Body mass index in psoriatic patients with or without familial psoriasis

Psoriasis is a chronic inflammatory disease caused by both genetic and environmental factors. The occurrence of psoriasis in family members indicates a genetic predisposition, while obesity is also a major contributor to psoriasis. We examined whether patients with versus without familial psoriasis were obese at the onset of psoriasis. Clinical information, including age at onset, age at first visit and body mass index (BMI) at first visit, was extracted from the Fukuoka University Psoriasis Registry. To compare BMI, patients aged 10 years or older who visited the clinic within 3 years of onset were selected. Familial psoriasis was observed in 27 patients (15 male, 12 female) out of 428 individuals (264 male, 164 female) with psoriasis, accounting for 6.3% of cases. Age at onset was younger for both men and women with familial psoriasis (34 ± 17 and 40 ± 15 years, respectively) relative to those with non-familial psoriasis (48 ± 19 and 53 ± 19 years, respectively). We examined age- and sex-adjusted average values of BMI at initial presentation after onset of psoriasis, finding that patients with familial psoriasis had lower BMI (22.0 kg/m² [95% confidence interval, 21.8–22.4]) than those with non-familial psoriasis (23.2 [23.1–23.3], P < 0.001). Individuals with a family history of psoriasis should be considered to be at risk for developing the disease even if obesity is not present.     

The evaluation of the sociodemographic and clinical features of Turkish psoriasis patients

BACKGROUND: Psoriasis is a common, chronic and recurrent, inflammatory disease of the skin. With no sociodemographic psoriasis data available in Turkey, we decided to investigate the clinical features and distribution of this disease in our country. METHODS: The records of 329 patients with psoriasis were retrospectively reviewed. RESULTS: Psoriasis constituted 1.3% of the total dermatological disorders. Sixty-one per cent of the patients were female, and 39% were male. The mean age at onset of disease was 25 +/- 16 years in females, and 28 +/- 15 years in males. Family history was positive 30% of the patients. A positive family history was observed in 25% of the females and 37% of the males. 312 cases (95%) had psoriasis vulgaris, 17 cases (5%) had pustular psoriasis. Of the patients with psoriasis vulgaris, 212 (68%) had plaque, 73 (23%) guttate, 18 (6%) palmoplantar, 9 (3%) inverse type. The mean and median PASI score were 3.7 +/- 3.8 & 2.7 for females, 5.4 +/- 6.1 & 3.5 for males, respectively. 1.5% of patients had psoriatic arthropathy. Nail changes were seen in 54 (16%) of the cases. The various nail involvement types observed in descending frequency were: pitting (13%), subungual hyperkeratoses (7%), onycholysis (2%), discoloration (1.5%), oily spot (1%) and splinter hemorrhages (0.3%). CONCLUSIONS: The prevalence of psoriasis in Turkey is similar to numbers reported in South America and Germany. Females were predominant, and the mean age of onset was lower in women. Positive family history was more frequent in males. Plaque type psoriasis was the most common presentation. The difference between mean PASI scores of female and male patients was not statistically significant. Psoriatic arthritis was extremely rare in Turkish psoriasis patients. Pitting was the most common abnormality of the nails.     

Relationship between environmental factors,age of onset and familial history in Japanese patients with psoriasis

Psoriasis is a chronic inflammatory disease that often involves the skin and joints. Psoriasis develops at any age and the distribution of age of onset of psoriasis is bimodal in Japan. Also, male predominance is distinct in Japanese psoriatic patients. To clarify the relationship between sex difference and habitual/environmental status, age and incidence of familial psoriasis, we analyzed data from the Fukuoka University Psoriasis Registry. A total of 1120 Japanese patients (751 men, 369 women) were analyzed. The male/female ratio was 2.03:1. Smoking and drinking habit, known as risk factors of psoriasis, were significantly more prevalent in men. Age‐specific psoriasis‐onset rate standardized by population showed bimodal distribution in both men and women; the younger peak was in their 30s for men and 10s in women; the second peak was in the 50s for both sexes. A familial history of psoriasis was seen in 6.3% of patients overall; however, female patients showed a significantly higher rate (8.7%) compared with men (5.1%, P = 0.024). When stratified by age of onset, the frequency of familial history was much higher among women with onset at less than 30 years (15.4%), compared with 30 years or more (5.3%, P = 0.0026). Our data suggest that genetic factors have a stronger influence in young women who experience fewer environmental factors such as smoking and drinking. This is the first study to show that there is a difference in the incidence of familial psoriasis depending on age of onset of psoriasis in Japan.     

