Clinical Descriptive Study of Psoriasis in India: Triggers, Morbidities and Coincidences
DOI:
https://doi.org/10.17140/DRMTOJ-6-144Keywords:
Psoriasis, Comorbidities, Cardiovascular disease, Metabolic syndrome, Risk factor, TriggersAbstract
Background
Psoriasis is a T-cell mediated chronic inflammatory, a papulosquamous disease involving complex interactions between the innate
and adaptive immune system and commonly manifested by skin lesions. It is characterized by hyperproliferation of keratinocytes
and inflammatory infiltration in the epidermis and dermis. Chronic psoriasis can be a risk factor for developing comorbid diseases
that share common immune pathophysiology and can be triggered by environmental factors in genetically susceptible individuals.
Aim
To study the clinico-demographic profile, determine the most common triggering factors and determine comorbidities' coexistence
in patients with psoriasis at a tertiary care centre.
Study Design
A cross-sectional study.
Methods
A teaching hospital-based cross-sectional study including 231 psoriasis patients visiting skin outpatient department (OPD) was
conducted by the dermatology department at Sri Krishna hospital, Karamsad, India following acceptance of the study proposal
by the human research ethics committee. This study was outcome of the dissertation topic of the author during dermatology
residency. Total 5 qualified dermatologists working in the dermatology department and 3 resident doctors took part in the study
as evaluators. After taking informed consent, detailed history regarding aggravating factors, progress and morbidities was taken
with clinical examinations, and the diagnosis was purely clinical. Data were analysed using statistical package for the social sciences
(SPSS).
Result
Our study revealed a peak incidence of psoriasis in the fourth and fifth decade of life with male preponderance (1.9:1). The most
commonly found psoriasis type was psoriasis vulgaris, and chronic plaque psoriasis and the most common site of involvement
was extensors and trunk. Pruritis was the most disabling complaint (91.34%), and the disease course was progressive. Aggravating
factors included stress, winter season, implant insertion, smoking, alcohol consumption, tobacco chewing and obesity. Koebner
phenomenon was commonly found with implant insertion in psoriasis patients (76.2%). Family history was one of the wellestablished
risk factors for developing psoriasis (14.2%). Our study’s most commonly found nail changes were pitting (35.49%)
and dystrophic changes (18.61%). Palmoplantar keratoderma (4.76%) and vitiligo (4.76%) were the most commonly found dermatological
condition with psoriasis and have been associated with various comorbidities such as cardiovascular disorder, metabolic
syndrome, psoriatic arthritis and psychiatric disorders. As it was a cross-sectional study, no controls were used.
Conclusion
The study shows male preponderance and extensors, trunk as common sites of psoriatic lesion presentation. Aggravating factors
included stress, winter season, implant insertion, smoking, alcohol consumption, tobacco chewing and obesity. Screening is
encouraged for symptoms of psoriatic arthritis, cardiovascular diseases and metabolic syndromes in psoriasis patients due to its
predilection with systemic comorbidities.
References
Boehncke WH, Schon MP. Psoriasis. Lancet. 2015; 386: 983-994. doi: 10.1016/S0140-6736(14)61909-7
Nestle FO, Kaplan DH, Barker J. Psoriasis. N Engl J Med. 2009; 361: 496-509. doi: 10.1056/NEJMra0804595
Lomholt G. Prevalence of skin diseases in a population: A cen-sus study from the Faroe Islands. Dan Med Bull. 1964; 11: 1-7.
Brandrup F, Green A. The prevalence of psoriasis in Denmark. Acta Derm Venereol. 1981; 61(4): 344-346. doi: 10.1136/bmjo-pen-2018-028116
Christophers E. Psoriasis - epidemiology and clinical spectrum. Clin Exp Dermatol. 2001; 26(4): 314-320. doi: 10.1046/j.1365- 2230.2001.00832.x
Gudjonsson JE, Elder JT. Psoriasis: Epidemiology. Clin Derma-tol. 2007; 25(6): 535-546. doi: 10.1016/j.clindermatol.2007.08.007
National Psoraisis Foundation®. Web site: https://www.psoria-sis.org/cure_known_statistics. Accessed October 1, 2015.
