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Older psoriasis patients experience more adverse events
Serious adverse events are more likely in patients older than 65 years undergoing psoriasis therapy, though whether these events are because of the treatment itself or other risk factors remains unclear, according to Dr. Carolina Medina and her associates.
In a review of data from 1,793 psoriasis patients enrolled in a national registry in Spain (10% of whom were older than 65 years), the overall risk of any adverse event was not significantly higher in the older group (drug group adjusted hazard ratio 1.09). However, the risk of serious adverse events was much greater (drug group adjusted HR, 3.2). Biologic exposure decreased the risk of adverse events in both younger and older patients, compared with those receiving classic therapy, even after adjustments for age (HR, 0.7, age adjusted), the researchers noted.
“These results are reassuring, although uncontrolled confounding could not be excluded as an explanation for these findings, and the power of the study to detect differences was low,” they concluded.
Find the full study in the Journal of the European Academy of Dermatology and Venereology (doi: 10.1111/jdv.12688).
Serious adverse events are more likely in patients older than 65 years undergoing psoriasis therapy, though whether these events are because of the treatment itself or other risk factors remains unclear, according to Dr. Carolina Medina and her associates.
In a review of data from 1,793 psoriasis patients enrolled in a national registry in Spain (10% of whom were older than 65 years), the overall risk of any adverse event was not significantly higher in the older group (drug group adjusted hazard ratio 1.09). However, the risk of serious adverse events was much greater (drug group adjusted HR, 3.2). Biologic exposure decreased the risk of adverse events in both younger and older patients, compared with those receiving classic therapy, even after adjustments for age (HR, 0.7, age adjusted), the researchers noted.
“These results are reassuring, although uncontrolled confounding could not be excluded as an explanation for these findings, and the power of the study to detect differences was low,” they concluded.
Find the full study in the Journal of the European Academy of Dermatology and Venereology (doi: 10.1111/jdv.12688).
Serious adverse events are more likely in patients older than 65 years undergoing psoriasis therapy, though whether these events are because of the treatment itself or other risk factors remains unclear, according to Dr. Carolina Medina and her associates.
In a review of data from 1,793 psoriasis patients enrolled in a national registry in Spain (10% of whom were older than 65 years), the overall risk of any adverse event was not significantly higher in the older group (drug group adjusted hazard ratio 1.09). However, the risk of serious adverse events was much greater (drug group adjusted HR, 3.2). Biologic exposure decreased the risk of adverse events in both younger and older patients, compared with those receiving classic therapy, even after adjustments for age (HR, 0.7, age adjusted), the researchers noted.
“These results are reassuring, although uncontrolled confounding could not be excluded as an explanation for these findings, and the power of the study to detect differences was low,” they concluded.
Find the full study in the Journal of the European Academy of Dermatology and Venereology (doi: 10.1111/jdv.12688).
Late-onset psoriasis genetics identified
Certain genetic loci are likely associated with late-onset psoriasis, based on data from a study of 543 cases and 4,373 healthy controls. Previous studies have shown 36 genetic loci linked to early-onset psoriasis (younger than 40 years), but the genetics of late-onset psoriasis (aged 40 years and older) have not been well studied, wrote Harry L. Hébert, a PhD candidate at the University of Manchester, England, and his colleagues.
In their genotyping analysis, the two loci HLA-C and IL12B, shown to be associated with early-onset psoriasis, also were significantly associated with late-onset disease, as were six other loci. In addition, IL1R1 on chromosome 2q13 was uniquely associated with late-onset psoriasis.
Find the full study online in the British Journal of Dermatology (2015;172:933-9 [doi:10.1111/bjd.13340]).
Certain genetic loci are likely associated with late-onset psoriasis, based on data from a study of 543 cases and 4,373 healthy controls. Previous studies have shown 36 genetic loci linked to early-onset psoriasis (younger than 40 years), but the genetics of late-onset psoriasis (aged 40 years and older) have not been well studied, wrote Harry L. Hébert, a PhD candidate at the University of Manchester, England, and his colleagues.
In their genotyping analysis, the two loci HLA-C and IL12B, shown to be associated with early-onset psoriasis, also were significantly associated with late-onset disease, as were six other loci. In addition, IL1R1 on chromosome 2q13 was uniquely associated with late-onset psoriasis.
Find the full study online in the British Journal of Dermatology (2015;172:933-9 [doi:10.1111/bjd.13340]).
Certain genetic loci are likely associated with late-onset psoriasis, based on data from a study of 543 cases and 4,373 healthy controls. Previous studies have shown 36 genetic loci linked to early-onset psoriasis (younger than 40 years), but the genetics of late-onset psoriasis (aged 40 years and older) have not been well studied, wrote Harry L. Hébert, a PhD candidate at the University of Manchester, England, and his colleagues.
In their genotyping analysis, the two loci HLA-C and IL12B, shown to be associated with early-onset psoriasis, also were significantly associated with late-onset disease, as were six other loci. In addition, IL1R1 on chromosome 2q13 was uniquely associated with late-onset psoriasis.
Find the full study online in the British Journal of Dermatology (2015;172:933-9 [doi:10.1111/bjd.13340]).
Contamination prompts voluntary injectables recall
Mylan N.V. has announced a voluntary recall of specific lots of injectable products for conditions including rheumatoid arthritis, severe psoriasis, lung cancer, breast cancer, ovarian cancer, and acute nonlymphocytic leukemia because foreign particles were observed during testing of retention samples, according to a statement issued by the company on April 23.
The specific lot numbers can be found on the company’s website.
Affected products include methotrexate injection, USP 25 mg/mL, which is indicated for adult rheumatoid arthritis, severe psoriasis, and some neoplastic diseases. According to Mylan, the contaminated lot was distributed in the United States between Jan. 16, 2014, and March 25, 2014.
Other recalled injectable products include gemcitabine, USP 200 mg, an intravenous product for ovarian cancer, breast cancer, non–small cell lung cancer, and pancreatic cancer; carboplatin 10 mg/mL, indicated for advanced ovarian cancer; and cytarabine, indicated for remission induction in acute nonlymphocytic leukemia in adults and children. The lots for these products were distributed in the United States in various periods of several months during 2014.
The recall is being conducted with the knowledge of the Food and Drug Administration, and any adverse events or quality problems should be reported to the FDA’s MedWatch adverse event reporting program.
Mylan N.V. has announced a voluntary recall of specific lots of injectable products for conditions including rheumatoid arthritis, severe psoriasis, lung cancer, breast cancer, ovarian cancer, and acute nonlymphocytic leukemia because foreign particles were observed during testing of retention samples, according to a statement issued by the company on April 23.
The specific lot numbers can be found on the company’s website.
Affected products include methotrexate injection, USP 25 mg/mL, which is indicated for adult rheumatoid arthritis, severe psoriasis, and some neoplastic diseases. According to Mylan, the contaminated lot was distributed in the United States between Jan. 16, 2014, and March 25, 2014.
Other recalled injectable products include gemcitabine, USP 200 mg, an intravenous product for ovarian cancer, breast cancer, non–small cell lung cancer, and pancreatic cancer; carboplatin 10 mg/mL, indicated for advanced ovarian cancer; and cytarabine, indicated for remission induction in acute nonlymphocytic leukemia in adults and children. The lots for these products were distributed in the United States in various periods of several months during 2014.
