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Lin TL, Fan YH, Chang YL, Ho HJ, Wu CY, Chen YJ. The epidemiology of pediatric psoriasis: A nationwide cohort study in Taiwan. J Dermatol 2024; 51:48-55. [PMID: 37870277 DOI: 10.1111/1346-8138.16996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/09/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023]
Abstract
Psoriasis can affect individuals of all age groups. While the epidemiology of psoriasis in adults has been extensively studied, there is limited research specifically investigating pediatric cases. This study aimed to investigate the prevalence and incidence of skin psoriasis (PsO) and psoriatic arthritis (PsA) among pediatric patients in Taiwan. A nationwide cohort of 17 535 patients with psoriatic diseases under the age of 18 was enrolled from the National Health Insurance Research Database for the period 2000-2013, including 16 129 PsO patients and 2022 PsA patients. The age- and sex-standardized prevalence and incidence of pediatric PsO and PsA were calculated. The 2007 yearly reports of age- and sex-specific distribution of the general population was adopted as a standard. The results showed that between 2000 and 2013, the prevalence for pediatric PsO increased from 0.03% to 0.07%, and from 0.003% to 0.014% for pediatric PsA. During the same period, the incidence slightly decreased from 19.81 to 17.55 per 100 000 for pediatric PsO but increased from 1.02 to 5.06 per 100 000 for pediatric PsA. Adolescents (12 to <18 years) had higher prevalence and incidence rates of PsO and PsA than children (aged ≤ 12 years), with no sex difference observed in either age group. PsA preceding PsO was more common among children than adolescents (27.07% vs. 13.46%). This study provides important insights into the prevalence and incidence of psoriatic diseases in the pediatric population. Further research is needed to identify risk factors for pediatric psoriasis and to investigate its long-term health outcomes.
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Affiliation(s)
- Teng-Li Lin
- Department of Dermatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- Ph.D. Program of Interdisciplinary Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Hsuan Fan
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yi-Ling Chang
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsiu J Ho
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chun-Ying Wu
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Translational Research, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Public Health, China Medical University, Taichung, Taiwan
| | - Yi-Ju Chen
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
- Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, National Chung-Hsing University, Taichung, Taiwan
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Nikolaishvili M, Di Lernia V. Biological therapies for the treatment of psoriasis in pediatrics. Expert Opin Biol Ther 2023; 23:1219-1226. [PMID: 37936485 DOI: 10.1080/14712598.2023.2281496] [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: 10/03/2023] [Accepted: 11/06/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Psoriasis is a multifactorial, immune-mediated condition with predominant skin involvement. It may develop at any age. In one-third of patients, the first symptoms of psoriasis start during childhood or adolescence. A marked impairment of the quality of life of patients and their caregivers is often associated. AREAS COVERED Databases including PubMed and Clinicaltrials.gov were used to identify clinical studies involving pediatric patients with psoriasis. In the last few years, the implementation of therapy with drugs targeting cytokines like interleukin (IL)-12/23 and IL-17A has expanded the number of available therapeutic options in pediatric psoriasis. This review focuses on the latest evidence on the clinical efficacy and safety profile of drugs licensed for severe pediatric psoriasis. EXPERT OPINION Increasing knowledge about the pathogenetic mechanisms underlying pediatric psoriasis is leading to an improvement in disease management. Effective treatment is crucial in patients affected with moderate to severe disease to reduce the burden of the disease and avoid stigmatization. The treatment of pediatric psoriasis remains challenging for specific clinical subtypes, when difficult areas are involved, after resistance to multiple treatments, and when psoriatic arthritis is associated. A personalized approach and a thorough understanding of the disease are required to advance pediatric psoriasis care.
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Affiliation(s)
- Mariam Nikolaishvili
- Faculty of Medicine, Ivane Javakhishvili, Tbilisi State University, Tbilisi, Georgia
| | - Vito Di Lernia
- Dermatology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Atak MF, Kundakci N, Farabi B. Link between childhood tobacco exposure and childhood psoriasis: A case-control study. Pediatr Dermatol 2022; 39:49-54. [PMID: 34918783 DOI: 10.1111/pde.14896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 12/04/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Childhood psoriasis is not uncommon, and its prevalence is estimated to be 128 per 100,000 children. There are sparse data regarding intrauterine and environmental tobacco smoke exposure and the development of psoriasis in childhood. In this study, we aimed to investigate these parameters in the Turkish pediatric population. MATERIALS AND METHODS We included 130 children with psoriasis and 390 children as controls. For each risk factor, odds ratios of psoriasis as an estimate of relative risks and corresponding 95% confidence interval were calculated. Univariate conditional logistic regression analysis was used to determining the crude odds ratio. Subsequently, to evaluate the effects of potential confounding factors, multivariate conditional logistic regression analysis was used. RESULTS Childhood psoriasis (CP) was found to be associated with environmental tobacco smoke exposure irrespective of intrauterine smoking exposure, family history of psoriasis, and obesity (OR: 2.23, 95% CI = 1.39-3.58), whereas multiple logistic regression analysis did not show a relationship between CP and intrauterine tobacco exposure (OR: 1.61, 95% CI = 0.75-3.43). CONCLUSIONS Environmental tobacco smoke exposure at home denotes an important preventable risk factor for developing CP. Further studies are needed to elucidate the relationship between CP and environmental tobacco exposure investigating a large cohort of CP patients who have been diagnosed by expert dermatologists.
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Affiliation(s)
| | - Nihal Kundakci
- Dermatology Department, Ankara University, Ankara, Turkey
| | - Banu Farabi
- Internal Medicine Department, Saint Peter's University Hospital, New Brunswick, New Jersey, USA
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Katakam BK, Munisamy M, Rao TN, Chiramel MJ, Panda M, Gupta S, PSS R, Seetharam KA. Recommendations for Management of Childhood Psoriasis. Indian Dermatol Online J 2021; 12:S71-S85. [PMID: 34976883 PMCID: PMC8664175 DOI: 10.4103/idoj.idoj_965_20] [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: 02/14/2021] [Revised: 03/09/2021] [Accepted: 05/22/2021] [Indexed: 12/17/2022] Open
Abstract
Childhood psoriasis is recognized as a potential multisystem disorder and hence it is imperative to optimize disease management to arrest progression, minimize psychological burden and evolution of metabolic syndrome. Clinical practice recommendations are necessary to assist practitioners in appropriate decision making based on available evidence. Owing to the lack of Indian recommendations on childhood psoriasis, the SIG Pediatric Dermatology under IADVL Academy undertook an evidence-based approach based on published literature on the topic, between January 2000 and July 2020 to frame the recommendations.
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Affiliation(s)
- Bhumesh Kumar Katakam
- Dermatology, Venereology and Leprology, Gandhi Medical College, Secunderabad, Telangana, India
| | - Malathi Munisamy
- Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | | | | | - Maitreyee Panda
- Dermatology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Sandeep Gupta
- Consultant Dermatologist, Balaji Skin Clinic, New Delhi, India
| | - Ranugha PSS
- Dermatology, JSS Medical College and Hospital, JSSAHER, Mysore, Karnataka, India
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Abstract
SUMMARY Exposure to air pollutants has been now associated with detrimental effects on a variety of organs, including the heart, lungs, GI tract, and brain. However, recently it has become clear that pollutant exposure can also promote the development/exacerbation of a variety of skin conditions, including premature aging, psoriasis, acne, and atopic dermatitis. Although the molecular mechanisms by which pollutant exposure results in these cutaneous pathological manifestations, it has been noticed that an inflammatory status is a common denominator of all those skin conditions. For this reason, recently, the activation of a cytosolic multiprotein complex involved in inflammatory responses (the inflammasome) that could promote the maturation of proinflammatory cytokines interleukin-1β and interleukin-18 has been hypothesized to play a key role in pollution-induced skin damage. In this review, we summarize and propose the cutaneous inflammasome as a novel target of pollutant exposure and the eventual usage of inflammasome inhibitor as new technologies to counteract pollution-induced skin damage. Possibly, the ability to inhibit the inflammasome activation could prevent cutaneous inflammaging and ameliorate the health and appearance of the skin.
