Comparison of early (EOP) and late onset psoriasis (LOP) regarding systemic inflammatory comorbidities: LOP is a more rapid subtype of psoriasis

Leyla Huseynova Terzi; Sibel Dogan Gunaydin

doi:10.5826/dpc.1203a144

Comparison of early (EOP) and late onset psoriasis (LOP) regarding systemic inflammatory comorbidities: LOP is a more rapid subtype of psoriasis

Authors

Leyla Huseynova Terzi Hacettepe University Faculty of Medicine, Department of Dermatology and Venerology
Sibel Dogan Gunaydin Hacettepe University, Faculty of Medicine, Department of Dermatology and Venereology; Hacettepe University, Graduate School of Medical Sciences, Department of Pediatric Basic Sciences, Immunology, Ankara, Turkey

Keywords:

psoriasis, comorbidity, early onset psoriasis, late onset psoriasis, inflammation

Abstract

Background: Early onset psoriasis (EOP) and late onset psoriasis (LOP) differs regarding genetic background, clinical presentation, and course of disease.

Objective: In this study, comparison of EOP and LOP regarding systemic inflammatory comorbidities which are frequently seen in psoriasis and determination of possible differences is aimed.

Methods: A total of 160 plaque psoriasis patients; 121 with EOP and 39 with LOP were enrolled for the study. Data was collected with face-to-face questionnaire and patients’ medical chart evaluation. Collected data included medical and family history, clinical features and parameters indicating severity of psoriasis, results of laboratory work-up, physical and dermatological examination findings, presence of joint and nail involvement and associated inflammatory systemic comorbidities such as cardiovascular diseases (CVD), diabetes mellitus (DM), hypertension (HT), metabolic syndrome (MS), obesity.

Results: Nail involvement and PsA occurred more rapidly in LOP compared to EOP (p<0.01, p<0.01). Compared frequencies in LOP and EOP were 7.7% vs 0.8% for CVD, 38.5% vs 14% for HT, 33.3% vs 9.9% for DM and 44.7% vs 24.8% for MS respectively. CVD, HT, DM and MS were significantly more frequent in LOP compared to EOP (p=0.045, p=0.001, p<0.01, p=0.022). Results of multivariate analysis performed taking into account the age, gender, severity parameters of disease, alcohol consumption, smoking habits, and other concurrent systemic comorbidities revealed LOP to be an independent risk factor for CVD and DM (p<0.01, R²: 0.036, p<0.01, R²: 0.077).

Conclusion: LOP seems to interact with systemic comorbidities hence generating more severe inflammatory burden and shows a more rapid course.

References

1. Herédi E, Csordás A, Clemens M, et al. The prevalence of obesity is increased in patients with late compared with early onset psoriasis. Ann Epidemiol. 2013;23:688–692. doi: 10.1016/j.annepidem.2013.08.006.
2. Henseler T, Christophers E. Psoriasis of early and late onset: characterization of two types of psoriasis vulgaris. J Am Acad Dermatol. 1985;13:450–6. doi: 10.1016/s0190-9622(85)70188-0.
3. Ferrándiz C, Pujol RM, García-Patos V, et al. Psoriasis of early and late onset: a clinical and epidemiologic study from Spain. J Am Acad Dermatol. 2002;46:867–73. doi: 10.1067/mjd.2002.120470.
4. Ejaz A, Raza N, Iftikhar N, et al. Presentation of early onset psoriasis in comparison with late onset psoriasis: a clinical study from Pakistan. Indian J Dermatol Venereol Leprol. 2009;75:36–40. doi: 10.4103/0378-6323.45218.
5. Mallbris L, Larsson P, Bergqvist S, et al. Psoriasis phenotype at disease onset: clinical characterization of 400 adult cases. J Invest Dermatol. 2005;124:499–504. doi: 10.1111/j.0022-202X.2004.23611.x.
6. Youn J, Park B, Park S, et al. Characterization of early and late onset psoriasis in the Korean population. J Dermatol. 1999;26:647–52. doi: 10.1111/j.1346-8138.1999.tb02066.x.
7. Chularojanamontri L, Kulthanan K, Suthipinittharm P, et al. Clinical differences between early- and late-onset psoriasis in Thai patients. Int J Dermatol. 2015;54:290–4. doi: 10.1111/ijd.12515.
8. Fan X, Yang S, Sun LD, et al. Comparison of clinical features of HLA-Cw*0602-positive and -negative psoriasis patients in a Han Chinese population. Acta Derm Venereol. 2007;87:335–40. doi: 10.2340/00015555-0253.
9. Gudjonsson JE, Karason A, Runarsdottir EH, et al. Distinct clinical differences between HLA-Cw*0602 positive and negative psoriasis patients--an analysis of 1019 HLA-C- and HLA-B-typed patients. J Invest Dermatol. 2006;126:740–5. doi: 10.1038/sj.jid.5700118.
10. Stuart P, Malick F, Nair RP, et al. Analysis of phenotypic variation in psoriasis as a function of age at onset and family history. Arch Dermatol Res. 2002;294:207–13. doi: 10.1007/s00403-002-0321-3.
11. Doğan S, Atakan N, Koç Yıldırım S, et al. Evaluation of psoriasis patients with a rheumatologic questionnaire efficiently aids in early detection of psoriatic arthritis. Turkderm-Turk Arch Dermatol Venereol. 2017;51:88–91. doi: 10.4274/turkderm.87405
12. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311:507–20. doi: 10.1001/jama.2013.284427.
13. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2018. Diabetes Care.2018; 41:S13–S27. doi: 10.2337/dc18-S002.
14. Jellinger PS, Handelsman Y, Rosenblit PD, et al. American Association Of Clinical Endocrinologists And American College Of Endocrinology Guidelines For Management Of Dyslipidemia And Prevention Of Cardiovascular Disease. Endocr Pract. 2017;23:1–87. doi: 10.4158/EP171764.APPGL.
15. Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement: Executive Summary. Crit Pathw Cardiol. 2015;4:198–203. doi: 10.1097/00132577-200512000-00018.
16. WHO | Obesity. Available at: https://www.who.int/health-topics/obesity#tab=tab_1
17. Gudjónsson JE, Kárason A, Antonsdóttir AA, et al. HLA-Cw6-positive and HLA-Cw6-negative patients with psoriasis vulgaris have distinct clinical features. J Invest Dermatol. 2002;118:362–5. doi: 10.1046/j.0022-202x.2001.01656.x.
18. Zaias N. Psoriasis of the nail. A clinical-pathologic study. Arch Dermatol. 1969;99:567–79. doi:10.1001/archderm.1969.01610230059011
19. Nestle FO, Kaplan DH, Barker J. Psoriasis. N Engl J Med. 2009;361:496–509. doi: 10.1056/NEJMra0804595.
20. Dogan S, Atakan N. Red Blood Cell Distribution Width is a Reliable Marker of Inflammation in Plaque Psoriasis. Acta Dermatovenerol Croat. 2017;25:26–31. doi: 10.5937/jomb0-27237
21. Vadakayil A, Dandekeri S, Srinath M, Ali N. Role of C-reactive Protein as a Marker of Disease Severity and Cardiovascular Risk in Patients With Psoriasis. Indian Dermatol Online J. 2015;6:322–5. doi: 10.4103/2229-5178.164483.
22. Elmets CA, Leonardi CL, Davis DMR, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. J Am Acad Dermatol. 2019;80:1073–1113. doi: 10.1016/j.jaad.2018.11.058.