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EDITORIAL
Year : 2017  |  Volume : 146  |  Issue : 2  |  Page : 147-149

Research on psoriasis in India: Where do we stand?


Department of Dermatology & Sexually Transmitted Diseases, Jawaharlal Institute of Post Graduate Medical Education & Research, Puducherry 605 006, India

Date of Submission10-Aug-2017
Date of Web Publication18-Dec-2017

Correspondence Address:
Devinder Mohan Thappa
Department of Dermatology & Sexually Transmitted Diseases, Jawaharlal Institute of Post Graduate Medical Education & Research, Puducherry 605 006
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_1296_17

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How to cite this article:
Thappa DM, Munisamy M. Research on psoriasis in India: Where do we stand?. Indian J Med Res 2017;146:147-9

How to cite this URL:
Thappa DM, Munisamy M. Research on psoriasis in India: Where do we stand?. Indian J Med Res [serial online] 2017 [cited 2018 Apr 26];146:147-9. Available from: http://www.ijmr.org.in/text.asp?2017/146/2/147/221081

This article is published on the occasion of Psoriasis Awareness Month - August 2017


Psoriasis is a genetically determined immune-mediated inflammatory disease mediated by T-helper 1 (Th1)/Th17 T cells. With a prevalence of 0.44-2.8 per cent in India, it commonly affects individuals in their third or fourth decade with males being affected two times more common than females[1]. Psoriasis significantly impairs the quality of life of patients and their families resulting in great physical, emotional and social burden.

It has been pointed out in the WHO's recent Global Report on Psoriasis[2] that there are many unmet research gaps in psoriasis addressing various aspects such as epidemiology, aetiology, association with comorbidities, treatment and ways to improve healthcare services. It has been recommended that therapeutic researches should focus on options which can be applicable globally, on a large scale.

Psoriasis is a genetically determined disease with environmental influences; ethnic differences are quite commonly expected involving all aspects of the disease from epidemiology, genetic susceptibility, clinical manifestations and response to treatment. Hence, data obtained from research done on different ethnic communities cannot be generalized globally. Hence, there is a need for research on psoriasis which is population specific or ethnicity specific. This draws attention to the status of research on psoriasis specific to the Indian population, an ethnically, genetically and culturally unique and diversified population.

At present, the data on the prevalence of psoriasis are from hospital-based studies rather than from well-defined large population-based studies. There is a paucity of data related to genetics, epidemiology, disease types, associations, severity and course amongst Indian patients with psoriasis[3]. Only recently the research on psoriasis from India has started focusing on the genetics and epigenetics of psoriasis and association with metabolic syndrome, and there is a large gap addressing the therapeutic aspects of psoriasis, particularly on the use of biologics. Studies on risk factors that would aid in identifying preventive strategies which are crucial for chronic non-communicable diseases which lack definitive curative therapy, are barely conducted.

A bibliometric study conducted on Indian psoriasis research in 2013[4] shows contribution of Indian researchers in the area of psoriasis. This study was undertaken to evaluate the global patterns of psoriasis literature output and to assess the contributions and impact of Indian scientists in the global psoriatic literature. The Indian researchers were ranked 11th when compared to most active countries (such as the US, UK and Germany) and were reported to actively contribute to psoriatic research as evidenced by their substantial number of publications (849 articles during 1973-2012; 2% of global production) with an overall growth rate of 127.5 per cent. International collaborative research was undertaken significantly in 2003-2012, with almost 17 countries with maximum collaboration with the US followed by the UK and Saudi Arabia[4].

Current research on psoriasis in India focuses on identifying human leukocyte antigen (HLA) associations and genetic polymorphisms conferring psoriatic risk amongst Indians and metabolic syndrome and cardiovascular risk amongst psoriatics[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16]. We have recently reported that Th2 cytokine/regulatory T-cell gene polymorphism - interleukin-10 (IL-10) (rs1800871) polymorphism[10], Th1/Th17 cytokine polymorphisms - IL-12B (rs3212227) and IL-23R (rs2201841) polymorphisms[11], tumour necrosis factor alpha (TNF a) polymorphisms - TNFAIP3 (rs610604) and TNIP1 (rs17728338) polymorphisms[12] confer increased risk of psoriasis, whereas Th-2 cytokine/regulatory T-cell gene polymorphism - IL-4 (rs2243250) polymorphism[11] is protective against psoriasis in south Indian Tamil speaking population. Th1 pro-inflammatory cytokine genes' IL-2 [–330 (G/T)] single nucleotide polymorphism[13] was associated with greater disease severity in our population. HLA-C*06 allele was found to be positively associated with susceptibility to psoriasis, female gender and early onset of psoriasis in south Indian Tamil population[14]. We also observed psoriasis to be associated with significantly lowered 25-hydroxy vitamin D levels and increased levels of ischaemia-modified albumin correlating with disease severity suggesting increased systemic inflammation and oxidative stress in psoriasis[15]. Comprehensive lipid tetrad index, atherogenic index and lipid peroxidation have been reported to be surrogate markers for increased cardiovascular risk in psoriasis[16].

The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL), the national association of Dermatologists has constituted a Special Interest Group (SIG)[17] on psoriasis comprising 11 members. The SIG will work towards updating knowledge by conducting continuing medical education (CME) and publishing symposia on various aspects of psoriasis and undertaking research in psoriasis. Thus, considerable nation-wide progress is being made to improve the awareness, knowledge and research on psoriasis in India[17].

