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Kearney N, Kirby B. Alcohol and Psoriasis for the Dermatologist: Know, Screen, Intervene. Am J Clin Dermatol 2022; 23:881-890. [PMID: 35997945 PMCID: PMC9576661 DOI: 10.1007/s40257-022-00713-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2022] [Indexed: 01/19/2023]
Abstract
Psoriasis patients are at increased risk of harmful alcohol use and alcohol dependency with many deleterious effects. Increasing alcohol use is associated with worsening psoriasis severity, is a risk factor for poor response to systemic treatments and may impact on comorbidities such as psoriatic arthritis, cardiovascular disease, cancer and liver disease. Harmful alcohol use and alcohol dependency can be defined by the updated ICD-11 coding system and screening can be completed using many tools including the Cut down, Annoyed, Guilty, Eye-Opener (CAGE), Alcohol Use Disorders Identification Test (AUDIT) and Michigan Alcohol Screening Test (MAST) questionnaires. Dermatologists may be able to complete brief interventions encouraging alcohol reduction in psoriasis patients. Psoriasis patients may respond to messages of gain with reduced psoriasis severity and loss with reduced cardiovascular risk. It is important for dermatologists to discuss alcohol with all psoriasis patients, to be aware of the impact of alcohol in psoriasis and to familiarise themselves with screening tools, brief intervention and local services available to patients who require specialist input for harmful alcohol use or alcohol dependency.
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Affiliation(s)
- Niamh Kearney
- Department of Dermatology, St. Vincent's University Hospital Dublin, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Brian Kirby
- Department of Dermatology, St. Vincent's University Hospital Dublin, Dublin, Ireland. .,School of Medicine, University College Dublin, Dublin, Ireland. .,Charles Institute of Dermatology, University College Dublin, Dublin, Ireland.
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Mahajan VK, Dhattarwal N, Chauhan PS, Mehta KS, Sharma R, Sharma A, Singh VK, Sharma J, Hooda S. The Association of Alcohol Use Disorder and Chronic Plaque Psoriasis: Results of a Pilot Study. Indian Dermatol Online J 2021; 12:128-133. [PMID: 33768034 PMCID: PMC7982022 DOI: 10.4103/idoj.idoj_226_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/01/2020] [Accepted: 06/28/2020] [Indexed: 01/19/2023] Open
Abstract
Background: Association between alcohol consumption, alcohol use disorder, and clinical features of psoriasis patients has not been adequately studied in the Indian context. Objectives: To study the frequency of alcohol consumption, alcohol use disorder, and its association with age, gender, duration, and severity of psoriasis. Materials and Methods: One hundred and forty-six (M: F 6.3:1) patients completed the Alcohol Use Disorder Identification Test (AUDIT) questionnaire by World Health Organization (WHO). Excessive drinkers, occasional drinkers, and abstainers were defined. AUDIT provided a measure of alcohol consumption, its dependence, and its impact on daily life. The severity of psoriasis was graded as mild, moderate, and severe. Results: Seventy-four (50.7%) patients were aged ≤40 years and 51.4% of patients had the disease for <5 years. Psoriasis was mild in 48.6% and moderate to severe in 51.4% of patients, respectively. Only males (32.9%) were consuming alcohol in varying amounts; 19.9% were occasional drinkers (AUDIT score <8). Other 67.1% of patients completely abstained from alcohol consumption (AUDIT score 0). The remaining 13% were regular drinkers (AUDIT score >8) and had more severe psoriasis compared to patients having AUDIT score <8 (P < 0.05). A high level of alcohol use disorder and alcohol dependence was present in one patient each. Limitations: Few patients, particularly females may not have disclosed their alcohol consumption due to fear of stigmatization. Small number of patients, hospital-based cross-sectional study design, and no follow-up for clinical improvement after cessation of alcohol are other limitations. Conclusions: Alcohol consumption was associated with alcohol use disorder in 32.9% of patients (AUDIT score >8) and significantly severe psoriasis compared to 67.1% abstainers. Whether increased alcohol consumption is a consequence or a risk factor for chronicity of psoriasis needs large linear studies for confirmation.
