Kate from Oz
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Psoriasis Client Research

PSORIASIS + WEATHER

Requested Literature summary for senior vp's presentation to major prospective client


AES had a client interested in exploring analytics plus the use of health technology (app, smartwatch, etc.), specifically the interactions between psoriasis and the weather. All information comes from peer-reviewed journals found through JStor, PubMed, Medline, Google Scholar, and the Wichita State University library. This is the resultant research that was presented to a client by the senior VP, based on information available in respected academic journals.


Psoriasis + Weather

Seasonal Weather Changes

  • 18.5% of patients in Taiwanese study found that seasonal weather changes triggered psoriasis (Lin 190)
  • 42.9% of patients in Taiwanese study found that seasonal weather changes exacerbated their psoriasis. (Lin 190)

Cold Weather

  • 81% of patients had flares of psoriasis in the winter. (Nyfors 440)
  • Dry, cold weather worsened pruritus (itching) from psoriasis. (Amatya 3)
  • In the winter, itching was aggravated in patients. Speculate that extreme dryness during winter months contributed to pruritus. (Amatya 4)
  • Infections like the common cold play a major role in precipitations and exacerbating psoriasis. (Nyfors 440) *Cold weather of winter months forces people inside more, leading to colds and illness spreading easily and then exacerbating psoriasis patients.
  • In a study of 870 Koreans with psoriasis, 65% saw worsening of disease during the winter months, with only 10% seeing improvement. (Park 98) Patients with moderate disease were most effected by seasonal changes. (Park 99)
  • 89% of psoriasis patients found their condition worsened during cold weather, in a study of 5600 patients. (Farber)
  • Psoriasis is more frequent in northern regions than in tropical regions. Incidence of disease has been reported to be 6.5% Germany, 5.5% Ireland, 4.8% Scotland, 4.8% Norway, 4.7% Canada, 0.1% Japan. (Faber/Nail)
  • An Indian study also showed that 42% of psoriatic patients worsened in winter. (Miyoshi 821)
  • Persons with psoriasis tend to fare poorly in cold weather. (Watson 103)
  • See Pascoe 2015 under Warm Weather

Sunshine

  • Sunlight and sea bathing improved conditions for 75-80% of psoriasis patients. (Nyfors 440)
  • Sunbathing and cold showers helped psoriasis in some patients. (Amatya 3)
  • Climate journeys/vacations to warm, sunny climates helped alleviate systems for some. (Amatya 3)
  • Treatment with ultraviolet light (UV-B and UV-A) are widely used to treat and relieve symptoms of psoriasis.
  • In the Park study, 58% of psoriasis patients saw improvement of symptoms with sunlight, and only 8% had worsening of disease. (Park 98) Patients with moderate disease were most effected by seasonal changes. (Park 99)
  • Measurements have been made of the biologically-effective environmental UV-B radiation received by people pursuing a variety of outdoor leisure activities. These UV-B doses have been compared with those received from artificial UV-B radiation by patients undergoing treatment for psoriasis. The results indicate that the therapeutic doses are not dissimilar to those received by active sunbathing for the same period during the summer months. (Diffey 33)

Warm Weather

  • Physical exercise and sweating worsened pruritus (itching) for some patients with psoriasis. (Amatya 3)
  • See sunshine for warm weather and being able to have skin exposed to sunlight.
  • In a study of 870 Koreans with psoriasis, 59% saw improvement of disease during the summer months, with only 12% worsening. (Park 98) Patients with moderate disease were most effected by seasonal changes. (Park 99)
  • 78% of psoriasis patients found that their disease improved during hot weather, in a study of 5600 patients. (Farber)
  • An Indian study also showed that 43% of psoriatic patients improved in summer. (Miyoshi 821)
  • Warm weather, sunlight, and humidity usually have a beneficial effect on psoriasis. (Watson 103)
  • PGA scores for 5468 psoriasis patients were collected. Sixteen percent of patients were seen in summer, 25% in fall, 31% in winter, and 28% in spring. There were no significant seasonal differences in age or sex. Psoriasis showed summer clearing: 20.4% of patients were graded effectively clear versus 15.3% in winter (Fig 2). When effectively clear patients were compared over 4 seasons, a chi-square test was significant (P < .01). Conversely, psoriasis flared in the winter (P < .01; Fig 2). Analysis of 3910 psoriasis patients seen multiple times maintained the significant trend of summer clearing (P <.05) and winter flaring (P < .01). (Pascoe 523)

Humidity

Humidity does not appear to play a dominant role on psoriasis prevalence in a country’s population. (Jacobson 872) – This pdf has a ton of great data on prevalence of psoriasis per countries and brings up considering altitude and days of actual sunshine per year for their effects on rates of psoriasis and severity of psoriasis symptoms. [Saved w\KatieCoriell\Psoriasis\Jacobson2011 - …]

Stress

  • 90% of patients suffering with psoriasis saw their symptoms worsen with stress. (Nyfors 440)
  • Vacations and relaxation relieved pruritus (itching) from psoriasis to some extent for patients. (Amatya 3)
  • In the Park study, 62% of psoriasis patients had worsening disease due to stress and 37% said there was no effect due to stress. (Park 98) Patients with moderate disease were most effected by seasonal changes. (Park 99)

Latitude

Psoriasis tends to be more frequent at higher latitudes than lower latitudes.(Lin 186)

