Archives of Dermatological Research

, Volume 309, Issue 5, pp 349–356 | Cite as

Dermatological comorbidity in psoriasis: results from a large-scale cohort of employees

  • N. Zander
  • I. Schäfer
  • M. Radtke
  • A. Jacobi
  • H. Heigel
  • M. Augustin
Original Paper


The field of dermatological comorbidity in psoriasis is only passively explored with contradictory results. Objective of this study was to further investigate the complex field of psoriasis and associated skin diseases by identifying skin comorbidity patterns in an extensive cohort of employees in Germany. Retrospective analysis of data deriving from occupational skin cancer screenings was conducted. From 2001 to 2014 German employees between 16 and 70 years from different branches underwent single whole-body screenings by trained dermatologists in their companies. All dermatological findings and need for treatment were documented. Point prevalence rates and their 95% confidence intervals were computed. Logistic regression analysis was performed to calculate odds ratios (OR) of single dermatological diseases to occur together with psoriasis controlled for age and sex. Data from 138,930 persons (56.5% male, mean age 43.2) were evaluated. Psoriasis point prevalence was 2.0%. Of those 20.6% had unmet treatment needs of their disease. Onychomycosis was the most frequent dermatological comorbidity with a prevalence of 7.8%. Regression analysis found rosacea (OR = 1.40, 95% CI 1.13–1.72) and telangiectasia (OR = 1.25, 95% CI 1.10–1.41) to be significantly associated with psoriasis. 17.2% of psoriasis patients had at least one further finding requiring treatment. The highest treatment needs were found for onychomycosis (3.4%), tinea pedis (3.1%), and verruca plantaris (1.0%). It can be concluded that persons with psoriasis are at increased risk to suffer from comorbid skin diseases, which should be considered in treatment regimens. Particular attention should be paid to fungal diseases of the feet.


Psoriasis Comorbidities Need for treatment Epidemiology Prevalence rates 


Compliance with ethical standards

Human and animal rights statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Conflict of interest

The authors declare that they have no conflict of interest.


No funding.


