A study of epidemiology, clinical features and co-morbidities in psoriasis

 

Nachiket Palaskar¹, Pralhad R Rathod^2*

 

Abstract              Background: Psoriasis is a papulosquamous disease with variable morphology, distribution, severity, and course. Psoriasis affects quality of life. Aim and Objective: To study the epidemiology, clinical features and co morbidities in patients of psoriasis. Methodology: Total 110 patients were studied at a tertiary care center. Data collection was done with pre tested questionnaire. Data collection included sociodemographic data, clinical features and associated comorbidities. Results and Discussion: patients were male (61.82%) and 38.18% were females. The most common type of psoriasis in our study was plaque psoriasis 99(90%). Nail discoloration was seen in 29.09% patients. Stress was most common aggravating factors. Most common co morbidity associated with psoriasis was hypertension(27.5%) followed by obesity (25%) and diabetes meillitus (18.20%).

Key Words: psoriasis.

 

INTRODUCTION

Psoriasis is a common chronic, recurrent, immune mediated disease of the skin and joints. Psoriasis is found worldwide but the prevalence varies among different ethnic groups. It has a strong genetic component but environmental factors such as recent streptococcal throat infection, viral infection, immunization, use of antimalarial drug, or trauma play an important role in the presentation of disease. Psoriasis can present at any age and has been reported at birth and in older people of advanced age. Symptoms of psoriasis may include well demarcated, symmetric and erythematous plaques with overlying silvery scale. Plaques are typically located on the scalp, trunk, buttocks and extremities but can occur anywhere on the body. Patients might demonstrate nail involvement which can present without concomitant plaques. Active lesions might be itchy or painful. Psoriasis can also present as an isomorphic response, where new lesions develop on previously normal skin that has sustained trauma or injury.¹ That patient with psoriasis feel stigmatized by the condition. This of itself contributes to everyday disability leading to depression and suicidal intention in more than 5% of patients.² Psoriasis generally does not affect survival but it has negative effects on patient’s quality of life.³

 

AIM AND OBJECTIVE

To study the epidemiology, clinical features and co morbidities in patients of psoriasis.

 

MATERIAL AND METHODS

Present study was a cross sectional study carried out on patients diagnosed with psoriasis attending dermatological OPD in a tertiary care center.

Inclusion Criteria

1. Histopathologically diagnosed psoriasis patients
2. Age above 18 years

 

Exclusion Criteria

1. Age below 18 years
2. Those who were not willing to participate.

Study was approved by ethical committee. A valid written consent was taken from patients after explaining study to them. Total 110 patients were studied. Data was collected with a pretested questionnaire. Data collected was sociodemographic data, detailed history, Clinical examination and co morbidities. The disease severity was assessed using the body surface area (BSA) involvement and presence of nail and joint involvement. Data analysis was done with appropriate statistical tests.

 

RESULTS

Mean age of onset in females was 34.37± 9.2 years and in males was 39.72±10.24 years. Among 110 patient’s majority of the patients were male (61.82%) and 38.18% were females. Positive family history was reported in (27)24.54% of patients. The most common type of psoriasis in our study was plaque psoriasis 99(90%), followed by guttate psoriasis 5(4.55%), erythrodermic psoriasis 3(2.73%), pustular psoriasis 2(1.82%) and flexural psoriasis 1(0.9%) fig 1 50% of patients in our study had identifiable aggravating factors. Stress was most common aggravating factors 53 (48.18%). Other factors were infection 10 (9.09%) sunlight 26(23.67%), trauma, drugs etc. Other less considerable factors were smoking, alcohol etc. Severity of disease was determined by body surface area involved. Majority (51.8%) of the patients were having body surface involvement of 5-10% followed by BSA of < 5% (23.67%). 22.73% patients were having BSA of >10- 90 %. Male patients had more severity than females (table1) Out of total 110 patients 68(54.76%) patients had nail involvement. It was significantly more in males (66.17%) than females (54.76%). Most common nail involvement was pitting (59.09%) followed by onycholysis (48.18%). Nail discoloration was seen in 29.09%patients. Nail discoloration was seen in patients (29.09%). Total nail dystrophy was observed in 5.46% patients. (Table 2) Various co morbidities were present in psoriatic patients. Most common co morbidity associated with psoriasis was hypertension (27.5%) followed by obesity (25%) and diabetes mellitus (18.20%). Less common co morbidities were ischaemic heart disease and cerebrovascular disease. (figure 2)

DISCUSSION

Mean age of onset in females was 34.37± 9.2 years and in males was 39.72±10.24 years. Similar findings were observed in A Ejaz et al ⁴ and Y.T. chang et al.⁵ Among 110 patients majority of the patients were male (61.82%) and 38.18% were females. Similar findings were observed in A Ejaz et al⁴ with M: F ratio of 1.2:1. Contrary to our study R. Parisi et al⁶ showed female preponderance. Some of the studies showed no difference in male and female prevalence.^7,8 The most common type of psoriasis in our study was plaque psoriasis 99(90%), followed by guttate psoriasis 5(4.55%). In a study of Marsa S et al ⁹ it was observed that psoriatic arthritis was the most frequent pattern with asymmetric knee involvement to be the most common presentation in 40% of the patients. Nail discoloration was seen in 29.09%patients. Nail discoloration was seen in patients (29.09%). Total nail dystrophy was observed in 5.46% patients. in a study by Veale D it was seen that orthopathy was often associated with dactylitis and nail dystrophy.¹⁰ Stress was most common aggravating factors.53 (48.18%).Similar findings were observed in previous studies^11,12. These studies found that psoriasis patients had significantly lower cortisol levels at moments when daily stressors are at peak levels. Cortisol levels are important in immune functions. The study also reported that psoriasis patients with high levels of daily stressors exhibited lower mean cortisol levels, as compared to psoriasis patients with low levels of daily stressors ¹³ Other aggrevating factors were infection 10 (9.09%) sunlight 26 (23.67%). In a study by J. Hayes et al smoking was found to be significant factor for development of psoriasis.¹⁴ Most common co-morbidity associated with psoriasis was hypertension (27.5%) followed by obesity (25%) and diabetes mellitus (18.20%). Similar findings were also reported in a study by Cohen et al., in which he reported hypertension and diabetes mellitus occurred in 27.5% and 13.8% of psoriatic patients respectively.¹⁵ In a study it was revealed that diabetes was significantly higher in psoriasis patients as compared with the control group (odds ratio [OR]: 1.27, 95% confidence interval [CI]: 1.1–1.48).¹⁶

