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

Adenosine 5'monophosphate-activated protein kinase activation reduces the risks of psoriasis and its comorbidities: a Mendelian randomization study in the UK Biobank

OBJECTIVE

Whether metformin and its adenosine 5'monophosphate-activated protein kinase (AMPK) activation protect from psoriasis risk is unconcluded. We investigated the effect of AMPK, a pharmacological target of metformin, on the risk of psoriasis and its comorbidities and mortality among participants in the UK Biobank (UKB).

METHODS

To avoid immortal time biases in pharmacoepidemiologic studies, Mendelian randomization was used to infer the AMPK pathway-dependent effects. The cut-off age for distinguishing early-onset/late-onset psoriasis (EOP/LOP) was set at 60 years, based on the incident psoriasis peak in UKB. A genetic instrument comprising 44 single-nucleotide polymorphisms associated with glycated haemoglobin (HbA1c), serving as a proxy for AMPK genetic risk score (negatively associated with AMPK activation), was employed as previously reported in the literature. Log-binomial models were used to estimate the effect size of AMPK regarding relative risk (RR) and 95% CI.

RESULTS

A total of 407 159 participants were analysed, including 9126 EOP and 3324 LOP. The AMPK genetic risk score was associated with a 12.4% increase in the risk of LOP in men (RR = 1.124, 95% CI: 1.022-1.236). This association was not significant for EOP or women. AMPK genetic risk score exhibited an elevated risk of ischemic heart disease (RR = 1.217, 95% CI 1.062-1.395) in male psoriasis patients.

CONCLUSIONS

AMPK activation may protect against LOPs and associated ischemic heart disease in men. A sex-specific, comorbidity-targeted intervention for psoriasis is needed.

Diagnosis and Management of Common Inflammatory Skin Diseases in Older Adults

Inflammatory skin conditions affect people of all ages, genders, and races. These common conditions are frequent causes of visits to the dermatologist. The geriatric population is often afflicted by these conditions because many are chronic and relapsing diseases. These inflammatory conditions include but are not limited to psoriasis, atopic dermatitis, contact dermatitis, seborrheic dermatitis, rosacea, and Grover disease. Chronic inflammatory skin conditions place a large burden on the health care system in the United States and have many associated comorbidities. This article discusses these inflammatory dermatoses that affect the geriatric population and common therapeutic options.

Unlocking the role of the B7-H4 polymorphism in psoriasis: Insights into methotrexate treatment outcomes: A prospective cohort study

B7-H4 is a recently discovered member of B7 family that negatively regulates T-cell immunity, specifically Th1 and Th17 cell responses. However, its role in the pathogenesis of psoriasis has yet to be determined. This study aims to investigate the effect of B7-H4 polymorphism on the efficacy of methotrexate (MTX) and its mechanism in psoriasis. Four single nucleotide polymorphisms of B7-H4 were genotyped in 310 psoriatic patients who received 12-week MTX. The protein expression of B7-H4 in platelets was characterized using immunofluorescence staining, confocal laser scanning microscopy, and flow cytometry techniques. We found that GG genotype carriers of B7-H4 rs1935780 had a lower Psoriasis Area and Severity Index (PASI) 75 response rate and higher weight (p = 0.0245) and body mass index (p = 0.0185) than AA and AG genotype carriers. Multiple regression analysis showed that the PASI score at baseline (p = 0.01) and age at disease onset (p = 0.003) were positively correlated with PASI 75 response rate, while weight (p = 0.005) and the rs1935780 genotype (p = 0.003) were negatively associated with PASI 75 response rate. B7-H4 was expressed in the platelet plasma membrane and cytoplasm. Furthermore, the expression of B7-H4 protein in platelets was lower in good responders than in non-responders and was upregulated considerably after 12-week MTX or in vitro MTX stimulation in good responders. Collectively, these results demonstrate that psoriatic patients with GG genotype of B7-H4 rs1935780 had a poorer response to MTX. Low expression of B7-H4 protein in platelets correlated with better clinical outcomes of MTX in psoriasis.

