Analysis of psoriasis patients registered with the Japanese Society for Psoriasis Research from 2002-2008

A survey of psoriasis patients from 1982-2001 has been reported by the Japanese Society for Psoriasis Research. The aim of this study is to analyze psoriasis patients in Japan registered from 2002-2008. A total of 11 631 cases were registered from 152 dermatological institutions in Japan. Males (7738 cases, 66.5%) were predominant over females (3893 cases, 33.5%). The clinical types of psoriasis were psoriasis vulgaris (88.5%), guttate psoriasis (3.9%), psoriasis arthropathica (3.3%), generalized pustular psoriasis (1.3%), psoriatic erythroderma (1.2%), localized pustular psoriasis (0.9%) and infantile psoriasis (0.1%). Topical corticosteroids (85.4%) and vitamin D(3) (59.7%) products were the main previous topical agents. Previous systemic treatments included etretinate (8.8%), cyclosporin (8.3%) and methotrexate (2.0%). Use of topical vitamin D(3) and systemic cyclosporin therapies has been increasing during the past 7 years. Topical psoralen and ultraviolet A therapy (PUVA) (7.6%) was the predominant phototherapy followed by UV-B (7.3%) and systemic PUVA (4.7%). Use of UV-B phototherapy has been increasing during the past 5 years. The survey of Japanese psoriasis patients during 2002-2008 disclosed that psoriasis arthropathica is more prevalent (1%) than that of the previous survey during 1982-2001. Use of topical vitamin D(3) and systemic cyclosporin has been increasing during the past 7 years.     

Hyperuricemia is an independent risk factor for psoriatic arthritis in psoriatic patients

Psoriatic arthritis (PsA) is a spondyloarthritic condition mainly seen in patients with psoriasis. Psoriatic patients with plaques on the scalp, gluteal fold or nail lesions are known to develop PsA more frequently, but other markers for PsA have not yet been identified. To determine which psoriatic patients are at greatest risk of developing PsA, psoriasis vulgaris (PsV) patients who visited the Department of Dermatology, Fukuoka University Hospital in 2015 were enrolled. Patients with and without PsA were statistically compared with respect to age, sex, age at onset, body mass index (BMI), smoking and drinking habits, familial history of psoriasis and comorbidities. Of 331 patients (237 men, 94 women), 55 had PsA (17%; 39 men, 16 women). PsA patients had significantly higher frequencies of nail lesions (PsA vs PsV‐only, 62% vs 29%; P < 0.0001) and hyperuricemia (PsA vs PsV‐only, 22% vs 9%; P = 0.01). These were confirmed as independent risk factors for PsA by logistic regression analysis, with odds ratios of 5.05 for nail lesions (P < 0.0001) and 4.18 for hyperuricemia (P < 0.01). There was no difference in age at onset, sex, BMI and incidence of diabetes mellitus, hypertension or dyslipidemia. Hyperuricemia is also known to be more frequent in psoriatic subjects than the normal population. Uric acid crystals are a strong stimulator of innate immunity. Considering that none of our cohort had gouty arthritis, hyperuricemia may increase uric acid crystallization in and around joints, thereby inducing PsA in psoriatic subjects. Hyperuricemia appears to be an independent risk factor for PsA.     

Body mass index in psoriatic patients with or without familial psoriasis

Psoriasis is a chronic inflammatory disease caused by both genetic and environmental factors. The occurrence of psoriasis in family members indicates a genetic predisposition, while obesity is also a major contributor to psoriasis. We examined whether patients with versus without familial psoriasis were obese at the onset of psoriasis. Clinical information, including age at onset, age at first visit and body mass index (BMI) at first visit, was extracted from the Fukuoka University Psoriasis Registry. To compare BMI, patients aged 10 years or older who visited the clinic within 3 years of onset were selected. Familial psoriasis was observed in 27 patients (15 male, 12 female) out of 428 individuals (264 male, 164 female) with psoriasis, accounting for 6.3% of cases. Age at onset was younger for both men and women with familial psoriasis (34 ± 17 and 40 ± 15 years, respectively) relative to those with non-familial psoriasis (48 ± 19 and 53 ± 19 years, respectively). We examined age- and sex-adjusted average values of BMI at initial presentation after onset of psoriasis, finding that patients with familial psoriasis had lower BMI (22.0 kg/m² [95% confidence interval, 21.8–22.4]) than those with non-familial psoriasis (23.2 [23.1–23.3], P < 0.001). Individuals with a family history of psoriasis should be considered to be at risk for developing the disease even if obesity is not present.     

