The reported prevalence of depression in psoriasis varies substantially. This study aims to determine the prevalence and odds of depressive symptoms and clinical depression in psoriasis. A systematic literature search was conducted. Mean questionnaire values and proportions for depressive symptoms and clinical depression were pooled according to different assessment methods. In controlled studies, standardized mean differences (SMDs) and odds ratio (OR) compared depression in psoriasis patients with controls using the random-effect model. The majority of the 98 eligible studies were conducted in tertiary centers without a control group. The prevalence of depressive symptoms was 28% using questionnaires and the prevalence of clinical depression was 12% using International Classification of Diseases codes, 19% using Diagnostic and Statistical Manual of Mental Disorders IV, and 9% for antidepressant use. Psoriasis patients had significantly more depressive symptoms (SMD 1.16; 95% confidence interval (CI) 0.67-1.66), and population-based studies showed that they were at least one and a half times more likely to experience depression (OR 1.57; 95% CI 1.40-1.76) and used more antidepressants than did controls (OR 4.24, 95% CI 1.53-11.76). More than 10% of psoriasis patients suffer from clinical depression, and twice as many have depressive symptoms. The high prevalence of these symptoms is likely to be affected by the tertiary study populations and differential misclassification using questionnaires, where psoriasis-related symptoms may be detected as depressive symptoms.

SummaryStudies investigating systemic inflammation in psoriasis use different serum markers and report discrepant results. We set out to determine whether systemic inflammation is elevated in patients with psoriasis compared with healthy controls, and to measure the extent of this elevation, by summarizing available data on serum inflammatory markers. PubMed, Embase and Web of Science were searched from inception to March 2011. We included studies comparing the serum inflammatory markers interleukin (IL)-1b, IL-6, IL-10, C-reactive protein (CRP), intracellular adhesion molecule (ICAM)-1, E-selectin and tumour necrosis factor (TNF)-a in patients with psoriasis and healthy controls. Differences in serum marker levels between patients and controls were pooled as standardized mean differences (SMDs; Cohen's d) using a random-effects model. Seventy-eight studies were eligible. Of the 7852 individuals included, 3085 had (severe plaque) psoriasis. The pooled SMDs were higher in patients with psoriasis than in healthy controls for IL-The SMD between cases and controls for IL-1b and IL-10 was not significant. Age had a significant effect on the SMD for IL-6 and TNF-a. For IL-6 the effect size was higher for plaque psoriasis studies (d = 1Á98). The effect size was not influenced by the Psoriasis Area and Severity Index, measurement method or quality assessment. The pooled analyses suggest modest but significantly elevated levels of the proinflammatory cytokines in the serum of patients with psoriasis with predominantly severe disease. To what extent this modest increment is clinically relevant could be investigated in a synthesis of all studies measuring inflammation before and after antipsoriatic therapy.What's already known about this topic?• Psoriasis is an inflammatory disease affecting the skin.• Many studies have investigated whether it can also be considered a systemic disease, by analysing serum levels of inflammatory cytokines in patients with psoriasis.What does this study add?• This study systematically synthesizes the evidence on selected serum inflammatory markers to determine whether systemic inflammation is elevated in patients with psoriasis compared with healthy controls, and to measure the extent of this elevation.

Limited data are available on the prevalence and risk factors of actinic keratoses (AKs). Within the Rotterdam Study, full-body skin examinations were performed among participants aged 45 years or older to estimate the age- and sex-standardized prevalence of AK and its associated risk factors. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for associations between risk factors and the presence of 1-3, 4-9, and ≥ 10 AKs. Of the 2,061 inspected cohort members (mean age 72 years), 21% had 1-3, 9% had 4-9, and 8% had ≥ 10 AKs. AK prevalence was 49% (95% CI: 46-52%) for men and 28% (26-31%) for women. Male gender, older age, light pigmentation status, severe baldness, skin wrinkling, and high tendency for sunburn were significantly associated with extensive actinic damage (≥ 10 AKs) in the multivariate analyses. Especially bald males were at an increased risk of severe actinic skin damage (adjusted OR=7.0 (3.8-13.1)). The prevalence of AK is very high, especially among elderly bald males. The prevention and management of AK is a true challenge for patients, physicians, and health-care policymakers.

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Psoriasis has been suggested to be an independent risk factor for cardiovascular disease (CVD); however, available studies have shown inconsistent results. In this study, embedded within the population-based Rotterdam Study, we aimed to assess the association between psoriasis and cardiovascular outcomes. Adjusted means were calculated for subclinical atherosclerosis using general linear models. Using Cox regression, the hazards of cardiovascular events for psoriasis, as a time-dependent variable, were calculated. A total of 262 psoriasis (24% systemic/UV treatment) and 8,009 reference subjects were followed up for a mean of 11 years. Psoriasis patients were significantly younger, smoked more, and had higher diastolic blood pressure and body mass index levels. The adjusted carotid intima-media thickness was 1.02±0.18 mm for psoriasis and 1.02±0.16 mm for reference subjects. Similarly, crude and adjusted ankle-brachial index, pulse-wave velocity, and coronary artery calcium scores did not differ between the two groups. The risk of incident CVD was not increased in psoriasis (adjusted hazard ratio 0.73, 95% confidence interval 0.50-1.06). The results were similar when coronary heart disease, stroke, and heart failure were analyzed separately. Psoriasis patients with predominantly mild disease from the general population are as likely to develop atherosclerosis and cardiovascular events as subjects without psoriasis.