Department of Dermatology, Venereology and Leprosy, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
Department of Transfusion Medicine and Immunohaematology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
Postgrad Med J. 2015 Jun;91(1076):309-14. doi: 10.1136/postgradmedj-2014-133188. Epub 2015 May 6.
Childhood-onset psoriasis (COP), a distinct clinical entity, may be associated with HLA-Cw6 positivity and metabolic and cardiovascular complications. There is some evidence that HLA-Cw6 positivity is associated with more extensive or severe disease and that positivity is lower in Asian patients than in Caucasians. We describe the clinical profile, prevalence of the HLA-Cw6 allele, metabolic syndrome (MetS) and vitamin D deficiency in Indian patients with COP.
In this cross-sectional hospital-based study over 15 months (June 2010-August 2011), 108 consecutive patients with disease onset ≤16 years were enrolled. Demographic, clinical and laboratory data were collected. Patients were categorised as children with COP (CCOP; n=69) or adults with COP (ACOP; n=39). Disease severity was assessed using body surface area (BSA) involved and Psoriasis Area and Severity Index (PASI) score.
The most common morphological type was chronic plaque psoriasis; follicular psoriasis was seen only in children. Adults with disease onset in childhood, when compared with CCOP, had later disease onset (11.0±4.0 vs 6.9±3.8 (mean±SD) years; p<0.0001) of greater severity (p=0.021) based on BSA involved. PASI scores were, however, similar in ACOP and CCOP. Body mass index was not associated with disease severity. Of the 83 who underwent HLA-C typing, 46 (55.4%) were positive; positivity was associated with guttate lesions (p=0.031), scalp involvement (p=0.004), greater BSA involvement (p=0.002) and higher PASI scores (p=0.013). Vitamin D deficiency, obesity and MetS were present in 77.4%, 10.7% and 14.5% of patients, respectively.
Among Indian patients, CCOP have earlier disease onset than ACOP. HLA-Cw6 was associated with guttate psoriasis, scalp involvement and disease severity. Vitamin D deficiency was common.
儿童发病的银屑病（COP）是一种独特的临床实体，可能与 HLA-Cw6 阳性和代谢及心血管并发症有关。有证据表明，HLA-Cw6 阳性与更广泛或更严重的疾病有关，而且亚洲患者的阳性率低于白种人。我们描述了印度 COP 患者的临床特征、HLA-Cw6 等位基因的流行率、代谢综合征（MetS）和维生素 D 缺乏症。
在这项为期 15 个月的横断面医院基础研究（2010 年 6 月至 2011 年 8 月）中，纳入了 108 例发病年龄≤16 岁的连续患者。收集了人口统计学、临床和实验室数据。患者分为儿童发病的银屑病（CCOP；n=69）或成人发病的银屑病（ACOP；n=39）。采用受累体表面积（BSA）和银屑病面积和严重程度指数（PASI）评分评估疾病严重程度。
最常见的形态学类型为慢性斑块型银屑病；儿童中仅见滤泡性银屑病。与 CCOP 相比，发病年龄为儿童期的成年患者发病较晚（11.0±4.0 与 6.9±3.8（均值±标准差）岁；p<0.0001），严重程度更高（p=0.021），根据受累 BSA 评估。然而，ACOP 和 CCOP 的 PASI 评分相似。体重指数与疾病严重程度无关。在接受 HLA-C 分型的 83 例患者中，46 例（55.4%）阳性；阳性与点滴状皮损（p=0.031）、头皮受累（p=0.004）、更大 BSA 受累（p=0.002）和更高 PASI 评分（p=0.013）有关。77.4%、10.7%和 14.5%的患者分别存在维生素 D 缺乏、肥胖和代谢综合征。
在印度患者中，CCOP 的发病年龄早于 ACOP。HLA-Cw6 与点滴状银屑病、头皮受累和疾病严重程度有关。维生素 D 缺乏症很常见。
