Comorbidities in Psoriasis

Nithya, M (2012) Comorbidities in Psoriasis. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION : Psoriasis is a common, chronic, inflammatory papulosquamous disorder of skin in which both genetic and environmental factors have a critical role. It is characterized by dull red, scaly, indurated plaque, having a chronic course with remission and exacerbation. It is a widespread disease with worldwide prevalence of 0.6- 4.8%. Among the patients attending hospitals in India, the prevalence is about 0.8-5.6%. It affects all the age groups, and its prevalence in children younger than 18 years is 0.71%. Comorbidity is the occurrence of one or multiple disorder(s) in association with a given disease(4,5). This has gained interest in various fields of medicine in recent times and often appears to be due to common pathogenic pathways. Comorbidities tend to arise in complex disorders, they are frequently multigenic & multifactorial and most often demonstrate an inflammatory background(4). Psoriasis is associated with numerous comorbidities which has a major impact on severely affected patients. Knowledge of comorbidities in psoriasis is of substantial importance because of the following aspects: 1. The concomitance of other diseases leads to intake of medications that could affect the onset, severity and course of psoriasis 2. Medications used to treat psoriasis may positively or negatively influence the comorbidities 3. An association to distinct diseases could help to obtain a deeper insight into the pathogenesis of psoriasis 4. Therapeutic management of patients with psoriasis needs to be adapted to the prevalence of other diseases and medication(8). As dermatologists are often the first consulted healthcare specialists by patients with psoriasis, we should be aware of these comorbidities and this study is designed for the purpose of studying these comorbidities. AIM OF THE STUDY : 1. To find out the comorbidities that occur in psoriasis. 2. To study the prevalence of these comorbidities. 3. To correlate the comobidities with clinical parameters like age, sex, duration of disease, type of psoriasis and severity. MATERIALS AND METHODS : Study design: Descriptive study. Study centre: Department of Dermatology and Leprosy, Rajiv Gandhi Government General Hospital, Chennai. Study period: October 2009 to September 2011 (2 years). Inclusion criteria: Cases of psoriasis proven by clinical examination or by biopsy. Exclusion criteria: • Patients on systemic management for psoriasis. • Patients who were not willing to undergo investigations as per the study protocol. Sample size: • A total of 171 patients were included in the study • All patients were explained about the disease and the benefits of being participating in this study. • Consent was obtained from all the patients for participating in this study. For children consent was obtained from their parents. Data collection: It was done as per the proforma. All patients were evaluated as follows: 1. History, 2. General examination, 3. Systemic examination, 4. Dermatological examination, 5. Investigations, 6. Speacialist opinions. History: The detailed history about the patients and regarding their disease were collected. Importance was given to the particulars like 1. Age, 2. Sex, 3. Duration of disease, 4. Area of skin involved, 5. History of comorbidities like Diabetes mellitus, Hypertension etc., 6. History of comorbidities in their family, 7. History of alcoholism, 8. Treatment history. General Examination: • A complete and thorough examination was done in all patients. • Blood pressure was recorded. • Waist circumference was measured in cm in all, at the level of iliac crest with the tape snuggly fitting on the skin and it was recorded. • Height and weight of the patients were measured and recorded. • Body mass index (BMI) was calculated using the following formula: Weight (kg) / Height (m2) Systemic Examination: The following systems were examined: • Cardiovascular System, • Respiratory System, • Abdomen, • Central nervous System. CONCLUSION : Comorbidities in psoriasis is common and its prevalence is 71.93% in our study. • The comorbidities observed in our study in the decreasing order of frequency are dyslipidemia, hypertension, diabetes mellitus, metabolic syndrome, obesity, myocardial infarction. • Hypertension, diabetes mellitus, metabolic syndrome, myocardial infarction are common in those aged above 40 years while dyslipidemia and obesity are present in younger age. • Both sexes had all the comorbidities and there is no statistically significant difference in its occurrence with respect to psoriasis duration or severity. • Comorbidities are common in psoriasis vulgaris of severe type. They are also seen in psoriasis vulgaris of mild or moderate type, psoriatic erythroderma, guttate type, pustular and palmoplantar psoriasis. • Our study states that psoriasis is emerging as a systemic disease in current days and it is not just skin deep. • As Dermatologists we should be aware of these comorbidities since we have the unique opportunity to screen, identify and followup the comorbidities in psoriasis. • So we strongly recommends screening for comorbidities in all patients with psoriasis, irrespective of their age, sex, duration of disease, severity and type of psoriasis. • Even if comorbidities are not detected at screening, adapting healthy life style practices are highly needed from the time of diagnosis in present era to prevent these comorbidities. • We would like to conclude that treatment of psoriasis successfully with a improvement in quality of life patients could be achived with unified management by dermatologists and other specialists.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Comorbidities ; Psoriasis.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 01 Mar 2018 17:07
Last Modified: 03 Mar 2018 06:34
URI: http://repository-tnmgrmu.ac.in/id/eprint/5948

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