Psoriasis: Epidemiology, clinical features, co-morbidities, and clinical scoring

Abstract

On the basis of current evidence derived from hospital-based studies, mostly from North India, the prevalence of psoriasis in adults varies from 0.44 to 2.8%, with a much lower prevalence in children. The peak age at onset in adults is in the third and fourth decade of life, with a slight male preponderance. It is recommended that population-based large epidemiologic studies should be undertaken in different parts of the country for estimating the correct prevalence of psoriasis in general population. Chronic plaque-type psoriasis is the most common morphologic presentation of psoriasis, accounting for more than 90% of all cases. Other morphologic variants that deserve special mention include palmoplantar psoriasis, pustular psoriasis, and recalcitrant psoriasis. For epidemiologic purposes, psoriasis can be classified into early and late onset psoriasis. Psoriasis can be classified on the basis of morphology and extent of involvement into localized and widespread disease. For the purpose of clinical trials, psoriasis may be classified as mild psoriasis, moderate psoriasis, and severe psoriasis. The literature shows that there is a significant risk of psoriatic arthritis (7–48%) in patients with plaque-type psoriasis. Hence, it is recommended to evaluate for its presence by detailed history taking and clinical examination, and if necessary, by appropriate radiological investigations. Evidence on the association between plaque-type psoriasis and cardiovascular disease risk factors and ischemic heart disease isinconsistent. On the basis ofavailable evidence, it is prudent to proactively look for metabolic syndrome, dyslipidemia, and obesity, especially in patientswith severe psoriasis (Level 1+ evidence based on systematic reviews and meta-analysis). Based on the current evidence, the psoriasis area severity index appears to be the most valid and reproducible clinical severity score in the management of adult patients with plaque-type psoriasis.

Research on psoriasis in India

“…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.…”

Dyslipidaemia & oxidative stress in patients of psoriasis

“…Psoriasis besides being a skin disorder is also a systemic inflammatory disease leading to atherosclerosis 6 7 . Different cross-sectional and case-control studies across the country have reported higher prevalence of cardiac risk in patients of psoriasis 8 9 .…”

A pharmaco-epidemiological study of psoriasis

“…This was similar to the findings in study by Dogra et al and Ayanlowo et al, but in contrast to Raghunandan et al which showed the peak incidence at third and fourth decade of life. 10,16,17 And Ramani et al which showed peak incidence at the age of 35-55 years. 12 The most common type of psoriasis seen in our study was Psoriasis vulgaris otherwise known as plaque type of psoriasis (82.22%) followed by erythrodermic psoriasis (4.44%) and psoriatic arthritis.…”