Skin Disease Profile in Geriatric Inpatients at a Tertiary Referral Hospital

Background

Elderly people are susceptible to various skin diseases. To monitor disease trends in the geriatric population, epidemiologic data on skin diseases are essential. However, studies on skin diseases in geriatric patients in Indonesia, particularly those who are hospitalised, are limited. Therefore, this retrospective study aims to determine the skin disease profile in geriatric patients at a tertiary referral hospital in Indonesia.

Methods

The subjects were all geriatric inpatients who were consulted at the Department of Dermatology and Venereology, Dr. Cipto Mangunkusumo National General Hospital between 2017 and 2019. The patients were analysed according to sex, age and comorbidities. They were divided into 15 groups according to the diseases. Chi-square test or Fisher's exact test was used to compare categorical variables.

Results

The most common skin diseases were infections (35.8%), dermatitis (21.8%), ulcers (12.8%), age-related skin changes (8.4%) and vascular diseases (5.3%). Dermatitis was significantly more common in males (P < 0.05), whereas infections were significantly more common in females (P < 0.05).

Conclusion

Consistent with previous studies, our inpatient data showed that infections were significantly more common in females, whereas dermatitis was significantly more common in males. The data collected may contribute to epidemiologic data on skin diseases in the geriatric population.

Efficacy and Safety of Tildrakizumab in Older Patients: Pooled Analyses of Two Randomized Phase III Clinical Trials (reSURFACE 1 and reSURFACE 2) Through 244 Weeks

The evidence on treating older patients with psoriasis with modern biologics is scarce. This study compared the efficacy and safety of tildrakizumab among younger and older patients with psoriasis (< 65/≥ 65 years) in a post hoc analysis of 2 phase III trials (reSURFACE1/2, n = 1,862). Tildrakizumab 100 mg/200 mg was administered at weeks 0/4/every 12 weeks thereafter. At week 28, patients with ≥ 75% improvement in baseline Psoriasis Area and Severity Index (PASI75) in reSURFACE1 were re-randomized to the same tildrakizumab dose or placebo; in reSURFACE2, PASI75 responders to 200 mg were re-randomized to tildrakizumab 100 mg or 200 mg; PASI75 responders to 100 mg maintained their dose. At weeks 64/52 (reSURFACE1/2), PASI50 responders entered an extension period (weeks 256/244). Outcomes were proportion of patients with PASI < 3, Dermatology Life Quality Index (DLQI) 0/1, comorbidities, comedication, and side-effects. The proportion of patients with a PASI < 3 was similar and maintained (tildrakizumab 100 mg and 200 mg, week 244: 83.3% and 84.1%/92.3% and 100.0%); DLQI 0/1 proportions at week 52 were 66.8% and 72.0%/68.3% and 81.3%. Comorbidity and comedication were more common in older patients. The safety profile of tildrakizumab appeared favourable in both groups. Tildrakizumab in patients ≥ 65 years appears effective and safe in long-term psoriasis management. These findings might assist treatment selection and overcome treatment reluctance.

Systemic treatment of psoriasis in special population

Psoriasis is a common skin disorder affecting approximately 1% of the general population. The treatment of psoriasis depends on the body surface area involvement, quality of life impairment and associated co-morbidities. Special population comprising of pregnant women, lactating mothers, elderly individuals and children, is more vulnerable. They are not included in drug trials; rendering the data for use of systemic treatment scant and is mainly based on anecdotal evidence. In this narrative review, we discuss systemic treatment options in this special population. Though couples planning a family are not considered a special population, they form a subset that require special therapeutic consideration and have also been included in this review.

Immunosenescence and Skin: A State of Art of Its Etiopathogenetic Role and Crucial Watershed for Systemic Implications

Immunosenescence is a complex multifactorial phenomenon consisting of wide-ranging remodeling of the immune system during the life span, resulting in an age-related qualitative-quantitative decline of immune cells and cytokines. A growing body of evidence in the international literature is highlighting the etiopathogenetic role of skin immunosenescence in the onset of various dermatologic conditions. Skin immunosenescence also serves as an interesting watershed for the onset of system-wide conditions in the context of allergic inflammation. Moreover, in recent years, an increasingly emerging and fascinating etiopathogenetic parallelism has been observed between some mechanisms of immunosenescence, both at cutaneous and systemic sites. This would help to explain the occurrence of apparently unconnected comorbidities. Throughout our review, we aim to shed light on emerging immunosenescent mechanisms shared between dermatologic disorders and other organ-specific diseases in the context of a more extensive discussion on the etiopathogenetic role of skin immunosenescence. A promising future perspective would be to focus on better understanding the mutual influence between skin and host immunity, as well as the influence of high inter-individual variability on immunosenescence/inflammaging. This can lead to a more comprehensive "immunobiographic" definition of each individual.