Prevalence of inflammatory bowel disease in Japanese psoriatic patients

Psoriatic patients reportedly have a higher prevalence of inflammatory bowel disease (IBD); however, there have been few research studies of Japanese psoriatic patients. To elucidate the prevalence of IBD in Japanese psoriatic patients, a cross‐sectional study was performed. Information was collected regarding psoriatic patients with current or prior history of Crohn's disease (CD) or ulcerative colitis (UC) who were treated at Fukuoka University Hospital from 2010 to 2018. Among 681 psoriatic patients (449 men and 232 women), eight (1.2%, six men, two women) had UC and two (0.3%, one man, one woman) had CD. Diagnosis of IBD preceded psoriasis in five patients, while diagnosis of psoriasis preceded IBD in two; the remaining patients’ records did not have sufficient information. Seven of 10 UC‐positive patients had mild psoriasis, two had moderate psoriasis and one had severe psoriasis. When UC‐positive psoriatic patients were compared with IBD‐negative psoriatic patients, there were no differences in age at onset of psoriasis, age at first visit or complications (e.g. psoriatic arthritis, hypertension, hyperlipidemia, hyperuricemia and diabetes). However, UC‐positive patients had significantly higher body mass index (BMI) (26.7 vs 23.7; P = 0.021), compared with patients without IBD. The CD/UC ratio in this cohort was 0.25, while the prevalence of IBD was 1.2%; these values were both lower than those in previous reports involving Caucasian patients. Patients with psoriasis and UC may have higher BMI and milder skin symptoms than those with psoriasis alone. These observations must be further confirmed by controlled domestic studies with larger samples.     

银屑病患者自身免疫性甲状腺炎调查分析

目的:调查我院银屑病患者中自身免疫性甲状腺炎的发生率。方法:纳入157例银屑病患者和年龄、性别及BMI相匹配的100例对照病例(非炎症性皮肤病患者)进行回顾性分析,测定三碘甲状腺原氨酸(T3)、甲状腺素(T4)、促甲状腺激素(TSH)、甲状腺球蛋白(TG)、甲状腺球蛋白抗体(TGAb)、抗甲状腺过氧化物酶抗体(TPOAb)水平。其中,TGAb和(或)TPOAb阳性界定为自身免疫性甲状腺炎。比较两组中自身免疫性甲状腺炎的发生率、甲状腺激素水平,并进行危险因素分析。结果:银屑病组中自身免疫性甲状腺炎发生率高于对照组(11.5%vs 9%),但两组间无明显差异(x~2=0.40,P>0.05)。银屑病中自身免疫性甲状腺炎的发生与发病年龄、病程、PASI评分和肥胖无关(P值均>0.05)。银屑病中血清TT3、FT3和TSH水平显著高于对照组(P<0.05),差异有统计学意义。结论:银屑病患者与正常人群相比,发生自身免疫性甲状腺炎的风险无增加;但血清T3可能在银屑病发病中发挥作用。     

Epidemiology and clinical pattern of psoriatic arthritis in Germany: a prospective interdisciplinary epidemiological study of 1511 patients with plaque-type psoriasis