Childhood psoriasis: a study of 277 patients from China

OBJECTIVES: Psoriasis is common in childhood. The aim of this study was to present the clinical and epidemiological profile of childhood psoriasis in China. METHODS: A total of 277 childhood psoriasis patients younger than 16 years old were enrolled. Statistical analysis and heritability were performed using EPI INFO 6.0, spss 10.0 and Falconer's method. RESULTS: The median age was 11 years. The male : female ratio was 1:1.13. The median age of onset was 10 years. Of the patients, 48.7% had previous episodes of psoriasis. Of the 277 children with psoriasis, 68.6% had plaque-type psoriasis, 28.9% had guttate psoriasis, 1.1% presented pustular forms of psoriasis and 1.4% had erythroderma. The extensor surface of the extremities was the most frequently affected site in our patients, followed by the appearance of lesions on the scalp. A positive family history of psoriasis was found in 34.3% patients. The prevalence of psoriasis in first- and second-degree relatives was 7.0% and 1.0%, respectively. The heritability of psoriasis in first- and second-degree relatives was 72.67% and 55.18%, respectively. CONCLUSION: Our epidemiologic studies offer the information about Han Chinese distribution, which provide clues to describe psoriasis in children.     

Successful Treatment of Severe Psoriasis in an Adolescent with Ustekinumab

Psoriasis is a chronic, inflammatory, immune‐mediated disease. Approximately 30% of patients have disease onset before age 18 years. Psoriasis in children and adolescents may be difficult to control, with subsequent poor quality of life and psychosocial consequences. We describe the case of a 12‐year‐old boy with severe, refractory, chronic plaque psoriasis for 6 years. Various therapeutic regimens including different topical corticosteroids, topical vitamin D analogs, phototherapy, photochemotherapy, systemic therapy with methotrexate, cyclosporin, and combination therapies showed only partial or transient responses with frequent relapses. Because anti‐interleukin‐12/23 agents have been successfully used in adults with psoriasis, ustekinumab was initiated and our patient showed a rapid, excellent, sustained response. No recurrence or flares have been observed after 33 months of follow‐up. This case illustrates that ustekinumab may be an effective and safe therapeutic option in adolescents with psoriasis.     

The genetic epidemiology of psoriasis vulgaris in Chinese Han

BACKGROUND: The aim of this study was to explore the effects of genetic factors on the onset of psoriasis vulgaris and to develop a possible genetic model of psoriasis in Chinese Han. METHODS: Data for 1043 patients with psoriasis vulgaris were obtained by questionnaire. Complex segregation analysis and heritability were performed using Penrose's method, Falconer's method, and the EPI INFO 6.0 and SAGE-REGTL programs. RESULTS: (1) For male and female patients, the peak ages of initial onset were 30-39 and 10-19 years, respectively, with the mean age of initial onset being 27.69 +/- 12.32 years in males and 23.26 +/- 12.56 years in females. (2) Of 1043 patients with psoriasis, 326 (31.26%) were reported to have a family history of psoriasis. The onset for males with a family history of psoriasis was earlier than that for those without a family history (P < 0.01). The morbidities of first-degree relatives were 7.67% in patients with type I psoriasis and 5.27% in patients with type II (P < 0.01), and those of second-degree relatives were 1.04% in type I and 0.24% in type II (P < 0.01). (3) The onset of psoriasis was earlier in females than in males in type I psoriasis (P < 0.01), but this was not the case in type II (P > 0.05). (4) The prevalence of psoriasis in first- and second-degree relatives of the proband with psoriasis was 7.24 and 0.95%, respectively; higher than that in the general population (0.146%). (5) The heritability of psoriasis in first- and second-degree relatives was 67.04 and 46.59%, respectively. The Mendelian, no-major-gene and environment model was rejected by complex segregation analysis. CONCLUSION: Psoriasis vulgaris follows a pattern of polygenetic or multifactorial inheritance rather than single-gene inheritance.     

