Psoriasis prevalence among adults in the United States

doi:10.1016/j.jaad.2013.11.013

Journal of the American Academy of Dermatology

Volume 70, Issue 3, March 2014, Pages 512-516

https://doi.org/10.1016/j.jaad.2013.11.013 Get rights and content

Background

Psoriasis is a chronic inflammatory disorder associated with significant morbidity and mortality. Up-to-date prevalence data on psoriasis provide the foundation for informing population research, education, and health policy.

Objective

We sought to determine the prevalence of psoriasis among US adults.

Methods

We performed a cross-sectional study using National Health and Nutrition Examination Survey 2009 through 2010 data to determine psoriasis prevalence rates.

Results

From 6218 participants older than 20 years of age, 6216 respondents provided complete information regarding a psoriasis diagnosis. The prevalence of psoriasis among US adults ages 20 years and older is 3.2% (95% confidence interval [CI] 2.6%-3.7%). A total of 7.2 million US adults had psoriasis in 2010; an estimated 7.4 million US adults were affected in 2013. When stratifying the sample by race among those between ages 20 and 59 years, the psoriasis prevalence was highest in Caucasians at 3.6% (95% CI 2.7%-4.4%), followed by African Americans (1.9%; 95% CI 1.0%-2.8%), Hispanics (1.6%; 95% CI 0.5%-2.8%), and others (1.4%; 95% CI 0.3%-2.6%). The prevalence of psoriasis among US adults has not changed significantly since 2003 to 2004 (P > .05).

Limitations

Dermatologist evaluation and skin photographs were unavailable for the 2009 through 2010 surveys.

Conclusions

In the United States, psoriasis remains a common, immune-mediated disease, affecting 7.4 million adults. Its prevalence has remained stable since the mid-2000s.

Section snippets

Study design

Using data from the NHANES 2009 to 2010, we examined the prevalence of psoriasis among US adults. The National Center for Health Statistics (NCHS) ethics review board approved this NHANES cycle. NHANES is a major component of the NCHS under the auspices of the Centers for Disease Control and Prevention.²⁷ The NHANES staff collects health data on a biennial basis that is frequently used to determine disease prevalence.28, 29 Participants first complete health care interviewer-administered

Results

An unweighted sample size of 6218 people aged 20 to 59 years participated in the questionnaire-based interviews in 2009 through 2010. Among this study cohort, 6216 of the subjects provided a definitive (yes/no) answer to the psoriasis questionnaire data. The participants’ demographic and clinical information is presented in Table I.

To determine psoriasis prevalence generalizable to the US population, we applied sample weights to account for the complex sampling method used in the study (Table I

Discussion

In this study, we report the latest prevalence statistics on psoriasis among adults in the United States using NHANES. NHANES is a robust data source for studying disease prevalence because it uses a multistage, stratified survey methodology to obtain prevalence data representative of the general, noninstitutionalized US population.²⁷ The data collected via survey instruments included demographic, socioeconomic, dietary, and health-related questions. The oversampling of African Americans,

References (45)

J. Koo
Population-based epidemiologic study of psoriasis with emphasis on quality of life assessment
Dermatol Clin
(1996)
A.W. Armstrong et al.
Coronary artery disease in patients with psoriasis referred for coronary angiography
Am J Cardiol
(2012)
J.M. Gelfand et al.
The risk of stroke in patients with psoriasis
J Invest Dermatol
(2009)
N.N. Mehta et al.
Attributable risk estimate of severe psoriasis on major cardiovascular events
Am J Med
(2011)
R.S. Stern et al.
Psoriasis is common, carries a substantial burden even when not extensive, and is associated with widespread treatment dissatisfaction
J Invest Dermatol Symp Proc
(2004)
J.M. Gelfand et al.
The prevalence of psoriasis in African Americans: results from a population-based study
J Am Acad Dermatol
(2005)
S.Y. Yip
The prevalence of psoriasis in the Mongoloid race
J Am Acad Dermatol
(1984)
S.K. Kurd et al.
The prevalence of previously diagnosed and undiagnosed psoriasis in US adults: results from NHANES 2003-2004
J Am Acad Dermatol
(2009)
H. Beltran-Sanchez et al.
Prevalence and trends of metabolic syndrome in the adult US population, 1999-2010
J Am Coll Cardiol
(2013)
R. Parisi et al.
Global epidemiology of psoriasis: a systematic review of incidence and prevalence
J Invest Dermatol
(2013)

C.C. Jacobson et al.

Latitude and psoriasis prevalence

J Am Acad Dermatol

(2011)

M. Enamandram et al.

Psoriasis epidemiology: the interplay of genes and the environment

J Invest Dermatol

(2013)

A.W. Armstrong et al.

Psoriasis and sexual behavior in US women: an epidemiologic analysis using the National Health and Nutrition Examination Survey (NHANES)

J Sex Med

(2013)

A.W. Armstrong et al.

Quality of life and work productivity impairment among psoriasis patients: findings from the National Psoriasis Foundation survey data 2003-2011

PLoS One

(2012)

J.M. Gelfand et al.