Background  Because psoriatic arthritis (PsA) usually develops years after the first manifestation of skin symptoms, in many cases the initial diagnosis of PsA depends on the dermatologist.
Objectives  To investigate the prevalence and clinical pattern of PsA in a daily practice population of patients with psoriasis.
Methods  Patients were enrolled in an observational prospective cross-sectional cohort study at 48 community and academic centres. Demographic and medical parameters were recorded, including severity of skin symptoms (Psoriasis Area and Severity Index, PASI), previous and current treatments, concomitant diseases, and the impact of psoriasis on productivity and health-related quality of life (Dermatology Life Quality Index, DLQI). Patients with joint symptoms were referred to a rheumatologist for diagnosis and to record the activity and pattern of arthritis.
Results  Among 1511 patients 20·6% had PsA; in 85% of the cases PsA was newly diagnosed. Of these patients more than 95% had active arthritis and 53·0% had five or more joints affected. Polyarthritis (58·7%) was the most common manifestation pattern, followed by oligoarthritis (31·6%) and arthritis mutilans (4·9%). Distal interphalangeal involvement was present in 41·0% and dactylitis in 23·7% of the patients. Compared with patients without arthritis, patients with PsA had more severe skin symptoms (mean PASI 14·3 vs. 11·5), a lower quality of life (mean DLQI 11·6 vs. 7·7) and greater impairment of productivity parameters.
Conclusions  The findings are consistent with a high prevalence of undiagnosed cases of active PsA among patients with psoriasis seen by dermatologists. As many of these patients also have significant skin symptoms, treatment strategies are required that are equally effective in the control of skin and joint symptoms of psoriasis.     

Economic burden of psoriatic patients in Japan: Analysis from a single outpatient clinic

Topical and systemic agents have dramatically improved the treatment efficacy of psoriasis. Few reports, however, exist describing the economic burden in Japanese psoriatic patients. The aim of the study was to evaluate the total costs as well as cost versus efficacy of topical and systemic treatments of psoriatic patients under the Japanese health insurance system. The retrospective study was performed from the database of our clinic, which is located in Hokkaido Prefecture. Cost and effectiveness of psoriatic patients were evaluated during the 12‐month period from April 2015 to March 2016. Data were collected and calculated for the total cost per year, treatment efficacy and cost versus efficacy. The mean total cost of topical corticosteroid treatment was ¥18 184/year and was lowest among the treatments. The systemic treatment with biologics was most expensive and the costs were over ¥400 000/year. Among the topical treatments, calcipotriol/betamethasone dipropionate was most expensive (¥34 693/year). However, cost versus efficacy was not significantly different from that of topical corticosteroid treatments. The cost of secukinumab was highest among all the treatments (¥631 600/year). However, treatment day per cost was lowest of all the psoriasis treatments. Biologics showed the highest cost than topical or systemic treatments. However, they showed most marked efficacy in terms of improving the psoriatic skin lesions.     

伴发代谢综合征的银屑病患者临床特征分析

1998年WHO将一组具有共同病理生理基础的代谢异常的病症正式命名为代谢综合征(metabolic syndrome)[1],主要包括糖耐量受损、脂代谢紊乱、高血压、肥胖、微量白蛋白尿等.银屑病除累及皮肤外,常伴发糖尿病、高脂血症、高血压等.     

Childhood psoriasis: a study of 277 patients from China

OBJECTIVES: Psoriasis is common in childhood. The aim of this study was to present the clinical and epidemiological profile of childhood psoriasis in China. METHODS: A total of 277 childhood psoriasis patients younger than 16 years old were enrolled. Statistical analysis and heritability were performed using EPI INFO 6.0, spss 10.0 and Falconer's method. RESULTS: The median age was 11 years. The male : female ratio was 1:1.13. The median age of onset was 10 years. Of the patients, 48.7% had previous episodes of psoriasis. Of the 277 children with psoriasis, 68.6% had plaque-type psoriasis, 28.9% had guttate psoriasis, 1.1% presented pustular forms of psoriasis and 1.4% had erythroderma. The extensor surface of the extremities was the most frequently affected site in our patients, followed by the appearance of lesions on the scalp. A positive family history of psoriasis was found in 34.3% patients. The prevalence of psoriasis in first- and second-degree relatives was 7.0% and 1.0%, respectively. The heritability of psoriasis in first- and second-degree relatives was 72.67% and 55.18%, respectively. CONCLUSION: Our epidemiologic studies offer the information about Han Chinese distribution, which provide clues to describe psoriasis in children.     

