Psoriasis incidence

Methotrexate is one of the few anticancer drugs that can be safely administered intrathecally for the treatment of meningeal metastases. Its routine use as prophylactic intrathecal chemotherapy in acute lymphoblastic leukemia has greatly reduced the incidence of recurrences in the CNS and has contributed to the cure rate in this disease. Daily oral doses of methotrexate are used for severe cases of the nonneoplastic skin disease psoriasis (see Chapter 41), and methotrexate has been used as an immunosuppressive agent in severe rheumatoid arthritis. 

Gasparro, F.R The role of PUVA in the treatment of psoriasis. Photobiology issues related to skin-cancer incidence. Am J Clin Dermatol. 1, 337, 2000. 

In the control and open-labeled portions of the clinical trials a threefold higher incidence of lymphomas was observed compared to the general population. While patients with RA or psoriasis, particularly those with active disease may be at high risk (up to sevenfold) for the development of lymphoma, the potential role of TNF-blocking therapy in the development of malignancies is not known... 

Flufenamic acid and meclofenamic acid are anthranilic acid derivatives similar to mefenamic acid. The withdrawal rate because of adverse effects is 7-31% and is higher in longterm studies. Flufenamic acid and meclofenamic acid are not widely prescribed and so there is little evidence to show whether they have any advantages over other NSAIDs. Both have a high incidence of gastrointestinal adverse effects (30-60% of patients at recommended doses). Diarrhea affects 11 6% of patients (SEDA-4, 68) (SEDA-6, 99) (SEDA-7, 116) (SEDA-14, 95). Thrombocytopenia with positive rechallenge has been described (1). Rashes occur in under 10% of patients. Meclofenamic acid exacerbates psoriasis in psoriatic arthropathy (2). 

Hannnksela A, Pnkkala E, Hannuksela M, Karvonen J. Cancer incidence among Finnish patients with psoriasis treated with trioxsalen bath PUVA. J Am Acad Dermatol 1996 35(5 Pt l) 685-9. 

Patients taking methotrexate, an antimetabolite used for controlling the symptoms of conditions such as rheumatoid arthritis and psoriasis, can cause suppression in bone marrow. To reduce the incidence of bone marrow suppression, this drug is only given once weekly ( 30mg a week) along with folic acid supplements. 

How common is psoriasis Estimates of the prevalence of psoriasis in the population at large vary from 0.2 to 4% (Table 1). Bereston and Cecclini (B9) and Sutton (S29) based their data on a study of Army personnel therefore, the mean age of the population studied was low and all were men. This no doubt explains the low frequencies since most studies indicate that the mean age of onset of psoriasis is in the twenties and about four years later in men than in women (Table 2). Lane and Crawford (Ll) actually reported an incidence rather than a prevalence figure for psoriasis since they were reporting the percentage of new cases of psoriasis admitted to the Massachusetts General Hospital per year per total hospital admissions. The prevalence of the disease would be expected to be much higher than the incidence, since once it appears it rarely goes away and it does not decrease the life expectancy of the... 

Gl. Gahan, E., Incidence of psoriasis among the population at large. Arch. Dermatol. Syphilol. 48, 305 (1943). 

Psoriasis is universal in occurrence and affects up to 3% of the American population. Approximately 25% of affected patients have severe conditions. The disorder occurs in all racial groups but is most prevalent in Caucasians. It is equally common in males and females. Two peaks of age of onset have been described the greatest incidence is between 20 and 30 years, and a smaller peak occurs between 50 and 60 years of age however, the age of onset is widely variable from infancy to old age. Although rarely Life-threatening, psoriasis has an adverse physical and emotional impact on quality of life." ... 

