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

Abstract

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.