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Groot J, Nybo Andersen AM, Blegvad C, Pinot de Moira A, Skov L. Prenatal, infantile, and childhood tobacco exposure and risk of pediatric psoriasis in the Danish National Birth Cohort offspring. J Am Acad Dermatol 2020; 83:1625-1632. [DOI: 10.1016/j.jaad.2019.09.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/22/2019] [Accepted: 09/10/2019] [Indexed: 12/14/2022]
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Ziyab AH, Karmaus W, AlShatti KA, Al-Kandari M, Hussein SH, Ali YM. Psoriasis Among Adolescents in Kuwait and the Role of Siblings, Breastfeeding, and Household Cat and Secondhand Smoke Exposure: A Cross-Sectional Study. Dermatol Ther (Heidelb) 2020; 10:1137-1153. [PMID: 32844373 PMCID: PMC7477028 DOI: 10.1007/s13555-020-00437-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Indexed: 10/29/2022] Open
Abstract
INTRODUCTION Globally, the epidemiology of psoriasis is poorly understood, and most countries lack essential epidemiologic data regarding disease burden and its determinants. This study sought to estimate the prevalence of psoriasis among adolescents in Kuwait and assess its association with different risk factors, including obesity, sibship size, breastfeeding, and exposure to household secondhand smoke (SHS) and pets. METHODS Schoolchildren aged 11-14 years (n = 3864) were enrolled in a cross-sectional study. Lifetime and current (past 12 months) prevalence of psoriasis were ascertained according to ever having a history of doctor-diagnosis plus current active lesion(s) and/or current use of treatment of psoriasis. Associations were assessed using Poisson regression with robust variance estimation, and adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) were estimated. RESULTS The lifetime and current prevalence of psoriasis were estimated to be 3.6% (136/3806) and 1.1% (42/3806), respectively. Commonly reported anatomical sites affected by psoriasis included scalp (47.6%) and the extensor surface of the knees (50%) and elbows (38.1%). Household SHS exposure was associated with increased lifetime psoriasis (aPR = 1.41, 95% CI 1.07-1.98), and showed a trend for association with current psoriasis (1.77, 0.89-3.53). Similarly, cat-keeping during infancy was associated with lifetime psoriasis (1.96, 1.14-3.37), and demonstrated a trend for association with current psoriasis (1.49, 0.52-1.98). In contrast, breastfeeding was associated with a decreased lifetime psoriasis (0.62, 0.44-0.89), but was not associated with current psoriasis. Trend analyses showed that the prevalence of lifetime and current psoriasis increased with increasing numbers of total, older, and younger siblings. CONCLUSIONS Psoriasis affects a considerable proportion of schoolchildren in Kuwait. Interestingly, psoriasis prevalence was related to risk factors also found in allergic diseases, such as exposure to SHS, cat-keeping in infancy, breastfeeding, and sibship size, possibly suggesting a role of immune dysregulation.
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Affiliation(s)
- Ali H Ziyab
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.
| | - Wilfried Karmaus
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | | | - Manal Al-Kandari
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Shaimaa H Hussein
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Yaser M Ali
- Department of Internal Medicine, Mubarak Al-Kabeer Hospital, Ministry of Health, Kuwait City, Kuwait
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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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Wong A, Frøslev T, Forbes H, Kjærsgaard A, Mulick A, Mansfield K, Silverwood R, Sørensen H, Smeeth L, Schmidt S, Langan S. Partner bereavement and risk of psoriasis and atopic eczema: cohort studies in the U.K. and Denmark. Br J Dermatol 2020; 183:321-331. [PMID: 31782133 PMCID: PMC7496681 DOI: 10.1111/bjd.18740] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Stress is commonly cited as a risk factor for psoriasis and atopic eczema, but such evidence is limited. OBJECTIVES To investigate the association between partner bereavement (an extreme life stressor) and psoriasis or atopic eczema. METHODS We conducted cohort studies using data from the U.K. Clinical Practice Research Datalink (1997-2017) and Danish nationwide registries (1997-2016). The exposed cohort was partners who experienced partner bereavement. The comparison cohort was up to 10 nonbereaved partners, matched to each bereaved partner by age, sex, county of residence (Denmark) and general practice (U.K.). Outcomes were the first recorded diagnosis of psoriasis or atopic eczema. We estimated hazard ratios (HRs) and confidence intervals (CIs) using a stratified Cox proportional hazards model in both settings, which were then pooled in a meta-analysis. RESULTS The pooled adjusted HR for the association between bereavement and psoriasis was 1·01 (95% CI 0·98-1·04) across the entire follow-up. Similar results were found in other shorter follow-up periods. Pooled adjusted HRs for the association between bereavement and atopic eczema were 0·97 (95% CI 0·84-1·12) across the entire follow-up, 1·09 (95% CI 0·86-1·38) within 0-30 days, 1·18 (95% CI 1·04-1·35) within 0-90 days, 1·14 (95% CI 1·06-1·22) within 0-365 days and 1·07 (95% CI 1·02-1·12) within 0-1095 days. CONCLUSIONS We found a modest increase in the risk of atopic eczema within 3 years following bereavement, which peaked in the first 3 months. Acute stress may play a role in triggering onset of new atopic eczema or relapse of atopic eczema previously in remission. We observed no evidence for increased long-term risk of psoriasis and atopic eczema following bereavement.
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Affiliation(s)
- A.Y.S. Wong
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonU.K
| | - T. Frøslev
- Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
| | - H.J. Forbes
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonU.K
- Health Data Research U.K.LondonU.K
| | - A. Kjærsgaard
- Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
| | - A. Mulick
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonU.K
| | - K. Mansfield
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonU.K
| | - R.J. Silverwood
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonU.K
- Centre for Longitudinal StudiesDepartment of Social ScienceUniversity College LondonLondonU.K
| | - H.T. Sørensen
- Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
| | - L. Smeeth
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonU.K
- Health Data Research U.K.LondonU.K
| | - S.A.J. Schmidt
- Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
- Department of DermatologyAarhus University HospitalAarhusDenmark
| | - S.M. Langan
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonU.K
- Health Data Research U.K.LondonU.K
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Blegvad C, Nybo Andersen AM, Groot J, Zachariae C, Barker J, Skov L. Clinical characteristics including cardiovascular and metabolic risk factors in adolescents with psoriasis. J Eur Acad Dermatol Venereol 2020; 34:1516-1523. [PMID: 31989688 DOI: 10.1111/jdv.16229] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Clinical studies on psoriasis in adolescents have mainly been performed in patients with severe psoriasis. Population-based studies of clinical characteristics and risk factors for later cardiovascular and metabolic disease in children and adolescents are lacking. OBJECTIVES To examine the clinical characteristics of adolescents with psoriasis nested in a general population cohort. Furthermore, to investigate cardiovascular and metabolic risk factors in the adolescents with psoriasis compared to parentally predisposed and non-predisposed adolescents without psoriasis from the same birth cohort. METHODS We identified adolescents with and without psoriasis using a nationwide general population birth cohort in Denmark. A clinical examination included skin inspection and scoring of psoriasis severity, completion of a questionnaire on psoriasis and comorbidities, physical measurements, and blood sampling. Participants also completed self-administered questionnaires on quality of life and mental health. RESULTS We included 81 adolescents with psoriasis and 234 controls (110 with genetic predisposition for psoriasis and 124 without predisposition). Median age was 15.6 (13.5-18.5) years, and in those with active psoriasis, median Psoriasis Area and Severity Index score was 1.2 (0.1-11.4). The scalp was the most common site of psoriasis, both at debut and at time of examination. Diaper rash in infancy was more frequent in the psoriasis group. No significant differences regarding quality of life, anxiety and depression were found. More adolescents with psoriasis were obese (8.6% vs. 1.7%, P = 0.008), and physical measures of abdominal obesity were also significantly higher. HbA1c was significantly higher (31.55 vs. 30.81 mmol/mol, P = 0.048), while no differences were found for blood pressure, lipids or high-sensitivity C-reactive protein. In a subgroup analysis, this was evident in the non-predisposed psoriasis-free controls only. CONCLUSIONS Overall, adolescents with psoriasis from this general population had mild disease. Still, early markers of cardiovascular and metabolic disease were elevated.
