1
|
Brandi SL, Skov L, Strandberg-Larsen K, Zachariae C, Cederkvist L, Groot J, Nybo Andersen AM. Psoriasis and mental health in adolescents: A cross-sectional study within the Danish National Birth Cohort. J Affect Disord 2024; 358:318-325. [PMID: 38703911 DOI: 10.1016/j.jad.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 04/19/2024] [Accepted: 05/01/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Psoriasis is a chronic skin disease associated with lower quality of life and higher risk of anxiety and depression in adults. We investigate whether adolescents with psoriasis also experience poorer mental health than their peers. METHODS In this cross-sectional study, we included questionnaire data on psoriasis and mental health from the 18-year follow-up of the Danish National Birth Cohort. We estimated odds ratios (OR) and 95 % confidence intervals (CI) using a logistic regression with inverse probability weighting to account for potential selection bias, adjusted for potential confounders identified a priori. We estimated associations between self-reported psoriasis and multiple aspects of mental health (self-rated health, life satisfaction, mental well-being, loneliness, overall and internalizing behavioral difficulties, depressive symptoms, and anxiety symptoms). In sensitivity analyses, we examined doctor-diagnosed psoriasis and psoriasis with and without joint pain. RESULTS Of the 44,838 included in this study, 1147 (2.6 %) reported psoriasis. Adolescents with psoriasis had a higher risk of nearly all outcomes, including depressive symptoms (OR 1.38; 1.19-1.58) and panic/agoraphobia among both males (OR 1.72; 1.33-2.19) and females (OR 1.60; 1.33-1.92). Associations attenuated when restricted to doctor-diagnosed psoriasis. Associations with poor mental health were mainly observed for adolescents with psoriasis also reporting joint pain. LIMITATIONS We could not establish temporality and lacked data on joint pain in referents. CONCLUSION Psoriasis is associated with poor mental health in adolescents. This appears to be driven by adolescents with psoriasis also reporting joint pain and is less evident in those with a doctor-confirmed diagnosis.
Collapse
Affiliation(s)
- Sandra L Brandi
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 15, 2900 Hellerup, Denmark; Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 24, Entrance Q, 2nd floor, 1356 Copenhagen K, Denmark.
| | - Lone Skov
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 15, 2900 Hellerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Katrine Strandberg-Larsen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 24, Entrance Q, 2nd floor, 1356 Copenhagen K, Denmark
| | - Claus Zachariae
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 15, 2900 Hellerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Luise Cederkvist
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 24, Entrance Q, 2nd floor, 1356 Copenhagen K, Denmark
| | - Jonathan Groot
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 24, Entrance Q, 2nd floor, 1356 Copenhagen K, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 24, Entrance Q, 2nd floor, 1356 Copenhagen K, Denmark
| |
Collapse
|
2
|
Zhang Y, Guo Y, Zhang K, Fan L, Ma J, Li Y, Zhou Q, Zhao Q, Hou S, Wang H. Comorbidities among adult patients with psoriasis in Tianjin: a cross-sectional analysis of the Health Database study. BMJ Open 2024; 14:e083683. [PMID: 38772892 PMCID: PMC11110554 DOI: 10.1136/bmjopen-2023-083683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 04/11/2024] [Indexed: 05/23/2024] Open
Abstract
OBJECTIVES This study aims to examine the prevalence of comorbidities in adult patients with psoriasis and compare them with those in control subjects without psoriasis in Tianjin, China. DESIGN The study is a cross-sectionalanalysis. PARTICIPANTS The participants were established by identifying all patients (age ≥18 years) who visited hospitals and clinics in Tianjin between 1 January 2016 and 31 October 2019. SETTING The study group consisted of 20 678 adult patients with psoriasis, and a comparison group was created after 1:1 propensity score matching. Logistic regression analyses were conducted to examine the risk of 22 comorbidities for these two groups. RESULTS Patients with psoriasis had a significantly higher prevalence of 11 comorbidities and a lower prevalence of 2 comorbidities within 12 months of follow-up. Our results also showed that the proportion of psoriatic arthritis might account for approximately 2% of all patients with psoriasis. This psoriatic arthritis group had a higher average age and CCI (Charlson Comorbidity Index) index score (2.27 >1.62, p <0.001) than the non-arthritis group. CONCLUSIONS This study showed that psoriasis in Tianjin is associated with various comorbidities. It also emphasises the importance of clinical treatment in improving therapeutic effects and reducing the burden of psoriasis in China.
Collapse
Affiliation(s)
- Yiming Zhang
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin, China
| | - Yali Guo
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin, China
- Department of Dermatology, Tianjin Haihe Hospital, Tianjin, China
| | - Kaiyue Zhang
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin, China
| | - Liyun Fan
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin, China
| | - Jingyue Ma
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin, China
| | - Yan Li
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin, China
| | - Quan Zhou
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin, China
| | - Qian Zhao
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin, China
| | - Shuping Hou
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin, China
| | - Huiping Wang
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin, China
| |
Collapse
|
3
|
Matsuo R, Haught K, Guo W, Na S, Lu K, Kaufmann T, Siamas K. Association between Psoriasis and MTHFR polymorphisms: a systematic review and meta-analysis. Arch Dermatol Res 2024; 316:184. [PMID: 38771513 DOI: 10.1007/s00403-024-02905-5] [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: 10/31/2023] [Revised: 04/18/2024] [Accepted: 04/25/2024] [Indexed: 05/22/2024]
Abstract
Methylenetetrahydrofolate reductase (MTHFR) is key to the metabolism of folic acid, with loss of function mutations resulting in elevated homocysteine levels, a known risk factor for cardiovascular disease. Psoriasis patients may demonstrate hyperhomocysteinemia. To assess for the association between psoriasis and MTHFR C677T and A1298C polymorphisms. A systematic literature search was conducted in MEDLINE, Embase, Cochrane CENTRAL, and Web of Science. Case reports, case-control, cohort, and cross-sectional studies with full-text availability in English were considered. Meta-analysis was conducted with pooled ORs calculated via the random effects model (I2 > 50%). Of 917 records identified, 10 studies were selected for review of 1965 psoriasis patients and 2030 controls. Meta-analysis demonstrated that for MTHFR C677T, there were positive associations between psoriasis and the allele contrast model (C vs T, pooled OR = 1.69, 95% CI = 1.10-2.59), the additive model (CC vs TT, pooled OR = 2.44, 95% CI = 1.06-5.60), the dominant model (CC vs CT + TT, pooled OR = 1.77, 95% CI = 1.06-2.98), and the recessive model (CC + CT vs TT, pooled OR = 2.08, 95% CI = 1.05-4.13). For MTHFR A1298C, there were positive associations between psoriasis and the allele contrast model (A vs C, pooled OR = 3.57, 95% CI = 1.19-10.68), the dominant model (AA vs AC + CC, pooled OR = 4.44, 95% CI = 1.12-17.66), and the overdominant model (AC vs AA + CC, pooled OR = 0.26, 95% CI = 0.07-0.91). There may be a link between the C677T and A1298C polymorphisms with psoriasis diagnosis.
Collapse
Affiliation(s)
- Rika Matsuo
- Renaissance School of Medicine at Stony Brook University, Stony Brook, USA.
| | - Katrina Haught
- Renaissance School of Medicine at Stony Brook University, Stony Brook, USA
| | - William Guo
- Department of Dermatology, Renaissance School of Medicine at Stony Brook University, Stony Brook, USA
| | - Sean Na
- Renaissance School of Medicine at Stony Brook University, Stony Brook, USA
| | - Kimberly Lu
- Renaissance School of Medicine at Stony Brook University, Stony Brook, USA
| | - Tara Kaufmann
- Department of Dermatology, Renaissance School of Medicine at Stony Brook University, Stony Brook, USA
| | - Katherine Siamas
- Department of Dermatology, Renaissance School of Medicine at Stony Brook University, Stony Brook, USA
| |
Collapse
|
4
|
Zhang M, Hu Y, Chen L, Chen H, Huang D, Luan C, Zhang J, Chen K. Roles of negative emotions and personality traits in psoriasis vulgaris: A mendelian randomization study. Skin Res Technol 2024; 30:e13702. [PMID: 38743386 DOI: 10.1111/srt.13702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 04/01/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Many studies have indicated that negative emotions and personality traits are related to psoriasis, though few have provided causal evidence. METHODS Our analysis utilized 15 genome-wide association study datasets to identify instrumental variables associated with negative emotions, personality traits and psoriasis vulgaris. Two-sample Mendelian randomization was conducted to identify the causal associations of negative emotions and personality traits with psoriasis vulgaris. To mitigate bias from multiple tests, we adjusted p-values using the Benjamini-Hochberg method. RESULTS Our study revealed causal links between negative emotions and psoriasis vulgaris, including depressed affect, worry too long, feeling hurt, guilty feelings, mood swings, unenthusiasm, miserableness, fed-up feelings. However, there was no significant evidence of a causal relationship between feeling lonely and psoriasis vulgaris. Additionally, personality traits including neuroticism and openness to experience were found to have causal effects on psoriasis vulgaris. However, no significant evidence supported a causal relationship between agreeableness, conscientiousness, and extraversion with psoriasis vulgaris. CONCLUSION Our findings suggest that experiencing negative emotions including depressed affect, worrying excessively, feeling hurt, guilty feelings, mood swings, lack of enthusiasm, miserableness and fed-up feelings may pose risks for psoriasis vulgaris. Additionally, neuroticism is associated with a risk of psoriasis vulgaris. Conversely, the openness trait may serve a protective role against psoriasis vulgaris.
