Epidemiology of Psoriasis in Portugal: A Population-Based Study

Authors

  • Tiago Torres Department of Dermatology. Centro Hospitalar Universitário do Porto. Porto; Instituto de Ciências Biomédicas Abel Salazar. University of Porto. Porto. https://orcid.org/0000-0003-0404-0870
  • Paulo Filipe Department of Dermatology. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon; Faculty of Medicine. University of Lisbon. Lisbon; Dermatology Research Unit. iMM João Lobo Antunes. University of Lisbon. Lisbon.
  • Francisco Menezes Brandão Private practice. Lisbon.
  • Américo Figueiredo Faculty of Medicine. University of Coimbra. Coimbra.
  • António Pinto Soares Faculty of Medicine. University of Coimbra. Coimbra.
  • Artur Sousa Basto Private practice. Braga.
  • Clarisse Rebelo Department of Dermatology. Centro Hospitalar Universitário do Algarve. Faro.
  • Osvaldo Correia Centro de Dermatologia Epidermis. Instituto CUF. Porto; Centre for Health Technology and Services Research. University of Porto; Basic and Clinical Immunology Unit. Department of Pathology. Faculty of Medicine. University of Porto.
  • Paulo Ferreira Dermatology Center. Hospital CUF Descobertas. Lisbon.
  • Ana Brasileiro Department of Dermatology. Centro Hospitalar Universitário de Lisboa Central. Lisbon; NOVA Medical School. Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisbon.
  • Pedro Mendes-Bastos Dermatology Center. Hospital CUF Descobertas. Lisbon.
  • Maria João Paiva-Lopes Department of Dermatology. Centro Hospitalar Universitário de Lisboa Central. Lisbon; Chronic Diseases Research Center. NOVA Medical School. Faculdade de Ciências. Médicas. Universidade NOVA de Lisboa. Lisbon.
  • Gabriela Marques Pinto Department of Dermatology. Centro Hospitalar Universitário de Lisboa Central. Lisbon.
  • Milton Severo Departamento de Ensino Pré-Graduado. Instituto de Ciências Biomédicas Abel Salazar. Universidade do Porto. Porto; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional. Porto; Unidade de Investigação em Epidemiologia. Instituto de Saúde Pública. Universidade do Porto. Porto.
  • Denisa Mendonça Departamento de Ensino Pré-Graduado. Instituto de Ciências Biomédicas Abel Salazar. Universidade do Porto. Porto; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional. Porto; Unidade de Investigação em Epidemiologia. Instituto de Saúde Pública. Universidade do Porto. Porto.
  • Pedro Oliveira Departamento de Ensino Pré-Graduado. Instituto de Ciências Biomédicas Abel Salazar. Universidade do Porto. Porto; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional. Porto; Unidade de Investigação em Epidemiologia. Instituto de Saúde Pública. Universidade do Porto. Porto.
  • Manuela Selores Department of Dermatology. Centro Hospitalar Universitário do Porto. Porto.
  • António Massa Private practice. Porto.
  • Marta Pereira Private practice. Porto.
  • Rui Tavares Bello Department of Dermatology. Hospital Lusíadas. Lisbon.
  • on behalf of the Portuguese Psoriasis Group of the Portuguese Society of Dermatology and Venereology

DOI:

https://doi.org/10.20344/amp.19048

Keywords:

Arthritis, Psoriatic/epidemiology, Portugal, Psoriasis/epidemiology, Surveys and Questionnaires

Abstract

Introduction: Psoriasis is a common, chronic, and inflammatory skin disorder with a high personal, social and economic burden and important implications for healthcare systems. The aim of this study was to provide an epidemiological characterization of individuals with psoriasis in Portugal.
Material and Methods: A large observational, cross-sectional, nationwide, population-based survey study developed by the Portuguese Psoriasis Group of the Portuguese Society of Dermatology and Venereology (GPP-SPDV). A structured questionnaire was designed and applied by experienced interviewers to a random, representative sample of Portuguese individuals with psoriasis and/or psoriatic arthritis. Patients were considered to have psoriasis if they replied positively to one of the following questions: “Does any physician have ever diagnosed you with psoriasis?” or “Do you have a skin disorder characterized by scaling, reddish skin lesions located in the elbows/knees/scalp?”.
Results: A total of 6381 individuals were interviewed, of which 283 met the criteria for psoriasis, corresponding to a prevalence rate of 4.4% (95% CI 3.95 – 4.98). Out of the participants that met psoriasis criteria, 24% had suggestive signs/symptoms but did not have a clinical diagnosis established and were not being monitored by a physician. Although more than 70% of participants had active disease (scaling, erythema, or pruritus) and one third had joint symptoms, only 12% were on systemic treatment. Fifty percent of participants with psoriasis (n = 139) had relevant comorbidities (most frequently depression/anxiety and cardiometabolic diseases). Sixteen percent of participants with psoriasis (n = 46) reported that psoriasis interfered with their daily activities (median impact of 5 in a 0 – 10 scale) and 12% mentioned the disease had an impact in their sexual life (median impact of 5 in a 0 – 10 scale).
Conclusion: The results of this study suggest that the prevalence rate of psoriasis is likely to be high in Portugal, and several gaps exist at different levels of healthcare delivery to these patients, from diagnosis to treatment. This study provides important data for the future planning of interventions targeting the improvement of psoriasis care in Portugal.