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Affiliation(s)
- C Blegvad
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - A-M Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - J Groot
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - C Zachariae
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J Barker
- St John's Institute of Dermatology, King's College London, London, UK
| | - L Skov
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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Menter A, Cordoro KM, Davis DM, Kroshinsky D, Paller AS, Armstrong AW, Connor C, Elewski BE, Gelfand JM, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kiselica M, Kivelevitch D, Korman NJ, Lebwohl M, Leonardi CL, Lichten J, Lim HW, Mehta NN, Parra SL, Pathy AL, Farley Prater EA, Rupani RN, Siegel M, Stoff B, Strober BE, Wong EB, Wu JJ, Hariharan V, Elmets CA. Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients. J Am Acad Dermatol 2020; 82:161-201. [DOI: 10.1016/j.jaad.2019.08.049] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 12/29/2022]
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Prieux R, Eeman M, Rothen-Rutishauser B, Valacchi G. Mimicking cigarette smoke exposure to assess cutaneous toxicity. Toxicol In Vitro 2019; 62:104664. [PMID: 31669394 DOI: 10.1016/j.tiv.2019.104664] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/19/2019] [Accepted: 09/22/2019] [Indexed: 12/24/2022]
Abstract
Cigarette smoke stands among the most toxic environmental pollutants and is composed of thousands of chemicals including polycyclic aromatic hydrocarbons (PAHs). Despite restrict cigarette smoking ban in indoor or some outdoor locations, the risk of non-smokers to be exposed to environmental cigarette smoke is not yet eliminated. Beside the well-known effects of cigarette smoke to the respiratory and cardiovascular systems, a growing literature has shown during the last 3 decades its noxious effects also on cutaneous tissues. Being the largest organ as well as the interface between the outer environment and the body, human skin acts as a natural shield which is continuously exposed to harmful exogenous agents. Thus, a prolonged and/or repetitive exposure to significant levels of toxic smoke pollutants may have detrimental effects on the cutaneous tissue by disrupting the epidermal barrier function and by exacerbating inflammatory skin disorders (i.e. psoriasis, atopic dermatitis). With the development of very complex skin tissue models and sophisticated cigarette smoke exposure systems it has become important to better understand the toxicity pathways induced by smoke pollutants in more realistic laboratory conditions to find solutions for counteracting their effects. This review provides an update on the skin models currently available to study cigarette smoke exposure and the known pathways involved in cutaneous toxicity. In addition, the article will briefly cover the inflammatory skin pathologies potentially induced and/or exacerbated by cigarette smoke exposure.
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Affiliation(s)
- Roxane Prieux
- Department of Biomedical and Specialist Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Marc Eeman
- Home & Personal Care, Dow Silicones Belgium, Seneffe, Belgium
| | | | - Giuseppe Valacchi
- Department of Biomedical and Specialist Surgical Sciences, University of Ferrara, Ferrara, Italy; Plants for Human Health Institute, North Carolina State University, Kannapolis, United States; Department of Food and Nutrition, Kyung Hee University, Seoul, South Korea.
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Shreberk-Hassidim R, Galili E, Hassidim A, Ramot Y, Merdler I, Baum S, Zlotogorski A, Barzilai A, Astman N. Epidemiology and Comorbidities of Psoriasis among Israeli Adolescents: A Large Cross-Sectional Study. Dermatology 2019; 235:488-494. [PMID: 31390627 DOI: 10.1159/000501032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/19/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Although psoriasis can develop at any age, the data regarding its characteristics in adolescents are sparse. This study was designed to determine the psoriasis prevalence and its associations with the body mass index (BMI), lipid profile, and comorbidities in adolescents. METHODS This was a nationwide population-based cross-sectional retrospective study of adolescents (16-18 years old) evaluated for military service between January 1999 and January 2014. RESULTS Our database included 887,765 adolescents (57.1% males), of whom 3,112 (0.35%) were diagnosed with psoriasis. During the 15-year study period, the psoriasis prevalence increased by 1.4-fold, from 0.3 to 0.42% (1.25-fold for the males and 1.63-fold for the females). Certain comorbidities, such as contact dermatitis, hyperhidrosis, and arthritis, were significantly associated with psoriasis (odds ratios [ORs] of 2.26, 1.51, and 5.3, respectively). The adolescents with psoriasis had significantly elevated BMI and triglyceride values. We found increased ORs of 1.34 (95% confidence interval [CI] = 1.25-1.56) and 1.56 (95% CI = 1.32-1.83) for the overweight and obese adolescents, respectively, while a lower BMI (<20) had an opposite effect with psoriasis (OR = 0.8). CONCLUSIONS Based on our results, the psoriasis prevalence in Israeli adolescents is rising. Dermatological comorbidities and an increased BMI were associated with psoriasis in these adolescents. A better understanding of the distinctive epidemiological characteristics of juvenile psoriasis may allow for the early detection of comorbidities and improve its management.
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Affiliation(s)
- Rony Shreberk-Hassidim
- Department of Dermatology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eran Galili
- Department of Dermatology, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayal Hassidim
- Department of Plastic Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yuval Ramot
- Department of Dermatology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ilan Merdler
- Department of Internal Medicine "H", Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Baum
- Department of Dermatology, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abraham Zlotogorski
- Department of Dermatology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aviv Barzilai
- Department of Dermatology, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nadav Astman
- Department of Dermatology, Chaim Sheba Medical Center, Tel Hashomer, Israel, .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, .,Medical Corps, Israel Defense Forces, Tel Hashomer, Israel,
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Tollefson MM, Van Houten HK, Asante D, Yao X, Maradit Kremers H. Association of Psoriasis With Comorbidity Development in Children With Psoriasis. JAMA Dermatol 2019; 154:286-292. [PMID: 29322175 DOI: 10.1001/jamadermatol.2017.5417] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Importance Children with psoriasis are at increased risk for comorbidities. Many children with psoriasis are also overweight or obese; it is unknown whether the increased risk of comorbidities in these children is independent of obesity. Objective To determine the risk of elevated lipid levels (hyperlipidemia/hypertriglyceridemia), hypertension, metabolic syndrome, polycystic ovarian syndrome, diabetes, nonalcoholic liver disease, and elevated liver enzyme levels in children with and without psoriasis, after accounting for obesity. Design, Setting, and Participants This was a retrospective cohort study of claims data from Optum Laboratories Data Warehouse (includes 150 million privately insured and Medicare enrollees). A cohort of 29 957 children with psoriasis (affected children) and an age-, sex-, and race-matched comparator cohort of 29 957 children without psoriasis were identified and divided into 4 groups: (1) nonobese, without psoriasis (reference cohort); (2) nonobese, with psoriasis; (3) obese, without psoriasis; and (4) obese, with psoriasis. Main Outcomes and Measures Risk of developing comorbidities (Cox proportional hazards regression). Results The overall mean (SD) age of those included in the cohort was 12.0 (4.4) years, and 16 034 (53.5%) were girls. At baseline, more affected children were obese (862 [2.9%] vs 463 [1.5%]; P < .001 for all comparisons). Children with psoriasis were significantly more likely to develop each of the comorbidities than those without psoriasis (P < .01). Obesity was a strong risk factor for development of each comorbidity, even in those without psoriasis (hazard ratios [HRs] ranging from 2.26 to 18.11). The risk of comorbidities was 40% to 75% higher among nonobese children with vs without psoriasis: elevated lipid levels (HR, 1.42; 95% CI, 1.25-1.62), hypertension (HR, 1.64; 95% CI, 1.40-1.93), diabetes (HR, 1.58; 95% CI, 1.27-1.95), metabolic syndrome (HR, 1.62; 95% CI, 1.13-2.33), polycystic ovarian syndrome (HR, 1.49; 95% CI, 1.18-1.88), nonalcoholic liver disease (HR, 1.76; 95% CI, 1.16-2.65), and elevated liver enzyme levels (HR, 1.46; 95% CI, 1.27-1.67). Except for hypertension (P = .03), no significant interaction occurred between psoriasis and obesity on the risk of comorbidities. Conclusions and Relevance Children with psoriasis are at greater risk of developing obesity, hyperlipidemia, hypertension, diabetes, metabolic syndrome, polycystic ovarian syndrome, nonalcoholic liver disease, and elevated liver function enzyme levels than children without psoriasis. While psoriasis is a small independent risk factor for the development of these comorbidities, obesity is a much stronger contributor to comorbidity development in children with psoriasis.