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Affiliation(s)
- Vikram K Mahajan
- Department of Dermatology, Venereology, and Leprosy, Dr. Rajendra Prasad Govt. Medical College, (Tanda), Himachal Pradesh, India
| | - Niharika Dhattarwal
- Department of Dermatology, Venereology, and Leprosy, Dr. Rajendra Prasad Govt. Medical College, (Tanda), Himachal Pradesh, India
| | - Pushpinder S Chauhan
- Department of Dermatology, Venereology, and Leprosy, Dr. Rajendra Prasad Govt. Medical College, (Tanda), Himachal Pradesh, India
| | - Karaninder S Mehta
- Department of Dermatology, Venereology, and Leprosy, Dr. Rajendra Prasad Govt. Medical College, (Tanda), Himachal Pradesh, India
| | - Reena Sharma
- Department of Dermatology, Venereology, and Leprosy, Dr. Rajendra Prasad Govt. Medical College, (Tanda), Himachal Pradesh, India
| | - Anuj Sharma
- Department of Dermatology, Venereology, and Leprosy, Dr. Rajendra Prasad Govt. Medical College, (Tanda), Himachal Pradesh, India
| | - Vijay K Singh
- Department of Dermatology, Venereology, and Leprosy, Dr. Rajendra Prasad Govt. Medical College, (Tanda), Himachal Pradesh, India
| | - Jyotshna Sharma
- Department of Dermatology, Venereology, and Leprosy, Dr. Rajendra Prasad Govt. Medical College, (Tanda), Himachal Pradesh, India
| | - Sheenam Hooda
- Department of Dermatology, Venereology, and Leprosy, Dr. Rajendra Prasad Govt. Medical College, (Tanda), Himachal Pradesh, India
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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
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Svanström C, Lonne-Rahm SB, Nordlind K. Psoriasis and alcohol. PSORIASIS-TARGETS AND THERAPY 2019; 9:75-79. [PMID: 31687362 PMCID: PMC6709030 DOI: 10.2147/ptt.s164104] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 07/17/2019] [Indexed: 12/20/2022]
Abstract
Psoriasis is a chronic inflammatory skin disease that may be triggered or worsened by several factors, including alcohol. A higher than average alcohol consumption is common among individuals with psoriasis. Neurobiological signaling affected by alcohol intake includes a range of neurotransmitters, such as the dopaminergic, serotonergic, and tachykinergic systems, involved in reward and drug-seeking. These neurotransmitters may also have an impact on the inflammatory processes per se in psoriasis. Future therapy may, therefore, be targeted at neurotransmitter networks involved with both alcohol intake and the inflammatory processes.
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Affiliation(s)
- Caroline Svanström
- Department of Dermatology, Mälarsjukhuset, Eskilstuna, Sweden.,Department of Medicine, Solna, Dermatology and Venereology Unit, Karolinska Institutet, Stockholm, Sweden
| | | | - Klas Nordlind
- Department of Medicine, Solna, Dermatology and Venereology Unit, Karolinska Institutet, Stockholm, Sweden
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Al‐Jefri K, Newbury‐Birch D, Muirhead C, Gilvarry E, Araújo‐Soares V, Reynolds N, Kaner E, Hampton P. High prevalence of alcohol use disorders in patients with inflammatory skin diseases. Br J Dermatol 2017; 177:837-844. [DOI: 10.1111/bjd.15497] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2017] [Indexed: 01/05/2023]
Affiliation(s)
- K. Al‐Jefri
- Newcastle Dermatology Newcastle University and Newcastle Dermatology Newcastle Hospitals NHS Trust Newcastle upon Tyne U.K
| | - D. Newbury‐Birch
- Health and Social Care Institute Teesside University Middlesbrough U.K
| | - C.R. Muirhead
- Institute of Health and Society Newcastle University Newcastle upon Tyne U.K
| | - E. Gilvarry
- Institute of Health and Society Newcastle University Newcastle upon Tyne U.K
| | - V. Araújo‐Soares
- Institute of Health and Society Newcastle University Newcastle upon Tyne U.K
| | - N.J. Reynolds
- Institute of Cellular Medicine Newcastle University and Newcastle Dermatology Newcastle Hospitals NHS Trust Newcastle upon Tyne U.K
| | - E. Kaner
- Institute of Health and Society Newcastle University Newcastle upon Tyne U.K
| | - P.J. Hampton
- Newcastle Dermatology Newcastle University and Newcastle Dermatology Newcastle Hospitals NHS Trust Newcastle upon Tyne U.K
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Zink A, Herrmann M, Fischer T, Lauffer F, Garzorz-Stark N, Böhner A, Spinner CD, Biedermann T, Eyerich K. Addiction: an underestimated problem in psoriasis health care. J Eur Acad Dermatol Venereol 2017; 31:1308-1315. [PMID: 28281329 DOI: 10.1111/jdv.14204] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/16/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Psoriasis is a disease of enormous socio-economic impact. Despite approval of numerous highly efficient and costly therapies, a minor proportion of severely affected patients actually receives sufficient treatment. OBJECTIVE To investigate whether addictions are associated with psoriasis and to develop evidence-based recommendations for dermatologists in their daily clinical practice in order to improve medical assessment of psoriasis and patients' quality of life. PATIENTS AND METHODS Psoriasis patients at the University Department of Dermatology were asked to fill out a paper-based self-reported anonymous questionnaire with 92 questions of validated screening tests for the six most common addictions in Germany (alcohol, nicotine, drugs and illegal drugs, gambling, food). Body weight and height as well as current Psoriasis Area and Severity Index (PASI) were documented as well. RESULTS Between October 2015 and February 2016, 102 patients (65 males, 37 females; mean age 49.7 years (SD 13.4), range 18-83 years) participated in the study. Fifty-seven of the 102 patients showed addictive behaviour. Of these, 23.8% were high-risk drinkers, 41% regular smokers, 11% at risk of drug abuse, 4.1% at risk of food dependency and 19% compulsive gamblers. Compared with the general population, these results are significantly higher for alcohol abuse (P < 0.005), nicotine (P < 0.001) and gambling (P < 0.001). Body mass index was significantly higher in the study population (P < 0.001). CONCLUSION Addictions and gambling are more prevalent in patients with psoriasis compared with the general population. Respective screening measures are recommended in daily practice for doctors treating psoriasis patients, and PeakPASI is suggested as a score to document patients' lifetime highest PASI. Parallel to new drug approvals and even more detailed insights into the pathomechanism of psoriasis, public health strategies and interdisciplinary approaches are essential for a general sustained psoriasis treatment.