Kurd SK, Gelfand JM. The prevalence of previously diagnosed and undiagnosed psoriasis in US adults: Results from NHANES 2003-2004. J Am Acad Dermatol. 2009; 60: 218-224. doi: 10.1016/j. jaad.2008.09.022
Rapp SR, Feldman SR, Exum ML, Fleischer AB, Reboussin DM. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol. 1999; 41(3 pt 1): 401-407. doi: 10.1016/s0190- 9622(99)70112-x
Watson W, Cann HM, Farber EM, Nall ML. The genetics of psoriasis. Arch Dermatol. 1972; 105(2): 197-207.
Elder JT, Nair RP, Guo SW, Henseler T, Christophers E, Voor-hees JJ. The genetics of psoriasis. Arch Dermatol. 1994; 130(2): 216- 224.
Henseler T. Genetics of psoriasis. Arch Dermatol Res. 1998; 290(9): 463-476.
Bhalerao J, Bowcock AM. The genetics of psoriasis: A complex disorder of the skin and immune system. Hum Mol Genet. 1998; 7(10): 1537-1545. doi: 10.1093/hmg/7.10.1537
Bowcock AM, Barker JN. Genetics of psoriasis: The potential impact on new therapies. J Am Acad Dermatol. 2003; 49(2 Suppl): S51-S56. doi: 10.1016/s0190-9622(03)01135-6
Braun-Falco O, Christophers E. Structural aspects of initial psoriatic lesions. Arch Dermatol Forsch. 1974; 251(2): 95-110. doi: 10.1007/BF00560390
Van de Kerkhof PC, Van Erp PE. The role of epidermal pro-liferation in the pathogenesis of psoriasis. Skin Pharmacol. 1996; 9(6): 343-354. doi: 10.1159/000211445
Hatta N, Takata M, Kawara S, Hirose T, Takehara K. Tape stripping induces marked epidermal proliferation and altered TGF-alpha expression in non-lesional psoriatic skin. J Dermatol Sci. 1997; 14(2): 154-161. doi: 10.1016/s0923-1811(96)00567-1
Burks JW, Montgomery H. Histopathologic study of psoria-sis. Arch Derm Syphilol. 1943; 48(5): 479-493. doi: 10.1001/arch-derm.1943.01510050003001
Gordon M, Johnson WC. Histopathology and histochemistry of psoriasis. I. The active lesion and clinically normal skin. Arch Dermatol. 1967; 95(4): 402-407.
Murphy M, Kerr P, Grant-Kels JM. The histopathologic spectrum of psoriasis. Clin Dermatol. 2007; 25(6): 524-528. doi: 10.1016/j.clindermatol.2007.08.005
Austin LM, Ozawa M, Kikuchi T, Walters IB, Krueger JG. The majority of epidermal T cells in Psoriasis Vulgaris lesions can pro-duce type 1 cytokines, interferon-gamma, interleukin-2, and tumor necrosis factor-alpha, defining TC1 (cytotoxic T lymphocyte) and TH1 effector populations: A type 1 differentiation bias is also mea-sured in circulating blood T cells in psoriatic patients. J Invest Derma-tol. 1999; 113(5): 752-759. doi: 10.1046/j.1523-1747.1999.00749.x
Lima HC, Kimball AB. Targeting IL-23: Insights into the pathogenesis and the treatment of psoriasis. Indian J Dermatol. 2010; 55(2): 171-175. doi: 10.4103/0019-5154.62760
Krueger JG, Fretzin S, Suárez-Fariñas M, Haslett PA, Phipps 13 Naik PP KM, Cameron GS, et al. IL-17A is essential for cell activation and inflammatory gene circuits in subjects with psoriasis. J Allergy Clin Immunol. 2012; 130(1): 145-54.e9. doi: 10.1016/j.jaci.2012.04.024
Parisi R, Symmons DP, Gri_ths, CE, Ashcroft DM, IMPACT project team. Global epidemiology of psoriasis: A systematic re-view of incidence and prevalence. J Invest Dermatol. 2013; 133: 377- 385. doi: 10.1038/jid.2012.339