Clinical study of psoriasis occurring over the age of 60 years: is elderly‐onset psoriasis a distinct subtype?

Background Previous studies demonstrated clinical differences of early‐ and late‐onset psoriasis. However, epidemiological data and clinical characteristics of psoriasis occurring in geriatric patients have been rarely studied. Objective Assessment of epidemiology and clinical features of psoriasis first occurring over the age of 60 years, so‐called elderly‐onset psoriasis, based on clinical data. Materials and methods Among 4049 patients visiting our psoriasis clinic for the last 27 years, patients were first divided into early‐ (onset age before 30 years) and late‐onset psoriasis (onset age after 30 years) based on our previous studies. Then, patients of late‐onset psoriasis were further divided into middle age‐onset group (onset age between 30 and 60 years) and elderly‐onset group (onset age over 60 years). Clinical characteristics of elderly‐onset psoriasis were compared with early‐ and middle age‐onset groups. We acquired the data both by physician’s assessments and patients’ responses. Results Elderly‐onset patients comprised 3.2% of total patients, 129 out of 4049. They have shown a lower incidence of family history (P < 0.05). The severity assessed by PASI score, body surface extent, and activity of individual lesions demonstrated that psoriasis of the elderly‐onset group was generally milder compared with early‐ and middle age‐onset groups (P < 0.05). In clinical phenotypes, the proportion of guttate type and generalized pustular psoriasis type decreased remarkably, while that of erythroderma type increased (P < 0.05). There was a significant change in the body part of origin comparing early‐ and middle age‐onset groups (P < 0.05). The proportion of scalp increased, while that of knee–elbow and trunk decreased significantly (P < 0.05). Patients’ subjective sensation of disease course improved statistically comparing early‐ and middle age‐onset groups (P < 0.05). There was no significant change in the degree of pruritus on psoriatic lesions and nail involvement (P > 0.05). Conclusion The elderly‐onset group demonstrated milder disease courses and some changes in clinical phenotypes and body part of origin compared with early‐ and middle age‐onset groups. Therefore, it seems that patients whose onset of psoriasis was over the age of 60 years might have distinct clinical features in some clinical aspects.     

HLA‐C*12:02 is a susceptibility factor in late‐onset type of psoriasis in Japanese

Psoriasis is thought to be a multifactorial disease triggered by both genetic and environmental factors. The HLA‐C locus on chromosome 6p21.33 remains the strongest susceptibility candidate locus in psoriasis. The strong association between psoriasis and the HLA‐Cw6 allele has been well documented in various races. It is known that psoriatic patients with early onset are more likely to be familial and associated with HLA‐Cw6. Familial occurrence of Japanese psoriasis is smaller than other populations. Furthermore, males are predominant over females in Japanese psoriasis. We investigated the relation between HLA‐C alleles and age of onset, and in each gender for Japanese psoriasis, and discuss male predominance in the incidence of psoriasis in Japan. Four hundred forty six unrelated Japanese patients with psoriasis vulgaris and 557 sex‐ and age‐matched unrelated Japanese healthy controls were investigated by genotyping. We confirmed the association between early‐onset type of psoriasis with HLA‐C*06:02 allele in Japanese. In addition, we detected the association between the late‐onset type of psoriasis and the HLA‐C*12:02 allele in Japanese. No significant differences in allele frequency were observed between females and males. Our results suggest that there is no genetic factor effect on male predominance in Japanese. In contract, the effect of environmental risk factors on the onset of Japanese psoriatic patients is stronger in males than in females. As a result, male predominant in psoriasis may occur in Japan.     