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Affiliation(s)
- A Zink
- Department of Dermatology and Allergy, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - M Herrmann
- Department of Dermatology and Allergy, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - T Fischer
- Department of Dermatology and Allergy, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - F Lauffer
- Department of Dermatology and Allergy, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - N Garzorz-Stark
- Department of Dermatology and Allergy, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - A Böhner
- Department of Dermatology and Allergy, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - C D Spinner
- Department of Medicine II, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - T Biedermann
- Department of Dermatology and Allergy, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - K Eyerich
- Department of Dermatology and Allergy, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Schlager JG, Rosumeck S, Werner RN, Jacobs A, Schmitt J, Schlager C, Nast A. Topical treatments for scalp psoriasis. Cochrane Database Syst Rev 2016; 2:CD009687. [PMID: 26915340 PMCID: PMC8697570 DOI: 10.1002/14651858.cd009687.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND People with chronic plaque psoriasis often have lesions on the scalp. Hair makes the scalp difficult to treat and the adjacent facial skin is particularly sensitive to topical treatments. OBJECTIVES To assess the efficacy and safety of topical treatments for scalp psoriasis. SEARCH METHODS We searched the following databases up to August 2015: the Cochrane Skin Group Specialised Register, CENTRAL (2015, Issue 7), MEDLINE (from 1946), EMBASE (from 1974) and LILACS (from 1982). We also searched five trials registers, screened abstracts of six psoriasis-specific conferences and checked the reference lists of included studies for further references to relevant randomised controlled trials. SELECTION CRITERIA Randomised controlled trials (RCTs) with a parallel-group, cross-over or within-patient design of topical treatments for people of all ages with scalp psoriasis. DATA COLLECTION AND ANALYSIS Two authors independently carried out study selection, data extraction and 'Risk of bias' assessment. Disagreements were settled by reference to a third author.To assess the quality of evidence, we focused on the following outcomes: 'clearance' or 'response' as assessed by the investigator global assessment (IGA), improvement in quality of life, adverse events requiring withdrawal of treatment and 'response' as assessed by the patient global assessment (PGA).We expressed the results of the single studies as risk ratios (RR) with 95% confidence intervals (CI) for dichotomous outcomes, and mean differences (MD) with 95% CI for continuous outcomes. If studies were sufficiently homogeneous, we meta-analysed the data by using the random-effects model. Where it was not possible to calculate a point estimate for a single study, we described the data qualitatively. We also presented the number needed to treat to benefit (NNTB).We categorised topical corticosteroids according to the German classification of corticosteroid potency as mild, moderate, high and very high. MAIN RESULTS We included 59 RCTs with a total of 11,561 participants. Thirty studies were either conducted or sponsored by the manufacturer of the study medication. The risk of bias varied considerably among the included studies. For instance, most authors did not state the randomisation method and few addressed allocation concealment. Most findings were limited to short-term treatments, since most studies were conducted for less than six months. Only one trial investigated long-term therapy (12 months). Although we found a wide variety of different interventions, we limited the grading of the quality of evidence to three major comparisons: steroid versus vitamin D, two-compound combination of steroid and vitamin D versus steroid monotherapy and versus vitamin D.In terms of clearance, as assessed by the IGA, steroids were better than vitamin D (RR 1.82; 95% CI 1.52 to 2.18; four studies, 2180 participants, NNTB = 8; 95% CI 7 to 11; moderate quality evidence). Statistically, the two-compound combination was superior to steroid monotherapy, however the additional benefit was small (RR 1.22; 95% CI 1.08 to 1.36; four studies, 2474 participants, NNTB = 17; 95% CI 11 to 41; moderate quality evidence). The two-compound combination was more effective than vitamin D alone (RR 2.28; 95% CI 1.87 to 2.78; four studies, 2008 participants, NNTB = 6; 95% CI 5 to 7; high quality evidence).In terms of treatment response, as assessed by the IGA, corticosteroids were more effective than vitamin D (RR 2.09; 95% CI 1.80 to 2.41; three studies, 1827 participants; NNTB = 4; 95% CI 4 to 5; high quality evidence). The two-compound combination was better than steroid monotherapy, but the additional benefit was small (RR 1.15; 95% CI 1.06 to 1.25; three studies, 2444 participants, NNTB = 13; 95% CI 9 to 24; moderate quality evidence). It was also more effective than vitamin D alone (RR 2.31; 95% CI 1.75 to 3.04; four studies, 2222 participants, NNTB = 3; 95% CI 3 to 4; moderate quality evidence).Reporting of quality of life data was poor and data were insufficient to be included