  1. 1.
    Alteras I, Ingberg A, Segal R et al (1986) The incidence of skin manifestations by dermatophytes in patients with psoriasis. Mycopathologia 95(1):37–39CrossRefPubMedGoogle Scholar
  2. 2.
    Altunay ZT, Ilkit M, Denli Y (2009) Psöriazisli olgularda tinea pedis ve ayak tirnaği onikomikozu prevalansinin araştirilmasi. Mikrobiyol Bul 43(3):439–447PubMedGoogle Scholar
  3. 3.
    Arunachalam M, Dragoni F, Colucci R et al (2014) Non-segmental vitiligo and psoriasis comorbidity—a case-control study in Italian patients. J Eur Acad Dermatol Venereol 28(4):433–437CrossRefPubMedGoogle Scholar
  4. 4.
    Augustin M, Glaeske G, Radtke M et al (2010) Epidemiology and comorbidity of psoriasis in children. Br J Dermatol 162(3):633–636CrossRefPubMedGoogle Scholar
  5. 5.
    Augustin M, Krüger K, Radtke M et al (2008) Disease severity, quality of life and health care in plaque-type psoriasis: a Multicenter Cross-Sectional Study in Germany. Dermatology 216(4):366–372CrossRefPubMedGoogle Scholar
  6. 6.
    Augustin M, Reich K, Glaeske G et al (2010) Co-morbidity and age-related prevalence of psoriasis: analysis of health insurance data in Germany. Acta Derm Venereol 90(2):147–151CrossRefPubMedGoogle Scholar
  7. 7.
    Augustin M, Schäfer I, Reich K et al (2011) Systemic treatment with corticosteroids in psoriasis–health care provision far beyond the S3-guidelines. J Dtsch Dermatol Ges 9(10):833–838PubMedGoogle Scholar
  8. 8.
    Bieber T (2008) Atopic dermatitis. N Engl J Med 358(14):1483–1494CrossRefPubMedGoogle Scholar
  9. 9.
    Blome C, Simianer S, Purwins S et al (2010) Time needed for treatment is the major predictor of quality of life in psoriasis. Dermatology 221(2):154–159CrossRefPubMedGoogle Scholar
  10. 10.
    Boehncke W-H, Boehncke S (2012) Cardiovascular mortality in psoriasis and psoriatic arthritis: epidemiology, pathomechanisms, therapeutic implications, and perspectives. Curr Rheumatol Rep 14(4):343–348CrossRefPubMedGoogle Scholar
  11. 11.
    Daniel CR, Jellinek NJ (2006) The pedal fungus reservoir. Arch Dermatol 142(10):1344–1346CrossRefPubMedGoogle Scholar
  12. 12.
    Eisen EA, Picciotto S, Robins JM (2013) Healthy worker effect. In: El-Shaarawi AH, Piegorsch WW (eds) Encyclopedia of environmetrics, 3rd edn. WileyGoogle Scholar
  13. 13.
    Eissing L, Radtke MA, Zander N et al (2016) Barriers to guideline-compliant psoriasis care: analyses and concepts. J Eur Acad Dermatol Venereol 30(4):569–575CrossRefPubMedGoogle Scholar
  14. 14.
    Federal Statistical Office of Germany (2014) Mikrozensus 2013: Bevölkerung und Erwerbstätigkeit. Beruf, Ausbildung und Arbeitsbedingungen der Erwerbstätigen in Deutschland. Fachserie 1 Reihe 4.1.2. Accessed 30 Aug 2016
  15. 15.
    Hamnerius N, Berglund J, Faergemann J (2004) Pedal dermatophyte infection in psoriasis. Br J Dermatol 150(6):1125–1128CrossRefPubMedGoogle Scholar
  16. 16.
    Henseler T, Christophers E (1995) Disease concomitance in psoriasis. J Am Acad Dermatol 32:982–986CrossRefPubMedGoogle Scholar
  17. 17.
    Klaassen KMG, Dulak MG, van de Kerkhof PCM et al (2014) The prevalence of onychomycosis in psoriatic patients: a systematic review. J Eur Acad Dermatol Venereol 28(5):533–541CrossRefPubMedGoogle Scholar
  18. 18.
    Kragballe K, Austad J, Barnes L et al (2006) A 52-week randomized safety study of a calcipotriol/betamethasone dipropionate two-compound product (Dovobet/Daivobet/Taclonex) in the treatment of Psoriasis vulgaris. Br J Dermatol 154(6):1155–1160CrossRefPubMedGoogle Scholar
  19. 19.
    Lebwohl MG, Bachelez H, Barker J et al (2014) Patient perspectives in the management of psoriasis: results from the population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis Survey. J Am Acad Dermatol 70(5):871–881.e1–30CrossRefPubMedGoogle Scholar
  20. 20.
    Leibovici V, Ramot Y, Siam R et al (2014) Prevalence of tinea pedis in psoriasis, compared to atopic dermatitis and normal controls–a prospective study. Mycoses 57(12):754–758CrossRefPubMedGoogle Scholar
  21. 21.
    Meyer-Hoffert U (2009) Reddish, scaly, and itchy: how proteases and their inhibitors contribute to inflammatory skin diseases. Arch Immunol Ther Exp 57(5):345–354CrossRefGoogle Scholar
  22. 22.
    Montaudié H, Albert-Sabonnadière C, Acquacalda E et al (2014) Impact of systemic treatment of psoriasis on inflammatory parameters and markers of comorbidities and cardiovascular risk: results of a prospective longitudinal observational study. J Eur Acad Dermatol Venereol 28(9):1186–1191CrossRefPubMedGoogle Scholar
  23. 23.
    Nast A, Boehncke W-H, Mrowietz U et al (2012) S3—guidelines on the treatment of psoriasis vulgaris (English version). Update. J Dtsch Dermatol Ges 10(Suppl 2):S1–S95CrossRefGoogle Scholar
  24. 24.
    Nestle FO, Kaplan DH, Barker J (2009) Psoriasis. N Engl J Med 361(5):496–509CrossRefPubMedGoogle Scholar
  25. 25.