Clinical characteristics of Japanese pustular psoriasis: A multicenter observational study

Generalized pustular psoriasis (GPP) is a rare and severe subtype of psoriasis. Because of its rarity, GPP studies with a large sample size have been scarce. We studied the characteristics of GPP and pustular psoriasis using data from the West Japan Psoriasis Registry that had been registered until the end of December 2020. The dataset included 104 patients with pustular psoriasis and 1290 patients with other subtypes of psoriasis. Multivariate analysis revealed a significantly greater number of female patients, a significantly lower mean body mass index, and a significantly lower ratio of habitual drinkers in pustular psoriasis, compared to other subtypes of psoriasis. Of the 104 patients, 102 had GPP, including 88 von Zumbusch, 10 juvenile-onset, and four annular pustular psoriasis. Although the male : female ratio of GPP with psoriasis vulgaris (GPP+PsV) (47/20) was similar to that of psoriasis in Japan, the GPP without PsV (GPP?PsV) group highlighted a female predominance (13/22). The mean age at GPP onset was 45.3 years, and the mean interval from PsV onset to GPP onset was 12.5 years. Four of nine patients with GPP had an IL36RN gene mutation. Infection, medicine, and pregnancy were the precipitating factors for GPP. A family history of psoriasis was present in eight (7.8%) patients with GPP. Twenty-four patients with GPP had psoriatic arthritis. Biologics were used in 76.5% of patients with GPP, followed by etretinate (37.3%), cyclosporine (24.5%), methotrexate (13.7%), apremilast (8.8%), and granulocyte and monocyte adsorption apheresis (6.9%). Etretinate was used in 17 (51.5%) of 33 patients with GPP with less than 10-year history. Thus, etretinate remains a good treatment option for GPP even in the era of biologics. Hypertension was the most commonly identified comorbidity, followed by diabetes. We believe that the characteristics revealed in this study can further contribute to effective GPP management.     

Psoriasis and bone mineral density: Implications for long‐term patients

Psoriasis is a chronic inflammatory disease associated with several comorbidities. Osteoporosis is defined as a reduction in bone mineral density with impaired bone microarchitecture. Several mechanisms may be implicated as a possible cause for the association between psoriasis and osteoporosis, such as systemic inflammation, anti‐psoriatic drug intake and joint dysfunction for psoriatic arthritis (PsA). The aim of the present study was to assess bone mineral density (BMD) in patients with psoriasis, correlating the prevalence of osteopenia/osteoporosis with Psoriasis Area and Severity Index (PASI) score, mean duration of psoriatic disease, PsA and previous treatments for psoriasis. Forty‐three consecutive patients with psoriasis, 19 of whom were affected by the arthropathic form, were enrolled. We evaluated the severity of psoriasis as measured by PASI score, the CASPAR criteria and ultrasounds of the joints to verify the diagnosis of PsA and the age of psoriasis onset to estimate mean disease duration. Patients underwent a bone density scan of the lumbar spine and femoral neck by dual‐energy X‐ray absorptiometry to measure BMD. Patients with osteopenia/osteoporosis showed a statistically significant longer average duration of psoriatic disease (17 years), compared to patients affected by psoriasis with normal T‐score (8.8 years) (P = 0.04). The linear logistic regression confirms a significant relation between mean psoriatic disease duration and BMD alterations (P = 0.04). Our results suggest the necessity of an early diagnostic evaluation of bone metabolism in patients with psoriasis, especially if characterized by longer disease duration.     

