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Psoriasis is a common, chronic, and immune-mediated inflammatory skin disease recognized to lead to a wide range of comorbid disorders, mainly obesity. The study aimed to evaluate the problem of overweightness and obesity among psoriasis patients in the context of their prevalence and influence on the disease course. Materials and Methods: The study group encompassed 147 adult patients with plaque psoriasis. Results: The prevalences of overweightness (39.46%) and obesity (37.41%) demonstrated in the study showed the strong predisposition of psoriatic patients for abnormal body mass. The vast majority (77%) of subjects with psoriatic arthritis were overweight or obese. The results of the correlation analysis revealed the significant impacts of overweightness and obesity, as defined by the BMI index, on modifying the severity of psoriasis (as assessed by the PASI with a correlation coefficient of R = 0.23, p = 0.016; and BSA values with a correlation coefficient of R = 0.21, p = 0.023), particularly in contrast to patients with a normal body mass. Conclusions: Overweightness and obesity constitute a major health burden among psoriatic patients, influencing the disease course and severity. Enhanced understanding of the phenomenon may directly translate into improving disease management and overall patient care.
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Affiliation(s)
- Anna Czarnecka
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-214 Gdansk, Poland; (M.Z.); (D.P.-B.); (R.J.N.); (A.S.-D.)
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Lowe ME, Akhtari FS, Potter TA, Fargo DC, Schmitt CP, Schurman SH, Eccles KM, Motsinger-Reif A, Hall JE, Messier KP. The skin is no barrier to mixtures: Air pollutant mixtures and reported psoriasis or eczema in the Personalized Environment and Genes Study (PEGS). JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023; 33:474-481. [PMID: 36460922 PMCID: PMC10234803 DOI: 10.1038/s41370-022-00502-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 06/03/2023]
Abstract
BACKGROUND Autoimmune (AI) diseases appear to be a product of genetic predisposition and environmental triggers. Disruption of the skin barrier causes exacerbation of psoriasis/eczema. Oxidative stress is a mechanistic pathway for pathogenesis of the disease and is also a primary mechanism for the detrimental effects of air pollution. METHODS We evaluated the association between autoimmune skin diseases (psoriasis or eczema) and air pollutant mixtures in 9060 subjects from the Personalized Environment and Genes Study (PEGS) cohort. Pollutant exposure data on six criteria air pollutants are publicly available from the Center for Air, Climate, and Energy Solutions and the Atmospheric Composition Analysis Group. For increased spatial resolution, we included spatially cumulative exposure to volatile organic compounds from sites in the United States Environmental Protection Agency Toxic Release Inventory and the density of major roads within a 5 km radius of a participant's address from the United States Geological Survey. We applied logistic regression with quantile g-computation, adjusting for age, sex, diagnosis with an autoimmune disease in family or self, and smoking history to evaluate the relationship between self-reported diagnosis of an AI skin condition and air pollution mixtures. RESULTS Only one air pollution variable, sulfate, was significant individually (OR = 1.06, p = 3.99E-2); however, the conditional odds ratio for the combined mixture components of PM2.5 (black carbon, sulfate, sea salt, and soil), CO, SO2, benzene, toluene, and ethylbenzene is 1.10 (p-value = 5.4E-3). SIGNIFICANCE While the etiology of autoimmune skin disorders is not clear, this study provides evidence that air pollutants are associated with an increased prevalence of these disorders. The results provide further evidence of potential health impacts of air pollution exposures on life-altering diseases. SIGNIFICANCE AND IMPACT STATEMENT The impact of air pollution on non-pulmonary and cardiovascular diseases is understudied and under-reported. We find that air pollution significantly increased the odds of psoriasis or eczema in our cohort and the magnitude is comparable to the risk associated with smoking exposure. Autoimmune diseases like psoriasis and eczema are likely impacted by air pollution, particularly complex mixtures and our study underscores the importance of quantifying air pollution-associated risks in autoimmune disease.
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Affiliation(s)
- Melissa E Lowe
- National Institute of Environmental Health Sciences, Division of the National Toxicology Program, Durham, USA.
- National Institute of Environmental Health Sciences, Clinical Research Branch, Durham, USA.
| | - Farida S Akhtari
- National Institute of Environmental Health Sciences, Biostatistics and Computational Biology Branch, Durham, USA
| | - Taylor A Potter
- National Institute of Environmental Health Sciences, Division of the National Toxicology Program, Durham, USA
| | - David C Fargo
- National Institute of Environmental Health Sciences, Division of the National Toxicology Program, Durham, USA
| | - Charles P Schmitt
- National Institute of Environmental Health Sciences, Office of Data Science, Durham, USA
| | - Shepherd H Schurman
- National Institute of Environmental Health Sciences, Clinical Research Branch, Durham, USA
- National Institute on Aging, Clinical Research Core, Bethesda, USA
| | - Kristin M Eccles
- National Institute of Environmental Health Sciences, Division of the National Toxicology Program, Durham, USA
| | - Alison Motsinger-Reif
- National Institute of Environmental Health Sciences, Biostatistics and Computational Biology Branch, Durham, USA
| | - Janet E Hall
- National Institute of Environmental Health Sciences, Clinical Research Branch, Durham, USA
| | - Kyle P Messier
- National Institute of Environmental Health Sciences, Division of the National Toxicology Program, Durham, USA
- National Institute of Environmental Health Sciences, Clinical Research Branch, Durham, USA
- National Institute of Environmental Health Sciences, Biostatistics and Computational Biology Branch, Durham, USA
- National Institute on Minority Health and Health Disparities, Bethesda, USA
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TOSUN M, İLGÜN G, TOSUN N. Psoriasis hastalarında sigara içme durumu ile yaşam kalitesi arasındaki ilişkide hastalık şiddetinin aracı etkisi. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1088577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: The aim of this study was to examine the relationship between smoking and quality of life and to investigate the mediating role of disease severity on this relationship in psoriasis patients.
Materials and Methods: In the study, 268 psoriasis patients were reached by the convenience sampling method. In the study, patients' quality of life was measured with “dermatology quality of life index (DLQI)” and disease severity was measured with “psoriasis area and severity index (PASI)”. The effect of the independent variable (smoking) on the dependent variable (quality of life), both directly and indirectly through the mediating variable (disease severity), was examined by process analysis.
Results: Smoking status shows statistically significant differences according to gender, age, marital status, occupation, and income groups. 17.02% of women and 44.09% of men smoke. 19.74% of single and 33.85% of married smoke. 20% of unemployed and 39.13% of employees smoke. 17.76% of low-income, 50.91% of middle-income, and 40.98% of high-income people smoke. This cross-sectional study revealed that smoking in psoriasis has no direct effect on the quality of life, but that smoking has a full indirect effect on the quality of life through disease severity.
Conclusion: In the study, it was found that smoking negatively affects the quality of life through both disease severity. Accordingly, it is recommended that patients be informed about the effect of smoking on their diseases.