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Affiliation(s)
- Megha M Tollefson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota.,Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Holly K Van Houten
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.,OptumLabs, Cambridge, Massachusetts
| | - Dennis Asante
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Xiaoxi Yao
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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15
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Groot J, Nybo Andersen AM, Adam A, Tind Nielsen TE, Blegvad C, Skov L. Associations between maternal socioeconomic position and psoriasis: a cohort study among the offspring of the Danish National Birth Cohort. Br J Dermatol 2018; 180:321-328. [PMID: 30117154 DOI: 10.1111/bjd.17091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The socioeconomic determinants of paediatric-onset psoriasis have not been previously investigated. OBJECTIVE To identify whether a social gradient exists for paediatric-onset psoriasis, using measures of maternal socioeconomic position. METHODS Data on paediatric-onset psoriasis from 36 003 Danish National Birth Cohort offspring were cross-linked with nationwide registry data on maternal age and three measures of maternal socioeconomic position: maternal educational attainment, maternal labour market attachment and equivalized household income. Univariable and multivariable logistic regression analyses were conducted to estimate the odds ratios (ORs) of psoriasis in the offspring, in cohort analyses for data from the year of enrolment and cross-sectional analyses from the year of the 11-year follow-up. RESULTS Maternal age at birth, maternal educational attainment and equivalized household income were inversely associated with psoriasis in the offspring. Low maternal educational attainment was associated with offspring psoriasis [adjusted OR 1·62, 95% confidence interval (CI) 1·20-2·18] after adjusting for maternal psoriasis and age in the cohort analysis. The crude OR of psoriasis in offspring of mothers in the highest quartile compared with mothers in the lowest quartile of equivalized household income was 0·57 (95% CI 0·43-0·76), and the adjusted OR was 0·59 (95% CI 0·44-0·80) after adjusting for maternal psoriasis and age. Similar results were observed for data on maternal socioeconomic position at enrolment and at follow-up. CONCLUSIONS A steep social gradient in paediatric-onset psoriasis was observed. Maternal socioeconomic position may play a role in early-life exposure to modifiable risk factors for psoriasis. Future studies may help to elucidate which biological factors mediate the social gradient observed in our study.
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Affiliation(s)
- J Groot
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Denmark
| | - A M Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - A Adam
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - T E Tind Nielsen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Denmark.,Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - C Blegvad
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Denmark
| | - L Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Denmark
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16
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Tekin B, Gurel MS, Topkarci Z, Topaloglu Demir F, Aytekin S, Cebeci Kahraman F, Singer R, Erdemir VA, Uzuncakmak TK, Yasar S, Akdeniz N, Altunay IK, Kocaturk E, Turkoglu Z, Erdogan B. Assessment of quality of life in Turkish children with psoriasis and their caregivers. Pediatr Dermatol 2018; 35:651-659. [PMID: 29984848 DOI: 10.1111/pde.13585] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND/OBJECTIVES The effect of pediatric psoriasis on quality of life has been demonstrated, but data regarding its influence on caregiver quality of life are scarce. The objective was to investigate how psoriasis affects quality of life of children and their caregivers. METHODS This multicenter study included 129 children with psoriasis and their caregivers, who were family members accompanying patients to the clinic. Patient quality of life was measured using the Child Dermatology Life Quality Index. Caregiver quality of life was assessed using Dermatological Family Impact Scale, a 15-item questionnaire validated for use in the Turkish language. RESULTS Mean Child Dermatology Life Quality Index score was 7.6, indicating a moderate effect on patient quality of life. Symptoms and feelings were the most severely impaired domains of patient quality of life, and emotions was the most severely impaired domain of caregiver quality of life. Dermatological Family Impact Scale score was significantly correlated with Child Dermatology Life Quality Index (correlation coefficient [r] = .554, P < .001) and Psoriasis Area and Severity Index (r = .350, P < .001). Caregivers of patients receiving systemic agents or phototherapy had relative impairment of multiple domains of quality of life compared to caregivers of patients receiving topical treatment only. CONCLUSION Psychosocial effect of pediatric psoriasis was shown to extend beyond the individual, highlighting the importance of addressing patient and caregiver quality of life concerns in an integrated approach.
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Affiliation(s)
- Burak Tekin
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mehmet Salih Gurel
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Zeynep Topkarci
- Department of Dermatology, Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | | | - Sema Aytekin
- Department of Dermatology, Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey
| | - Filiz Cebeci Kahraman
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ralfi Singer
- Department of Dermatology, Okmeydani Research and Training Hospital, Istanbul, Turkey
| | - Vefa Asli Erdemir
- Department of Dermatology, Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Tugba Kevser Uzuncakmak
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Sirin Yasar
- Department of Dermatology, Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey
| | - Necmettin Akdeniz
- Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ilknur Kivanc Altunay
- Department of Dermatology, Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey
| | - Emek Kocaturk
- Department of Dermatology, Okmeydani Research and Training Hospital, Istanbul, Turkey
| | - Zafer Turkoglu
- Department of Dermatology, Haseki Research and Training Hospital, Istanbul, Turkey
| | - Bilgen Erdogan
- Department of Dermatology, Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey
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17
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Prevalence of psoriatic arthritis in patients with psoriasis: A systematic review and meta-analysis of observational and clinical studies. J Am Acad Dermatol 2018; 80:251-265.e19. [PMID: 29928910 DOI: 10.1016/j.jaad.2018.06.027] [Citation(s) in RCA: 336] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/30/2018] [Accepted: 06/10/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Wide-ranging prevalence estimates of psoriatic arthritis (PsA) in patients with psoriasis have been reported. OBJECTIVES To assess the prevalence and incidence of PsA in patients with psoriasis. METHODS Two authors independently searched 3 databases for studies reporting on the prevalence or incidence of PsA in patients with psoriasis. A proportion meta-analysis was performed to calculate the pooled proportion estimates of PsA in patients with psoriasis. RESULTS A total of 266 studies examining 976,408 patients with psoriasis were included. Overall, the pooled proportion (95% confidence interval [CI]) of PsA among patients with psoriasis was 19.7% (95% CI, 18.5%-20.9%). In children and adolescents (<18 years of age), the pooled prevalence was 3.3% (95% CI, 2.1%-4.9%). The PsA prevalence was 22.7% (95% CI, 20.6%-25.0%) in European patients with psoriasis, 21.5% (95% CI, 15.4%-28.2%) in South American patients with psoriasis, 19.5% (95% CI, 17.1%-22.1%) in North American patients with psoriasis, 15.5% (95% CI, 0.009%-51.5%) in African patients with psoriasis, and 14.0% (95% CI, 95% CI, 11.7%-16.3%) in Asian patients with psoriasis. The prevalence of PsA was 23.8% (95% CI, 20.1%-27.6%) in studies in which the Classification Criteria for Psoriatic Arthritis were applied. The incidence of PsA among patients with psoriasis ranged from 0.27 to 2.7 per 100 person-years. LIMITATIONS Between-study heterogeneity may have affected the estimates. CONCLUSIONS We found that 1 in 4 patients with psoriasis have PsA. With the growing recognition of the Classification Criteria for Psoriatic Arthritis, more homogenous and comparable prevalence estimates are expected to be reported.
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18
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Kara T, Topkarcı Z, Yılmaz S, Akaltun İ, Erdoğan B. Pediatric patients with psoriasis and psychiatric disorders: premorbidity and comorbidity in a case-control study. J DERMATOL TREAT 2018; 30:129-134. [DOI: 10.1080/09546634.2018.1476653] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Tayfun Kara
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Zeynep Topkarcı
- Department of Dermatology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Semra Yılmaz
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - İsmail Akaltun
- Department of Child and Adolescent Psychiatry, Gaziantep Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Bilgen Erdoğan
- Department of Dermatology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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19
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Aune D, Snekvik I, Schlesinger S, Norat T, Riboli E, Vatten LJ. Body mass index, abdominal fatness, weight gain and the risk of psoriasis: a systematic review and dose-response meta-analysis of prospective studies. Eur J Epidemiol 2018; 33:1163-1178. [PMID: 29680995 PMCID: PMC6290660 DOI: 10.1007/s10654-018-0366-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 02/14/2018] [Indexed: 12/11/2022]
Abstract
Greater body mass index (BMI) has been associated with increased risk of psoriasis in case–control and cross-sectional studies, however, the evidence from prospective studies has been limited. We conducted a systematic review and dose–response meta-analysis of different adiposity measures and the risk of psoriasis to provide a more robust summary of the evidence based on data from prospective studies. PubMed and Embase databases were searched for relevant studies up to August 8th 2017. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using a random effects model. The summary relative risk (RR) for a 5 unit increment in BMI was 1.19 (95% CI 1.10–1.28, I2 = 83%, n = 7). The association appeared to be stronger at higher compared to lower levels of BMI, pnonlinearity < 0.0001, and the lowest risk was observed at a BMI around 20. The summary RR was 1.24 (95% CI 1.17–1.31, I2 = 0%, pheterogeneity = 0.72, n = 3) per 10 cm increase in waist circumference, 1.37 (95% CI 1.23–1.53, I2 = 0%, pheterogeneity = 0.93, n = 3) per 0.1 unit increase in waist-to-hip ratio, and 1.11 (95% CI 1.07–1.16, I2 = 47%, pheterogeneity = 0.15, n = 3) per 5 kg of weight gain. Adiposity as measured by BMI, waist circumference, waist-to-hip ratio, and weight gain is associated with increased risk of psoriasis.
