The Relation of Comorbidities with Psoriasis Patients Treated in

Ermatovenereology Outpatient Clinic of Dr. Moewardi General

Hospital Surakarta January 2013-December 2017

Tutik Rahayu, Eka Putra Wirawan, Marsita Endy Dhamayanti, Rina Diana, Danu Yuliarto, Arie

Kusumawardhani

Dermatovenerology Departement Dr.Moewardi General Hospital/Faculty of Medicine Sebelas Maret University,

Surakarta, Indonesia

Keywords: comorbidities, relation, psoriasis.

Abstract: Psoriasis is a chronic inflammatory disease with typically lesions and especially concerning on the body that

are often affected trauma. The onset of psoriasis is primarily 15-35 years of age, the prevalence various with

age, geography and environment. Immunopathogenic psoriasis involves Th1 and Th 17 cells that can cause

the formation of inflammatory mediators that can trigger other comorbidities physically, psychologically and

socially. This Cross sectional study assesed the relation of comorbidities with psoriasis in dermatovenerology

outpatient clinic of Dr. Moewardi Hospital Surakarta between January 2013-December 2017. Psoriasis

patients visited dermatovenereology outpatient clinic during January 2013-December 2017 were included in

our study. There were 97 psoriasis patients, of these 51 were males and 46 females. All study subjects were

under 80 years old. The data were analyzed statistically by using SPSS and Chi-Square test with P<0.05 was

considered significant. Various comorbidities were found including hypertension (28.6%), diabetic militus

(20.4%), hyperuricemia (4.1%), dyslipidemia (16.3%), nerve disease (6.1%), dermatophyte (12.2%), kidney

disease (14.3%), malignancy (6.1%), gastropathy (24.5%), obesity (4.1%), heart disease (26.5%), lung disease

(22.4%), arthritis psoriasis (10.2%), depression (12.2%), systemic lupus erytematosus/SLE (4.1%) and

vitiligo (2%). Chi-Square test showed that age and occupation are significantly relation with all

commorbidities with P=0.011 and P=0.000 respectively. Our study revealed that age and occupation are

related to comorbidities occured in psoriasis patients. The older the age and the lower the income the greater

the momorbidity affect psoriasis patients

1 INTRODUCTION

Psoriasis is a chronic inflammatory skin disease

associated with genetic. It is characterized by

complex changes in the epidermal growth,

differentiation, multiple biochemistry, immunology

and vascular abnormalities with an unknown

association of nervous system function. This chronic

disease is triggered by environment, trauma, infection

and medication, typical clinical features of psoriasis

is well defined erythematous plaque with thick

squama coated in white silvery layer, occuring on

elbow, knees, scalps, trunk and umbilicus which often

get trauma injury (Johan, 2012). Psoriasis has various

forms of clinical manifestations and the most

common variant is psoriasis vulgaris (Johan, 2012;

Factor, 2017).

The prevalence of psoriasis affected by several

factors such as age, geography and environment,

affecting for about 2%-3% of the overall population

with onset of patients ranging between the ages of 15-

35 years (Johan, 2012), (WHO, 2016). The incidence

of psoriasis in Asia is 0.4% and more common in

male patients and study by Eka et all in

RSUD.Dr.Moewardi Solo reported that the

prevalence rate is about 4.5% with male patients were

more dominant than females and age dominant in the

second and third decades (Johan, 2012; Putra, 2016).

The severity of this disease is assessed by

calculating psoriasis area and severity index (PASI)

and classified into 3 parts: mild, moderate and severe

( Bozek, 2017). The severity of PASI scores is often

associated with increased comorbidity in patients

with moderate to severe (WHO, 2016).

Rahayu, T., Wirawan, E., Dhamayanti, M., Diana, R., Yuliarto, D. and Kusumawardhani, A.

The Relation of Comorbidities with Psoriasis Patients Treated in Ermatovenereology Outpatient Clinic of Dr. Moewardi General Hospital Surakarta January 2013-December 2017.

