Non-psoriatic Patients Research Articles

Comparison of dermoscopic characteristics on toenail onychomycosis in psoriatic and non-psoriatic patients: A prospective study.

Psoriatic patients may experience the coexistence of onychomycosis (OM). However, the evaluation of OM in psoriatics has been hindered by potential clinical differences from OM in non-psoriatics. To assess and compare dermoscopic features between toenail OM in psoriatic and in non-psoriatic patients. Between September 2020 and September 2023, dermoscopy was conducted on 183 affected toenails by OM in psoriatics and 232 affected toenails by OM in non-psoriatics in two centres. The dermoscopic characteristics were compared using the Chi-squared test. Among toenail OM cases in psoriatic subjects, the most prevalent dermoscopic features included pitting (147/183, 80.33%) and subungual hyperkeratosis (118/183, 64.48%). Conversely, toenail OM in non-psoriatics was characterized by subungual hyperkeratosis (175/232, 75.43%) and nail spikes (139/232, 59.91%). Comparative analysis revealed a significantly higher occurrence of pitting (80.33% vs. 15.96%, p < .001), periungual telangiectasis (22.40% vs. 4.74%, p < .001), oil patches (12.57% vs. 0.43%,p < .001) and transverse grooves (43.72% vs. 28.45%,p < .01) in toenail OM in psoriatics. Furthermore, toenail OM in psoriatics exhibited a significantly lower frequency of yellow structureless area (13.11% vs. 42.67%, p < .001), nail spikes (43.17% vs. 59.91%, p < .01), ruin appearance of sulphur nugget (8.20% vs. 31.03%, p < .001), dotted/blocky haemorrhage (6.01% vs. 20.69%,p < .001) and partial onycholysis (32.79% vs. 46.98%, p < .01). Dermoscopic features of toenail OM in psoriatic and non-psoriatic patients exhibit notable differences. OM in psoriatics shows a higher frequency of pitting and periungual telangiectasis, while a lower frequency of yellow structureless areas and nail spikes under dermoscopy.

Dyslipidemia and Thyroid Dysfunction Associated with Psoriasis.

Psoriasis is a T-cell mediated inflammatory skin disorder which causes considerable psychosocial disability resulting in major impact on patient's quality of life. The dominant response of Th1 cells and the high expression of related inflammatory factors appears in both psoriasis and thyroid dysfunction. Psoriasis can lead to increased risk of incidence of cardiovascular events for which dyslipidemia is an important risk factor. This study aims to evaluate thyroid function and lipid profile and its association in patients with psoriasis. This was a prospective case-control study conducted at the Department of Biochemistry, Nobel Medical College Teaching Hospital from November 2021 to October 2022. Seventy six clinically diagnosed psoriatic patients were taken as case and eighty non-psoriatic patients coming for other skin lesions were included in the study as control. Thyroid function test (serum free T3, T4, TSH) and lipid profile (total cholesterol, low density lipoprotein, high density lipoprotein and triglyceride) were done. Hypothyroidism was most common thyroid abnormalities in our study population which was 13.15% (n=10). The lipid profile parameters were significantly higher in the psoriatic patients than in the controls (p<0.001). The odds of psoriatic patient having thyroid dysfunction was 2.8 times higher compared to other non-psoriatic patients and the odds of psoriatic patient having dyslipidemia was 8.7 times higher compared to other non-psoriatic patients. It is thus useful to assess thyroid function test and lipid profile in patients with psoriasis considering their role in etiopathogenesis and co-morbidity of psoriasis.

Significance of cuproptosis- related genes in the diagnosis and classification of psoriasis.