Collapse
Affiliation(s)
- Min Zhang
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, Jiangsu, China
| | - Yu Hu
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, Jiangsu, China
| | - Lihao Chen
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, Jiangsu, China
| | - Hongying Chen
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, Jiangsu, China
| | - Dan Huang
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, Jiangsu, China
| | - Chao Luan
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, Jiangsu, China
| | - Jiaan Zhang
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, Jiangsu, China
| | - Kun Chen
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, Jiangsu, China
| |
Collapse
|
5
|
Liu W, Wang Y, Zhang Y, Zhou M, Gu H, Lu M, Xia Y. Rh family C glycoprotein contributes to psoriatic inflammation through regulating the dysdifferentiation and cytokine secretion of keratinocytes. J Dermatol Sci 2024; 114:2-12. [PMID: 38514279 DOI: 10.1016/j.jdermsci.2024.02.007] [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: 08/24/2023] [Revised: 02/16/2024] [Accepted: 02/27/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Keratinocyte dysdifferentiation and proinflammatory cytokine production play a central role in psoriatic inflammation. According to recent studies, the Rh family C glycoprotein (RHCG) enhances cell proliferation and disrupts cell differentiation. However, the specific role of RHCG psoriasis development remains unclear. OBJECTIVE We here explored the effect of RHCG on keratinocytes under psoriatic inflammation. METHODS The cell counting kit‑8 assay was conducted to assess proliferation. RHCG protein expression was assessed through western blotting and enzyme-linked immunosorbent assays. The expression of proinflammatory cytokines and differentiation markers was analyzed through a quantitative reverse-transcription polymerase chain reaction. RESULTS Both RHCG mRNA and protein levels increased in psoriatic skin. Notably, cultured keratinocytes treated with an M5 cocktail, which mimics psoriatic inflammation, exhibited higher RHCG expression. Furthermore, RHCG overexpression promoted keratinocyte proliferation, accompanied by an increase in the production of interleukin (IL)-1β, IL-6, and IL-8, and tumor necrosis factor-α. RHCG overexpression also resulted in higher expression of keratin 17, a differentiation marker. Conversely, RHCG gene knockdown reduced keratinocyte proliferation and cytokine secretion. RHCG inhibition in cells recovered both keratin 1 and loricrin expression. Additionally, RHCG overexpression facilitated the phosphorylation of nuclear factor-kappa B and extracellular signal-regulated protein kinase signaling pathways. Importantly, when these signaling pathways were inhibited, the effect of RHCG on keratinocytes was attenuated. CONCLUSION These findings support the substantial role of RHCG in psoriatic inflammation development and suggest that RHCG serves as a potential target for psoriasis treatment.
Collapse
Affiliation(s)
- Wei Liu
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yaqi Wang
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yitian Zhang
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Mingzhu Zhou
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hanjiang Gu
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Mei Lu
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yumin Xia
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
| |
Collapse
|
6
|
Bewley A, Hiribarne L, Galván J, Mburu S. Burden of Topical Treatments in Psoriasis and Preferred Criteria of Choice: A Survey-Based Evaluation of Patients in Europe. Dermatol Ther (Heidelb) 2024:10.1007/s13555-024-01132-0. [PMID: 38457035 DOI: 10.1007/s13555-024-01132-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/23/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Topical treatments (TT) are widely used in psoriasis management. While psoriasis itself has been associated with diminished quality of life and mental well-being, the impact of TT remains underexplored. This study aimed to evaluate the burden of TT on the daily lives of patients with psoriasis, the convenience of the TT, and the choice criteria. METHODS Patients were recruited across five countries (France, Germany, Italy, Spain, UK) by Wefight and the International Federation of Psoriasis Associations (IFPA) to complete a 29-item online survey. RESULTS A total of 766 patients completed the survey (54% female, mean age of 53 years). The mean body surface area covered by psoriasis was 7%, predominantly on the scalp and elbows. Participants had been living with psoriasis for a mean duration of 18 years. Of the respondents, 34% reported feeling affected by their TT in their daily routines and activities. Those feeling affected were more likely to have a more complex disease, be using more treatments, or be diagnosed more recently compared to those less affected. Among those most affected by their TT, 27% reported a strong impact on mental health, 30% on sexual life, and 25% on physical activities, compared to 7%, 6% and 4% in those least affected, respectively. Both cohorts considered tolerability factors such as "does not cause itching/burning" and "good tolerability" as most important when choosing a topical. However, only least affected participants regarded convenience factors such as "does not run off," "ease of application," "does not leave stains" among others equally as important. CONCLUSION Overall, one-third of patients report a significant burden of TT on their daily lives. These patients have different criteria of choice, highlighting the importance of communication between physicians and patients to tailor treatment to individual preferences, thereby enhancing adherence and treatment outcomes.
Collapse
Affiliation(s)
- Anthony Bewley
- Department of Dermatology, Barts Health NHS Trust-Queen Mary University, London, UK.
| | | | | | - Sicily Mburu
- International Federation of Psoriasis Associations (IFPA), Stockholm, Sweden
| |
Collapse
|
7
|
Blauvelt A, Armstrong A, Merola JF, Strober B, de Cuyper D, Peterson L, Davies O, Stark JL, Lebwohl M. Mental health outcomes in patients with moderate to severe psoriasis treated with bimekizumab: Analysis of phase 2/3 randomized trials. J Am Acad Dermatol 2024:S0190-9622(24)00438-9. [PMID: 38447700 DOI: 10.1016/j.jaad.2024.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/08/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Patients with psoriasis have increased risk of suicidal ideation and behavior (SIB) and depression. Bimekizumab, a biologic that inhibits interleukin (IL)-17A and IL-17F, received Food and Drug Administration approval in 2023 for moderate to severe plaque psoriasis, following 2021 European Medicines Agency approval. OBJECTIVE To report SIB and depression in patients with moderate to severe psoriasis treated in bimekizumab clinical trials. METHODS Mental health changes, including neuropsychiatric events, were actively monitored across 9 bimekizumab clinical trials in psoriasis phase 2/3 trials. The patient-reported electronic Columbia-Suicide Severity Rating Scale (measuring SIB) and Patient Health Questionnaire-9 (measuring depression) were administered, monitored by an independent Neuropsychiatric Adjudication Committee. RESULTS Throughout 7166 patient-years (PY) of bimekizumab exposure, the adjudicated SIB rate was 0.13/100PY; SIB ranges for the general psoriasis population and patients receiving anti-IL-17A/anti-IL-23 therapies are 0.09 to 0.54/100PY and 0.09 to 0.19/100PY, respectively. At week 16, 92.9% vs 81.1% of bimekizumab- vs placebo-treated patients had no/minimal depression. Newonset positive electronic Columbia-Suicide Severity Rating Scale responses and mean Patient Health Questionnaire-9 scores were low for bimekizumab-treated patients. LIMITATIONS Patient exclusion for significant/severe prespecified SIB/depression history. CONCLUSION The long-term adjudicated SIB rate with bimekizumab was low and within ranges reported in the general psoriasis patient population and psoriasis patients treated with anti-IL-17A/anti-IL-23 biologics. Screening/monitoring questionnaires reported low SIB and depression levels.
Collapse
Affiliation(s)
| | - April Armstrong
- University of California Los Angeles (UCLA), Los Angeles, California
| | - Joseph F Merola
- Division of Rheumatology, Departments of Dermatology and Medicine, Division of Rheumatology, Departments of Dermatology and Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Bruce Strober
- Department of Dermatology, Yale University, New Haven, Connecticut; Central Connecticut Dermatology Research, Cromwell, Connecticut
| | | | | | | | | | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
8
|
Paradoxical Reactions to Anti-TNFα and Anti-IL-17 Treatment in Psoriasis Patients: Are Skin and/or Gut Microbiota Involved? Dermatol Ther (Heidelb) 2023; 13:911-933. [PMID: 36929119 DOI: 10.1007/s13555-023-00904-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/14/2023] [Indexed: 03/18/2023] Open
Abstract
Psoriasis is a chronic, immune-mediated, inflammatory disease primarily affecting the skin. It is currently coming to light that patients with psoriasis have disrupted intestinal barrier and often suffer from comorbidities associated with the gastrointestinal tract. Moreover, there is growing evidence of both cutaneous and intestinal paradoxical reactions during biologic treatment in patients with psoriasis. This review focuses on barrier defects and changes in immune responses in patients with psoriasis, which play an important role in the development of the disease but are also influenced by modern biological treatments targeting IL-17 and TNFα cytokines. Here, we highlight the relationship between the gut-skin axis, microbiota, psoriasis treatment, and the incidence of paradoxical reactions, such as inflammatory bowel disease in patients with psoriasis. A better understanding of the interconnection of these mechanisms could lead to a more personalized therapy and lower the incidence of treatment side effects, thereby improving the quality of life of the affected patients.
Collapse
|
9
|
[Recommendations for individual comorbidity risk assessment in adult patients with psoriasis]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:350-355. [PMID: 36811642 PMCID: PMC10169877 DOI: 10.1007/s00105-023-05116-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 02/24/2023]
Abstract
It has long been known that chronic inflammatory systemic diseases, such as psoriasis, pose a high risk of developing comorbidities. In everyday clinical practice, it is therefore of particular importance to identify patients who have an individually increased risk profile. In patients with psoriasis, the comorbidity patterns "metabolic syndrome", "cardiovascular comorbidity" and "mental illness" were identified as particularly relevant in epidemiological studies depending on the duration and severity of the disease. In the everyday care of patients with psoriasis in dermatological practice, the use of an interdisciplinary checklist for risk analysis and the initiation of professional follow-up care has proven valuable. On the basis of an existing checklist, the contents were critically evaluated by an interdisciplinary group of experts and a guideline-oriented update was prepared. In the opinion of the authors, the new analysis sheet represents a practicable, factually focused and updated tool for comorbidity risk assessment in patients with moderate and severe psoriasis.
Collapse
|
10
|
Rosenø NAL, Lørup EH, Richardson C, Alarcon I, Egeberg A. Exploring disease comorbidities and temporal disease progression of psoriasis: an observational, retrospective, multi-database, cohort study. Br J Dermatol 2023; 188:372-379. [PMID: 36637104 DOI: 10.1093/bjd/ljac086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/10/2022] [Accepted: 11/02/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Comorbidities associated with psoriasis are well documented. However, few studies have explored the comorbidity trajectories that patients with psoriasis commonly experience over time. This study reports the 5-year comorbidity trajectories of patients with psoriasis. OBJECTIVES To determine the long-term comorbidity trajectories of patients with psoriasis in Denmark. METHODS This observational cohort study explored the Danish National Patient Registry (DNPR) between 1999 and 2013 to identify comorbidities diagnosed 5 years prior to or after a psoriasis diagnosis. Comorbidity occurrence in patients with psoriasis (psoriasis cohort) was compared with patients without psoriasis (the N group). Comparison groups, each the same size as the psoriasis cohort, were created by selecting random patients from the N group. If a comorbidity occurrence was higher in more than nine comparison groups than in the psoriasis cohort, it was not analysed and only comorbidities that occurred in ≥ 0·8% of the psoriasis cohort were analysed. The strength of association between a psoriasis diagnosis and a comorbidity diagnosis was measured using relative risk (RR). All psoriasis and comorbidity pairs that achieved RR > 1 (P < 0·001) (known as a Diagnosed Pair) were tested for directionality to identify the sequence of diagnoses using a binomial test. Diagnosed Pairs with a statistically significant direction (Bonferroni corrected P-value < 0·025) were then used to create comorbidity trajectory clusters 5 years before and after a psoriasis diagnosis. RESULTS A total of 17 683 patients with psoriasis were compared with 10 000 comparison groups. A total of 121 comorbidities met the minimum criteria that ≥ 0·8% of the psoriasis cohort were diagnosed with the comorbidity within 5 years (before or after) of their psoriasis diagnosis. Thirty-eight of these comorbidities achieved RR > 1 (P < 0·001) with psoriasis, of which 19 achieved a significant direction from psoriasis to a comorbidity (including psoriasis to hypothyroidism), and four achieved a significant direction from a comorbidity diagnosis to a psoriasis diagnosis (including Crohn disease to psoriasis); four of five comorbidity trajectories with three sequential diagnoses achieved an RR > 1 (P < 0·001) and a significant direction from psoriasis to the first comorbidity to the second comorbidity (including psoriasis to hypertension to atrial fibrillation and flutter). CONCLUSIONS Comorbidity trajectories may support clinicians in conducting disease risk analyses of patients with psoriasis and help plan optimal treatment to prevent future high-risk comorbidities.
