SPIN2019

Conference summaries


INFLAMMATORY SKIN DISEASES

Epidemiology of major inflammatory skin diseases 2019

Presented by: Luigi Naldi, MD
Department of Dermatology, AULSS 8, San Bartolo Hospital, Vicenza, Italy
  • Major inflammatory skin diseases, when considered together, are the 4th highest ranking global disease in terms of years lived with disability.
  • Dermatologists should be more active in global health issues, such as obesity, air pollution climate change and social stigma, with epidemiological studies defining their impact and providing the base for protection strategies development.
  • The comparison of skin disorders with other conditions, the global representation of skin disorder, and the need to improve the weight of the disability, in terms of common metrics but also the social, including the social disability of skin conditions globally.
  • How we should deal with epidemiology with emerging health issues, including obesity.
  • Low back pain, although not a specific diagnosis, can be considered an epidemic. It is estimated to affect between 65 to 80% of the population at some stage during their lives, and has a large impact on life quality. Do we have anything similar in Dermatology?
  • In a European prevalence study, mainly focusing on contact allergy to fragrance but also including several other skin disorders [1], studied the prevalence of itching skin rash (lasting more than 3 days) not justifiable by infection [2]. This condition was found to be very prevalent in the population (51.7%), and is only sometimes linked with eczema or dermatitis (22%) or product use (31.3%). However, despite this high prevalence of skin related conditions, compared to back pain, there are definitely fewer publications dedicated to pruritus and itching in PubMed.
  • Inflammatory bowel disease (IBS), chronic digestive disease affecting five million people world-wide, is on the increase. These diseases have a functional pathway, where the diagnostic process and progression of symptoms are similar.
  • Chronic inflammatory skin diseases have many similarities to IBS and a similar unifying functional model could be applied. The proposed model divides the chronic inflammatory skin disease according to bullous and non bullous (or nodular and non-nodular) despite common symptoms (itching skin, disability, stigmatization and co-morbidities). Both groups then have the same outcome of skin failure. This proposal groups skin conditions in a harmonised and uniform way, distinguishing them from other skin conditions (such as acne, wart, urticaria etc.). This is especially important in a growing competition of providing data regarding the condition to be treated.
  • The Global Burden of Disease is an initiative supported by the Bill Gates Foundation and Washington University [3] with the aim of collecting information world-wide regarding prevalence and risk factors of any human disorder with metrics of mortality and disability adjusted life years (DALY).
  • There have been several publications [4] and skin disorders have been categorized vaguely, suggesting that there is a low understanding of what skin disorders are.
  • However, specific studies dedicated to skin disorders [5] excluding melanoma, sexually transmitted diseases and rheumatologic conditions relevant to skin manifestations, rank 4th in terms of years lived with disability (YLD) when considered collectively. Interestingly, the disability indexes do not include stigma, and this is a significant aspect of the daily struggle associated with living with a skin condition.
  • Obesity is now a global epidemic, and a greater body mass index among psoriasis patients compared to the healthy population, has been proven [6].
    • In a randomized control trial in 300 psoriasis overweight or obese patients, diet and physical exercise was shown to alleviate psoriasis symptoms over a 20-week period, according to PASI scores [7].
    • The incidence of psoriasis is increasing and a possible explanation for this may be environmental, such as diet and obesity.
    • An association between atopic dermatitis and overweight/obesity has also been proven [8] and dermatologists need to play an active part in fighting these epidemics.
  • Pollution and global climate change are unknown risk factors that need to be investigated.
    • We know that smoking (individual exposure) is associated with psoriasis but we don’t know much about air pollution and its association with skin conditions
    •  This impact has been documented through the biological impact [9] but not through the impact in terms of disease epidemiology.
    • Additionally, apart from UV light exposure or the hole in the ozone layer, we don’t know anything about climate change and its impact on skin disorders [10].
  • Finally, there is a global disequality for psoriasis treatment access, with a statistically significant higher chance of a patient receiving anti-TNF treatment with tertiary level education or a higher-ranking occupation, compared to a non-tertiary educated, manual occupation patients.
