Catherine Dolan from the Facebook Psoriasis Group suggests to fill in a form.  This form describes a research study that Samuel Kunjukunju from the University of Rochester is conducting.

Sam Kunjukunju, is researching into psoriasis (particularly the treatment of) and would like our help! The purpose of this research study is to look at how Psoriasis patients are managing their condition in order to further Psoriasis research.
http://www.surveymonkey.com/s.aspx?sm=cAZwnVTvKQ6UNoHZhE%2fC9A%3d%3d#q1

This study involves a survey of 32 questions. We estimate that approximately 500 individuals will take part in this study. You will be asked to complete questions about how you have treated your Psoriasis and your experience in managing your condition. This should take about 15 minutes. There is a small chance that some of the questions may make you feel uncomfortable. You don’t have to answer those questions if you don’t want to. In fact you don’t have to answer any question that you choose not to answer (except the initial eligibility questions). Just skip that question and go on to the next one.

Your participation in this survey is completely voluntary. You are free not to participate or to withdraw at any time, for whatever reason without penalty or loss of benefit to which you are otherwise entitled.
All answers are confidential and you will not be required to enter any contact information/information that will identify you individually. It took me under 10 minutes to complete so please if you have a spare few minutes do take part.

Patients with psoriasis resistant to topical therapy frequently wait a year or longer to receive systemic therapy, investigators reported.

On average, patients continued with ineffective topical therapy for four years before their physicians initiated systemic therapy with a conventional disease-modifying antirheumatic drug or a biological agent.

A comparison of patients with and without long delays in systemic therapy revealed no clinical differences that could explain the delay, according to a presentation at the European Academy of Dermatology and Venereology meeting.

In particular, disease severity did not appear to influence the decision to initiate systemic therapy.

“Despite the availability of systemic treatment, including biological agents, there is a delay in the appropriate care of patients with moderate to severe psoriasis,” Carle Paul, MD, of Toulouse University in France, and colleagues concluded.

“Strategies are needed to improve the referral process and to reduce the time to initiation of systemic treatment in patients with moderate to severe psoriasis.”

The findings came from an examination of the start of systemic therapy within the context of patients’ perceptions that their psoriasis was inadequately controlled by topical agents. The study involved 52 psoriasis patients referred for evaluation by general practitioners or office-based dermatologists.

Each patient completed a questionnaire that covered clinical and demographic information, quality of life, and symptoms of depression. Additionally, patients were asked to estimate the interval between the time they perceived their psoriasis was not controlled and the initiation of systemic therapy.

The study population’s Psorasis Area and Severity Index (PASI) score averaged 18. The Beck Depression Index (BDI) score averaged 3, and the mean Dermatology Life Quality Index (DLQI) score was 11. The median delay in the start of systemic therapy was 13 months.

Paul and colleagues separated the patients into two groups: those who waited less than 12 months to start systemic therapy and those who waited 12 months or longer. The two groups did not differ significantly with respect to baseline PASI score (19.5 versus 23), BDI score (5.1 versus 6.3), or DLQI score (10.8 versus 12.4).

Evaluation of sociodemographic variables showed that treatment delay was more likely among patients who performed manual labor, who lived in rural areas, and whose monthly income was less than 1,200 Euros.

Source: European Academy of Dermatology and Venereology – MedPage Today

Psoriasis patients have a substantial comorbidity burden that can reduce life expectancy by 10 years or more, according to data presented recently.

On average, patients whose psoriasis was diagnosed before age 25 did not live to age 60. In contrast, a psoriasis diagnosis at age 25 or afterward was associated with an average life expectancy greater than 70.

The disparity emphasizes the need to diagnose psoriasis and initiate treatment to clear the disease and possibly increase longevity by avoiding psoriasis-related comorbidity, Wayne Gulliver, MD, said at the European Academy of Dermatology and Venereology meeting.

“There is an intriguing relationship between psoriasis, multiple comorbidities, and loss of longevity,” said Gulliver, of NewLab Research in St. John’s, Newfoundland.

“It is documented in the literature that individual diseases, such as diabetes, may decrease life expectancy by five or six years, and high blood pressure and heart disease by three to four years. When you start layering all of those comorbid conditions with psoriasis, then, in people who have early age of onset of psoriasis, the loss of longevity may be as high as 20 years. For people with psoriasis at age 25, it’s about 10 years.”

The findings came from an ongoing study of comorbidity among psoriasis patients living in Newfoundland and Labrador. Gulliver presented data on the nature of psoriasis-associated comorbidities and all-cause mortality in a founder population of psoriasis patients and in patients included in a newer, more contemporary dataset.