Prevalence, comorbidities and mortality of generalized pustular psoriasis: A literature review

Generalized pustular psoriasis (GPP) is a rare auto-inflammatory skin disease characterised by acute episodes of sterile pustule formation. Diagnosis and treatment of the disease have historically been complicated by a lack of awareness, and no consistent global definition or clinical coding standards. Now acknowledged as a distinct clinical entity with a recognised genetic component, GPP can take a serious and life-threatening course due to systemic inflammatory complications and its association with various comorbidities. As with other rare diseases, there are significant challenges to understanding the epidemiology of GPP, notably a small patient population, non-standardised study methodologies and ethnic differences in its presentation. A clearer understanding of GPP is therefore required for clinicians to better manage patients with this rare condition. In this review article, we present an overview of the available data on GPP prevalence estimates in key demographics and report the frequency of genetic mutations associated with the disease. We detail the incidence of known comorbidities and summarise the data on mortality and assigned causes of death. Lastly, we discuss the various factors that impact the collection, interpretation and comparison of these data.

Efficacy and safety of biologics and small molecules for psoriasis in pediatric and geriatric populations. Part II: focus on elderly patients

INTRODUCTION

The management of moderate-to-severe forms of psoriasis is becoming a frequent concern in geriatric age due to the higher risk to develop treatment adverse events, logistic issues, vulnerability to immune-related diseases and cancer, presence of comorbidities and the risk of drug interactions. In this context, traditional systemic treatments are often contraindicated, and biologic drugs and small molecules seem to be a valuable option. However, data on their effectiveness and safety in elderly patients are scant.

AREAS COVERED

The aim of this review is to analyze the current literature in order to point out data on the efficacy and safety of biologic drugs and small molecules for the management of psoriasis in elderly patients in order to put the basis for universally shared treatment algorithm following available evidence. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used for the literature research.

EXPERT OPINION/COMMENTARY

Our review suggests biologics and small molecules as an effective and safe option for the management of moderate-to-severe forms of psoriasis in elderly patients.

Treating psoriasis in the elderly: biologics and small molecules

INTRODUCTION

Psoriasis prevalence in the elderly is growing. It is estimated that 15% of elderly psoriasis patients suffer from moderate-to-severe disease, thus requiring systemic treatments. However, conventional systemic agents' use is limited due to contraindications and drug-interactions. Conversely, biologics and small molecules seem to be a valuable option, although the geriatric psoriasis population is frequently excluded from trials and shared guidelines are lacking.

AREAS COVERED

Relevant English literature (trials, real-life studies, case series, and reviews) regarding biologics and/or small molecules in the elderly were searched for up to January 17, 2022.

EXPERT OPINION

Treatment of moderate-to-severe psoriasis in the elderly may be challenging due to multiple comorbidities, polypharmacy, and increased risk of infections and cancers. However, new targeted therapies offer the possibility to perform a tailored-tail management, considering comorbidities, drug-interactions, and frailties which characterize this class of patients. Several real-world data support biologics and small molecules' efficacy and safety in the elderly with mainly no significant difference as compared to young adults. Elderly psoriasis patients' expectations are as high as those of their younger counterparts. Hence, they deserve the best therapeutic options according to their peculiarities for a long-term psoriasis remission and an improved quality of life.

Early-Onset Versus Late-Onset Psoriasis: A Comparative Study of Clinical Variables, Comorbidities, and Association with HLA CW6 in a Tertiary Care Center

Background:

Psoriasis is a chronic inflammatory diseaseresulting from a complex interplay of genetic and environmental factors affecting the skin, nail and joints. Two distinct types of psoriasis are said to exist (i) early onset psoriasis (EOP), beginning before the age of 40 years and (ii) late onset psoriasis (LOP), beginning ≥40 years; with the presence of Human lymphocyte antigen (HLA) Cw6, present in majority of patients with early onset. Several studies demonstrated clinical and genetic differences between EOP and LOPamong European and East Asian populations. Lack of similar study in the Indian population has prompted us to undertake the present work.

