Caitlin T. Harskamp

The association between psoriasis and obesity: a systematic review and meta-analysis of observational studies.

Objective:Psoriasis is an inflammatory skin disease affecting 2–4% of the world population. The objective of this study was to perform a systematic review and meta-analysis synthesizing the epidemiological associations between psoriasis and obesity.Data sources:We searched for observational studies from MEDLINE, EMBASE and Cochrane Central Register from 1 January 1980 to 1 January 2012. We applied the Meta-Analysis of Observational Studies in Epidemiology guidelines in the conduct of this study.Study selection:We identified 16 observational studies with a total of 2.1 million study participants (201 831 psoriasis patients) fulfilling the inclusion criteria.Results:Using random-effects meta-analysis, the pooled odds ratio (OR) for obesity among patients with psoriasis was 1.66 (95% confidence interval (CI) 1.46–1.89) compared with those without psoriasis. From the studies that reported psoriasis severity, the pooled OR for obesity among patients with mild psoriasis was 1.46 (95% CI 1.17–1.82) and the pooled OR for patients with severe psoriasis was 2.23 (95% CI 1.63–3.05). One incidence study found that psoriasis patients have a hazard ratio of 1.18 (95% CI 1.14–1.23) for new-onset obesity.Conclusions:Overall, compared with the general population, psoriasis patients have higher prevalence and incidence of obesity. Patients with severe psoriasis have greater odds of obesity than those with mild psoriasis.

Psoriasis and metabolic syndrome: A systematic review and meta-analysis of observational studies

BACKGROUND Increasing population-based studies have suggested a relationship between psoriasis and metabolic syndrome. OBJECTIVE The objective of this study was to perform a systematic review and meta-analysis that synthesizes the epidemiologic associations between psoriasis and metabolic syndrome. METHODS We searched for observational studies from MEDLINE, EMBASE, and Cochrane Central Register from Jan 1, 1980 to Jan 1, 2012. We applied the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines in the conduct of this study. RESULTS We identified 12 observational studies with a total of 1.4 million study participants fulfilling the inclusion criteria, among whom 41,853 were patients with psoriasis. Based on random-effects modeling of cross-sectional and case-controlled studies, the pooled odds ratio (OR) for metabolic syndrome among patients with psoriasis was 2.26 (95% confidence interval [CI] 1.70-3.01) compared with the general population. Visual inspection of a funnel plot and formal analysis with the Egger test suggested publication bias and absence of small studies in the published literature (P = .03). A dose-response relationship was also observed between psoriasis severity and prevalence of metabolic syndrome. LIMITATIONS No studies to date have assessed incidence of metabolic syndrome among patients with psoriasis. CONCLUSIONS Compared with the general population, psoriasis patients have higher prevalence of metabolic syndrome, and patients with more severe psoriasis have greater odds of metabolic syndrome than those with milder psoriasis.

Psoriasis and Major Adverse Cardiovascular Events: A Systematic Review and Meta-Analysis of Observational Studies

Background Psoriasis is a chronic inflammatory disease that may be associated with increased risk of cardiovascular events, including cardiovascular mortality, myocardial infarction, and stroke. Methods and Results We searched the MEDLINE, EMBASE, and Cochrane Central Register databases for relevant studies in English between January 1, 1980, and January 1, 2012. Extraction was by 3 independent reviewers. Summary incidence, risk ratios (RRs), and confidence intervals (CIs) were calculated using fixed‐effects and random‐effects modeling. Meta‐regression was also performed to identify sources of between‐study variation. Nine studies were included, representing a total of 201 239 patients with mild and 17 415 patients with severe psoriasis. The level of covariate adjustment varied among studies, leading to the possibility of residual confounding. Using the available adjusted effect sizes, mild psoriasis remained associated with a significantly increased risk of myocardial infarction (RR, 1.29; 95% CI, 1.02 to 1.63) and stroke (RR, 1.12; 95% CI, 1.08 to 1.16). Severe psoriasis was associated with a significantly increased risk of cardiovascular mortality (RR, 1.39; 95% CI, 1.11 to 1.74), myocardial infarction (RR, 1.70; 95% CI, 1.32 to 2.18), and stroke (RR, 1.56 95% CI, 1.32 to 1.84). Based on these risk ratios and the background population event rates, psoriasis is associated with an estimated excess of 11 500 (95% CI, 1169 to 24 407) major adverse cardiovascular events each year. Conclusions Mild and severe psoriasis are associated with an increased risk of myocardial infarction and stroke. Severe psoriasis is also associated with an increased risk of cardiovascular mortality. Future studies should include more complete covariate adjustment and characterization of psoriasis severity.