An initial comorbidity and mortality study included 3,228 patients who had a new diagnosis of psoriasis from 1989 through 2005. Almost half of the patients (1,494) had one or more acute-care hospitalizations during follow-up.

Conditions most often associated with hospitalization included digestive disorders (27.3%), circulatory disorders (25.8%), genitourinary conditions (20.5%), and respiratory disease (19.7%).

More than half (55%) of the 1,494 psoriasis patients had multiple comorbid conditions, including a third of patients who had three or more comorbidities.

Using provincial and nationwide data sources, Gulliver and colleagues examined causes of death in a founder population of 120 individuals with psoriasis and in a new dataset including 418 psoriasis patients.

In both groups, circulatory diseases were the most common cause of death (39%), followed by cancer (37.5% of the founder population and 28.5% of the more recent group).

Demographic data on patients in the founder population showed that women died at an average age of 73 and men at 67.5. Severity of psoriasis and psoriasis genotype did not significantly affect life expectancy.

However, age at diagnosis of psoriasis did. Patients whose diagnosis occurred at age 25 or earlier had an average age of 59.3 at death compared with 71.2 for patients whose diagnosis occurred after age 25 (P=0.001).

Of particular concern to Gulliver was the proportion of deaths attributed to mental and nervous-system disorders and accidental or other “external causes,” such as injury or poisoning.

Deaths due to mental/nervous system disorders increased from 3.4% to 4.3% from the founder population to the newer dataset.

External causes accounted for 2.5% of deaths in the founder population and 3.6% in the newer dataset for psoriasis patients.

“The data suggest that the risk of dying from suicide, injury, or poisoning may be as high as 1 in 600 and the risk of death from cardiovascular disease is approximately 1 in 75,” said Gulliver.

“Knowing that the risk of dying from an adverse drug event related to psoriasis treatment is less than 1 in 10,000, and that systemic psoriasis treatment may decrease the risk of cardiovascular comorbidities, it is important that physicians initiate therapy that will clear the psoriasis, improve the quality of life, and potentially decrease the risk of premature death from a psoriasis-related comorbidity,” he said.

Source: European Academy of Dermatology and Venereology (EADV) – MedPage Today

Summary
Accumulating evidence indicates that body weight, alcohol and smoking are associated with psoriasis. However, these factors have scarcely been investigated in relation to onset and disease activity at onset of psoriasis.

A population-based case-control study was performed including 373 cases with onset of first-time plaque psoriasis within 12 months and matched healthy controls. Psoriasis activity was measured using the Psoriasis Area and Severity Index (PASI). Analyses were performed using conditional logistic regression. In multivariable analyses for each unit increment in body mass index, there was statistically significant 9% increased risk for psoriasis onset and 7% higher risk for increased PASI. Obesity (body mass index ≥ 30) compared with normal body weight was associated with a two-fold increased risk for psoriasis onset. Smoking was associated with a 70% increased risk for onset, but was not related to PASI. A positive association with alcohol drinking was observed among men, but not among women.

No associations were observed for weight gain and use of smokeless tobacco. Our results indicate that excessive body weight and smoking are risk factors for onset of psoriasis and that higher body mass index increases the PASI of plaque psoriasis at onset.

PubMed

Indian J Dermatol Venereol Leprol. 2009 Sep-Oct; 75(5): 551Bilac C, Ermertcan AT, Bilac DB, Deveci A
Department of Dermatology, Celal Bayar University, Faculty of Medicine, Manisa, Turkey

Pruritus (itch) is a common symptom of many dermatological and systemic diseases. It is a common complaint among patients with psoriasis of the chronic plaque type.

Patients with pruritus (itch) suffer from more severe psoriasis although some authors did not find a significant relationship between pruritus intensity and psoriasis severity. AIMS: In this study, we aimed to investigate the relationship between clinical features and symptoms among psoriasis patients. And also we aimed to evaluate whether the severity of disease, depression and quality of life scores could effect these symptoms or not.

Methods
Eighty seven patients with psoriasis were enrolled in this study. Epidemiological data of patients were noted. Clinical symptoms, such as pruritus, pain, burning, exudation, bleeding, weakness, etc. were interrogated. The answers to these questions were classified as ‘never’, ‘rare’, ’sometimes’, ‘often’ and ‘all the time’. Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), Hamilton Anxiety-Depression Scale (HAD) were calculated for each patient. PASI and DLQI scores were classified as > or = and < 10.

