Sex- and gender-associated clinical and psychosocial characteristics of patients with psoriasis.

BACKGROUND: Sex and gender may affect disease prevalence, adverse effects and response to therapy. AIM: To analyse sex and gender differences in outpatients with psoriasis. METHODS: A cross-sectional study was conducted at IDI-IRCCS, Rome, over a 3-year period. In total, 3023 patients with psoriasis were enrolled. Anthropometric and demographic characteristics were recorded, and a dermatologist evaluated the clinical severity of disease. Quality of life (QoL) questionnaires were collected. Univariate and multivariate analyses were performed to examine factors associated with sex. RESULTS: We found sex- and gender-associated differences in clinical characteristics, disease severity, psychological distress and quality of life. Male sex was associated with body mass index, smoking, alcohol consumption, Psoriasis Area Severity Index ≥ 10 and age at onset ≥ 20 years. Female sex was associated with family history of diabetes, joint involvement, clinical type other than diffuse plaque psoriasis, higher psychological distress and a greater effect on QoL. CONCLUSION: Our study identified sex and gender differences of potential clinical relevance in psoriasis.

Quality of life in patients with early- and late-onset hidradenitis suppurativa.

Hidradenitis suppurativa (HS) usually has an early onset, however, also onset in the mid-40 s may occur. Recently, the threshold of 28 years to distinguish patients with early and late onset has been proposed. The objective of our study was to compare the quality of life (QoL) and psychological distress in early- and late-onset HS patients. In this cross-sectional, observational study, consecutive patients diagnosed with HS aged ≥ 16 years were recruited. Dermatology-specific QoL was evaluated using the Skindex-17 questionnaire, and psychological distress using the 12-item General Health Questionnaire (GHQ-12). Patients were categorized into "early onset" (< 28 years) and "late onset" (≥ 28 years). Data were collected on 467 patients. Mean age at diagnosis was 21.6 years, with 22.0% of patients presenting with late disease onset. Patients with late onset reported worse psychosocial QoL and higher psychological distress compared to early onset. No differences between the two groups were observed for clinical severity. In the final multivariate model lower diagnostic delay, higher number of fistulae, higher BMI, ex-smoker, no localization on axillae, no localization on mammary region, presence of psoriasis, and higher scores on the psychosocial scale of Skindex-17 were statistically significantly associated with late onset. In conclusion, the psychosocial impact of HS is higher in patients with late onset compared to those with early onset. Differences between these two groups should be further investigated.

Psychological distress and coping strategies in patients attending a dermatology outpatient clinic.

BACKGROUND: Psychological distress is frequent among dermatological patients. The development of a positive attitude toward diagnosis and treatment is thought to be critical for successful coping and mental health outcomes. OBJECTIVE: The aim of this study was to assess the coping strategies and the psychological distress, due to anxiety and depression, in an unselected sample of dermatological patients. METHODS: Self-administered questionnaires (HADS, COPE) were given to 603 dermatological patients. RESULTS: Out of 567 participants, 149 (26.2%) scored positive for Anxiety, and 52 (9.2%) scored positive for Depression. Multivariate analysis, adjusting for gender, age, socio-economic status, and disease, showed that both Anxiety and Depression are associated with a less frequent use of Positive attitude coping. CONCLUSION: Our results reinforce the notion that while planning the treatment of dermatological patients, evaluating their mental health might help to provide optimal treatment. Since coping ability was found to be important for mental health status, policy implications could include emphasis on social programs to assist individuals to manage stress, as well as psychological support.

Clinical Predictors of Response to Anti-PD-1 First-Line Treatment in a Single-Centre Patient Cohort: A Real-World Study.