Aims and Objectives:

(i) To compare the clinical patterns of early onset and late onset psoriasisin patients attending the Dermatology outpatientdepartment (OPD) and admitted in the in-patient department (IPD). (ii) To analyze the association age of onset with presence of HLA Cw6.

Materials and Methods:

It was an institution-based, descriptive, cross-sectional study. Consecutive patients with psoriasis at the OPD and IPD of the department of Dermatology during the study period, were recruited in the study after obtaining informed consents. Detailed history was obtained regarding the disease, co-morbidities and complications. Through physical examination was carried out, PASI was calculated and blood samples were drawn fromconsenting adult patients (age>/=18 years) to study the presence of Cw6.

Results:

The study population (n=250) wasbroadly divided into “Early onset psoriasis(EOP)” (n=138) and Late onset psoriasis (LOP)” (n=112).Significant higher occurrence of positive family history, nail involvement and koebnerization were found in EOP, but such differences were absent considering the types, patterns, joint involvement, severity and HLACW6 positivity.

Conclusion:

This study supports the concept of two subtypes of psoriasis based on age of onset showing different clinical and evolutionary features.

Anti-interleukin-23 for psoriasis in elderly patients: guselkumab, risankizumab and tildrakizumab in real-world practice

Background

Elderly patients (aged ≥ 65 years) represent an increasing proportion of patients with psoriasis and 15% of these have moderate to severe disease. Biologics are being used frequently in this group of patients even though safety and efficacy data are limited. In addition, owing to anti‐interleukin (IL)‐23 therapies being a relatively recent option, no data have been reported about their use in elderly patients with psoriasis.

Aim

To evaluate and compare the safety and efficacy of guselkumab, risankizumab and tildrakizumab in real‐world practice in elderly patients.

Methods

This was a single‐centre retrospective study that enrolled patients aged ≥ 65 years with moderate to severe plaque psoriasis, treated with guselkumab, risankizumab or tildrakizumab. The length of the study for each group depended on the drug (44 weeks for risankisumab, 40 weeks for guselkumab and 28 weeks for tildrakizumab, owing to its more recent availability in Italy).

Results

In total, 34 patients were enrolled (n = 20 on guselkumab; n = 8 on risankizumab; n = 6 on tildrakizumab). At Week 4, 29.4% reached 90% improvement in Psoriasis Area and Severity Index (PASI90) and 8.8% reached 100% improvement in PASI (PASI100); at Week 28, PASI90 and PASI100 was reached by 58.8% and 29.4%, respectively. At the final follow‐up (Week 40 or 44, depending on drug), data were available only for the risankizumab (Week 40) and guselkumab (Week 44) and groups, and showed that 71.4% of patients had reached PASI90 and 53.5% had reached PASI100. Four patients (11.7%) discontinued treatment. No significant differences were found between the three groups. The limitations of the study included its retrospective nature of the study, small sample size, and different numbers of patients and follow‐up duration for the different groups (highest for guselkumab, lowest for tildrakizumab).

Conclusion

The three anti‐IL‐23 therapies assessed are promising, safe and effective options in elderly patients, and there was no significant difference between them. However, more data are needed to confirm our results and to understand their role in the management of this group of patients.

Nail Psoriasis in Older Adults: Epidemiology, Diagnosis, and Topical Therapy

Nail involvement is common in patients with cutaneous psoriasis, which is prevalent among older adults. Nail psoriasis greatly impacts patients' quality of life and self-esteem. Concomitant psoriatic arthritis is common. Treating nail psoriasis in the geriatric population may be challenging. General nail care measures may prevent exacerbations. Topical therapy is relatively effective, with a low rate of adverse events and little to no risk of systemic toxicity or drug interactions. However, application under occlusion may be cumbersome. There is a need for randomized controlled clinical trials in the elderly population to make more evidence-based treatment guidelines.

