Naldi L, Peli L, Parazzini F, Carrel C F
Clinica Dermatologica, Università degli Studi de Milano-Bicocca, Ospedale Riuniti de Bergamo, Bergamo, Italy.
J Am Acad Dermatol. 2001 Mar;44(3):433-8. doi: 10.1067/mjd.2001.110876.
The association of guttate psoriasis with streptococcal pharyngitis is well accepted. The association of other risk factors is less well defined.
We attempted to provide an estimate of the risk for guttate psoriasis associated with a recent infectious disease and to explore other potential risk factors, including family history of psoriasis and psychologic stress.
This was a case-control study. Cases were patients with a first diagnosis ever of acute guttate psoriasis, made by a dermatologist. Controls were patients newly diagnosed as having dermatologic conditions other than psoriasis and seen in the same outpatient services as the cases. Inclusion of cases and controls was restricted to patients older than 16 years. The Holmes and Rahe Social Readjustment Rating Scale was used to assess stressful life events during the 6 months before diagnosis. A total of 73 cases (median age, 26 years) and 430 controls (median age, 28 years) were included in the analysis.
A family history of psoriasis was strongly associated with guttate psoriasis, the multivariate odds ratio being 7.0 (95% confidence interval, 3.7-13.5) for subjects who reported a history of the disease in parents or siblings. Stressful life events were also associated with guttate psoriasis. The multivariate odds ratio was 1.7 (95% confidence interval, 0.8-3.6) for subjects scoring 41 to 100 and 2.6 (95% confidence interval, 1.3-5.2) for those scoring more than 100 on the Holmes and Rahe Scale. The risk increased with the reported history of any infectious disease. The analysis of specific diagnoses documented a high and significant association with acute pharyngitis, the adjusted odds ratio being 7.8 (95% confidence interval, 1.8-32.5).
The study confirmed that recent pharyngeal infection is a risk factor for guttate psoriasis. It also documented the strong association between guttate psoriasis and a family history of psoriasis. Finally, the study added evidence to the belief that stressful life events may represent risk factors for the onset of psoriasis. By relying on the clinical diagnosis we possibly underestimate the association of guttate psoriasis with infection.
点滴状银屑病与链球菌性咽炎之间的关联已得到广泛认可。其他风险因素的关联则不太明确。
我们试图评估近期传染病与点滴状银屑病相关的风险，并探索其他潜在风险因素，包括银屑病家族史和心理压力。
这是一项病例对照研究。病例为首次由皮肤科医生诊断为急性点滴状银屑病的患者。对照是新诊断为除银屑病以外的皮肤病且与病例在同一门诊就诊的患者。病例和对照的纳入仅限于16岁以上的患者。使用霍尔姆斯和拉赫社会再适应评定量表评估诊断前6个月内的应激性生活事件。分析共纳入73例病例（中位年龄26岁）和430例对照（中位年龄28岁）。
银屑病家族史与点滴状银屑病密切相关，报告父母或兄弟姐妹有该病病史的受试者多变量优势比为7.0（95%置信区间，3.7 - 13.5）。应激性生活事件也与点滴状银屑病相关。在霍尔姆斯和拉赫量表上得分41至100的受试者多变量优势比为1.7（95%置信区间，0.8 - 3.6），得分超过100的受试者为2.6（95%置信区间，1.3 - 5.2）。任何传染病的报告病史都会增加风险。对特定诊断的分析显示与急性咽炎有高度且显著的关联，校正优势比为7.8（95%置信区间，1.8 - 32.5）。
该研究证实近期咽部感染是点滴状银屑病的一个风险因素。它还证明了点滴状银屑病与银屑病家族史之间的密切关联。最后，该研究进一步证明了应激性生活事件可能是银屑病发病的风险因素这一观点。由于依赖临床诊断，我们可能低估了点滴状银屑病与感染的关联。