AIMS: Cutaneous melanoma is one of the most immunogenic tumours. Immunotherapy with checkpoint inhibitors, such as anti-PD-1 antibodies, has significantly improved the prognosis in metastatic melanoma. However, only half of the patients respond to this therapy and have a favourable outcome. Identifying factors associated with treatment failure and early identification of responders are both important to select the best treatment approach for each patient. The aim of our study was to investigate clinical biomarkers of response to treatment with anti-PD-1 antibodies. MATERIALS AND METHODS: We selected all patients with stage IV melanoma (n = 147), subjected to first-line treatment with anti-PD-1 in the last 10 years. We investigated the associations between patients' different clinical features and progression-free survival, using the Cox proportional hazards models. RESULTS: In the multivariate analysis, an increased risk of disease progression was observed among patients with stage M1d metastases (hazard ratio 3.30; 95% confidence interval 1.58-6.91), compared with patients with stage M1a-M1b. Moreover, the risk of progression was greater in patients with the Eastern Cooperative Oncology Group Performance Status (ECOG PS) 1 (hazard ratio 2.04; 95% confidence interval 1.02-4.06) and in patients with ECOG PS ≥ 2 (hazard ratio 2.19; 95% confidence interval 1.05-4.55) compared with ECOG PS 0. High levels of lactate dehydrogenase (hazard ratio 2.06; 95% confidence interval 1.18-3.59) and the presence of respiratory diseases (hazard ratio 4.14; 95% confidence interval 1.42-12.0) at the beginning of anti-PD-1 treatment were also associated with an increased risk of disease progression. In a subgroup analysis, neutrophil count and neutrophil/lymphocyte ratio before anti-PD-1 treatment were higher in patients who underwent disease progression. CONCLUSION: In our study population, independent predictors of disease progression among patients treated with first-line anti-PD-1 were as follows: ECOG PS, staging, lactate dehydrogenase and the presence of respiratory diseases.

High level of TILs is an independent predictor of negative sentinel lymph node in women but not in men.

Factors that are most associated with positive lymph node status in melanoma are Breslow thickness and ulceration. However, there are other factors that have been little explored and could help in the identification of "at risk patients" harbouring occult metastasis. The objective of this study was to determine whether intensity of tumour-infiltrating lymphocytes (TILs) in a cohort study (N = 4133) is an independent predictor of sentinel lymph node (SLN) status in patients with primary cutaneous melanoma. Of the patients with cutaneous melanoma who resulted negative for nodal metastasis, 50.7% had moderate/marked TILs versus 27.7% among those patients who resulted positive for nodal metastasis. In the multivariate analysis, controlling for sex, age, mitotic rate, ulceration and Breslow, high levels of TILs in primary invasive melanoma was associated with a lower risk of developing SLN metastasis (OR 0.46; 95% CI 0.23-0.95, p = 0.037). When the analysis was stratified by sex, the protective effect of moderate/marked TIL remained only for women (OR 0.30; 95% CI 0.10-0.93, p = 0.037) but not for men (OR 0.51; 95% CI 0.19-1.34, p = 0.172). Other independent predictors of negative lymph node were low Breslow thickness (≤ 2.0 mm) and low mitotic rate. Besides predicting a negative lymph node response, TILs were also associated with a decreased risk of 10-year mortality among females with positive lymph node. Our findings suggest that high level of TILs is an independent predictor of negative SLN status among women. Further research is warranted to confirm our findings.

Mediterranean diet: fresh herbs and fresh vegetables decrease the risk of Androgenetic Alopecia in males.

It is well established that Androgenetic Alopecia (AGA) occurs in genetically predisposed individuals but little is known of its non-genetic risk factors. The aim of the study was to investigate the role of the Mediterranean diet in determining the risk of AGA. A hospital-based case-control study was conducted in the outpatient clinics of the hospital "Istituto Dermopatico dell'Immacolata, Rome, Italy". We included 104 males and 108 controls not affected by AGA. Controls were frequency matched to cases. Information on socio-demographic characteristics, medical history, smoking and diet were collected for all patients. Logistic regression was used to estimate odds ratio and 95% confidence intervals. After controlling for age, education, body mass index and family history of AGA, protective effects for AGA were found for high consumption (≥ 3 times weekly) of raw vegetables (OR 0.43; 95% CI 0.21-0.89) and high consumption of fresh herbs (3 or more regularly) (OR 0.44; 95% CI 0.22-0.87). We suggest that some foods of the Mediterranean diet, say fresh herbs and salad, may reduce the risk of AGA onset.

Quality of life impairment and psychological distress in elderly patients with psoriasis.

