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Feb 20, 2010 - Psoriasis Associated with Hepatitis C but. Not with Hepatitis B. Arnon D. Cohen a, b Dahlia Weitzman c Shlomo Birkenfeld a Jacob Dreiher a, b.
Original Paper Received: November 10, 2008 Accepted after revision: November 19, 2009 Published online: February 20, 2010

Dermatology DOI: 10.1159/000286131

Psoriasis Associated with Hepatitis C but Not with Hepatitis B Arnon D. Cohen a, b Dahlia Weitzman c Shlomo Birkenfeld a Jacob Dreiher a, b a

Clalit Health Services, b Siaal Research Center for Family Medicine and Primary Care, c Department of Epidemiology and Health Services Evaluation, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

Key Words Hepatitis C ⴢ Hepatitis B ⴢ Psoriasis, comorbidity

not with hepatitis B. Physicians who care for patients with psoriasis should be aware of this possible association and consider screening patients with psoriasis for hepatitis C. Copyright © 2010 S. Karger AG, Basel

Abstract Purpose: To investigate the association between psoriasis and viral hepatitis. Methods: Psoriasis patients were compared to controls regarding the prevalence of viral hepatitis in a case-control study using logistic multivariate models. The study was performed utilizing the medical database of Clalit Health Services. Results: The study included 12,502 psoriasis patients 120 years old and 24,287 age- and sexmatched controls. The prevalence of hepatitis C in patients with psoriasis was increased compared to the prevalence in controls (1.03 vs. 0.56%; p ! 0.001). In a multivariate analysis, psoriasis was associated with hepatitis C. An interaction with smoking was noted (smokers: odds ratio, OR = 1.93, 95% confidence interval, CI = 1.30–2.67; nonsmokers: OR = 2.22, 95% CI = 1.63–3.04). The prevalence of hepatitis B in patients with psoriasis was higher than in the controls (0.74 vs. 0.56%; p = 0.043). However, in a multivariate analysis psoriasis was not associated with hepatitis B (OR = 1.22, 95% CI = 0.93–1.60, p = 0.15). Conclusion: Our observation supports previous reports of an association between psoriasis and hepatitis C but

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Introduction

Hepatitis B and C are systemic viral infections primarily involving the liver, which may result in chronic disease. Both viruses are transmitted through blood or its products and during hemodialysis. Health care workers, intravenous drug users and sexually active homosexual males are at increased risk. Hepatitis B and C may be associated with autoimmune disorders such as thyroiditis, immune complex nephritis (particularly membranous glomerulopathy) and idiopathic mixed cryoglobulinemia [1, 2]. In recent years, it has been shown that psoriasis is an immune disease in which systemic inflammation and tumor necrosis factor (TNF) ␣ have an important role [3, 4]. As both types of viral hepatitis are associated with chronic inflammation and aberrant immune response, we hypothesized that hepatitis B and C may indepenDr. Arnon D. Cohen 17/2 Yehushua Bin Nun St. Hod Hasharon, 45350 (Israel)

Table 1. Baseline characteristics of the study population (n =

36,789) Characteristic Age, years Mean 8 SD Median Range Male sex Obesity Current smoker IFN-␣2 therapy

Psoriasis patients Controls (n = 12,502) (n = 24,287)

p value

55.8816.7 56 20–101 6,516 (52.1%) 3,080 (24.5%) 3,558 (28.5%) 28 (0.2%)