累及黏液囊的关节病性银屑病

报告关节病性银屑病致黏液囊炎1例.患者男,60岁.因银屑病15年,指(趾)关节疼痛3年,右肘伸侧肿胀1个月来诊.右肘关节外侧鳞屑性红斑伴压痛,关节伸侧有一囊肿;双膝关节肿胀无压痛.影像学检查示尺骨鹰嘴和髌上黏液囊炎均伴有邻近部位的附着点炎.     

Drug survival of biologic agents for psoriatic patients in a real-world setting in Japan

This is a Japanese retrospective single-center study carried out between 1 January 2010 and 21 November 2018 at the Department of Dermatology in Jichi Medical University Hospital. The drug survival rate for six biologic agents used for the treatment of psoriasis was investigated. We reviewed the clinical records of 315 treatment series of 205 patients with moderate to severe psoriasis treated with adalimumab (103 cases), infliximab (70 cases), ustekinumab (66 cases), secukinumab (38 cases), brodalumab (12 cases) and ixekizumab (26 cases). In our study, ustekinumab revealed a trend towards higher drug survival among the six biologic agents. Ustekinumab had a higher drug survival rate than infliximab and secukinumab with significant differences by log–rank test among all patients and among biologic-naive (bio-naive) patients. There was no significant difference in drug survival between bio-naive and biologic-experienced (non-naive) patients in the treatment courses with adalimumab, infliximab, ustekinumab, secukinumab and ixekizumab. The dose augmentation therapy in infliximab-treated patients was associated with longer drug survival. Of all patients, 25 cases with generalized pustular psoriasis (GPP) were included, who functioned as the negative predictor for drug persistence with a hazard ratio of 1.87 (95% confidence interval, 1.12–3.11; P = 0.016). Our results reveal that ustekinumab had a superior drug survival, which is supported by the previous studies. Further studies are needed to clarify the efficacy of biologic agents on patients with GPP.     

Focus groups in Swedish psoriatic patients with pruritus

Pruritus is a common complaint among patients of psoriasis vulgaris of the chronic plaque type. Despite a high prevalence of pruritus in psoriasis, limited information is available on this subject. The aim was to assess patients' perspective of pruritus in psoriasis vulgaris of plaque type, by using focus groups. A total of 20 patients with chronic plaque psoriasis participated in focus group discussions and were divided into five groups, on different occasions. Themes for the discussion were introduced and moderated by the investigators. The focus groups created a proper atmosphere for discussion on different aspects of pruritus in psoriasis. The patients regarded themselves able to discriminate between pruritus and pain. Pruritus was most common on the lower back and legs. Stress, cold weather and skin dryness were seen as the most common worsening factors for pruritus. Sunbathing and application of emollients with or without steroids and calcipotriol cream were suggested as factors that relieved pruritus. Quality of life was affected in some patients, for instance they were reluctant to participate in social activities. Patients' perspectives on pruritus in psoriasis were important for a better understanding of this sensation. The information collected from the focus group discussions might be useful for further study in this area.     

The increased prevalence of non-alcoholic fatty liver disease in psoriatic patients: A study from South India

Background: Psoriasis is an inflammatory disease of the skin and joints. Previous studies have shown a higher prevalence of metabolic syndrome (MS) in psoriatic patients. Recent studies show that non‐alcoholic fatty liver disease (NAFLD) is also frequent in psoriasis patients. Objectives: To investigate the occurrence and severity of NAFLD in South Indian psoriatic patients and healthy controls. Methods: In phase 1 we performed a case control study on 333 adult psoriasis patients and 330 controls matched by age, sex and body mass index. NAFLD was diagnosed by ultrasonography and liver enzymes after excluding other liver diseases. In phase 2 we compared the NAFLD subgroups in psoriasis patients and controls by determining their fibrosis, steatosis and non‐alcoholic steatohepatitis (NASH) scores. Results: The occurrence of NAFLD was higher in psoriasis patients than in controls (17.4 vs 7.9%; P = 0.002). NAFLD patients in the psoriasis group (n = 58) were more likely to have MS (P = 0.03) and diabetes (P = 0.02) than those with psoriasis alone (n = 254). The former group had a longer duration of psoriasis and arthritis (P = 0.003 and 0.005). Psoriasis patients with NAFLD had more severe disease as per the psoriasis area and severity index scores (P = 0.02). Psoriasis patients had more severe NAFLD than controls as reflected by the steatosis, NASH and fibrosis scores (P = 0.001, 0.003, 0.03 respectively). Conclusion: NAFLD is the commonest liver disease in Indian psoriatic patients when compared to controls. As NAFLD is more severe in psoriasis patients we suggest routine screening for NAFLD in this group especially when systemic therapy is considered.     