Psoriasis in the geriatric population: A retrospective study in Asians

There is a paucity of data focusing on geriatric psoriatic patients. The clinical features were different among those with early-onset psoriasis and elderly-onset psoriasis among the geriatric population. From 2014 to 2018, a total of 290 geriatric psoriatic patients were retrospectively enrolled in our study. They were subclassified into two groups, early-onset (aged <60 years, n = 154) and elderly-onset (aged ≥60 years, n = 136). The characteristics and treatment course of these two groups were reviewed. Psoriasis of the elderly-onset group was generally milder than the early-onset groups (P < 0.05). Less nail involvement and arthritis were noted among the elderly-onset group (P < 0.05). There were four cases of erythrodermic psoriasis in the early-onset group and three cases of palmoplantar psoriasis in the elderly-onset group. Oral medication and biologics for treatment of psoriasis appeared to be safe among the geriatric psoriatic patients. Elderly-onset psoriasis has features which are distinct from early-onset psoriasis and may be a particular subtype, which needs further evaluation.

Safety and efficacy of interleukin inhibitors in elderly patients with rheumatoid arthritis, psoriasis, and psoriatic arthritis

Elderly patients with rheumatoid arthritis, psoriasis and psoriatic arthritis encompass those with elderly-onset disease, over 60 years of age, but also those with earlier disease onset who entered old age. Considering the age-related changes of the immune system, possible frailty, susceptibility to infection and concomitant comorbidity that implies multiple medicines, the treatment of these diseases in elderly patients can be challenging. Interleukin inhibitors have been shown to be an efficient and safe treatment for these diseases. However, elderly patients with these diseases were often included in the pivotal clinical trials for interleukin inhibitors in numbers insufficient to determine whether they responded differently from younger subjects. The aim of this paper was to review the findings on the efficacy and safety of interleukin inhibitor treatment in elderly patients with rheumatoid arthritis, psoriasis, and psoriatic arthritis. The findings suggest that, for all the interleukin inhibitors reviewed herein, used in elderly patients with rheumatoid arthritis, or with psoriasis and psoriatic arthritis, the efficacy was comparable to younger patients. Furthermore, the incidence of reported adverse events was similar in these two age groups. Severe adverse events, which were related to sarilumab treatment for rheumatoid arthritis and secukinumab treatment for psoriasis, were higher in elderly patients. The reviewed findings suggest that the interleukin inhibitors approved and currently in use in clinical practice for the treatment of rheumatoid arthritis, psoriasis, and psoriatic arthritis can be considered a safe and efficient option for these diseases in elderly patients.

Sociodemographic and Clinical Characteristics of Geriatric Patients with Psoriasis Receiving Narrowband Ultraviolet B Phototherapy

Background

Although the demographic and clinical characteristics of patients with psoriasis have been evaluated in many countries, studies specifically on geriatric patients remain scarce and none have focused on those receiving phototherapy. This study describes the sociodemographic and clinical characteristics of geriatric patients with psoriasis in Indonesia, specifically those who received narrowband ultraviolet B (NB-UVB) phototherapy.

Methods

This retrospective study using data obtained from phototherapy and medical records of psoriasis patients who received phototherapy in 2014–2019 was conducted at the Dermatovenereology Clinic of Dr. Cipto Mangunkusumo National General Hospital.

Results

Among 24 geriatric patients with psoriasis who received NB-UVB phototherapy, the median age of onset was 61 years (range, 36–74 years). Regarding comorbidities, 15 patients (62.5%) had dyslipidemia, 15 patients (62.5%) had hypertension, 11 patients (45.8%) had obesity, 9 patients (37.5%) had periodontitis/gingivitis, 9 patients (37.5%) had type 2 diabetes mellitus, and 6 patients (25.0%) had hyperuricemia.

Conclusion

Some comorbidities have been associated with psoriasis, including metabolic syndrome and periodontitis. The data from this study could help physicians in evaluating and making appropriate clinical decisions when managing psoriasis patients in the geriatric population.

Real-World Effectiveness and Safety of Apremilast in Older Patients with Psoriasis

INTRODUCTION

Apremilast is a drug recently developed for psoriasis. Few data are available on its use in the elderly. We evaluated the tolerance and effectiveness of apremilast used in daily practice for psoriasis treatment in older patients.