for meta-analysis.Steroids caused fewer withdrawals due to adverse events than vitamin D (RR 0.22; 95% CI 0.11 to 0.42; four studies, 2291 participants; moderate quality evidence). The two-compound combination and steroid monotherapy did not differ in the number of adverse events leading withdrawal (RR 0.88; 95% CI 0.42 to 1.88; three studies, 2433 participants; moderate quality evidence). The two-compound combination led to fewer withdrawals due to adverse events than vitamin D (RR 0.19; 95% CI 0.11 to 0.36; three studies, 1970 participants; high quality evidence). No study reported the type of adverse event requiring withdrawal.In terms of treatment response, as assessed by the PGA, steroids were more effective than vitamin D (RR 1.48; 95% CI 1.28 to 1.72; three studies, 1827 participants; NNTB = 5; 95% CI 5 to 7; moderate quality evidence). Statistically, the two-compound combination was better than steroid monotherapy, however the benefit was not clinically important (RR 1.13; 95% CI 1.06 to 1.20; two studies, 2226 participants; NNTB = 13; 95% CI 9 to 26; high quality evidence). The two-compound combination was more effective than vitamin D (RR 1.76; 95% CI 1.46 to 2.12; four studies, 2222 participants; NNTB = 4; 95% CI 3 to 6; moderate quality evidence).Common adverse events with these three interventions were local irritation, skin pain and folliculitis. Systemic adverse events were rare and probably not drug-related.In addition to the results of the major three comparisons we found that the two-compound combination, steroids and vitamin D monotherapy were more effective than the vehicle. Steroids of moderate, high and very high potency tended to be similarly effective and well tolerated. There are inherent limitations in this review concerning the evaluation of salicylic acid, tar, dithranol or other topical treatments. AUTHORS' CONCLUSIONS The two-compound combination as well as corticosteroid monotherapy were more effective and safer than vitamin D monotherapy. Given the similar safety profile and only slim benefit of the two-compound combination over the steroid alone, monotherapy with generic topical steroids may be fully acceptable for short-term therapy.Future RCTs should investigate how specific therapies improve the participants' quality of life. Long-term assessments are needed (i.e. 6 to 12 months).
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Affiliation(s)
- Justin Gabriel Schlager
- Charité ‐ Universitätsmedizin BerlinDivision of Evidence Based Medicine, Department of Dermatology, Venerology and AllergologyCharitéplatz 1BerlinGermany10117
| | - Stefanie Rosumeck
- Charité ‐ Universitätsmedizin BerlinDivision of Evidence Based Medicine, Department of Dermatology, Venerology and AllergologyCharitéplatz 1BerlinGermany10117
| | - Ricardo Niklas Werner
- Charité ‐ Universitätsmedizin BerlinDivision of Evidence Based Medicine, Department of Dermatology, Venerology and AllergologyCharitéplatz 1BerlinGermany10117
| | - Anja Jacobs
- Federal Joint Committee (G‐BA, Gemeinsamer Bundesausschuss)Department of Medical ConsultingWegelystrasse 8BerlinGermany10623
| | - Jochen Schmitt
- Faculty of Medicine Carl Gustav Carus, Technischen Universität (TU) DresdenCenter for Evidence‐Based HealthcareFetscherstr. 74DresdenGermany01307
| | - Christoph Schlager
- The University of Nottinghamc/o Cochrane Skin GroupA103, King's Meadow CampusLenton LaneNottinghamUKNG7 2NR
| | - Alexander Nast
- Charité ‐ Universitätsmedizin BerlinDivision of Evidence Based Medicine, Department of Dermatology, Venerology and AllergologyCharitéplatz 1BerlinGermany10117
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Gyldenløve M, Vilsbøll T, Zachariae C, Holst JJ, Knop FK, Skov L. Impaired incretin effect is an early sign of glucose dysmetabolism in nondiabetic patients with psoriasis. J Intern Med 2015; 278:660-70. [PMID: 26174490 DOI: 10.1111/joim.12388] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with psoriasis have an increased risk of type 2 diabetes. The gastrointestinal system plays a major role in normal glucose metabolism, and in healthy individuals, postprandial insulin secretion is largely mediated by the gut incretin hormones. This potentiation is termed the incretin effect and is reduced in type 2 diabetes. The impact of psoriasis on gastrointestinal factors involved in glucose metabolism has not previously been examined. OBJECTIVE To investigate whether the incretin effect, gastrointestinal-mediated glucose disposal (GIGD) and/or secretion of glucagon and gut incretin hormones are impaired in normal glucose-tolerant patients with psoriasis. METHODS Oral glucose tolerance tests and intravenous isoglycaemic glucose infusions were performed in 12 patients with moderate-to-severe psoriasis and 12 healthy matched control subjects. RESULTS In patients with psoriasis, the incretin effect (39% vs. 57%, P = 0.02) and GIGD (53% vs. 61%, P = 0.04) were significantly reduced compared to control subjects. In addition, patients were glucose intolerant and showed exaggerated glucose-dependent insulinotropic polypeptide responses. CONCLUSION These novel findings support the notion that psoriasis is a prediabetic condition and suggest that gastrointestinal-related mechanisms are involved in the increased susceptibility to type 2 diabetes in patients with psoriasis.