Collapse
Affiliation(s)
- Nana A L Rosenø
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Erik Hillo Lørup
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | | | | | - Alexander Egeberg
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| |
Collapse
|
11
|
Huang S, Bai Y. Knowledge Mapping and Research Hotspots of Comorbidities in Psoriasis: A Bibliometric Analysis from 2004 to 2022. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020393. [PMID: 36837593 PMCID: PMC9961708 DOI: 10.3390/medicina59020393] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/02/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023]
Abstract
Background and Objectives: Psoriasis is a chronic inflammatory disease whose impact on health is not only limited to the skin, but is also associated with multiple comorbidities. Early screening for comorbidities along with appropriate treatment plans can provide a positive prognosis for patients. This study aimed to summarize the knowledge structure in the field of psoriasis comorbidities and further explore its research hotspots and trends through bibliometrics. Materials and Methods: A search was conducted in the core collection of the Web of Science for literature on comorbidities of psoriasis from 2004 to 2022. VOSviewer and CiteSpace software were used for collaborative network analysis, co-citation analysis of references, and keyword co-occurrence analysis on these publications. Results: A total of 1803 papers written by 6741 authors from 81 countries was included. The publications have shown a progressive increase since 2004. The United States and Europe were at the forefront of this field. The most prolific institution was the University of California, and the most productive author was A. Armstrong. Research has focused on "psoriatic arthritis", "metabolic syndrome", "cardiovascular disease", "psychosomatic disease", "inflammatory bowel disease", "prevalence", "quality of life", and "risk factor" in the past 18 years. Keywords such as "biologics" and "systemic inflammation", have been widely used recently, suggesting current research hotspots and trends. Conclusions: Over the past 18 years, tremendous progress has been made in research on psoriasis comorbidity. However, collaborations among countries, institutions, and investigators are inadequate, and the study of the mechanisms of interaction between psoriasis and comorbidities and management of comorbidities is insufficient. The treatment of comorbidities with biologic agents, screening of comorbidities, and multidisciplinary co-management are predicted to be the focus of future research.
Collapse
Affiliation(s)
- Shan Huang
- Graduate School, Beijing University of Chinese Medicine, Beijing 100105, China
| | - Yanping Bai
- Department of Dermatology, China-Japan Friendship Hospital, Beijing 100029, China
- Correspondence: ; Tel.: +86-13910758509
| |
Collapse
|
12
|
Dorozhenok IY. [Nosogenic psychosomatic disorders in patients with skin diseases]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:36-43. [PMID: 37141127 DOI: 10.17116/jnevro202312304236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Development of a clinical typology of nosogenic psychosomatic disorders in patients with skin diseases. MATERIAL AND METHODS The study was carried out in the interclinical psychosomatic department of the Clinical Center and the Clinic of Skin and Venereal Diseases named after. V.A. Rakhmanov Sechenov University in 2007 to 2022. Nine hundred and forty-two patients (253 males, 689 females, average age 37.3±12.4 years) with nosogenic psychosomatic disorders in chronic dermatoses, including ichen planus (n=143), psoriasis (n=137), atopic dermatitis (n=132), acne (n=118), rosacea (n=115), eczema n=10), seborrheic dermatitis (n=88), vitiligo (n=52), pemphigus (n=48), were studied. Index of clinical symptoms (ICS); the Dermatology Quality of Life Index (DQLI); itching severity questionnaire - Behavioral rating scores (BRS); the Hospital Anxiety and Depression Scale (HADS) and statistical methods were used. RESULTS In patients with chronic dermatoses, nosogenic psychosomatic disorders were diagnosed according to ICD-10 criteria within adaptation disorders [F43.8] (n=465; 49.3%); hypochondriacal disorder [F45.2] (n=235; 24.9%); constitutionally determined and acquired (hypochondriac development) personality disorders [F60] (n=118; 12.5%); schizotypal disorder [F21] (n=65; 6.9%); recurrent depressive disorder [F33] (n=59; 6.2%). A typological model of nosogenic disorders in dermatology has been developed: hypochondriacal nosogenies in severe clinical forms of dermatosis (pemphigus, psoriasis, lichen planus, atopic dermatitis, eczema) and dysmorphic nosogenies in objectively mild, but cosmetically significant forms of dermatosis (acne, rosacea, seborrheic dermatitis, vitiligo). When analyzing socio-demographic and psychometric indicators, significant differences were revealed between the selected groups (p<0.001). In turn, the selected groups of nosogenic disorders demonstrate significant clinical heterogeneity and include various types of nosogenies that form a unique palette of the nosogenic spectrum in the structure of an extensive psychodermatological continuum. Along with the severity of the skin process, the dominant role in the formation of the clinical picture of nosogeny, including cases of paradoxical dissociation of the quality of life with the severity of dermatosis, amplification and somatization of itching, has a premorbid personality structure and somatoperceptive accentuation of the patient, as well as the presence of a comorbid mental disorder. CONCLUSION The typology of nosogenic psychosomatic disorders in patients with skin diseases requires consideration of both the psychopathological structure of the disorders under discussion and the severity/clinical features of the skin process.
Collapse
Affiliation(s)
- I Yu Dorozhenok
- Sechenov First Moscow Medical University (Sechenov University), Moscow, Russia
- Mental Health Research Center, Moscow, Russia
| |
Collapse
|
13
|
Bardazzi F, Bonci C, Sacchelli L, DI Altobrando A, Iommi M, Rucci P, Sacchelli P, Berardi D, Patrizi A, Tengattini V. Suicide risk and depression in patients with psoriasis. Ital J Dermatol Venerol 2022; 157:497-501. [PMID: 36651203 DOI: 10.23736/s2784-8671.22.07184-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Psoriasis is associated with comorbid psychiatric conditions. However, its relationship with suicidality is not completely understood. The aim of this study was to analyze the prevalence and the correlates of depressive symptoms and suicide risk in patients with psoriasis. METHODS Adult psoriatic patients referring to the Outpatient Service of the Sant'Orsola-Malpighi Polyclinic were enrolled. Depressive symptoms and suicidality were assessed using the Patient Health Questionnaire (PHQ-9) and section C of Mini-International Neuropsychiatric Interview (M.I.N.I. 5.0.0). Psoriasis was evaluated using the Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA) and the Dermatology Life Quality Index (DLQI). RESULTS The prevalence of depressive symptoms was 14.9% and that of suicidality 6.3%. PHQ-9 scores were higher in patients with moderate-to-severe psoriasis (PASI≥10, Mann-Whitney U Test=4014.5; P<0.001; BSA≥10, Mann-Whitney Test=3930.5; P<0.001) and poorer quality of life (Mann-Whitney Test=805.5; P=0.024). Moreover, PHQ-9 scores were higher in females (Mann-Whitney Test U=3612.5; P=0.008) and were unrelated to age (r<inf>s</inf>=-0.056, P=0.423). Conversely, suicide risk was significantly higher in younger patients (Mann-Whitney=744, P=0.013) and females (χ2=5.69, P=0.028), and was unrelated to psoriasis severity. CONCLUSIONS Patients with moderate-to-severe psoriasis, especially females, should be screened for depression and suicidal ideation to support them with effective strategies to treat depressive symptoms.
Collapse
Affiliation(s)
- Federico Bardazzi
- Unit of Dermatology, Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Camilla Bonci
- Unit of Dermatology, Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Lidia Sacchelli
- Unit of Dermatology, Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy -
| | - Ambra DI Altobrando
- Unit of Dermatology, Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Marica Iommi
- Department of Biomedical and Neuromotor Sciences, Division of Hygiene and Biostatistics, University of Bologna, Bologna, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Division of Hygiene and Biostatistics, University of Bologna, Bologna, Italy
| | - Paola Sacchelli
- School of Specialization in Psychotherapy with "Relationship Psychoanalysis, " Area 25 Clinical Center, Società Italiana di Psicoanalisi della Relazione (SIPRe), Milan, Italy
| | - Domenico Berardi
- Department of Biomedical and Neuromotor Sciences, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Unit of Dermatology, Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy.,Departiment of Dermatology, IRCCS Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Vera Tengattini
- Unit of Dermatology, Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| |
Collapse
|
14
|
Gisondi P, Geat D, Maurelli M, Degli Esposti L, Bellinato F, Girolomoni G. Cost per Responder Analysis of Secukinumab versus Adalimumab in the Treatment of Psoriatic Disease. Vaccines (Basel) 2022; 10:646. [PMID: 35632402 PMCID: PMC9142895 DOI: 10.3390/vaccines10050646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/13/2022] [Accepted: 04/16/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The EXCEED study evaluated the efficacy and safety of secukinumab versus adalimumab in psoriatic arthritis, but it did not include a pharmacoeconomic analysis. The objective of this study was to compare the cost per responder of secukinumab versus adalimumab in patients with psoriatic disease. METHODS The cost per responder was calculated by multiplying the cost of treatment by the number needed to treat for each therapy. The 52-week primary endpoint was the American College of Rheumatology response rate (ACR) 20; secondary endpoints were ACR 50, Psoriasis Area and Severity Index (PASI) 90, and minimal disease activity (MDA). RESULTS The cost per responder for ACR 20 was €19,846 versus €19,766 for secukinumab and adalimumab, respectively, whereas the costs per responder for ACR 50 and PASI 90 were €27,820 versus €27,384 and €22,102 versus €32,375 for secukinumab and adalimumab, respectively. The cost per MDA responder was €34,072 and €38,906 for secukinumab versus adalimumab. CONCLUSIONS The costs per responder associated with the psoriatic arthritis end points were similar for adalimumab and secukinumab; conversely, the costs for psoriasis and composite end points were lower for secukinumab.
Collapse
Affiliation(s)
- Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37126 Verona, Italy; (D.G.); (M.M.); (F.B.); (G.G.)
| | - Davide Geat
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37126 Verona, Italy; (D.G.); (M.M.); (F.B.); (G.G.)
| | - Martina Maurelli
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37126 Verona, Italy; (D.G.); (M.M.); (F.B.); (G.G.)
| | - Luca Degli Esposti
- CliCon S.r.l. Health, Economics & Outcomes Research, 40121 Bologna, Italy;
| | - Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37126 Verona, Italy; (D.G.); (M.M.); (F.B.); (G.G.)