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Affiliation(s)
- Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK. .,Department of Nutrition, Bjørknes University College, Oslo, Norway. .,Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
| | - Ingrid Snekvik
- Department of Public Health and Nursing, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Dermatology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sabrina Schlesinger
- German Diabetes Center (DDZ), Institute for Biometrics and Epidemiology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Teresa Norat
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK
| | - Lars J Vatten
- Department of Public Health and Nursing, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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20
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Stewart TJ, Tong W, Whitfeld MJ. The associations between psychological stress and psoriasis: a systematic review. Int J Dermatol 2018. [PMID: 29516474 DOI: 10.1111/ijd.13956] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Psoriasis is estimated to affect around 2-3% of the general population. More than one-third of Australians report having a significant level of distress in their daily lives. Psychological stress has long been shown to play an important role in the natural history of psoriasis, but the details of this relationship remain to be clearly defined. We performed a systematic review of the literature with the aim of determining whether there is a temporal association between psychological stress as the predictor and onset and/or exacerbation of psoriasis as the outcome measure. Our secondary aim was to establish whether there is a relationship between the degree of psychological stress and clinical severity of psoriasis. Our systematic review demonstrates a probable temporal association between different measures of psychological stress and onset, recurrence, and severity of psoriasis. In the light of this, we suggest clinicians include "stress" as a trigger factor in their psoriasis assessment and consider psychological interventions as adjuncts, particularly in those who identify as "stress-responders".
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Affiliation(s)
- Thomas J Stewart
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Winnie Tong
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Margot J Whitfeld
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
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21
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Snast I, Reiter O, Atzmony L, Leshem YA, Hodak E, Mimouni D, Pavlovsky L. Psychological stress and psoriasis: a systematic review and meta-analysis. Br J Dermatol 2018; 178:1044-1055. [PMID: 29124739 DOI: 10.1111/bjd.16116] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Psychological stress has long been linked with the exacerbation/onset of psoriasis. OBJECTIVES To determine if antecedent psychological stress is associated with the exacerbation/onset of psoriasis. METHODS A search of the PubMed, PsycINFO, Cochrane library and ClinicalTrials.gov databases was performed. Surveys evaluating beliefs about stress reactivity were analysed separately. Suitable studies were meta-analysed. RESULTS Thirty-nine studies (32 537 patients) were included: 19 surveys, seven cross-sectional studies, 12 case-control studies and one cohort study. Forty-six per cent of patients believed their disease was stress reactive and 54% recalled preceding stressful events. Case-control studies evaluating stressful events rates prior to the exacerbation (n = 6) or onset (n = 6) of psoriasis varied in time lag to recollection (≤ 9 months to ≥ 5 years). Pooling five studies evaluating stressful events preceding onset of psoriasis gave an odds ratio (OR) of 3·4 [95% confidence interval (CI) 1·8-6·4; I2 = 87%]; the only study evaluating a documented stress disorder diagnosis reported similar rates between patients and controls (OR 1·2, 95% CI 0·8-1·8). Four studies evaluating stressful events prior to psoriasis exacerbation reported comparable rates with controls, whereas two found more frequent/severe preceding events among patients with psoriasis. A small prospective cohort study reported a modest association between stress levels and exacerbation of psoriasis (r = 0·28, P < 0·05). CONCLUSIONS The association between preceding stress and exacerbation/onset of psoriasis is based primarily on retrospective studies with many limitations. No convincing evidence exists that preceding stress is strongly associated with exacerbation/onset of psoriasis.
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Affiliation(s)
- I Snast
- Department of Dermatology, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - O Reiter
- Department of Dermatology, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - L Atzmony
- Department of Dermatology, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - Y A Leshem
- Department of Dermatology, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Hodak
- Department of Dermatology, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Mimouni
- Department of Dermatology, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Pavlovsky
- Department of Dermatology, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
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22
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Eichenfield LF, Paller AS, Tom WL, Sugarman J, Hebert AA, Friedlander SF, Siegfried E, Silverberg N, Cordoro KM. Pediatric psoriasis: Evolving perspectives. Pediatr Dermatol 2018; 35:170-181. [PMID: 29314219 DOI: 10.1111/pde.13382] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/OBJECTIVES Childhood-onset psoriasis is a common skin disorder that has recently received increasing attention, particularly because of its significant medical, social, financial, and psychological burdens and its associated comorbidities. With limited data available and lack of standardized management guidelines for pediatric psoriasis, an expert panel desired to provide an updated critical overview and practical guidance for management of the affected population. METHODS A panel of pediatric dermatologists with extensive experience in pediatric psoriasis defined and prioritized a core set of topics, performed an English-language literature review, prepared critical evaluations and presentations of topic areas, and carried out a consensus meeting and follow-up consensus manuscript. RESULTS The summation of evolving perspectives in pediatric psoriasis includes epidemiology and natural history of the disease, precipitating factors and comorbidities, quality of life and burden of disease, clinical features and disease presentation, differential diagnosis, pathogenesis and treatment, including topical, photo, and systemic therapies. CONCLUSION Pediatric psoriasis is an important immune-mediated inflammatory skin disease with potential for significant impact on affected individuals and their caregivers. Current state-of-the-art care is based primarily on experience and expert consensus, but pediatric data are accumulating and therapeutic options are rapidly evolving.
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Affiliation(s)
- Lawrence F Eichenfield
- Department of Dermatology, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA.,Department of Pediatrics, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA
| | - Amy S Paller
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Wynnis L Tom
- Department of Dermatology, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA.,Department of Pediatrics, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA
| | - Jeffrey Sugarman
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Adelaide A Hebert
- Pediatric Dermatology, McGovern School of Medicine and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Sheila Fallon Friedlander
- Department of Dermatology, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA.,Department of Pediatrics, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA
| | - Elaine Siegfried
- Department of Pediatrics, Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, MO, USA.,Department of Dermatology, Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Nanette Silverberg
- Department of Dermatology, Icahn School of Medicine at Mt Sinai, New York, NY, USA.,Department of Pediatrics, Icahn School of Medicine at Mt Sinai, New York, NY, USA
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, CA, USA.,Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, CA, USA
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23
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Abstract
Psoriasis is a chronic inflammatory systemic disease associated with an important physical and physiological burden. It primarily affects the skin, but it is associated with several serious medical co-morbidities. One third of total psoriatic cases have their onset during the pediatric age, although some of them may not be diagnosed until the patient reaches adulthood. Additionally, in the pediatric age, there is an association with several medical co-morbidities; thus, an early recognition of the disease and a subsequent appropriate approach may delay or even prevent considerable co-morbidities. Because children are not just 'small adults', specific guidelines for the diagnosis, management, and treatment of psoriasis are of extreme importance. However, these guidelines are still lacking in this age group. Most of the psoriasis treatments used in adults are not officially approved for the pediatric age and require off-label prescription. Moreover, efficacy and safety studies are lacking in this population, especially with long-term follow-up and outcomes. Many biologic agents have been recently approved for the treatment of psoriasis in children, while others are currently being studied. This bibliographic review aims to summarize the most relevant aspects, as well as updated information about the epidemiology, pathogenesis, clinical features, diagnosis, co-morbidities and treatment of pediatric psoriasis.