Other investigators who have examined the possibility of increased skin cancer incidence in psoriasis patients (Jones et al.1985 Menter and Cram 1983 Torinuki and Tagami 1988) have concluded that coal tar treatment did not produce an increase in cancer incidence, but all of these studies are limited in scope and it is not likely that they would be sufficiently sensitive to detect a small increase in risk. Jones et al. (1985) reported no increase in cancer incidence in 719 tar-treated psoriasis patients compared with the general population. Torinuki and Tagami (1988) reported no effect of tar on cancer rates in patients treated with coal tar and UV light, but only 5 of 43 patients had a follow-up duration of >6 years and this is likely to be insufficient to detect a possible cancer effect. Menter and Cram (1983) reported their opinion that there was no increase in incidence of skin cancer in patients treated with UV light and coal tar, but this was a study of the efficacy of the treatment regime and thus, no untreated controls were included for comparison and no statistical analysis was performed. 

Alderson MR, Clarke JA. 1983. Cancer incidence in patients with psoriasis. Br J Cancer 47 857-859. 

I m munosuppressive agents The incidence of cyclosporine-associated hypertension after renal, bone marrow, and cardiac transplantation varies between 30% and 100%. It is also common in patients with autoimmune disease and in patients with psoriasis treated with cyclosporine. Cyclosporine-induced hypertension is characterized by disturbance of the circadian rhythm, with the absence or reversal of the normal nocturnal fall in blood pressure. Hypertension usually decreases after the tvithdrawal or substitution of cyclosporine immunosuppression but may not remit completely... 

Systemic and cutaneous reactions have been reported following administration of infliximab. These include anaphylaxis, serum sickness, maculopapular rashes, urticaria, psoriasis, flare-up of atopic dermatitis, and leukocytoclastic vascuhtis. The overall incidence of infusion reactions in one study was 6.1 %. Mild, moderate, and severe reactions occurred in 3.1, 1.2, and 1 % of infliximab infusions, respectively. Patients with lymphocyte counts greater than 50 XIQP/L experienced a severe cytokine release syndrome shown by peaks in release of TNF and lL-6 90 min after infusion with rituximab. A number of post-infusion hypersensitivity or hypersensitivity-like reactions occur to rituximab. These reactions include serum sickness, vasculitis, various cutaneous manifestations, interstitial pneumonitis, and acute respiratory distress syndrome. 

The incidence is probably underestimated, because many cases are either unrecognized or confused with pustular psoriasis. 

In a comparative study, patients with rheumatoid arthritis treated with adalimumab had a significantly higher rate of incident psoriasis than patients who used etanercept and infiiximab... 

Calcipotriol foam was safe with an overall incidence of AEs similar to those experienced in the vehicle foam group. Application site reactions were noted in approximately 1-2% of subjects in each group. No AEs were reported in more than 25% of subjects in the calcipotriene foam group. Treatment was discontinued because of AEs in approximately 2% of subjects in both groups. In two identically designed, phase 111 clinical trials, calcipotriene 0.005% foam was safe and effective for the treatment of mild-to-moderate plaque-type psoriasis for up to 8weeks. 

Another study looked at the association between herpes zoster (HZ) vaccination and HZ incidence in adults aged 60 years and over with rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis or IBD (individuals who have an increased risk of HZ due to both the disease processes and the treatments used). They assessed whether exposure to biologies affects this association. This retrospective cohort study of over 400,000 adults (including 4% who received the zoster vaccine) found that receipt of the vaccine was not associated with an increased short-term (within 42 days of vaccination) risk of HZ, including in those individuals treated with biologies [80 ]. 

Skin - psoriasis in rheumatoid arthritis patients Psoriasis has been reported with rituximab therapy. A nationwide registry set up by the French Society of Rheumatology to collect data on patients was examined to assess the rates of new-onset and flare of pre-existing psoriasis in patients taking rituximab for rheumatoid arthritis. Incidence rates were 1.04/1000 person-years for new-onset psoriasis and 2.6/1000 person-years for flare. Rechallenges of two new-onset and two flare cases were not followed by recurrence or exacerbation of psoriasis. Although the number of cases observed were fairly small (1927), the findings do not support a causative role for rituximab in the promotion of psoriasis in rheumatoid arthritis patients [194 ]. 

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