Association between moderate to severe psoriasis and periodontitis in a Scandinavian population.

BACKGROUND: The aim of the present study was to compare the prevalence of periodontitis and alveolar bone loss among individuals with psoriasis and a group of randomly selected controls. METHODS: Fifty individuals with psoriasis and 121 controls completed a structured questionnaire, and were examined clinically and radiographically. Oral examination included numbers of missing teeth, probing pocket depth (PPD), clinical attachment level (CAL), presence of dental plaque and bleeding on probing, as well as alveolar bone loss from radiographs. Questionnaires requested information on age, gender, education, dental care, smoking habits, general diseases and medicament use. For adjustment for baseline differences between psoriasis individuals and controls the propensity score based on gender, age and education was computed using multivariate logistic regression. A subsample analysis for propensity score matched psoriasis individuals (n = 50) and controls (n = 50) was performed. RESULTS: When compared with controls, psoriasis individuals had significantly more missing teeth and more sites with plaque and bleeding on probing. The prevalence of moderate and severe periodontitis was significantly higher among psoriasis individuals (24%) compared to healthy controls (10%). Similarly, 36% of psoriasis cases had one or more sites with radiographic bone loss ≥3 mm, compared to 13% of controls. Logistic regression analysis showed that the association between moderate/severe periodontitis and psoriasis remained statistically significant when adjusted for propensity score, but was attenuated when smoking was entered into the model. The association between psoriasis and one or more sites with bone loss ≥3 mm remained statistically significant when adjusted for propensity score and smoking and regularity of dental visits. In the propensity score (age, gender and education) matched sample (n = 100) psoriasis remained significantly associated with moderate/severe periodontitis and radiographic bone loss. CONCLUSIONS: Within the limits of the present study, periodontitis and radiographic bone loss is more common among patients with moderate/severe psoriasis compared with the general population. This association remained significant after controlling for confounders.

Increased subclinical atherosclerosis in patients with chronic plaque psoriasis.

BACKGROUND: Psoriasis is an immune-mediated inflammatory skin condition of unknown aetiology which usually requires life-long treatment. It is regarded a systemic inflammatory disease with a possible increased risk of cardiovascular disease. The aim of this study was to assess carotid intima-media thickness (IMT), plaque prevalence and carotid stenosis as surrogate measures for cardiovascular disease in psoriasis patients and healthy controls. METHODS: Sixty-two patients with psoriasis and thirty-one healthy controls were included in the study. All were examined by Colour duplex ultrasound of the carotid arteries to compare carotid IMT values, carotid plaques and carotid stenosis in the two groups. Adjustments were made for traditional cardiovascular risk factors. RESULTS: Patients with psoriasis had increased carotid IMT values compared to the controls: mean ± SD 0.71 ± 0.17 mm vs. 0.59 ± 0.08 mm; p = 0.001. When adjusted for known atherosclerotic risk factors this difference remained significant (p = 0.04). Carotid plaques were also more common (p = 0.03) in patients with psoriasis 13 (21%) compared to controls 1 (3%). There was no difference with regard to the number of carotid stenoses in patients and controls. CONCLUSION: The results of this study support previous evidence which suggests that psoriasis is associated with an increased risk for atherosclerosis and subsequent cardiovascular disease.

Genital ulcers as initial manifestation of Epstein-Barr virus infection: two new cases and a review of the literature.

Genital ulceration is an uncommon manifestation of primary Epstein-Barr virus (EBV) infection. We present here two cases of genital ulcers probably caused by EBV. The first case is a 12-year-old girl with a genital ulcer appearing before specific EBV serology could identify a primary infection. However, serology was positive 13 days after the ulcer appeared. Polymerase chain reaction for EBV was positive in the biopsy from the ulcer as well. The second case is an 18-year-old female in whom the specific EBV serology was positive 8 days after appearance of the ulcer. The ulcers in both cases healed after 21 days. We reviewed the literature and a total of 26 cases of EBV-associated genital ulcers in females are now published. Median age of the 26 cases is 14.5 years of whom only 6 reports previous sexual contact. Mean healing time for the ulcers is 18 days. Our two cases correspond well with clinical reports of 24 EBV-associated genital ulcers in the literature.