Dermatology - 香港醫學組織聯會
Dermatology - 香港醫學組織聯會
Dermatology - 香港醫學組織聯會
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VOL.15 NO.11 NOVEMBER 2010<br />
related quality of life (HRQOL) such as depression,<br />
anxiety and stress, which may result in an unhealthy<br />
life style leading to alcoholism and chronic smoking.<br />
The presence of arthropathy may lead to lack of<br />
exercise. The well known side-effects of some systemic<br />
antipsoriatic drugs may also count, such as acitretin<br />
may cause hyperlipidaemia and cyclosporine may<br />
cause hypertension. All these confounding factors<br />
may contribute to the cardiovascular diseases and<br />
metabolic syndrome. Conversely, obesity and smoking<br />
may increase the risk of developing psoriasis as<br />
reported, while drugs like lithium in treating manicdepressive<br />
illnesses and certain beta-blockers in treating<br />
cardiovascular diseases may also induce psoriasis.<br />
Despite many studies that had supported the association<br />
of these co-morbidities, there are also inconsistencies in<br />
the findings in other studies. 12<br />
Finally, although in the supporting papers, most of the<br />
reported associations had reached statistical significance<br />
after statistical analysis, as they had involved very<br />
large data base, it is essential to know that statistical<br />
associations do not equate to causal relationships, and<br />
do not always have clinical relevancy.<br />
Diagram 2. Schematic overview of possible confounding<br />
factors influencing the association between psoriasis and its<br />
co-morbidities (Modifeid from Nijsten T and Wakkee M) 11<br />
Conclusion<br />
Although there are increasing reports that psoriasis<br />
may have significant systemic co-morbidities, judging<br />
from the present evidences, causality has not yet been<br />
proven. Whether there is true causal relationship<br />
between psoriasis and these co-morbidities is still<br />
uncertain and open to debate. Upgrading psoriasis<br />
to an systemic disease obviously will have significant<br />
impacts on the management of this chronic disease,<br />
such as more aggressive treatments, routine screening<br />
of the co-morbidities, and possibly healthcare resources<br />
reallocation. Therefore, until more well proven<br />
evidences are available, it is still more appropriate to<br />
regard psoriasis as a cutaneous disease at the moment.<br />
Nonetheless, psoriasis is definitely more than skin depth<br />
in its impact on the affected patients, in view of its<br />
physical and psychosocial impairments. It also reminds<br />
Medical Bulletin<br />
dermatologists the need to manage patients holistically<br />
as a whole, rather than just focusing on their skin.<br />
References<br />
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Complexity of the Association Between Psoriasis and Comorbidities<br />
Nijsten T, Wakkee M. J Inves Dermatol. 2009;129:1601-3.<br />
Psoriasis may not be an independent risk factor for acute ischemic<br />
heart disease hospitalizations: Results of a large population-based<br />
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