Early- and late-onset psoriasis: a cross-sectional clinical and immunocytochemical investigation

• Published in: British journal of dermatology (1951) Vol. 175; no. 5; pp. 1038 - 1044
• Main Authors: Theodorakopoulou, E., Yiu, Z.Z.N., Bundy, C., Chularojanamontri, L., Gittins, M., Jamieson, L.A., Motta, L., Warren, R.B., Griffiths, C.E.M.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.11.2016
• Subjects: Adolescent; Adult; Age of Onset; Aged; CD4-CD8 Ratio; Cell Count; Cross-Sectional Studies; England - epidemiology; Female; Humans; Immunohistochemistry; Male; Middle Aged; Psoriasis - epidemiology; Psoriasis - pathology; Retrospective Studies; Young Adult
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1111/bjd.14886

Summary Background 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. Objectives We aimed to identify potential clinical and immunocytochemical differences between EOP and LOP. Methods 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. Results 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). Conclusions Our findings provide further evidence for the difference between EOP and LOP. What's already known about this topic? Late‐onset psoriasis (LOP), presenting after 40 years of age, has distinct genetic differences from early‐onset psoriasis (EOP), which presents at or before 40 years of age. LOP is specifically associated with distinct polymorphisms at the interleukin (IL)1B gene and an impairment of the mobilization of epidermal Langerhans cells in response to IL‐1β has been demonstrated in the uninvolved skin of EOP but not of LOP. What does this study add? There is a higher CD4+ : CD8+ T‐cell ratio in the epidermis of involved skin of patients with LOP as compared with EOP. Our evidence suggests differences in the heritability of LOP compared with EOP. LOP is more strongly associated with type 2 diabetes and autoimmune thyroiditis and patients with LOP had a higher likelihood of anxiety. We provide further evidence for the hypothesis that LOP and EOP are two distinct conditions. Linked Comment: Kirby. Br J Dermatol 2016; 175:869–870.