METHODS

We performed a multicenter, retrospective study involving patients aged ≥ 65 years who had received apremilast as a psoriasis treatment. Demographic data and details regarding psoriasis and adverse events (AEs) were collected from patient medical records.

RESULTS

135 patients were included (mean age: 73.5 years). Treatment was stopped in 74 patients (54.8%) for AEs (n = 43, 56.6%), primary failures (n = 18, 23.4%), and relapses (n = 7, 9.2%). When patients were stratified by age at treatment initiation, the main cause of discontinuation in patients ≥ 75 years was AEs, whereas in patients aged 65-74 years it was primary failures (28.3%). Sixty-one patients reported AEs, mainly digestive (n = 49). Regarding effectiveness, 45.2% of patients reached PGA 0/1 between 3 and 6 months after treatment initiation. One-year apremilast continuation rates were better in the 65-74 and 75-84 years subgroups than in the > 85 years subgroup (p = 0.01).

CONCLUSION

Apremilast seems to be an effective and safe therapeutic option for psoriasis in the elderly. The main AEs reported by patients did not seem to differ from those reported previously in younger populations. However, AEs were more frequent in patients > 75 years old leading to more frequent discontinuation of apremilast compared with younger patients, suggesting a higher level of vigilance is needed in the elderly.

Biologic Treatment in Elderly Patients With Psoriasis: A Systematic Review

With our aging population, an increasing number of psoriasis patients are classified as elderly. However, psoriasis treatment in older adults can be challenging, given an increased number of comorbid conditions and immunosenescence. Biologic agents present a solution to this treatment dilemma because of their high efficacy and favorable tolerability. The objective of this systematic review was to summarize the findings of clinical trial and real-world studies exploring the safety and efficacy of biologic agents in elderly patients with moderate-to-severe psoriasis. We searched MEDLINE, Embase, the Cochrane Library, and clinical trial databases. Studies analyzing biologics for psoriasis were included if elderly patients were the main population of interest or were a separate subgroup in their analysis. Eighteen articles met inclusion criteria after screening. Across all biologic classes, efficacy for biologics between nonelderly adult patient and elderly patients was similar. Adverse events (AEs) and infections occured at a similar frequency between both groups. However, serious AEs were more common in the elderly. The available literature on the safety and efficacy of biologic agents in elderly patients supports the use of these agents in this population. However, serious AEs and discontinuation due to AEs were more common in older patients. As elderly patients have a higher burden of comorbid conditions and an increased baseline vulnerability for AE, physicians should continue to be prudent in screening before initiating biologics and monitor patients more closely as AEs tend to be more severe.

Young patients with risk factors prevalent in the elderly - differences in comorbidity depending on severity of psoriasis: a nationwide cross-sectional study in Swedish health registers

Background

Association between psoriasis severity and cerebro- and cardiovascular comorbidities has rarely been investigated.

Aim

We aimed to investigate differences in cerebro- and cardiovascular comorbidities by psoriasis severity.

Materials and methods

Using Swedish nationwide health-care registers, new adult users of anti-psoriatic drugs (2007–2013) with a recorded diagnosis of psoriasis/psoriatic arthritis or a filled prescription for calcipotriol were included. Psoriasis severity was based on the type of anti-psoriatic treatment (topical/mild, non-biologic systemic/moderate-to-severe, and biologics/ severe). Age standardized prevalence rates of cerebro- and cardiovascular comorbidities and their risk factors were compared between the groups.

Results

We found that severe psoriasis patients (N=2147) were younger than moderate-to-severe (N=11,919) or mild (N=70,796) patients (median 44, 52, and 55 years). Prevalence of hypertension was 29.9%, 32.6%, and 36.5%, myocardial infarction was 2.5%, 2.3%, and 1.8%, and stroke was 2.4%, 2.2%, and 1.1% in mild, moderate-to-severe, and severe psoriasis patients, respectively. Diabetes prevalence was 7.6% in mild, 8.0% in moderate-to-severe, and 10.7% in severe psoriasis.

Conclusion

Myocardial infarction and stroke were less common in patients with severe psoriasis while, despite being younger, they had a higher prevalence of diabetes and hypertension.