The recall is being conducted with the knowledge of the Food and Drug Administration, and any adverse events or quality problems should be reported to the FDA’s MedWatch adverse event reporting program.
Mylan N.V. has announced a voluntary recall of specific lots of injectable products for conditions including rheumatoid arthritis, severe psoriasis, lung cancer, breast cancer, ovarian cancer, and acute nonlymphocytic leukemia because foreign particles were observed during testing of retention samples, according to a statement issued by the company on April 23.
The specific lot numbers can be found on the company’s website.
Affected products include methotrexate injection, USP 25 mg/mL, which is indicated for adult rheumatoid arthritis, severe psoriasis, and some neoplastic diseases. According to Mylan, the contaminated lot was distributed in the United States between Jan. 16, 2014, and March 25, 2014.
Other recalled injectable products include gemcitabine, USP 200 mg, an intravenous product for ovarian cancer, breast cancer, non–small cell lung cancer, and pancreatic cancer; carboplatin 10 mg/mL, indicated for advanced ovarian cancer; and cytarabine, indicated for remission induction in acute nonlymphocytic leukemia in adults and children. The lots for these products were distributed in the United States in various periods of several months during 2014.
The recall is being conducted with the knowledge of the Food and Drug Administration, and any adverse events or quality problems should be reported to the FDA’s MedWatch adverse event reporting program.
Researchers will evaluate ustekinumab’s ability to treat lupus
The effectiveness of treating lupus with a drug approved for treating plaque psoriasis and active psoriatic arthritis will be tested in a clinical study.
The study, which will be conducted by the Alliance for Lupus Research and Janssen Research & Development, LLC, will evaluate the drug, ustekinumab (Stelara) for the treatment of systemic lupus erythematosus, the Alliance announced in a written statement.
Ustenkinumab was selected for this study as part of the LRxL-STAT Lupus Drug Repositioning Initiative, which seeks to find therapies approved for indications other than lupus that can also treat lupus. Ustenkinumab was identified as the most promising biologic candidate for treating lupus over hundreds of other potential lupus therapies.
The ALR and Janssen will begin recruiting patients for the study later this year.
The effectiveness of treating lupus with a drug approved for treating plaque psoriasis and active psoriatic arthritis will be tested in a clinical study.
The study, which will be conducted by the Alliance for Lupus Research and Janssen Research & Development, LLC, will evaluate the drug, ustekinumab (Stelara) for the treatment of systemic lupus erythematosus, the Alliance announced in a written statement.
Ustenkinumab was selected for this study as part of the LRxL-STAT Lupus Drug Repositioning Initiative, which seeks to find therapies approved for indications other than lupus that can also treat lupus. Ustenkinumab was identified as the most promising biologic candidate for treating lupus over hundreds of other potential lupus therapies.
The ALR and Janssen will begin recruiting patients for the study later this year.
The effectiveness of treating lupus with a drug approved for treating plaque psoriasis and active psoriatic arthritis will be tested in a clinical study.
The study, which will be conducted by the Alliance for Lupus Research and Janssen Research & Development, LLC, will evaluate the drug, ustekinumab (Stelara) for the treatment of systemic lupus erythematosus, the Alliance announced in a written statement.
Ustenkinumab was selected for this study as part of the LRxL-STAT Lupus Drug Repositioning Initiative, which seeks to find therapies approved for indications other than lupus that can also treat lupus. Ustenkinumab was identified as the most promising biologic candidate for treating lupus over hundreds of other potential lupus therapies.
The ALR and Janssen will begin recruiting patients for the study later this year.
Update on Biologics: Report From the AAD Meeting
At the 73rd Annual Meeting of the American Academy of Dermatology in San Francisco, California, Dr. Jashin J. Wu spoke about the risk for cancer, infection, and MACE (major adverse cardiovascular events) in psoriasis patients on a biologic. Dr. Wu provides an overview of the data evaluating biologics versus nonbiologic therapies. He discusses biologics such as infliximab, ustekinumab, etanercept, and adalimumab, as well as tumor necrosis factor inhibitors.
At the 73rd Annual Meeting of the American Academy of Dermatology in San Francisco, California, Dr. Jashin J. Wu spoke about the risk for cancer, infection, and MACE (major adverse cardiovascular events) in psoriasis patients on a biologic. Dr. Wu provides an overview of the data evaluating biologics versus nonbiologic therapies. He discusses biologics such as infliximab, ustekinumab, etanercept, and adalimumab, as well as tumor necrosis factor inhibitors.
At the 73rd Annual Meeting of the American Academy of Dermatology in San Francisco, California, Dr. Jashin J. Wu spoke about the risk for cancer, infection, and MACE (major adverse cardiovascular events) in psoriasis patients on a biologic. Dr. Wu provides an overview of the data evaluating biologics versus nonbiologic therapies. He discusses biologics such as infliximab, ustekinumab, etanercept, and adalimumab, as well as tumor necrosis factor inhibitors.
New psoriatic arthritis screening tool passes initial validation
The second version of the Toronto Psoriatic Arthritis screen performed well at identifying psoriatic arthritis in 336 psoriasis patients, 131 psoriatic arthritis patients, and 89 individuals in the general population, according to Dr. Brian Tom and his associates.
The sensitivities of the capped and uncapped version of the ToPAS 2 system were the same across all measured groups (92.0%) when the cutpoint was 7 for ToPAS2_cap and 8 for ToPAS2_uncap, although the sensitivity for ToPAS2_uncap was slightly lower when the cutpoint was 9 (84.0% vs. 87.2)%. Both were higher than the original ToPAS index (sensitivity 86.6%), which did not include a spinal domain. However, the specificity of the original ToPAS index across all measured groups was slightly higher (80.5%-95.5%) than with ToPAS2_cap and ToPAS2_uncap (73.8%-89.9% and 71.6%-91.0%).
Besides the addition of a spinal domain, the ToPAS 2 “incorporates further pictures of cutaneous psoriasis, joint inflammation, and dactylitis to improve its performance, as well as more carefully worded questions regarding spinal involvement,” the investigators wrote.
While the specificity is lower with ToPAS 2, this should not be a major issue, because “for the purposes of identifying patients whom dermatologists or primary care physicians should refer to a rheumatologist, the specificity is not as important, because patients with rheumatological disorders other than PsA would benefit from a rheumatologist’s consultation,” the investigators said.
Find the full study in Journal of Rheumatology (doi:10.3899/jrheum.140857).
The second version of the Toronto Psoriatic Arthritis screen performed well at identifying psoriatic arthritis in 336 psoriasis patients, 131 psoriatic arthritis patients, and 89 individuals in the general population, according to Dr. Brian Tom and his associates.
The sensitivities of the capped and uncapped version of the ToPAS 2 system were the same across all measured groups (92.0%) when the cutpoint was 7 for ToPAS2_cap and 8 for ToPAS2_uncap, although the sensitivity for ToPAS2_uncap was slightly lower when the cutpoint was 9 (84.0% vs. 87.2)%. Both were higher than the original ToPAS index (sensitivity 86.6%), which did not include a spinal domain. However, the specificity of the original ToPAS index across all measured groups was slightly higher (80.5%-95.5%) than with ToPAS2_cap and ToPAS2_uncap (73.8%-89.9% and 71.6%-91.0%).
