Fatema Farhat, Ghoshal Loknath, Saha Abanti, Agarwal Sristi, Bandyopadhyay Debabrata
Department of Dermatology, M. R. Bangur Hospital, Kolkata, West Bengal, India.
Department of Dermatology, Maldah Medical College, Kolkata, West Bengal, India.
Indian J Dermatol. 2021 Nov-Dec;66(6):705. doi: 10.4103/ijd.ijd_45_21.
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.
(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.
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.
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.
This study supports the concept of two subtypes of psoriasis based on age of onset showing different clinical and evolutionary features.
银屑病是一种慢性炎症性疾病，由影响皮肤、指甲和关节的遗传和环境因素复杂相互作用所致。据说存在两种不同类型的银屑病：（i）早发型银屑病（EOP），发病年龄在40岁之前；（ii）晚发型银屑病（LOP），发病年龄≥40岁；早发型患者中大多数存在人类淋巴细胞抗原（HLA）Cw6。多项研究表明，欧洲和东亚人群中早发型和晚发型银屑病在临床和遗传方面存在差异。印度人群缺乏类似研究促使我们开展本研究。
（i）比较皮肤科门诊（OPD）就诊患者和住院部（IPD）收治患者中早发型和晚发型银屑病的临床模式。（ii）分析发病年龄与HLA Cw6存在情况之间的关联。
这是一项基于机构的描述性横断面研究。在研究期间，皮肤科门诊和住院部的连续银屑病患者在获得知情同意后被纳入研究。获取了有关疾病、合并症和并发症的详细病史。进行了全面体格检查，计算了银屑病面积和严重程度指数（PASI），并从同意参与的成年患者（年龄≥18岁）采集血样以研究Cw6的存在情况。
研究人群（n = 250）大致分为“早发型银屑病（EOP）”（n = 138）和“晚发型银屑病（LOP）”（n = 112）。早发型银屑病患者中家族史阳性、指甲受累和同形反应的发生率显著更高，但在类型、模式、关节受累情况、严重程度和HLA CW6阳性方面不存在此类差异。
本研究支持基于发病年龄的银屑病两种亚型概念，这两种亚型具有不同的临床和演变特征。