BACKGROUND/AIMS: The management of psoriasis, which has a major impact on quality of life (QoL), deserves a specific attention to elderly patients' problems and needs. Our aim was to describe the QoL of elderly patients with psoriasis. METHODS: This is a cross-sectional study on 305 psoriatic inpatients, aged > or = 65 years. QoL, measured by the Skindex-29, was compared in groups of patients based on clinical and sociodemographic characteristics, and the possible determinants of psychological distress were investigated. RESULTS: The mean age of the patients was 71 years (range: 65-93). Clinical severity tended to increase with age. Psychological distress was higher in patients > 70 years of age, while QoL showed an improvement for all the Skindex-29 scales in older age groups. Gender (women vs. men), and Skindex-29 emotions and functioning scales emerged as associated with psychological distress, after adjusting for age and clinical severity. CONCLUSION: These observations indicate that clinical severity of psoriasis increases among very elderly patients and is associated with different levels of skin-related QoL and psychological distress. It is important for dermatologists to be aware of the specific impact of psoriasis in the different subgroups of the elderly population, to meet the peculiar needs of each group.

The relation between dietary habits and urinary levels of 3-phenoxybenzoic acid, a pyrethroid metabolite.

Concerns about pesticide exposure through food consumption have increased during the past several years. Pyrethroids are applied as insecticides throughout the world. Human metabolism of pyrethroids results in urinary metabolites that are suitable for biological monitoring. The objective of our study was to investigate the relation between food consumption and urinary levels of 3-phenoxybenzoic acid (3-PBA), a general metabolite of pyrethroids, in a non-occupational exposed adult population from the IDI-IRCCS, Rome, Italy. Information on socio-demographic characteristics, smoking, diet and self-reported household pesticide exposure was collected. Urinary 3-PBA level of each subject was measured and adjusted by urinary creatinine. We found that people consuming both raw and cooked vegetables five times weekly or more had higher mean levels of 3-PBA in urine (1.03 µg/g creatinine versus 0.52 µg/g creatinine; p=0.009 and 0.99 µg/g creatinine versus 0.58 µg/g creatinine; p=0.01, respectively) than subjects consuming less than five times weekly. In a multivariate model, after adjusting for age, sex, BMI, smoking and household insecticide exposure, high intake of raw vegetables (OR: 5.31; 95%CI: 1.32-21.3) and high intake of cooked vegetables, in particular cruciferous (OR: 4.67; 95%CI: 1.07-20.5) and leafy vegetables (OR: 6.88; 95%CI: 1.50-31.7), were associated with high urine 3-PBA levels (≥0.70 µg/g creatinine). The results of this study suggest that part of the variation in pyrethrois intake is explained by vegetable intake.

A protective effect of the Mediterranean diet for cutaneous melanoma.

BACKGROUND: Many studies have investigated the Mediterranean diet as a risk factor for cancer, none of which has included cutaneous melanoma. The latter is usually fatal, rendering knowledge about prevention extremely important. We assessed the role of some food components of the Mediterranean diet and cutaneous melanoma. METHODS: A hospital-based case-control study was conducted in the inpatient wards of IDI-San Carlo Rome, Italy including 304 incident cases of cutaneous melanoma and 305 controls, frequency matched to cases. Information on socio-demographic characteristics, medical history, smoking, sun exposure, pigmentary characteristics and diet was collected. Logistic regression was the method used to estimated odds ratio and 95% CIs. RESULTS: After careful control for several sun exposure and pigmentary characteristics, we found a protective effect for weekly consumption of fish (OR, 0.65, 95%CI = 0.43-0.97), shellfish (OR, 0.53, 95%CI = 0.31-0.89), fish rich in n-3 fatty acids (OR, 0.52, 95%CI = 0.34-0.78), daily tea drinking (OR, 0.42, 95%CI, 0.18-0.95; P(trend) = 0.025) and high consumption of vegetables (OR, 0.50, 95%CI = 0.31-0.80, P(trend) = 0.005) in particular carrots, cruciferous and leafy vegetables and fruits (OR, 0.54, 95%CI =0.33-0.86, P(trend) = 0.013), in particular citrus fruits. No association was found for alcohol consumption and any other food items. CONCLUSION: Overall, our findings suggest that some dietary factors present in the Mediterranean diet might protect from cutaneous melanoma.