Besides the addition of a spinal domain, the ToPAS 2 “incorporates further pictures of cutaneous psoriasis, joint inflammation, and dactylitis to improve its performance, as well as more carefully worded questions regarding spinal involvement,” the investigators wrote.
While the specificity is lower with ToPAS 2, this should not be a major issue, because “for the purposes of identifying patients whom dermatologists or primary care physicians should refer to a rheumatologist, the specificity is not as important, because patients with rheumatological disorders other than PsA would benefit from a rheumatologist’s consultation,” the investigators said.
Find the full study in Journal of Rheumatology (doi:10.3899/jrheum.140857).
The second version of the Toronto Psoriatic Arthritis screen performed well at identifying psoriatic arthritis in 336 psoriasis patients, 131 psoriatic arthritis patients, and 89 individuals in the general population, according to Dr. Brian Tom and his associates.
The sensitivities of the capped and uncapped version of the ToPAS 2 system were the same across all measured groups (92.0%) when the cutpoint was 7 for ToPAS2_cap and 8 for ToPAS2_uncap, although the sensitivity for ToPAS2_uncap was slightly lower when the cutpoint was 9 (84.0% vs. 87.2)%. Both were higher than the original ToPAS index (sensitivity 86.6%), which did not include a spinal domain. However, the specificity of the original ToPAS index across all measured groups was slightly higher (80.5%-95.5%) than with ToPAS2_cap and ToPAS2_uncap (73.8%-89.9% and 71.6%-91.0%).
Besides the addition of a spinal domain, the ToPAS 2 “incorporates further pictures of cutaneous psoriasis, joint inflammation, and dactylitis to improve its performance, as well as more carefully worded questions regarding spinal involvement,” the investigators wrote.
While the specificity is lower with ToPAS 2, this should not be a major issue, because “for the purposes of identifying patients whom dermatologists or primary care physicians should refer to a rheumatologist, the specificity is not as important, because patients with rheumatological disorders other than PsA would benefit from a rheumatologist’s consultation,” the investigators said.
Find the full study in Journal of Rheumatology (doi:10.3899/jrheum.140857).
Psoriatic arthritis associated with heavy drinking
Heavy alcohol consumption was associated with incident psoriatic arthritis in women, Shaowei Wu, Ph.D., and his associates reported in a study of 116,430 female registered nurses in the Nurses’ Health Study II.
The investigators found 141 incident cases of psoriatic arthritis (PsA) during 1,137,763 years of follow-up in 1991-2005. The risk for PsA was not signficantly different between drinkers and nondrinkers for women who consumed 0.1-14.9 g/day (hazard ratio, 0.7) or 15-29.9 g/day (HR, 1.43), but women who consumed more than 30 g/day had a signficantly elevated risk (HR, 4.45). The results remained consistent when updated alcohol intake and 1991 baseline consumption was used, and when the analysis was restricted to those who developed psoriasis during follow-up.
“These findings are also in line with the biological evidence that high levels of alcohol intake contribute to systemic inflammation and may trigger psoriatic eruption, and thus may have important implications for the prevention of PsA,” the investigators concluded.
Find the full study in the Journal of Rheumatology (doi:10.3899/jrheum.140808).
Heavy alcohol consumption was associated with incident psoriatic arthritis in women, Shaowei Wu, Ph.D., and his associates reported in a study of 116,430 female registered nurses in the Nurses’ Health Study II.
The investigators found 141 incident cases of psoriatic arthritis (PsA) during 1,137,763 years of follow-up in 1991-2005. The risk for PsA was not signficantly different between drinkers and nondrinkers for women who consumed 0.1-14.9 g/day (hazard ratio, 0.7) or 15-29.9 g/day (HR, 1.43), but women who consumed more than 30 g/day had a signficantly elevated risk (HR, 4.45). The results remained consistent when updated alcohol intake and 1991 baseline consumption was used, and when the analysis was restricted to those who developed psoriasis during follow-up.
“These findings are also in line with the biological evidence that high levels of alcohol intake contribute to systemic inflammation and may trigger psoriatic eruption, and thus may have important implications for the prevention of PsA,” the investigators concluded.
Find the full study in the Journal of Rheumatology (doi:10.3899/jrheum.140808).
Heavy alcohol consumption was associated with incident psoriatic arthritis in women, Shaowei Wu, Ph.D., and his associates reported in a study of 116,430 female registered nurses in the Nurses’ Health Study II.
The investigators found 141 incident cases of psoriatic arthritis (PsA) during 1,137,763 years of follow-up in 1991-2005. The risk for PsA was not signficantly different between drinkers and nondrinkers for women who consumed 0.1-14.9 g/day (hazard ratio, 0.7) or 15-29.9 g/day (HR, 1.43), but women who consumed more than 30 g/day had a signficantly elevated risk (HR, 4.45). The results remained consistent when updated alcohol intake and 1991 baseline consumption was used, and when the analysis was restricted to those who developed psoriasis during follow-up.
“These findings are also in line with the biological evidence that high levels of alcohol intake contribute to systemic inflammation and may trigger psoriatic eruption, and thus may have important implications for the prevention of PsA,” the investigators concluded.
Find the full study in the Journal of Rheumatology (doi:10.3899/jrheum.140808).
Impact of Diet and Obesity on Psoriasis Severity
There is a higher prevalence of obesity in patients with psoriasis. Studies have shown that psoriasis patients may gain weight after the onset of psoriasis. Dr. Jeffrey Weinberg discusses the mechanisms of psoriasis that can lead to obesity. He also provides tips on how to evaluate the patient for comorbidities associated with obesity. Although there is no evidence that certain foods make psoriasis worse or better, recommending a healthy diet is important. Dr. Weinberg also discusses the impact of obesity on the efficacy of psoriasis treatments, such as the biologics.
The psoriasis audiocast series is created in collaboration with Cutis® and the National Psoriasis Foundation®.
Suggested Reading
Bremmer S, Van Voorhees AS, Hsu S, et al; for the National Psoriasis Foundation. Obesity and psoriasis: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol. 2010;63:1058-1069.
There is a higher prevalence of obesity in patients with psoriasis. Studies have shown that psoriasis patients may gain weight after the onset of psoriasis. Dr. Jeffrey Weinberg discusses the mechanisms of psoriasis that can lead to obesity. He also provides tips on how to evaluate the patient for comorbidities associated with obesity. Although there is no evidence that certain foods make psoriasis worse or better, recommending a healthy diet is important. Dr. Weinberg also discusses the impact of obesity on the efficacy of psoriasis treatments, such as the biologics.
The psoriasis audiocast series is created in collaboration with Cutis® and the National Psoriasis Foundation®.
There is a higher prevalence of obesity in patients with psoriasis. Studies have shown that psoriasis patients may gain weight after the onset of psoriasis. Dr. Jeffrey Weinberg discusses the mechanisms of psoriasis that can lead to obesity. He also provides tips on how to evaluate the patient for comorbidities associated with obesity. Although there is no evidence that certain foods make psoriasis worse or better, recommending a healthy diet is important. Dr. Weinberg also discusses the impact of obesity on the efficacy of psoriasis treatments, such as the biologics.
The psoriasis audiocast series is created in collaboration with Cutis® and the National Psoriasis Foundation®.
Suggested Reading
Bremmer S, Van Voorhees AS, Hsu S, et al; for the National Psoriasis Foundation. Obesity and psoriasis: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol. 2010;63:1058-1069.
