Tuesday, 27 June 2017

A Case of Remitting Psoriasis in Association with Hyperthyroidism in a Morbidly Obese Iraqi Female


Psoriasis is a chronic and a very common papulosquamous skin pathology; it affects more than three percent of the population in the United States. Although it occurs in all age groups, it primarily affects adults with a bimodal peak of age at the 3rd and 6th decades of life. It almost equally affects males and females. Psoriasis prevalence is variable across the globe. Therefore, the worldwide incidence and prevalence of psoriasis are poorly understood. Parisi et al. In their systematic review, concluded that the prevalence in children ranged from 0% in Taiwan to 2.1% in Italy, while varied in adults from 0.91% to 8.5% in the United States and Norway respectively. Data indicated that psoriasis varied according to age and geographic region, being more frequent in countries that are located far away from the equator. Prevalence estimates also varied in relation to demographics. Psoriasis can be very crippling, affecting other body systems, including the musculoskeletal system in the form of psoriatic arthritis (PsA) to be specific, and the cardiovascular system.

The Quality of Life (QoL) can be affected, not only by the feeling of embarrassment and shame, and social isolation and withdrawal but also as a result of the involvement of other body systems as aforementioned. Prey et al. In their systematic review, revealed that PsA could affect up to 24% of psoriasis patients. PsA may even predate the cutaneous involvement. In relation to the cardiovascular system, Miller et al. In their meta-analysis, indicated that psoriasis patients are at a significantly higher risk, to develop hypertension, both systolic and diastolic, higher lipid profile especially Low-Density Lipoprotein Cholesterol and Triglycerides. Additionally, such patients have natural propensity to be obese and to have a higher blood glucose levels and higher HbA1c. Another systematic review and meta-analysis in 2013, reported that the relative risks of cardiovascular diseases (CVD) were highest in the younger patients, and patients with severe psoriasis, while absolute risks were greatest in older individuals with severe psoriasis. In relation to morbid obesity, both overweight and obesity, are associated with the incidence of multiple other co-morbidities including type-2 diabetes, cancer and CVD. Furthermore, psoriasis also serves as an independent risk factor for CVD. Systemic therapies for moderate to severe psoriasis also potentiate the cardiovascular risk and CVD.

Consequently, the QoL of patients with psoriasis will be jeopardised. De Korte and colleagues, clarified that more severe psoriasis was associated with lower levels of quality of life. There was a tendency that older patients had slightly lower levels of physical functioning. These studies were based on multiple QoL indices including DLQI Dermatology Life Quality Index (DLQI), Psoriasis Disability Index (PDI), SF-36MOS 36- Item Short-Form Health Survey SF-36, and Sickness Impact Profile (SIP).Furthermore, stress is not only inducible by psoriasis, but psoriasis is frequently triggered by a stressful and/or a traumatic psychologic event, as in post-traumatic stress disorder (PTSD). Neria et al. In their systematic review on PTSD, revealed that PTSD is associated with a range of predisposing factors and correlates, including demographic variables, socioeconomics, event exposure characteristics, social factors and personality traits 

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