To conclude, despite the prevalence of psoriasis in Indian population and progress in research, India still lags behind in psoriasis research output. With the increasing prevalence and awareness of psoriasis and its association with various co-morbidities, there is ongoing need for research on various aspects of this disease related to epidemiology, aetiopathogenesis, management, co-morbidities, impact on quality of life, economic and societal burden and healthcare costs owing to the paucity of Indian data. Hence, well-conducted research in these areas specific to Indian population considering the differences in genetic makeup, environmental influences and health care costs would go a long way in improving the healthcare services for the affected patients in our country. Setting policy priorities and agenda would be the key and setting up a national research centre by the government bodies or providing funds to enhance the research in psoriasis in India would encourage researchers to continuously work on this chronic disease wherein definitive curative therapy is not available.



 
   References Top

1.
Dogra S, Yadav S. Psoriasis in India: Prevalence and pattern. Indian J Dermatol Venereol Leprol 2010; 76 : 595-601.  Back to cited text no. 1
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2.
World Health Organization. Global report on psoriasis. Available from: http://www.apps.who.int/iris/bitstream/10665/204417/1/9789241565189_eng.pdf, accessed on June 12, 2017.  Back to cited text no. 2
    
3.
Dogra S, Mahajan R. Psoriasis: Epidemiology, clinical features, co-morbidities, and clinical scoring. Indian Dermatol Online J 2016; 7 : 471-80.  Back to cited text no. 3
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4.
Ram S. Indian psoriasis research: An impact assessment through bibliometric studies. J Sci Res 2013; 2 : 126-31.  Back to cited text no. 4
    
5.
Salunke AS, Nagargoje MV, Belgaumkar VA, Tolat SN, Chavan RB. Association of metabolic syndrome in chronic plaque psoriasis patients and their correlation with disease severity, duration and age: A case control study from western Maharashtra. J Clin Diagn Res 2017; 11 : WC06-WC10.  Back to cited text no. 5
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6.
Girisha BS, Thomas N. Metabolic syndrome in psoriasis among urban south Indians: A case control study using SAM-NCEP criteria. J Clin Diagn Res 2017; 11 : WC01-04.  Back to cited text no. 6
    
7.
Rajesh D, Gurumurthy R, Kutty AV, Balakrishna S. Tumor necrosis factor alpha gene promoter- 238G/A polymorphism increases the risk of psoriasis vulgaris in Indian patients. Int J Dermatol 2017; 56 : 307-11.  Back to cited text no. 7
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8.
Narayanasamy K, Sanmarkan AD, Rajendran K, Annasamy C, Ramalingam S. Relationship between psoriasis and non-alcoholic fatty liver disease. Prz Gastroenterol 2016; 11 : 263-9.  Back to cited text no. 8
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9.
Kothiwale SK, Khanna N, Tandon N, Naik N, Sharma VK, Sharma S, et al. Prevalence of metabolic syndrome and cardiovascular changes in patients with chronic plaque psoriasis and their correlation with disease severity: A hospital-based cross-sectional study. Indian J Dermatol Venereol Leprol 2016; 82 : 510-8.  Back to cited text no. 9
    
10.
Indhumathi S, Rajappa M, Chandrashekar L, Ananthanarayanan PH, Thappa DM, Negi VS, et al. T helper-2 cytokine/regulatory T-cell gene polymorphisms and their relation with risk of psoriasis in a South Indian Tamil cohort. Hum Immunol 2017; 78 : 209-15.  Back to cited text no. 10
    
11.
Indhumathi S, Rajappa M, Chandrashekar L, Ananthanarayanan PH, Thappa DM, Negi VS, et al. TNFAIP3 and TNIP1 polymorphisms confer psoriasis risk in South Indian Tamils. Br J Biomed Sci 2015; 72 : 168-73.  Back to cited text no. 11
    
12.
Indhumathi S, Rajappa M, Chandrashekar L, Ananthanarayanan PH, Thappa DM, Negi VS, et al. Investigation of association of the IL-12B and IL-23R genetic variations with psoriatic risk in a South Indian Tamil cohort. Hum Immunol 2016; 77 : 54-62.  Back to cited text no. 12
    
13.
Indhumathi S, Rajappa M, Chandrashekar L, Ananthanarayanan PH, Thappa DM, Negi VS, et al. Polymorphisms in T helper 1 proinflammatory cytokine genes and the risk of psoriasis in a South Indian Tamil cohort. J Dtsch Dermatol Ges 2017; 15 : 208-11.  Back to cited text no. 13
    
14.
Indhumathi S, Rajappa M, Chandrashekar L, Ananthanarayanan PH, Thappa DM, Negi VS, et al. The HLA-C*06 allele as a possible genetic predisposing factor to psoriasis in South Indian Tamils. Arch Dermatol Res 2016; 308 : 193-9.  Back to cited text no. 14
    
15.
Sunitha S, Rajappa M, Thappa DM, Chandrashekar L, Munisamy M, Revathy G, et al. Comprehensive lipid tetrad index, atherogenic index and lipid peroxidation: Surrogate markers for increased cardiovascular risk in psoriasis. Indian J Dermatol Venereol Leprol 2015; 81 : 464-71.  Back to cited text no. 15
[PUBMED]    
16.
Chandrashekar L, Kumarit GR, Rajappa M, Revathy G, Munisamy M, Thappa DM, et al. 25-hydroxy vitamin D and ischaemia-modified albumin levels in psoriasis and their association with disease severity. Br J Biomed Sci 2015; 72 : 56-60.  Back to cited text no. 16
    
17.
Indian Association of Dermatologists, Venereologists, and Leprologists. IADVL Academy Special Interest Group (SIG) Psoriasis. Available from: http://newsletters.iadvl.org/flowpaper/SIG_PSORIASIS_newsletter_1/SIG_PSORIASIS_newsletter_1.html, accessed on June 12, 2017.  Back to cited text no. 17
    




 

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