 

CONCLUSION

Psoriasis is a chronic disorder affecting skin, joints. It affects quality of life. In future more studies are needed for better understanding of disease.

 

REFERENCES

1. Whan B. Kim, Dana Jerome, Jensen Yeung. Diagnosis and management of psoriasis. Canadian Family Physician. 2017 April; 63(4): 278-285.
2. Finlay AY, Kelly SE. Psoriasis—an index of disability. Clin Exp Dermatol 1987; 12:8–11.
3. Krueger GG, Feldman SR, Camisa C, Duvic M, Elder JT, Gottlieb AB, et al. Two considerations for patients with psoriasis and their clinicians: what defines mild, moderate, and severe psoriasis? What constitutes a clinically significant improvement when treating psoriasis? J Am Acad Dermatol 2000;43:281–5
4. A. Ejaz, N. Raza, N. Iftikhar, A. Iftikhar, and M. Farooq, “Presentation of early onset psoriasis in comparison with late onset psoriasis: A clinical study from Pakistan,” Indian Journal of Dermatology, Venereology and Leprology, vol. 75, no. 1, pp. 36–40, 2009.
5. Y. T. Chang, T. J. Chen, P. C. Liu et al., “Epidemiological study of psoriasis in the national health insurance database in Taiwan,” Acta Dermato-Venereologica, vol. 89, no. 3, pp. 262–266, 2009.
6. R. Parisi, D. P. M. Symmons, C. E. M. Griffiths, and D. M. Ashcroft, “Global epidemiology of psoriasis: a systematic review of incidence and prevalence,” Journal of Investigative Dermatology, vol. 133, no. 2, pp. 377–385, 2013. 
7. X. Ding, T. Wang, Y. Shen, X. Wang, C. Zhou, and S. Tian, “Prevalence of psoriasis in China: a population-based study in six cities,” European Journal of Dermatology, vol. 22, no. 5, pp. 663–667, 2012.
8. K. Bo, M. Thoresen, and F. Dalgard, “Smokers report more psoriasis, but not atopic dermatitis or hand eczema: Results from a Norwegian population survey among adults,” Dermatology, vol. 216, pp. 40–45, 2008. 
9. Marsa S, Armadans-Gil L, Martinez M, Gallardo D, Ribera A, Lience E. Clinical, radiographic and HLA associations as markers for different patterns of psoriatic arthritis. Rheumatology. 1999;38:332–7
10. Veale D, Rogers S, Fiztgerald O. Classification of clinical subsets in psoriatic arthritis. Br J Rheumatol. 1994;33:133–8.
11. A. Buske-Kirschbaum, M. Ebrecht, S. Kern, and D. H. Hellhammer, “Endocrine stress responses in TH1-mediated chronic inflammatory skin disease (psoriasis vulgaris)—do they parallel stress-induced endocrine changes in TH2-mediated inflammatory dermatoses (atopic dermatitis)?” Psychoneuroendocrinology, vol. 31, no. 4, pp. 439–446, 2006.
12. A. W. M. Evers, Y. Lu, P. Duller, P. G. M. Van Der Valk, F. W. Kraaimaat, and P. C. M. Van De Kerkhoft, “Common burden of chronic skin diseases? Contributors to psychological distress in adults with psoriasis and atopic dermatitis,” British Journal of Dermatology, vol. 152, no. 6, pp. 1275–1281, 2005.
13. A. W. M. Evers, E. W. M. Verhoeven, F. W. Kraaimaat et al., “How stress gets under the skin: Cortisol and stress reactivity in psoriasis,” British Journal of Dermatology, vol. 163, no. 5, pp. 986–991, 2010. 
14. J. Hayes and J. Koo, “Psoriasis: Depression, anxiety, smoking, and drinking habits,” Dermatologic Therapy, vol. 23, no. 2, pp. 174–180, 2010
15. A. D. Cohen, M. Sherf, L. Vidavsky, D. A. Vardy, J. Shapiro, and J. Meyerovitch, “Association between psoriasis and the metabolic syndrome: A cross-sectional study,” Dermatology, vol. 216, no. 2, pp. 152–155, 2008. 
16. J. Shapiro, A. D. Cohen, M. David et al., “The association between psoriasis, diabetes mellitus, and atherosclerosis in Israel: A case-control study,” Journal of the American Academy of Dermatology, vol. 56, no. 4, pp. 629–634, 2007. 

 

 

 

Policy for Articles with Open Access
Authors who publish with MedPulse International Journal of Anesthesiology (Print ISSN:2579-0900) (Online ISSN: 2636-4654) agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.