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Psoriasis of early and late onset: A clinical and epidemiologic study from Spain,☆☆,

https://doi.org/10.1067/mjd.2002.120470Get rights and content

Abstract

Background: The existence of 2 distinct forms of psoriasis related to age at onset has been postulated. However, precise data regarding the clinical and epidemiologic characteristics of psoriasis depending on the age at onset are still lacking. Objective: The purpose of this study was to define the clinical and epidemiologic features of this disease in Spain and to compare patients with psoriasis of early and late onset. Methods: An observational, analytic, cross-sectional, multicenter study was carried out. From January 1999 to November 1999, 179 participating dermatologists completed a questionnaire detailing the clinical and epidemiologic features of the first 10 consecutive patients with psoriasis seen in their clinical practice. The sample distribution was proportional to the Spanish population. Both statistical and descriptive analyses were performed. Results: Available data were obtained from 1774 patients. The onset of the disease before 30 years of age was significantly associated with a higher incidence of family history of psoriasis, a more severe and extensive cutaneous involvement, and greater psychosocial impact. Guttate psoriasis, nail involvement, evidence of precipitating factors, and a recurrent clinical course were more frequent in this group of patients. Patients with psoriasis of late onset had a less severe clinical course and a more continuous evolution. Palmoplantar pustulosis was more frequent in this group of patients. No significant relationship was detected between the age at onset and development of joint involvement. Conclusion: Patients with early and late onset psoriasis often show different clinical and evolutionary features. From the analysis of our data, it seems that 2 different groups of patients with psoriasis related to age at onset can be defined. (J Am Acad Dermatol 2002;46:867-73.)

Section snippets

Patients and methods

An observational, analytic, cross-sectional, multicenter study evaluating the clinical and epidemiologic features of psoriasis in Spain was carried out from January 1999 to November 1999. A total of 179 dermatologists working in different regions of Spain participated in this study. These dermatologists were selected on the basis of geographic distribution and demographic data for the country and were distributed proportionally to the population of the different regions of Spain to obtain a

Results

A total of 1774 forms from patients with psoriasis (939 men and 829 women) were included in the study; in 6 individuals the sex was not specified. The vast majority of patients (99.5%) were white. One thousand ninety-two patients were included in group 1 (psoriasis of early onset) and 662 patients in group 2 (psoriasis of late onset). In 20 patients, the age at onset was not specified, and these patients were not included when the characteristics of groups 1 and 2 were compared. According to

Discussion

This study documents details of 1774 patients with psoriasis representative of the full spectrum of the general population in Spain. In our population, the disease started at a wide range of ages, with a mean age at onset of 29.1 years and with a modal distribution in the second decade of life. This age at onset is slightly higher than those reported in other western European countries where several studies based on the general population have also shown a higher prevalence.6, 7, 8 It seems

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    Funding sources: A grant from Farmacusí S.A./Leo Pharmaceutical Products A.S.

    ☆☆

    Conflict of interest: None.

    Reprint requests: Carlos Ferrándiz, MD, Department of Dermatology, Hospital Universitario Germans Trias i Pujol, Carretera de Canyet s/n, 08916 Badalona, Spain.

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