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37126 Verona, Italy; (D.G.); (M.M.); (F.B.); (G.G.)
| |
Collapse
|
15
|
Hoelker S, Ninosu N, Buettner S, Peitsch WK, Schaarschmidt ML. Patient preferences for topical psoriasis treatments: a discrete choice experiment. J DERMATOL TREAT 2022; 33:2595-2604. [DOI: 10.1080/09546634.2022.2059052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Suna Hoelker
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Nadia Ninosu
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Sylvia Buettner
- Department for Biomathematics and Medical Statistics, Faculty of Medicine Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Wiebke K. Peitsch
- Department of Dermatology and Phlebology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Marthe-Lisa Schaarschmidt
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| |
Collapse
|
16
|
Milan R, LeLorier J, Brouillette MJ, Holbrook A, Litvinov IV, Rahme E. Sex Differences in the Patterns of Systemic Agent use Among Patients With Psoriasis: A Retrospective Cohort Study in Quebec, Canada. Front Pharmacol 2022; 13:810309. [PMID: 35242034 PMCID: PMC8886891 DOI: 10.3389/fphar.2022.810309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Sex differences exist in psoriasis manifestation and expectations from treatment with systemic agents, including, conventional systemic agents (CSA) and tumor necrosis factor inhibitors or ustekinumab (TNFi/UST). However, sex differences in patterns of systemic agent use, such as CSA discontinuation and switch from CSA to TNFi/UST have not been examined. Objectives: To assess sex differences in patterns of CSA use and identify factors associated with switch to (or add) a TNFi/UST and those associated with CSA discontinuation. Methods: We conducted a retrospective cohort study using the Quebec health administrative databases. We included patients with psoriasis initiating a CSA in 2002–2015. We excluded patients with a psoriasis diagnosis in the 3 years prior to the first diagnosis date between 2002 and 2015, and those with a systemic agent dispensation in the year prior to that date. We used Cox regression models with the Least Absolute Shrinkage and Selection Operator method to identify factors associated with Switch/add TNFi/UST, and those associated with CSA discontinuation. Separate analyses were performed for male and female patients. Results: We included 1,644 patients (55.7% females, mean age 60.3 years), among whom 60.4% discontinued their CSA and 7.4%, switched/added TNFi/UST (3.4% switched and 4.0% added) within a median of 0.78 years of follow-up. Among male and female patients, rates of Switch/add TNFi/UST per 1,000 person-year were 49.1 and 41.0 and rates of CSA discontinuation were 381.2 and 352.8. Clinical obesity in male patients (HR 3.53, 95% CI 1.20–10.35), and adjustment/somatoform/dissociative disorders (HR 3.17, 95% CI 1.28–7.85) and use of nonsteroidal anti-inflammatory drugs (HR 2.70, 95% CI 1.56–4.70) in female patients were associated with Switch/add TNFi/UST. Male patients followed by a rheumatologist (HR 0.66, 95% CI 0.46–0.94) and those with a prior hospitalization (HR 0.70, 95% CI 0.57–0.87) were at lower risk of CSA discontinuation, while those initiated on acitretin (vs methotrexate) were at higher risk to discontinue their CSA (HR 1.61, 95% CI 1.30–2.01). Female patients with rheumatoid arthritis comorbidity (HR 0.69, 95% CI 0.51–0.93), those with a dispensed lipid-lowering agent (HR 0.72, 95% CI 0.59–0.88) and hypoglycemic agent (HR 0.75, 95% CI 0.57–0.98) and those initiated on methotrexate (vs all other CSAs) were less likely to discontinue their CSA. Male and female patients entering the cohort between 2011 and 2015 were at reduced risk of CSA discontinuation compared to those entering the cohort before 2011. Conclusion: Most male and female patients discontinued their CSA within 1 year of follow-up. Our study highlighted sex differences in patients’ characteristics associated with switch/add a TNFi/UST and CSA discontinuation; treatment switch and discontinuation may be indications of treatment failure in most patients.
Collapse
Affiliation(s)
- Raymond Milan
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Jacques LeLorier
- Faculté de Médecine, Université de Montréal, Montreal, QC, Canada.,Centre de Recherche Du Centre Hospitalier De L'Université de Montréal, Montreal, QC, Canada
| | - Marie-Josée Brouillette
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Anne Holbrook
- Department of Medicine, Division of Clinical Pharmacology and Toxicology, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Ivan V Litvinov
- Department of Medicine, Division of Dermatology, McGill University, Montreal, QC, Canada
| | - Elham Rahme
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada
| |
Collapse
|
17
|
Fabrazzo M, Romano F, Arrigo M, Puca RV, Fuschillo A, De Santis V, Sampogna G, Giordano GM, Catapano F, Lo Schiavo A. A Multivariate Analysis of Depression Prevalence in Psoriasis Patients: A Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042060. [PMID: 35206248 PMCID: PMC8871876 DOI: 10.3390/ijerph19042060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/28/2022]
Abstract
The literature reported higher depression rates in psoriasis patients compared to the general population. Our study aimed to verify whether variability in depression prevalence was due to using different diagnostic tools. We also aimed to determine whether dysfunctional coping strategies might increase the depression burden. We assessed psoriasis severity by the Psoriasis Area Severity Index (PASI) and PSOdisk. We analyzed mental alterations of 120 outpatients by Hamilton Depression and Anxiety Rating Scales (HAM-D and HAM-A), Symptom Checklist-90-Revised (SCL-90-R), plus coping strategies and quality of life by Coping Orientation to Problems Experienced (COPE) Inventory and 36-Item Short Form Health Survey (SF-36). We divided our cohort into five subgroups from minimal to severe psoriasis using the PSOdisk total score. Depression prevalence varied according to the assessment criteria for specificity, frequency, and severity. Different mood disorders other than major depression emerged when we used DSM-IV-TR criteria. Correlation analysis of the criteria we used to diagnose depression or depressed mood indicated that a dysfunctional coping strategy was highly and positively correlated only in patients of the severe subgroup. Differently, a negative correlation emerged between the SF-36 Mental Summary Component (MSC) and behavioral disengagement, thus suggesting that psychopathological distress might induce patients with a marked/severe psoriasis to adopt dysfunctional coping strategies. Dermatologists are fundamental in detecting comorbid depression, referring psoriasis patients to mental health specialists to achieve adequate treatments, and preventing suicide risk.
Collapse
Affiliation(s)
- Michele Fabrazzo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (M.A.); (A.F.); (V.D.S.); (G.S.); (G.M.G.); (F.C.)
- Correspondence: ; Tel.: +39-(0)81-566-65-29
| | - Francesca Romano
- Dermatology Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (F.R.); (R.V.P.); (A.L.S.)
| | - Marzia Arrigo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (M.A.); (A.F.); (V.D.S.); (G.S.); (G.M.G.); (F.C.)
| | - Rosa Valentina Puca
- Dermatology Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (F.R.); (R.V.P.); (A.L.S.)
| | - Antonietta Fuschillo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (M.A.); (A.F.); (V.D.S.); (G.S.); (G.M.G.); (F.C.)
| | - Valeria De Santis
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (M.A.); (A.F.); (V.D.S.); (G.S.); (G.M.G.); (F.C.)
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (M.A.); (A.F.); (V.D.S.); (G.S.); (G.M.G.); (F.C.)
| | - Giulia Maria Giordano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (M.A.); (A.F.); (V.D.S.); (G.S.); (G.M.G.); (F.C.)
| | - Francesco Catapano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (M.A.); (A.F.); (V.D.S.); (G.S.); (G.M.G.); (F.C.)
| | - Ada Lo Schiavo
- Dermatology Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (F.R.); (R.V.P.); (A.L.S.)
| |
Collapse
|
18
|
Hewitt RM, Bundy C, Newi A, Chachos E, Sommer R, Kleyn CE, Augustin M, Griffiths CE, Blome C. How do dermatologists’ personal models inform a patient–centred approach to management: a qualitative study using the example of prescribing a new treatment (Apremilast). Br J Dermatol 2022; 187:82-88. [PMID: 35064926 PMCID: PMC9540747 DOI: 10.1111/bjd.21029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 11/30/2022]
Abstract
Background The quality of dermatology consultations is partly determined by how clinicians approach patient care. The term ‘Personal Models’ describes the explanatory frameworks of thoughts, feelings and experiences that drive behaviour. One study found that clinicians’ personal models, specifically their beliefs about autonomy and patient self‐management, influenced the degree to which clinicians engage patients in shared decision making during consultations. Further research is needed to further explore how clinicians’ personal models inform and affect the quality of patient care. Objectives To explore how clinicians’ personal models inform shared decision making and consultation style in managing people living with psoriasis in the context of a new treatment, Apremilast. Methods A framework analysis of qualitative semi‐structured telephone interviews with 13 dermatologists from the UK and Germany who participated in a novel medicine trial for psoriasis called APPRECIATE. Results Two themes were derived from the data. Theme 1, ‘personal working models of patient care’, comprised two subthemes: ‘patient‐centredness: a continuum’ and ‘stereotypes and assumptions’. Theme 2, ‘impact of personal working models on patient care’, included three subthemes: ‘shared decision making: a continuum’, ‘consultation skills’ and ‘impact of concerns about Apremilast on prescribing behaviour’. Conclusions Although many dermatologists endorsed a patient‐centred approach, not all reported working in this way. Clinicians’ personal models, their beliefs, stereotypes, personal perceptions and assumptions about patients are likely to affect their prescribing behaviour and shared decision making. Additional specialized training and education could increase patient‐centredness and whole‐person management. What is already known about this topic?‘Personal models’ is the term used to describe the thoughts, feelings and experiences that determine behaviour. Research has shown that clinicians’ personal models can influence their approach to psoriasis management, although the evidence base is limited.
What does this study add?Some, but not all, clinicians endorse a patient‐centred approach. Clinicians’ beliefs and attitudes about patients, psoriasis and evidence for psoriasis treatments all potentially influence the degree to which clinicians champion whole‐person management. Clinicians’ personal models impact how clinicians communicate with and behave towards patients during consultations and more specifically, the extent to which they demonstrate techniques to engage patients in joint decisions related to their condition and treatment.
What are the clinical implications ofthiswork?Additional specialized training and education could help clinicians to recognize how their beliefs, feelings and experiences influence their clinical practice, extend their skills in shared decision making, and facilitate whole‐person management.