Prevalence of Psoriasis in Korea: A Population-Based Epidemiological Study Using the Korean National Health Insurance Database

Background

Although psoriasis is universal in its occurrence worldwide, its prevalence varies by geographic location and race. A few hospital-based surveys have reported on the demographic characteristics in Korean patients with psoriasis. However, a nation-wide study on the prevalence of psoriasis in Korea remains uncompleted.

Objective

The purpose of this study was to determine the prevalence of psoriasis in Korea and to describe the demographic and social characteristics of afflicted individuals.

Methods

We identified patients with psoriasis using a relevant diagnostic code from the sixth revision of the Korean Standard Classification of Disease in the 2011~2015 claims database of the Health Insurance Review and Assessment Service of Korea. We estimated the annual prevalence of psoriasis and described the age and sex distribution of the patients, type and severity of psoriasis, comorbidities, type of health insurance, type of health-care institution and residence area. Patients with moderate-to-severe psoriasis were defined as those who had been treated with phototherapy, classical systemic agents, and/or biologic agents.

Results

The standardized prevalence of psoriasis was 453 per 100,000 individuals of the database population in 2015. We found male preponderance with a 1.3:1 male-to-female ratio, and that the largest number of patients belonged to the age group of 50s. Of the patients diagnosed with psoriasis in 2015, 83.8% had plaque psoriasis and 22.6% had moderate-to-severe psoriasis.

Conclusion

The annual standardized prevalence of psoriasis in Korea was 453 per 100,000 of the population in 2015.

Causes, pathophysiology, and treatment of pruritus in the mature patient

Chronic itch is a common and debilitating health condition in the elderly. There are several common causes of itch in the mature population, such as skin xerosis, immunosenescence, and neuropathic changes. In addition, skin diseases, such as seborrheic dermatitis and stasis dermatitis, systemic conditions (end-stage renal disease and diabetes), or psychogenic derailments, such as depression, anxiety, and dementia, can all serve as triggers of pruritus. Polypharmacy, a common occurrence among the elderly population, may also serve as a cause of itch that may or may not be accompanied by dermatitis. Such medications as μ opioids and calcium channel blockers have been found to have a connection with pruritus in the advanced aging population. Determining the exact trigger for pruritus in the elderly may be especially challenging, because itch can be idiopathic in many cases. The role of treatments should not only take into account elimination of various underlying cutaneous, systemic, or psychogenic conditions associated with itch but also focus on the skin changes that are characteristic of the aging process. Development of such treatment options can be guided by elucidation of the mechanisms underlying the pathophysiology of itch in the geriatric population.

Efficacy and safety of infliximab in psoriatic patients over the age of 65

BACKGROUND

Clinical data on the long-term safety and efficacy of infliximab on psoriatic patients who are older than 65 years are limited.

OBJECTIVES

The aim is to report the long-term efficacy, safety and tolerance of infliximab in geriatric patients.

METHODS

This was a retrospective study conducted at the Department of Dermatology of the University of Rome Tor Vergata. Clinical data were reported at week 12, 52, 104, 208.

RESULTS

151 charts were evaluated. A total of 27 patients were included. Range of the age was between 65 and 85 years; mean age was 73 years ±5.4; female to male ratio was 1:2; mean age of onset of psoriasis was 43 years±17. The average of treatment duration was 39 months ±27 (range 1-100). Fourteen patients suffered from plaque type psoriasis and 13 from psoriatic arthritis. At the baseline the mean PASI score was 15.6 ± 10.2. At week 12, 52, 104, and 208 the mean PASI was 2, 2.3, 1.9 and 1.8 respectively. A reduction in the mean PASI was maintained in the long-term treatment in 12 patients (p < 0.001).

CONCLUSION

Our data suggest that long-term treatment with infliximab is effective and safe in patients over 65 years old and that IV therapy is also associated with a high compliance.