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Krajina I, Stupin A, Šola M, Mihalj M. Oxidative Stress Induced by High Salt Diet—Possible Implications for Development and Clinical Manifestation of Cutaneous Inflammation and Endothelial Dysfunction in Psoriasis vulgaris. Antioxidants (Basel) 2022; 11:antiox11071269. [PMID: 35883760 PMCID: PMC9311978 DOI: 10.3390/antiox11071269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 02/07/2023] Open
Abstract
Although oxidative stress is recognized as an important effector mechanism of the immune system, uncontrolled formation of reactive oxygen and nitrogen species promotes excessive tissue damage and leads to disease development. In view of this, increased dietary salt intake has been found to damage redox systems in the vessel wall, resulting in endothelial dysfunction associated with NO uncoupling, inflammation, vascular wall remodeling and, eventually, atherosclerosis. Several studies have reported increased systemic oxidative stress accompanied by reduced antioxidant capacity following a high salt diet. In addition, vigorous ionic effects on the immune mechanisms, such as (trans)differentiation of T lymphocytes are emerging, which together with the evidence of NaCl accumulation in certain tissues warrants a re-examination of the data derived from in vitro research, in which the ionic influence was excluded. Psoriasis vulgaris (PV), as a primarily Th17-driven inflammatory skin disease with proven inflammation-induced accumulation of sodium chloride in the skin, merits our interest in the role of oxidative stress in the pathogenesis of PV, as well as in the possible beneficial effects that could be achieved through modulation of dietary salt intake and antioxidant supplementation.
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Affiliation(s)
- Ivana Krajina
- Department of Dermatology and Venereology, Osijek University Hospital, J. Huttlera 4, HR-31000 Osijek, Croatia;
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
| | - Ana Stupin
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia;
- Institute and Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
| | - Marija Šola
- Department of Dermatology and Venereology, Osijek University Hospital, J. Huttlera 4, HR-31000 Osijek, Croatia;
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
- Correspondence: (M.Š.); (M.M.); Tel.: +385-31-512-800 (M.M.)
| | - Martina Mihalj
- Department of Dermatology and Venereology, Osijek University Hospital, J. Huttlera 4, HR-31000 Osijek, Croatia;
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia;
- Institute and Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
- Correspondence: (M.Š.); (M.M.); Tel.: +385-31-512-800 (M.M.)
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Dalrymple A, McEwan M, Brandt M, Bielfeldt S, Bean E, Moga A, Coburn S, Hardie G. A novel clinical method to measure skin staining reveals activation of skin damage pathways by cigarette smoke. Skin Res Technol 2022; 28:162-170. [PMID: 34758171 PMCID: PMC9299119 DOI: 10.1111/srt.13108] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/21/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Long-term use of cigarettes can result in localised staining and aging of smokers' skin. The use of tobacco heating products (THPs) and electronic cigarettes (ECs) has grown on a global scale; however, the long-term effect of these products' aerosols on consumers' skin is unknown. This pilot clinical study aimed to determine whether THP or EC aerosol exposure results in skin staining or activation of biomarkers associated with oxidative stress. MATERIALS AND METHODS Eight areas were identified on the backs of 10 subjects. Two areas were used for air control, and two areas exposed to 32-puffs of cigarette smoke (CS), THP or EC aerosols, which were delivered to the skin using a 3-cm diameter exposure chamber and smoke engine. Skin colour was measured using a Chromameter. Squalene (SQ), SQ monohydroperoxide (SQOOH) and malondialdehyde (MDA) levels were measured in sebum samples by mass spectrometry and catalase colorimetry. RESULTS CS exposure significantly increased skin staining, SQOOH and MDA levels and SQOOH/SQ ratio. THP and EC values were significantly lower than CS; EC values being comparable to air control. THP values were comparable to EC and air control at all endpoints, apart from skin staining. SQ and catalase levels did not change with exposure. CONCLUSIONS CS stained skin and activated pathways known to be associated with skin damage. THPs and ECs produced significantly lower values, suggesting they could offer hygiene and cosmetic benefits for consumers who switch exclusively from smoking cigarettes. Further studies are required to assess longer-term effects of ECs and THPs on skin function.
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Affiliation(s)
| | | | - Marianne Brandt
- proDERMInstitut für Angewandte Dermatologische ForschungHamburgGermany
| | - Stephan Bielfeldt
- proDERMInstitut für Angewandte Dermatologische ForschungHamburgGermany
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Visser MJE, Tarr G, Pretorius E. Thrombosis in Psoriasis: Cutaneous Cytokine Production as a Potential Driving Force of Haemostatic Dysregulation and Subsequent Cardiovascular Risk. Front Immunol 2021; 12:688861. [PMID: 34335591 PMCID: PMC8324086 DOI: 10.3389/fimmu.2021.688861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/06/2021] [Indexed: 12/18/2022] Open
Abstract
Psoriasis (PsO) is a common T cell-mediated inflammatory disorder of the skin with an estimated prevalence of 2%. The condition manifests most commonly as erythematous plaques covered with scales. The aetiology of PsO is multifactorial and disease initiation involves interactions between environmental factors, susceptibility genes, and innate and adaptive immune responses. The underlying pathology is mainly driven by interleukin-17. In addition, various inflammatory mediators from specific T helper (TH) cell subsets, namely TH1, TH17, and TH22, are overexpressed in cutaneous lesions and may also be detected in the peripheral blood of psoriatic patients. Moreover, these individuals are also at greater risk, compared to the general population, of developing multiple comorbid conditions. Cardiovascular disease (CVD) has been recognised as a prominent comorbidity of PsO. A potential mechanism contributing to this association may be the presence of a hypercoagulable state in these individuals. Inflammation and coagulation are closely related. The presence of chronic, low-grade systemic inflammation may promote thrombosis – one of the major determinants of CVD. A pro-inflammatory milieu may induce the expression of tissue factor, augment platelet activity, and perturb the vascular endothelium. Altogether, these changes will result in a prothrombotic state. In this review, we describe the aetiology of PsO, as well as the pathophysiology of the condition. We also consider its relationship to CVD. Given the systemic inflammatory nature of PsO, we evaluate the potential contribution of prominent inflammatory mediators (implicated in PsO pathogenesis) to establishing a prothrombotic state in psoriatic patients.
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Affiliation(s)
- Maria J E Visser
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - Gareth Tarr
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa.,Division of Rheumatology, Institute of Orthopaedics and Rheumatology, Winelands Mediclinic Orthopaedic Hospital, Stellenbosch, South Africa
| | - Etheresia Pretorius
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
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The role of xenobiotics in triggering psoriasis. Arch Toxicol 2020; 94:3959-3982. [PMID: 32833044 DOI: 10.1007/s00204-020-02870-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
Psoriasis is a common inflammatory skin disease affecting approximately 2% of the world population. A complex interplay of genetic predisposition and risk factors contributes to the risk of its onset. Several xenobiotics have been implicated in the pathogenesis of psoriasis. Drugs are among the most investigated trigger factors; strong association with disease induction or exacerbation has been reported for β-blockers, lithium, NSAIDs and ACE inhibitors, all of which are commonly used in the management of various comorbidities in psoriasis patients. Furthermore, inhibitors of TNF have a well-documented potential for triggering new-onset psoriasis when used for other indications (e.g. Crohn's disease or rheumatoid arthritis), while post-marketing data have revealed the same association for ustekinumab. Several other drugs have been connected with psoriasis, but the evidence is less compelling. Smoking and alcohol have been reported to increase the risk for occurrence of psoriasis, but can also affect unfavorably the course of the disease and its response to treatment. Furthermore, exposure to secondhand smoke, especially in childhood, also mediates the risk. Emerging data now suggest that air pollution also has a detrimental effect on skin disease, including psoriasis, but this association needs further investigation. Understanding of the toxic effect of xenobiotics on the initiation and clinical course of psoriasis can contribute to its better control, as it can help with the avoidance of triggering factors and, in some cases, influence the success of pharmacological treatment. It, therefore, has an important place in the comprehensive management of psoriasis.