The association between psoriasis and hypertension: A systematic review and meta-analysis of observational studies

Population-based observational studies have suggested a relationship between psoriasis and hypertension. We performed a systematic review and meta-analysis to better understand the association between psoriasis and hypertension. We systematically searched MEDLINE, EMBASE, and the Cochrane Central Register from 1 January 1980 to 1 January 2012. Two authors independently assessed trial eligibility and quality. We applied the Meta-Analysis of Observational Studies in Epidemiology guidelines in the conduct of this study. We identified 24 observational studies with a total of approximately 2.7 million study participants fulfilling our inclusion criteria. Among them, 309 469 were patients with psoriasis. On the basis of random effects modeling of case–control and cross–sectional studies, the odds ratio (OR) for hypertension among patients with psoriasis was 1.58 [95% confidence interval (CI) 1.42–1.76] compared with the controls. The OR for hypertension among patients with mild psoriasis was 1.30 (95% CI 1.15–1.47) and the OR for hypertension among patients with severe psoriasis was 1.49 (95% CI 1.20–1.86) compared with the controls. Two cohort studies examining incidence of hypertension found that psoriasis was associated with a hazard ratio of 1.09 (95% CI 1.05–1.14) and 1.17 (95% CI 1.06–1.30) for development of hypertension. In a subgroup analysis, patients with psoriatic arthritis also had an increased prevalence of hypertension (OR 2.07, 95% CI 1.41–3.04). Psoriasis and psoriatic arthritis are associated with greater prevalence of hypertension. Patients with severe psoriasis have greater odds of hypertension than those with mild psoriasis.

Psoriasis and smoking: a systematic review and meta-analysis.

Psoriasis is an inflammatory skin disease associated with increased cardiovascular comorbidity. Smoking is associated with an increased risk of cardiovascular disease, and prior studies have suggested that patients with psoriasis are more likely to be active smokers. Smoking may also be a risk factor in the development of psoriasis. We conducted a systematic review and meta‐analysis to assess the prevalence of smoking among patients with psoriasis, and we reviewed the contribution of smoking to the incidence of psoriasis. A total of 25 prevalence and three incidence studies were identified. The meta‐analysis of prevalence studies included a total of 146 934 patients with psoriasis and 529 111 patients without psoriasis. Random effects meta‐analysis found an association between psoriasis and current smoking [pooled odds ratio (OR) 1·78, 95% confidence interval (CI) 1·52–2·06], as well as between psoriasis and former smoking (pooled OR 1·62, 95% CI 1·33–1·99). Meta‐regression analysis did not reveal any sources of study heterogeneity, but a funnel plot suggested possible publication bias. A subset of studies also examined the association between moderate‐to‐severe psoriasis and smoking, with a pooled OR of 1·72 (95% CI 1·33–2·22) for prevalent smoking. The three incidence studies found an association between smoking and incidence of psoriasis, with a possible dose‐effect of smoking intensity and duration on psoriasis incidence. These findings suggest that smoking is an independent risk factor for the development of psoriasis, and that patients with established psoriasis continue to smoke more than patients without psoriasis.

The association between psoriasis and dyslipidaemia: a systematic review

Psoriasis may be associated with dyslipidaemia, a known risk factor for cardiovascular disease. This systematic review aims to synthesize evidence for the association between psoriasis and dyslipidaemia. Through a systematic search using MEDLINE, Embase and the Cochrane Central Register, from 1 January 1980 to 1 January 2012, we identified 25 observational studies that met the inclusion criteria. These 25 studies included over 2·4 million participants, among whom 265 512 were patients with psoriasis. Twenty studies (80%) reported that psoriasis was significantly associated with dyslipidaemia, with odds ratios (ORs) for dyslipidaemia ranging from 1·04 to 5·55 in 238 385 patients with psoriasis, from a population of 2 340 605 participants. Specifically, four studies defining dyslipidaemia as triglyceride levels ≥ 150 mg dL−1 reported significantly increased ORs of 1·20–4·98 for hypertriglyceridaemia in psoriasis. Three studies found that patients with psoriasis presented with significantly increased ORs (1·36–1·77) for high‐density lipoprotein cholesterol levels < 40 mg dL−1, and two studies found hyperlipoproteinaemia to be significantly elevated in patients with psoriasis (ORs 1·55 and 2·09). One cohort study found a significantly higher incidence of hyperlipidaemia among patients with psoriasis (hazard ratio 1·17; 95% confidence interval 1·11–1·23). Among studies that assessed the severity of psoriasis, in 2662 patients with mild psoriasis and 810 patients with severe psoriasis, higher odds of dyslipidaemia were seen in patients with severe psoriasis. Five of the 25 studies (20%) in our review did not show any significant relationship between psoriasis and dyslipidaemia. This systematic review found that psoriasis was significantly associated with greater odds and incidence of dyslipidaemia. Greater psoriasis severity appeared to be associated with higher prevalence of dyslipidaemia.