Michalek IM, Loring B, John SM. A systematic review of worldwide epidemiology of psoriasis. J Eur Acad Dermatol Venereol. 2017; 31: 205-212. doi: 10.1111/jdv.13854
Trembath, R.C, Clough, R.L, Rosbotham, J.L, Jones, A.B, Camp, R.D, Frodsham, A, et al. Identification of a major suscep-tibility locus on chromosome 6p and evidence for further disease loci revealed by a two-stage genome-wide search in psoriasis. Hum Mol Genet. 1997; 6: 813-820. doi: 10.1093/hmg/6.5.813
Burden AD, Javed S, Bailey M, Hodgins M, Connor M, Till-man D. Genetics of psoriasis: Paternal inheritance and a locus on chromosome 6p. J Invest Dermatol. 1998; 110: 958-960. doi: 10.1046/j.1523-1747.1998.00213.x
Sagoo GS, Tazi-Ahnini R, Barker JW, Elder JT, Nair RP, Sam-uelsson L, Taupe, H, Trembath, R.C, Robinson, D.A, Iles, M.M. Meta-analysis of genome-wide studies of psoriasis susceptibility reveals linkage to chromosomes 6p21 and 4q28-q31 in Caucasian and Chinese Hans population. J Invest Dermatol. 2004; 122: 1401- 1405. doi: 10.1111/j.0022-202X.2004.22607.x
Camargo CM, Brotas AM, Ramos-e-Silva M, Carneiro S. Isomorphic phenomenon of Koebner: Facts and controversies. Clin Dermatol. 2013; 31(6): 741-749. doi: 10.1016/j.clinderma-tol.2013.05.012
Noah PW. The role of microorganisms in psoriasis. Semin Der-matol. 1990; 9(4): 269-276.
Poikolainen K, Reunala T, Karvonen J, Lauharanta, Kärk-käinen P. Alcohol intake: A risk factor for psoriasis in young and middle aged men? BMJ. 1990; 300(6727): 780-783. doi: 10.1136/ bmj.300.6727.780
Jankovic S, Raznatovic M, Marinkovic J, Jankovic J, Maksimov-ic N. Risk factors for psoriasis: A case-control study. J Dermatol. 2009; 36(6): 328-334. doi: 10.1111/j.1346-8138.2009.00648.x
Kanda N, Watanabe S. Regulatory roles of sex hormones in cutaneous biology and immunology. J Dermatol Sci. 2005; 38(1): 1-7. doi: 10.1016/j.jdermsci.2004.10.011
Lipozencić J, Milavec-Puretić V, Pasić A. Contact allergy and psoriasis. Arh Hig Rada Toksikol. 1992; 43(3): 249-254.
Birkenfeld S, Dreiher J, Weitzman D, Cohen AD. Celiac disease Original Research | Volume 6 | Number 1 | associated with psoriasis. Br J Dermatol. 2009; 161: 1331-1334. doi: 10.1111/j.1365-2133.2009.09398.x
Gisondi P, Targher G, Zoppini G, Girolomoni G. Non-alco-holic fatty liver disease in patients with chronic plaque psoriasis. J Hepatol. 2009; 51: 758-764. doi: 10.1016/j.jhep.2009.04.020
Miele L, Vallone S, Cefalo C, La Torre G, Di Stasi C, Vecchio FM, et al. Prevalence, characteristics and severity of non-alcoholic fatty liver disease in patients with chronic plaque psoriasis. J Hepa-tol. 2009; 51: 778-786. doi: 10.1016/j.jhep.2009.06.008
Goulding JM, Price CL, Defty CL, Hulangamuwa CS, Bader E, Ahmed I. Erectile dysfunction in patients with psoriasis: Increased prevalence, an unmet need, and a chance to intervene. Br J Der-matol. 2011; 164: 103-109. doi: 10.1111/j.1365-2133.2010.10077.x
Strauss H. Zur Lehre von der neurogenen und der thyreogenen Glykosurie [German]. Dtsch Med Wochenschr. 1897; 20: 309-312. doi: 10.1055/s-0029-1204973
Reed WB, Becker SW, Rohde R, Heiskell CL. Psoriasis and ar-thritis. Clinicopathologic study. Arch Dermatol. 1961; 83: 541-548. doi: 10.1001/archderm.1961.01580100005001
Okhandiar RP, Banerjee BN. Psoriasis in the tropics: An epide-miological survey. J Indian Med Assoc. 1963; 41: 550-556.