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Baggio R, Le Treut C, Darrieux L, Vareliette A, Safa G. Psoriasiform Diaper Rash Possibly Induced by Oral Propranolol in an 18-Month-Old Girl with Infantile Hemangioma. Case Rep Dermatol 2016; 8:369-373. [PMID: 28303101 PMCID: PMC5260511 DOI: 10.1159/000455021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 12/08/2016] [Indexed: 11/21/2022] Open
Abstract
Propranolol, a nonselective blocker of β-adrenergic receptors, has become the first-line treatment for complicated infantile hemangiomas. Therefore, its use in the pediatric population has expanded in recent years. In adults, β-blockers have been reported to be the most common causative agents for drug-induced psoriasis. In infants treated with propranolol for infantile hemangioma, the onset of psoriasiform diaper rash has not yet been reported. Here, to the best of our knowledge, we report the first case of psoriasiform diaper rash possibly induced by oral propranolol in an 18-month-old girl with no family history of psoriasis.
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Affiliation(s)
- Raphaëlle Baggio
- Department of Dermatology, Centre Hospitalier de Saint-Brieuc, Saint-Brieuc, France
| | - Claire Le Treut
- Department of Dermatology, Centre Hospitalier de Saint-Brieuc, Saint-Brieuc, France
| | - Laure Darrieux
- Department of Dermatology, Centre Hospitalier de Saint-Brieuc, Saint-Brieuc, France
| | - Amélie Vareliette
- Department of Pediatrics, Centre Hospitalier de Saint-Brieuc, Saint-Brieuc, France
| | - Gilles Safa
- Department of Dermatology, Centre Hospitalier de Saint-Brieuc, Saint-Brieuc, France
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25
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Horton DB, Scott FI, Haynes K, Putt ME, Rose CD, Lewis JD, Strom BL. Antibiotic Exposure, Infection, and the Development of Pediatric Psoriasis: A Nested Case-Control Study. JAMA Dermatol 2016; 152:191-9. [PMID: 26560335 DOI: 10.1001/jamadermatol.2015.3650] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
IMPORTANCE Antibiotics disrupt human microbiota and have been associated with several pediatric autoimmune diseases. Psoriasis activity has been linked to group A streptococcal and viral infections. OBJECTIVE To determine whether antibiotic exposure and infections are independently associated with incident psoriasis in children. DESIGN, SETTING, AND PARTICIPANTS This nested case-control study used data from the Health Improvement Network database, a population-representative electronic health records database from the United Kingdom, from June 27, 1994, through January 15, 2013. Data were analyzed from September 17, 2014, through August 12, 2015. Children aged 1 to 15 years with newly diagnosed psoriasis (n = 845) were compared with age- and sex-matched controls (n = 8450) randomly chosen at the time of psoriasis diagnosis from general practices with at least one case, excluding children with immunodeficiency, inflammatory bowel disease, and juvenile arthritis. EXPOSURES Systemic antibacterial prescriptions and infections of the skin and other sites within 2 years before psoriasis diagnosis. MAIN OUTCOMES AND MEASURES Incident psoriasis as determined by validated diagnostic codes. The association of antibiotic exposure and infections with incident psoriasis was determined by conditional logistic regression, adjusting for confounders. RESULTS After adjusting for matching, country, socioeconomic deprivation, outpatient visits, and infections within the past 2 years, antibiotic exposure in the last 2 years was weakly associated with incident psoriasis (adjusted odds ratio [aOR], 1.2; 95% CI, 1.0-1.5). The associations for infections of skin (aOR, 1.5; 95% CI, 1.2-1.7) and other sites (aOR, 1.3; 95% CI, 1.1-1.6) were similar. Untreated nonskin infections (aOR, 1.5; 95% CI, 1.3-1.8) but not antibiotic-treated nonskin infections (aOR, 1.1; 95% CI, 0.9-1.4) were associated with psoriasis. Results were similar when using a lifetime exposure window. Different classes of antibiotics and age of first antibiotic exposure were also not associated with psoriasis. The findings did not substantively change when excluding periods of varying length before diagnosis. CONCLUSIONS AND RELEVANCE Infections are associated with the development of pediatric psoriasis, but antibiotics do not appear to contribute substantially to that risk.
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Affiliation(s)
- Daniel B Horton
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia2Division of Rheumatology, Nemours A.I. duPont Hospital for Children, Thomas Jefferson University, Wilmington, Delaware3Rutgers Biomed
| | - Frank I Scott
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia4Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia
| | - Kevin Haynes
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia5Clinical Epidemiology, HealthCore, Wilmington, Delaware
| | - Mary E Putt
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Carlos D Rose
- Division of Rheumatology, Nemours A.I. duPont Hospital for Children, Thomas Jefferson University, Wilmington, Delaware
| | - James D Lewis
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia4Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia
| | - Brian L Strom
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia3Rutgers Biomedical and Health Sciences, Child Health Institute of New Jersey, New Brunswick
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Burden‐Teh E, Thomas K, Ratib S, Grindlay D, Adaji E, Murphy R. The epidemiology of childhood psoriasis: a scoping review. Br J Dermatol 2016; 174:1242-57. [DOI: 10.1111/bjd.14507] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2016] [Indexed: 12/13/2022]
Affiliation(s)
- E. Burden‐Teh
- Centre of Evidence Based Dermatology University of Nottingham Nottingham U.K
| | - K.S. Thomas
- Centre of Evidence Based Dermatology University of Nottingham Nottingham U.K
| | - S. Ratib
- Centre of Evidence Based Dermatology University of Nottingham Nottingham U.K
| | - D. Grindlay
- Centre of Evidence Based Dermatology University of Nottingham Nottingham U.K
| | - E. Adaji
- Division of Epidemiology & Public Health University of Nottingham Nottingham U.K
| | - R. Murphy
- Sheffield Teaching Hospitals NHS Foundation Trust Sheffield U.K
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Matterne U, Apfelbacher C. Peer-relationship-problems account for quality of life impairments in pediatric psoriasis. J Psychosom Res 2016; 84:31-36. [PMID: 27095156 DOI: 10.1016/j.jpsychores.2016.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/03/2016] [Accepted: 03/14/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Most research on HRQoL-impairments in psoriasis has been conducted in adult patients, small pediatric patient samples or samples not representative of the pediatric population at large. We thus aimed to comprehensively describe HRQoL in pediatric psoriasis compared to psoriasis-free children and adolescents, identify domains most commonly affected and analyze its impact on HRQoL while controlling for important other predictors of HRQoL in a representative pediatric sample. METHODS The impact of lifetime-prevalence of psoriasis on total and subscale HRQoL was analyzed by complex sample general linear models alone and adjusted for sociodemographic and clinical variables in a population-based sample (n=6518) of children and adolescents aged 11-17. RESULTS Total HRQoL and the physical domain were significantly affected by lifetime-psoriasis in univariate analysis. In multivariate analyses, lifetime-psoriasis significantly impacted on total HRQoL and the subscale 'quality of relationships with friends/peers'. Although substantial amounts of variance in HRQoL were explained by mental health, independent effects of lifetime-psoriasis remained after adjustment for this covariate. Total explained variance in total HRQoL was 20%. CONCLUSION Our findings suggest psoriasis to be a significant burden as it affects HRQoL even when controlling for mental health. Most of this effect appears to be driven by perceived impairments in the quality of relationship with friends/peers. How this exactly occurs needs to be explored in future research. Meanwhile clinicians need to be more attentive to this effect of psoriasis.
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Affiliation(s)
- Uwe Matterne
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology and Health Services Research, University Hospital Heidelberg, University of Heidelberg, Germany; Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Germany
| | - Christian Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Germany.
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Swary JH, Stratman EJ. Identifying Performance Gaps in Comorbidity and Risk Factor Screening, Prevention, and Counseling Behaviors of Providers Caring for Children with Psoriasis. Pediatr Dermatol 2015; 32:813-8. [PMID: 26337861 DOI: 10.1111/pde.12669] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND/OBJECTIVES Comorbidities and risk factors are associated with pediatric psoriasis. It is unknown whether pediatricians and dermatologists ask about, record, or counsel on pediatric psoriasis risk factors and comorbidities. The aim of our study was to assess the rate at which pediatricians and dermatologists inquire about, counsel on, and document pediatric psoriasis risk factors and comorbidities in a stable population. METHODS This was a retrospective chart review from 2011 to 2013 in a large, rural multidisciplinary clinic, the Marshfield Epidemiologic Study Area. Participants were children ages 18 years and younger with plaque psoriasis. Rates of counseling and screening for pediatric psoriasis risk factors and comorbidities by pediatricians and dermatologists were determined. RESULTS Thirty patients qualified for the study. Data were collected on body mass index (BMI) and tobacco exposure. Caregiver counseling rates on these factors were low; 66.7% and 60% did not receive counseling on BMI reduction or family member smoking cessation, respectively. Counseling on stress as a risk factor was performed at only one patient's dermatology visit (3.3%). Lipid panels were collected for 40% of patients and fasting glucose levels for 33.3% since the date of first psoriasis diagnosis. Blood pressure was collected for all patients. Only 13.3% of patients were counseled on the psoriasis comorbidity hyperlipidemia, 10% on hypertension, and 3.3% on diabetes mellitus. CONCLUSIONS Dermatologists and pediatricians have a low rate of counseling, documenting, and screening for pediatric psoriasis risk factors and comorbidities, suggesting that psoriasis comorbidity education is an aspect of the patient visit that may need improvement. Pediatric psoriasis counseling and screening guidelines are needed.