Linked Comment: F. Cowdell. Br J Dermatol 2022; 187:4. Plain language summary available online
Collapse
Affiliation(s)
- Rachael M. Hewitt
- School of Healthcare Sciences, College of Biomedical & Lifesciences Cardiff University Cardiff UK
| | - Chris Bundy
- School of Healthcare Sciences, College of Biomedical & Lifesciences Cardiff University Cardiff UK
| | - Antonia‐Luise Newi
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Evangelos Chachos
- Turner Institute for Brain and Mental Health Monash University Melbourne Australia
| | - Rachel Sommer
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Christine Elise Kleyn
- University of Manchester The Dermatology Centre, Barnes Building, Salford Royal NHS Foundation Trust Manchester UK
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Christopher E.M. Griffiths
- University of Manchester The Dermatology Centre, Barnes Building, Salford Royal NHS Foundation Trust Manchester UK
| | - Christine Blome
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf Hamburg Germany
| |
Collapse
|
19
|
Anderson ZT, Dawson AD, Slominski AT, Harris ML. Current Insights Into the Role of Neuropeptide Y in Skin Physiology and Pathology. Front Endocrinol (Lausanne) 2022; 13:838434. [PMID: 35418942 PMCID: PMC8996770 DOI: 10.3389/fendo.2022.838434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Neuropeptide Y is widely distributed within the body and has long been implicated as a contributor to skin disease based on the correlative clinical data. However, until recently, there have been few empirical investigations to determine whether NPY has a pathophysiological role in the skin. Due to appearance-altering phenotypes of atopic dermatitis, psoriasis, and vitiligo, those suffering from these diseases often face multiple forms of negative social attention. This often results in psychological stress, which has been shown to exacerbate inflammatory skin diseases - creating a vicious cycle that perpetuates disease. This has been shown to drive severe depression, which has resulted in suicidal ideation being a comorbidity of these diseases. Herein, we review what is currently known about the associations of NPY with skin diseases and stress. We also review and provide educated guessing what the effects NPY can have in the skin. Inflammatory skin diseases can affect physical appearance to have significant, negative impacts on quality of life. No cure exists for these conditions, highlighting the need for identification of novel proteins/neuropetides, like NPY, that can be targeted therapeutically. This review sets the stage for future investigations into the role of NPY in skin biology and pathology to stimulate research on therapeutic targeting NPY signaling in order to combat inflammatory skin diseases.
Collapse
Affiliation(s)
- Zoya T. Anderson
- Department of Biology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Alex D. Dawson
- Department of Biology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Andrzej T. Slominski
- Department of Dermatology, Comprehensive Cancer Center, Cancer Chemoprevention Program, University of Alabama at Birmingham, Birmingham, AL, United States
- Veteran Administration Medical Center, Birmingham, AL, United States
| | - Melissa L. Harris
- Department of Biology, University of Alabama at Birmingham, Birmingham, AL, United States
- *Correspondence: Melissa L. Harris,
| |
Collapse
|
20
|
Role of Epithelium-Derived Cytokines in Atopic Dermatitis and Psoriasis: Evidence and Therapeutic Perspectives. Biomolecules 2021; 11:biom11121843. [PMID: 34944487 PMCID: PMC8699296 DOI: 10.3390/biom11121843] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 02/06/2023] Open
Abstract
Atopic dermatitis and psoriasis are two of the most common chronic skin conditions. Current target therapies represent viable and safe solutions for the most severe cases of these two dermatoses but, presently, several limitations exist in terms of efficacy and side effects. A new class of products, epithelium-derived cytokines (TSLP, IL-25, IL-33), show an increasing potential for use in target therapy for these patients, and demonstrate a direct link between a generalized inflammatory and oxidative stress status and the human skin. A review was conducted to better understand their role in the aforementioned conditions. Of these three molecules, TSLP led has been most often considered in studies regarding target therapies, and most of the results in the literature are related to this cytokine. These three cytokines share common stimuli and are linked to each other in both acute and chronic phases of these diseases, and have been challenged as target therapies or biomarkers of disease activity. The results lead to the conclusion that epithelium-derived cytokines could represent a therapeutic opportunity for these patients, especially in itch control. Furthermore, they might work better when paired together with currently available therapies or in combination with in-development treatments. Further studies are needed in order to verify the efficacy and safety of the biologic treatments currently under development.
Collapse
|
21
|
Hölsken S, Krefting F, Schedlowski M, Sondermann W. Common Fundamentals of Psoriasis and Depression. Acta Derm Venereol 2021; 101:adv00609. [PMID: 34806760 PMCID: PMC9455336 DOI: 10.2340/actadv.v101.565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Psoriasis is an inflammatory, immune-mediated disease that is frequently associated with psychological comorbidities such as depression. The stigma patients feel because of the appearance of their skin may contribute to the high psycho-social burden of psoriasis. However, there is emerging evidence that overlapping biological mechanisms are, to a substantial degree, responsible for the close interaction between psoriasis and depression. Increased proinflammatory mediators, such as C-reactive protein or interleukin-6, are present in both psoriasis and depression, indicating that inflammation may represent a pathophysiological link between the diseases. Anti-inflammatory biologic therapies treat the clinical manifestations of psoriasis, but might also play a significant role in reducing associated depressive symptoms in patients with psoriasis. Comparison between single studies focusing on the change in depressive symptoms in psoriasis is limited by inconsistency in the depression screening tools applied.
Collapse
Affiliation(s)
| | | | | | - Wiebke Sondermann
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, DE-45122 Essen, Germany.
| |
Collapse
|
22
|
Wang M, Wang Y, Zhang M, Duan Q, Chen C, Sun Q, Liu M, Zheng Y, Shao Y. Kynureninase contributes to the pathogenesis of psoriasis through pro-inflammatory effect. J Cell Physiol 2021; 237:1044-1056. [PMID: 34553380 DOI: 10.1002/jcp.30587] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 11/09/2022]
Abstract
Kynureninase (KYNU) is a key enzyme in the tryptophan metabolism pathway with elevated expression in psoriatic lesions relative to normal skin. However, whether KYNU contributes to the pathogenesis of psoriasis remains unknown. We sought to investigate the role of KYNU in psoriasis and its possible regulation mechanism. In the results, KYNU is upregulated in psoriatic skin samples from patients or animal models compared with normal skin control which was assayed in psoriatic patient samples, IMQ-induced psoriasis-like skin inflammation in BABL/c mice and M5-stimulated keratinocyte cell lines by immunohistochemistry (IHC). KYNU knockdown had a trivial impact on keratinocyte proliferation, but significantly inhibited the production of inflammatory cytokines in HaCaT, HEKα, and HEKn cells by quantitative reverse-transcription polymerase chain reaction, enzyme-linked immunosorbent assay, and western blot analysis. The 3'-untranslated region of KYNU contains a conserved target site of a skin-specific microRNA (miRNA), miR-203a, as predicted by TargetScan software. Furthermore, miR-203a exhibited an inversed expression kinetics to KYNU during the development of IMQ-induced psoriasis-like skin inflammation in BABL/c mice. Overexpression of miR-203 subsequently leading to the inhibition of KYNU, could significantly reduce the production of M5-induced, psoriasis-related inflammatory factors in keratinocytes. Finally, KYNU inhibitors could alleviate the pathological phenotypes in IMQ-mice. Our study supported the contributive role of KYNU in the development of psoriasis and provided preliminary evidence for KYNU as a potential therapeutic target in psoriasis.
Collapse
Affiliation(s)
- Min Wang
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Yuqian Wang
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Mengdi Zhang
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Qiqi Duan
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Caifeng Chen
- Department of Dermatology, Fujian Provincial Hospital, Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Qiong Sun
- Department of Life Science and Technology, Institute of Mitochondria, Xi'an Jiaotong University, Xi'an, China
| | - Meng Liu
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Yan Zheng
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Yongping Shao
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
23
|
Leonardi C, See K, Gallo G, McKean-Matthews M, Zhang Y, Goldblum O, Mallbris L, Burge R. Psoriasis Severity Assessment Combining Physician and Patient Reported Outcomes: The Optimal Psoriasis Assessment Tool. Dermatol Ther (Heidelb) 2021; 11:1249-1263. [PMID: 34047947 PMCID: PMC8322262 DOI: 10.1007/s13555-021-00544-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/28/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction Psoriasis Area Severity Index (PASI) assessment is complex and time-consuming. A simpler assessment measure more sensitive to changes in symptom severity and predictive of patients’ quality of life (Dermatology Life Quality Index, DLQI) is needed. This study aims to evaluate the Optimal Psoriasis Assessment Tool (OPAT) as an alternative to PASI. Methods This integrated analysis of three UNCOVER trials (NCT01474512, NCT01597245, and NCT01646177) randomized patients (N = 3866) with moderate-to-severe psoriasis to subcutaneously administered ixekizumab 80 mg Q2W or Q4W, or placebo or etanercept 50 mg Q2W. Pearson correlations were computed for clinical and patient-reported measures with PASI and DLQI. Results As the correlations with PASI and BSA were high and not much higher when adding severity, body surface area (BSA) was used for the clinical measure. BSA was the main measure influencing OPAT. Week 12 regression analyses results showed that PASI had a higher correlation with BSA combined with patient assessments than with BSA alone. Sensitivity analyses were also completed for PASI 75 and 90. For DLQI, correlations with the combined measures were even stronger than with BSA alone. A comprehensive model selection procedure was conducted, which illustrated that the two-term models are preferred. Conclusion The OPAT is a simple and time-saving alternative to PASI. It can be derived using BSA and patient-reported assessments having strong correlation with PASI and moderate correlation with DLQI. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00544-6.
Collapse
Affiliation(s)
| | | | - Gaia Gallo
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Ying Zhang
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | - Russel Burge
- Eli Lilly and Company, Indianapolis, IN, USA
- University of Cincinnati, Cincinnati, OH, USA
| |
Collapse
|
24
|
Nawaz S, Tapley A, Davey AR, van Driel ML, Fielding A, Holliday EG, Ball J, Patsan I, Berrigan A, Morgan S, Spike NA, FitzGerald K, Magin P. Management of a Chronic Skin Disease in Primary Care: An Analysis of Early-Career General Practitioners' Consultations Involving Psoriasis. Dermatol Pract Concept 2021; 11:e2021055. [PMID: 34123559 DOI: 10.5826/dpc.1103a55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 10/31/2022] Open
Abstract
Background The management of psoriasis by general practitioners (GPs) is vital, given its prevalence, chronicity, and associated physical and psychosocial co-morbidities. However, there is little information on how GPs (including early-career GPs) manage psoriasis. Objectives This study assessed the frequency with which Australian specialist GP vocational trainees ('registrars') provide psoriasis care and the associations of that clinical experience. Methods A cross-sectional analysis was done of data from the ReCEnT study, an ongoing multi-site cohort study of Australian GP registrars' experiences during vocational training. In ReCEnT, 60 consecutive consultations are recorded 3 times (6-monthly) during each registrar's training. The outcome factor for this analysis was a problem/diagnosis being psoriasis, and independent variables were related to registrar, patient, practice and consultation factors. This study analysed 17 rounds of data collection (2010-2017) using univariate and multivariable regression. Results Data from 1,741 registrars regarding 241,888 consultations and 377,980 problems/diagnoses were analysed. Psoriasis comprised 0.15% (n=550) of all problems/diagnoses (95% CI, 0.13-0.16). Significant patient multivariable associations of a problem/diagnosis being psoriasis included age, gender, being new to a practice or a registrar, and psoriasis being an existing problem rather than a new diagnosis. Significant registrar associations included seeking in-consultation information/assistance, not scheduling a follow-up appointment, prescribing medication, and generating learning goals. Conclusions Australian registrars have modest training exposure to psoriasis and may find psoriasis management challenging. Furthermore, continuity of care (essential for optimal chronic disease management) was modest. The findings have implications for GPs' approaches to the management of psoriasis more widely as well for general practice education and training policies.
