Early and late onset psoriasis: a cross-sectional clinical and immunocytochemical investigation

Eleni Theodorakopoulou, Zenas Yiu, Christine Bundy, Leena Chularojanamontri, Matthew Gittins, Lynne A. Jamieson, L Motta, Richard Warren, Christopher Griffiths

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    BACKGROUND: There is accumulating evidence that early onset psoriasis (EOP; presenting at or before 40 years of age) and late onset psoriasis (LOP; presenting after 40 years of age) are different diseases.

    OBJECTIVES AND METHODS: We aimed to identify potential differences between EOP and LOP by assessing immunocytochemistry involved (PP) and uninvolved (PN) skin (n=31) and demographics, psoriasis phenotype and psychological parameters (n=340) in a cross-sectional study. We categorized patients who developed psoriasis before age 40y in the EOP group, whilst those whose psoriasis occurred after age 50y were included in the LOP group.

    RESULTS: Immunocytochemistry revealed (17 EOP; 14 LOP) a greater lymphocytic infiltrate in PP skin of EOP than LOP (p=0.03), with a higher epidermal CD4(+) /CD8(+) ratio in LOP (1.3) compared to EOP (0.5; p=0.002). In 340 psoriasis patients (278 EOP; 62 LOP), we found a lower association with a positive 1(st) or 2(nd) degree family history of psoriasis (35.6% vs 62%; OR 0.33, 95% CI 0.18-0.59) and lower likelihood of having parents with EOP (OR=0.093, 95% CI 0.012-0.74) in LOP compared with EOP. EOP patients were more likely to have received biologic therapy (13.3%, EOP vs 3.5% LOP; P=0.042), whilst LOP patients had a higher likelihood of having type 2 diabetes (adjusted OR 3.43, 95%CI 1.004-11.691) and autoimmune thyroiditis (adjusted OR 5.05, 95%CI 1.62-15.7). LOP patients also had greater anxiety than EOP (mean HADS-A score LOP 8±5; EOP 5±5, p=0.006).

    CONCLUSIONS: Our findings provide further evidence for the difference between EOP and LOP. This article is protected by copyright. All rights reserved.

    Original languageEnglish
    JournalBritish Journal of Dermatology
    Early online date26 Jul 2016
    Publication statusPublished - 2016


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