Downloads

Download data is not yet available.

References

Michalek IM, Loring B, John SM. A systematic review of worldwide epidemiology of psoriasis. J Eur Acad Dermatology Venereol 2017;31:205–12. DOI: https://doi.org/10.1111/jdv.13854

Rapp SR, Feldman SR, Exum ML, Fleischer AB, Reboussin DM. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol 1999;41:401–7. DOI: https://doi.org/10.1016/S0190-9622(99)70112-X

World Health Organization. Global report on psoriasis. Geneva: WHO; 2016.

Boehncke WH, Schön MP. Psoriasis. Lancet 2015;386:983–94. DOI: https://doi.org/10.1016/S0140-6736(14)61909-7

Griffiths CE, Armstrong AW, Gudjonsson JE, Barker JN. Psoriasis. Lancet 2021;397:1301–15. DOI: https://doi.org/10.1016/S0140-6736(20)32549-6

Massa A, Alves R, Amado J, Matos E, Sanches M, Selores M, et al. Prevalence of cutaneous lesions in Freixo de Espada à Cinta. Acta Med Port. 2000;13:247–54.

Torres T, Puig L, Vender R, Lynde C, Piaserico S, Carrascosa JM, et al. Drug survival of IL-12/23, IL-17 and IL-23 inhibitors for psoriasis treatment: a retrospective multi-country, multicentric cohort study. Am J Clin Dermatol. 2021;22:567–79. DOI: https://doi.org/10.1007/s40257-021-00598-4

Lebwohl MG, Kavanaugh A, Armstrong AW, Van Voorhees AS. US perspectives in the management of psoriasis and psoriatic arthritis: patient and physician pesults from the population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) Survey. Am J Clin Dermatol. 2016;17:87–97. DOI: https://doi.org/10.1007/s40257-015-0169-x

Enamandram M, Kimball AB. Psoriasis epidemiology: the interplay of genes and the environment. J Invest Dermatol. 2013;133:287–9. DOI: https://doi.org/10.1038/jid.2012.434

Zozaya N, Villoro R, Abdalla F, Alfonso Zamora S, Balea Filgueiras J, Carrascosa Carrillo JM, et al. Unmet needs in the management of moderate-tosevere psoriasis in Spain: a multidimensional evaluation. Acta Derm Venereol. 2022;102:adv00678. DOI: https://doi.org/10.2340/actadv.v102.583

Hoffman MB, Hill D, Feldman SR. Current challenges and emerging drug delivery strategies for the treatment of psoriasis. Expert Opin Drug Deliv. 2016;13:1461–73. DOI: https://doi.org/10.1080/17425247.2016.1188801

Saraceno R, Griffiths CE. A European perspective on the challenges of managing psoriasis. J Am Acad Dermatol. 2006;54:81–4. DOI: https://doi.org/10.1016/j.jaad.2005.10.051

Lebwohl M, Thaçi D, Warren RB. Addressing challenges associated with long-term topical treatment and benefits of proactive management in patients with psoriasis. J Eur Acad Dermatol Venereol. 2021;35:35–41. DOI: https://doi.org/10.1111/jdv.17053

Armstrong AW, Koning JW, Rowse S, Tan H, Mamolo C, Kaur M. Under-treatment of patients with moderate to severe psoriasis in the United States: analysis of medication usage with health plan data. Dermatol Ther. 2017;7:97–109. DOI: https://doi.org/10.1007/s13555-016-0153-2

Yang E, Beck K, Sanchez I, Koo J, Liao W. The impact of genital psoriasis on quality of life: a systematic review. Psoriasis Targets Ther. 2018;8:41–7. DOI: https://doi.org/10.2147/PTT.S169389

Paul C, Guenther L, Torii H, Sofen H, Burge R, Lin CY, et al. Impact of ixekizumab on facial psoriasis and related quality of life measures in moderate-tosevere psoriasis patients: 12-week results from two phase III trials. J Eur Acad Dermatol Venereol. 2018;32:68–72. DOI: https://doi.org/10.1111/jdv.14581

Torres T, Tavares Bello R, Paiva Lopes MJ, Menezes Brandão F, Ferreira A, Ferreira P, et al. Portuguese recommendations for the treatment of psoriasis with biologic therapy. Eur J Dermatol. 2020;30:645–54. DOI: https://doi.org/10.1684/ejd.2020.3945

Patel N, Nadkarni A, Cardwell LA, Vera N, Frey C, Patel N, et al. Psoriasis, depression, and inflammatory overlap: a review. Am J Clin Dermatol. 2017;18:613–20. DOI: https://doi.org/10.1007/s40257-017-0279-8

Korman AM, Hill D, Alikhan A, Feldman SR. Impact and management of depression in psoriasis patients. Expert Opin Pharmacother. 2016;17:147–52. DOI: https://doi.org/10.1517/14656566.2016.1128894

