Background:The seasonal patterns of psoriasis have been observed in previous studies. However, no published data indicated the risk factors associated with the seasonal variation. Purpose: This study aimed to investigate potentially related factors associated with seasonal pattern of psoriasis and provide possible implications for alleviating psoriasis in clinical practice. Patients and Methods: The retrospective study was conducted in Chinese patients with psoriasis. Demographic and clinical information were collected. Multivariable logistic regression analyses (calculating adjusted odds ratios [AORs]) were used to analyze data. Results: We continually enrolled 2270 patients (1496 males and 774 females) with psoriasis based on inclusion criteria. Disease duration (AOR=1.06, 95% CI: 1.05-1.07), hyperlipidemia (AOR=1.77, 95% CI: 1.06-2.98) and smoking (AOR=1.40, 95% CI: 1.17-1.68) were significantly associated with severe psoriasis in autumn/winter. Age (AOR=0.98, 95% CI:0.97-0.99) and occupations with more sunlight exposure (AOR=0.78, 95% CI: 0.61-0.99) were negatively associated with the seasonal aggravation. Subgroup analysis showed that occupations with more sunlight exposure (AOR=0.64, 95% CI: 0.43-0.94) were protective factors only in late-onset psoriasis but not early-onset, while smoking (AOR=1.39, 95% CI: 1.11-1.74) was risk factor in the early-onset psoriasis. Conclusion: Psoriatic patients who had occupation with more sunlight exposure were less likely to report aggravation of psoriasis in autumn/winter. On the contrary, smoking and hyperlipidemia were positively associated with the seasonal aggravation. Additional prospective study is needed to identify the causality.

Psoriasis can be provoked or exacerbated by environmental exposures such as certain microbiomes. The distinction between plaque psoriasis (PP) and guttate psoriasis (GP) in the skin or pharyngeal microbiota is not yet clear. High-throughput sequencing using Illumina MiSeq was used in this study to characterize skin and pharyngeal microbial composition in patients with PP [large PP (LPP, n = 62), small PP (SPP, n = 41)] and GP (n = 14). The alpha- and beta-diversity of skin microbiota LPP was similar to that of the SPP group, but different from the GP group. There were no differences in pharyngeal microbiota among the groups. According to linear discriminant analysis effect size (LEfSe) analysis, Staphylococcus, Stenotrophomonas, Enhydrobacter, Brevundimonas, and Allorhizobium–Neorhizobium–Pararhizobium–Rhizobium were the dominant genera of skin microbiota in PP. Diversity of skin microbiota correlated with Psoriasis Area and Severity Index (PASI). Moderate-to-severe psoriasis and mild psoriasis have different microbiota compositions. The skin microbiota may be related to the pharyngeal microbiota. Furthermore, two microbiota-based models could distinguish psoriasis subtypes with area under the receiver-operating characteristic curve (AUC-ROC) of 0.935 and 0.836, respectively. In conclusion, the skin microbiota in patients with LPP is similar to that in patients with SPP, but displays variations compared to that of GP, no differences are noted between subtypes in pharyngeal microbiota. Skin microbiota diversity correlated with PASI.

Patient acceptable symptom state (PASS) is a patient-reported outcome that re ects patient's perspective well. The relationship between the PASS and disease scores in psoriasis has not been described. This study of 198 patients with psoriasis, assessed PASS using a binary question on patient's feeling on their symptom. The disease scores including Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA) affected by lesions and other patient characteristics were collected. Logistic regression was used to investigate the associations. 71.4% patients with mild psoriasis based on PASI and 76.3% based on BSA considered their symptom state acceptable. Female (adjusted OR=0.47; 95% CI: 0.42-0.92) and patients with exposed skin (head, neck, and hands) involved (adjusted OR=0.38; 95% CI: 0.19-0.76) were less likely to report acceptable symptom state. Receiver-Operating Characteristics curve showed that both PASI and BSA have limited capability in differentiating acceptable symptom state in psoriasis, which further indicated the unique value of PASS in the management of psoriasis.