Clinical Descriptive Study of Psoriasis in India: Triggers, Morbidities and Coincidences

Abstract

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.