Epidemiology of childhood psoriasis: a study of 419 patients from northern India

BACKGROUND: We undertook this study in order to determine the pattern and prevalence of childhood psoriasis in northern India and to highlight the differences and similarities with previous studies. MATERIALS AND METHODS: In this retrospective epidemiologic study, the data from 419 children (less than 14 years of age) with psoriasis registered at the Psoriasis Clinic between January 1990 and December 2002 were included. RESULTS: The 419 children registered at the Psoriasis Clinic constituted 0.3% of the dermatology outpatients and 12.5% of the total psoriasis patients seen over a period of 13 years in the department. There were 219 (52.2%) boys and 200 (47.7%) girls, with a male to female ratio of 1.09 : 1. The age of onset ranged from 4 days to 14 years. The mean age of onset was 8.1 +/- 2.1 years in boys and 9.3 +/- 2.3 years in girls. The peak age of onset in boys was in the 6-10-year age group, whereas the majority of girls showed an onset of psoriasis between the ages of 10 and 14 years. A positive family history was present in only 19 (4.5%) patients. The extensors of the legs were the most common initial site affected [105 (25%) cases], followed by the scalp [87 (20.7%)]. Classical plaque psoriasis was the most frequent clinical presentation [254 (60.6%) patients], followed by plantar psoriasis [54 (12.8%)]. Nail involvement was observed in 130 (31%) cases. All types of nail changes described in psoriasis were seen in these patients. Pitting was the most common nail change, followed by ridging and discoloration. Five children (1.1%) (three girls and two boys) had psoriatic arthropathy. Precipitating factors that brought about the onset of the disease or were associated with exacerbation could be recalled in only 28 (6.6%) patients. Koebnerization was observed in 27.9% of patients. Pruritus was the most frequent symptom, reported by 365 (87.1%) children. Twenty-seven (6.4%) children had other concurrent mucocutaneous diseases (vitiligo, pityriasis alba, alopecia areata, ichthyosis vulgaris, halo nevus, aphthous stomatitis, urticaria, pityriasis versicolor, nummular eczema, salmon patch, and verrucous epidermal nevus). Eighteen children had systemic disorders, including seizures, bronchial asthma, mitral regurgitation, scleroderma, Down's syndrome, high arched palate, cholelithiasis, anterior mongoloid slant, and prognathism; however, these conditions were possibly chance findings only and no correlation with the age of onset or severity of the disease was found. CONCLUSIONS: Our findings differ from those of previous studies in showing a delayed onset, equal sex distribution, less frequent facial involvement, uncommon guttate lesions, more frequent involvement of the soles, and a less frequent history of familial occurrence.     

Profile of patients with psoriasis associated with hepatitis C virus infection

Psoriasis is a chronic inflammatory skin disease associated with various complications such as arthritis, diabetes mellitus and hypertension. Hepatitis C is caused by chronic infection of hepatitis C virus (HCV), and eventually leads to liver cirrhosis and hepatocellular carcinoma. Although an association between psoriasis and HCV has been reported, there have been no large case series to date. The aim of the present study was to outline the profiles of HCV‐positive psoriatic patients. Patients with a diagnosis of psoriasis who visited Fukuoka University from 1991–2011 were sought in the database, and their medical records were manually checked for detailed information about serum liver enzymes, anti‐HCV antibodies, medical history, and treatments and outcomes of both psoriasis and hepatitis. There were 54 (7.5%) anti‐HCV antibody‐positive patients among the 717 psoriatic patients detected. Male predominance (male/female ratio, 44:10) and late onset (median age, 55 years) were the characteristics of the 54 patients. HCV infection preceded the onset of psoriasis definitely in 80% and probably in 11%. Interferon therapy exacerbated 70% of pre‐existing psoriasis cases, and induced de novo psoriasis in eight patients. Complication with diabetes mellitus was found in 35% of the patients. Our observations suggest that HCV infection can be an inducing factor for psoriasis. In hepatitis C patients, elevated tumor necrosis factor‐α is known to cause progression of hepatic disease and possibly induces psoriasis in patients with a certain predisposition.     

Epidemiology and clinical features of pediatric psoriasis in tertiary referral psoriasis clinic

Few epidemiological studies of pediatric patients with moderate to severe psoriasis have been available despite there being no approved systemic therapy for these patients. The aim of the present study was to elucidate clinical features of pediatric psoriasis in a tertiary referral psoriasis clinic. We analyzed the clinical data of 358 patients under 18 years of age referred to our clinic from other private clinics and medical centers. Our data showed a male :female ratio of 1.06:1 and a peak age of onset of 10-11 years. Of the patients, 32.4% had a positive family history. The most prevalent phenotype was plaque type (67.3%) and the mean Psoriasis Area and Severity Index score was 17.2 ± 12.7. The most frequently affected body part was the trunk (69.5%), followed by the legs (65.3%). Exposure to sunlight and summer season improved psoriatic lesions, while stress and winter season aggravated the clinical course. Only 26.0% of patients received systemic therapy or phototherapy during the therapeutic course. Oral acitretin (11.2%) was most frequently used followed by ultraviolet B phototherapy (7.3%). The childhood group (<13 years) showed higher prevalence of guttate and generalized pustular phenotypes and more severe clinical course compared with the adolescent group (13-18 years). In conclusion, our patients showed distinctive features in clinical phenotypes, disease severity and affected body parts compared with previous reports. We also found that clinical application of systemic therapies were limited considering the severe disease state of our patients, demanding a need for more research on treatment of pediatric psoriasis.     

