Psoriasis treatment is associated with a reduced risk of some infections and improved survival in patients with end-stage kidney disease (ESKD), according to recent study findings.
Patients with ESKD and psoriasis may be at greater risk for infection due to chronic vascular access and epidermal dysfunction, in addition to other factors, Wendy B. Bollag, PhD, of the Medical College of Georgia at Augusta University, and colleagues explained.
Of 866,828 patients on hemodialysis or peritoneal dialysis in the 2004-2011 US Renal Data System (USRDS), 8911 (1.0%) had psoriasis. In adjusted analyses, a psoriasis diagnosis, compared with no psoriasis diagnosis, was significantly associated with an increased risk for 9 common infections in the ESKD population, including cellulitis (55% increased risk), conjunctivitis (47%), onychomycosis (36%), herpes zoster (32%), pericarditis (27%), bacteremia (17%), fungemia (15%), septicemia (9%), and systemic inflammatory response syndrome (SIRS; 5%).
Psoriasis treatment significantly reduced the risk of some of these infections and was associated with improved survival, Dr Bollag and her peers reported in The American Journal of the Medical Sciences. Compared with no psoriasis treatment, systemic, local, and light therapies for psoriasis significantly decreased SIRS risk by 31%, 31%, and 25%, respectively. Septicemia risk decreased significantly by 25%, 29%, and 28%, respectively. Bacteremia risk decreased significantly by 38% and 25% with systemic and local therapy, respectively. Mortality risk declined significantly by 45%, 40%, and 25% with systemic, local, and light therapies, respectively.
Conversely, the risk for herpes zoster increased significantly by 91% with local therapy and the risk for cellulitis increased significantly by 56% with light therapies.
In the psoriasis cohort, 1071 patients (12.0% of cohort) received systemic (2.7%), local (3.6%), or light therapy (5.8%). Systemic therapy included methotrexate, cyclosporine, corticosteroids, and parenteral biologics. Local treatment was defined as intralesional corticosteroid injections. Light-based treatment included ultraviolet light and laser therapy.
“We speculate that all forms of treatment included in this analysis improve the epidermal barrier disruption associated with untreated psoriasis, and thus may decrease the likelihood of microbial invasion via psoriatic skin portals,” Dr Bollag’s team wrote. “Despite psoriasis treatment being associated with protection against mortality, only 12.0% of patients received psoriasis treatment.”
“Physicians caring for psoriasis patients on dialysis should be attentive to proper referrals for disease therapy, be cognizant of the increased risk of infection, and be vigilant about vaccination, especially for herpes zoster,” they concluded.
Schwade MJ, Tien L, Waller JL, et al. Treatment of psoriasis in end-stage renal disease patients is associated with decreased mortality: a retrospective cohort study. Am J Med Sci. Published online March 30, 2021. doi:10.1016/j.amjms.2021.03.009