The risk of mortality in patients with psoriasis: results from a population-based study

Arch Dermatol

(2007)

O. Ghatnekar et al.

Costs and quality of life for psoriatic patients at different degrees of severity in southern Sweden–a cross-sectional study

Eur J Dermatol

(2012)

A.B. Kimball et al.

Economic burden of comorbidities in patients with psoriasis is substantial

J Eur Acad Dermatol Venereol

(2011)

N. Meyer et al.

Psoriasis: an epidemiological evaluation of disease burden in 590 patients

J Eur Acad Dermatol Venereol

(2010)

H. Yeung et al.

Psoriasis severity and the prevalence of major medical comorbidity: a population-based study

JAMA Dermatol

(2013)

A. Ogdie et al.

Prevalence and treatment patterns of psoriatic arthritis in the UK

Rheumatology

(2013)

A.W. Armstrong et al.

Infectious, oncologic, and autoimmune comorbidities of psoriasis and psoriatic arthritis: a report from the GRAPPA 2012 annual meeting

J Rheumatology

(2013)

A.W. Armstrong et al.

Cardiovascular comorbidities of psoriasis and psoriatic arthritis: a report from the GRAPPA 2012 annual meeting

J Rheumatology

(2013)

Cited by (663)

A therapeutic strategy of parthenolide in improving imiquimod-induced psoriasis-like skin inflammation targeting IL-36/NETs through skin transdermal therapeutic system
2024, International Immunopharmacology
Psoriasis is an inflammatory skin disease that occurs repeatedly over time. The natural product of sesquiterpene lactones, Parthenolide (Par), is isolated from Tanacetum parthenium L. (feverfew) which has significant effects on anti-inflammatory. The therapeutic effect of the medication itself is crucial, but different routes of administration of the same drug can also produce different effects.
The aim of our research sought to investigate the ameliorating effects of Par in psoriasis-like skin inflammation and its related mechanism of action.
In the IMQ-induced model, intragastric administration of Par reduced the Psoriasis Area and Severity Index (PASI) score, improved skin erythema, scaling, and other symptoms. And Par decreased the expression of Ki67, keratin14, keratin16 and keratin17, and increased the expression of keratin1. Par could reduce IL-36 protein expressions, meanwhile the expression of Il1b, Cxcl1 and Cxcl2 mRNA were also decreased. Par regulated the expression levels of F4/80, MPO and NE. However, skin transdermal administration of Par was more effective. Similarly, Par attenuated IL-36γ, IL-1β and caspase-1 activated by Poly(I:C) in in vitro and ex vivo. In addition, Par also reduced NE, PR3, and Cathepsin G levels in explant skin tissues.
Par ameliorated psoriasis-like skin inflammation in both in vivo and in vitro, especially after treatment with transdermal drug delivery, possibly by inhibiting neutrophil extracellular traps and thus by interfering IL-36 signaling pathway. It indicated that Par provides a new research strategy for the treatment of psoriasis-like skin inflammation and is expected to be a promising drug.
Association of antihypertensive drugs with psoriasis: A trans-ancestry and drug-target Mendelian randomization study
2024, Vascular Pharmacology
GC-MS analysis and the effect of topical application of essential oils of Pinus canariensis C.Sm., Cupressus lusitanica Mill. and Cupressus arizonica Greene aerial parts in Imiquimod–Induced Psoriasis in Mice
2024, Journal of Ethnopharmacology
Traditionally, Coniferous plants, in particular Pinus and Cupressus species, have been used in the treatment of burns, skin infections, and immune-mediated inflammatory diseases such as psoriasis.
A comparative study between essential oils (EOs) extracted from aerial parts of three coniferous plants: Pinus canariensis C.Sm. (PC), Cupressus lusitanica Mill. (CL) and Cupressus arizonica Greene (CA), cultivated in Egypt, was designed to investigate their composition and their anti-psoriasis mechanism.
The phytochemical profiles were confirmed using Gas Chromatography–Mass Spectrometry (GC-MS) method. In-vivo Imiquimod (IMQ)-induced psoriasis model was performed and EOs were applied topically and compared to mometasone cream as a standard subsequently histopathological analysis and inflammatory biomarkers were measured.
In GC-MS analysis, Monoterpene hydrocarbons, sesquiterpene hydrocarbons and oxygenated monoterpenes were the major detected classes in the three plants, except in Pinus canariensis essential oil, oxygenated monoterpenes were absent. A significant attenuation of imiquimod-induced psoriasis symptoms after topical application of P. canariensis C.Sm., and C. lusitanica Mill. essential oils were observed by reducing the psoriasis area severity index (PASI) score, alleviating histopathological alteration, restoring the spleen index, and decreasing serum levels of interleukins 23 and 17A. Indeed, the results of Pinus canariensis essential oil is comparable to mometasone and showed no significant difference from standard treatment. On the other hand, the topical application of C. arizonica essential oil failed to alleviate imiquimod-induced psoriasis symptoms as observed in the PSAI score, the histopathological investigation, and the spleen index.
The essential oils of P. canariensis C.Sm., and C. lusitanica Mill aerial parts could be promising candidates for psoriasis treatment and for further studies on inflammation-related skin diseases.
The Role of Genetics on Psoriasis Susceptibility, Comorbidities, and Treatment Response
2024, Dermatologic Clinics
Self-assembled Gallic acid loaded lecithin-chitosan hybrid nanostructured gel as a potential tool against imiquimod-induced psoriasis
2023, Environmental Research
Increased thickness of the skin and hyperproliferation of keratinocyte cell is the main obstacle in the treatment of psoriasis. Gallic Acid (GA) has shown efficacious results against the hyperproliferation of keratinocytes while lipid-polymer loaded hybrid nanoparticles (LPHNs) have an edge over lipidic and polymeric nanoparticles considering drug loading, controlled release, stability, and retention. The LPHNs were optimized using Box-Behnken method and was further characterized by FTIR, DSC and Zetasizer. The optimized preparation demonstrated a size of 170.5 ± 0.087 nm and a PDI of 0.19 ± 0.0015, respectively. The confocal study has suggested that the hybrid nanosystem enhanced the drug penetration into the deeper layer with a higher drug release of 79 ± 0.001% as compared to the gallic acid-loaded gel. In addition, the formulation significantly reduced PASI score and splenomegaly without causing any serious irritation. The morphological study of the spleen suggested that the prepared formulation has well controlled the disease compared to the marketed formulation while maintaining a normal level of immune cells after treatment. Hence GALPHN could be accepted as one of the excellent vehicles for the topical conveyance of GA (gallic acid) due to enhanced penetration, and good retention, along with fewer side effects and higher efficacy of the GALPHN gel against imiquimod (IMQ) induced psoriasis.
Discovery of 5-((1H-indazol-3-yl) methylene)-2-thioxoimidazolidin-4-one derivatives as a new class of AHR agonists with anti-psoriasis activity in a mouse model
2023, Bioorganic and Medicinal Chemistry Letters
Aryl hydrocarbon receptor (AHR) is a ligand dependent transcription factor and participates in the regulation of the immune balance of Th17/22 and Treg cells. It has been found to be widely expressed in the skin, and involved in the pathology of psoriasis. Therefore, AHR is thought as a potential intervention target for psoriasis. Here, we report the discovery of 5-((1H-indazol-3-yl) methylene)-2-thioxoimidazolidin-4-one derivatives as a new class of AHR agonists. Structure-activity relationship analyses led to the identification of the most active compound, 5- ((1H-indazol-3-yl)methylene) -3- (prop-2-yn-1-yl) -2-thiooimidazolidin-4-one (24e), which exhibited an EC₅₀ value of 0.015 µM against AHR. Mechanism of action studies showed that 24e regulated the expression of CYP1A1 by activating the AHR pathway. Topical administration of 24e substantially alleviated imiquimod (IMQ)-induced psoriasis-like skin lesion. Overall, compound 24e could be a good lead compound for drug discovery against psoriasis, and hence deserving further in-depth studies.