Epidemiology and quality of life of patients with psoriasis in Chile

BackgroundClinical characteristics of psoriasis vary between different races and climates. There are few data on Latin American and even fewer on Chilean patients with psoriasis.ObjectivesTo assess that clinical characteristics and quality of life (QoL) of a group of Chilean patients with psoriasis.MethodsA cross-sectional, observational and analytic study was conducted at the Dermatology Department of the Clinical Hospital of the University of Chile between July 2006 and December 2008 applying an epidemiological and QoL-related survey to psoriatic patients.ResultsOne hundred fifty-three patients with psoriasis were included in the study. The mean (SD) age was 42.7 (14.9) years and 60.1% of the patients were male. The most frequent disease subtype was plaque psoriasis (71.9%), followed by “guttatiform” (guttate morphology without confirmed streptococcal infection) psoriasis (17.7%). In 38.6% of patients, less than 10% of body surface area (BSA) was affected. Joint involvement was reported in 28.8% of patients. Those with early onset of disease (before 30 years of age) were more likely to have a positive family history of psoriasis. Hypertension and diabetes were present in 20.3% and 11.1% of patients, respectively. The mean Dermatology Life Quality Index was 14. Greater impact of the disease on QoL was associated with male sex, young age of onset, newly diagnosed disease, facial involvement, and widespread disease.ConclusionChilean patients with psoriasis have clinical characteristics and QoL comparable to patients in other countries. A notable difference, however, was the greater impact of psoriasis on the QoL of Chilean men compared to women.     

Epidemiological survey of patients with pustular psoriasis in the Japanese Society for Psoriasis Research from 2017 to 2020

The Japanese Society for Psoriasis Research (JSPR) has been conducting annual epidemiological surveys of patients with pustular psoriasis in Japan since 2017. This study aimed to conduct a recent epidemiological analysis of patients with pustular psoriasis who were enrolled in the JSPR from 2017 to 2020. A total of 291 patients from 131 medical institutions were enrolled, of which 47.4% (138 cases) were males and 52.6% (153 cases) were females. The mean ± standard deviation (SD) age of the patients was 57.4 ± 20.3 years (males, 61.2 ± 17.3 years; females, 54.1 ± 22.1 years). The mean ± SD age of the patients at disease onset was 48.5 ± 22.5 years (males, 50.8 ± 20.6 years; females, 46.4 ± 24.0 years). The types of pustular psoriasis observed included the von Zumbusch type (59.8%), annular pustular psoriasis (8.2%), impetigo herpetiformis (6.5%), and acrodermatitis continua of Hallopeau (4.8%), of which, the majority of the patients with impetigo herpetiformis were female. Among the patients, 58.4% were treated with oral medications and 44.0% were treated with biologics. The most common oral medication prescribed was etretinate (52.4%), followed by corticosteroids (24.7%) and cyclosporin (22.9%). The most common biologics used were IL-17 inhibitors (ixekizumab [28.1%] and secukinumab [22.7%]), followed by tumor necrosis factor (TNF) inhibitors (infliximab [15.6%]) and IL-23 inhibitors (guselkumab [14.8%] and risankizumab [10.2%]). This survey thus provides new and significant information regarding the recent perspective of pustular psoriasis, such as patient characteristics and treatment trends, in Japan.     

Characterization of early and late onset psoriasis in the Korean population.

It has been proposed that two types of psoriasis can be characterized based upon age of onset. The purpose of our study was to investigate the characteristics of early and late onset psoriasis in the Korean population. A total of 986 psoriasis patients were included in this study, and the age of onset frequency proved to be bimodal. Family history in the first-degree relatives was significantly higher in the early onset group (< 40 years old) when compared with the late onset group (> or = 40 years old). A series of statistical analyses concerning the correlation between the extent of involvement and age of onset showed that earlier onset is related to more extensive involvement. A questionnaire survey concerning the influence of various external factors upon their psoriasis was given to a subgroup of 800 psoriasis patients. Multiple logistic regression analysis, controlled for confounding factors such as current age, sex and extent of involvement, revealed that early onset psoriasis patients showed significantly increased tendencies to worsen at times of psychological stress and in winter, and to improve in summer, compared with late onset psoriasis patients. In conclusion, distribution of the age of onset revealed two peaks in Korean psoriasis patients, and psoriasis with an onset prior to the age of 40 years was associated with increased inheritability, greater susceptibility to seasonal changes and more psychological stress than psoriasis with later onset.     