    • These outcomes are despite a higher baseline PASI among the lower educated psoriasis population [11].
    • There is clearly an inequity in terms of care provisions.
  • There is limited data to attest the level of impact of global health issues on skin, such as obesity and air pollution, and the social processes to the reactions to skin disorders, such as stigmatization.
  • Epidemiological studies are required to quantify the deleterious effects of ambient pollution exposure for the development of protection strategies, and disability indexes should be defined to capture stigmatizing processes.
  • Finally, dermatologists should be more active in global health issues.
  • Low back pain, although not a specific diagnosis, can be considered an epidemic. It is estimated to affect between 65 to 80% of the population at some stage during their lives, and has a large impact on life quality. Do we have anything similar in Dermatology?
  • In a European prevalence study, mainly focusing on contact allergy to fragrance but also including several other skin disorders [1], studied the prevalence of itching skin rash (lasting more than 3 days) not justifiable by infection [2]. This condition was found to be very prevalent in the population (51.7%), and is only sometimes linked with eczema or dermatitis (22%) or product use (31.3%). However, despite this high prevalence of skin related conditions, compared to back pain, there are definitely fewer publications dedicated to pruritus and itching in PubMed.
  • Inflammatory bowel disease (IBS), chronic digestive disease affecting five million people world-wide, is on the increase. These diseases have a functional pathway, where the diagnostic process and progression of symptoms are similar.
  • Chronic inflammatory skin diseases have many similarities to IBS and a similar unifying functional model could be applied. The proposed model divides the chronic inflammatory skin disease according to bullous and non bullous (or nodular and non-nodular) despite common symptoms (itching skin, disability, stigmatization and co-morbidities). Both groups then have the same outcome of skin failure. This proposal groups skin conditions in a harmonised and uniform way, distinguishing them from other skin conditions (such as acne, wart, urticaria etc.). This is especially important in a growing competition of providing data regarding the condition to be treated.
  • The Global Burden of Disease is an initiative supported by the Bill Gates Foundation and Washington University [3] with the aim of collecting information world-wide regarding prevalence and risk factors of any human disorder with metrics of mortality and disability adjusted life years (DALY).
  • There have been several publications [4] and skin disorders have been categorized vaguely, suggesting that there is a low understanding of what skin disorders are.
  • However, specific studies dedicated to skin disorders [5] excluding melanoma, sexually transmitted diseases and rheumatologic conditions relevant to skin manifestations, rank 4th in terms of years lived with disability (YLD) when considered collectively. Interestingly, the disability indexes do not include stigma, and this is a significant aspect of the daily struggle associated with living with a skin condition.
  • Obesity is now a global epidemic, and a greater body mass index among psoriasis patients compared to the healthy population, has been proven [6].
    • In a randomized control trial in 300 psoriasis overweight or obese patients, diet and physical exercise was shown to alleviate psoriasis symptoms over a 20-week period, according to PASI scores [7].
    • The incidence of psoriasis is increasing and a possible explanation for this may be environmental, such as diet and obesity.
    • An association between atopic dermatitis and overweight/obesity has also been proven [8] and dermatologists need to play an active part in fighting these epidemics.
  • Pollution and global climate change are unknown risk factors that need to be investigated.
    • We know that smoking (individual exposure) is associated with psoriasis but we don’t know much about air pollution and its association with skin conditions
    •  This impact has been documented through the biological impact [9] but not through the impact in terms of disease epidemiology.
    • Additionally, apart from UV light exposure or the hole in the ozone layer, we don’t know anything about climate change and its impact on skin disorders [10].
  • Finally, there is a global disequality for psoriasis treatment access, with a statistically significant higher chance of a patient receiving anti-TNF treatment with tertiary level education or a higher-ranking occupation, compared to a non-tertiary educated, manual occupation patients.
    • These outcomes are despite a higher baseline PASI among the lower educated psoriasis population [11].
    • There is clearly an inequity in terms of care provisions.

