Facial involvement in Indian psoriatic patients and its association with disease severity and metabolic syndrome: A cross-sectional study.

BACKGROUND

Face was often thought to be spared in psoriasis possibly due to the protective effect of sebum and low-dose ambient ultraviolet radiation exposure. Some have suggested that facial involvement is common and indicates disease severity. There is a paucity of data on this, particularly from India. Psoriatics have a higher prevalence of metabolic syndrome, and patients with severe disease are at greater risk.

OBJECTIVE

A study of the frequency and type of facial involvement in Indian psoriatic patients and its association with disease severity and metabolic syndrome.

METHODS

A total of 250 consecutive psoriatic patients were screened and these yielded 188 patients with facial involvement. Facial psoriatics were divided into peripherofacial, centrofacial and mixed facial types. Disease severity was assessed using whole body, scalp, facial psoriasis area severity index scores and nail area psoriasis severity index scores. Patients were evaluated for the presence of metabolic syndrome using NCEP-III criteria. All parameters were compared both between facial and nonfacial psoriatics and between cases with different types of face involvement.

RESULTS

The mean age (P = 0.04) and age of onset of disease (P = 0.02) was lower and median whole-body psoriasis area severity index score was higher in psoriatics with facial involvement (P < 0.001) than those without. No significant association was found between facial involvement and metabolic syndrome. Mixed facial was the commonest type of facial involvement and there was a significant association of mixed facial involvement with increased total body psoriasis area severity index scores (P < 0.001).

LIMITATIONS

Dietary habits, physical activity level, family history of diabetes and obesity were not enquired for in our patients. Centrofacial cases were too few in number, hence statistical comparisons are not relevant.

CONCLUSION

Facial involvement in psoriatics is associated with severe disease but not metabolic syndrome. Mixed facial type might be considered a marker of overall psoriasis disease severity in the Indian population.