PracticeUpdate: Dermatology - Vol 1 - No.1 - 2017

GENERAL DERMATOLOGY 20

Depression associated with increased risk of psoriatic arthritis among patients with psoriasis Take-home message • Given that major depressive disorder (MDD) has been associated with increased systemic inflammation, this study investigated whether patients who develop MDD are at increased risk of psoriatic arthritis (PsA) by following 73,337 individuals with psoriasis for up to 25 years until the development of PsA. Patients with psoriasis who developed MDD were at significantly increased risk of subsequently developing PsA compared with patients who did not develop MDD, even after adjusting for multiple factors (HR, 1.37; P=0.021). • These data suggest that depression may be associated with increased risk of developing PsA among patients with psoriasis. Patients with psoriasis may benefit from heightened prevention and management of depression. Journal of Investigative Dermatology

Wound healing through topical approaches to improve surgical outcomes Take-home message • In this review article, little evidence was found to support the use of empiric topical antibiotics to pre- vent infection in clean postsurgical wounds. Additionally, topical anti- biotics often cause irritant and allergic contact dermatitis. • The authors suggest hypochlorous acid as an alternative to chlorhex- idine due to its lower risk of side effects. Abstract Surgical procedures are an important piece of a dermatologist’s daily practice. There- fore, the optimization of post-surgical wound healing is an area of utmost importance and interest. Although low risk, one notable bar- rier to proper wound healing is surgical site infection. In an attempt to mitigate this risk and improve surgical outcomes, multiple topical products continue to be used both pre- and postproce- dure. Traditionally, this includes both topical antibiotics and antiseptics. However, these products are not without consequence. The overuse of topical antibiotics as prophy- laxis for infection has contributed to increased bacterial resistance, and in fact is no longer recommended by the American Academy of Dermatology in clean post surgical wounds. Topical antiseptics, including chlorhexidine and povidone-iodine, can have a cytotoxic effect on keratinocytes and may actually impede wound healing as a result. In addi- tion, chlorhexidine in particular can produce both otologic and ocular toxic effects when used on the face. Emerging products, such as hypochlorous acid, may be a potential alter- native to the more commonly used agents, as it has effective antimicrobial actions and minimal adverse effects. Therefore, the pur- pose of this review is to highlight several topical products used to optimize post-sur- gical wound healing and discuss both their efficacy and safety. Topical approaches to improve surgical outcomes and wound healing: a review of efficacy and safety. J Drugs Dermatol 2017 Mar 01;16(3)209-212, K Totoraitis, JL Cohen, A Friedman. Journal of Drugs in Dermatology

models showed that patients with psoriasis who developed MDD were at significantly increased risk of subsequently developing PsA compared with patients who did not develop MDD, even after accounting for numerous covariates (haz- ard ratio 1.37, 95% confidence interval 1.05–1.80, P = 0.021). This result was maintained through numerous sensitivity analyses. These data sup- port the hypothesis that MDD increases the risk of developing PsA among patients with psoriasis, suggesting a need for heightened prevention and management of MDD in patients with psoriasis. Depression is associated with an increased risk of psoriatic arthritis among patients with psoria- sis: a population-based study. J Invest Dermatol 2017 Feb 22;[EPub Ahead of Print], RT Lewinson, IA Vallerand, MW Lowerison, et al. primary risk factor. However, we can con- clude that depression appears to play a role in the appearance of comorbid arthri- tis in patients with psoriasis. It behooves clinicians to determine the presence of MDD in their patients with psoriasis, which can be performed with very brief, well-validated, 2- to 3-question tests. Those individuals who are depressed should be treated appropriately in order to minimise the chance of developing arthri- tis. A referral to a psychiatrist/psychologist may well help your patients, and save the healthcare system consid- erable resources.

Abstract The factors that contribute to the development of psoriatic arthritis (PsA) among patients with psoriasis are not well known; however, systemic inflammation is believed to be important. On the basis of recent laboratory work demonstrating that major depressive disorder (MDD) is associated with increased systemic inflammation, we hypoth- esized that patients with psoriasis who develop MDD are at increased risk of subsequently devel- oping PsA. We utilized The Health Improvement Network, a primary care medical records data- base, to identify 73,447 individuals with psoriasis. Patients were followed up to 25 years until the development of the primary outcome of PsA or the censor date. The exposure of interest was the development of MDD. Cox proportional-hazards COMMENT By Francisco A Tausk MD A number of studies have linked the occurrence of psoriasis and major depressive disorder (MDD), which may be supported by recent findings showing that MDD is associated with a state of enhanced inflammation, presum- ably mediated by TNFα, which is elevated in both disorders. In the present report, Lewinson et al mined the British database THIN to assess those individuals suffering from psoriasis and MDD, noting that they were more predisposed to develop pso- riatic arthritis. Indeed, they found that the risk of psoriatic arthritis associated with depression has an unadjusted hazard ratio of 1.56. Because depressed people tend to have poor health habits (sedentary life- style, unhealthy diet), it is not possible to be certain that MDD is independently the

Dr Tausk is Professor of Dermatology and

Psychiatry at the University of Rochester in New York.

PRACTICEUPDATE DERMATOLOGY