Suggested Reading
Bremmer S, Van Voorhees AS, Hsu S, et al; for the National Psoriasis Foundation. Obesity and psoriasis: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol. 2010;63:1058-1069.
Yoga for Dermatologic Conditions
Regardless of its spiritual origins, yoga has become a popular way of reaching mind and body well-being with nearly 30 million people practicing regularly worldwide.1 Yoga, which is the combination of physical postures, controlled breathing, and meditation or mindfulness, has long been used in complementary and alternative medicine around the world and recently has gained popularity as a therapeutic practice, with nearly 14 million Americans reporting that yoga was recommended to them by a physician or therapist.2,3 Studies suggest that people who participate in even brief yoga programs may see improvements in anxiety, somatic stress and discomfort, health-related quality of life, and self-rated sleep quality, all benefits that can help medical conditions, especially those that are dermatologic in nature.4,5
Stress and Dermatologic Conditions
The interaction between the mind, skin, and body is well known. Research in psychoneuroimmunology, the interaction between psychological processes and the nervous and immune systems, has examined the role of neuropeptides, hormones, and neurotransmitters in psychodermatological disorders. The correlation between neuroimmunological pathways and skin inflammation is now well recognized, specifically the interactions between the brain and skin underlying many dermatological diseases (eg, acne, alopecia areata, various types of eczema and dermatitis, oral and genital herpes, hyperhidrosis, pruritus, psoriasis, rosacea, urticaria, warts, breaking or ridging of the nails).6-9
Two biological systems are known to be affected by the systemic stress response: (1) the hypothalamic-pituitary-adrenal axis, which regulates the release of adrenocorticotropin, ß-endorphin, and cortisol, and (2) the sympathoadrenal medullary system, which regulates the release of catecholamines (eg, epinephrine, norepinephrine).7 Cortisol and catecholamines have been shown to have potent effects on the immune system as well as the inflammatory response.9 Additionally, it has been shown that cutaneous sensory nerve terminals release neuropeptides, including calcitonin gene-related peptide and substance P, both of which have different effects on the local inflammatory response.10,11
Psychological stress is well known to trigger many dermatologic conditions, but it also may lead to abnormal skin barrier function.12 The mechanism in which skin barrier function is affected appears to involve a stress-induced increase of endogenous glucocorticoids, which may consequently disrupt skin barrier function and recovery rates, stratum corneum cohesion, and epidermal antimicrobial function.13,14
Atopic dermatitis, for example, is classified as a psychophysiological disorder. Although it is not caused by stress, atopic dermatitis has been described to be precipitated or exacerbated by stress in patients.15 In fact, it was found that stressful life events preceded the onset of itching in more than 70% of patients with atopic dermatitis,16 which is especially relevant, as there is no cure and patients often experience a lifelong struggle with the condition. Additionally, stress mediates the degranulation of mast cells via corticotropin-releasing hormone and neuropeptides, and the upregulation of mast cell corticotropin-releasing hormone receptors supporting its putative role in the pathogenesis of urticaria.9,17 Furthermore, the increase in cortisol also has been described in the exacerbation of acne during times of stress.18
Psychological factors affect the management of skin conditions in more than one-third of reported dermatology patients; therefore, it is important to consider these factors in the treatment of chronic dermatological conditions, especially when they are inquired by the patient.19,20
Yoga Benefits in the Literature
The therapeutic potential of yoga has been explored in a growing number of randomized controlled trials to date.21 A recently published bibliometric analysis provided a comprehensive review of the characteristics of the randomized yoga trials available in the literature.22 The review included 366 full-text articles, with the 2 earliest studies published in 1975 and nearly 90% published within the last decade. In addition to healthy patients, it was found these randomized controlled yoga trials most commonly enrolled patients with breast cancer, depression, asthma, and type 2 diabetes mellitus.22 Another study examined psychological (eg, self-rated stress and stress behavior, anger, exhaustion, quality of life) and physiological (eg, blood pressure, heart rate, urinary catecholamines, salivary cortisol) measurements obtained before and after a 10-session yoga program that participants completed over a 4-month period, with results showing significant improvements (P<.05) on almost all stress-related subjective and physiological variables. Results were comparable with cognitive behavioral therapy.23
Not only has it been shown that yoga helps patients on a psychological level, but a recent study reported that 90-minute sessions of mindfulness meditation and gentle Hatha yoga over an 8-week period led to observable benefits on a cellular level, as telomere length was maintained in distressed breast cancer survivors compared to decreases in telomere length in the control group with patients who solely participated in a stress management seminar.24 To date, there are no known studies examining the effects of yoga on patients with skin cancer. However, a few studies have specifically examined the effect of yoga in managing non–cancer-related dermatologic issues. Specifically, one small study of psoriasis patients found that those who listened to mindfulness meditation tapes while undergoing standard phototherapy (psoralen plus UVA) healed faster than those who underwent phototherapy treatment alone.25
Because some dermatologic problems have comorbidities and increased risk factors of other medical problems, such as psoriasis with psoriatic arthritis and metabolic diseases (eg, abdominal obesity, diabetes, nonalcoholic fatty liver disease, dyslipidemia, metabolic syndrome, chronic kidney disease), it is even more pertinent to recommend approaches for healthy mind and body well-being as a supplement to medical care.26
Final Thoughts
With accurate diagnosis by a dermatologist, appropriate conventional treatments can improve dermatologic problems. These treatments alone can reduce patients’ stress and improve skin, hair, and nail conditions; however, if it is clear that stress is interfering with a patient’s overall well-being and ability to cope with his/her dermatologic condition, concurrent stress management interventions may be warranted. In some instances, recommending yoga sessions, mindful meditation, or breathing exercises may help, while in others referral to a mental health professional may be necessary.
Beyond the direct physiological effects of stress, it also is worth mentioning that patients who deal with stress also tend to scratch, pick, or irritate their skin more and often lack the motivation to adhere to skin care regimens or treatments, again supporting the idea that our approach in managing these patients must be multifaceted. As dermatologists in training, residents should be cognizant of the potential psychological sequelae of some dermatologic problems and be aware of the possible use of supplemental interventions by our patients.
1. Dangerfield A. Yoga wars. BBC News. http://news.bbc.co.uk/1/hi/7844691.stm. Published January 23, 2009. Accessed March 25, 2015.
2. Yoga Journal releases 2012 yoga in America market study [press release]. San Francisco, CA: Yoga Journal; December 6, 2012.
3. De Michaelis E. A History of Modern Yoga: Patanjali and Western Esotericism. London, United Kingdom: A&C Black; 2005.
4. Telles S, Singh N, Yadav A, et al. Effect of yoga on different aspects of mental health. Indian J Physiol Pharmacol. 2012;56:245-254.
5. Rodriguez-Vallecillo E, Woodbury-Fariña MA. Dermatological manifestations of stress in normal and psychiatric populations. Psychiatr Clin North Am. 2014;37:625-651.
6. Stander S, Raap U, Weisshaar E, et al. Pathogenesis of pruritus. J Dtsch Dermatol Ges. 2011;9:456-463.
7. Arck PC, Slominski A, Theoharides TC, et al. Neuroimmunology of stress: skin takes center stage. J Invest Dermatol. 2006;126:1697-1704.
8. Recognizing the mind-skin connection. Harvard Health Publications Web site. http://www.health.harvard.edu/newsletter_article/Recognizing_the_mind-skin_connection. Published November 1, 2006. Accessed March 31, 2015.