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Çetinarslan T, Türel Ermertcan A, Temiz P. Dermoscopic clues of palmoplantar hyperkeratotic eczema and palmoplantar psoriasis: A prospective, comparative study of 90 patients. J Dermatol 2020; 47:1157-1165. [PMID: 32691449 DOI: 10.1111/1346-8138.15487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 06/03/2020] [Indexed: 11/30/2022]
Abstract
Diagnosis can be difficult in isolated palmar and plantar lesions in patients with psoriasis and eczema. The purpose of our study is to compare the dermoscopic findings in patients with palmoplantar psoriasis and palmoplantar hyperkeratotic eczema. This prospective, comparative study included 90 patients histopathologically diagnosed with eczema or psoriasis (35 psoriasis and 55 eczema). The age range was 18-75 years. The most common vessel type was dot vessel in psoriasis. Red globular ring vessels were seen in five patients with psoriasis, but not in any with eczema (P = 0.007). The most common vascular distribution pattern was regular in psoriasis (40%). Patchy vascular pattern was significant in eczema. The most common background color was light red in psoriasis (48.6%) (P < 0.001). Brownish-orange globules were observed in 25.7% of patients with eczema and 5.7% in patients with psoriasis (P = 0.02). There is only one study in the published work about dermoscopy of palmoplantar psoriasis and eczema. In our study, yellow crusts, patchy scale distribution, patchy vascular pattern, yellow scale color, dull red background color and brownish-orange globules were significant in patients with palmoplantar eczema. On the other hand, patients with psoriasis had light red background color, regular vascular distribution pattern and white scale color. We observed globule structures with a pale center and dark peripheral rim only in patients with eczema, which was not identified in previous studies. This globule structure may be a new finding in eczema.
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Affiliation(s)
| | - Aylin Türel Ermertcan
- Departments of, Department of, Dermatology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Peyker Temiz
- Department of, Pathology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
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Lee YB, Lee JH, Lee SY, Yu DS, Han KD, Park YG. Association between vitiligo and smoking: A nationwide population-based study in Korea. Sci Rep 2020; 10:6231. [PMID: 32277157 PMCID: PMC7148336 DOI: 10.1038/s41598-020-63384-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/18/2020] [Indexed: 01/23/2023] Open
Abstract
No study has examined the associations between vitiligo and smoking. The purpose of this study was to investigate the incidence of vitiligo according to smoking status. We used clinical data from individuals aged over 20 years who received a health examination in the National Insurance Program between 2009 and 2012 (n = 23,503,807). We excluded individuals with pre-existing vitiligo who had ever been diagnosed with vitiligo before the index year (n = 35,710) or who were diagnosed with vitiligo within a year of the index year (n = 46,476). Newly diagnosed vitiligo was identified using claims data from baseline to date of diagnosis or December 31, 2016 (n = 22,811). The development of vitiligo was compared according to self-reported smoking status by a health examination survey. The hazard ratio of vitiligo in current smokers was 0.69 (95% confidence interval; 0.65-0.72) with a reference of never-smokers after adjustment for age, sex, regular exercise, drinking status, body mass index, diabetes mellitus, hypertension, dyslipidemia, history of stroke, and history of ischemic heart diseases. The decreased risk of vitiligo in current smokers persisted after subgroup analysis of sex and age groups. The results suggested there are suppressive effects of smoking on the development of vitiligo. Further studies are needed to evaluate the mechanism of smoking on the development of vitiligo.
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Affiliation(s)
- Young Bok Lee
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hyun Lee
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Soo Young Lee
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Soo Yu
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung Do Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Gyu Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Thiol/disulphide balance in patients with psoriasis. Postepy Dermatol Alergol 2020; 37:52-55. [PMID: 32467684 PMCID: PMC7247074 DOI: 10.5114/ada.2018.77767] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/08/2018] [Indexed: 01/15/2023] Open
Abstract
Introduction Psoriasis is a common chronic inflammatory skin disease with unknown etiopathogenesis. Aim To examine the thiol/disulfide balance in psoriasis patients and to compare the results with a healthy control group. Material and methods Eighty patients with psoriasis and 80 healthy individuals who were age- and gender-matched with these patients were included in this study. Serum native thiol, disulfide and total thiol levels were measured by a new automated method developed by Erel and Neselioglu. Disulphide/total thiol, disulphide/native thiol and native thiol/total thiol were calculated. Results While there was no statistically significant difference in terms of disulphide levels (SS) between the patient and control groups (p > 0.05), there were significant differences in terms of total thiol and native thiol (SH) levels, SS/SH, SS/total thiol and SH/total thiol ratios between the patient and control groups (p < 0.05). There was a statistically significant relationship between duration of the disease and the disulfide/native thiol ratio (p > 0.05). Conclusions In recent years, there have been few studies on the role of oxidative stress in the etiopathogenesis of psoriasis. In this study, we investigated in psoriasis patients, thiol/disulfide balance as a new oxidative stress marker. The results were compared with a healthy control group. Our results showed that thiol/disulphide balance shifted towards disulphide in psoriasis patients. This is important as a finding that supports the role of oxidative stress in the pathogenesis of psoriasis.
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Bacchetti T, Simonetti O, Ricotti F, Offidani A, Ferretti G. Plasma oxidation status and antioxidant capacity in psoriatic children. Arch Dermatol Res 2019; 312:33-39. [PMID: 31531730 DOI: 10.1007/s00403-019-01976-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 07/16/2019] [Accepted: 08/30/2019] [Indexed: 12/18/2022]
Abstract
Psoriasis, a chronic inflammatory skin disease, is associated with oxidative stress of serum lipoproteins. In psoriatic children we evaluated the activity and levels of myeloperoxidase, the activity of paraoxonase-1 (PON1) and biochemical markers of lipid peroxidation, to investigate wether an unbalance between oxidant-antioxidants occurs very early in psoriasis. A total of 52 patients affected by psoriasis and 48 sex-age-matched healthy controls were enrolled. Serum MPO levels were measured using ELISA method. MPO and PON1 activities (paraoxonase, arylesterase and lactonase) were evaluated by spectroscopic methods. Our results demonstrated a significant increase of MPO levels and activity in psoriatic subjects. PON1 activities were found to be significantly decreased. A positive correlation has been established between the MPO/PON1 ratio and levels of lipid peroxides in all psoriatic patients. These results suggest that an unbalance between MPO and PON1 can reflect in higher oxidative stress in serum lipoproteins.