Cuproptosis is a novel form of cell death linked to mitochondrial metabolism and is mediated by protein lipoylation. The mechanism of cuproptosis in many diseases, such as psoriasis, remains unclear. In this study, signature diagnostic markers of cuproptosis were screened by differential analysis between psoriatic and non-psoriatic patients. The differentially expressed cuproptosis-related genes (CRGs) for patients with psoriasis were screened using the GSE178197 dataset from the gene expression omnibus database. The biological roles of CRGs were identified by GO and KEGG enrichment analyses, and the candidates of cuproptosis-related regulators were selected from a nomogram model. The consensus clustering approach was used to classify psoriasis into clusters and the principal component analysis algorithms were constructed to calculate the cuproptosis score. Finally, latent diagnostic markers and drug sensitivity were analyzed using the pRRophetic R package. The differential analysis revealed that CRGs (MTF1, ATP7B, and SLC31A1) are significantly expressed in psoriatic patients. GO and KEGG enrichment analyses showed that the biological functions of CRGs were mainly related to acetyl-CoA metabolic processes, the mitochondrial matrix, and acyltransferase activity. Compared to the machine learning method used, the random forest model has higher accuracy in the occurrence of cuproptosis. However, the decision curve of the candidate cuproptosis regulators analysis showed that patients can benefit from the nomogram model. The consensus clustering analysis showed that psoriasis can be grouped into three patterns of cuproptosis (clusterA, clusterB, and clusterC) based on selected important regulators of cuproptosis. In advance, we analyzed the immune characteristics of patients and found that clusterA was associated with T cells, clusterB with neutrophil cells, and clusterC predominantly with B cells. Drug sensitivity analysis showed that three cuproptosis regulators (ATP7B, SLC31A1, and MTF1) were associated with the drug sensitivity. This study provides insight into the specific biological functions and related mechanisms of CRGs in the development of psoriasis and indicates that cuproptosis plays a non-negligible role. These results may help guide future treatment strategies for psoriasis.

Infarctus du myocarde, accident vasculaire cérébral et psoriasis : une revue systématique des études observationnelles

Patients with psoriasis can have higher rates of hypertension, diabetes mellitus 2, and dyslipidemia. This study aimed to assess the association between psoriasis, myocardial infarction (MI), and stroke. A systematic review was carried out using PubMed/Medline, EMBASE, and LILACS databases searching for observational studies that assessed stroke and/or MI in patients diagnosed with psoriasis vulgaris compared to non-psoriatic patients. A total of 649 articles were identified but only 15 were included in the study. Although there were studies that have observed a significant positive association between psoriasis and MI or stroke, an almost equal number of studies showed no statistically significant association. The relationship between psoriasis and ischemic cardiovascular events is still controversial and it is difficult to establish psoriasis as the etiology of these events.

Psoriasis and Post-Surgical Infections in Primary Total Knee Arthroplasty: An Analysis of 10,727 Patients

BackgroundPsoriasis is a dermatologic condition characterized by erythematous plaques that may increase wound complications and deep infections following total knee arthroplasty (TKA). There is a paucity of evidence concerning the association of this disease and complications after TKA. This study aimed to determine if patients who have psoriasis vs non-psoriatic patients have differences in demographics and various comorbidities as well as post-operative infections, specifically the following: (1) wound complications; (2) cellulitic episodes; and (3) deep surgical site infections (SSIs). MethodsWe identified 10,727 patients undergoing primary TKA utilizing an institutional database between January 1, 2017 and April 1, 2019. A total of 133 patients who had psoriasis (1.2%) were identified using International Classification of Diseases, Tenth Revision codes and compared to non-psoriatic patients. The rate of wound complications, cellulitic episodes, and deep SSIs were determined. After controlling for age and various comorbidities, multivariate analyses were performed to identify the associated risks for post-operative infections. ResultsPsoriasis patients showed an increased associated risk of deep SSIs (3.8%) compared to non-psoriasis patients (1.2%, P = .023). Multivariate analyses demonstrated a significant associated risk of deep SSIs (odds ratio 7.04, 95% confidence interval 2.38-20.9, P < .001) and wound complications (odds ratio 4.44, 95% confidence interval 1.02-19.2, P = .047). ConclusionPsoriasis is an inflammatory dermatologic condition that warrants increased pre-operative counseling, shared decision-making, and infectious precautions in the TKA population given the increased risk of wound complications and deep SSIs. Increased vigilance is required given the coexistence of certain comorbidities with this population, including depression, substance use disorder, smoking history, gastroesophageal reflux disease, and inflammatory bowel disease.