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Affiliation(s)
- M Gyldenløve
- Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - T Vilsbøll
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - C Zachariae
- Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - J J Holst
- NNF Centre for Basic Metabolic Research, Department of Biomedicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - F K Knop
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,NNF Centre for Basic Metabolic Research, Department of Biomedicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - L Skov
- Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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Grønbæk L, Vilstrup H, Deleuran B, Wiest R, Krag A, Jepsen P. Alcoholic Cirrhosis Increases Risk for Autoimmune Diseases: A Nationwide Registry-Based Cohort Study. Clin Gastroenterol Hepatol 2015; 13:2017-22. [PMID: 26044312 DOI: 10.1016/j.cgh.2015.05.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 04/14/2015] [Accepted: 05/20/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Alcoholic cirrhosis is associated with hyperactivation and dysregulation of the immune system. In addition to its ability to increase risk for infections, it also may increase the risk for autoimmune diseases. We studied the incidence of autoimmune diseases among patients with alcoholic cirrhosis vs controls in Denmark. METHODS We collected data from nationwide health care registries to identify and follow up all citizens of Denmark diagnosed with alcoholic cirrhosis from 1977 through 2010. Each patient was matched with 5 random individuals from the population (controls) of the same sex and age. The incidence rates of various autoimmune diseases were compared between patients with cirrhosis and controls and adjusted for the number of hospitalizations in the previous year (a marker for the frequency of clinical examination). RESULTS Of the 24,679 patients diagnosed with alcoholic cirrhosis, 532 developed an autoimmune disease, yielding an overall increased adjusted incidence rate ratio (aIRR) of 1.36 (95% confidence interval [CI], 1.24-1.50). The strongest associations were with Addison's disease (aIRR, 2.47; 95% CI, 1.04-5.85), inflammatory bowel disease (aIRR, 1.56; 95% CI, 1.26-1.92), celiac disease (aIRR, 5.12; 95% CI, 2.58-10.16), pernicious anemia (aIRR, 2.35; 95% CI, 1.50-3.68), and psoriasis (aIRR, 4.06; 95% CI, 3.32-4.97). There was no increase in the incidence rate for rheumatoid arthritis (aIRR, 0.89; 95% CI, 0.69-1.15); the incidence rate for polymyalgia rheumatica decreased in patients with alcoholic cirrhosis compared with controls (aIRR, 0.47; 95% CI, 0.33-0.67). CONCLUSIONS Based on a nationwide cohort study of patients in Denmark, alcoholic cirrhosis is a risk factor for several autoimmune diseases.
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Affiliation(s)
- Lisbet Grønbæk
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
| | - Hendrik Vilstrup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Bent Deleuran
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Reiner Wiest
- Department of Gastroenterology, Inselspital, Bern, Switzerland
| | - Aleksander Krag
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - Peter Jepsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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10
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Wu S, Cho E, Li WQ, Han J, Qureshi AA. Alcohol intake and risk of incident psoriatic arthritis in women. J Rheumatol 2015; 42:835-40. [PMID: 25834201 DOI: 10.3899/jrheum.140808] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2015] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Alcohol intake has been associated with an increased risk of psoriasis. However, the association between alcohol intake and risk of psoriatic arthritis (PsA) has been unclear. We evaluated the association between alcohol intake and risk of incident PsA in a large cohort of US women. METHODS Our present study included a total of 82,672 US women who provided repeated data on alcohol intake over the followup period (1991-2005). Self-reported PsA was validated using the Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire. Cox proportional hazards models were used to estimate the age-adjusted and multivariate-adjusted HR and 95% CI for the PsA in association with alcohol intake. RESULTS We documented 141 incident PsA cases during 14 years (1,137,763 person-yrs) of followup. Compared to non-drinkers, the multivariate HR for PsA were 0.70 (95% CI 0.48-1.01) for 0.1-14.9 g/day, 1.43 (95% CI 0.67-3.08) for 15.0-29.9 g/day, and 4.45 (95% CI 2.07-9.59) for ≥ 30.0 g/day of cumulative average alcohol intake. Risk estimates were generally consistent when using updated alcohol intake and baseline alcohol intake in 1991 as the exposures, and when the analysis was restricted to those who developed psoriasis during the followup. CONCLUSION Excessive alcohol intake was associated with an increased risk of incident PsA in a cohort of US women.