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Affiliation(s)
- Tiziana Bacchetti
- Department of Life and Environmental Sciences- Biochemistry, Università Politecnica delle Marche, 60100, Ancona, Italy
| | - Oriana Simonetti
- Department of Clinical and Molecular Sciences- Dermatology, Università Politecnica delle Marche, 60100, Ancona, Italy.
| | - Francesca Ricotti
- Department of Clinical and Molecular Sciences- Dermatology, Università Politecnica delle Marche, 60100, Ancona, Italy
| | - Annamaria Offidani
- Department of Clinical and Molecular Sciences- Dermatology, Università Politecnica delle Marche, 60100, Ancona, Italy
| | - Gianna Ferretti
- Department of Clinical Experimental Science and Odontostomatology- Biochemistry, Università Politecnica delle Marche, 60100, Ancona, Italy
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Zhang Y, Li Z, Ma Y, Mu Z. Association of total oxidant status, total antioxidant status, and malondialdehyde and catalase levels with psoriasis: a systematic review and meta-analysis. Clin Rheumatol 2019; 38:2659-2671. [DOI: 10.1007/s10067-019-04676-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/29/2019] [Accepted: 07/03/2019] [Indexed: 12/13/2022]
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14
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Lee Y, Lee J, Lee S, Lee J, Yu D, Han K, Park Y. Association between smoking and Behçet's disease: a nationwide population‐based study in Korea. J Eur Acad Dermatol Venereol 2019; 33:2114-2122. [DOI: 10.1111/jdv.15708] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 05/07/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Y.B. Lee
- Department of Dermatology College of Medicine The Catholic University of Korea Seoul Korea
| | - J.H. Lee
- Department of Dermatology College of Medicine The Catholic University of Korea Seoul Korea
| | - S.Y. Lee
- Department of Dermatology College of Medicine The Catholic University of Korea Seoul Korea
| | - J.H. Lee
- Department of Dermatology College of Medicine The Catholic University of Korea Seoul Korea
| | - D.S. Yu
- Department of Dermatology College of Medicine The Catholic University of Korea Seoul Korea
| | - K.D. Han
- Department of Biostatistics College of Medicine The Catholic University of Korea Seoul Korea
| | - Y.G. Park
- Department of Biostatistics College of Medicine The Catholic University of Korea Seoul Korea
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Skoie IM, Dalen I, Omdal R, Jonsson G. Malondialdehyde and advanced oxidation protein products are not increased in psoriasis: a controlled study. Arch Dermatol Res 2019; 311:299-308. [PMID: 30830309 DOI: 10.1007/s00403-019-01903-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 02/18/2019] [Accepted: 02/25/2019] [Indexed: 12/22/2022]
Abstract
This study investigated oxidative stress in patients with psoriasis of low and medium disease activity. We measured advanced oxidation protein products (AOPP) and malondialdehyde (MDA) in plasma using UV-spectrophotometry and high performance liquid chromatography connected to a fluorescence detector in 84 patients and 84 matched healthy subjects. AOPP is a marker of protein oxidation due to inflammation, whereas MDA is a hydroxyl radical initiated lipid peroxidation product. Clinico-demographic variables including age, gender, disease severity, and fatigue were assessed in relation to AOPP and MDA. Disease severity was evaluated with the Psoriasis Area and Severity Index and the Dermatology Life Quality Index. Median (interquartile range, IQR) AOPP concentrations were 66 µmol/l (IQR 54-102) in patients and 69 µmol/l (IQR 55-87) in healthy subjects (P = 0.75). Median plasma MDA concentrations were significantly lower in patients than in healthy subjects (0.68 µM, IQR 0.54-0.85 vs. 0.76 µM, IQR 0.60-0.97; P = 0.03). Plasma levels of AOPP and MDA did not indicate oxidative stress in patients with mild psoriasis. Higher AOPP concentrations were associated with male gender, high body mass index, and high hemoglobin values. Elevated MDA concentrations were associated with advanced age and male gender. No associations with disease severity were detected. Although, the two selected biomarkers do not provide a complete measure of oxidative damage, our study demonstrates that a number of physiological and methodological factors influence the levels of MDA and AOPP. Such methodological issues are important to consider when interpreting results using these biomarkers in patients with psoriasis.
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Affiliation(s)
- I M Skoie
- Department of Dermatology, Stavanger University Hospital, Stavanger, Norway
| | - I Dalen
- Section of Biostatistics, Research Department, Stavanger University Hospital, Stavanger, Norway
| | - R Omdal
- Clinical Immunology Unit, Department of Internal Medicine, Stavanger University Hospital, PO Box 8100, 4068, Stavanger, Norway. .,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - G Jonsson
- Department of Medical Biochemistry, Stavanger University Hospital, Stavanger, Norway
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Wadhwa D, Mahajan VK, Mehta KS, Chauhan PS, Yadav RS, Bhushan S, Sharma V, Sharma A, Sharma A, Chauhan S. Malondialdehyde, lipoprotein-a, lipoprotein ratios, comprehensive lipid tetrad index and atherogenic index as surrogate markers for cardiovascular disease in patients with psoriasis: a case–control study. Arch Dermatol Res 2019; 311:287-297. [PMID: 30830310 DOI: 10.1007/s00403-019-01896-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Dhaarna Wadhwa
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. GovKangrat. Medical College, Kangra, (Tanda), Himachal Pradesh, 176001, India
| | - Vikram K Mahajan
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. GovKangrat. Medical College, Kangra, (Tanda), Himachal Pradesh, 176001, India.
| | - Karaninder S Mehta
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. GovKangrat. Medical College, Kangra, (Tanda), Himachal Pradesh, 176001, India
| | - Pushpinder S Chauhan
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. GovKangrat. Medical College, Kangra, (Tanda), Himachal Pradesh, 176001, India
| | - Rajinder S Yadav
- Department of Biochemistry, Dr. R. P. Govt. Medical College, Kangra, (Tanda), Himachal Pradesh, 176001, India
| | - Satya Bhushan
- Department of Biochemistry, Dr. R. P. Govt. Medical College, Kangra, (Tanda), Himachal Pradesh, 176001, India
| | - Vikas Sharma
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. GovKangrat. Medical College, Kangra, (Tanda), Himachal Pradesh, 176001, India
| | - Anuj Sharma
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. GovKangrat. Medical College, Kangra, (Tanda), Himachal Pradesh, 176001, India
| | - Aditi Sharma
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. GovKangrat. Medical College, Kangra, (Tanda), Himachal Pradesh, 176001, India
| | - Shailja Chauhan
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. GovKangrat. Medical College, Kangra, (Tanda), Himachal Pradesh, 176001, India
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Kamel AM, Abdelghani R. Carboxytherapy for treatment of localized chronic plaque psoriasis: Clinical and histopathologic evaluation. J Cosmet Dermatol 2018; 17:527-532. [DOI: 10.1111/jocd.12494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Abeer Mostafa Kamel
- Dermatology and Venereology; Faculty of Medicine for Girls; Al-Azhar University; Cairo Egypt
| | - Rania Abdelghani
- Dermatology and Venereology; Faculty of Medicine for Girls; Al-Azhar University; Cairo Egypt
- Armed Forces College of Medicine; Cairo Egypt
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18
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Yamamoto T, Kawada A. Clinical characteristics of Japanese patients with psoriatic arthritis: Comparison with East Asian countries. J Dermatol 2017; 45:273-278. [DOI: 10.1111/1346-8138.14097] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 09/19/2017] [Indexed: 01/20/2023]
Affiliation(s)
- Toshiyuki Yamamoto
- Department of Dermatology; Fukushima Medical University; Fukushima Japan
| | - Akira Kawada
- Department of Dermatology; Faculty of Medicine; Kinki University; Osaka Japan
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Peluso I, Cavaliere A, Palmery M. Plasma total antioxidant capacity and peroxidation biomarkers in psoriasis. J Biomed Sci 2016; 23:52. [PMID: 27377373 PMCID: PMC4932672 DOI: 10.1186/s12929-016-0268-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 06/28/2016] [Indexed: 01/05/2023] Open
Abstract
Systemic biomarkers of oxidative stress can be relevant for assessment of psoriasis severity, for prediction of the outcome of therapy and of the development of comorbidities. In this review we aimed to evaluate the relationship between plasma total antioxidant capacity (TAC) and peroxidation biomarkers, as well as their association with dyslipidemia and systemic inflammation in psoriasis. The review of 59 case–control comparisons (from 41 studies) and 17 interventions (from 13 studies) suggests that peroxidation markers are more sensitive than TAC in the evaluation of oxidative stress in psoriasis. Although few studies investigated the effect of treatment on oxidative stress, it seems that biological drugs could be the better choice in the treatment of psoriasis. However, considering the limitations of TAC and plasma peroxidation markers, this review suggests that new methods should be developed in order to evaluate systemic oxidative stress in psoriasis.
