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Consuelo Huerta, MD, MPH; Elena Rivero, MD, MPH, FISPE; Luis A. García Rodríguez, MD, MSc

Arch Dermatol. 2007;143(12):1559-1565.

Objectives  To study the clinical spectrum of psoriasis and the incidence in the general population and to identify risk factors associated with the occurrence of psoriasis.

Design  Prospective cohort study with nested case-control analysis.

Setting  The data source was the United Kingdom General Practice Research Database containing computerized clinical information entered by general practitioners (GPs).

Patients  The study population comprised patients receiving a first-ever diagnosis of psoriasis between January 1, 1996, and December 31, 1997, and free of cancer.

Interventions  Diagnosis of psoriasis was validated in a random sample of 14% of all ascertained cases requesting confirmation by the GPs. Nested case-control analysis included 3994 cases of psoriasis and a random sample of 10 000 controls frequency matched to cases by age, sex, and calendar year.

Main Outcome Measures  Incidence rate of psoriasis and estimates of the odds ratio (OR) and 95% confidence interval (CI) for psoriasis as associated with selected risk factors.

Results  The incidence rate of psoriasis was 14 per 10 000 person-years. Patients with antecedents of skin disorders and skin infection within the last year carried the highest risk of developing psoriasis (OR, 3.6 [95% CI, 3.2-4.1], and OR, 2.1 [95% CI, 1.8-2.4], respectively). Also, smoking was found to be an independent risk factors for psoriasis (OR, 1.4 [95% CI, 1.3-1.6]). We did not find an association between risk of psoriasis and antecedents of stress, diabetes, hypertension, hyperlipidemia, cardiovascular disease, or rheumatoid arthritis.

Conclusions  The incidence rate in our study was higher than those published in other studies, probably owing to our case definition that considered cases recorded by the GPs independently of a specialist confirmation. Our results confirm the association between psoriasis, skin disorders, and smoking.

Author Affiliations: Spanish Center for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain (Drs Huerta and García Rodríguez); and Department of Clinical Epidemiology, Novartis Farmacéutica SA, Barcelona, Spain (Dr Rivero).

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