Prevalence of Atherosclerosis in Psoriatic Patients Detected with Epiaortic Color Doppler Ultrasound and Computed Tomography Angiography.

IntroductionPsoriasis (PsO), a chronic inflammatory, multisystemic, and multifactorial disease can cause endothelial dysfunction, artery calcification, and atherosclerotic disease. A higher incidence of vascular occlusive events has been observed in psoriatic patients compared to healthy controls, and multiple studies confirm the association between moderate-severe PsO and atherosclerosis, coronary artery calcification, and higher cardiovascular risk.ObjectiveWe sought to analyze atherosclerotic disease prevalence in epiaortic vessels of psoriatic and non-psoriatic patients to understand if PsO could represent an independent risk factor predisposing to atherosclerotic disease.MethodsWe evaluated 47 psoriatic patients without cardiovascular risk factors with color Doppler ultrasound (CDUS). If atheromatous plaques were detected, a computed tomography angiography (CTA) was performed. We evaluated 47 non-psoriatic patients without cardiovascular risk factors with CDUS. Atherosclerosis prevalence in both groups were statistically analyzed. CDUS performance was compared to CTA.ResultsIn the psoriatic group (mean age 50.9 years), 6 had atheromatous plaques and 12 had an intima-media thickness (IMT) > 1 mm (overall prevalence of atherosclerotic disease: 38.2%). All plaques detected with CDUS were confirmed at CTA. In the control group (mean age 51.3 years), CDUS revealed atheromatous plaques in 4 patients and IMT > 1 mm in 4 ones (overall prevalence of 17%). The difference of atherosclerotic disease prevalence between the groups was statistically significant (P < 0.05).ConclusionOur results highlight that PsO could be considered a predisposing factor for atherosclerotic disease development in epiaortic vessels, as it causes an increased IMT, that is also considered an independent cardiovascular risk factor.

Characterisation of the nail microbiome in psoriatic and nonpsoriatic patients with onychomycosis.

Onychomycosis (OM) is the most common infectious nail disease, and it occurs frequently in patients with psoriasis. Microbial community shifts have been suggested to play a role in psoriasis and fungal infection occurrence. To investigate and compare nail microbial community compositions in psoriatic and nonpsoriatic patients with OM. Toenail samples were collected from nonpsoriatic patients with OM, psoriatic patients with nail psoriasis (NP) and OM, patients with only NP and healthy controls. Bacterial and fungal community compositions were analysed by amplicon sequencing of the V3-V4 regions of the 16S rDNA gene and the ITS1 region, respectively. Psoriatic OM patients had higher bacterial and fungal alpha diversities. Taxonomic analysis revealed a significantly lower relative abundance of Trichophytonrubrum (32.88% vs 82.18%, p<.001) and an increased trend of the abundance of Candida in psoriatic patients with OM than in nonpsoriatic patients. Nonpsoriatic patients with OM had a higher abundance of Staphylococcus than healthy controls (59.66% vs 45.76%, p<.05). Trichophyton, Alternaria and Malassezia could accurately differentiate psoriatic and nonpsoriatic patients with OM, with an area under the curve (AUC) of 0.86. The severity of OM was positively correlated with the relative abundance of Trichophytonrubrum. Further, Trichophyton was positively correlated with Staphylococcus and negatively correlated with Corynebacterium, Anaerococcus, Malassezia and Alternaria. The nail microbiome in psoriatic patients with OM has distinct bacterial and fungal signatures, suggesting that different dysbiosis is associated with the pathogenesis of OM in psoriatic and nonpsoriatic patients.

Distribution of comorbidities in spondyloarthritis with regard to the phenotype and psoriasis: data from the ASAS-COMOSPA study.