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Affiliation(s)
- Ilaria Peluso
- Center of Nutrition, Council for Agricultural Research and Economics (CREA-NUT), Via Ardeatina 546, Rome, 00178, Italy.
| | - Arturo Cavaliere
- Dermopathic Institute of the Immaculate IDI-IRCCS, Via dei Monti di Creta, 104, Rome, 00167, Italy
| | - Maura Palmery
- Department of Physiology and Pharmacology "V. Erspamer", "Sapienza" University of Rome, P.le Aldo Moro 5, Rome, 00185, Italy
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20
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Severs M, van Erp SJH, van der Valk ME, Mangen MJJ, Fidder HH, van der Have M, van Bodegraven AA, de Jong DJ, van der Woude CJ, Romberg-Camps MJL, Clemens CHM, Jansen JM, van de Meeberg PC, Mahmmod N, Ponsioen CY, Bolwerk C, Vermeijden JR, Pierik MJ, Siersema PD, Leenders M, van der Meulen-de Jong AE, Dijkstra G, Oldenburg B. Smoking is Associated With Extra-intestinal Manifestations in Inflammatory Bowel Disease. J Crohns Colitis 2016; 10:455-61. [PMID: 26721937 PMCID: PMC4946753 DOI: 10.1093/ecco-jcc/jjv238] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 12/18/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Smoking affects the course of disease in patients with ulcerative colitis (UC) and Crohn's disease (CD). We aimed to study the association between smoking and extra-intestinal manifestations (EIMs) in inflammatory bowel disease (IBD). METHODS We cross-sectionally explored the association between smoking and EIMs in IBD in three cohort studies: (1) the COIN study, designed to estimate healthcare expenditures in IBD; (2) the Groningen study, focused on cigarette smoke exposure and disease behaviour in IBD; and (3) the JOINT study, evaluating joint and back manifestations in IBD. RESULTS In the COIN, Groningen and JOINT cohorts, 3030, 797 and 225 patients were enrolled, of whom 16, 24 and 23.5% were current smokers, respectively. Chronic skin disorders and joint manifestations were more prevalent in smoking IBD patients than in non-smokers (COIN, 39.1 vs 29.8%, p <0.01; Groningen, 41.7 vs 30.0%, p <0.01) in both CD and UC. In the JOINT cohort, smoking was more prevalent in IBD patients with joint manifestations than in those without (30.3 vs 13.0%, p <0.01). EIMs appeared to be more prevalent in high- than in low-exposure smokers (56.0 vs 37.1%, p = 0.10). After smoking cessation, the prevalence of EIMs in IBD patients rapidly decreased towards levels found in never smokers (lag time: COIN cohort, 1-2 years; Groningen cohort, within 1 year). CONCLUSIONS There is a robust dose-dependent association between active smoking and EIMs in both CD and UC patients. Smoking cessation was found to result in a rapid reduction of EIM prevalence to levels encountered in never smokers.
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Affiliation(s)
- M. Severs
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - S. J. H. van Erp
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - M. E. van der Valk
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M. J. J. Mangen
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - H. H. Fidder
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M. van der Have
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A. A. van Bodegraven
- Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands,Department of Gastroenterology and Hepatology, Atrium-Orbis Medical Centre, Sittard, The Netherlands
| | - D. J. de Jong
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - C. J. van der Woude
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - M. J. L. Romberg-Camps
- Department of Gastroenterology and Hepatology, Atrium-Orbis Medical Centre, Sittard, The Netherlands
| | - C. H. M. Clemens
- Department of Gastroenterology and Hepatology, Diaconessenhuis, Leiden, The Netherlands
| | - J. M. Jansen
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - P. C. van de Meeberg
- Department of Gastroenterology and Hepatology, Slingeland Hospital, Doetinchem, The Netherlands
| | - N. Mahmmod
- Department of Gastroenterology and Hepatology, Antonius Hospital, Nieuwegein, The Netherlands
| | - C. Y. Ponsioen
- Department of Gastroenterology and Hepatology, Academic Medical Centre Amsterdam, Amsterdam,The Netherlands
| | - C. Bolwerk
- Department of Gastroenterology and Hepatology, Reinier de Graaf Groep, Delft, The Netherlands
| | - J. R. Vermeijden
- Department of Gastroenterology and Hepatology, Meander Medical Centre, Amersfoort, The Netherlands
| | - M. J. Pierik
- Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P. D. Siersema
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M. Leenders
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - G. Dijkstra
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - B. Oldenburg
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
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21
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V A. A STUDY OF CORRELATION BETWEEN SERUM MALONDIALDEHYDE AND THE CLINICAL SEVERITY OF PSORIASIS. ACTA ACUST UNITED AC 2016. [DOI: 10.18410/jebmh/2016/250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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22
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Richer V, Roubille C, Fleming P, Starnino T, McCourt C, McFarlane A, Siu S, Kraft J, Lynde C, Pope JE, Keeling S, Dutz J, Bessette L, Gulliver WP, Haraoui B, Bissonnette R. Psoriasis and Smoking: A Systematic Literature Review and Meta-Analysis With Qualitative Analysis of Effect of Smoking on Psoriasis Severity. J Cutan Med Surg 2015; 20:221-7. [PMID: 26553732 DOI: 10.1177/1203475415616073] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Smoking has been associated with psoriasis prevalence and severity. OBJECTIVE To evaluate prevalence of smoking in patients with psoriasis and to examine the relationship between smoking and psoriasis severity. METHODS MEDLINE, EMBASE, and Cochrane databases (1960-2012) and conference proceedings (2010-2012) were systematically searched using keywords relevant to psoriasis and smoking. Controlled studies addressing psoriasis and smoking status were included. A meta-analysis for the relative risk of smoking in psoriasis patients was performed. RESULTS Meta-analysis identified a significant association between smoking and psoriasis with a relative risk of 1.88 (95% CI, 1.66-2.13) for smoking in patients with psoriasis versus patients without psoriasis. Eight articles of 11 with data on smoking and psoriasis severity suggested that severity increases with smoking status. CONCLUSIONS This literature review is in favor of a positive association between the prevalence of smoking and psoriasis as well as an association between smoking and severity of psoriasis.