miR‐424 levels in hair shaft are increased in psoriatic patients

Objective diagnostic markers have not been in clinical use for psoriasis. In this study, we investigated the levels of miR‐424 in hair roots and hair shafts in psoriatic patients, and evaluated the possibility that miR‐424 can be a biomarker of the disease. A single hair root and five pieces of hair shafts (~5 cm in length) were obtained from the non‐lesional occiput of each individual of 26 psoriatic patients. Control hair samples were collected from nine normal subjects. Samples from 10 atopic dermatitis patients were also included as the disease control. miR‐424 levels were determined by quantitative real‐time polymerase chain reaction. Hair shaft miR‐424 levels were significantly upregulated only in patients with psoriasis compared with normal controls and those with atopic dermatitis. By receiver–operator curve analysis of hair shaft miR‐424 to distinguish psoriatic patients from normal subjects, the area under the curve was 0.77. However, relative miR‐424 levels were not correlated with disease activity markers including disease duration, body surface area and Psoriasis Area and Severity Index. Hair root miR‐424 was not useful for evaluating both diagnosis and severity of the disease. Our results indicated hair shaft miR‐424 levels may be useful as a diagnostic marker of psoriasis.     

Clinical study on psoriasis patients for past 30 years (1982–2012) in Seoul National University Hospital Psoriasis Clinic

Psoriasis is a chronic relapsing disorder which shows variable clinical features. The long‐term clinical study with many patients is important to elucidate the epidemiologic characteristics and clinical features of psoriasis. The purpose of this study was to analyze the epidemiologic characteristics and clinical features of psoriasis in Korean patients. Epidemiologic and clinic data and assessments for severity of extent and activity of psoriasis were collected from the medical records of 5084 patients, who had been newly diagnosed with psoriasis in the Psoriasis Clinic of Seoul National University Hospital between 1982 and 2012. The sex ratio of the psoriasis patients was 1.2:1 (male 54.6%, female 45.4%). The peak age of onset in males was 20s, while it was the teenage years in females. A total of 63.5% of patients developed psoriasis before 30 years of age. Family history of psoriasis was observed in 26.0% of patients. Moderate to severe extent of involvement were more frequently observed in male patients and patients under 30 years of onset age than in females and patients 30 years or over of onset age, respectively. Moderate to severe disease activity were also more frequently presented in male patients, but not in patients under 30 years of onset age. The most common morphological type was nummular (56.7%), followed by large plaque (28.5%) and guttate (8.5%). Nail involvement accompanied in 26.4% of patients. We demonstrated the epidemiologic and clinical characteristics of psoriasis in Korean patients.     

Switch from etanercept to efalizumab in a psoriatic patient with HCV infection: a case report

Psoriasis vulgaris is a chronic dermatosis and is a widespread dematological disease. The most represented lesions are erythemato-squamous plaques with a tendency to cover large body areas with a great impairment of normal activities and a poor quality of life. Very often psoriasis is associated to other illnesses and the dermatologist has to be aware that comorbidities have to be taken in account for a successfull treatment of the disease.
We report a case of a patient affected by severe psoriasis and HCV infection. He underwent a first treatment with etenarcept with good clinical results and no change of his viral load. When etenarcept became ineffective, he received efalizumab, with a good control of his dermatological condition and a reduction of the viral load.