Introduction:The aim of the study was to compare the prevalence of comorbidities between patients with axial and peripheral phenotypes and to evaluate the role of psoriasis in such comorbidities.Methods:Patients from the cross-sectional Assessment in SpondyloArthritis Inter-national Society (ASAS)-COMOSPA study were classified as having either the axial (presence of sacroiliitis on X-ray or MRI) or peripheral phenotype (absence of sacroiliitis AND presence of peripheral involvement). Patients with each phenotype were divided into two groups depending on the presence or history of psoriasis. Pair-wise comparisons among the four groups (axial/peripheral phenotype with/without psoriasis) were conducted through univariate logistic regressions and generalized linear mixed models using disease duration and sex as fixed effects and country as random effect.Results:A total of 3291 patients were included in this analysis. The peripheral involvement with psoriasis phenotype showed the highest prevalence of hypertension (44.9%), dyslipidaemia (34%) and diabetes (8.8%), while the axial involvement without psoriasis phenotype exhibited the lowest prevalence of dyslipidaemia (14.2%), diabetes (4.1%) and stroke (0.9%). Among patients with psoriasis, the axial phenotype showed a significantly lower prevalence of hypertension (OR: 0.51, 95% CI: 0.35–0.75) and lower prevalence of Framingham score ⩾15 (OR: 0.57, 95% CI: 0.38–0.85) than patients with peripheral involvement after adjusting for disease duration, sex and country. Among patients with the axial phenotype, patients with psoriasis showed a higher prevalence of hypertension (OR 1.76, 1.40–2.20), dyslipidaemia (OR: 1.99, 95% CI: 1.56–2.53), diabetes (OR: 2.05, 95% CI: 1.39–3.02) and Framingham score ⩾15 (OR: 2.00, 95% CI: 1.57–2.55) than non-psoriatic patients. No differences were found across groups concerning bone metabolism disorders.Conclusion:Both the peripheral phenotype and psoriasis are independently associated with an increased prevalence of cardiovascular risk factors. No differences were found for bone metabolism disorders.

Vitamin D Deficiency and Psoriasis: A Cross-Sectional study of Iranian Population in Yazd Province

Objective: Psoriasis is an inflammatory disease of the skin and the joints. Psoriatic patients sometimes suffer from vitamin D deficiency and hypocalcemia. The aim of our study was to evaluate the level of calcium and vitamin D in patients with psoriasis. Materials and Methods: In this analytical cross sectional study, 110 cases of psoriasis that were referred to Shohadaye Mehrab clinic during 2015 and 110 non-psoriatic patients enrolled. Serum levels of calcium, phosphorus, parathyroid hormone (PTH), alkaline phosphatase (ALK) and 25- hydroxy vitamin D3 [(25OH) D3] were measured in both groups. Data were analyzed using SPSS software version 19. Chi square test and T-test were used for statistical analysis. Results: Among110 patients with psoriasis 74 (67.3%) were men and 36 (32.75%) were women. There was no significant difference in the serum level of calcium (P-value: 0.563), phosphorus (P-value: 0.381), PTH (P-value: 0.364) and ALK (P-value: 0.639) between two groups. Vitamin D deficiency was found in 64.5% of psoriatic patients and 60% of the controls (P-value= 0.45); However 30.9% of psoriatic and 17.3% of the controls suffered from severe hypovitaminosis D. This difference was statistically significant (Pvalue= 0.014).Conclusion: We found a significant relationship between severe hypovitaminosis D and psoriasis. This finding revealed the need for evaluation of psoriatic patients for the presence of vitamin D deficiency.

Axial and peripheral spondyloarthritis: does psoriasis influence the clinical expression and disease burden? Data from REGISPONSER registry.

