Dermatology Centre, Salford Royal NHS Foundation Trust, Salford, U.K.
Centre for Dermatology Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.
Br J Dermatol. 2016 Nov;175(5):1038-1044. doi: 10.1111/bjd.14886. Epub 2016 Sep 29.
There is accumulating evidence that early-onset psoriasis (EOP; presenting at or before 40 years of age) and late-onset psoriasis (LOP; presenting after 40 years of age) are different diseases.
We aimed to identify potential clinical and immunocytochemical differences between EOP and LOP.
We assessed immunocytochemistry in involved (PP) skin and uninvolved skin (n = 31) and demographics, psoriasis phenotype and psychological parameters (n = 340) in a cross-sectional study.
Immunocytochemistry revealed (17 EOP, 14 LOP) a greater lymphocytic infiltrate in PP skin of EOP compared with LOP (P = 0·03), with a higher epidermal CD4 : CD8 ratio in LOP (1·3) compared with EOP (0·5) (P = 0·002). In 340 patients with psoriasis (278 EOP, 62 LOP), we found an association with a positive first or second degree family history of psoriasis [62·0% vs. 35·6%, adjusted odds ratio (OR) 8·32, 95% confidence interval (CI) 1·90-36·52] and a higher likelihood of having parents with EOP (adjusted OR 10·34, 95% CI 1·32-81·83) in the EOP group. Patients with EOP were more likely to have received biological therapy (13·3% EOP vs. 3·5% LOP, P = 0·042), while patients with LOP had a higher likelihood of having type 2 diabetes (adjusted OR 3·43, 95% CI 1·004-11·691) and autoimmune thyroiditis (adjusted OR 5·05, 95% CI 1·62-15·7). Patients with LOP also had greater anxiety than patients with EOP (mean Hospital Anxiety and Depression Scale-A score LOP 8 ± 5, EOP 5 ± 5; P = 0·006).
Our findings provide further evidence for the difference between EOP and LOP.
越来越多的证据表明，早发性银屑病（EOP；发病年龄在 40 岁之前）和晚发性银屑病（LOP；发病年龄在 40 岁之后）是两种不同的疾病。
我们旨在确定 EOP 和 LOP 之间潜在的临床和免疫细胞化学差异。
我们在一项横断面研究中评估了 31 例受累（PP）皮肤和非受累（n = 31）皮肤的免疫细胞化学，并评估了 340 例患者的人口统计学、银屑病表型和心理参数。
免疫细胞化学显示（17 例 EOP，14 例 LOP）EOP 的 PP 皮肤中淋巴细胞浸润程度高于 LOP（P = 0.03），LOP 的表皮 CD4：CD8 比值（1.3）高于 EOP（0.5）（P = 0.002）。在 340 例银屑病患者（278 例 EOP，62 例 LOP）中，我们发现与银屑病阳性一级或二级家族史有关[62.0%对 35.6%，调整后的优势比（OR）8.32，95%置信区间（CI）1.90-36.52]，EOP 组中父母患有 EOP 的可能性更高（调整后的 OR 10.34，95%CI 1.32-81.83）。EOP 组患者更有可能接受生物治疗（13.3%EOP 对 3.5%LOP，P = 0.042），而 LOP 组患者患 2 型糖尿病的可能性更高（调整后的 OR 3.43，95%CI 1.004-11.691）和自身免疫性甲状腺炎（调整后的 OR 5.05，95%CI 1.62-15.7）。LOP 组患者的焦虑程度也高于 EOP 组（平均医院焦虑和抑郁量表-A 评分 LOP 8 ± 5，EOP 5 ± 5；P = 0.006）。
我们的发现为 EOP 和 LOP 之间的差异提供了进一步的证据。