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Affiliation(s)
- Jillian H Swary
- Department of Dermatology, Marshfield Clinic, Marshfield, Wisconsin
| | - Erik J Stratman
- Department of Dermatology, Marshfield Clinic, Marshfield, Wisconsin
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Abstract
Psoriatic arthritis (PsA) is a chronic systemic inflammatory disorder characterized by joint and entheseal inflammation with a prevalence of 0.05% to 0.25% of the population and 6% to 41% of patients with psoriasis. PsA is a highly heterogeneous inflammatory arthritis. In this review, current knowledge is discussed regarding the epidemiology of PsA, including disease manifestations, classification criteria for adult and juvenile PsA, methods for recognizing early PsA, including use of screening tools and knowledge of risk factors for PsA, and medical comorbidities associated with PsA.
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Affiliation(s)
- Alexis Ogdie
- Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, White Building, Room 5024, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - Pamela Weiss
- Division of Rheumatology, Children's Hospital of Philadelphia, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 3535 Market Street, Room 1526, Philadelphia, PA 19104, USA
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Lønnberg AS, Skov L, Skytthe A, Kyvik KO, Pedersen OB, Thomsen SF. Smoking and risk for psoriasis: a population-based twin study. Int J Dermatol 2015; 55:e72-8. [PMID: 26275356 DOI: 10.1111/ijd.13073] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/05/2015] [Accepted: 04/15/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Smoking is a potential risk factor for psoriasis. Both psoriasis and smoking habits are partly explained by genetic factors. However, twin studies investigating the association between these traits are limited. METHODS Questionnaire-based data on smoking habits and psoriasis were collected for 34,781 twins, aged 20-71 years, from the Danish Twin Registry. A co-twin control analysis was performed on 1700 twin pairs discordant for lifetime history of smoking. Genetic and environmental correlations between smoking and psoriasis were estimated using classical twin modeling. RESULTS After multivariable adjustment, age group (50-71 vs. 20-49 years) and childhood exposure to environmental tobacco smoke (ETS) were significantly associated with psoriasis in the whole population (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.02-1.29 [P = 0.021] and OR 1.28, 95% CI 1.10-1.49 [P = 0.002], respectively). Risk for psoriasis increased substantially (OR 2.18, 95% CI 1.82-2.61; P < 0.001) for smokers with a history of >5 pack-years, even after adjusting for age, sex, and childhood ETS. Among twin pairs discordant for smoking, risk for psoriasis in the ever-smoking twin was lower among monozygotic twins (OR 1.23, 95% CI 0.59-2.56; P = 0.578) than among same-sex dizygotic twins (OR 2.21, 95% CI 1.36-3.58; P = 0.001). Genetic factors explained 20% (14-25%; P < 0.001) of the correlation between psoriasis and smoking, whereas non-shared environmental factors explained 8% (0-22%; P = 0.504). CONCLUSIONS Tobacco consumption and childhood ETS are significantly associated with psoriasis. Results indicate shared genetic factors for smoking and psoriasis.
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Affiliation(s)
- Ann Sophie Lønnberg
- Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Lone Skov
- Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Axel Skytthe
- Danish Twin Registry, University of Southern Denmark, Odense, Denmark
| | - Kirsten Ohm Kyvik
- Institute of Regional Health Services Research, University of Southern Denmark, Odense, Denmark.,Odense Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | | | - Simon Francis Thomsen
- Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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[Psoriasis vulgaris in children and adolescents. Pathogenesis, clinical picture and therapy]. Hautarzt 2015; 66:267-76. [PMID: 25659385 DOI: 10.1007/s00105-015-3585-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The prevalence of psoriasis vulgaris in childhood ranges from 0.12 % in infants to 1.2 % in adolescents. Psoriasis is a polygenic disease triggered by external factors and is influenced by comorbidities such as obesity, metabolic syndrome, chronic inflammatory bowel diseases and rheumatic diseases. CLINICAL FEATURES Its clinical presentation is variable. Typical complications include erythroderma, disseminated pustulosis and arthropathy. THERAPY Amongst a wide range of topical or systemic therapeutical options, individualized treatment is based on severity, site and extent of cutaneous involvement, age, potential side-effects and comorbidities.
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Abstract
Psoriasis is a common chronic inflammatory skin disease with a spectrum of clinical phenotypes and results from the interplay of genetic, environmental, and immunological factors. Four decades of clinical and basic research on psoriasis have elucidated many of the pathogenic mechanisms underlying disease and paved the way to effective targeted therapies. Here, we review this progress and identify future directions of study that are supported by a more integrative research approach and aim at further improving the patients' life.
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Affiliation(s)
- Paola Di Meglio
- Molecular Immunology, Medical Research Council National Institute for Medical Research, London NW7 1AA, United Kingdom
| | - Federica Villanova
- St. John's Institute of Dermatology, King's College London, London SE1 9RT, United Kingdom National Institute for Health Research GSTT/KCL Comprehensive Biomedical Research Centre, Guy's and St. Thomas' National Health Service Foundation Trust, London SE1 9RT, United Kingdom
| | - Frank O Nestle
- St. John's Institute of Dermatology, King's College London, London SE1 9RT, United Kingdom National Institute for Health Research GSTT/KCL Comprehensive Biomedical Research Centre, Guy's and St. Thomas' National Health Service Foundation Trust, London SE1 9RT, United Kingdom
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Naldi L, Conti A, Cazzaniga S, Patrizi A, Pazzaglia M, Lanzoni A, Veneziano L, Pellacani G. Diet and physical exercise in psoriasis: a randomized controlled trial. Br J Dermatol 2014; 170:634-42. [DOI: 10.1111/bjd.12735] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/04/2013] [Accepted: 11/10/2013] [Indexed: 01/16/2023]
Affiliation(s)
- L. Naldi
- Centro Studi GISED; Presidio Ospedaliero Matteo Rota; Via Garibaldi 13/15 24122 Bergamo Italy
- Azienda Ospedaliera Papa Giovanni XXIII; Bergamo Italy
| | - A. Conti
- Department of Dermatology; Azienda Ospedaliero-Universitaria Policlinico; Modena Italy
| | - S. Cazzaniga
- Centro Studi GISED; Presidio Ospedaliero Matteo Rota; Via Garibaldi 13/15 24122 Bergamo Italy
| | - A. Patrizi
- Dermatolologia; Dipartimento di Medicina Specialistica, Diagnostica Sperimentale (DIMES); Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi; Bologna Italy
| | - M. Pazzaglia
- Dermatolologia; Dipartimento di Medicina Specialistica, Diagnostica Sperimentale (DIMES); Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi; Bologna Italy
| | - A. Lanzoni
- Department of Dermatology; IRCCS Ospedale Bellaria; Bologna Italy
| | - L. Veneziano
- Department of Dermatology; IRCCS Ospedale Bellaria; Bologna Italy
| | - G. Pellacani
- Department of Dermatology; Azienda Ospedaliero-Universitaria Policlinico; Modena Italy
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Glavin K, Roelants M, Strand BH, Júlíusson PB, Lie KK, Helseth S, Hovengen R. Important periods of weight development in childhood: a population-based longitudinal study. BMC Public Health 2014; 14:160. [PMID: 24524269 PMCID: PMC3925776 DOI: 10.1186/1471-2458-14-160] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 02/11/2014] [Indexed: 02/08/2023] Open
Abstract
Background Identifying important ages for the development of overweight is essential for optimizing preventive efforts. The purpose of the study was to explore early growth characteristics in children who become overweight or obese at the age of 8 years to identify important ages for the onset of overweight and obesity. Methods Data from the Norwegian Child Growth Study in 2010 (N = 3172) were linked with repeated measurements from health records beginning at birth. Weight and height were used to derive the body mass index (BMI) in kg/m2. The BMI standard deviation score (SDS) for each participant was estimated at specific target ages, using a piecewise linear mixed effect model. Results At 8 years of age, 20.4% of the children were overweight or obese. Already at birth, overweight children had a significantly higher mean BMI SDS than normal weight 8-year-olds (p < .001) and this difference increased in consecutive age groups in infancy and childhood. A relatively large increase in BMI during the first 9 months was identified as important for being overweight at 8 years. BMI SDS at birth was associated with overweight at 8 years of age (OR, 1.8; 1.6–2.0), and with obesity (OR, 1.8; 1.4–2.3). The Odds Ratios for the BMI SDS and change in BMI SDS further increased up to 1 year of age became very high from 2 years of age onwards. Conclusions A high birth weight and an increasing BMI SDS during the first 9 months and high BMI from 2 years of age proved important landmarks for the onset of being overweight at 8 years of age. The risks of being overweight at 8 years appear to start very early. Interventions to prevent children becoming overweight should not only start at a very early age but also include the prenatal stage.