Collapse
Affiliation(s)
- Sameerah Nawaz
- GP Synergy, Regional Training Organisation, Liverpool, NSW, Australia
| | - Amanda Tapley
- The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Mayfield West, NSW, Australia
| | - Andrew R Davey
- The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Mayfield West, NSW, Australia
| | - Mieke L van Driel
- The University of Queensland Faculty of Medicine, Primary Care Clinical Unit, Brisbane, QLD, Australia
| | - Alison Fielding
- The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Mayfield West, NSW, Australia
| | - Elizabeth G Holliday
- The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia
| | - Jean Ball
- Hunter Medical Research Institute, Clinical Research Design, IT and Statistical Support Unit (CReDITSS), New Lambton, NSW, Australia
| | - Irena Patsan
- The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Mayfield West, NSW, Australia
| | - Alyse Berrigan
- GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Mayfield West, NSW, Australia
| | - Simon Morgan
- GP Synergy, Regional Training Organisation, Liverpool, NSW, Australia
| | - Neil A Spike
- Eastern Victoria GP Training, General Practice Training Organisation, Melbourne, Australia.,The University of Melbourne, Department of General Practice, Melbourne, VIC, Australia
| | - Kristen FitzGerald
- University of Tasmania, School of Medicine, Hobart, TAS, Australia.,General Practice Training Tasmania (GPTT), Regional Training Organisation, Hobart, TAS, Australia
| | - Parker Magin
- The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Mayfield West, NSW, Australia
| |
Collapse
|
25
|
|
26
|
Schön MP. Psoriasis und nichtalkoholische Fettleber. J Dtsch Dermatol Ges 2021; 19:503-504. [PMID: 33860996 DOI: 10.1111/ddg.14469_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
27
|
Sondermann W, Fiege O, Körber A, Scherbaum N. Psychological burden of psoriatic patients in a German university hospital dermatology department. J Dermatol 2020; 48:794-806. [DOI: 10.1111/1346-8138.15721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/29/2020] [Accepted: 11/16/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Wiebke Sondermann
- Department of Dermatology, Venereology and Allergology University Hospital Essen University of Duisburg‐Essen Essen Germany
| | - Oliver Fiege
- Department of Psychiatry and Psychotherapy Medical Faculty LVR‐Hospital Essen University of Duisburg‐Essen Essen Germany
| | | | - Norbert Scherbaum
- Department of Psychiatry and Psychotherapy Medical Faculty LVR‐Hospital Essen University of Duisburg‐Essen Essen Germany
| |
Collapse
|
28
|
Bell KA, Balogh EA, Feldman SR. An update on the impact of depression on the treatment of psoriasis. Expert Opin Pharmacother 2020; 22:695-703. [PMID: 33198529 DOI: 10.1080/14656566.2020.1849141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Introduction: Estimates of the prevalence of comorbid depression vary, ranging from 9 and 62%. Deterioration of mental health may emerge as a result of psoriasis; however, it is theorized that depression alone may independently predispose patients to new-onset psoriasis.Areas covered: The aim of this brief review is to explore the impact of depression on psoriasis treatment.Expert opinion: The two studies that directly assess the role of depression in psoriasis treatment outcomes are important, as unaddressed depression can undermine the success of a given treatment. This may reflect the notion that depressed individuals are less likely to be adherent. Thus, it may be valuable for clinicians to not only screen for depression, but to ensure that it is adequately treated. Our knowledge of treatment preferences in psoriasis patients with comorbid depression is limited. Expanding our understanding of preferences may allow providers to better align their recommendations to ultimately increase adherence. Additionally, given that many psoriasis treatments have an impact on depression, it may be beneficial for clinicians to evaluate patients for psychiatric risk factors to optimize the treatment regimen.
Collapse
Affiliation(s)
- Katheryn A Bell
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Esther A Balogh
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Dermatology, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
29
|
Bissonnette R, Stein Gold L, Rubenstein DS, Tallman AM, Armstrong A. Tapinarof in the treatment of psoriasis: A review of the unique mechanism of action of a novel therapeutic aryl hydrocarbon receptor-modulating agent. J Am Acad Dermatol 2020; 84:1059-1067. [PMID: 33157177 DOI: 10.1016/j.jaad.2020.10.085] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/19/2020] [Accepted: 10/29/2020] [Indexed: 02/08/2023]
Abstract
Tapinarof, a novel, first-in-class, small-molecule topical therapeutic aryl hydrocarbon receptor (AhR)-modulating agent, is in clinical development for the treatment of psoriasis and atopic dermatitis. The efficacy of tapinarof in psoriasis is attributed to its specific binding and activation of AhR, a ligand-dependent transcription factor, leading to the downregulation of proinflammatory cytokines, including interleukin 17, and regulation of skin barrier protein expression to promote skin barrier normalization. AhR signaling regulates gene expression in immune cells and skin cells and has critical roles in the regulation of skin homeostasis. Tapinarof-mediated AhR signaling underlies the mechanistic basis for the significant efficacy and acceptable tolerability observed in early-phase clinical trials of tapinarof cream in the treatment of psoriasis.
Collapse
Affiliation(s)
| | | | | | | | - April Armstrong
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| |
Collapse
|
30
|
Aktaş Karabay E, Fişek İzci N, Aksoy B. Psoriasis affects self‐perception of stress negatively: A prospective, case‐control study. Dermatol Ther 2020; 33:e13864. [DOI: 10.1111/dth.13864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/31/2020] [Accepted: 06/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Ezgi Aktaş Karabay
- Department of Dermatology Bahçeşehir University Faculty of Medicine Istanbul Turkey
| | - Neslihan Fişek İzci
- Department of Dermatology Bahçeşehir University Faculty of Medicine Istanbul Turkey
| | - Berna Aksoy
- Department of Dermatology Bahçeşehir University Faculty of Medicine Istanbul Turkey
| |
Collapse
|
31
|
Guo X, Zhou D, Sun L, Wang P, Qu J, Zhang C, Wang Y, Chen Z, Li B, Hu J, Lin Z, Shi F, Bai Y, Li Y, Duan X, Bao S, Lan H, Sun X, Wang X, Liu X, Li L, Zhang L, Feng F, Meng Y, Liu Q, Guo X, Guo J, Liu Y, Qi C, Chen J, Feng S, Li P. Traditional Chinese medicine for psoriasis vulgaris: A Protocol of a prospective, multicenter cohort study. Medicine (Baltimore) 2020; 99:e21913. [PMID: 33031257 PMCID: PMC7544398 DOI: 10.1097/md.0000000000021913] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The incidence of psoriasis vulgaris is increasing worldwide. Chronic recurrence of the disease, as well as accompanying cardiovascular disease, metabolic syndrome, and depression has affected the physical and mental health of these patients. Psoriasis vulgaris is a difficult and major disease in the dermatology field. Short-term curative effects using conventional therapy for psoriasis vulgaris has made major strides. However, traditional Chinese medicine (TCM) treatment has long-term curative advantages for psoriasis vulgaris but lacks the scientific and clinical evidence for its use. This study intends to demonstrate and provide scientific and clinical evidence for the use of TCM to delay the recurrence of psoriasis vulgaris. METHODS AND ANALYSIS This will be a prospective, multicenter cohort study. We intend to recruit 1521 psoriasis vulgaris patients from 14 hospitals in Beijing, Tianjin, and Hebei. Treatment will be based on the diagnosis specifications and clinical practice guidelines of TCM and conventional therapy. During inclusion and the subsequent follow-up period, doctors through electronic case reports will collect different therapeutic TCM regimens and conventional therapy that were administered. Information on life condition, skin lesions at each visit, World Health Organization Quality of Life Instruments, Zung Self-rating Anxiety Scale, Zung Self-assessment of Depression, laboratory examinations, incidence of new rash and recurrence during the remission and recurrence stages will be recorded. ETHICS AND DISSEMINATION The clinical trial protocol for this study was approved by the ethics committee of the Beijing hospital of TCM affiliated to capital medical university (Ethics number: 2019BL02-010-02). We will publish and present our results at national and international conferences and in peer-reviewed journals specialized in dermatology. TRIAL REGISTRATION This protocol has been registered in clinicaltrials. gov (ChiCTR1900021629).
Collapse
Affiliation(s)
- Xinwei Guo
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine
| | - Dongmei Zhou
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University
| | - Liyun Sun
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University
- Beijing Hospital of Traditional Chinese Medicine Shunyi Branch
| | - Ping Wang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University
| | - Jianhua Qu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University
| | - Cang Zhang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University
| | - Yan Wang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine
| | - Zhaoxia Chen
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine
| | - Bo Li
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine
| | - Jing Hu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine
| | | | - Fei Shi
- Air Force General Hospital, PLA
| | | | - Yuanwen Li
- Dongfang Hospital Beijing University of Chinese Medicine
| | - Xingwu Duan
- Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital
| | - Shentao Bao
- Beijing University of Chinese Medicine Third Affiliated Hospital
| | - Haibing Lan
- Beijing Gulou Hospital of Traditional Chinese Medicine
| | | | - Xiong Wang
- Traditional Chinese Medicine hospital of Beijing Miyun
| | - Xiang Liu
- Hebei Province Hospital of Traditional Chinese Medicine
| | - Linge Li
- Traditional Chinese Medicine Hospital of Shijiazhuang City
| | - Litao Zhang
- Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, dermatology department
| | - Fang Feng
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine
| | - Yujiao Meng
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine
| | - Qingwu Liu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine
| | - Xiaoyao Guo
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine
| | - Jianning Guo
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine
| | - Yu Liu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine
| | - Cong Qi
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine
| | - Jia Chen
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine
| | - Shuo Feng
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine
| | - Ping Li
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine
| |
Collapse
|
32
|
Duvetorp A, Mrowietz U, Nilsson M, Seifert O. Sex and Age Influence the Associated Risk of Depression in Patients with Psoriasis: A Retrospective Population Study Based on Diagnosis and Drug-Use. Dermatology 2020; 237:595-602. [PMID: 32927456 DOI: 10.1159/000509732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/08/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The reported prevalence of depression among individuals with psoriasis varies substantially, and the effect of gender on depression distribution has revealed conflicting results. In addition, using medication to identify cases is uncommon. OBJECTIVE To study the prevalence of pharmacologically treated depression among individuals with and without psoriasis in a Swedish population using ICD-10 codes and data from the Swedish Prescribed Drug Register. METHODS A retrospective case-control population-based study was performed including all living individuals (age ≥18 years) in Region Jönköping, southern Sweden (n = 273,536). ICD-10 codes for the diagnosis of psoriasis (L40.*) and depression (F32.* and F33.*), and data on pharmacological treatment from the Swedish Prescribed Drug Register, were extracted from electronic medical records between April 9, 2008 and January 1, 2016. The extraction date was January 1, 2016. RESULTS The risk of pharmacologically treated depression was increased in individuals with psoriasis (age- and sex-adjusted OR 1.55; CI 1.43-1.68); 21.1% of women with psoriasis received pharmacological treatment for depression during the study period compared to 14.2% in the control population. Prevalence figures for depression were significantly higher in women with psoriasis compared to men. The risk of suffering from depression was highest among male and female patients with psoriasis under the age of 31 years. CONCLUSIONS Depression is common among patients with psoriasis. The results of the current study underline the need for dermatologists to adopt a holistic approach, looking beyond the skin, when handling patients with psoriasis in every-day clinical practice.
