Prenatal, infantile, and childhood tobacco exposure and risk of pediatric psoriasis in the Danish National Birth Cohort offspring.

BACKGROUND: Tobacco smoking is implicated in psoriasis among adults. OBJECTIVE: To determine whether prenatal, infantile, and childhood tobacco exposure increase risk of pediatric psoriasis. METHODS: Data from Danish National Birth Cohort participants were collected at approximately gestational week 12 and when the children were approximately 6 months and 11 years of age. In total, 25 812 offspring with complete data from the Danish National Birth Cohort were included. We estimated the odds of pediatric psoriasis with tobacco exposure prenatally, from birth to age 6 months (early infancy), and at age 11 years (childhood). RESULTS: We observed an increased risk of pediatric psoriasis among offspring with prenatal tobacco exposure (adjusted odds ratio [OR], 1.39; 95% confidence interval [CI], 1.06-1.82). An exposure-response relationship was observed for increasing quantities of cigarettes smoked daily (≥16 cigarettes: adjusted OR, 2.92; 95% CI, 1.20-7.10; P for trend = .038). The associations with infantile (adjusted OR, 1.17; 95% CI, 0.76-1.79) and childhood (adjusted OR, 1.10; 95% CI, 0.77-1.58) tobacco exposure were attenuated after controlling for prenatal exposure. LIMITATIONS: Outcome status was maternally reported. CONCLUSIONS: Prenatal tobacco exposure may increase the risk of pediatric psoriasis in a monotonic fashion, indicating that smoking may play a causal role in psoriasis pathogenesis.

Tonsillitis and pediatric psoriasis: Cohort and cross-sectional analyses of offspring from the Danish National Birth Cohort.

BACKGROUND: Streptococcal tonsillitis has been implicated in psoriasis; however, few population studies have examined its role in the pediatric population. OBJECTIVE: To investigate the association between tonsillitis and pediatric psoriasis. METHODS: Data from the Danish National Birth Cohort were obtained on parentally reported psoriasis by age 11 years and history of tonsillitis at ages 6 to 18 months, 10 to 11 years, and (from hospital patient registry data) 0 to 11 years. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) of pediatric psoriasis using logistic regression analyses. RESULTS: In total, 35 188 offspring were eligible for analyses. Tonsillitis at 6 to 18 months was not associated with pediatric psoriasis (adjusted OR, 0.73; 95% CI, 0.47-1.14), nor was recent tonsillitis at ages 10 to 11 years (adjusted OR, 1.09; 95% CI, 0.81-1.47). However, recurrent tonsillitis between ages 10 to 11 was strongly associated with pediatric psoriasis (adjusted OR, 2.28; 95% CI, 1.17-4.48). Our results for streptococcal tonsillitis indicated a potential association (adjusted OR, 2.12; 95% CI, 0.86-5.17). LIMITATIONS: It was not possible to clarify the temporal relationship between tonsillitis and pediatric psoriasis. CONCLUSION: Recurrent tonsillitis is of clinical relevance to pediatric psoriasis.

Cohort profile: the clinical 'Psoriasis in Adolescents' (PIA) cohort in Denmark.

PURPOSE: Psoriasis is a chronic inflammatory skin disease that frequently debuts in childhood and adolescence. We wished to determine environmental and genetic risk factors for the development of psoriasis in children and adolescents, as well as to investigate debut type, trigger factors, course of disease, nature and influence of stress related to both child and family and risk factors for comorbidity. The 'Psoriasis in Adolescents' (PIA) cohort will provide data on the relationship between psoriasis and, respectively, genetic disposition, early-life exposures, quality of life and comorbidity. PARTICIPANTS: The PIA cohort is nested in the large general population Danish National Birth Cohort (DNBC). We invited 390 adolescents with psoriasis and corresponding maternally predisposed and non-predisposed controls. Participants underwent an interview and a clinical examination consisting of a skin inspection and physical measurements including blood sampling and microbiological swabs. Additionally, four self-administered questionnaires on physical and mental health were completed. FINDINGS TO DATE: The final PIA cohort consists of 81 adolescents with psoriasis, 110 parentally predisposed and 124 non-predisposed psoriasis-free adolescents. The validity of the maternally reported psoriasis status from the DNBC was found to be low on clinical examination (47.5%). In contrast, the self-reported psoriasis status of the DNBC mothers was clinically confirmed in 80.8% of the cases. FUTURE PLANS: The PIA cohort offers the possibility of assessing the clinical characteristics, course of psoriasis and development of comorbidities in adolescents with clinically confirmed disease from a general population. Comparison with predisposed and non-predisposed controls is possible and genetic analyses are scheduled. We plan to invite the participants for a follow-up in 5-10 years. Furthermore, we plan to include newly diagnosed adolescents with psoriasis from the 18-year DNBC follow-up. All information is linkable on the individual level with data from the DNBC and nationwide registries in Denmark.

