A Review of Skin Disease in Schizophrenia.

BACKGROUND: Schizophrenia is a debilitating neuropsychiatric condition that affects 0.5% of the North American population. Skin disease in schizophrenia has not been well described. Identifying skin diseases that are commonly comorbid with schizophrenia may help clinicians address the burden of skin disease in patients with schizophrenia. SUMMARY: We conducted a nonsystematic review of the literature to identify skin diseases that may be associated with schizophrenia. We searched MEDLINE, EMBASE, and PsycINFO for articles published in English from December 2000 through April 2020 using the key words "skin disease" or "dermatological" or "dermatology" and "schizophrenia." Based on our results, we further refined the search terms to include more specific skin diseases. Schizophrenia appears to be associated with a number of skin diseases, including inflammatory dermatoses, autoimmune diseases, and certain genodermatoses. Limitations include being a nonsystematic review and the relative paucity of more rigorous clinical research using longitudinal study designs.

Canadian Burden of Skin Disease From 1990 to 2017: Results From the Global Burden of Disease 2017 Study [Formula: see text].

BACKGROUND: Skin diseases can have high morbidity that can be costly to society and individuals. To date, there has been no comprehensive assessment of the burden of skin disease in Canada. OBJECTIVES: To evaluate the burden of 18 skin and subcutaneous diseases from 1990 to 2017 in Canada using the Global Burden of Disease (GBD) data. METHODS: The 2017 GBD study measures health loss from 359 diseases and injuries in 195 countries; we evaluated trends in population health in Canada from 1990 to 2017 using incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs). Data are presented as rates (per 100 000), counts, or percent change with the uncertainty interval in brackets. RESULTS: From 1990 to 2017 for all skin diseases, DALY rates increased by 8% to 971 per 100 000 (674-1319), YLD rates increased by 8% to 897 per 100 000 (616-1235), YLL rates increased by 4% to 74 per 100 000 (53-89), and death rates increased by 18% to 5 per 100 000 (3-6). DALY rates for melanoma increased by 2% to 54 per 100 000 (39-68), for keratinocyte carcinoma by 14% to 17 per 100 000 (16-19), and for skin and subcutaneous disease by 8% to 900 per 100 000 (619-1233). The observed over expected ratios were higher for skin and subcutaneous disease (1.37) and keratinocyte carcinoma (1.17) and were lower for melanoma (0.73). CONCLUSIONS: The burden of skin disease has increased in Canada since 1990. These results can be used to guide health policy regarding skin disease in Canada.

Inflammatory dietary pattern and incident psoriasis, psoriatic arthritis, and atopic dermatitis in women: A cohort study.

BACKGROUND: Diet is a modulator of inflammation that might impact inflammatory skin diseases. OBJECTIVE: To assess the relationship between pro-inflammatory dietary patterns and incident psoriasis, psoriatic arthritis (PsA), and atopic dermatitis (AD). METHODS: We conducted cohort studies among women in the Nurses' Health Study II. The Empirical Dietary Inflammatory Pattern (EDIP) score was calculated at baseline and every 4 years. Incident psoriasis, PsA, and AD were assessed by validated self-report. We used multivariable-adjusted Cox proportional hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between EDIP quintiles and risk for psoriasis, PsA, and AD. RESULTS: We had 85,185 participants in the psoriasis analysis and 63,443 in the AD analysis. There were 1432 cases of psoriasis, 262 cases of PsA, and 403 cases of AD. Pro-inflammatory dietary patterns were not associated with the risk for outcomes in multivariable models (all P values for trend >.05). HRs comparing the highest to the lowest EDIP quintile were 0.99 (95% CI 0.83-1.18) for psoriasis, 1.22 (95% CI 0.81-1.83) for PsA, and 0.96 (95% CI 0.69-1.34) for AD. LIMITATIONS: Recall and self-report. CONCLUSION: Our findings do not support dietary inflammatory potential as a risk factor for psoriasis, PsA, or AD.

Combination Therapies for Hidradenitis Suppurativa: A Retrospective Chart Review of 31 Patients.