To evaluate whether the presence of psoriasis influences the clinical expression, disease activity and disease burden in both axial and peripheral phenotypes of spondyloarthritis (SpA). Patients from the Spanish REGISPONSER registry classified as having SpA according to the ESSG criteria were included. Patients were classified as psoriatic or non-psoriatic depending on the presence of cutaneous or nail psoriasis; thereafter, they were classified as having either axial [presence of radiographic sacroiliitis OR inflammatory back pain (IBP)] or peripheral phenotype (absence of radiographic sacroiliitis AND absence of IBP AND presence of peripheral involvement). Pair-wise univariate and multivariate analyses among the four groups (psoriatic/non-psoriatic axial phenotypes and psoriatic/non-psoriatic peripheral phenotypes) were performed with adjustment for treatment intake. A total of 2296 patients were included in the analysis. Among patients with axial phenotype, psoriasis was independently associated (P < 0.05) with HLA-B27+ [odds ratio (OR) 0.27], uveitis (OR 0.46), synovitis (ever) (OR 2.59), dactylitis (OR 2.78) and the use of conventional synthetic DMARDs (csDMARDs) (OR 1.47) in comparison with non-psoriatic patients. Among patients with peripheral phenotype and adjusting for csDMARD intake, psoriasis was independently associated with higher age at disease onset (OR 1.05), HLA-B27+ (OR 0.14) and heel enthesitis (OR 0.22). Higher scores for patient-reported outcomes and greater use of treatment at the time of the study visit were observed in psoriatic patients with either axial or peripheral phenotype. These findings suggest that, among all patients with SpA, psoriasis is associated with differences in clinical expression of SpA, a greater disease burden and increased use of drugs.

P1767 Abnormal longitudinal peak systolic strain in asymptomatic patients with psoriatic arthritis

Abstract Background/Introduction: Psoriatic arthritis (PsA) is a systemic inflammatory disease affecting 15-30% of patients with psoriasis. Patients with PsA present 43% higher risk of cardiovascular disease compared to non-psoriatic patients. However, the probable existence of subclinical myocardial dysfunction in these patients has not been fully elucidated. Purpose Purpose of this study is to evaluate systolic and diastolic myocardial function in asymptomatic patients with PsA and no cardiac comorbidities and to reveal the value of speckle tracking echocardiography in this object. Methods Sixty patients (29 males, mean age 52.55) and 34 healthy controls (18 males, mean age 50.79) participated the study. They were subjected to TTE to evaluate left ventricular systolic function with conventional indexes such as ejection fraction (EF) and with novel indexes such as global longitudinal strain (GLS); diastolic dysfunction was also assessed in both groups. Blood exams were conducted including crp, esr. Severity scales of the disease such as PASI and DAS 28 scores, and the duration of the disease were also recorded. Results Linear regression analysis showed significantly impaired global longitudinal peak systolic strain (GLS) in PsA patients (mean =-19.79, s.d. =4.54) compared to the controls (mean =-23.67, s.d. =3.27). Ejection fraction, on the contrary, did not show any significant difference between the two groups. Left ventricular diastolic function did not present significant difference between the two groups. Comparison of GLS with PASI and DAS 28 scores, disease duration, esr and crp showed no association. Conclusions PsA patients present a higher risk of left ventricular systolic dysfunction. GLS is a useful tool in revealing myocardial impairment. Moreover, this high risk for systolic dysfunction did not appear to correlate with disease severity markers. Systolic and diastolic function indexes GroupStatistics group N Mean Std. Deviation Std. ErrorMean p-value E/A Cases 60 1,1510 ,49319 ,06367 0,971 Controls 34 1,1471 ,53555 ,09185 E/E" (average) Cases 60 8,21 3,016 ,389 0,703 Controls 32 7,95 3,096 ,547 GLS (%) Cases 52 -19,795 4,5495 ,6309 &amp;lt;0,001 Controls 34 -23,671 3,2668 ,5602 EF(%) Cases 59 59,24 3,919 ,510 0,986 Controls 34 59,26 10,880 1,866 Differences between PsA patients and control group Abstract P1767 Figure. GLS in PsA patients and control group

An understanding of interlink of psoriasis with metabolic syndrome- A case control study