Collapse
Affiliation(s)
- Albert Duvetorp
- Department of Dermatology and Venereology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Ulrich Mrowietz
- Psoriasis-Center at the Department of Dermatology, University Medical Centre Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Mats Nilsson
- Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.,Futurum - Academy for Health and Care, Region Jönköping County, Jönköping, Sweden
| | - Oliver Seifert
- Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden, .,Department of Dermatology and Venereology, Ryhov Hospital, Jönköping, Sweden,
| |
Collapse
|
33
|
Depressive symptoms and insecure attachment predict disability and quality of life in psoriasis independently from disease severity. Arch Dermatol Res 2020; 313:431-437. [PMID: 32776228 PMCID: PMC8238751 DOI: 10.1007/s00403-020-02116-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/10/2020] [Accepted: 07/31/2020] [Indexed: 12/04/2022]
Abstract
Psoriasis is a multisystemic inflammatory disease with a significant burden in terms of disability and reduced quality of life. The interrelations between disease severity, psychological well-being, and disability and/or health-related quality of life (HRQOL) of psoriatic patients are not fully understood. The aim of the study was to assess the relative role of disease severity, depressive symptoms, and insecure attachment in predicting disability and HRQOL in 105 patients with psoriasis. Objective measures of disease severity included the Body Surface Area (BSA), the Psoriasis Area and Severity Index (PASI), and the Pain Visual Analog Scale (pain-VAS). The Sheehan Disability Scale (SDS). The Dermatology Life Quality Index (DLQI). Multivariate hierarchical regression analysis showed that a preoccupied style of attachment and the presence of depressive symptoms were predictors of disability and HRQOL over and above the contribution of demographic and clinical variables. The inclusion of attachment and depression into multivariate regression models improved substantially the prediction of disability and HRQOL. Conversely, the predictive utility of objective indicators of disease severity was scarce and only the pain-VAS emerged as a significant predictor of disability whereas there were no significant correlations between HRQOL and any of the objective indicators of disease severity. Measures capturing patients’ perspectives of the functional impact of disease should be routinely included in the clinical assessment of psoriasis.
Collapse
|
34
|
Laverde‐Saad A, Milan R, Mohand‐Saïd S, LeLorier J, Litvinov I, Rahme E. The risk of suicidal behaviour in individuals with psoriasis: A retrospective cohort study in Quebec, Canada. J Eur Acad Dermatol Venereol 2020; 34:e800-e802. [DOI: 10.1111/jdv.16647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 12/21/2022]
Affiliation(s)
| | - R. Milan
- Department of Medicine Division of Experimental Medicine McGill University Montreal QC Canada
| | - S. Mohand‐Saïd
- Faculty of Medicine McGill University Montreal QC Canada
| | - J. LeLorier
- Faculté de Médecine Université de Montréal Montreal QC Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CHUM) Montreal QC Canada
| | - I.V. Litvinov
- Department of Medicine Division of Dermatology McGill University Montreal QC Canada
| | - E. Rahme
- Department of Medicine Division of Clinical Epidemiology McGill University Montreal QC Canada
- Centre for Outcomes Research and Evaluation Research Institute of the McGill University Health Centre Montreal QC Canada
| |
Collapse
|
35
|
Wang Q, Li M, Hu X, Luo Q, Hao P. Autologous blood or autologous serum acupoint injection therapy for psoriasis vulgaris: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20555. [PMID: 32502022 PMCID: PMC7306372 DOI: 10.1097/md.0000000000020555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Psoriasis vulgaris (PV) is a refractory and relapsing skin disease that affects the physical and mental health of patients and leads to poor quality of life. Current conventional systemic therapy shows a large side effect, which can not be used for a long time, easy to relapse after drug withdrawal, long-term efficacy is poor. At present, traditional Chinese medicine treatment of psoriasis vulgaris effective, can alleviate symptoms, improve the quality of life, stabilize the condition, prolong the remission period. Whereas, there is no related systematic review and meta-analysis. Thus, we intend to conduct a systematic review and meta-analysis to testify autologous blood or autologous serum acupoint injection therapy for Psoriasis Vulgaris. METHODS Our systematic review will search all randomized controlled trials for autologous blood therapy of PV, electronically and manually, regardless of publication status and language, until March 19, 2020. Databases include PubMed, EMBASE, Web of Science, Cochrane Controlled Trials Register, China National Knowledge Infrastructure, China Biomedical Literature Database, Chinese Science Journal Database, and Wanfang database. Other sources, including reference lists of identified publications and meeting minutes, will also be searched. Manually search for grey literature, including unpublished conference articles. RESULT The main outcomes contain the variation of Psoriasis area and severity index, dermatology life quality index, itching score, the effective rate and adverse events from baseline to the end of studies. This study will provide a comprehensive review of the available evidence for the treatment of PV with this therapy. CONCLUSION We will summarize sufficient evidence to confirm the therapeutic effect and safety of autologous blood or autologous serum acupoint injection therapy for PV. Due to the data is not individualized, formal ethical approval is not required. INPLASY REGISTRATION NUMBER INPLASY202040052.
Collapse
|
36
|
Founta O, Adamzik K, Tobin AM, Kirby B, Hevey D. Psychological Distress, Alexithymia and Alcohol Misuse in Patients with Psoriasis: A Cross-Sectional Study. J Clin Psychol Med Settings 2020; 26:200-219. [PMID: 30206746 DOI: 10.1007/s10880-018-9580-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This study investigates (a) the prevalence of psychological distress, alexithymia and alcohol misuse in psoriasis patients; and (b) the relationship between psoriasis severity, alexithymia, alcohol and psychological distress in patients with psoriasis. A cross-sectional study was conducted. Outpatients (n = 184) with moderate to severe psoriasis completed a psychological screening battery. Measures included the Hospital Anxiety and Depression Scale, the Penn State Worry Questionnaire, the twenty-item Toronto Alexithymia Scale, the Dermatology Life Quality Index, the Psoriasis Area and Severity Index, the Self-Administered Psoriasis Area and Severity Index, and the Alcohol Use Disorders Identification Test. Demographic, clinical details and information on knowledge of psychosocial issues, alcohol and confidence on coping with distress and talking to others about psoriasis was also gathered. Alexithymia was associated with anxiety, depression and worry; subjective psoriasis severity was associated with worry. Alcohol misuse was related to anxiety and worry, but not to depression. Appropriate identification and treatment of alcohol difficulties and psychological distress of patients with psoriasis is needed.
Collapse
Affiliation(s)
- Ourania Founta
- Research Centre for Psychological Health, School of Psychology, Trinity College Dublin, Dublin 2, Ireland.
| | - Karoline Adamzik
- Dermatology Department, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Anne-Marie Tobin
- Dermatology Department, The Adelaide & Meath Hospital, Tallaght, Dublin 24, Ireland
| | - Brian Kirby
- Dermatology Department, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.,Charles Department of Dermatology, St Vincent's University Hospital and School of Health Sciences, UCD, Dublin 4, Ireland
| | - David Hevey
- Research Centre for Psychological Health, School of Psychology, Trinity College Dublin, Dublin 2, Ireland
| |
Collapse
|
37
|
Esaa F, Prezzano J, Pentland A, Ryan Wolf J. The utility of PROMIS domain measures in dermatologic care. Arch Dermatol Res 2020; 313:17-24. [PMID: 32270322 DOI: 10.1007/s00403-020-02074-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
Patient-reported outcome (PRO) measures play an important role in clinical care. Currently, a broad-spectrum, validated PRO measure suitable for all dermatology patients, as part of clinical care, does not exist. Patient-reported Outcome Measures Information System (PROMIS) measures track specific domain outcomes across all diseases. To assess the relevance and utility of a computer-adaptive health assessment consisting of three PROMIS domains in routine dermatologic care. This retrospective study evaluated a PROMIS health assessment, consisting of three computer-adaptive test domains (pain interference, anxiety, and depression), administered as part of routine clinical care in three dermatology clinics at an academic medical center. The primary objective was to identify clinically significant associations between high PROMIS domain scores (i.e., t score > 55) and dermatologic disease, as well as change in PROMIS domain scores in response to treatment. The majority of patients who initiated the assessment completed all domains (88.7%). In patients with atopic dermatitis, acne, hidradenitis suppurativa, and psoriasis, high PROMIS scores correlated with clinically relevant outcomes, such as severe disease, unsuccessful treatment, uncontrolled disease, and the presence of a mental health condition. PROMIS Pain Interference, anxiety and depression identified patients with severe disease, unsuccessful treatment regimens, poorly-controlled disease, and/or mental health comorbidities for multiple skin conditions. Further utilization of PROMIS domains in routine clinical care will promote patient-centered care and improve quality of care.