Psoriasis as a Predictor of Cardiometabolic Comorbidity in Women: A Study Based on the Danish National Birth Cohort.

Psoriasis is associated with cardiometabolic comorbidity; however, whether this is due to common lifestyle-related risk factors is unclear. This study investigated the association between psoriasis and cardiometabolic comorbidity, taking body mass index and smoking into account. The population comprised expectant mothers in the Danish National Birth Cohort (established 1996-2002). During pregnancy, the women were asked about physician-diagnosed psoriasis. Any association with self-reported cardiometabolic comorbidity 11 years later was assessed using logistic regression. The cohort was also followed up for hospital-diagnosed comorbidity, including cardiac death, until 31 December 2014, and the risk was assessed using Cox regression. A total of 2,435 women with psoriasis (2.90%) and 81,388 women without were identified. Psoriasis was significantly associated with self-reported hypercholesterolaemia (adjusted odds ratio 1.31; 1.01-1.70) and hospital-diagnosed hypertension (adjusted hazard ratio 1.33; 1.08-1.65). Women with psoriasis have an increased risk of developing cardiometabolic comorbidity in early adult life.

Ixekizumab for the treatment of psoriasis: an update on new data since first approval.

Introduction: Psoriasis is a chronic immune-mediated skin disease with a multifactorial etiology. Studies have shown that the inflammatory cytokine interleukin-17A (IL-17A) is a key mediator in the pathogenesis. Targeted biologics have changed the outcome for patients in a variety of diseases including psoriasis. Ixekizumab is a humanized monoclonal antibody directed against IL-17A and it has been approved for the treatment of moderate-to-severe plaque psoriasis, and recently also psoriatic arthritis. Areas covered: In this review, we summarize the latest clinical study results on ixekizumab. Long-term Phase III study data on efficacy and safety are now available for both plaque psoriasis and psoriatic arthritis. Additionally, new indications for ixekizumab are under investigation. Expert commentary: Overall, the efficacy and safety of ixekizumab are promising. In plaque psoriasis, the efficacy of ixekizumab was superior to etanercept and ustekinumab, while the efficacy was comparable to adalimumab in psoriatic arthritis. The safety profile has also been found very tolerable and similar to other biologics; however, vigilance regarding non-invasive Candida infections is necessary. Also, caution is advised when treating patients with concomitant inflammatory bowel disease, since ixekizumab could cause exacerbations. Long-term studies in real-life treatment settings are needed to decide the actual potential and safety of ixekizumab.

Autoimmune Disease in Children and Adolescents with Psoriasis: A Cross-sectional Study in Denmark.

Psoriasis is an immune-mediated inflammatory disease, which, in studies among adults, have been shown to cluster with autoimmune disease. The aim of this cross-sectional register study was to examine possible associations between 9 pre-selected autoimmune diseases and psoriasis in children and adolescents. The study population consisted of all individuals living in Denmark, age under 18 years on 31 December 2012. A total of 1,925 children and adolescents with psoriasis and 1,194,712 without psoriasis were identified. Psoriatic arthritis (adjusted odds ratio (OR) 10.08; 7.97-12.74), rheumatoid arthritis (adjusted OR 6.61; 2.75-15.87) and vitiligo (adjusted OR 4.76; 1.71-13.20) showed strong associations with psoriasis. In addition to increased risk of selected autoimmune diseases, the presence of psoriasis was associated with increased risk of multiple concurrent autoimmune diseases compared with children and adolescents with-out psoriasis. Clinicians should be aware of extracutaneous symptoms when treating children and adole-scents with psoriasis.