9. Tausk F, Elenkov I, Moynihan J. Psychoneuroimmunology. Dermatol Ther. 2008;21:22-31.
10. Pavlovic S, Liezmann C, Blois SM, et al. Substance P is a key mediator of stress-induced protection from allergic sensitization via modified antigen presentation. J Immunol. 2011;186:848-855.
11. Toyoda M, Nakamura M, Makino T, et al. Nerve growth factor and substance P are useful plasma markers of disease activity in atopic dermatitis. Br J Dermatol. 2002;147:71-79.
12. Koo JYM, Lee CS. General approach to evaluating psychodermatological disorders. In: Koo JYM, Lee CS, eds. Psychocutaneous Medicine. New York, NY: Marcel Dekker; 2003:1-29.
13. Garg A, Chren MM, Sands LP, et al. Psychological stress perturbs epidermal permeability barrier homeostasis: implications for the pathogenesis of stress-associated skin disorders. Arch Dermatol. 2001;137:53-59.
14. Elias PM, Sun R, Eder AR, et al. Treating atopic dermatitis at the source: corrective barrier repair therapy based upon new pathogenic insights. Expert Rev Dermatol. 2013;8:27-36.
15. Morren MA, Przybilla B, Bamelis M, et al. Atopic dermatitis: triggering factors. J Am Acad Dermatol. 1994;31:467-473.
16. Faulstich ME, Williamson DA. An overview of atopic dermatitis: toward a bio-behavioural integration. J Psychosom Res. 1985;29:647-654.
17. Theoharides TC, Donelan JM, Papadopoulou N, et al. Mast cells as targets of corticotropin-releasing factor and related peptides. Trends Pharmacol Sci. 2004;25:563-568.
18. Suh DH, Kwon HH. What’s new in the physiopathology of acne [published online ahead of print Jan 24, 2015]? Br J Dermatol. doi:10.1111/bjd.13634.
19. Picardi A, Mazzotti E, Pasquini P. Prevalence and correlates of suicidal ideation among patients with skin disease. J Am Acad Dermatol. 2006;54:420-426.
20. Ponarovsky B, Amital D, Lazarov A, et al. Anxiety and depression in patients with allergic and non-allergic cutaneous disorders. Int J Dermatol. 2011;50:1217-1222.
21. Khalsa SB. Yoga as a therapeutic intervention: a bibliometric analysis of published research studies. Indian J Physiol Pharmacol. 2004;48:269-285.
22. Cramer H, Lauche R, Dobos G. Characteristics of randomized controlled trials of yoga: a bibliometric analysis. BMC Complement Altern Med. 2014;14:328.
23. Granath J, Ingvarsson S, von Thiele U, et al. Stress management: a randomized study of cognitive behavioural therapy and yoga. Cogn Behav Ther. 2006;35:3-10.
24. Carlson LE, Beattie TL, Giese-Davis J, et al. Mindfulness-based cancer recovery and supportive-expressive therapy maintain telomere length relative to controls in distressed breast cancer survivors. Cancer. 2015;121:476-484.
25. Kabat-Zinn J, Wheeler E, Light T, et al. Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosom Med. 1998;60:625-632.
26. Gisondi P, Galvan A, Idolazzi L, et al. Management of moderate to severe psoriasis in patients with metabolic comorbidities. Front Med (Lausanne). 2015;2:1.
Regardless of its spiritual origins, yoga has become a popular way of reaching mind and body well-being with nearly 30 million people practicing regularly worldwide.1 Yoga, which is the combination of physical postures, controlled breathing, and meditation or mindfulness, has long been used in complementary and alternative medicine around the world and recently has gained popularity as a therapeutic practice, with nearly 14 million Americans reporting that yoga was recommended to them by a physician or therapist.2,3 Studies suggest that people who participate in even brief yoga programs may see improvements in anxiety, somatic stress and discomfort, health-related quality of life, and self-rated sleep quality, all benefits that can help medical conditions, especially those that are dermatologic in nature.4,5
Stress and Dermatologic Conditions
The interaction between the mind, skin, and body is well known. Research in psychoneuroimmunology, the interaction between psychological processes and the nervous and immune systems, has examined the role of neuropeptides, hormones, and neurotransmitters in psychodermatological disorders. The correlation between neuroimmunological pathways and skin inflammation is now well recognized, specifically the interactions between the brain and skin underlying many dermatological diseases (eg, acne, alopecia areata, various types of eczema and dermatitis, oral and genital herpes, hyperhidrosis, pruritus, psoriasis, rosacea, urticaria, warts, breaking or ridging of the nails).6-9
Two biological systems are known to be affected by the systemic stress response: (1) the hypothalamic-pituitary-adrenal axis, which regulates the release of adrenocorticotropin, ß-endorphin, and cortisol, and (2) the sympathoadrenal medullary system, which regulates the release of catecholamines (eg, epinephrine, norepinephrine).7 Cortisol and catecholamines have been shown to have potent effects on the immune system as well as the inflammatory response.9 Additionally, it has been shown that cutaneous sensory nerve terminals release neuropeptides, including calcitonin gene-related peptide and substance P, both of which have different effects on the local inflammatory response.10,11
Psychological stress is well known to trigger many dermatologic conditions, but it also may lead to abnormal skin barrier function.12 The mechanism in which skin barrier function is affected appears to involve a stress-induced increase of endogenous glucocorticoids, which may consequently disrupt skin barrier function and recovery rates, stratum corneum cohesion, and epidermal antimicrobial function.13,14
Atopic dermatitis, for example, is classified as a psychophysiological disorder. Although it is not caused by stress, atopic dermatitis has been described to be precipitated or exacerbated by stress in patients.15 In fact, it was found that stressful life events preceded the onset of itching in more than 70% of patients with atopic dermatitis,16 which is especially relevant, as there is no cure and patients often experience a lifelong struggle with the condition. Additionally, stress mediates the degranulation of mast cells via corticotropin-releasing hormone and neuropeptides, and the upregulation of mast cell corticotropin-releasing hormone receptors supporting its putative role in the pathogenesis of urticaria.9,17 Furthermore, the increase in cortisol also has been described in the exacerbation of acne during times of stress.18
Psychological factors affect the management of skin conditions in more than one-third of reported dermatology patients; therefore, it is important to consider these factors in the treatment of chronic dermatological conditions, especially when they are inquired by the patient.19,20
Yoga Benefits in the Literature
The therapeutic potential of yoga has been explored in a growing number of randomized controlled trials to date.21 A recently published bibliometric analysis provided a comprehensive review of the characteristics of the randomized yoga trials available in the literature.22 The review included 366 full-text articles, with the 2 earliest studies published in 1975 and nearly 90% published within the last decade. In addition to healthy patients, it was found these randomized controlled yoga trials most commonly enrolled patients with breast cancer, depression, asthma, and type 2 diabetes mellitus.22 Another study examined psychological (eg, self-rated stress and stress behavior, anger, exhaustion, quality of life) and physiological (eg, blood pressure, heart rate, urinary catecholamines, salivary cortisol) measurements obtained before and after a 10-session yoga program that participants completed over a 4-month period, with results showing significant improvements (P<.05) on almost all stress-related subjective and physiological variables. Results were comparable with cognitive behavioral therapy.23
Not only has it been shown that yoga helps patients on a psychological level, but a recent study reported that 90-minute sessions of mindfulness meditation and gentle Hatha yoga over an 8-week period led to observable benefits on a cellular level, as telomere length was maintained in distressed breast cancer survivors compared to decreases in telomere length in the control group with patients who solely participated in a stress management seminar.24 To date, there are no known studies examining the effects of yoga on patients with skin cancer. However, a few studies have specifically examined the effect of yoga in managing non–cancer-related dermatologic issues. Specifically, one small study of psoriasis patients found that those who listened to mindfulness meditation tapes while undergoing standard phototherapy (psoralen plus UVA) healed faster than those who underwent phototherapy treatment alone.25
Because some dermatologic problems have comorbidities and increased risk factors of other medical problems, such as psoriasis with psoriatic arthritis and metabolic diseases (eg, abdominal obesity, diabetes, nonalcoholic fatty liver disease, dyslipidemia, metabolic syndrome, chronic kidney disease), it is even more pertinent to recommend approaches for healthy mind and body well-being as a supplement to medical care.26
Final Thoughts
With accurate diagnosis by a dermatologist, appropriate conventional treatments can improve dermatologic problems. These treatments alone can reduce patients’ stress and improve skin, hair, and nail conditions; however, if it is clear that stress is interfering with a patient’s overall well-being and ability to cope with his/her dermatologic condition, concurrent stress management interventions may be warranted. In some instances, recommending yoga sessions, mindful meditation, or breathing exercises may help, while in others referral to a mental health professional may be necessary.