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Affiliation(s)
- Kari Glavin
- Oslo and Akershus University College of Applied Sciences, (Nursing), P,O, Box 4, St,Olav plass, 0130 Oslo, Norway.
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Psoriasis vulgaris bei Kindern und Jugendlichen. Monatsschr Kinderheilkd 2014. [DOI: 10.1007/s00112-013-3062-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Dietert RR. Developmental Immunotoxicity, Perinatal Programming, and Noncommunicable Diseases: Focus on Human Studies. Adv Med 2014; 2014:867805. [PMID: 26556429 PMCID: PMC4590951 DOI: 10.1155/2014/867805] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 10/17/2013] [Accepted: 10/30/2013] [Indexed: 12/20/2022] Open
Abstract
Developmental immunotoxicity (DIT) is a term given to encompass the environmentally induced disruption of normal immune development resulting in adverse outcomes. A myriad of chemical, physical, and psychological factors can all contribute to DIT. As a core component of the developmental origins of adult disease, DIT is interlinked with three important concepts surrounding health risks across a lifetime: (1) the Barker Hypothesis, which connects prenatal development to later-life diseases, (2) the hygiene hypothesis, which connects newborns and infants to risk of later-life diseases and, (3) fetal programming and epigenetic alterations, which may exert effects both in later life and across future generations. This review of DIT considers: (1) the history and context of DIT research, (2) the fundamental features of DIT, (3) the emerging role of DIT in risk of noncommunicable diseases (NCDs) and (4) the range of risk factors that have been investigated through human research. The emphasis on the human DIT-related literature is significant since most prior reviews of DIT have largely focused on animal research and considerations of specific categories of risk factors (e.g., heavy metals). Risk factors considered in this review include air pollution, aluminum, antibiotics, arsenic, bisphenol A, ethanol, lead (Pb), maternal smoking and environmental tobacco smoke, paracetamol (acetaminophen), pesticides, polychlorinated biphenyls, and polyfluorinated compounds.
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Affiliation(s)
- Rodney R. Dietert
- Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, North Tower Road, Ithaca, NY 14853, USA
- *Rodney R. Dietert:
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Zitelli KB, Lucky AW. Psoriasis first presenting around an enteral feeding tube in three pediatric patients: an important consideration for timely diagnosis and management. Pediatr Dermatol 2014; 31:68-72. [PMID: 23937450 DOI: 10.1111/pde.12211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Pediatric dermatologists may care for patients with percutaneous enteral feeding tubes. Although ostomy complications such as allergic contact and irritant dermatitis are common, psoriasis may be misdiagnosed. We report three novel cases of childhood psoriasis first presenting around an enteral feeding tube site. Localized psoriasis is an important clinical consideration in children with ostomy site eruptions to ensure timely diagnosis and effective management.
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Abstract
Dermatological conditions are intimately related to stress. There was a great interest in this field in the last years. Stress could be involved as a trigger factor for a lot of cutaneous diseases: alopecia areata, psoriasis, vitiligo, lichen planus, acne, atopic dermatitis, urticaria. For other conditions: seborrheic dermatitis, hyperhydrosis, herpes, pemphigus, a.s.o, there are anecdotal notices. On the other hand, the skin disease itself could induce a secondary stress for the patient, influencing his quality of life. The stress per se is less important than the “perceived stress”, the patient’s perception of the stressful situation. This perception could be influenced by the psychological state of the patient. Anxiety, depression could change the perception of the event. It is important to take care of these aspects during the consultation. A good cooperation with psychiatrist or/and psychologist could improve the results, besides the specific therapy.
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Abstract
Psoriasis is a common yet complex inflammatory dermatosis that may be seen in infants, children, and adolescents. The clinical presentation and course may be quite variable, and while patients with mild disease are often easily managed, those with recalcitrant or more severe disease often present a therapeutic dilemma given the number of therapies available and the relative lack of data on the efficacy and safety of use of these therapies in children. This review presents the reader with an overview of the current understanding of the pathophysiology, diagnosis, and treatment of pediatric psoriasis, with an emphasis on the available data in the literature that pertains to the use in children of currently available topical and systemic therapies, including topical corticosteroids, vitamin D analogs, phototherapy, systemic immunosuppressive medications, and biologic agents.
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Bassaganyas L, Riveira-Muñoz E, García-Aragonés M, González JR, Cáceres M, Armengol L, Estivill X. Worldwide population distribution of the common LCE3C-LCE3B deletion associated with psoriasis and other autoimmune disorders. BMC Genomics 2013; 14:261. [PMID: 23594316 PMCID: PMC3639927 DOI: 10.1186/1471-2164-14-261] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 01/02/2013] [Indexed: 01/29/2023] Open
Abstract
Background There is increasing evidence of the importance of copy number variants (CNV) in genetic diversity among individuals and populations, as well as in some common genetic diseases. We previously characterized a common 32-kb insertion/deletion variant of the PSORS4 locus at chromosome 1q21 that harbours the LCE3C and LCE3B genes. This variant allele (LCE3C_LCE3B-del) is common in patients with psoriasis and other autoimmune disorders from certain ethnic groups. Results Using array-CGH (Agilent 244 K) in samples from the HapMap and Human Genome Diversity Panel (HGDP) collections, we identified 54 regions showing population differences in comparison to Africans. We provided here a comprehensive population-genetic analysis of one of these regions, which involves the 32-kb deletion of the PSORS4 locus. By a PCR-based genotyping assay we characterised the profiles of the LCE3C_LCE3B-del and the linkage disequilibrium (LD) pattern between the variant allele and the tag SNP rs4112788. Our results show that most populations tend to have a higher frequency of the deleted allele than Sub-Saharan Africans. Furthermore, we found strong LD between rs4112788G and LCE3C_LCE3B-del in most non-African populations (r2 >0.8), in contrast to the low concordance between loci (r2 <0.3) in the African populations. Conclusions These results are another example of population variability in terms of biomedical interesting CNV. The frequency distribution of the LCE3C_LCE3B-del allele and the LD pattern across populations suggest that the differences between ethnic groups might not be due to natural selection, but the consequence of genetic drift caused by the strong bottleneck that occurred during “out of Africa” expansion.
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Barbarot S. [What's new in pediatric dermatology?]. Ann Dermatol Venereol 2013; 139 Suppl 5:S202-16. [PMID: 23522707 DOI: 10.1016/s0151-9638(12)70135-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This paper is based on a review of the literature focused on pediatric dermatology, from October 2011 to september 2012. Our objective was to highlight the main advances in fields such as atopic dermatitis, infantile hemangiomas, infectious diseases, inflammatory disorders, and genodermatoses.
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Affiliation(s)
- S Barbarot
- Clinique dermatologique, Hôtel Dieu, CHU Nantes, Place Alexis Ricordeau, 44000 Nantes, France.
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Perry M, Streusand WC. The Role of Psychiatry and Psychology Collaboration in Pediatric Dermatology. Dermatol Clin 2013; 31:347-55. [DOI: 10.1016/j.det.2012.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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