Hölsken S, Krefting F, Schedlowski M, Sondermann W. Common fundamentals of psoriasis and depression. Acta Derm Venereol. 2021;101:1–9. DOI: https://doi.org/10.2340/actadv.v101.565

Puig L, Kirby B, Mallbris L, Strohal R. Psoriasis beyond the skin: a review of the literature on cardiometabolic and psychological co-morbidities of psoriasis. Eur J Dermatol. 2014;24:305–11. DOI: https://doi.org/10.1684/ejd.2014.2299

Bulat V, Šitum M, Aždajiü MD, Lovriü I, Dediol I. Study on the impact of psoriasis on quality of life: psychological, social and financial implications. Psychiatr Danub. 2021;32:155–63.

Yamazaki F. Psoriasis: comorbidities. J Dermatol. 2021;48:732–40. DOI: https://doi.org/10.1111/1346-8138.15840

Szentkereszty-Kovács Z, Gáspár K, Szegedi A, Kemény L, Kovács D, Törőcsik D. Alcohol in Psoriasis — from bench to bedside. Int J Mol Sci. 2021;22:4987. DOI: https://doi.org/10.3390/ijms22094987

Armstrong AW, Harskamp CT, Dhillon JS, Armstrong EJ. Psoriasis and smoking: a systematic review and meta-analysis. Br J Dermatol. 2014;170:304–14. DOI: https://doi.org/10.1111/bjd.12670

Gisondi P, Fostini AC, Fossà I, Girolomoni G, Targher G. Psoriasis and the metabolic syndrome. Clin Dermatol. 2018;36:21–8. DOI: https://doi.org/10.1016/j.clindermatol.2017.09.005

Auker L, Cordingley L, Pye SR, Griffiths CE, Young HS. What are the barriers to physical activity in patients with chronic plaque psoriasis? Br J Dermatol. 2020;183:1094–102. DOI: https://doi.org/10.1111/bjd.18979

Correia B, Torres T. Obesity: A key component of psoriasis. Acta Biomed. 2015;86:121–9.

Chiricozzi A, Gisondi P, Girolomoni G. The pharmacological management of patients with comorbid psoriasis and obesity. Expert Opin Pharmacother. 2019;20:863–72. DOI: https://doi.org/10.1080/14656566.2019.1583207

Jensen P, Skov L. Psoriasis and Obesity. Dermatology. 2017;232:633–9. DOI: https://doi.org/10.1159/000455840

Fleming P, Kraft J, Gulliver WP, Lynde C. The relationship of obesity with the severity of psoriasis: A systematic review. J Cutan Med Surg. 2015;19:450–6. DOI: https://doi.org/10.1177/1203475415586332

Abuabara K, Azfar RS, Shin DB, Neimann AL, Troxel AB, Gelfand JM. Cause-specific mortality in patients with severe psoriasis: a population-based cohort study in the U.K. Br J Dermatol. 2010;163:586–92. DOI: https://doi.org/10.1111/j.1365-2133.2010.09941.x

Torres T, Alexandre JM, Mendonça D, Vasconcelos C, Silva BM, Selores M. Levels of physical activity in patients with severe psoriasis: a cross-sectional questionnaire study. Am J Clin Dermatol. 2014;15:129–35. DOI: https://doi.org/10.1007/s40257-014-0061-0

Scotti L, Franchi M, Marchesoni A, Corrao G. Prevalence and incidence of psoriatic arthritis: a systematic review and meta-analysis. Semin Arthritis Rheum. 2018;48:28–34. DOI: https://doi.org/10.1016/j.semarthrit.2018.01.003

Villani AP, Rouzaud M, Sevrain M, Barnetche T, Paul C, Richard MA, et al. Prevalence of undiagnosed psoriatic arthritis among psoriasis patients: systematic review and meta-analysis. J Am Acad Dermatol. 2015;73:242–8. DOI: https://doi.org/10.1016/j.jaad.2015.05.001

Puig L, van de Kerkhof PC, Reich K, Bachelez H, Barker J, Girolomoni G, et al. A European subset analysis from the population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis shows country-specific features: results from psoriasis patients in Spain. J Eur Acad Dermatol Venereol. 2017;31:1176–82. DOI: https://doi.org/10.1111/jdv.14195

Published

2023-01-06

How to Cite

1.
Torres T, Filipe P, Menezes Brandão F, Figueiredo A, Pinto Soares A, Sousa Basto A, Rebelo C, Correia O, Ferreira P, Brasileiro A, Mendes-Bastos P, Paiva-Lopes MJ, Marques Pinto G, Severo M, Mendonça D, Oliveira P, Selores M, Massa A, Pereira M, Tavares Bello R, Portuguese Society of Dermatology and Venereology on behalf of the PPG of the. Epidemiology of Psoriasis in Portugal: A Population-Based Study. Acta Med Port [Internet]. 2023 Jan. 6 [cited 2024 Apr. 13];36(9):541-9. Available from: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/19048

Issue

Section

Original