BACKGROUND: Although a variety of medical and surgical interventions exist for the treatment of hidradenitis suppurativa (HS), it remains a challenging disease to manage because of its variable presentation and unpredictable clinical course. Apart from the combination of clindamycin and rifampin, the success of other combination therapies is largely unknown. OBJECTIVES: The goal of our study was to examine the clinical utility of various combination therapies for the treatment of HS. METHODS: We conducted a qualitative retrospective chart review of 31 patients with dermatologist-diagnosed HS who were seen at an academic teaching hospital between 2014 and 2018. Demographic data, disease location, disease severity, and treatment protocol were retrieved for analysis. Hurley stage was used to classify disease severity on initial presentation, and the International Hidradenitis Suppurativa Severity Score System (IHS4) was used to track changes across visits. RESULTS: Of the 31 patients (Mage = 37.7 years; 67.7% female) included in the study, 6 (19.4%), 11 (35.5%), and 14 (45.2%) patients were classified as Hurley stages I, II, and III, respectively. Although no statistical results are provided because of the small sample size, we have identified several drug combinations that show promising clinical response for patients with HS based on their IHS4 score, such as isotretinoin/spironolactone for mild disease, isotretinoin or doxycycline with adalimumab for moderate disease, and cyclosporine/adalimumab for severe disease. CONCLUSIONS: This preliminary work demonstrates that HS treatment with combination therapy appears to be a promising method of disease management.

The Burden of Moderate to Severe Atopic Dermatitis in Canadian Children: A Cross-Sectional Survey.

OBJECTIVES: Although atopic dermatitis (AD) has significant impacts on quality of life, data from Canada on the subject are limited. This survey aims to assess the burden of moderate to severe AD on quality of life and disease management for pediatric patients and their caregivers in Canada. METHODS: The Eczema Society of Canada conducted an online national cross-sectional survey in English and French. We included children with self-reported moderate to severe AD. We present descriptive statistics from the survey. RESULTS: Of all initial respondents (n = 658), 70% (n = 458) were children or caregivers of children who have moderate or severe AD and were therefore eligible. Among them, 27% (123/451) are managed by a dermatologist, with 71% (174/244) waiting more than 3 months to see a dermatologist. Many respondents (85%, 279/330) feel that their child's AD is not well controlled, and 27% (75/275) have difficulty obtaining treatments for their child's AD. Impaired quality of life was found in 52% of families (200/381), with most reporting sleep disturbances in both the child (70%, 253/361) and the caregiver (55%, 199/361), as well as mental health issues. CONCLUSIONS: This survey demonstrates the medical and psychosocial burden of moderate to severe AD in Canadian children. Quality of life, access to care, and disease management are all areas of concern for patients and their families and warrant attention from individual clinicians and the health care system as a whole.

Effects of varenicline on motor cortical plasticity in non-smokers with schizophrenia.

BACKGROUND: Nicotinic acetylcholine receptors (nAChR) have been implicated in the pathophysiology of schizophrenia, and deficits in this system may contribute to high rates of cigarette smoking in this population. nAChR stimulation may modulate neuroplasticity, or long-term potentiation (LTP), which is a key mediator of cognitive performance. Varenicline is a nAChR partial agonist that may improve cognitive deficits in both smokers and non-smokers with schizophrenia; however, the mechanism by which varenicline alters cognition in schizophrenia remains unclear. Thus, the aim of this randomized, double-blind, placebo-controlled, crossover study was to determine the effects of varenicline on LTP-like plasticity indexed through transcranial magnetic stimulation (TMS) in non-smokers with schizophrenia. METHODS: Varenicline (0.5mg BID × 5 doses) or placebo was administered to 9 non-smokers with schizophrenia and 10 non-smoker healthy subjects. LTP-like plasticity was induced by TMS and paired associative stimulation (PAS) at 0.1Hz to the left motor cortex and measured every 15min for two hours post-PAS. RESULTS: There was a significant diagnosis × medication interaction on peak potentiation (F (3, 34)=6.04, p<0.02) and post-hoc analyses indicated that varenicline significantly increased LTP in schizophrenia and decreased LTP in healthy subjects. CONCLUSIONS: These preliminary findings suggest that varenicline may produce differential effects in non-smoking schizophrenia compared to control subjects. Given the role of LTP in learning and memory, these observations may suggest the potential for varenicline in the treatment of cognitive deficits in patients with schizophrenia.