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Affiliation(s)
- Shaowei Wu
- From the Department of Dermatology, and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts; Department of Dermatology, the Warren Alpert Medical School of Brown University, Rhode Island; Department of Epidemiology, Richard M. Fairbanks School of Public Health, the Melvin and Bren Simon Cancer Center, and the Department of Dermatology, School of Medicine, Indiana University, Indianapolis, Indiana, USA.S. Wu, PhD, Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, and Department of Dermatology, The Warren Alpert Medical School of Brown University; E. Cho, ScD, Department of Dermatology, The Warren Alpert Medical School of Brown University, and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School; W.Q. Li, PhD, Department of Dermatology, The Warren Alpert Medical School of Brown University; J. Han, PhD, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, and the Department of Epidemiology, Richard M. Fairbanks School of Public Health, Melvin and Bren Simon Cancer Center, and the Department of Dermatology, School of Medicine, Indiana University; A.A. Qureshi, MD, MPH, Department of Dermatology, The Warren Alpert Medical School of Brown University, and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School
| | - Eunyoung Cho
- From the Department of Dermatology, and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts; Department of Dermatology, the Warren Alpert Medical School of Brown University, Rhode Island; Department of Epidemiology, Richard M. Fairbanks School of Public Health, the Melvin and Bren Simon Cancer Center, and the Department of Dermatology, School of Medicine, Indiana University, Indianapolis, Indiana, USA.S. Wu, PhD, Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, and Department of Dermatology, The Warren Alpert Medical School of Brown University; E. Cho, ScD, Department of Dermatology, The Warren Alpert Medical School of Brown University, and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School; W.Q. Li, PhD, Department of Dermatology, The Warren Alpert Medical School of Brown University; J. Han, PhD, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, and the Department of Epidemiology, Richard M. Fairbanks School of Public Health, Melvin and Bren Simon Cancer Center, and the Department of Dermatology, School of Medicine, Indiana University; A.A. Qureshi, MD, MPH, Department of Dermatology, The Warren Alpert Medical School of Brown University, and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School
| | - Wen-Qing Li
- From the Department of Dermatology, and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts; Department of Dermatology, the Warren Alpert Medical School of Brown University, Rhode Island; Department of Epidemiology, Richard M. Fairbanks School of Public Health, the Melvin and Bren Simon Cancer Center, and the Department of Dermatology, School of Medicine, Indiana University, Indianapolis, Indiana, USA.S. Wu, PhD, Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, and Department of Dermatology, The Warren Alpert Medical School of Brown University; E. Cho, ScD, Department of Dermatology, The Warren Alpert Medical School of Brown University, and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School; W.Q. Li, PhD, Department of Dermatology, The Warren Alpert Medical School of Brown University; J. Han, PhD, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, and the Department of Epidemiology, Richard M. Fairbanks School of Public Health, Melvin and Bren Simon Cancer Center, and the Department of Dermatology, School of Medicine, Indiana University; A.A. Qureshi, MD, MPH, Department of Dermatology, The Warren Alpert Medical School of Brown University, and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School
| | - Jiali Han
- From the Department of Dermatology, and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts; Department of Dermatology, the Warren Alpert Medical School of Brown University, Rhode Island; Department of Epidemiology, Richard M. Fairbanks School of Public Health, the Melvin and Bren Simon Cancer Center, and the Department of Dermatology, School of Medicine, Indiana University, Indianapolis, Indiana, USA.S. Wu, PhD, Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, and Department of Dermatology, The Warren Alpert Medical School of Brown University; E. Cho, ScD, Department of Dermatology, The Warren Alpert Medical School of Brown University, and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School; W.Q. Li, PhD, Department of Dermatology, The Warren Alpert Medical School of Brown University; J. Han, PhD, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, and the Department of Epidemiology, Richard M. Fairbanks School of Public Health, Melvin and Bren Simon Cancer Center, and the Department of Dermatology, School of Medicine, Indiana University; A.A. Qureshi, MD, MPH, Department of Dermatology, The Warren Alpert Medical School of Brown University, and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School
| | - Abrar A Qureshi
- From the Department of Dermatology, and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts; Department of Dermatology, the Warren Alpert Medical School of Brown University, Rhode Island; Department of Epidemiology, Richard M. Fairbanks School of Public Health, the Melvin and Bren Simon Cancer Center, and the Department of Dermatology, School of Medicine, Indiana University, Indianapolis, Indiana, USA.S. Wu, PhD, Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, and Department of Dermatology, The Warren Alpert Medical School of Brown University; E. Cho, ScD, Department of Dermatology, The Warren Alpert Medical School of Brown University, and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School; W.Q. Li, PhD, Department of Dermatology, The Warren Alpert Medical School of Brown University; J. Han, PhD, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, and the Department of Epidemiology, Richard M. Fairbanks School of Public Health, Melvin and Bren Simon Cancer Center, and the Department of Dermatology, School of Medicine, Indiana University; A.A. Qureshi, MD, MPH, Department of Dermatology, The Warren Alpert Medical School of Brown University, and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School.
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11
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Murzaku EC, Bronsnick T, Rao BK. Diet in dermatology: Part II. Melanoma, chronic urticaria, and psoriasis. J Am Acad Dermatol 2014; 71:1053.e1-1053.e16. [PMID: 25454037 DOI: 10.1016/j.jaad.2014.06.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 06/04/2014] [Accepted: 06/09/2014] [Indexed: 02/07/2023]
Abstract
The roles of dietary factors in aggravating, preventing, or treating skin diseases are common questions encountered in dermatology practice. Part II of this two-part series reviews dietary modifications that can potentially be utilized in the management of melanoma, chronic urticaria, and psoriasis patients. Specifically, we examine the effect of alcohol consumption and supplementation with vitamins D and E, polyunsaturated fatty acids, selenium, green tea, resveratrol, and lycopene on melanoma risk. The relationships between chronic urticaria symptoms and dietary pseudoallergens, gluten, and vitamin D are analyzed. We explore weight loss, reduced alcohol consumption, and gluten avoidance as means of reducing psoriasis-associated morbidity, as well as the possible utility of supplementation with polyunsaturated fatty acids, folic acid, vitamin D, and antioxidants. With proper knowledge of the role of diet in these cutaneous disease processes, dermatologists can better answer patient inquiries and consider implementation of dietary modifications as adjuncts to other treatments and preventative measures.
