Summary Background National Institute for Health and Care Excellence guidance recommends assessment of psychological and social well‐being in people with psoriasis. Objectives To screen systematically for depression and anxiety in patients with psoriasis in routine clinical practice and to identify at‐risk groups for psychiatric morbidity. Methods Consecutive patients attending a single, tertiary centre over a 10‐month period were invited to complete the Patient Health Questionnaire Depression Scale (PHQ‐9), Generalized Anxiety Disorder Scale (GAD‐7) and Dermatology Life Quality Index (DLQI) as part of IMPARTS: Integrating Mental and Physical Healthcare: Research, Training and Services. Information on demographics, treatment and clinical disease severity was collated from electronic patient records. Regression models were used to identify at‐risk groups for psychiatric morbidity. Results Of 607 patients included (56·2% on biologics), 9·9% (95% confidence interval 7·5–12·3%) screened positive for major depressive disorder (MDD) and 13·1% (79/604) (95% confidence interval 10·4–15·8%) for generalized anxiety disorder (GAD; GAD‐7 score > 9). Suicidal ideation was reported in 35% of those with MDD; DLQI was < 10 in 38·3% and 45·6% cases of MDD and GAD, respectively. After adjusting for covariates, the risk of MDD or GAD was significantly higher in women and those with severe clinical disease, psoriatic arthritis and previous depression/anxiety. The risk of GAD was significantly increased with Asian ethnicity and use of topical treatments only. Conclusions Systematic screening for anxiety and depression identifies clinically important levels of depression and anxiety that may be missed using DLQI data alone. Women and those with severe disease, psoriatic arthritis and/or a prior history of psychiatric morbidity may be at particular risk.
The management of osteomyelitis in hidradenitis suppurativa Dear Editor, Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory disease of apocrine gland-bearing skin. Complications include secondary infection of affected areas in addition to scarring. Osteomyelitis via contiguous spread from soft tissue in this context is comparatively rare with no established guidelines on its management. We describe two cases from a tertiary clinic.Patient 1, a 53-year-old woman with Hurley stage 3 HS affecting the vulva and buttocks, developed osteomyelitis of the sacrum while being worked up for adalimumab. This was treated with intravenous (IV) antibiotics for 2 months and then switched to oral cephalexin as maintenance. Magnetic resonance imaging (MRI) scans demonstrated high STIR signal in
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