Beyond the direct physiological effects of stress, it also is worth mentioning that patients who deal with stress also tend to scratch, pick, or irritate their skin more and often lack the motivation to adhere to skin care regimens or treatments, again supporting the idea that our approach in managing these patients must be multifaceted. As dermatologists in training, residents should be cognizant of the potential psychological sequelae of some dermatologic problems and be aware of the possible use of supplemental interventions by our patients.
Regardless of its spiritual origins, yoga has become a popular way of reaching mind and body well-being with nearly 30 million people practicing regularly worldwide.1 Yoga, which is the combination of physical postures, controlled breathing, and meditation or mindfulness, has long been used in complementary and alternative medicine around the world and recently has gained popularity as a therapeutic practice, with nearly 14 million Americans reporting that yoga was recommended to them by a physician or therapist.2,3 Studies suggest that people who participate in even brief yoga programs may see improvements in anxiety, somatic stress and discomfort, health-related quality of life, and self-rated sleep quality, all benefits that can help medical conditions, especially those that are dermatologic in nature.4,5
Stress and Dermatologic Conditions
The interaction between the mind, skin, and body is well known. Research in psychoneuroimmunology, the interaction between psychological processes and the nervous and immune systems, has examined the role of neuropeptides, hormones, and neurotransmitters in psychodermatological disorders. The correlation between neuroimmunological pathways and skin inflammation is now well recognized, specifically the interactions between the brain and skin underlying many dermatological diseases (eg, acne, alopecia areata, various types of eczema and dermatitis, oral and genital herpes, hyperhidrosis, pruritus, psoriasis, rosacea, urticaria, warts, breaking or ridging of the nails).6-9
Two biological systems are known to be affected by the systemic stress response: (1) the hypothalamic-pituitary-adrenal axis, which regulates the release of adrenocorticotropin, ß-endorphin, and cortisol, and (2) the sympathoadrenal medullary system, which regulates the release of catecholamines (eg, epinephrine, norepinephrine).7 Cortisol and catecholamines have been shown to have potent effects on the immune system as well as the inflammatory response.9 Additionally, it has been shown that cutaneous sensory nerve terminals release neuropeptides, including calcitonin gene-related peptide and substance P, both of which have different effects on the local inflammatory response.10,11
Psychological stress is well known to trigger many dermatologic conditions, but it also may lead to abnormal skin barrier function.12 The mechanism in which skin barrier function is affected appears to involve a stress-induced increase of endogenous glucocorticoids, which may consequently disrupt skin barrier function and recovery rates, stratum corneum cohesion, and epidermal antimicrobial function.13,14
Atopic dermatitis, for example, is classified as a psychophysiological disorder. Although it is not caused by stress, atopic dermatitis has been described to be precipitated or exacerbated by stress in patients.15 In fact, it was found that stressful life events preceded the onset of itching in more than 70% of patients with atopic dermatitis,16 which is especially relevant, as there is no cure and patients often experience a lifelong struggle with the condition. Additionally, stress mediates the degranulation of mast cells via corticotropin-releasing hormone and neuropeptides, and the upregulation of mast cell corticotropin-releasing hormone receptors supporting its putative role in the pathogenesis of urticaria.9,17 Furthermore, the increase in cortisol also has been described in the exacerbation of acne during times of stress.18
Psychological factors affect the management of skin conditions in more than one-third of reported dermatology patients; therefore, it is important to consider these factors in the treatment of chronic dermatological conditions, especially when they are inquired by the patient.19,20
Yoga Benefits in the Literature
The therapeutic potential of yoga has been explored in a growing number of randomized controlled trials to date.21 A recently published bibliometric analysis provided a comprehensive review of the characteristics of the randomized yoga trials available in the literature.22 The review included 366 full-text articles, with the 2 earliest studies published in 1975 and nearly 90% published within the last decade. In addition to healthy patients, it was found these randomized controlled yoga trials most commonly enrolled patients with breast cancer, depression, asthma, and type 2 diabetes mellitus.22 Another study examined psychological (eg, self-rated stress and stress behavior, anger, exhaustion, quality of life) and physiological (eg, blood pressure, heart rate, urinary catecholamines, salivary cortisol) measurements obtained before and after a 10-session yoga program that participants completed over a 4-month period, with results showing significant improvements (P<.05) on almost all stress-related subjective and physiological variables. Results were comparable with cognitive behavioral therapy.23
Not only has it been shown that yoga helps patients on a psychological level, but a recent study reported that 90-minute sessions of mindfulness meditation and gentle Hatha yoga over an 8-week period led to observable benefits on a cellular level, as telomere length was maintained in distressed breast cancer survivors compared to decreases in telomere length in the control group with patients who solely participated in a stress management seminar.24 To date, there are no known studies examining the effects of yoga on patients with skin cancer. However, a few studies have specifically examined the effect of yoga in managing non–cancer-related dermatologic issues. Specifically, one small study of psoriasis patients found that those who listened to mindfulness meditation tapes while undergoing standard phototherapy (psoralen plus UVA) healed faster than those who underwent phototherapy treatment alone.25
Because some dermatologic problems have comorbidities and increased risk factors of other medical problems, such as psoriasis with psoriatic arthritis and metabolic diseases (eg, abdominal obesity, diabetes, nonalcoholic fatty liver disease, dyslipidemia, metabolic syndrome, chronic kidney disease), it is even more pertinent to recommend approaches for healthy mind and body well-being as a supplement to medical care.26
Final Thoughts
With accurate diagnosis by a dermatologist, appropriate conventional treatments can improve dermatologic problems. These treatments alone can reduce patients’ stress and improve skin, hair, and nail conditions; however, if it is clear that stress is interfering with a patient’s overall well-being and ability to cope with his/her dermatologic condition, concurrent stress management interventions may be warranted. In some instances, recommending yoga sessions, mindful meditation, or breathing exercises may help, while in others referral to a mental health professional may be necessary.
