psoriasis not just skin and bone n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Psoriasis Not Just Skin and Bone PowerPoint Presentation
Download Presentation
Psoriasis Not Just Skin and Bone

Loading in 2 Seconds...

play fullscreen
1 / 15

Psoriasis Not Just Skin and Bone - PowerPoint PPT Presentation


  • 57 Views
  • Uploaded on

Psoriasis Not Just Skin and Bone. Dr Verity Blackwell West Hertfordshire Dermatology Team. P soriasis. 2.3% of population 125 million people world wide Associated with Arthritis Depression Reduced quality of life Increased prevalence of cardiovascular and cerebrovascular disease.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Psoriasis Not Just Skin and Bone' - moya


Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
psoriasis not just skin and bone

PsoriasisNot Just Skin and Bone

Dr Verity Blackwell

West Hertfordshire Dermatology Team

p soriasis
Psoriasis
  • 2.3% of population
  • 125 million people world wide
  • Associated with
    • Arthritis
    • Depression
    • Reduced quality of life
    • Increased prevalence of cardiovascular and cerebrovascular disease
psoriasis
Psoriasis
  • Patients with severe psoriasis have increased mortality
    • 19.6% deaths versus 9% in controls
  • Increased risk of myocardial infarction independent of other risk factors
  • Increased risk of Stroke
slide4
Prevalence of cardiovascular risk factors in patients with psoriasis. [J Am AcadDermatol. 2006 Gelfand et al]
  • Prospective UK based study
  • 20-90 yr olds, mean 5.4 yr follow up
  • Controlled for age, sex, previous MI,diabetes,hypertension,smoking, hyperlipidaemia,BMI
  • Psoriasis absent(controls),mild or severe
  • Severe if ever received systemic therapy
slide5
Prevalence of cardiovascular risk factors in patients with psoriasis. [J Am AcadDermatol. 2006 Gelfand et al]
  • 555,995 controls
  • 127,139 mild psoriasis
  • 3837 severe psoriasis
  • MI controls=2%
    • mild psoriasis =1.8%
    • severe psoriasis= 2.9%
  • Relative risk of MI with severe psoriasis
    • Aged 30=3.1 aged 60 =1.36
    • Aged 40=2.69 aged 60= 1.92(Danish study 2009)
psorisiasis and risk of af and ischaemic stroke
Psorisiasis and risk of AF and Ischaemic Stroke
  • Danish study July 2011
  • >36,000 pts with mild psoriasis,2793 pts with severe psoriasis versus controls
  • Rate ratio for AF
    • Mild psoriasis <50yrs=1.5 >50yrs=1.16
    • Severe psoriasis <50yrs 2.98 >50yrs 1.29
  • Rate ratio for Ischaemic stroke
    • Mild psoriasis <50yrs =1.97 >50yrs =1.13
    • Severe psoriasis <50yrs=2.8 >50yrs =1.34
slide7
Why?
  • Genetics
  • Lifetime burden of inflammation
association of cardiovascular risk factors and psoriasis
Association of cardiovascular risk factors and psoriasis

Large UK study showed increased incidence of

  • Obesity
  • Hypertension
  • Dyslipidaemia
  • Diabetes
  • Hyperhomocysteinaemia
  • Smoking
atherosclerosis
Atherosclerosis
  • Chronic immuno-inflammatory disorder of arterial wall
  • Chronic inflammation implicated in formation of fatty streaks
  • Activation of TH1 mediated cytokine cascade also trigger for acute coronary event
psoriasis1
Psoriasis
  • Most common Th1 disorder
  • Chronic inappropriate activation of Th1 cytokines
    • TNF,IFN,IL2
  • Also new Th –IL-17 subset that has role in pathogenesis of psoriatic lesion and via IL12 also stimulates Th1 response in arteries
what can we do as dermatologists
What can we do as dermatologists
  • Obesity
    • Measure BMI; advice re diet and exercise
  • Hypertension
    • >140/90 advise repeat in primary care
  • Diabetes
    • ?check fasting blood sugar if obese

Refer to primary care

what can we do
What can we do?
  • Cholesterol
    • Refer pt to primary care
  • Aspirin therapy
    • Refer patient to primary care
what can we do1
What can we do?
  • Smoking
    • Advising pt to stop increases cessation rate by 30%
    • Give out NHS helpline cards
    • Single most important intervention in improving patient health
summary
Summary
  • Dermatologist and dermatology nurses may be seeing patient more frequently than primary care team
  • May be best placed to nudge patients to see GP about controlling risk factors
  • Severe psoriasis independently increases risk of cardiovascular disease
  • ?will treating severe psoriasis lower this risk?