Severe psoriasis associated with increased risk of death

December 17, 2007

Patients with severe psoriasis appear to have an increased risk of death compared with patients without the skin condition, according to a report in the December issue of Archives of Dermatology, one of the JAMA/Archives journals.

Psoriasis is a common inflammatory disorder that affects the skin and joints, according to background information in the article. The condition has been associated with various other factors, including smoking, alcohol use and diseases such as obesity, cardiovascular disease and some cancers. "In addition, certain systemic therapies for psoriasis may rarely be associated with mortality [death] due to chronic cumulative drug toxicity or idiosyncratic reactions, and the disease itself may lead to death in rare instances," the authors write.

Joel M. Gelfand, M.D., M.S.C.E., and colleagues at the University of Pennsylvania School of Medicine, Philadelphia, analyzed records from a database of patients who visited general practitioners in the United Kingdom between 1987 and 2002. They identified 133,568 patients with mild psoriasis, defined as having a diagnosis of psoriasis but no history of treatment for the condition, and 3,951 patients with severe psoriasis, who did receive medications or other therapies. These patients were matched with up to five control patients who visited the same practice at around the same time but did not have psoriasis, including 560,358 matched to those with mild psoriasis and 15,075 matched to those with severe psoriasis.

During the study period, patients with severe psoriasis had a 50 percent increased risk of death compared with patients who did not have psoriasis (21.3 deaths per 1,000 individuals per year vs. 12 deaths per 1,000 individuals per year, respectively). Mild psoriasis was not associated with increased risk of death. Men with severe psoriasis died an average of 3.5 years younger than men without the condition, while women with severe psoriasis died 4.4 years earlier than women without psoriasis.

"Further studies are necessary to determine the cause of excess morality in patients with severe psoriasis, how the extent of skin disease affects morality risk and whether the risk of mortality in patients with severe psoriasis is altered by various systemic therapies," the authors conclude. "Patients with severe psoriasis should receive comprehensive health assessments to enhance preventive health practices, improve overall health and decrease the risk of mortality."
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(Arch Dermatol. 2007;143(12):1493-1499. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This study was supported by an unrestricted grant to the Trustees of the University of Pennsylvania from Centocor and a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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