Beyond the direct physiological effects of stress, it also is worth mentioning that patients who deal with stress also tend to scratch, pick, or irritate their skin more and often lack the motivation to adhere to skin care regimens or treatments, again supporting the idea that our approach in managing these patients must be multifaceted. As dermatologists in training, residents should be cognizant of the potential psychological sequelae of some dermatologic problems and be aware of the possible use of supplemental interventions by our patients.
1. Dangerfield A. Yoga wars. BBC News. http://news.bbc.co.uk/1/hi/7844691.stm. Published January 23, 2009. Accessed March 25, 2015.
2. Yoga Journal releases 2012 yoga in America market study [press release]. San Francisco, CA: Yoga Journal; December 6, 2012.
3. De Michaelis E. A History of Modern Yoga: Patanjali and Western Esotericism. London, United Kingdom: A&C Black; 2005.
4. Telles S, Singh N, Yadav A, et al. Effect of yoga on different aspects of mental health. Indian J Physiol Pharmacol. 2012;56:245-254.
5. Rodriguez-Vallecillo E, Woodbury-Fariña MA. Dermatological manifestations of stress in normal and psychiatric populations. Psychiatr Clin North Am. 2014;37:625-651.
6. Stander S, Raap U, Weisshaar E, et al. Pathogenesis of pruritus. J Dtsch Dermatol Ges. 2011;9:456-463.
7. Arck PC, Slominski A, Theoharides TC, et al. Neuroimmunology of stress: skin takes center stage. J Invest Dermatol. 2006;126:1697-1704.
8. Recognizing the mind-skin connection. Harvard Health Publications Web site. http://www.health.harvard.edu/newsletter_article/Recognizing_the_mind-skin_connection. Published November 1, 2006. Accessed March 31, 2015.
9. Tausk F, Elenkov I, Moynihan J. Psychoneuroimmunology. Dermatol Ther. 2008;21:22-31.
10. Pavlovic S, Liezmann C, Blois SM, et al. Substance P is a key mediator of stress-induced protection from allergic sensitization via modified antigen presentation. J Immunol. 2011;186:848-855.
11. Toyoda M, Nakamura M, Makino T, et al. Nerve growth factor and substance P are useful plasma markers of disease activity in atopic dermatitis. Br J Dermatol. 2002;147:71-79.
12. Koo JYM, Lee CS. General approach to evaluating psychodermatological disorders. In: Koo JYM, Lee CS, eds. Psychocutaneous Medicine. New York, NY: Marcel Dekker; 2003:1-29.
13. Garg A, Chren MM, Sands LP, et al. Psychological stress perturbs epidermal permeability barrier homeostasis: implications for the pathogenesis of stress-associated skin disorders. Arch Dermatol. 2001;137:53-59.
14. Elias PM, Sun R, Eder AR, et al. Treating atopic dermatitis at the source: corrective barrier repair therapy based upon new pathogenic insights. Expert Rev Dermatol. 2013;8:27-36.
15. Morren MA, Przybilla B, Bamelis M, et al. Atopic dermatitis: triggering factors. J Am Acad Dermatol. 1994;31:467-473.
16. Faulstich ME, Williamson DA. An overview of atopic dermatitis: toward a bio-behavioural integration. J Psychosom Res. 1985;29:647-654.
17. Theoharides TC, Donelan JM, Papadopoulou N, et al. Mast cells as targets of corticotropin-releasing factor and related peptides. Trends Pharmacol Sci. 2004;25:563-568.
18. Suh DH, Kwon HH. What’s new in the physiopathology of acne [published online ahead of print Jan 24, 2015]? Br J Dermatol. doi:10.1111/bjd.13634.
19. Picardi A, Mazzotti E, Pasquini P. Prevalence and correlates of suicidal ideation among patients with skin disease. J Am Acad Dermatol. 2006;54:420-426.
20. Ponarovsky B, Amital D, Lazarov A, et al. Anxiety and depression in patients with allergic and non-allergic cutaneous disorders. Int J Dermatol. 2011;50:1217-1222.
21. Khalsa SB. Yoga as a therapeutic intervention: a bibliometric analysis of published research studies. Indian J Physiol Pharmacol. 2004;48:269-285.
22. Cramer H, Lauche R, Dobos G. Characteristics of randomized controlled trials of yoga: a bibliometric analysis. BMC Complement Altern Med. 2014;14:328.
23. Granath J, Ingvarsson S, von Thiele U, et al. Stress management: a randomized study of cognitive behavioural therapy and yoga. Cogn Behav Ther. 2006;35:3-10.
24. Carlson LE, Beattie TL, Giese-Davis J, et al. Mindfulness-based cancer recovery and supportive-expressive therapy maintain telomere length relative to controls in distressed breast cancer survivors. Cancer. 2015;121:476-484.
25. Kabat-Zinn J, Wheeler E, Light T, et al. Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosom Med. 1998;60:625-632.
26. Gisondi P, Galvan A, Idolazzi L, et al. Management of moderate to severe psoriasis in patients with metabolic comorbidities. Front Med (Lausanne). 2015;2:1.
1. Dangerfield A. Yoga wars. BBC News. http://news.bbc.co.uk/1/hi/7844691.stm. Published January 23, 2009. Accessed March 25, 2015.
2. Yoga Journal releases 2012 yoga in America market study [press release]. San Francisco, CA: Yoga Journal; December 6, 2012.
3. De Michaelis E. A History of Modern Yoga: Patanjali and Western Esotericism. London, United Kingdom: A&C Black; 2005.
4. Telles S, Singh N, Yadav A, et al. Effect of yoga on different aspects of mental health. Indian J Physiol Pharmacol. 2012;56:245-254.
5. Rodriguez-Vallecillo E, Woodbury-Fariña MA. Dermatological manifestations of stress in normal and psychiatric populations. Psychiatr Clin North Am. 2014;37:625-651.
6. Stander S, Raap U, Weisshaar E, et al. Pathogenesis of pruritus. J Dtsch Dermatol Ges. 2011;9:456-463.
7. Arck PC, Slominski A, Theoharides TC, et al. Neuroimmunology of stress: skin takes center stage. J Invest Dermatol. 2006;126:1697-1704.
8. Recognizing the mind-skin connection. Harvard Health Publications Web site. http://www.health.harvard.edu/newsletter_article/Recognizing_the_mind-skin_connection. Published November 1, 2006. Accessed March 31, 2015.
9. Tausk F, Elenkov I, Moynihan J. Psychoneuroimmunology. Dermatol Ther. 2008;21:22-31.
10. Pavlovic S, Liezmann C, Blois SM, et al. Substance P is a key mediator of stress-induced protection from allergic sensitization via modified antigen presentation. J Immunol. 2011;186:848-855.
11. Toyoda M, Nakamura M, Makino T, et al. Nerve growth factor and substance P are useful plasma markers of disease activity in atopic dermatitis. Br J Dermatol. 2002;147:71-79.
12. Koo JYM, Lee CS. General approach to evaluating psychodermatological disorders. In: Koo JYM, Lee CS, eds. Psychocutaneous Medicine. New York, NY: Marcel Dekker; 2003:1-29.
13. Garg A, Chren MM, Sands LP, et al. Psychological stress perturbs epidermal permeability barrier homeostasis: implications for the pathogenesis of stress-associated skin disorders. Arch Dermatol. 2001;137:53-59.