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Affiliation(s)
- Vincent Richer
- Department of Medicine, Dermatology Service, St-Luc Hospital, Montreal, Quebec, Canada
| | - Camille Roubille
- University of Montreal Hospital Research Center (CRCHUM), Notre-Dame Hospital, Montreal, Quebec, Canada
| | - Patrick Fleming
- Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Tara Starnino
- Sacré-Coeur Hospital of Montreal, University of Montreal, Montreal, Quebec, Canada
| | - Collette McCourt
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Stephanie Siu
- Division of Rheumatology, Department of Medicine, Western University of Canada, London, Ontario, Canada
| | - John Kraft
- Lynde Dermatology, Markham, Ontario, Canada
| | | | - Janet E Pope
- Division of Rheumatology, Department of Medicine, Western University of Canada, London, Ontario, Canada
| | - Stephanie Keeling
- Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada
| | - Jan Dutz
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Louis Bessette
- Department of Medicine, Rheumatic Disease Unit, Centre Hospitalier Universitaire de Québec (pavillon CHUL), Quebec City, Quebec, Canada
| | - Wayne P Gulliver
- Department of Medicine, Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Boulos Haraoui
- Department of Medicine, Rheumatic Disease Unit, Centre Hospitalier de l'Université de Montréal (CHUM) and Institut de Rhumatologie de Montréal, Montreal, Quebec, Canada
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23
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Roubille C, Richer V, Starnino T, McCourt C, McFarlane A, Fleming P, Siu S, Kraft J, Lynde C, Pope J, Gulliver W, Keeling S, Dutz J, Bessette L, Bissonnette R, Haraoui B. Evidence-based Recommendations for the Management of Comorbidities in Rheumatoid Arthritis, Psoriasis, and Psoriatic Arthritis: Expert Opinion of the Canadian Dermatology-Rheumatology Comorbidity Initiative. J Rheumatol 2015; 42:1767-80. [DOI: 10.3899/jrheum.141112] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2015] [Indexed: 01/04/2023]
Abstract
Objective.Comorbidities such as cardiovascular diseases (CVD), cancer, osteoporosis, and depression are often underrecognized in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or psoriasis (PsO). Recommendations may improve identification and treatment of comorbidities. The Canadian Dermatology-Rheumatology Comorbidity Initiative reviewed the literature to develop practical evidence-based recommendations for management of comorbidities in patients with RA, PsA, and PsO.Methods.Eight main topics regarding comorbidities in RA, PsA, and PsO were developed. MEDLINE, EMBASE, and the Cochrane Library (1960–12/2012), together with abstracts from major rheumatology and dermatology congresses (2010–2012), were searched for relevant publications. Selected articles were analyzed and metaanalyses performed whenever possible. A meeting including rheumatologists, dermatologists, trainees/fellows, and invited experts was held to develop consensus-based recommendations using a Delphi process with prespecified cutoff agreement. Level of agreement was measured using a 10-point Likert scale (1 = no agreement, 10 = full agreement) and the potential effect of recommendations on daily clinical practice was considered. Grade of recommendation (ranging from A to D) was determined according to the Oxford Centre for Evidence-Based Medicine evidence levels.Results.A total of 17,575 articles were identified, of which 407 were reviewed. Recommendations were synthesized into 19 final recommendations ranging mainly from grade C to D, and relating to a large spectrum of comorbidities observed in clinical practice: CVD, obesity, osteoporosis, depression, infections, and cancer. Level of agreement ranged from 80.9% to 95.8%.Conclusion.These practical evidence-based recommendations can guide management of comorbidities in patients with RA, PsA, and PsO and optimize outcomes.
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Sørensen JA, Clemmensen KK, Nixon RL, Diepgen TL, Agner T. Tobacco smoking and hand eczema - is there an association? Contact Dermatitis 2015; 73:326-35. [DOI: 10.1111/cod.12429] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 04/16/2015] [Accepted: 05/02/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Jennifer A. Sørensen
- Department of Dermatology; University of Copenhagen, Bispebjerg Hospital; 2400 Copenhagen NV Denmark
| | - Kim K. Clemmensen
- Department of Dermatology; University of Copenhagen, Bispebjerg Hospital; 2400 Copenhagen NV Denmark
| | - Rosemary L. Nixon
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc.; 3053 Melbourne Australia
| | - Thomas L. Diepgen
- Department of Social Medicine, Occupational and Environmental Dermatology; University Hospital; D-69115, Heidelberg Germany
| | - Tove Agner
- Department of Dermatology; University of Copenhagen, Bispebjerg Hospital; 2400 Copenhagen NV Denmark
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Kinahan CE, Mazloom S, Fernandez AP. Impact of smoking on response to systemic treatment in patients with psoriasis: a retrospective case-control study. Br J Dermatol 2014; 172:428-36. [PMID: 25142556 DOI: 10.1111/bjd.13359] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Smoking is a well-established risk factor for developing psoriasis and is associated with development of more severe disease. Smoking cessation does not appear to result in clinical improvement of psoriasis. Whether smoking in patients with psoriasis impacts response to systemic therapy is unknown. OBJECTIVES To determine whether smokers with psoriasis with or without psoriatic arthritis respond to systemic agents as well as nonsmokers do. METHODS We performed a retrospective review of patients with moderate-to-severe psoriasis with or without psoriatic arthritis seen at our institution, who were either active smokers or nonsmokers, and calculated changes in Physician's Global Assessment (PGA) scores after 3-16 months of systemic treatment. We also calculated the average number of systemic treatments tried per patient. RESULTS Sixty-six patients (46 nonsmokers, 20 smokers) met our inclusion criteria. Changes in PGA scores between baseline and 3-16 months after initiation of systemic treatment did not significantly differ between smokers and nonsmokers, nor did the average number of systemic treatments tried per patient. We detected a borderline significant trend in the percentage of patients who had significant outcomes after treatment, with a higher percentage of patients smoking < 10 cigarettes daily achieving target PGA scores compared with those smoking > 10 cigarettes daily. Limitations of our study include its retrospective nature and the relatively small number of patients meeting our inclusion criteria. CONCLUSIONS In our retrospectively studied cohort, smoking did not affect response to systemic treatment in patients with psoriasis. A prospective study examining the complex relationship between smoking, psoriasis and response to systemic therapy is warranted to explore this association better.
