Background
Geriatric psoriasis, due to its unusual clinical manifestations and higher rates of systemic complications in this age group, is a challenging topic for dermatologists. Therefore, we aimed to provide an overview of the epidemiological, clinical and therapeutic consequences among patients older than 60 years with psoriasis in a referral center in Iran.
Materials and methods
This cross-sectional study was conducted in 156 patients over 60 years of age with a definitive diagnosis of psoriasis who were referred to our center between 2015 and 2019. By reviewing the patients’ medical records, baseline characteristics including demographic data, underlying comorbidities, Age of disease onset, clinical type of disease, clinical manifestations and therapeutic approaches were extracted.
Results
The most common clinical feature was plaque type (73.1%) followed by pustular type (10.9%). The most frequently involved area was the lower extremities (84.6%).
The majority of patients were treated topically (87.1%), while methotrexate and acitretin were considered the most common systemic approaches for 74.4% and 60.3%, respectively.
A significantly higher mean age of onset of the disease was found in female patients than in male patients. The type of plaque was more common in men than in women.
Furthermore, the probability of nail involvement was 2.43 times higher in men than in women (p=0.011, 95% CI: 1.22-4.84).
Disease duration was significantly longer in patients with plaque compared to those without plaque. In contrast, those with palmoplantar type experienced a shorter disease duration.
Conclusion
Clinical characteristics, patterns of disease involvement, as well as treatment approaches considered, may be influenced by demographic characteristics.
Comments
Sex and age were associated with clinical characteristics of geriatric psoriasis, including disease type and location, therapeutic considerations, and risk of comorbid nail involvement and psoriatic arthritis.
Clinical manifestations, patterns of disease involvement, and treatment approaches considered for geriatric psoriasis were associated with demographic characteristics such as age and sex, according to study findings published last week in Dermatologic Therapy .
Geriatric psoriasis is characterized by unusual clinical manifestations and higher rates of systemic complications that have proven to be a challenge for dermatologists. Since a wide range of people with psoriasis are older, with the 60 to 69 age group linked to the highest rate of psoriasis onset in the United States, there are increased risks of life-threatening sequelae, such as heart failure, psoriatic arthritis (PsA), and poorer quality of life may contribute to increased financial and healthcare burden and warrant personalized approaches to disease management.
“Consequently, management and therapeutic approaches in psoriasis should be different compared to the younger population. To achieve this objective, the first step will be to collect sufficient information on the epidemiological, demographic and clinical characteristics of the disease in each community,” said the authors of the study.
They conducted a cross-sectional study to provide an overview of the epidemiological, clinical and therapeutic consequences among patients over 60 years of age with a definitive diagnosis of psoriasis who were referred to the Razi Dermatological Hospital in Tehran, Iran, between 2015 and 2019.
A total of 156 psoriasis patients (mean [SD] age, 68.5 [SD] years; men, n = 95) who had files recorded of baseline characteristics including demographics, underlying comorbidities, age of disease onset, Clinical type of the disease, clinical manifestations and therapeutic approaches were included in the analysis.
Among the study cohort, the most common clinical feature was plaque type (73.1%), followed by pustular type (10.9%). The most frequently affected area was the lower extremities (84.6%), with involvement of the scalp, nails and joints (APs) also found in 26.9%, 40.3% and 19.2% of patients, respectively. . The most common comorbidities were high blood pressure (25.0%) and diabetes (16.0%).
Regarding therapeutic management , the majority of patients were treated topically (87.1%), with methotrexate (74.4%) and acitretin (60.3%) considered the most common systemic approaches.
When comparing baseline characteristics between men and women affected by psoriasis, female patients compared to male patients were significantly older at disease onset (59.23 [13.48] vs. 51.83 [15.80 ] years; P = 0.002), the type of plaque was more prevalent in men than in women (76.9% vs. 67.3%; P = 0.026), and the probability of nail involvement was 2.43 times greater in men than in women (48.4% vs. 27.9%; 95% CI, 1.22-4.84; P = 0.011). No differences were observed between the 2 groups for topical or systemic therapeutic approaches.
In contrast, the mean age of patients who received methotrexate was significantly younger than in other patients (67.54 [6.56] vs. 71.13 [8.80] years; p = 0.013) and slightly older in patients who received topical therapy (68.88 [7.49] vs. 65.65 [5.53] years; p = 0.052). Patients who had earlier onset of psoriasis were also found to be more likely to receive adalimumab or phototherapy.
The mean disease duration was also shown to be significantly longer in patients with plaque psoriasis compared to those without (14.82 [12.67] vs. 9.53 [11.67] years ; P = 0.034), while those with palmoplantar type experienced a shorter disease duration (14.82 [12.67] vs 9.53 [11.67] years, p = 0.034).
Comorbid PsA was associated with younger patients, with a mean age in patients with and without joint involvement of 65.23 (6.33) versus 69.23 (7.37) years ( p = 0.007).
“Sex differences in disease characteristics are mainly related to the mean age of disease onset, disease duration, type of disease plaque, and risk of nail involvement. “Further studies are required to determine which pharmacological therapies are most effective and should be prescribed to geriatric psoriatic patients,” the researchers concluded.