Bedi TR. Psoriasis in north India. Geographical variations. Der-matologica. 1977; 155: 310-314. doi: 10.1159/000250983
Smith AE, Kassab JY, Payne CMR, Beer WE. Bimodality in age of onset of psoriasis, in both patients and their relatives. Dermatol-ogy. 1993; 186: 181-186. doi: 10.1159/000247341
Farber EM, Nall L. The Natural history of psoriasis in 5,600 patients. Dermatologica. 1974; 148: 1-18. doi: 10.1159/000251595 Submit your article to this journal | https://openventio.org/submit-manuscript/ Original Research | Volume 6 | Number 1 | Naik PP
Kaur I, Handa S, Kumar B. Natural history of psoriasis: A study from the Indian subcontinent. J Dermatol. 1997; 24: 230-234. doi: 10.1111/j.1346-8138.1997.tb02779.x
Ghosal A, Gangopadhyay D, Chanda M, Das N. Study of nail changes in psoriasis. Indian J Dermatol. 2004; 49: 18-21.
Moll JM, Wright V. Psoriatic arthritis. Semin Arthritis Rheum. 1973; 3: 55-78. doi: 10.1016/0049-0172(73)90035-8
Rajendran CP, Ledge SG, Rani KP, Madhavan R. Psoriatic ar-thritis. J Assoc Physicians India. 2003; 51: 1065-1068.
Ray SPC, Singh T, Kaur I, Suri S, Sehgal S, Kaur S. Clinical profile of psoriatic arthropathy. Indian J Dermatol Venereol Leprol. 1990; 56: 200-2003.
Sandhu K, Kaur I, Kumar B. Psoriasis and vitiligo. J Am Acad Dermatol. 2004; 51: 149-150. doi: 10.1016/j.jaad.2003.12.014
Gisondi P, Tessari G, Conti A, Piaserico S, Schianchi S, Peserico A, et al. Prevalence of metabolic syndrome in patients with psoria-sis: A hospital-based case-control study. Br J Dermatol. 2007; 157: 68-73. doi: 10.1111/j.1365-2133.2007.07986.x
Cassia FF, Cardoso JF, Porto LC, Ramos-e-Silva M, Carneiro S. Association of HLA alleles and HLA haplotypes with psoriasis, psoriatic arthritis and disease severity in a miscegenated popula-tion. Psoriasis (Auckl). 2021; 11: 41-51. doi: 10.2147/PTT.S258050
Singh D, Das CJ, Baruah MP. Imaging of non alcoholic fatty liver disease: A road less travelled. Indian J Endocrinol Metab. 2013; 17(6): 990-995. doi: 10.4103/2230-8210.122606
Gandha N, Wibawa LP, Jacoeb TNA, Sulaiman AS. Correla-tion between psoriasis severity and nonnlcoholic fatty liver disease degree measured using controlled attenuation parameter. Psoriasis (Auckl). 2020; 10: 39-44. doi: 10.2147/PTT.S272286
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
All content published in Dermatology (DER) is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license allows anyone to copy, distribute, transmit, and adapt the work — including for commercial purposes — provided appropriate credit is given to the original author(s) and source.