View all citing articles on Scopus

: Funding sources: None.

: Disclosure: Dr Rachakonda has served as a subinvestigator for Amgen and Abbvie. Dr Armstrong serves as investigator and/or consultant to AbbVie, Amgen, Janssen, Pfizer, and Merck. Dr Schupp has no conflicts of interest to declare.

View full text

Original articlePsoriasis prevalence among adults in the United States

Background

Objective

Methods

Results

Limitations

Conclusions

Section snippets

Study design

Results

Discussion

Dermatol Clin

Am J Cardiol

J Invest Dermatol

Am J Med

J Invest Dermatol Symp Proc

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Coll Cardiol

J Invest Dermatol

J Am Acad Dermatol

J Invest Dermatol

J Sex Med

Quality of life and work productivity impairment among psoriasis patients: findings from the National Psoriasis Foundation survey data 2003-2011

PLoS One

The risk of mortality in patients with psoriasis: results from a population-based study

Arch Dermatol

Costs and quality of life for psoriatic patients at different degrees of severity in southern Sweden–a cross-sectional study

Eur J Dermatol

Economic burden of comorbidities in patients with psoriasis is substantial

J Eur Acad Dermatol Venereol

Psoriasis: an epidemiological evaluation of disease burden in 590 patients

J Eur Acad Dermatol Venereol

Psoriasis severity and the prevalence of major medical comorbidity: a population-based study

JAMA Dermatol

Prevalence and treatment patterns of psoriatic arthritis in the UK

Rheumatology

Infectious, oncologic, and autoimmune comorbidities of psoriasis and psoriatic arthritis: a report from the GRAPPA 2012 annual meeting

J Rheumatology

Cardiovascular comorbidities of psoriasis and psoriatic arthritis: a report from the GRAPPA 2012 annual meeting

J Rheumatology

Original article
Psoriasis prevalence among adults in the United States