Results
We found that the most frequent symptom was pruritus (96.6%). Other frequent symptoms were burning (56.3%), exudation (56.3%) and bleeding (49.4%). Hurting, sensitiveness and bothering were more frequent in women. Percentages of hurting, pain, exudation and weakness symptoms had been increasing with age. Frequency of weakness was significantly high in PASI > or = 10 patients.

Conclusion
Pruritus is a very common symptom in psoriasis. Burning, exudation and bleeding are also common symptoms seen in psoriasis. New scoring systems including symptoms of psoriasis patients may be developed for evaluating the severity of the disease.

As a result of this study, we suggest that dermatologists should be alert to the presence, frequency and relevance of symptoms experienced by their patients with psoriasis on the evaluation of disease severity both in clinical practice and in clinical trials. It is also important to interrogate these associated symptoms before deciding therapeutic approaches and evaluating their efficacies.

Original article

The brains of patients with psoriasis are less responsive to expressions of disgust on other people’s faces, a neurological device that may help them cope with the social stigma of the disease, a recent study found.

Psoriasis patients had significantly smaller signal responses to disgusted faces in the bilateral insular cortex compared with healthy controls, according to an online report in the Journal of Investigative Dermatology. The insular cortex is the region of the brain associated with feelings and observation of disgust.

“We hypothesize that patients with psoriasis, in this case male patients, develop a coping mechanism to protect them from stressful emotional responses by blocking the processing of disgusted facial expressions,” Professor Christopher E.M. Griffiths, Dermatological Sciences, The University of Manchester and colleagues wrote.

Original Article

People with 3 independent genetic variants are 9 times more likely to get psoriasis.

A specific genetic region that has been increasingly identified as the strongest genetic link to psoriasis has an even more significant role in the chronic skin disease than has been suspected, University of Utah medical researchers show in a new study.

In the Aug. 13 issue of PLoS Genetics, researchers in the U School of Medicine’s Department of Dermatology confirm that the presence of HLA-Cw*0602, a gene variation or allele on chromosome 6 found by numerous investigators to be associated with psoriasis, is the “major genetic determinant” of the disease, but that other nearby genetic variations also play an independent role in contributing to psoriasis.

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Denise Globe1 , Martha S Bayliss2  and David J Harrison1
1Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA, 91320 USA
2Mapi Values, 3rd Floor 133 Portland Street, Boston, MA 02114, USA

Background
The objective of this qualitative study was to better understand the impact of psoriasis symptoms using a 3-part process: 1) develop a disease model for psoriasis to identify the most important concepts relevant to psoriasis patients; 2) conduct interviews with dermatologists to identify key areas of clinical concern; and 3) explore psoriasis patients’ perceptions of the impact of psoriasis.

Methods
A disease model was developed from a review of the published literature and later revised based on the findings of clinician interviews and patient focus groups. To confirm the clinical relevance of the concepts identified in the disease model, 5 dermatologists were selected and interviewed one-on-one. They were asked to rate major psoriasis symptoms according to importance and bothersomeness level to patients on separate scales of 1 to 10. Results of clinician interviews were used to develop interview guides for patient focus groups. To identify important domains of psoriasis, 39 patients participated in 5 separate concept elicitation focus groups. Four focus groups included patients with severe psoriasis (n = 31) and one included patients with mild psoriasis (n = 8). Patients were asked to describe their current psoriasis symptoms and to rate them on a scale of 1 to 10, according to importance, severity, and troublesomeness. An average mean rating was calculated for each symptom throughout all focus groups.

Results
Clinicians most frequently mentioned itch (n = 5), psoriatic arthritis or “joint pains” (n = 4), flaking (n = 4), and pain (n = 3) as primary physical symptoms of psoriasis. Three clinicians gave a rating of 10 for the importance of itch; two clinicians gave ratings of 8 and 7 for importance. The majority of patients rated itch as the most important (31/39), most severe (31/39), and most troublesome (24/39) symptom and noted that itch negatively impacted daily activities (eg, concentration, sleep, ability to attend work or school), as well as emotions (eg, anxiety and embarrassment).

Conclusion
These analyses suggest that itch is one of the most important symptoms of psoriasis, contributing to diminished health-related quality of life (HRQoL) in patients with both mild and severe disease.

Original article

Home UVB therapy for psoriasis as effective and safe as hospital treatment, recent study suggests.

For patients with psoriasis, treatment with ultraviolet B (UVB) at home is as effective and as safe as conventional hospital based phototherapy, concludes a recent study published on the British Medical Journal website. Patients also find home UVB therapy less of a burden and are more satisfied with treatment, the findings show.

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