Psoriasis is a chronically relapsing, inflammatory, autoimmune, genetically mediated, skin disorder. Most often association of psoriasis with metabolic syndrome has been seen. Components of metabolic syndrome like diabetes, hypertension and obesity are oftenly linked with psoriasis therefore it is crucial to understand this interlink and prompt diagnosis and treatment therefore plays important role to reduce the morbidity and mortality. It has been seen that psoriasis is associated with metabolic syndrome and its components, such as obesity, diabetes and hypertension. These phenotypically diverse conditions are found to share similar pathologic changes owing to similar susceptibility genes and genetic loci. Objectives: 1: Selection of clinically diagnosed cases of psoriasis vulgaris attending the Derma OPD; 2: Evaluation of the psoriasis vulgaris patients on different parameters ; 3: Comparision of the cases with age and sex matched control groups; 4: Study the link of psoriasis vulgaris with metabolic syndrome. Study Design: It is Case Control study (100 cases and 100 controls). Results: Our study shows that in comparision to non-psoriatic patients i.e 12 (12%) metabolic syndrome is present in 37 (37%) of the psoriatic patients attending the OPD during the period of Jan 2017 to Dec 2017 i.e 1 year duration.the result is statistically significant (odds ratio (OR) –3-175, Degree of freedom(df)-1,p value-0.002. c 2 -8.772]. Conclusion: Study shows that psoriasis is highly linked with metabolic syndrome and its components. Keywords: Metabolic Syndrome, TNF alpha, Psoriasis, Hyperlipidemia, Hypertension, BMI, Obesity, Interleukins.

A 15‐year retrospective study on the prevalence of onychomycosis in psoriatic vs non‐psoriatic patients: A new European shift from dermatophytes towards yeast

Because of their similar clinical presentation, discrimination between nail psoriasis and onychomycosis often is difficult. We aim to investigate the actual frequency of onychomycosis in psoriatic patients and to compare it between psoriatic and non-psoriatic patients. This retrospective study included a total of 9281 patients, referring to our Mycology Laboratory from September 2003 to May 2018. The patients are divided into two groups: PsoGroup (patients with psoriasis) and non-PsoGroup (non-psoriatic patient). Direct microscopic examination with 20% KOH and culture was carried out in both groups. In PsoGroup (711 patients, 59.50% female, 40.50% male, median age of 52.22±15.01), the prevalence of onychomycosis was 49.08%. On the other hand, in non-PsoGroup (8570 patients (71.65% female, 28.35% male, median age of 48.51±19.31years), the prevalence of onychomycosis was 51.30%. There was no statistically significant difference between the prevalence of onychomycosis in PsoGroup 49.08% (349/711) compared to 51.30% (4397/8570) of non-PsoGroup (P=0.2578). However, yeasts were significantly more prevalent in non-psoriatic than in psoriatic patients (P=0.0144.). In our Mycological Laboratory, we observed a similar prevalence of onychomycosis in psoriatic patients and non-psoriatic patients. However, the spectrum of fungal species isolated was different from each other, with a higher prevalence of yeasts in non-PsoGroup that reflect a recent oriental trends.

Association between geographic tongue and psoriasis: A systematic review and meta‐analyses

Geographic tongue (GT) has been described as a predictor of psoriasis. The objective of this study was to analyse the prevalence of GT in psoriatic and non-psoriatic patients. For this purpose, we conducted a systematic review and meta-analysis. A literature search was performed on PubMed, Embase, Web of Science and the Cochrane Database of Systematic Reviews. The search and selection process was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria. Only case-control studies were selected, and the prevalence of GT in both groups was compared. Eleven articles met the inclusion criteria, and the frequency of GT was statistically associated with psoriasis in ten studies. The pooled odds ratio (OR) was 3.53 (95% confidence interval [CI] 2.56-4.86). There were no significant differences between the presence of GT and the clinical form. However, the Psoriasis Area and Severity Index (PASI) score was statistically higher in patients affected by GT in three of four studies. Psoriatic patients with GT also exhibited less improvement in the PASI score after treatment. One study found an association between GT and a negative impact on patients' quality of life. Nevertheless, age, gender, toxic habits, psoriasis onset and duration of the disease were not clearly associated. The results support the concept of GT as a manifestation of psoriasis. Future research should focus on the repercussions of GT in psoriatic patients, due to the negative consequences on severity and treatment response.

