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- Page navigation anchor for Psoriatic patients: New emerging comorbidities?Psoriatic patients: New emerging comorbidities?
Dear Editor,
To the good review article “Diagnosis and management of psoriasis” by Dr. Kim et al., we would like to make one further comment [1]. In the principles of psoriasis management, it is important not only to consider classic co-morbidities such as psoriatic arthritis, cardiovascular disease or psychological/psychiatric disorders but also to incorporate "new" emerging co-morbidities into the diagnosis.
For example, current studies show a bidirectional association between obstructive sleep apnea (OSA) and psoriasis (e.g. increased oxidative stress and systemic inflammation, intermittent hypoxemia, upper airway obstruction) [2-6]. The prevalence of OSA in psoriasis patients is significantly increased in comparison to the general population (36%-81.8% versus 2%-4%) [7]. Clinicians should therefore remember that patients with psoriasis may have an undiagnosed OSA [4, 8]. A practical approach would be to use a simple validated screening tool for OSA such as the STOP-Bang questionnaire (snoring, tiredness, observed apnea, high blood pressure (STOP) - body mass index, age, neck circumference and gender (Bang)) [9, 10].
Furthermore, the prevalence of non-alcoholic fatty liver disease [11-14], celiac disease [15, 16], osteoporosis, and pathological fractures is significantly higher in patients diagnosed with psoriasis [17, 18].
Psoriasis also adversely affects the risk and severity of periodontitis [19, 20]. In a recent pooled meta-anal...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Psoriatic patients: Do you smoke?RE: Psoriatic patients: Do you smoke?
Dear Editor:
We thank Dr. Kim et al. for their recently published review article “Diagnosis and management of psoriasis” [1]. We agree with the authors, but in addition to lifelong healthy eating habits and an active lifestyle of psoriasis patients, which we have already pointed out in an eLetter [2], there is one more important lifestyle aspect worth mentioning. Tobacco smoking is an independent risk factor for psoriasis: Smoking habits negatively affect the development of psoriasis and the disease severity (e.g. oxidative stress, free radical damage, vascular endothelial dysfunction). A dose-effect relationship of smoking intensity, duration, and pack-years of smoking is also documented [3, 4]. First reports about the possible significant association between psoriasis and smoking have been published more than 25 years ago [5]. In a pooled meta-analysis of 25 case-control studies (676,045 study participants and 146,934 psoriatic patients), the odds ratio (OR) of psoriasis among smokers was 1.78 (95% confidence interval (CI) 1.53-2.06) and 1.62 (95% CI 1.33-1.98) in former smokers. In this meta-analysis, Armstrong et al. also evaluated three cohort studies (the Nurses' Health Study, the Nurses' Health Study II, and the Health Professionals' follow-up study) for the association between smoking and incidence of psoriasis: Compared with nonsmokers, the risk of incident psoriasis was 1.81 (95% CI 1.38-2.36) in those who smoked 1-14 cigarettes per day and...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Psoriasis: Obesity is an underestimated modifiable risk factorRE: Psoriasis: Obesity is an underestimated modifiable risk factor
Dear Editor,
We congratulate Dr. Kim et al. for their very interesting review article “Diagnosis and management of psoriasis” in the April 2017 issue of the Canadian Family Physician [1]. There is one lifestyle aspect worth mentioning. First reports about the possible significant association between psoriasis and obesity have been published more than 40 years ago [2]. In 2012, a meta-analysis of 16 observational studies (2.1 million study participants and 201,831 psoriatic patients) has found that patients with psoriasis have a more than 50% increased odds of obesity compared with the general population, with a pooled odds ratio (OR) of 1.46 for mild psoriasis (95% confidence interval (CI) 1.17-1.82) and an OR of 2.23 (95% CI 1.63-3.05) for moderate-to-severe psoriasis [3]. There is now a strong evidence for this bidirectional relationship [4]. The "Canadian Psoriasis Guidelines Addendum Committee" has also listed obesity among the associated comorbidities and recommends “Advise obese patients to lose weight for potential skin benefits” [5].
Genetic (e.g. HLA-Cw6, HLA-B27), epigenetic, environmental and immune-mediated factors are involved in the interaction/pathogenesis of obesity and psoriasis. In this pathogenic crosstalk the following pro-inflammatory cytokines and adipokines in adipose tissue play a key role: tumor necrosis factor-alpha, interleukin (IL)-6, IL-18, IL-23, leptin, resistin, visfatin, and the anti-inflammatory adiponectin [4]. It...
Show MoreCompeting Interests: None declared.