Coronary Artery Disease in Patients With Psoriasis Referred for Coronary Angiography

Patients with psoriasis may have an increased risk of cardiovascular disease and myocardial infarction. The aim of this study was to investigate whether psoriasis is associated with an increased prevalence of coronary artery disease (CAD) independent of established cardiovascular risk factors in patients undergoing coronary angiography. A retrospective cohort analysis was performed by linking records of all patients undergoing coronary angiography from 2004 through 2009 with dermatology medical records. From an overall cohort of 9,473 patients, we identified 204 patients (2.2%) with psoriasis before coronary angiography. Patients with psoriasis had higher body mass index (31.3 ± 8.1 vs 29.3 ± 7.1 kg/m(2), p <0.001) but the prevalence of other risk factors was similar. Median duration of psoriasis before cardiac catheterization was 8 years (interquartile range 2 to 24). Patients with psoriasis were more likely to have CAD (84.3% vs 75.7%, p = 0.005) at coronary angiography. After adjusting for established cardiovascular risk factors, psoriasis was independently associated with presence of angiographically confirmed CAD (adjusted odds ratio 1.8, 95% confidence interval 1.2 to 2.8, p = 0.006). In patients with psoriasis, duration of psoriasis >8 years was also independently associated with angiographically confirmed CAD after adjusting for established cardiovascular risk factors (adjusted odds ratio 3.5, 95% confidence interval 1.3 to 9.6, p = 0.02). In conclusion, patients with psoriasis and especially those with psoriasis for >8 years have a higher prevalence of CAD than patients without psoriasis undergoing coronary angiography.

Harnessing the power of crowds: crowdsourcing as a novel research method for evaluation of acne treatments.

AbstractBackground: Crowdsourcing is a novel process of data collection that can provide insight into the effectiveness of acne treatments in real-world settings. Little is known regarding the feasibility of crowdsourcing as a means of collecting dermatology research data, the quality of collected data, and how the data compare to the published literature. Objective: The objective of this analysis is to compare acne data collected from a medical crowdsourcing site with high-quality controlled studies from peer-reviewed medical literature. Methods: Crowdsourced data was collected from 662 online acne patients. Online patients reported data in a Likert-type format to characterize their symptom severity (740 total responses) and their treatment outcomes (958 total responses). The crowdsourced data were compared with meta-analyses and reviews on acne treatment from August 20, 2010 to August 20, 2011. Results: We compared topical, oral systemic, alternative, phototherapy, and physical acne treatments of crowdsourced data to published literature. We focused on topical tretinoin due to the large number of online patient responses. While approximately 80% of tretinoin users observed clinical improvement after a 12-week treatment period in clinical trials, 46% of online users reported improvement in an unspecified time period. For most topical treatments, medication with high efficacy in clinical trials did not produce high effectiveness ratings based on the crowdsourced online data. Conclusion: While limitations exist with the current methods of crowdsourced data collection, with standardization of data collection and use of validated instruments, crowdsourcing will provide an important and valuable platform for collecting high-volume patient data in real-world settings.

Crowdsourcing for data collection: a pilot study comparing patient-reported experiences and clinical trial data for the treatment of seborrheic dermatitis.

CROWDSOURCING is a novel method of research data collection. One type of crowdsourcing in healthcare research invites patients to report their symptoms and responses to treatments online (1, 2). These websites have the potential to generate large volumes of real-world patient data on treatment outcomes. However, few studies exist that compare crowdsourced data to peer-reviewed literature. In this pilot study, we examined how data from patients with seborrheic dermatitis from a crowdsourcing site compared with results from randomized controlled studies. We obtained anonymized data from a popular crowdsourcing site, CureTogether (curetogether.com), on patients with seborrheic dermatitis from 2008 to 2011. To compare the crowdsourced data to published literature, we searched Medline for systematic reviews and meta-analyses examining treatments for seborrheic dermatitis from 5 August 2008 to 5 August 2011. A total of 65 online patients with seborrheic dermatitis provided 167 symptom responses and 120 treatment responses (Tables 1 and 2). Thirty-five percent (7/20) of online patients reported improvement using an unspecified shampoo. Seventeen percent (1/6) of online patients reported improvement with selenium sulfide shampoo, and 25% (1/4) reported improvement with ketoconazole shampoo. Although the majority of online patients were not able to achieve adequate control with topical antifungal preparations, the literature suggests otherwise. In a randomized controlled trial by Danby et al., patients with moderateto-severe seborrheic dermatitis were treated with selenium sulfide 2.5% shampoo, ketoconazole 2% shampoo, or placebo shampoo twice weekly. Both ketoconazole and selenium sulfide shampoo were effective treatments for seborrheic dermatitis (3). In addition to topical antifungal treatments, topical corticosteroids are used to manage seborrheic dermatitis-associated erythema and pruritus on the facial and ear regions (4). From the crowdsourcing site, 27% (7/26) of online patients reported improvement with topical corticosteroid preparations. Of these patients, 33% (5/15) reported improvement with hydrocortisone and 18.2% (2/11) reported improvement with an unspecified topical steroid. Although most patients were not able to achieve adequate control with topical corticosteroid preparations, controlled studies have shown that low-potency corticosteroids are highly effective. For example, 94.4% of patients achieved adequate responses after 4-week treatment with 1% hydrocortisone cream (5). Alternative treatments, such as tea tree oil, were found to be ineffective among online patients. On the crowdsourcing site, 0% (0/6) of online patients reported improvement with tea tree oil. The antifungal property of tea tree oil