Clinical Characteristics of Geriatric Psoriasis Vary by Age, Sex

Clinical manifestations, disease involvement patterns, and considered treatment approaches of 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 a challenge for dermatologists. As a wide range of people with psoriasis are elderly, with the age group 60-69 linked with the highest rate of psoriasis occurrence in the United States, greater risks of potentially life-threatening sequelae such as heart failure, psoriatic arthritis (PsA), and poorer quality of life may contribute to a greater financial and health care burden and warrant personalized approaches to disease management.

“Accordingly, managerial and therapeutic approaches in psoriasis should be different as compared with the younger population. To achieve such a goal, the first step will be to gather sufficient information about the epidemiological, demographic, and clinical features of the disease in each community,” said the study authors.

They conducted a cross-sectional study to provide an overview of the epidemiological, clinical, and therapeutic consequences among patients older than 60 years with a definitive diagnosis of psoriasis who were referred to the Razi Dermatology Hospital of Tehran, Iran, between 2015 and 2019.

A total of 156 patients with psoriasis (mean [SD] age, 68.5 [7.3] years; male, n = 95) who had recorded files 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 involved zone was the lower extremities (84.6%), with scalp, nail, and joint (PsA) involvements also found in 26.9%, 40.3%, and 19.2% of patients, respectively. The most common comorbidities were hypertension (25.0%) and diabetes (16.0%).

Regarding therapeutic management, the majority of patients were treated topically (87.1%), with the most frequent systemic approaches considered being methotrexate (74.4%) and acitretin (60.3%).

In comparing baseline characteristics between men and women affected by psoriasis, female patients compared with male patients were significantly older at disease onset (59.23 [13.48] vs 51.83 [15.80] years; P = .002), plaque type was more prevalent in men than in women (76.9% vs 67.3%; P = .026), and chance of nail involvement was 2.43 times higher in men than in women (48.4% vs 27.9%; 95% CI, 1.22-4.84; P = .011). No differences between the 2 groups were observed for topical or systemic therapeutic approaches.

Conversely, 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 = .013) and slightly older in patients who received topical therapy (68.88 [7.49] vs 65.65. [5.53] years; P = .052). Patients who had earlier onset of psoriasis were also found to be more likely to receive adalimumab or phototherapy.

Mean disease duration was also shown to be significantly longer in patients suffering from plaque psoriasis compared with those without this feature (14.82 [12.67] vs 9.53 [11.67] years; P = .034), whereas those with palmoplantar type experienced shorter disease duration (14.82 [12.67] vs 9.53 [11.67] years; P = .034). Comorbid PsA was linked with younger patients, with the mean age in patients with and without joint involvement being 65.23 (6.33) vs 69.23 (7.37) years (P = .007).

“Sex differences in disease characteristics are mainly related to mean age at disease onset, disease duration, plaque type of the disease, and the risk for nail involvement. Further studies are required to determine which drug therapies are more effective and should be prescribed to geriatric psoriatic patients,” concluded the researchers.

Reference

Asili P, Tootoonchi N, Nasimi M, Daneshpajooh M, Sedaghatzadeh M, Mirahmad M. Demographic aspects, clinical characteristics, and therapeutic approaches in geriatric psoriasis: A study from a tertiary center. Dermatol Ther. Published online June 9, 2022. doi:10.1111/dth.15628