THE FIRST-EVER GLOBAL DATABASE ON PSORIASIS
The Global Psoriasis Atlas (GPA) is a joint project of the ILDS (International League of Dermatological Societies), IFPA (International Federation of Psoriasis Associations ), and IPC (International Psoriasis Council).
The mission of the GPA is to provide the common benchmark on the complete burden of psoriasis in all countries and regions throughout the world. The GPA will leverage existing data from publications and registries; where gaps are identified, additional studies will be commissioned.
The GPA is a long-term project that seeks to drive continuous improvement in the understanding of psoriasis and to uncover how it affects both the individual and society at large. While the first edition of the GPA focuses on the incidence and prevalence of psoriasis, future editions will be expanded to include access to treatment, comorbidities, and cost to society. For more information, visit the GPA website.
DEVELOPMENT OF CLINICAL DIAGNOSTIC CRITERIA FOR CHRONIC PLAQUE PSORIASIS: AN INTERNATIONAL E-DELPHI STUDY
Abo-Tabik M, Parisi R, Willis SC, Griffiths CEM, Ashcroft DM; Global Psoriasis Atlas (GPA). Br J Dermatol. 2021 Apr 2. doi: 10.1111/bjd.20096. Epub ahead of print. PMID: 33811321.
Despite psoriasis being a common disease, surprisingly little guidance exists on clinical diagnostic criteria 1 . The variable presentation of psoriasis and its differential diagnoses 2 make the diagnosis a challenging task, particularly for non-dermatologists.
NATIONAL, REGIONAL, AND WORLDWIDE EPIDEMIOLOGY OF PSORIASIS: SYSTEMATIC ANALYSIS AND MODELLING STUDY
Parisi R, Iskandar IYK, Kontopantelis E, Augustin M, Griffiths CEM, Ashcroft DM. BMJ. 2020 May 28;369:m1590. doi: 10.1136/bmj.m1590.
To systematically review and provide information on the incidence of psoriasis and quantify global, regional, and country specific estimates of its prevalence.
Systematic review and meta-analysis.
Medline, Embase, Web of Science, SciELO, Korean Journal Databases, Russian Science Citation Index, WPRIM, SaudiMedLit, Informit, IndMed, and HERDIN were searched systematically from their inception dates to October 2019.
Studies were included if they reported on the incidence or prevalence of psoriasis in the general population. Incidence data were summarised descriptively, whereas bayesian hierarchical models were fitted to estimate the global, regional, and country specific prevalence of psoriasis.
41 164 records were identified and 168 studies met the inclusion criteria. In adults, the incidence of psoriasis varied from 30.3 per 100 000 person years (95% confidence interval 26.6 to 34.1) in Taiwan to 321.0 per 100 000 person years in Italy. The prevalence of psoriasis varied from 0.14% (95% uncertainty interval 0.05% to 0.40%) in east Asia to 1.99% (0.64% to 6.60%) in Australasia. The prevalence of psoriasis was also high in western Europe (1.92%, 1.07% to 3.46%), central Europe (1.83%, 0.62% to 5.32%), North America (1.50%, 0.63% to 3.60%), and high income southern Latin America (1.10%, 0.36% to 2.96%).
Eighty one per cent of the countries of the world lack information on the epidemiology of psoriasis. The disease occurs more frequently in adults than in children. Psoriasis is unequally distributed across geographical regions; it is more frequent in high income countries and in regions with older populations. The estimates provided can help guide countries and the international community when making public health decisions on the appropriate management of psoriasis and assessing its natural history over time.
Systematic Review Registration
SYSTEMATIC REVIEW EXAMINING CHANGES OVER TIME AND VARIATION IN THE INCIDENCE AND PREVALENCE OF PSORIASIS BY AGE AND GENDER
Iskandar IYK, Parisi R, Griffiths CEM, Ashcroft DM; Global Psoriasis Atlas. Br J Dermatol. 2020 May 1. doi: 10.1111/bjd.19169. [Epub ahead of print]
Background: There is a lack of any overview of changes over time and variation in the epidemiology of psoriasis with age and between genders.
Objectives: To perform a systematic review of published population-based studies on variations in psoriasis incidence and prevalence with age and between genders, and to explore trends in psoriasis epidemiology over time.
Methods: Eleven electronic and regional databases were searched from their inception dates to October 2019. No language restrictions were applied. Studies were eligible if they reported on changes in psoriasis incidence and/or prevalence over time and/or by age group and gender.
Results: In total 308 papers were critically appraised, from which 90 studies from 22 countries were included. Incidence data confirmed a clear bimodal age pattern in psoriasis onset, with the first and second peaks at around 30-39 and 60-69 years of age, respectively, and evidence suggesting that it presents slightly earlier in women than in men. Prevalence data showed an increasing trend with age until around 60 or 70 years, after which it decreases. Although there was lack of agreement on specific gender differences in psoriasis incidence and prevalence, a slight male predominance was reported in several studies. Studies worldwide suggested a stable or slightly decreasing trend in psoriasis incidence, while an increasing trend in psoriasis prevalence has been consistently reported. One particular challenge faced was the vastly different methodologies used in the included studies, which contributed to some of the heterogeneity of the results.
Conclusions: Studies on changes over time in the occurrence of psoriasis have contributed to a greater appreciation of the increasing burden of the disease. However, further research is required to determine the reasons driving the increase in psoriasis prevalence over time.
INCIDENCE AND PREVALENCE OF PSORIASIS IN ISRAEL BETWEEN 2011 AND 2017
Schonmann Y, Ashcroft DM, Iskandar IYK, Parisi R, Sde-Or S, Comaneshter D, Batat E, Shani M, Vinker S, Griffiths CEM, Cohen AD. J Eur Acad Dermatol Venereol. 2019 Nov;33(11):2075-2081. doi: 10.1111/jdv.15762.