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Affiliation(s)
- C E Kinahan
- Royal College of Surgeons, 123 St Stephen's Green, Dublin 2, Ireland
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26
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Højgaard P, Glintborg B, Hetland ML, Hansen TH, Lage-Hansen PR, Petersen MH, Holland-Fischer M, Nilsson C, Loft AG, Andersen BN, Adelsten T, Jensen J, Omerovic E, Christensen R, Tarp U, Østgård R, Dreyer L. Association between tobacco smoking and response to tumour necrosis factor α inhibitor treatment in psoriatic arthritis: results from the DANBIO registry. Ann Rheum Dis 2014; 74:2130-6. [PMID: 25063827 DOI: 10.1136/annrheumdis-2014-205389] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 07/11/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To investigate the association between tobacco smoking and disease activity, treatment adherence and treatment responses among patients with psoriatic arthritis (PsA) initiating the first tumour necrosis factor α inhibitor therapy (TNFi) in routine care. METHODS Observational cohort study based on the Danish nationwide DANBIO registry. Kaplan-Meier plots, logistic and Cox regression analyses by smoking status (current/previous/never smoker) were calculated for treatment adherence, ACR20/50/70-responses and EULAR-good-response. Additional stratified analyses were performed according to gender and TNFi-subtype (adalimumab/etanercept/infliximab). RESULTS Among 1388 PsA patients included in the study, 1148 (83%) had known smoking status (33% current, 41% never and 26% previous smokers). Median follow-up time was 1.22 years (IQR 0.44-2.96). At baseline, current smokers had lower Body Mass Index (27 kg/m(2) (23-30)/28 kg/m(2) (24-31)) (median (IQR)), shorter disease duration (3 years (1-8)/5 years (2-10)), lower swollen joint count (2 (0-5)/3 (1-6)), higher visual-analogue-scale (VAS) patient global (72 mm (54-87)/68 mm (50-80)), VAS fatigue (72 mm (51-86)/63 mm (40-77)) and Health Assessment Questionnaire (HAQ) score (1.1 (0.7 to 1.5)/1.0 (0.5 to 1.5)) than never smokers (all p<0.05). Current smokers had shorter treatment adherence than never smokers (1.56 years (0.97 to 2.15)/2.43 years (1.88 to 2.97), (median (95% CI)), log rank p=0.02) and poorer 6 months' EULAR-good-response rates (23%/34%), ACR20 (24%/33%) and ACR50 response rates (17%/24%) (all p<0.05), most pronounced in men. In current smokers, the treatment adherence was poorer for infliximab (HR) 1.62, 95% CI 1.06 to 2.48) and etanercept (HR 1.74, 1.14 to 2.66) compared to never smokers, but not for adalimumab (HR 0.80, 0.52 to 1.23). CONCLUSION In PsA, smokers had worse baseline patient-reported outcomes, shorter treatment adherence and poorer response to TNFi's compared to non-smokers. This was most pronounced in men and in patients treated with infliximab or etanercept.
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Affiliation(s)
- Pil Højgaard
- Department of Rheumatology, Gentofte Hospital, Copenhagen, Denmark Department of Rheumatology, Frederiksberg Hospital, Copenhagen, Denmark
| | - Bente Glintborg
- Department of Rheumatology, Gentofte Hospital, Copenhagen, Denmark Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Glostrup, Denmark The Danish Rheumatologic Database (DANBIO), Copenhagen University Hospital Glostrup, Denmark
| | - Merete Lund Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Glostrup, Denmark The Danish Rheumatologic Database (DANBIO), Copenhagen University Hospital Glostrup, Denmark Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | - Christine Nilsson
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Anne Gitte Loft
- Department of Rheumatology, Vejle Sygehus, Sygehus Lillebælt, Vejle, Denmark
| | | | - Thomas Adelsten
- Department of Rheumatology, Helsingør and Hillerød Hospital, Hillerød, Denmark
| | - Jørgen Jensen
- Department of Rheumatology, Køge Hospital, Køge, Denmark
| | - Emina Omerovic
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Glostrup, Denmark
| | | | - Ulrik Tarp
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - René Østgård
- Department of Rheumatology, Silkeborg Hospital, Denmark
| | - Lene Dreyer
- Department of Rheumatology, Gentofte Hospital, Copenhagen, Denmark The Danish Rheumatologic Database (DANBIO), Copenhagen University Hospital Glostrup, Denmark
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Coimbra S, Santos-Silva A. Biomarkers of psoriasis severity and therapy monitoring. World J Dermatol 2014; 3:15-27. [DOI: 10.5314/wjd.v3.i2.15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/13/2014] [Accepted: 02/18/2014] [Indexed: 02/06/2023] Open
Abstract
Psoriasis is a chronic, recurrent inflammatory cutaneous disease. Psoriasis patients alternate between periods of remission and periods of exacerbation of the disease. Usually, psoriasis severity is clinically evaluated using tools like Psoriasis Area and Severity Index that present some limitations and subjectivity. Clinicians select the therapy according to psoriasis severity, aiming that patients achieve longer remission periods and improve their quality of life. Biological markers for diagnosis and prognosis of psoriasis help to establish its severity and to monitor the therapeutic response; moreover, biomarkers of psoriasis assist clinicians in their therapeutic decision to treat psoriasis and to choose earlier and more adequate therapeutic strategies, avoiding or minimising worsening of psoriasis. With these markers, they would be able to monitor therapeutics, avoiding unnecessary therapeutic surcharge or changes to a more aggressive therapy. As any attempt to identify these biomarkers should be encouraged, in this review, we will debate published data concerning the proposal of biomarkers to evaluate severity and response to treatment of psoriasis vulgaris.
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The role of T helper (TH)17 cells as a double-edged sword in the interplay of infection and autoimmunity with a focus on xenobiotic-induced immunomodulation. Clin Dev Immunol 2013; 2013:374769. [PMID: 24151516 PMCID: PMC3787652 DOI: 10.1155/2013/374769] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 06/04/2013] [Accepted: 06/22/2013] [Indexed: 12/18/2022]
Abstract
Extensive research in recent years suggests that exposure to xenobiotic stimuli plays a critical role in autoimmunity induction and severity and that the resulting response would be exacerbated in individuals with an infection-aroused immune system. In this context, heavy metals constitute a prominent category of xenobiotic substances, known to alter divergent immune cell responses in accidentally and occupationally exposed individuals, thereby increasing the susceptibility to autoimmunity and cancer, especially when accompanied by inflammation-triggered persistent sensitization. This perception is learned from experimental models of infection and epidemiologic studies and clearly underscores the interplay of exposure to such immunomodulatory elements with pre- or postexposure infectious events. Further, the TH17 cell subset, known to be associated with a growing list of autoimmune manifestations, may be the “superstar” at the interface of xenobiotic exposure and autoimmunity. In this review, the most recently established links to this nomination are short-listed to create a framework to better understand new insights into TH17's contributions to autoimmunity.