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Affiliation(s)
- Era Caterina Murzaku
- Department of Dermatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Tara Bronsnick
- Department of Dermatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey.
| | - Babar K Rao
- Department of Dermatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
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12
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Adamzik K, McAleer MA, Kirby B. Alcohol and psoriasis: sobering thoughts. Clin Exp Dermatol 2013; 38:819-22. [DOI: 10.1111/ced.12013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2012] [Indexed: 12/21/2022]
Affiliation(s)
- K. Adamzik
- Department of Dermatology; St. Vincent's University Hospital; Dublin Ireland
| | - M. A. McAleer
- Department of Dermatology; St. Vincent's University Hospital; Dublin Ireland
| | - B. Kirby
- Department of Dermatology; St. Vincent's University Hospital; Dublin Ireland
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13
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Farkas A, Kemény L. Alcohol, liver, systemic inflammation and skin: a focus on patients with psoriasis. Skin Pharmacol Physiol 2013; 26:119-26. [PMID: 23549156 DOI: 10.1159/000348865] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 02/11/2013] [Indexed: 12/18/2022]
Abstract
Emerging evidence suggests that excessive alcohol consumption is associated with psoriasis. In alcoholics, antipsoriatic treatments are less efficient, but more toxic and an additional challenge is poor therapeutic compliance. There is a correlation between excess alcohol intake and increased risk of infections, but on the other hand alcohol and its metabolites can trigger a persistent systemic inflammation, mediated by pro-inflammatory cytokines released from activated Kupffer cells in the liver and from monocytes in the circulation. Ethanol and its metabolites can also enhance lymphocyte and keratinocyte activation and proliferation and can increase the mRNA levels of genes characteristic for proliferating keratinocytes. In this review, we discuss the mechanisms by which alcohol contributes to psoriasis development focusing on liver, systemic inflammation and skin.
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Affiliation(s)
- A Farkas
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.
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14
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Jales RD, Nast A, Saconato H, Atallah ÁN, Hirata SH. Topical treatments for scalp psoriasis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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15
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McAleer MA, Mason DL, Cunningham S, O'Shea SJ, McCormick PA, Stone C, Collins P, Rogers S, Kirby B. Alcohol misuse in patients with psoriasis: identification and relationship to disease severity and psychological distress. Br J Dermatol 2012; 164:1256-61. [PMID: 21457207 DOI: 10.1111/j.1365-2133.2011.10345.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Moderate to severe psoriasis is associated with increased alcohol intake and excessive mortality from alcohol-related causes. Alcohol biomarkers provide an objective measure of alcohol consumption. Carbohydrate-deficient transferrin (CDT) is the single most sensitive and specific alcohol biomarker. OBJECTIVES To assess alcohol consumption in a cohort of patients with moderate to severe psoriasis using standard alcohol screening questionnaires and biomarkers. We investigated whether there was an association between alcohol intake, anxiety, depression and disease severity. METHODS Consecutive patients with chronic plaque psoriasis were recruited and completed a range of anonymized assessments. Psoriasis severity, anxiety and depression, and the impact of psoriasis on quality of life were assessed. Alcohol screening questionnaires were administered. Blood specimens were taken and γ-glutamyltransferase (γGT) and CDT were measured. RESULTS A total of 135 patients completed the study. Using validated questionnaires, between 22% and 32% had difficulties with alcohol. Seven per cent had CDT > 1·6% indicating a heavy alcohol intake. The Alcohol Use Disorders Identification Test (AUDIT) questionnaire was superior to other validated questionnaires in detecting alcohol misuse. There were no significant associations between measures of excessive alcohol consumption and disease severity. Excessive alcohol intake as measured by the CAGE questionnaire was associated with increased depression (P = 0·001) but other measures of alcohol excess did not correlate with psychological distress. Men had significantly more difficulties with alcohol than women (P < 0·001). CONCLUSION Alcohol misuse is common in patients with moderate to severe psoriasis. Screening with the AUDIT questionnaire and CDT may allow the identification of patients who are misusing alcohol and allow appropriate intervention.
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Affiliation(s)
- M A McAleer
- Department of Dermatology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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16
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Cassano N, Mastrandrea V, Principi M, Loconsole F, De Tullio N, Di Leo A, Vena GA. Anti-tumor necrosis factor treatment in occult hepatitis B virus infection: a retrospective analysis of 62 patients with psoriatic disease. J BIOL REG HOMEOS AG 2011; 50:1323-1331. [PMID: 21880218 DOI: 10.1111/j.1365-4632.2011.05100.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
One of the problems possibly related to the use of biological agents targeting tumor necrosis factor (TNF)-alpha is the increased risk of infections, including the activation of hepatitis B virus (HBV). HBV activation can occur in carriers of hepatitis B surface antigen (HBsAg), but the risk may also involve the HBsAg-negative (anti-HBc ± anti-HBs) occult carriers. Precise data on the safety of anti-TNF and/or other immunosuppressive drugs in HBV occult carriers are not available. We performed a retrospective analysis of 62 psoriatic patients with occult HBV infection treated with anti-TNF biological agents over a period of approximately 4 years: 44 subjects were treated with etanercept, 8 with infliximab and 10 with adalimumab. During the observational treatment period, no signs of HBV activation were observed. Only in one patient the reappearance of HBsAg, without detectable HBV-DNA, was noted before retreatment with etanercept and after 10 months from discontinuation of the previous course. In this patient etanercept was re-administered in association with lamivudine without any adverse event. Our results suggest the overall safety of treatment with anti-TNF drugs in HBV occult carriers, although a careful and constant monitoring of virological markers is required in such patients during treatment with anti-TNF drugs in order to have an early recognition of viral reactivation.
