DOI: http://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20204934

A clinico-epidemiological study of psoriasis patients with moderate to severe plaque type in tertiary care centre in South India

Suganya Sekar, Samuel J. Daniel

Abstract


Background: Psoriasis is a chronic disorder with the most common manifestation being the plaque-type. Nearly 20% of the plaque type suffer from a disease of moderate to severe intensity with immense effect on the quality of life. Aim was to study the clinical, socio-economic and demographic characteristics of patients with moderate to severe plaque type of psoriasis.

Methods: This was an observational study conducted in about fourty patients diagnosed with moderate to severe plaque type of psoriasis based upon the clinical history, morphology of the lesions and assessed using psoriasis area and severity index (PASI), dermatology life quality index (DLQI) scoring and for comorbidities. Data was compiled and analyzed with statistical package for social science (SPSS) Version 20.0.

Results: Mean age was 37.43±10.1 years. 22 were males (55%) and 18 were females (45%). The mean duration was 8.93 years and 15% had family history. The mean age of onset was earlier in the females (20.23 years) with a positive family history, as compared to males (25.36 years). About 62.5% had moderate psoriasis and 37.5% had severe psoriasis. At the baseline the PASI score was 31.98±6.08 and DLQI score was 36. About 67.5% had nail changes and 10% had psoriatic arthritis. Almost in half (47.5%) the duration of the disease was 1 to 5 years and scalp (32.5%) the most common initial site of involvement. Various comorbidities were documented, 72% in moderate psoriasis and 73.33% in severe psoriasis with dyslipidemia (67.5%) being commonest.

Conclusions: Patients with moderate to severe psoriasis mostly have a low quality of life with multiple significant co-morbidities that increases the risk for morbidity and mortality.  


Keywords


Moderate to severe plaque psoriasis, Psoriasis area and severity index, Comorbidities, Dyslipidemia

Full Text:

PDF

References


Naldi L. Epidemiology of psoriasis. Curr Drug Targets Inflamm Aller. 2004;3:121-8.

Menter A, Korman NJ, Elmets CA. Guidelines of care for themanagement of psoriasis and psoriatic arthritis. Section 6. Guide-lines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions. J Am Acad Dermatol. 2011;65:137-74.

Gottlieb AB. Etanercept for the treatment of psoriasis and psoriatic arthritis. Dermatol Ther. 2004;17:401-8.

Lebwohl M, Menter A, Koo J, Feldman SR. Combination therapy to treat moderate to severe psoriasis. J Am Acad Dermatol. 2004;50(3):416-30.

Gerdes S, Mroweitz U. Impact of co-morbidities on the management of psoriasis. Curr Probl Dermatol. 2009;38:21-36.

Hussain I, Haroon TS. Comorbidities in psoriasis and their therapeutic implications. J Pak Assoc Dermatol. 2016;19(2):63-5.

Liem WH, McCullough JL, Weinstein GD. Effectiveness of topical therapy for psoriasis: results of a national survey. Cutis. 1995;55(5):306-10.

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(2):281-5.

Spuls PI, Bossuyt PM, van Everdingen JJ, Witkamp L, Bos JD. The development of practice guidelines for the treatment of severe plaque form psoriasis. Arch Dermatol. 1998;134(12):1591-6.

Sharma T, Sepha GC. Psoriasis – clinical study. Ind J Dermatol Venereol. 1964;30:191-7.

Lal S. Clinical pattern of psoriasis in Punjab. Ind J Dermatol Venereol.1966;35:5-12.

Lahfa M, Mrowietz U, Koenig M, Simon JC. Calcitriol ointment and clobetasol propionate cream: a new regimen for the treatment of palmoplantar psoriasis. Eur J Dermatol. 2003;13:261-5.

Newbold PCH. Pruritus in Psoriasis. In: Farber EM, Cox AJ, eds. Proceedings of Second International Symposium. New York: Yorke Medical Books. 1977:334-6.

Yosipovitch G, Goon A, Wee J, Chan YH, Goh CL. The prevalence and clinical characteristics of pruritus among patients with extensive psoriasis. Brit J Dermatol. 2000;143(5):969-73.

Mehta TK, Shah RN, Marquis L. A study of 300 cases of psoriasis. Ind J Dermatol Venerol Leprol. 1976;42:67-74.

Gottlieb AB, Langley RG, Strober BE, Papp KA, Klekotka P, Creamer K, et al. A randomized, double‐blind, placebo‐controlled study to evaluate the addition of methotrexate to etanercept in patients with moderate to severe plaque psoriasis. Brit J Dermatol. 2012;167(3):649-57.

Gunawardena DA, Gunawardena KA, Vasanthanathan NS, Gunawardena JA. Psoriasis in Sri‐Lanka—a computer analysis of 1366 cases. Brit J Dermatol. 1978;98(1):85-96.

Faber EM and Peterson JB. Variations in the natural history of psoriasis. Calif. 1961;95:6-11.

Holgate MC. The age of onset of psoriasis and relationship to parental psoriasis Brit J Dermatol. 1975;92:443-8.

Yasuda T, Ischikawa E, Mori S. Psoriasis in the Japanese, Proceedings of the International symposium on psoriasis, Stanford University Press, Stanford, California.1971;25-34.

Lomholt G. Psoriasis: A statistical analysis of 230 cases, Arch Dermatol. 1963;35:1051.

Farber EM, Nall L. The natural history of psoriasis in 5,600 patients. Dermatol. 1974;148(1):1-8.

El-Zawahry M. Psoriasis: Its atypical clinical varieties, J Egypt Med Assoc. 1963;47:1213-7.

Wassman K. Rheumatoid arthritis and psoriasis: Statistical statements, Ann Rheum Dis. 1949;8:70-1.

Ingram JT. The significance and management of psoriasis. Brit Med J. 1954;2:823-8.

Jayakar Thomas, Ashok kumar N. Comorbid conditions associated with psoriasis. J Ind Soc Teledermatol. 2010;4:1.

Kaye JA, Li L, Jick SS. Incidence of risk factors for myocardial infarction and other vascular diseases in patients with psoriasis. Brit J Dermatol. 2008;159(4):895-902.

Gisondi P, Tessari G, Conti A, Piaserico S, Schianchi S, Peserico A, et al. Prevalence of metabolic syndrome in patients with psoriasis: a hospital‐based case–control study. Brit J Dermatol. 2007;157(1):68-73.

Shapiro J, Cohen AD, David M, Hodak E, Chodik G, Viner A, et al. The association between psoriasis, diabetes mellitus, and atherosclerosis in Israel: a case-control study. J Am Acad Dermatol. 2007;56(4):629-34.

Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB, Gelfand JM. Prevalence of cardiovascular risk factors in patients with psoriasis. J Am Acad Dermatol. 2006;55(5):829-35.

Braun-Falco O, Burg G, Farber EM. Psoriasis: eine fragebogenstudie bei 536 patienten. Munch Med Wochenschr. 1972;114:1105-10.