乌鸦传媒

Skin health is closely associated with overall quality of life, mental health, and risk of death, three studies appearing in the Journal of the American Academy of Dermatology showed:

• In a , researchers found a bidirectional relationship between major depression and vitiligo, such that having either one increased the risk for developing the other. For example, those with major depressive disorder (MDD) were at 64% greater risk for vitiligo (P<0.0001) when compared to the general population, reported Isabelle Vallerand, PhD, of the University of Calgary in Alberta, Canada, and colleagues.
• A found impaired quality of life among parents of children with alopecia, especially for older children and those with more severe disease.
• And a indicated that psoriasis is related to a greater risk of death.

Depression, Vitiligo Intertwined

Vallerand and colleagues also found that patients with vitiligo were at increased risk for MDD, with hazard ratios of 1.31 for those age 30 and older (P<0.0001) and 1.22 for those younger than 30 (P=0.001), compared with non-vitiligo patients.

"Clinicians involved in the care of patients with vitiligo and other dermatologic conditions should be aware of the strong link with MDD and initiate treatment with mental health professionals when needed," the investigators wrote.

Clinicians have long known that vitiligo patients might have MDD, noted Tiffany Mayo, MD, of the University of Alabama at Birmingham, who was not involved in the study.

The present study "demonstrates that the relationship between the two may be quite more complex. It highlights that the two conditions actually share common inflammatory patterns linking the pathogenesis of one to the other. So patients with MDD are actually at increased risk of suffering from vitiligo and treating MDD may reduce the risk of developing vitiligo," Mayo told 乌鸦传媒.

Moreover, this paper has several clinical implications, emphasized Rajani Katta, MD, of McGovern Medical School at UTHealth in Houston, who was not involved in the study. "While this risk is higher for those under age 30, it does impact all age groups, and clinicians should be screening for MDD in patients with vitiligo, and referring appropriately," Katta told 乌鸦传媒.

"Second, for clinicians who treat patients with MDD, it is important to recognize the possibility that these patients may be at higher risk for autoimmune conditions, which may encompass vitiligo. An important finding in the study was that the use of antidepressants reduced the risk of new-onset vitiligo, which provides additional justification for clinicians to focus on accurate diagnosis and treatment of MDD," she continued.

Data for the study came from covering some 12 million individuals with follow-up from 1986 to 2012.

There were 405,397 patients in the MDD cohort, median age 37 and about two-thirds women, along with 5.5 million non-depressed individuals (median age 36, 51% women) who served as the reference population.

Also analyzed were 7,104 vitiligo patients (median age 38, 55% women) and some 6 million non-vitiligo patients (median age 40, 52% women).

"Future research should be done to determine the impact that mental health treatments, such as antidepressants, have on remission and recurrences of autoimmune dermatologic conditions and identify the underlying mechanism of action," Vallerand and colleagues concluded.

QoL in Alopecia-Affected Families

Statistically significant negative relationships were reported between the Severity of Alopecia Tool (SALT) scores and Quality of Life in a Child's Chronic Disease Questionnaire (QLCCDQ) emotional domain scores (Spearman ρ= -0.32, P<0.001), and SALT scores and QLCCDQ per-item scores (Spearman ρ= -0.28, P<.001). A statistically significant positive relationship was found between SALT scores and Family Dermatology Life Quality Index (FDLQI) scores (Spearman ρ=0.29, P<0.001), according to Leslie Castelo-Soccio, MD, PhD, of the Children's Hospital of Philadelphia, and colleagues.

The child's age was negatively correlated with QLCCDQ emotional domain (Spearman ρ=-0.18, P<0.030) and per-item scores (Spearman ρ=-0.27, P<0.001). But there was no relationship between FDLQI and age (Spearman ρ= -0.03, P=0.723), the researchers reported.

Duration of disease demonstrated no significant correlation with either average per-item QLCCDQ scores (Spearman ρ=-0.15, P=0.064) or overall FDLQI scores (Spearman ρ=0.06, P=0.459), and a significant negative correlation with QLCCDQ emotional domain scores (Spearman ρ=-0.16, P=0.049), they added.

The clinical implications of this investigation are "far-reaching," the investigators noted. "It is crucial for providers to be aware that the severity of disease predicts parental QoL [quality of life] impairment, but only to some extent, so that we are careful not to neglect the counseling and education that is warranted in families facing milder disease in addition to those dealing with severe disease."

The researchers also point out that taking into consideration that "the greatest impairment in parents' QoL is emotional should inform patient encounters and prompt providers to tailor counseling accordingly. Such adjustments during clinic visits could include asking parents about how the disease has affected them and providing coping strategies such as support group information or additional educational resources."

Finally, "the finding that parents might experience greater impairment in overall wellbeing as children age can be used to help parents set realistic expectations for long-term prognosis and course of the disease," the researchers continued.

Commenting on the paper, Marc Glashofer, MD, MS, of The Dermatology Group in West Orange, New Jersey, noted that clinicians specializing in this condition need to understand that they're counseling patients, and there isn't one definitive treatment that consistently helps all patients.

"It's actually nothing that's FDA approved right now. So when we talk about treatment of a condition, like this is a psychosocial condition, part of it involves acceptance and therapy and counseling for building up the patient's confidence and expressing their concerns and why they look different and how to sort of build up your confidence about your uniqueness," Glashofer told 乌鸦传媒.

Clinicians should not only talk to the patients, but their families and parents, emphasized Glashofer.

The investigators assessed 153 pediatric alopecia (areata, totalis, and universalis) patients with a female-to-male ratio of 1.3:1 and a mean patient age of 11 years. Patients had a mean SALT score of 38.2. Most of the parents providing information were the children's mothers.

The investigators noted limitations including the cross-sectional design, small sample size, and potentially significant risk factors unaddressed.

"Further parent-centered QoL research is needed, given that caregiver QoL and perception of a child's symptoms play an important role in controlling chronic disease in children," the researchers wrote.

Psoriasis Tied to Early Mortality

For all-cause mortality, the pooled relative risks (RRs) were 1.52 (95% CI 1.35-1.71) in severe psoriasis, 1.13 (95% CI 1.09-1.16) in mild psoriasis, and 1.21 (95% CI 1.14-1.28) in psoriasis, reported Ashar Dhana, MBBCh, MPH, of the University of Cape Town in South Africa, and colleagues from their meta-analysis.

For cardiovascular mortality, the pooled RRs were 1.38 (95% CI 1.09-1.74) in severe psoriasis, 1.05 (95% CI 0.92-1.20) in mild psoriasis, and 1.15 (95% CI 1.09-1.21) in psoriasis, the researchers found.

The researchers evaluated 12 studies performed in seven countries including the U.S., Finland, the U.K., Denmark, Sweden, Taiwan, and Argentina. The percentage of female patients ranged from 4.5% to 54.5%, and the mean age of the psoriasis patients varied from 43.6 to 67.9 years.

"Our findings suggest that psoriasis patients, particularly those with risk factors and severe disease, should receive appropriate screening and preventative interventions," the researchers wrote.

Looking ahead, more research is warranted to evaluate "the effect of psoriasis on mortality independent of mortality risk factors, to clarify cause-specific mortality in psoriasis patients, and to determine the mechanisms underlying excess mortality," the investigators concluded.