Reply to: low response of granulomatous cheilitis to currently established treatments

Abstract

subgroup for all outcomes except for mortality, where there was no statistically significant trend (Table 1).Our findings are comparable to a U.S based study between 1979 and 2001, which showed that among PsO patients, while the rates of principal PsO hospitalizations decreased, hospitalization increased for non-PsO reasons during the study period. 3 We hypothesized that use of biologic agents for moderate-severe PsO & PsA has reduced the need for admission due to PsO flare and may have contributed to the reducing mortality of PsO patients over time. Increased incidence of hospitalization of PsO patients over time may be due to increased disease awareness, increased comorbidity burden of psoriasis patients driving admissions due to comorbidities or better documentation of secondary diagnosis due to shift to electronic medical records which is able to capture more patient diagnosis upon admission.Our findings are in contrast to a multi-centre study, from 2005 to 2015, which showed a non-statistically significant trend towards an increase in number of hospitalizations for PsO flare over time. 2 However, this study was done in France and included only 998 patients. Similar to our study, a United Kingdom primary care database study between 1999 and 2013 showed reduction in mortality of PsO patients over time, a trend similar to that of the general population. 4 We found increasing CCI of PsO patients over time. PsO patients are known to have higher comorbidity burden than controls. 5 The increasing CCI of PsO patients warrants need for increased outpatient screening and management of medical comorbidities to reduce preventable hospitalizations. Reduction in LOS and increase in total hospital charges of PsO patients is in keeping with the general trend in the U.S healthcare system in recent times. 6,7