DOI: 10.5220/0008150400440047

In Proceedings of the 23rd Regional Conference of Dermatology (RCD 2018), pages 44-47

ISBN: 978-989-758-494-7

Psoriasis is a chronic disease that can cause

various comorbidities physically, psychologically

and socially (WHO, 2016). Immunopathogenesis of

psoriasis involves Th1, Th17 and proinflammatory

lymphocytes such as tumor necrosis factor-alpha

(TNF-α), interferon-γ and interleukin-2 predisposing

factors to comorbidities such as arteriosclerosis, skin

disorders and metabolism, psoriasis arthritis,

malignancies and other autoimmune diseases (factor,

2017), (Mazlin, 2012), (Tsai, 2011).

Pradyumma et

all study on psoriasis patients in Europe in 2013 found

that psoriasis had some comorbidities such as

hypertension, diabetis militus, obesity, dyslipidemia,

heart disease, metabolic syndrome, cardiovascular

disease, psoriasis arthritis, crohn's disease, lung

disease, mental disorders and malignancies

(Bhandary, 2016).

Soorya et al also studied in

patients with psoriasis in India in 2017 and found

some skin comorbidities in these patients (Factor,

2017). Thus we investigated the relation of

comorbidities with psoriasis in patients who visited

dermatovenerology outpatient clinic of Dr. Moewardi

General Hospital Surakarta in period

of January

2013-December 2017.

2 METHODS AND RESULTS

This Cross sectional study was performed in psoriasis

patients visited of dermatovenerology outpatient

clinic of Dr. Moewardi Hospital Surakarta during

January 2013-December 2017. The data were taken

from medical record data of patients. The data were

then analyzed with SPSS and Chi-Square test, with

the significant value of P<0.05.

The study sample of these subject the age ranged

from 0-17 years, 18-65 years, 66-79 years were 4.1%,

83.5% and 12.4% respectively. Males were more

dominant than females (52.6% vs 47.4%). The study

subjects were comprised of part time (31.9%). All

psoriasis patients in our study had been suffering

from this disease for more than 3 months. Psoriasis

area and severity index score revealed mild (26.8%),

medium (52.6%) and severe (20.6%). The most

common comorbidity was hypertension (28.6%),

followed by heart disease (24.5%), gastropathy

(24.5%) and lung disease (22.5%).(Table 1).

Table 1. Comorbidities of psoriasis patients

Chi-Square test showed that age and occupation are

significantly relation with all commorbidities with

value of P=0.011 and P=0.011.

3 DISCUSSION

Psoriasis is a skin disease of the erythrosquamous

dermatoses, characterized by autoimmune and

chronic residif with typical are macula erythema,

covered by thick, layered squama and clear white as

mica, accompanied by droplets of wax phenomenon

and an Auspitz sign. Psoriasis can occur at any age

but rarely in the age of under 10 years old, usually

appears at the age of 15-35 years (Johan, 2012),

(WHO, 2016). In our study it appeared at the age of

18-65 years old. It is consistent with previous study

by Alexander et all, in which the dominant age in

psoriasis is in the second and third decades (Egeberg,

2017). This probably due to the onset of this disease

is at the age of 15-35 years old and the disease tends

to be residual and lasts for a lifetime (WHO, 2016).

Table 2. Comorbidities and their relation to psoriasis

According to the National Health Council the

definition of chronic disease is a disease lasts more

than 3 months (National Health Council, 2014). This

study found that all respondents (100%) suffered for

The Relation of Comorbidities with Psoriasis Patients Treated in Ermatovenereology Outpatient Clinic of Dr. Moewardi General Hospital

Surakarta January 2013-December 2017

more than 3 months. This is because psoriasis is a

long-term chronic disease (WHO, 2016).

Psoriasis may occur in both men and women, but

more likely in men (WHO, 2016). This study found

that the number of male respondents were more

dominant. Similar results were also reported by Tsen-

Fang Tsai et al. that psoriasis sufferers were more

common in men than women (Ogdie, 2013). These

conditions are not due to phenotypic differences but

because men were more frequently exposed to

precipitating factors due to their physical activity

(Johan, 2012;WHO, 2016;Griffits, 2010).