Psoriasis is a common chronic inflammatory skin disease associated with a heavy burden of morbidity, disability and cost. The occurrence of the disease in Israel has not been previously investigated.
To provide standardized estimates of trends in psoriasis incidence, prevalence and mortality among patients in Israel between 2011 and 2017.
Using electronic health records from Clalit Health Services, the largest nationwide public health provider in Israel, we conducted a population-based study investigating trends in the annual incidence and prevalence of psoriasis between the years 2011 and 2017. We report age- and sex-adjusted rates, using the standard European population as a reference.
We identified 71 094 incident psoriasis cases. The mean (SD) age of onset was 42.4 (21.0) years with a bimodal distribution, peaking in the early ’30s and early ’60s. Late-onset psoriasis, occurring after 40 years of age, accounted for 51.1% of incident cases. The annual psoriasis incidence rate was constant throughout the study period (280/100 000 person-years). Psoriasis prevalence rose from 2.5% in 2011 to 3.8% in 2017.
Psoriasis prevalence is increasing in Israel, although its incidence is stable. Clinicians and policymakers should plan to address the growing demands in the clinical, economic and societal burden of psoriasis.
ASSOCIATION OF PSORIASIS WITH THE RISK OF DEVELOPING OR DYING OF CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS
Trafford AM, Parisi R, Kontopantelis E, Griffiths CEM, Ashcroft DM. JAMA Dermatol. 2019 Oct 16;155(12):1390–403. doi: 10.1001/jamadermatol.2019.3056. [Epub ahead of print]
The risk of cancer developing in people with psoriasis has raised some concern, with little clarity regarding differentiation in risk according to psoriasis severity.
To conduct a systematic review and meta-analysis of observational studies on the risk of cancer incidence and mortality in people with psoriasis.
Six electronic databases (MEDLINE, Embase, MEDLINE in Process, Cochrane Central Register, Web of Science, and LILACS [Literatura Latino-Americana e do Caribe em Ciências da Saúde]) were searched from inception to November 15, 2017, for eligible studies.
Cohort and case-control studies that provided estimates of the risk of cancer incidence or cancer mortality associated with psoriasis were included.
Data extraction and synthesis
Data were extracted relating to study design, study population, and risk estimates. Study-specific estimates of the relative risk (RR) were combined using a random-effects model. Heterogeneity was quantified using the I2 statistic. Data were analyzed from April 9, 2018, through February 22, 2019.
Main outcomes and measures
Pooled RR estimates for cancer incidence and cancer mortality for psoriasis cohorts compared with people without psoriasis.
A total of 58 unique studies were included, with quality varying for the incidence and the mortality studies. Severe psoriasis (RR, 1.22; 95% CI, 1.08-1.39 [9 studies]) and all severities of psoriasis (RR, 1.18; 95% CI, 1.06-1.31 [7 studies]) were associated with an increased risk of cancer (overall), and associations were found for a range of site-specific cancers, including colon (RR, 1.18 [95% CI, 1.03-1.35]), colorectal (RR, 1.34 [95% CI, 1.06-1.70]), kidney (RR, 1.58 [95% CI, 1.11-2.24]), laryngeal (RR, 1.79 [95% CI, 1.06-3.01]), liver (RR, 1.83 [95% CI, 1.28-2.61]), lymphoma (RR, 1.40 [95% CI, 1.24-1.57]), non-Hodgkin lymphoma (RR, 1.28 [95% CI, 1.15-1.43]), keratinocyte cancers (RR, 1.71 [95% CI, 1.08-2.71]), esophageal (RR, 2.05 [95% CI, 1.04-4.07]), oral cavity (RR, 2.80 [95% CI, 1.99-3.93]), and pancreatic (RR, 1.41 [95% CI, 1.16-1.73]). Overall cancer mortality risk was higher in patients with severe psoriasis (RR, 1.22; 95% CI, 1.08-1.38 [4 studies]). Specifically, liver (RR, 1.43 [95% CI, 1.09-1.88]), esophageal (RR, 2.53 [95% CI, 1.87-3.41]), and pancreatic (RR, 1.31 [95% CI, 1.02-1.69]) cancer mortality were found to be elevated in those with severe psoriasis. The heterogeneity of estimates was often very high despite stratification. Marked attenuation of risk was found in those studies that adjusted estimates for smoking, alcohol consumption, and obesity.
Conclusions and relevance
In this study, people with psoriasis appeared to have an increased risk of cancer incidence and cancer-related mortality involving a range of site-specific cancers. Future research examining specific lifestyle factors, treatments, and the inflammatory processes that contribute to psoriasis may help provide additional information on the underlying mechanisms for the apparent increased cancer risk.
THE GLOBAL STATE OF PSORIASIS DISEASE EPIDEMIOLOGY: A WORKSHOP REPORT.
C.E.M. Griffiths, J.M. van der Walt, D.M. Ashcroft, C. Flohr, L. Naldi, T. Nijsten, M. Augustin, Br J Dermatol. 2017 Jul;177(1):e4-e7. doi: 10.1111/bjd.15610. 28555722
The International Psoriasis Council, a global nonprofit organization dedicated to innovation across the full spectrum of psoriasis, led a symposium to discuss the current state of psoriasis epidemiology and to introduce the vision and development of a Global Psoriasis Atlas. The symposium was held on 9 September 2015 at the 45th annual meeting of the European Society for Dermatological Research, Rotterdam, the Netherlands. Collectively, these presentations highlighted challenges associated with assessing psoriasis epidemiology and emphasized the urgent need for an authoritative resource to clarify psoriasis disease burden on a global scale.
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