Disease concomitance in psoriasis: A clinical study of 61 cases
Mavilethu House, Cherukole P.O, Mavelikara, Kerala-690104
|How to cite this article:
Alexander E, Pinto J, Pal GS, Kamath N, Kuruvilla M. Disease concomitance in psoriasis: A clinical study of 61 cases. Indian J Dermatol Venereol Leprol 2001;67:66-68
AbstractSixty-one patients with psoriasis were studied for concomitant diseases and compared with 61 age and sex-matched controls. Concomitant cutaneous diseases most often seen with psoriasis were lichen simplex chronicus (16.3%), verruca vulgaris (9.8%) and me Iasina (4.9%). Of the systemic disorders, diabetes showed the highest frequency (13.1%) followed by hypertension (8.1%). Two patients had HIV infection (3.2%). Both the patients had severe and atypical lesions.
The prevalence of other diseases associated with psoriasis has been investigated in recent years. These include cutaneous as well as systemic ones. The cutaneous diseases found to be associated include vitiligo, seborrhoeic dermatitis, bullous pemphigoid, photosensitive disorders, viral warts and others. The systemic diseases found to be associated with psoriasis include diabetes, gout, ulcerative colitis, Crohn′s disease, cardiac insufficiency and others. In view of the different cutaneous and systemic associations, a study was done on concomitant diseases which included 61 psoriatic and 61 age - and - sex - matched control patients from Dermatology department.
Materials and Methods
Sixty-one patients with psoriasis were stud-ied between January 96 and June 97, and were compared with sixty one age and sex-matched controls. History included details of psoriasis and concomitant cutaneous and systemic diseases. Detailed cutaneous and systemic examination were done. Relevant laboratory investigations were also done.
Among the sixty-one patients with psoria-sis, the male to female ratio was 7.7:1. The maxi-mum incidence of psoriasis was in the age group of 40-50 years.
Psoriasis vulgaris was the most common clinical type of psoriasis (91.8%). Clinical types of psoriasis are shown in [Table - 1].
Among 61 patients with psoriasis, 3 had psoriatic arthritis and these 3 patients had psoriasis vulgaris. Among the three patients of psoriatic arthritis, two had classical type (3.2%) and one had symmetric polyarticular type (1.6%). In all the 3 the skin lesions preceded arthritis.
Various changes observed in the nails in the order of frequency, were pitting (63.9%), ridging (56.3%), discolouration (47.5%), subungual hyperkeratosis (29.5%), onycholysis (16.3%), onychodystrophy (4.9%) and leukonychia (3.2%).
[Table - 2] shows concomitant cutaneous diseases in patients with psoriasis. They included leucoderma, acne vulgaris, seborrhoeic dermatitis, forefoot eczema, sebaceous cyst, freckles, folliculi-tis, alopecia areata, candidiasis and acrochordon.
Concomitant systemic diseases are shown in [Table - 3]. Of the systemic disorders noted with psoriasis, diabetes mellitus showed the highest frequency with an O/E ratio of 2.6 (O/E ratio - observed by expected ratio).
We have compared the simultaneous oc-currence of skin and systemic disorders in patients with psoriasis and in control patients without pso-riasis. As a result, a distinct group of cutaneous diseases were more frequently noted in patients with psoriasis than in age matched controls.
Lichen simplex chronicus (-LSC) showed an O/E ratio of 10, which indicates that it is 10 times more common in patients with psoriasis. The high incidence of LSC in our study may be because of a bidirectional relationship i.e., if a psoriatic lesion itches, the lesion may become complicated by a lichen simplex or a lichen simplex can itch per se and the resultant rubbing may worsen the psoriasis.
Several common disorders were less fre-quent in patients with psoriasis such as eczemas, allergic contact dermatitis, urticaria, atopic derma-titis, bacterial, viral and fungal infection. This is an agreement with the study done by Henseler and Christopher. According to Richard Weller, the decreased incidence of skin infections caused by dermatophytes and particularly by bacteria and viruses is due to enhanced production of nitric oxide in psoriatic skin, which has antimicrobial activity against a wide range of organisms including bacteria, fungi and viruses.
Of the systemic disorders, diabetes showed the highest frequency with an O/E ratio of 2.6. This is in agreement with the study done by Sundharam who showed a relationship between abnormal glucose tolerance and psoriasis.
In our study, 2 patients (3.25%) had HIV infection, and both the patients had severe and atypical lesions. This is in agreement with the find-ings of Obuch and Maurae that in HIV patients the different morphological types of psoriasis like papules, crusted and hyperkeratotic lesions co- exist. As the number of patients studied here is small, these findings have to be corroborated by studying a larger group.
Tilo Henseler, Enno Christopher. Disease concomitance in psoriasis. J Am Acad Dermatol 1995; 32:982-986.[Google Scholar]
Sharma T, Sepha GL. Psoriasis - Clinical study. Indian J Dermatol Venereol Leprol 1964;30 :191-197.[Google Scholar]
Verma KC, Bharagava NC, Chaudhary, et al. Psoriasis : a clinical and some biochemical investigative study. Indian J Dermatol Venereol Leprol 1979; 45: 32 - 36.[Google Scholar]
Mehta TK, Shah RN, Marquis L. A study of 300 cases of psoriasis. Indian J Dermatol Venereol Leprol 1976; 42: 67-74.[Google Scholar]
Henseler T, Christopher E. Psoriasis of early and late onset. Characterisation of 2 types of psoriasis vulgaris. J Am Acad Dermatol 1985; 13: 450-456.[Google Scholar]
Duncan C, Dougall H, Johnson P, et al. Chemical generation of nitric oxide in the mouth from the enterosalivary circulation of dietary nitrate. Nature Med 1995;1: 546-551.[Google Scholar]
Sudharam JA, Singh Ratan, Agarwal. Psoriasis and diabetes mellitus. Indian 3 Dermatol Venereol Leprol 1980; 46: 158-162.[Google Scholar]
Obuch ML, Maurer TA, Becker BG. Psoriasis and HIV infection. J Am Acad Dermatol S1992, 27: 667-673.[Google Scholar]