Psoriasis in Sri-Lanka—a computer analysis of 1366 cases

A clinical and epidemiological study of psoriasis in Sri-Lanka is presented. The prevalence in the population is estimated to be over 0.4%. The clinic incidence was 8.7%; of these 53.2% were male, and 46.8% female and 8.3% reported a family history of the disease. The mean age at onset was 25.2 years. The frequency distribution for the age at onset was bimodal with peaks at the second and fifth decades. The age at onset was significantly low in females, in patients with a family history of the disease, in those affected by weather changes and in patients whose disease was precipitated by sore throats. The existence of natural subpopulations of patients is suggested. Clinical types and complications of the disease were not essentially different from those observed in the West.     

Cross-sectional study on the correlation of serum uric acid with disease severity in Korean patients with psoriasis

Background. Hyperuricaemia is a common finding in patients with psoriasis. However, previous studies have reported inconsistent results about the association between serum uric acid concentration (SUAC) and psoriasis severity. Recent studies have also reported that SUAC is associated with metabolic dysregulation. Aim. To assess any association between SUAC and clinical features of psoriasis, and to investigate the characteristics of patients with psoriasis with hyperuricaemia compared with similar patients with normouricaemia. Methods. Cross‐sectional data from 198 Korean patients with psoriasis who visited our clinic were analysed. Association of SUAC with clinical features of psoriasis, body mass index (BMI) and various laboratory values was assessed in both genders separately. Results. The average uric acid concentration of patients with psoriasis was not significantly different from that of the healthy population, for both genders (P > 0.05). There was a positive correlation between SUAC and Psoriasis Area and Severity Index (PASI) and BMI in patients with psoriasis (P < 0.05). There was no association with age of disease onset, family history of psoriasis, or other laboratory values (P > 0.05), in either gender. Of the other factors of disease severity, the extent of body surface involvement was correlated with uric acid concentration (P < 0.05) although there was no significant relationship with activity of individual lesions (P > 0.05). Mean PASI and extent of psoriasis were increased in hyperuricaemic compared with normouricaemic patients (P < 0.05). Conclusions. SUAC in patients with psoriasis is positively associated with PASI, extent of skin involvement and BMI for both genders independently.     

Metabolic syndrome and psoriasis severity in South‐East Asian patients: An investigation of potential association using current and chronological assessments

Although studies regarding prevalence of metabolic syndrome (MS) in Asian psoriatic patients are limited and show varying results, a previous report describes a significant increase in prevalence of MS in Thai psoriatic patients, as compared with rates in the general population. However, no significant association between MS and psoriasis severity using the Psoriasis Area and Severity Index (PASI) was found, which differs from the findings of Korean and Japanese studies. This study aimed at re‐evaluating the association between MS and psoriasis severity in Thai patients using current assessment (PASI) and chronological assessment (historical course and interventions). A total of 273 psoriatic patients were recruited. After controlling for age and sex, 96 patients were assigned to the MS group and 96 patients to the non‐MS group. Similar to the previous study, no significant differences were identified between metabolic and non‐metabolic patients regarding PASI, age of onset, disease duration and family history of psoriasis. However, the numbers of hospitalizations (P = 0.018) and interventions (P = 0.028) were significantly higher in metabolic patients than in non‐metabolic patients. Further, a greater number of metabolic components was significantly associated with a higher number of hospitalizations (P = 0.012), pustular or erythrodermic psoriasis episodes (P = 0.049), and interventions (P = 0.005). Body mass index of 23 kg/m² or more, abdominal obesity and high blood pressure were associated with an increased risk of treatment failure. Using chronological assessment, our study supported that MS negatively affects psoriasis severity and treatment outcomes. Screening for MS is highly recommended for psoriatic patients.