The most common clinical variant of psoriasis is

the type of vulgaris psoriasis, which affects about

58%-97% of all patients with psoriasis (WHO, 2016).

The number of vulgaris psoriasis patients in this study

was 74.2% and it is the most common type of

psoriasis compared with other psoriasis types as

another previous study by Kurniasari et al. reported

that the most dominant type of psoriasis is psoriasis

vulgaris (Boham, 2016). However, to date there has

not been any study which definitively report the

reason for this type to be the most dominant. psoriasis

vulgaris (Boham, 2016). However, to date there has

not been any study which definitively report the

reason for this type to be the most dominant. Most of

psoriasis patients in our study are part timers with low

income. This finding is similar to that of study by

Carlson et all. Perhaps this is due to the patients

perception that psoriasis gives negative impact on

their life causing problems with work, daily activities

and socialization (Carlson, 2016).

In this study obtained PASI score of mild 26.8%,

moderate 52.6% and severe 20.6%. The severity of

the PASI score is associated with increased

comorbidity in patients, where comorbidity is

obtained primarily in patients with moderate to severe

(WHO, 2016). In this study, the majority of patients

had a moderate PASI score of 52.2% and the number

of psoriasis patients who had comorbidities 51.5%.

Research with similar results was previously reported

by Pradyumna et al (Bhandary, 2016). The condition

is presumed because the majority of respondents in

this study worked part timers/low income so the

ability of patients to seek medical attention also

decreased and caused less controlled the disease

(Carlson, 2016).

Psoriasis is a chronic disease that affects the nails,

skin and can cause various comorbidities physically,

psychologically and socially (WHO, 2016). This

study reported that 50.5% of these patients had

comorbidities of disease including hypertension

(28.6%), diabetic militus (20.4%), hyperuricemia

(4.1%), dyslipidemia (16.3%), nerve disease (6.1%),

dermatophyte (12.2%), kidney disease (14.3%),

malignancy (6.1%), gastropathy (24.5%), obesity

(4.1%), heart disease (26.5%), lung disease (22.4%),

arthritis psoriasis (10.2%), depression (12.2%), SLE

(4.1%) and vitiligo (2%). This is similar with

previous study by Bergamo et all and Howa yeung et

all (Factor, 2017), (Rota, 2010). The comorbidities in

psoriasis are due to psoriasis is an immune disease

involving Th1, Th17 and proinflammatory

lymphocytes suspected to be predisposing factors for

various comorbidities including arteriosclerosis, skin

disorders and metabolism as well as trigger the

emergence of symptoms of other autoimmune

diseases (Factor, 2017;Mazlin, 2016;Tsai, 2011). In

this chronic disease where the increase of T cell

activation, both Th1 and Th17 cells to produce

proinflammatory cytokines. These inflammatory

cells can affect the function of cells, other tissues and

trigger the comorbidities (Factor, 2017;Mazlin,

2016;Tsai, 2011).

Our study revealed that age and occupation are

related to comorbidities occured in psoriasis patients.

The older the age the greater the momorbidity affect

psoriasis patients. This is similar to previous study by

Pradyumna et all. who reported that the older the age

the greater the momorbidity affect psoriasis patients

(Bhandary, 2016). While the relation between

occupation status and comorbidities is also similar

with study by Carlson et all. It is due to the patients

perception that psoriasis gives negative impact on

their life causing problems with work, daily activities

socialization and that economic level the majority in

low treatment (Carlson, 2016).

4 CONCLUSION

There is a relation between comorbidity with

psoriasis particularly age and occupation. The older

the psoriasis sufferer the greater the comorbidities,

and the lower the income, the greater the

comorbidities too. Thus routine screening is required

in patients with psoriasis and need cooperation with

other clinical divisions is necessary to prevent and

manage accompany it.

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The Relation of Comorbidities with Psoriasis Patients Treated in Ermatovenereology Outpatient Clinic of Dr. Moewardi General Hospital

Surakarta January 2013-December 2017