Effect of eating and psychopathological traits in psoriatic patients

Background Psoriasis is a chronic inflammatory immune-mediated skin disease. Few studies have investigated the link between psychiatric disorders including eating disorders (EDs) and psoriasis. We hypothesized that EDs and the psychological effect of psoriasis contribute to the development of obesity and metabolic syndrome in psoriatic patients, who are frequently susceptible to psychiatric comorbidity. Objective The objective of this study was to evaluate the presence of EDs and psychological distress in patients affected by psoriasis compared with a control population and correlate these data with different features of the cutaneous disease and BMI. This was done to suggest the importance of a psychological support that could reduce the occurrence of loss of control over food and help psoriasis improvement. Patients and methods From September 2014 till February 2015, we enrolled 100 consecutive psoriatic outpatients and a control group of 100 selected nonpsoriatic outpatients, matched by age, sex, and BMI to the study group. The assessment utilities were composed by the Eating Disorder Inventory (EDI), the Symptom Checklist-90-Revised (SCL-90-R), and the Psoriasis Area Severity Index score. Results Regarding EDI and SCL-90-R subscales, psoriatic patients had higher scores for all EDI and SCL-90-R subscales than nonpsoriatic patients. According to the relation between BMI and SCL-90-R subscales in psoriatic patients, obese and overweight groups showed higher scores in all SCL-90-R subscales than the normal weight group. Conclusion In patients with psoriasis, EDs and severe psychiatric symptoms seem to be associated with overweight/obesity more frequently than in the general population.

The prevalence and etiological factors of onychomycosis in psoriatic patients.

IntroductionThe role of a number of inherited, acquired and environmental factors has been identified to increase the risk of onychomycosis. The literature data on psoriasis as a risk factor are contradictory. The potential relationship between these pathologies is very important as it influences the patient management.AimTo evaluate the frequency of onychomycosis and etiological factors in patients with psoriasis compared to controls.Material and methodsThe studied group (n = 2427) included 2325 patients with nail abnormalities raising a clinical suspicion of nail onychomycosis (with no history of psoriasis) and 102 psoriatic inpatients. The control group included 100 patients with clinically normal nails. The assessment of psoriasis severity using Nail Psoriasis Severity Index (NAPSI) and Psoriasis Area and Severity Index (PASI) was performed in all psoriatic patients. The presence of fungi was confirmed in direct microscopy and culture.ResultsA significantly higher incidence of onychomycosis was observed in psoriatic patients as well as in non-psoriatic patients with clinically abnormal nails compared to controls. The prevalence of onychomycosis did not differ significantly between psoriatic patients and non-psoriatic patients with nail alterations. The characteristics of isolated fungi differed significantly between psoriatic and non-psoriatic patients. NAPSI ≥ 40 and receiving systemic treatment increased the risk of onychomycosis in psoriatic patients.ConclusionsThe presented study showed a relatively high prevalence of onychomycosis in patients with psoriasis, what confirms the accuracy of performing screening mycological examination in this group. Further studies are warranted to evaluate the role of specific risk factors, explain the differences observed in previous studies and to determine optimal patient management.

Co-Morbidities in psoriatic versus non-psoriatic patients

Background: Psoriasis is a chronic dermatological disorder which involves inflammatory and immune mechanisms. It affects the outer surfaces of the body including skin, hair and nails. It has been related to extracutaneous manifestations and systemic disorders. The aim of this study is to compare the chronic illnesses, including diabetes, hypertension, dyslipidaemia, hypothyroidism and abnormal renal and liver profiles, among patients with psoriasis and patients who had appendectomy. Methods: A case–control study took a place in Riyadh. It included a case group of psoriatic patients and a control group of appendectomy patients. Each one had patients from both genders of all age groups. Data were collected by reviewing patients' charts to obtain demographic information, blood pressure, blood glucose level, lipid profile, kidney function, liver function and thyroid function. Results: A total of 140 patients were included (74 males and 66 females). They have been divided into a case group of psoriatic patients and a control group of appendectomy patients, each had 70 participants. The mean age for both groups was 46 ± 18 and 41 ± 15 years, respectively. The proportion of psoriatic patients having diabetes (64%) was found to be higher than the proportion of control patients (46%) (odds ratio [OR], 2.85; 95% confidence interval [CI], 1.12–7.28; P = 0.03). Abnormal renal profile was significantly associated with psoriasis (21%) in comparison to control (3%) (OR, 12.74; 95% CI, 2.28–68.29; P = 0.004). Conclusion: Patients with psoriasis were found to have an increased risk of developing major co-morbid disorders including diabetes, liver and renal function profile abnormalities. This indicates the importance of checking if this group of patients have co-morbid disorders.