Key messages/clinical perspectives

  • There is limited data to attest the level of impact of global health issues on skin, such as obesity and air pollution, and the social processes to the reactions to skin disorders, such as stigmatization.
  • Epidemiological studies are required to quantify the deleterious effects of ambient pollution exposure for the development of protection strategies, and disability indexes should be defined to capture stigmatizing processes.
  • Finally, dermatologists should be more active in global health issues.


References

References


  1. Rossi M, Coenraads P, Diepgen T, et al. Design and Feasibility of an International Study Assessing the Prevalence of Contact Allergy to Fragrances in the General Population: The European Dermato-Epidemiology Network Fragrance Study. Dermatology. 2010;221:267-75
  2. Naldi L, Cazzaniga S, Gonçalo M, Det al.; EDEN Fragrance Study Group. Prevalence of self-reported skin complaints and avoidance of common daily life consumer products in selected European Regions. JAMA Dermatol. 2014;150(2):154-63
  3.  http://www.healthdata.org/gbd
  4. Lim SS, Vos T, Flaxman AD, Danaei G, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2224-60
  5. Hay RJ, Johns NE, Williams HC, et al. The Global Burden of skin disease in 2010: An analysis of the prevalence and impact of skin conditions. J Invest Dermatol. 2014;134:1527-34
  6. Armstrong AW, Harskamp CT, Armstrong EJ. The association between psoriasis and obesity: a systematic review and meta-analysis of observational studies. Nutr Diabetes. 2012;3;2:e54
  7. Naldi L, Conti A, Cazzaniga S, et al; Psoriasis Emilia Romagna Study Group. Diet and physical exercise in psoriasis: a randomized controlled trial. Br J Dermatol. 2014;170:634-42
  8. Zhang A, Silverberg JI. Association of atopic dermatitis with being overweight and obese: a systematic review and metaanalysis. J Am Acad Dermatol. 2015;72:606-16
  9. Kabashima K, Otsuka A, Nomura T. Linking air pollution to atopic dermatitis. Nat Immunol. 2016;18:5-6
  10. Coates SJ, McCalmont TH, Williams ML. Adapting to the Effects of Climate Change in the Practice of Dermatology-A Call to Action. JAMA Dermatol. 2019 Mar 2. [Epub ahead of print]
  11. Naldi L, Cazzaniga S, Di Mercurio M, et al.; Psocare study centres. Inequalities in access to biological treatments for psoriasis: results from the Italian Psocare registry. Br J Dermatol. 2017;176:1331-8

Presenter disclosure(s): [none provided]

Written by: Johanna Chester, BA

Reviewed by: Martina Lambertini, MD


All report

Welcome to the SPIN 2019 Highlights

Jo Lambert, MD, PhD

With this collection of summaries from selected presentations at SPIN 2019, and interviews with international experts, we hope to share with you some of the highlights of this year’s congress. The international network met … [ Read all ]

SUMMARIES

ATOPIC DERMATITIS & PSORIASIS

Atopic dermatitis and psoriasis: On a spectrum?

Presented by: Emma Guttman-Yassky, MD, PhD

INFLAMMATORY SKIN DISEASES

PSORIASIS

Which drug for which patient?

Presented by: Emilie Sbidian, MD, PhD

PSORIASIS

Effects of biotherapy on vascular disease in psoriasis

Presented by: Nehal N. Mehta, MD, MSCE, FAHA

SYSTEMIC THERAPIES

Classical systemic therapies – Methotrexate

Presented by: Rolland Gyulai, MD, PhD, DSc

SMALL MOLECULES

Small molecules, apremilast, and beyond

Presented by: Richard G.B. Langley, MD

PSORIASIS

Treatment goals in psoriasis

Presented by: Ulrich Mrowietz, MD

PSORIASIS

Combined therapy in psoriasis

Presented by: Pablo Coto-Segura, MD, PhD

MEASURING OUTCOMES

PSORIASIS & ADHERENCE

How can we support optimal medication adherence?

Presented by: Rachael Thorneloe, MD