Age at disease onset: a key factor in understanding psoriasis

Evidence suggests that early-onset psoriasis (EOP) and late-onset psoriasis (LOP) are different diseases. The current study investigated the difference between EOP and LOP in an Indian population and found clinical differences between both groups.

HLA-Cw6 is an allele associated with psoriasis susceptibility and increased severity. Normally, this form of psoriasis is present at a younger age because of its genetic origin. Depending on the age of onset, different clinical patterns have been identified for psoriasis: EOP, presenting <40 years of age and LOP, presenting ≥40 years of age. A difference in treatment response has been observed for EOP versus LOP in European and East Asian populations, but there is a lack of data from Indian patients. Dr Farhat Fatima (M. R. Bangur Hospital, India) shared the results of a descriptive, cross-sectional study that compared clinical patterns of HLA-C2w6 association of EOP versus LOP in Indian patients [1].

Medical history and clinical variables were collected, as well as blood samples that were taken from a subset of patients to test for the presence of HLA-Cw6 [1]. Of the total study population (n=250), 138 patients were allocated to the EOP group and 112 in the LOP group. Sex ratio differed significantly (P=0.01) between groups; more men were included in both groups. Family history of psoriasis was higher in EOP than LOP (12.3% vs 3.6%; P=0.01).

In both groups, the most common site involved were the lower limbs (70% EOP; 75% LOP; P=0.28). A significantly higher percentage of nail involvement was found for EOP compared with LOP (55.8% vs 34%; P-value not shown). HLA-Cw6 analysis was done in 15 EOP and 15 LOP patients. A significantly higher percentage of patients with EOP were positive for HLA-Cw6 than LOP patients (73.3% vs 20%; P-value not shown). For a better understanding of the role of HLA-Cw6 in psoriasis, a higher number of patients and healthy controls should be analysed.

The current study supports the concept of 2 subtypes of psoriasis based on the age of onset: EOP and LOP. Further recruitment of patients and adding more clinical parameters, such as comorbidities and treatment response, are required for future investigation on the difference between the 2 subtypes.

1. 
   
   1. Fatima F. Early vs late onset psoriasis: comparative study of clinical variables and association with HLACW6. Abstract 234, ICD 2021, 10–13 November 2021.

 

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Posted on 2 December, 20212 December, 2021