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Pietrzak A, Jastrzębska I, Chodorowska G, Maciejewski R, Mosiewicz J, Krupski W, Prystupa A, Szubstarski F, Szepietowski JC, Hercogova J. Psoriasis and unreported excessive alcohol intake--a simple screening approach. J Eur Acad Dermatol Venereol 2011; 25:1261-8. [PMID: 21564326 DOI: 10.1111/j.1468-3083.2011.04101.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Psoriasis is a chronic immune-mediated skin disease of complex aetiology. Alcohol overuse has long been suspected to contribute to psoriasis pathology, and the knowledge of individual's drinking pattern may be of substantial importance for managing the disease. Unfortunately, a number of patients fail to admit to their true alcohol consumption and there is no single sign, symptom or laboratory parameter adequate for alcohol abuse diagnosis. However, there are some laboratory findings that, when present, should raise physician's suspicion that alcohol may be a problem. The aim of this article was to present simple, widely available and relatively reliable laboratory markers that might effectively assist physicians in establishing patient's drinking status. A possible screening approach is illustrated by two distinct reports of psoriatic patients who initially concealed having the problem with alcohol.
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Affiliation(s)
- A Pietrzak
- Department of Dermatology, Medical University of Lublin, Poland
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18
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TOBIN ANNEMARIE, VEALE DOUGLASJ, FITZGERALD OLIVER, ROGERS SARAH, COLLINS PAUL, O’SHEA DONAL, KIRBY BRIAN. Cardiovascular Disease and Risk Factors in Patients with Psoriasis and Psoriatic Arthritis. J Rheumatol 2010; 37:1386-94. [DOI: 10.3899/jrheum.090822] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective.Patients with psoriasis and psoriatic arthritis (PsA) have an increased incidence of cardiovascular disease (CVD) and cardiovascular risk factors such as smoking, hypertension, and metabolic syndrome compared to the normal population. Patients with psoriasis and PsA may also have increased risk from nonconventional risk factors such as raised levels of homocysteine and excessive alcohol consumption. We conducted a comprehensive review of the literature on CVD and all cardiovascular risk factors in patients with psoriasis and PsA.Methods.Data sources: All studies identified from a Medline (www.ncbi.nlm.nih.gov) search pertaining to CVD, individual risk factors in psoriasis, and PsA were included. Study selection: Studies included a healthy reference population, were published between 1975 and 2009, and were written in English.Results.Our search yielded 14 studies that documented rates of CVD in patients with psoriasis and PsA compared to controls. Substantial evidence points to elevated risk of CVD in patients with psoriasis and PsA.Conclusion.It remains difficult to conclude if risk factors are caused by psoriasis or share a common pathogenesis. Physicians treating patients with psoriasis and PsA must be aware of all potential cardiovascular risk factors in their patients.
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Kimball AB, Gieler U, Linder D, Sampogna F, Warren RB, Augustin M. Psoriasis: is the impairment to a patient's life cumulative? J Eur Acad Dermatol Venereol 2010; 24:989-1004. [PMID: 20477920 DOI: 10.1111/j.1468-3083.2010.03705.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Psoriasis is associated with significant physical and psychological burden affecting all facets of a patient's life--relationships, social activities, work and emotional wellbeing. The cumulative effect of this disability may be self-perpetuating social disconnection and failure to achieve a 'full life potential' in some patients. Health-related quality of life studies have quantified the burden of psoriasis providing predominantly cross-sectional data and point-in-time images of patients' lives rather than assessing the possible cumulative disability over a patient's lifetime. However, social and economic outcomes indicate there are likely negative impacts that accumulate over time. To capture the cumulative effect of psoriasis and its associated co-morbidities and stigma over a patient's life course, we propose the concept of 'Cumulative Life Course Impairment' (CLCI). CLCI results from an interaction between (A) the burden of stigmatization, and physical and psychological co-morbidities and (B) coping strategies and external factors. Several key aspects of the CLCI concept are supported by data similar to that used in health-related quality of life assessments. Future research should focus on (i) establishing key components of CLCI and determining the mechanisms of impairment through longitudinal or retrospective case-control studies, and (ii) assessing factors that put patients at increased risk of developing CLCI. In the future, this concept may lead to a better understanding of the overall impact of psoriasis, help identify more vulnerable patients, and facilitate more appropriate treatment decisions or earlier referrals. To our knowledge, this is a first attempt to apply and develop concepts from 'Life Course Epidemiology' to psoriasis research.
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Affiliation(s)
- A B Kimball
- Department of Dermatology, Harvard Medical School, Boston, MA, USA
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20
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Affiliation(s)
- Tracey Wheeler
- United Hospitals Bristol NHS Foundation Trust, Bristol Dermatology Centre, Bristol Royal Infirmary, Bristol
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