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Effect of the systemic use of methotrexate on the oxidative stress and paraoxonase enzyme in psoriasis patients. Arch Dermatol Res 2013; 305:495-500. [PMID: 23660995 DOI: 10.1007/s00403-013-1366-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 04/19/2013] [Accepted: 04/30/2013] [Indexed: 12/25/2022]
Abstract
Previous studies have indicated that oxidative stress contributes in the efficacy and toxicity of methotrexate (MTX) treatment. The present study aims to investigate the systemic MTX treatments impact on the total oxidant and antioxidant status of the patients with psoriasis. A total of 26 psoriasis patients were included in the study. Serum total oxidant status (TOS), total antioxidant status (TAS), and serum paraoxonase enzyme (PON) levels were measurement of all patients, and Oxidative Stress Index (OSI) were calculated before and after 8 weeks of MTX therapy. Psoriasis Area Severity Index scores of the patients decreased significantly after MTX treatment. While the serum concentrations of total cholesterol, low density lipoprotein, and high density lipoprotein decreased significantly, the serum ALT levels of the patients increased significantly after MTX treatment. There was no statistically significant alteration in serum levels of PON, TAS, TOS, and OSI after the MTX therapy. The oxidative stress emerging with 8-week MTX treatment is not significantly increased in the patients. In parallel with the decreasing inflammation by MTX treatment in patients with psoriasis, a decrease in oxidative stress (OS) is also expected. However, the expected reduction in OS might have been precluded by MTX-induced OS, which resulted in no significant difference between pre- and post-treatment values of OS parameters in our study. There is a possibility that the 8-week results may change with longer treatment durations and higher cumulative doses.
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Epidemiology and Natural History of Psoriatic Arthritis: an UpdateWhat Dermatologists Need to Know. CURRENT DERMATOLOGY REPORTS 2013. [DOI: 10.1007/s13671-012-0032-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Bens G, Maccari F, Estève É. Psoriasis : une maladie systémique. Presse Med 2012; 41:338-48. [DOI: 10.1016/j.lpm.2011.09.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Revised: 08/28/2011] [Accepted: 09/28/2011] [Indexed: 12/14/2022] Open
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Li W, Han J, Choi HK, Qureshi AA. Smoking and risk of incident psoriasis among women and men in the United States: a combined analysis. Am J Epidemiol 2012; 175:402-13. [PMID: 22247049 DOI: 10.1093/aje/kwr325] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The authors evaluated the association between smoking and the incidence of psoriasis among 185,836 participants from a cohort of older women (the Nurses' Health Study, 1996-2008), a cohort of younger women (the Nurses' Health Study II, 1991-2005), and a cohort of men (Health Professionals' Follow-up Study, 1986-2006). Information on smoking was collected biennially during follow-up. The authors identified a total of 2,410 participants with incident psoriasis. Compared with never smokers, past smokers had a relative risk of incident psoriasis of 1.39 (95% confidence interval (CI): 1.27, 1.52) and current smokers had a relative risk of 1.94 (95% CI: 1.64, 2.28). For current smokers who smoked 1-14 cigarettes/day, the relative risk was 1.81 (95% CI: 1.38, 2.36); for those who smoked 15-24 cigarettes/day, the relative risk was 2.04 (95% CI: 1.68, 2.47); and for those who smoked 25 or more cigarettes/day, the relative risk was 2.29 (95% CI: 1.74, 3.01). There was a trend toward an increased risk of psoriasis with increasing pack-years or duration of smoking (P(trend) < 0.0001). The risk was highest among smokers who had 65 or more pack-years of smoking (relative risk = 2.72, 95% CI: 2.05, 3.60) and among those with a smoking duration of 30 or more years (relative risk = 1.99, 95% CI: 1.75, 2.25). The authors observed a graded reduction of risk with an increase in time since smoking cessation (P(trend) <0.0001). In this study, smoking was found to be an independent risk factor for psoriasis in both women and men. Psoriasis risk was particularly augmented for heavy smokers and persons with longer durations of smoking.
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Affiliation(s)
- Wenqing Li
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Umar N, Schöllgen I, Terris DD. It is not always about gains: utilities and disutilities associated with treatment features in patients with moderate-to-severe psoriasis. Patient Prefer Adherence 2012; 6:187-94. [PMID: 22536054 PMCID: PMC3333813 DOI: 10.2147/ppa.s29285] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Patient-centered care has been proposed as a strategy for improving treatment outcomes in the management of psoriasis and other chronic diseases. A more detailed understanding of patients' utilities and disutilities associated with treatment features may facilitate shared decision-making in the clinical encounter. The purpose of this study was to examine the features of psoriasis treatment that are most and least preferred by patients and to identify correlates of these preferences. METHODS A cross-sectional survey of 163 patients with moderate-to-severe psoriasis was conducted in a German academic medical center. We assessed patients' characteristics, elicited their preferences for a range of potential treatment features, and quantified preference scores (utilities) associated with each treatment feature using hierarchical Bayes estimation. After identifying the most and least preferred treatment features, we explored correlates of these preferences using multivariate regression models. RESULTS Mean preference scores (MPS) for the least preferred treatment features were consistently greater than those for the most preferred treatment features. Patients generally expressed strong preferences against prolonged treatments in the inpatient setting (MPS = -13.48) and those with a lower probability of benefit (MPS = -12.28), while treatments with a high probability of benefit (MPS = 10.51) were generally preferred. Younger patients and women were more concerned with treatment benefit as compared with older patients and men. CONCLUSION Both negative and positive preferences appear important for shared decision-making. Recognition of characteristics associated with strong negative preferences may be particularly useful in promoting patient-centered environments.
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Affiliation(s)
- Nasir Umar
- Mannheim Institute of Public Health, Social and Preventive Medicine, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Correspondence: Nasir Umar, Mannheim Institute of Public Health, Social and Preventive Medicine, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg, Ludolf-Krehl-Strasse 7–11, 68167 Mannheim, Germany, Tel +49 62 1383 9922, Fax +49 62 1383 9920, Email
| | - Ina Schöllgen
- Mannheim Institute of Public Health, Social and Preventive Medicine, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Darcey D Terris
- Mannheim Institute of Public Health, Social and Preventive Medicine, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA
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Abstract
OBJECTIVES Psoriatic arthritis (PsA) is an inflammatory arthritis that is associated with psoriasis. Previous studies have found an association between smoking and psoriasis, but the association with PsA is unclear. The authors aimed to evaluate the association between smoking and the risk of incident PsA in a large cohort of women. METHODS 94 874 participants were included from the Nurses' Health Study II over a 14-year period (1991-2005). Information on smoking was collected biennially during follow-up. The incidence of clinician-diagnosed PsA was ascertained and confirmed by self-reported questionnaires. RESULTS During 1 303 970 person-years' follow-up, the authors identified 157 incident PsA cases. Among total participants, smoking was associated with an elevated risk of incident PsA. Compared with never smokers, the RR was 1.54 for past smokers (95% CI 1.06 to 2.24) and 3.13 for current smokers (95% CI 2.08 to 4.71). With increasing smoking duration or pack-years, the risk of PsA increased monotonically (p for trend <0.0001). The increase in risk was particularly significant for PsA cases with more severe phenotypes. Secondary analysis among participants developing psoriasis during the follow-up replicated the association, demonstrating an increased risk of PsA among psoriasis cases. The risk was significant for those with higher cumulative measures of smoking or PsA cases with more severe phenotypes. CONCLUSION In this study smoking was found to be associated with a risk of PsA and cumulative measures of smoking were also associated with a higher risk of PsA among women.
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Affiliation(s)
- Wenqing Li
- Department of Dermatology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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Kütting B, Uter W, Weistenhöfer W, Baumeister T, Drexler H. Does Smoking Have a Significant Impact on Early Irritant Hand Dermatitis in Metal Workers? Dermatology 2011; 222:375-80. [DOI: 10.1159/000329433] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 04/24/2011] [Indexed: 11/19/2022] Open
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