Altitude

This pdf has a ton of great data on prevalence of psoriasis per countries and brings up considering altitude and days of actual sunshine per year for their effects on rates of psoriasis and severity of psoriasis symptoms. [Saved w\KatieCoriell\Psoriasis\Jacobson2011 - …]
Altitude’s effect on psoriasis: Psoriasis patients usually fare better in Arizona than in Florida. Besides factors as density of air, humidity, pollens, fungi, and temperature, there is a striking difference in altitudes between Florida and Arizona. Dr. Fahri Izgi stated that in his opinion the rarity of neurodermatitis/psoriasis occurring on the plateau of Central Anatolia (Turkey) may be attributed exclusively to the altitude. (Schmidt 1083)

Ethnicity

  • The condition affects 2%-11% of the Caucasian population but only 0.3% of the Mongoloid population. (Lin 186)
  • Psoriasis is rare in North and South American Indians. (Watson 103)
  • Psoriasis affects 0.1-3% of the population. Based on race/ethnicity, psoriasis is most prevalent in Caucasians, roughly half as prevalent in African Americans compared to Caucasians, and about half as prevalent in Asian Americans compared to African Americans. (Dika 214)
  • In Spain, 1.17-1.43% of population have psoriasis. Higher prevalence in the central dry region of the country (drier and colder weather compared to rest of country). (Ferrandiz 20)
  • A recent epidemiological study of psoriasis in Taiwan reported the mean one-year prevalence rate of psoriasis was 0.19%. One possible explanation for the relatively lower occurrence of psoriasis compared with that in Caucasian populations might be the lower frequency of the HLA-Cw6 gene in the Taiwanese population. (Lin 187)

Further interesting information

  • It is even reported that topical hyperthermia is beneficial to psoriasis vulgaris. Although the increased susceptibility to psoriasis in northern regions might be explained by a decreased amount of ultraviolet rays, this tendency suggests that cold temperature would worsen or initiate psoriasis. However, the prevalence of psoriasis is exceptionally low in Eskimos and this may be related to their high dietary intake of fish or genetic basis. (Miyoshi 821)
  • In a case of psoriasis from a cooling pillow used to sleep at night: The fact that the patient’s initial psoriatic lesions were localized to the cooling zone strongly suggests that they were triggered by cold exposure. (Miyoshi 821)
  • There were no significant age or sex differences among the response groups in the respective categories of these four external factors. (Park)

BIBLIOGRAPHY
Amatya, Beni, and Klas Nordlind. "Focus groups in Swedish psoriatic patients with pruritus." The Journal of dermatology 35, no. 1 (2008): 1-5.
Diffey, B. L., O. Larkö, and G. Swanbeck. "UV‐B doses received during different outdoor activities and UV‐B treatment of psoriasis." British Journal of Dermatology 106, no. 1
     (1982): 33-41.
Dika, E., and H. I. Maibach. "Exogenous factors and psoriasis." Exogenous Dermatology 3, no. 5 (2004): 214-222.
Farber EM, Nail L. “Epidermiology: natural history and genetics.” Psoriasis, 3rd edn. New York: Marcel Dekker, 1998; 107– 157.
Farber EM, Nall ML. “The natural history of psoriasis in 5,600 patients.” Dermatologica 148 (1974): 1–18.
Ferrándiz, C., S. Puig, R. Pujol, and A. Smandía. "Prevalence of psoriasis in Spain (Epiderma Project: phase I)." Journal of the European Academy of Dermatology and
     Venereology
 15, no. 1 (2001): 20-23.
Jacobson, Christine C., Sandeep Kumar, and Alexa B. Kimball. "Latitude and psoriasis prevalence." Journal of the American Academy of Dermatology 65, no. 4 (2011): 870-
     873.
Kaur I, Handa S, Kumar B. “Natural history of psoriasis: a study from the Indian Subcontinent.” Journal of Dermatology 24 (1997): 230–234.
Lin, Tung-Yi, Lai-Chu See, Yu-Ming Shen, Chung-Yu Liang, Hsin-Ning Chang, and Yin-Ku Lin. "Quality of life in patients with psoriasis in northern Taiwan." Chang Gung Med
     J
 34, no. 2 (2011): 186-96.
Miyoshi, K., Takamura et al. “Manifestation of psoriatic lesions in a cooling pillow user.” The Journal of Dermatology 38 (2011): 819–821.
Nyfors, Allan, and Klavs Lemholt. "Psoriasis in children." British Journal of dermatology 92, no. 4 (1975): 437-442.
Park, B. S. and Youn, J. I. “Factors Influencing Psoriasis: An Analysis Based upon the Extent of Involvement and Clinical Type.” The Journal of Dermatology 25 (1998): 97–
     102. 
Pascoe, Vanessa Lindsay, and Alexandra Boer Kimball. "Seasonal variation of acne and psoriasis: A 3-year study using the Physician Global Assessment severity
     scale." Journal of the American Academy of Dermatology 73, no. 3 (2015): 523-525.
Schmidt, Frederick Rehm. "Action of iodine on diseases of the skin as influenced by season and weather." Archives of Dermatology and Syphilology 42, no. 6 (1940): 1083-
     1091.
Watson, William, and Eugene M. Farber. "Controlling psoriasis." Postgraduate medicine 61, no. 6 (1977): 103-109.