14. Elias PM, Sun R, Eder AR, et al. Treating atopic dermatitis at the source: corrective barrier repair therapy based upon new pathogenic insights. Expert Rev Dermatol. 2013;8:27-36.
15. Morren MA, Przybilla B, Bamelis M, et al. Atopic dermatitis: triggering factors. J Am Acad Dermatol. 1994;31:467-473.
16. Faulstich ME, Williamson DA. An overview of atopic dermatitis: toward a bio-behavioural integration. J Psychosom Res. 1985;29:647-654.
17. Theoharides TC, Donelan JM, Papadopoulou N, et al. Mast cells as targets of corticotropin-releasing factor and related peptides. Trends Pharmacol Sci. 2004;25:563-568.
18. Suh DH, Kwon HH. What’s new in the physiopathology of acne [published online ahead of print Jan 24, 2015]? Br J Dermatol. doi:10.1111/bjd.13634.
19. Picardi A, Mazzotti E, Pasquini P. Prevalence and correlates of suicidal ideation among patients with skin disease. J Am Acad Dermatol. 2006;54:420-426.
20. Ponarovsky B, Amital D, Lazarov A, et al. Anxiety and depression in patients with allergic and non-allergic cutaneous disorders. Int J Dermatol. 2011;50:1217-1222.
21. Khalsa SB. Yoga as a therapeutic intervention: a bibliometric analysis of published research studies. Indian J Physiol Pharmacol. 2004;48:269-285.
22. Cramer H, Lauche R, Dobos G. Characteristics of randomized controlled trials of yoga: a bibliometric analysis. BMC Complement Altern Med. 2014;14:328.
23. Granath J, Ingvarsson S, von Thiele U, et al. Stress management: a randomized study of cognitive behavioural therapy and yoga. Cogn Behav Ther. 2006;35:3-10.
24. Carlson LE, Beattie TL, Giese-Davis J, et al. Mindfulness-based cancer recovery and supportive-expressive therapy maintain telomere length relative to controls in distressed breast cancer survivors. Cancer. 2015;121:476-484.
25. Kabat-Zinn J, Wheeler E, Light T, et al. Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosom Med. 1998;60:625-632.
26. Gisondi P, Galvan A, Idolazzi L, et al. Management of moderate to severe psoriasis in patients with metabolic comorbidities. Front Med (Lausanne). 2015;2:1.
To Stop or Not to Stop
With the advent of biologic therapies, there has been debate about the necessity to stop these therapies prior to elective surgery. The concern has been that there might be an increased risk for perioperative infections in the presence of these agents. Several current guidelines of care recommend a planned break from biologic therapy in patients undergoing major surgical procedures; for example, the British Association of Dermatologists and the British Society for Rheumatology recommend stopping biologics for at least 4 half-lives before surgery.
Bakkour et al published a study online on March 2 in the Journal of the European Academy of Dermatology and Venereology that audited the management of biologic therapy perioperatively in a tertiary referral psoriasis clinic against guidelines of care. In addition, they investigated the effects of continuing and stopping biologic therapy in psoriasis and psoriatic arthritis patients. Information was collected on the biologics used, whether they were held perioperatively, and whether patients developed postoperative complications and/or disease flare.
The authors identified 42 patients who had a total of 77 procedures performed. Procedures included cutaneous surgery, orthopedic procedures, and cardiothoracic surgery. Biologic therapy was continued in 76% of procedures. Comparing those who continued with those who stopped biologic therapy, there was no significant difference in postoperative risk for infection and delayed wound healing. This finding included patients who underwent major surgery. Interestingly, the interruption of biologic therapy perioperatively was associated with a significant (P=.003) risk for flare of psoriasis or psoriatic arthritis.
What’s the issue?
The authors concluded that continuing biologic therapy did not increase the risk for postoperative complications. However, stopping biologic therapy perioperatively significantly increased the risk for disease flare.
Although this study was small, it shed light on an issue of great interest in the use of biologic therapy. It showed that there is a potential downside to stopping these agents before surgery. Further data are needed to fully elucidate the proper management in these cases.
With the advent of biologic therapies, there has been debate about the necessity to stop these therapies prior to elective surgery. The concern has been that there might be an increased risk for perioperative infections in the presence of these agents. Several current guidelines of care recommend a planned break from biologic therapy in patients undergoing major surgical procedures; for example, the British Association of Dermatologists and the British Society for Rheumatology recommend stopping biologics for at least 4 half-lives before surgery.
Bakkour et al published a study online on March 2 in the Journal of the European Academy of Dermatology and Venereology that audited the management of biologic therapy perioperatively in a tertiary referral psoriasis clinic against guidelines of care. In addition, they investigated the effects of continuing and stopping biologic therapy in psoriasis and psoriatic arthritis patients. Information was collected on the biologics used, whether they were held perioperatively, and whether patients developed postoperative complications and/or disease flare.
The authors identified 42 patients who had a total of 77 procedures performed. Procedures included cutaneous surgery, orthopedic procedures, and cardiothoracic surgery. Biologic therapy was continued in 76% of procedures. Comparing those who continued with those who stopped biologic therapy, there was no significant difference in postoperative risk for infection and delayed wound healing. This finding included patients who underwent major surgery. Interestingly, the interruption of biologic therapy perioperatively was associated with a significant (P=.003) risk for flare of psoriasis or psoriatic arthritis.
What’s the issue?
The authors concluded that continuing biologic therapy did not increase the risk for postoperative complications. However, stopping biologic therapy perioperatively significantly increased the risk for disease flare.
Although this study was small, it shed light on an issue of great interest in the use of biologic therapy. It showed that there is a potential downside to stopping these agents before surgery. Further data are needed to fully elucidate the proper management in these cases.
With the advent of biologic therapies, there has been debate about the necessity to stop these therapies prior to elective surgery. The concern has been that there might be an increased risk for perioperative infections in the presence of these agents. Several current guidelines of care recommend a planned break from biologic therapy in patients undergoing major surgical procedures; for example, the British Association of Dermatologists and the British Society for Rheumatology recommend stopping biologics for at least 4 half-lives before surgery.
Bakkour et al published a study online on March 2 in the Journal of the European Academy of Dermatology and Venereology that audited the management of biologic therapy perioperatively in a tertiary referral psoriasis clinic against guidelines of care. In addition, they investigated the effects of continuing and stopping biologic therapy in psoriasis and psoriatic arthritis patients. Information was collected on the biologics used, whether they were held perioperatively, and whether patients developed postoperative complications and/or disease flare.
The authors identified 42 patients who had a total of 77 procedures performed. Procedures included cutaneous surgery, orthopedic procedures, and cardiothoracic surgery. Biologic therapy was continued in 76% of procedures. Comparing those who continued with those who stopped biologic therapy, there was no significant difference in postoperative risk for infection and delayed wound healing. This finding included patients who underwent major surgery. Interestingly, the interruption of biologic therapy perioperatively was associated with a significant (P=.003) risk for flare of psoriasis or psoriatic arthritis.
What’s the issue?
The authors concluded that continuing biologic therapy did not increase the risk for postoperative complications. However, stopping biologic therapy perioperatively significantly increased the risk for disease flare.
Although this study was small, it shed light on an issue of great interest in the use of biologic therapy. It showed that there is a potential downside to stopping these agents before surgery. Further data are needed to fully elucidate the proper management in these cases.