Chronic pruritus in the elderly: pathophysiology, diagnosis and management

Chronic itch in the elderly is a common problem, with a significant impact on quality of life and sleep in elderly patients. Chronic itch may be attributable to several causes, including dry skin, immunosenescence and neural degeneration. Itch may also be caused by skin diseases, such as seborrhoeic dermatitis and stasis dermatitis; systemic conditions, such as end-stage renal disease and diabetes; and psychogenic conditions, such as depression and anxiety. The use of polypharmacy may also cause itch, with or without a rash. Specifically, thiazides and calcium channel blockers have been known to cause itch in elderly patients. Management should be tailored according to the underlying dermatological or systemic aetiology of itch. Topical treatment is the mainstay of therapy, providing special emphasis on skin hydration and barrier repair. In addition, topical and oral medications that target the nervous system and reduce neuronal hypersensitization, such as gabapentin and selective antidepressants, have a role in treating patients with severe chronic itch. Furthermore, management must account for changes in metabolism and pharmacokinetics of drugs in the aging population in order to prevent the occurrence of adverse effects.

Clinical differences between early- and late-onset psoriasis in Thai patients

OBJECTIVES

There is a paucity of data regarding clinical differences between early-onset psoriasis (EOP) and late-onset psoriasis (LOP) in Asian populations. This study aimed to investigate clinical differences between EOP (onset at the age of <40 years) and LOP (onset at the age of ≥40 years) in Thai patients.

METHODS

From 2002 until 2008, staff and residents in the Department of Dermatology, Siriraj Hospital, were asked to complete a questionnaire detailing the age of onset, family history of psoriasis, comorbid diseases, clinical features, nail and joint involvement, and severity of psoriasis in all psoriasis patients. Data were analyzed using descriptive statistics and chi-squared tests.

RESULTS

A total of 1017 patients were enrolled. Of these, 663 (65.2%) patients had EOP and 354 (34.8%) had LOP. The mean ± standard deviation age of onset was 24.8 ± 8.7 years in the EOP group and 51.6 ± 9.6 years in the LOP group. The two most common comorbid diseases were hypertension and diabetes mellitus in both groups. Patients with EOP had a significantly higher likelihood of both a family history of disease and guttate psoriasis. Palmoplantar psoriasis was more commonly found in LOP patients. Nail and joint involvement and disease severity were not associated significantly with age of onset.

CONCLUSIONS

The present study supports the hypothesis that there are clinical differences between EOP and LOP in Asian populations.

Limited evidence of the effects of patient education and self-management interventions in psoriasis patients: a systematic review

OBJECTIVE

To describe the contents of educational and self-management programmes for patients with psoriasis, and to evaluate their effects.

METHODS

A systematic review of randomized controlled trials (RCTs), quasi-randomized trials and controlled clinical trials identified by a systematic literature search. Risk of bias was assessed by two independent reviewers and interventional effects were summarized descriptively and by meta-analysis.

RESULTS

Nine studies were included, which ranged from single brief interventions to long complex multidisciplinary programmes. Four RCTs with adequate sequence allocation were included to analyze interventional effects. One RCT compared two different educational programmes and found no differences between groups. The results of three trials that focused on combinations of education and self-management were heterogeneous. One RCT based on a 12-week comprehensive programme reported statistically significant effects (p<0.05) on disease severity and health-related quality of life. Two RCTs with less comprehensive programmes reported no effects on HRQoL.

CONCLUSION

This review showed that little evidence is available to support the effects of educational and self-management interventions in patients with psoriasis that are studied in RCTs. There is a significant lack of focused self-management and, compared with other chronic conditions, there appear to be few effective disease-specific tailored educational programmes for psoriasis.

[Pruritus and psoriasis : an important but frequently underestimated relation]

Pruritus is a frequent but often unrecognized and underestimated symptom in patients with psoriasis. The underreporting may be due to lower frequency and reduced intensity of pruritus compared to other pruritic diseases such as atopic eczema or uremic pruritus, as well as impairment of psychosocial well-being caused by e.g. depression, social withdraw and secretiveness. Recent studies show pruritus being more prevalent in psoriasis, especially plaque-type psoriasis, than previously believed and severely affecting patients' quality of life. The assessment of pruritus and its associated effects is a significant component of clinical management of psoriasis. The presented suggest we should not underestimate pruritus in psoriasis and must consider this symptom in planning therapy.

Psoriasis incidence and prevalence in the Russian Federation

The article presents materials and analyzes the main trends in the epidemiology of psoriasis and follow-up of patients from this category in the Russian Federation for 2009—2011.