    Paquet P, Claessens N, Piérard-Franchimont C et al (2005) Effets cutanés indésirables du lithium. Rev Med Liege 60(11):885–887PubMedGoogle Scholar
  26. 26.
    Parisi R, Symmons DP, Griffiths CE et al (2013) Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Investig Dermatol 133(2):377–385CrossRefPubMedGoogle Scholar
  27. 27.
    Poljacki M, Begenesić M, Duran V et al (2002) Psorijaza i oboljenja koze autoimunske prirode. Med Pregl (Medicinski pregled) 55(7–8):325–328CrossRefGoogle Scholar
  28. 28.
    Radtke MA, Reich K, Blome C et al (2009) Prevalence and clinical features of psoriatic arthritis and joint complaints in 2009 patients with psoriasis: results of a German national survey. J Eur Acad Dermatol Venereol 23(6):683–691CrossRefPubMedGoogle Scholar
  29. 29.
    Radtke MA, Schafer I, Glaeske G et al (2016) Prevalence and comorbidities in adults with psoriasis compared to atopic eczema. J Eur Acad Dermatol Venereol. doi: 10.1111/jdv.13813 Google Scholar
  30. 30.
    Rapp S, Feldmann S, Exum M et al (1999) Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol 41:401–407CrossRefPubMedGoogle Scholar
  31. 31.
    Reich A, Hrehorów E, Szepietowski JC (2010) Pruritus is an important factor negatively influencing the well-being of psoriatic patients. Acta Derm Venereol 90(3):257–263CrossRefPubMedGoogle Scholar
  32. 32.
    Reich K (2012) The concept of psoriasis as a systemic inflammation: implications for disease management. J Eur Acad Dermatol Venereol 26(Suppl 2):3–11CrossRefPubMedGoogle Scholar
  33. 33.
    Reich K, Krüger K, Mössner R et al (2009) Epidemiology and clinical pattern of psoriatic arthritis in Germany: a prospective interdisciplinary epidemiological study of 1511 patients with plaque-type psoriasis. Br J Dermatol 160(5):1040–1047CrossRefPubMedGoogle Scholar
  34. 34.
    Sawchuk M, Spano F, Loo WJ et al (2012) The coexistence of psoriasis and vitiligo: a review. J Cutan Med Surg 16(5):300–305CrossRefPubMedGoogle Scholar
  35. 35.
    Schaefer I, Rustenbach SJ, Zimmer L et al (2008) Prevalence of skin diseases in a cohort of 48,665 employees in Germany. Dermatology 217(2):169–172CrossRefPubMedGoogle Scholar
  36. 36.
    Schäfer I, Rustenbach SJ, Radtke M et al (2011) Epidemiologie der Psoriasis in Deutschland-Auswertung von Sekundärdaten einer gesetzlichen Krankenversicherung. Gesundheitswesen 73(5):308–313CrossRefPubMedGoogle Scholar
  37. 37.
    Schauber J, Gallo RL (2008) Antimicrobial peptides and the skin immune defense system. J Allergy Clin Immunol 122(2):261–266CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Schittek B, Paulmann M, Senyurek I et al (2008) The role of antimicrobial peptides in human skin and in skin infectious diseases. Infect Disord Drug Targets 8(3):135–143CrossRefPubMedGoogle Scholar
  39. 39.
    Schmid-Ott G, Malewski P, Kreiselmaier I et al (2005) Psychosocial consequences of psoriasis—an empirical study on the burden of skin disease in 3753 patients. Hautarzt 56(5):466–472CrossRefPubMedGoogle Scholar
  40. 40.
    Sheth VM, Guo Y, Qureshi AA (2013) Comorbidities associated with vitiligo: a ten-year retrospective study. Dermatology 227(4):311–315CrossRefPubMedGoogle Scholar
  41. 41.
    Shi VY, Leo M, Hassoun L et al (2015) Role of sebaceous glands in inflammatory dermatoses. J Am Acad Dermatol 73(5):856–863CrossRefPubMedGoogle Scholar
  42. 42.
    Ständer S, Schäfer I, Phan NQ et al (2010) Prevalence of chronic pruritus in Germany: results of a cross-sectional study in a sample working population of 11,730. Dermatology 221(3):229–235CrossRefPubMedGoogle Scholar
  43. 43.
    Szepietowski JC, Reich A, Garlowska E et al (2006) Factors influencing coexistence of toenail onychomycosis with tinea pedis and other dermatomycoses: a survey of 2761 patients. Arch Dermatol 142(10):1279–1284CrossRefPubMedGoogle Scholar
  44. 44.
    World Health Organization (2016) Global report on psoriasis. Accessed 03 Nov 2016
  45. 45.
    Yazici A, Akturk AS, Cefle A et al (2014) Rosacea associated with etanercept. Joint Bone Spine 81(3):274–275CrossRefPubMedGoogle Scholar
  46. 46.
    Yeung CK, Chan HHL (2004) Cutaneous adverse effects of lithium: epidemiology and management. Am J Clin Dermatol 5(1):3–8CrossRefPubMedGoogle Scholar
  47. 47.
    Zander N (2015) Comorbid akin diseases in psoriasis—results of nationwide occupational screenings. Accessed 03 Nov 2016
  48. 48.
    Zhu K-J, Lv Y-M, Yin X-Y et al (2011) Psoriasis regression analysis of MHC loci identifies shared genetic variants with vitiligo. PLoS One 6(11):e23089CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • N. Zander
    • 1
  • I. Schäfer
    • 1
  • M. Radtke
    • 1
  • A. Jacobi
    • 1
  • H. Heigel
    • 2
  • M. Augustin
    • 1
  1. 1.German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Heigel GmbHHanstedtGermany

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