Oral features in patients with psoriasis: an observational study.

The aim of this study was to investigate and compare the prevalence of oral mucosal lesions in a group of psoriatic patients and healthy subjects. 120 psoriatic patients were enrolled in this observational study. Clinical examination, panoramic X-ray, magnetic nuclear resonance of temporo-mandibular joint, parodontal evaluation, oropharyngeal buffer and incisional biopsies by scalpel, as applicable, were done in order to value the patients. The control group was formed by 201 non-psoriatic patients attending the hospital for dental conditions. Oral clinical evaluation of these patients was performed, to assess the presence of any oral manifestation that can be related to psoriasis: fissured tongue, geographic tongue, parodontitis, temporo-mandibular joint disorders and oral candidiasis. After the observational analysis, a statistical examination was conducted using the chi-square test (2-sided). A percentage of 78.34% of patients belonging to the case group presented oral manifestations, while in the control group the 35.3% of the individuals presented any oral lesions. Especially geographic and fissured tongue showed a strong correlation with psoriasis. Some oral mucosal lesions, such as geographic and fissured tongue, are strongly associated with psoriasis. Although these lesions are non-pathognomonic to psoriasis, their precise relationship needs to be clarified and further investigated.

The prevalence of cardiovascular diseases risk factors associated with psoriasis in Saudi Arabia.

BackgroundExtensive studies have revealed an increased risk of major adverse cardiac outcomes in patients with severe psoriasis. However, some studies show conflicting results.ObjectiveThis study was conducted to assess the CV risk factors in psoriasis patients, and compare it with non-psoriatic patients. In addition, we evaluated if psoriasis is an independent CV risk factor, if its severity can predict CV risk, and if systemic psoriasis treatments modify CV risk.MethodsThis was a case-control study in 200 participants -100 with psoriasis, and 100 with dermatitis who served as the control. The study was carried out from September 2015 to September 2016. Data was collected using self-administered questionnaires, one each for both groups. Questions include body surface area, current psoriasis/dermatitis therapies, presence of diabetes mellitus, hypertension, smoking history, weight, height, body mass index (BMI), elevated cholesterol, Coronary Artery Disease (CAD) history.ResultsAnalyses of the associations between psoriasis and CV symptoms has demonstrated that psoriasis was associated with CAD (p<0.001) and hospitalizations (p<0.001) due to CAD. We found that the psoriasis group have the following association: Angina (p=0.005), hypertension (p=0.001), diabetes mellitus (p=0.016), hypercholesterolemia (p=0.015), and “CAD succeeding psoriasis (p=0.001)” (it assesses how many patients with psoriasis had CAD after they are diagnosed with psoriasis). Our study showed that there was no statistically significant risk of CVD in dermatitis patients (p=0.16). There was no association between severity of psoriasis and CV risk (p=0.07).ConclusionsThere is a higher CV risk prevalence among Saudi psoriatic patients and this confirms that psoriasis is an independent CV risk factor in this population.

Psoriasis and Depression: A Comprehensive Review for Clinicians

Psoriasis has various systemic comorbidities including psychiatric disorders. Due to limited experience of dermatologists, psychiatric comorbidities are often not adequately addressed or treated. Recently, the association between depression, a risk factor for suicidality, and psoriasis has become a topic of interest due to suicides occurring in patients on new therapies such as apremilast and brodalumab for the treatment of psoriasis. A systematic literature search was conducted to provide an overview for clinicians on the epidemiological relationship between depression and psoriasis. Although there seems to be higher prevalence of depression in patients with psoriasis compared to non-psoriatic patients, the estimated prevalence of the comorbidity varies greatly and does not necessarily correlate with severity of psoriasis. Given the clear increased risk and association of depression with psoriasis, it is plausible that depression is not directly linked with the apremilast or brodalumab, but rather with psoriasis itself.