Collapse
Affiliation(s)
- Fatema Esaa
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - James Prezzano
- Department of Dermatology, University of Rochester Medical Center, 601 Elmwood Ave, Box 697, Rochester, NY, 14642, USA
| | - Alice Pentland
- Department of Dermatology, University of Rochester Medical Center, 601 Elmwood Ave, Box 697, Rochester, NY, 14642, USA
| | - Julie Ryan Wolf
- Department of Dermatology, University of Rochester Medical Center, 601 Elmwood Ave, Box 697, Rochester, NY, 14642, USA.
| |
Collapse
|
38
|
Gisondi P, Bellinato F, Girolomoni G, Albanesi C. Pathogenesis of Chronic Plaque Psoriasis and Its Intersection With Cardio-Metabolic Comorbidities. Front Pharmacol 2020; 11:117. [PMID: 32161545 PMCID: PMC7052356 DOI: 10.3389/fphar.2020.00117] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/28/2020] [Indexed: 12/14/2022] Open
Abstract
Psoriasis is a chronic, systemic immune-mediated disease characterized by development of erythematous, indurated, scaly, pruritic plaques on the skin. Psoriasis is frequently associated to comorbidities, including psoriatic arthritis, cardiovascular diseases, diabetes mellitus, obesity, non-alcoholic fatty liver disease, and inflammatory bowel diseases. In this review, we discuss the pathophysiological relationship between psoriasis and cardio-metabolic comorbidities and the importance of therapeutic strategies to reduce systemic inflammation in patients with moderate-to-severe psoriasis. Pathogenesis of psoriasis and its comorbidities share both genetic predisposition and inflammatory pathways, which include the TNFα and the IL-23/IL-17 pathways. These pathways are selectively addressed by biological treatments, which have substantially changed the outcomes of psoriasis therapy and affect positively comorbidities including reducing cardiovascular risk, allowing a more comprehensive approach to the patient.
Collapse
Affiliation(s)
- Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Cristina Albanesi
- Laboratory of Experimental Immunology, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
| |
Collapse
|
39
|
Psychological and Sexual Consequences of Psoriasis Vulgaris on Patients and Their Partners. J Sex Med 2019; 16:1900-1911. [DOI: 10.1016/j.jsxm.2019.08.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/13/2019] [Accepted: 08/20/2019] [Indexed: 12/14/2022]
|
40
|
Martínez-Ortega JM, Nogueras P, Muñoz-Negro JE, Gutiérrez-Rojas L, González-Domenech P, Gurpegui M. Quality of life, anxiety and depressive symptoms in patients with psoriasis: A case-control study. J Psychosom Res 2019; 124:109780. [PMID: 31443809 DOI: 10.1016/j.jpsychores.2019.109780] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare quality of life (QoL), anxiety and depressive symptoms, alcohol consumption and other correlates between patients with psoriasis and controls; and to identify features of psoriasis associated with lower levels of QoL. METHOD Case-control study including 70 subjects with moderate-severe psoriasis and 140 controls without psoriasis. All participants answered the Short Form Health Survey (SF-36), with physical and mental component scores of quality of life, and the Hospital Anxiety and Depression Scale (HADS). Among subjects with psoriasis, the Psoriasis Area and Severity Index (PASI) and the Dermatology Life Quality Index (DLQI) were used, respectively, to measure the severity of psoriasis and the impact of psoriasis on the specific quality of life. RESULTS Compared to controls, patients with psoriasis showed higher HADS depression score and alcohol consumption, and lower QoL. Among subjects with psoriasis, multivariate analysis showed: 1) poorer physical QoL was associated with older age, articular lesions and anxious symptoms, whereas poorer mental QoL was associated with younger age, female sex, genital lesions and depressive symptoms; 2) the higher the severity of psoriasis, the lower the level of QoL and the higher the levels of anxious or depressive symptoms; and 3) female sex and articular or genital location of lesions are linked with higher HADS scores. CONCLUSION Higher scores in anxiety and depression and lower QoL is common in psoriasis, especially among women and those with genital or articular lesions. Dermatologists should give special attention to this subgroup of persons with psoriasis in order to prevent future psychopathology.
Collapse
Affiliation(s)
- José M Martínez-Ortega
- Department of Psychiatry, University of Granada, Granada, Spain; CTS-549 Research Group, Institute of Neurosciences, University of Granada, Granada, Spain
| | - Paloma Nogueras
- Dermatology Service, Virgen de la Nieves University Hospital, Granada, Spain
| | - José E Muñoz-Negro
- Department of Psychiatry, University of Granada, Granada, Spain; UGC Salud Mental, San Cecilio University Hospital and ibs Granada, Spain
| | - Luis Gutiérrez-Rojas
- Department of Psychiatry, University of Granada, Granada, Spain; CTS-549 Research Group, Institute of Neurosciences, University of Granada, Granada, Spain; UGC Salud Mental, San Cecilio University Hospital and ibs Granada, Spain.
| | | | - Manuel Gurpegui
- Department of Psychiatry, University of Granada, Granada, Spain; CTS-549 Research Group, Institute of Neurosciences, University of Granada, Granada, Spain
| |
Collapse
|
41
|
Armstrong AW, Edson-Heredia E, Naegeli AN, Burge R, Poon JL, Anatchkova M, Sun L, Zhu B, Wyrwich KW. Development of the Psoriasis Symptoms Scale (PSS) in patients with moderate-to-severe psoriasis: qualitative and quantitative analyses. J DERMATOL TREAT 2019; 31:452-459. [DOI: 10.1080/09546634.2019.1623370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- April W. Armstrong
- Department of Dermatology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | | | | | - Russel Burge
- Eli Lilly and Company, Indianapolis, IN, USA
- Department of Pharmaceutical Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
| | | | - Milena Anatchkova
- Evidera, Bethesda, MD, USA
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Luna Sun
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Baojin Zhu
- Eli Lilly and Company, Indianapolis, IN, USA
| | | |
Collapse
|
42
|
Tzur Bitan D, Krieger I, Comaneshter D, Cohen AD, Feingold D. The association between the socioeconomic status and anxiety-depression comorbidity in patients with psoriasis: a nationwide population-based study. J Eur Acad Dermatol Venereol 2019; 33:1555-1561. [PMID: 31054151 DOI: 10.1111/jdv.15651] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/12/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Numerous studies have indicated that comorbid anxiety and depression are associated with a more severe course of illness. Yet generally, the study of the effect of psoriasis on patients' mental health has considered anxiety and depression to be separate states. OBJECTIVE To measure the association between psoriasis and anxiety, depression and anxiety-depression co-occurrence among patients according to their socioeconomic statuses (SES). METHODS A nationwide population-based study of psoriasis patients and age and gender frequency-matched controls (n = 255 862) was designed. Diagnostic data were obtained from Clalit Health Services, the largest managed care organization in Israel. This database was established using continuous real-time input from healthcare providers, pharmacies, medical care facilities and administrative computerized operating systems. RESULTS After controlling for demographic and clinical variables, psoriasis was associated with anxiety (OR 1.11, 95% CI 1.01-1.23, P < 0.05), depression (OR 1.17, 95% CI 1.08-1.26, P < 0.001), and anxiety and depression co-occurrence (OR 1.32, 95% CI 1.21-1.45, P < 0.001) among patients with low SES, yet was associated only with anxiety (OR 1.15 95% CI 1.04-1.27, P < 0.001) but not depression or comorbid anxiety-depression among patients with high SES. Survival analyses indicated that between the ages of 40 and 60, the cumulative probability of psoriasis patients with low SES to suffer from anxiety, depression and their co-occurrence inclined more sharply with age as compared to psoriasis patients with high SES. CONCLUSIONS As psoriasis patients with low SES are prone to suffer from more severe courses of anxiety and depression, the choice of treatment of psoriasis should address the SES as well as the underlying psychiatric disease.
Collapse
Affiliation(s)
- D Tzur Bitan
- Department of Behavioral Sciences, Ariel University, Ariel, Israel.,Shalvata Mental Health Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - I Krieger
- Shalvata Mental Health Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Comaneshter
- Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
| | - A D Cohen
- Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - D Feingold
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
| |
Collapse
|
43
|
Baumgart DC, Misery L, Naeyaert S, Taylor PC. Biological Therapies in Immune-Mediated Inflammatory Diseases: Can Biosimilars Reduce Access Inequities? Front Pharmacol 2019; 10:279. [PMID: 30983996 PMCID: PMC6447826 DOI: 10.3389/fphar.2019.00279] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/05/2019] [Indexed: 12/30/2022] Open
Abstract
Biological therapies are an effective treatment for a range of immune-mediated inflammatory diseases (IMIDs), including rheumatoid arthritis, psoriasis, and inflammatory bowel diseases. However, due to their high costs, considerable differences in their utilization exist across the world, even among the various European countries, with many countries restricting access despite professional society guideline recommendations. Adoption of biologics by healthcare providers has been particularly poor in many Central and Eastern European countries. Differences in utilization have also been observed across medical specialties, healthcare providers, and at a regional and national level. The objective of this paper is to provide an overview of the different market access policies for biologics in Europe and to investigate reasons for such differences. One of the potential solutions for providing broader access to IMID patients, where cost is the major barrier, is to encourage the use of biosimilars in place of their reference products. Biosimilars are generally less expensive alternatives to already licensed biological therapies and are approved on the basis that they are similar to the reference product in terms of quality, safety, and efficacy. Budget impact models predict considerable cost savings following the introduction of biosimilars in the next few years. These savings could be used to increase access to biologics and other innovative therapies.
Collapse
Affiliation(s)
- Daniel C. Baumgart
- Inflammatory Bowel Disease Unit – Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
- Department of Gastroenterology and Hepatology, Charité Medical School, Humboldt-University of Berlin, Berlin, Germany
| | - Laurent Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | | | - Peter C. Taylor
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
44
|
Deveci E, Kocacenk T, Şahan E, Yılmaz O, Öztürk A, Kırpınar İ. Oxidative stress and inflammatory response in patients with psoriasis; is there any relationship with psychiatric comorbidity and cognitive functions? PSYCHIAT CLIN PSYCH 2019. [DOI: 10.1080/24750573.2019.1589176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Erdem Deveci
- Department of Psychiatry, Bezmialem Vakif University, Istanbul, Turkey
| | - Tuba Kocacenk
- Abant İzzet Baysal Üniversitesi İzzet Baysal Ruh Sağlığı Ve Hastalıkları Eğitim Ve Araştırma, Hastanesi, Bolu, Turkey
| | - Ebru Şahan
- Department of Psychiatry, Bezmialem Vakif University, Istanbul, Turkey
| | - Onur Yılmaz
- Department of Psychiatry, Bezmialem Vakif University, Istanbul, Turkey
| | - Ahmet Öztürk
- Department of Psychiatry, Bezmialem Vakif University, Istanbul, Turkey
| | - İsmet Kırpınar
- Department of Psychiatry, Bezmialem Vakif University, Istanbul, Turkey
| |
Collapse
|
45
|
Wu KK, Armstrong AW. Suicidality among psoriasis patients: a critical evidence synthesis. GIORN ITAL DERMAT V 2019; 154:56-63. [DOI: 10.23736/s0392-0488.18.06112-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
46
|
Wechter T, Heath M, Aung-Din D, Sahni D, Cline A, Feldman SR. Current Psoriasis Efficacy Outcome Measures in Clinical Trials. CURRENT DERMATOLOGY REPORTS 2018. [DOI: 10.1007/s13671-018-0237-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
47
|
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
| |
Collapse
|