Even in patients with only mild or moderate psoriasis, the scalp, face, soles of the feet, palms of the hands, nails and genitals are often affected. This can have a negative impact on the subjectively perceived quality of life, as epidemiological data from a large-scale Danish study show.
A research team led by Dr. Alexander Egeberg, Associate Professor at the Department of Dermatology at Bispebjerg Hospital, Copenhagen (DK), collected prevalence data as well as clinical and demographic characteristics of psoriasis in specific locations in a population-based cohort [1]. Scalp infestation is common in psoriasis and due to the visibility and itching problems, the quality of life of patients can be significantly impaired [2]. While psoriatic lesions on the face used to be considered rare, high prevalence estimates are now reported [3]. Palmoplantar psoriasis also has a significant impact on the quality of life and the ability to function in everyday life, which can be objectified using measuring instruments such as the “Palmoplantar Quality Of Life Index” [4]. And psoriasis patients with infestation of the palms of the hands and soles of the feet suffer greater physical limitations than those without palmolplantar symptoms [5]. Isolated nail psoriasis only occurs in 1-5% of patients, but around half of all psoriasis patients are affected by nail psoriasis at some point [6–8]. Psoriasis lesions in the genital area affect between 29-63% of psoriasis patients at some point during the course of the disease [9–13]. Overall, all of the areas mentioned are considered difficult-to-treat psoriasis localizations [14].
Data set from the “Danish Skin Cohort”
Egeberg et al. identified 4016 adult ≥18-year-old patients with confirmed plaque psoriasis [1]. Of these, 64.8% currently had lesions in at least one area that was difficult to treat. The patients with psoriasis in difficult-to-treat locations were on average slightly younger than the others (57.8 vs. 62.4 years). In patients with scalp, facial, hand or foot infestations, the proportion of women predominated, while genital or nail infestations were more common in men. The most frequently affected specific localization was the scalp (43.0%), followed by the face (29.9%), nails (24.5%), soles of the feet (15.6%), genitals (14.1%) and palms (13.7%). A higher prevalence was generally observed with increasing severity of psoriasis. Of all patients, 64.8%, 42.4% and 21.9% of patients were affected in ≥1, ≥2 and ≥3 hard-to-treat areas, respectively. Psoriasis infestation in one or more of these localizations was associated with a relevant impairment of quality of life (Dermatological Life Quality Index, DLQI), as shown inTable 1 .
Literature:
- Egeberg A, et al: Epidemiology of psoriasis in hard-to-treat body locations: data from the Danish skin cohort. BMC Dermatol 2020; 20: 3,
https://doi.org/10.1186/s12895-020-00099-7. - Wozel G: Psoriasis treatment in difficult locations: scalp, nails, and intertriginous areas. Clin Dermatol 2008; 26(5): 448-459.
- Mallbris L, et al: Psoriasis phenotype at disease onset: clinical characterization of 400 adult cases. J Investig Dermatol 2005; 124(3): 499-504.
- Raposo I, Torres T: Palmoplantar psoriasis and palmoplantar pustulosis: current treatment and future prospects. Am J Clin Dermatol 2016; 17(4): 349-358.
- Pettey AA, et al: Patients with palmoplantar psoriasis have more physical disability and discomfort than patients with other forms of psoriasis: implications for clinical practice. JAAD 2003; 49(2): 271-275.
- van Laborde S, Scher RK: Developments in the treatment of nail psoriasis, melanonychia striata, and onychomycosis. A review of the literature. Dermatol Clin 2000; 18(1): 37-46.
- Baran R. The burden of nail psoriasis: an introduction. Dermatology 2010; 221(Suppl 1): 1-5.
- Reich A, Szepietowski JC: Health-related quality of life in patients with nail disorders. Am J Clin Dermatol 2011; 12(5): 313-320.
- Fouere S, Adjadj L, Pawin H: How patients experience psoriasis: results from a European survey. JEADV 2005; 19(Suppl 3): 2-6.
- Meeuwis KA, et al: Genital psoriasis: a questionnaire-based survey on a concealed skin disease in the Netherlands. JEADV 2010; 24(12): 1425-1430.
- Meeuwis KA, et al: Genital psoriasis: a systematic literature review on this hidden skin disease. Acta Derm Venereol 2011; 91(1): 5-11.
- Ryan C, et al: Genital psoriasis is associated with significant impairment in quality of life and sexual functioning. JAAD 2015; 72(6): 978-983.
- Meeuwis KAP, et al: Prevalence of genital psoriasis in patients with psoriasis. J Dermatolog Treat 2018; 29(8): 754-760.
- Sarma N: Evidence and suggested therapeutic approach in psoriasis of difficult-to-treat areas: Palmoplantar psoriasis, nail psoriasis, scalp psoriasis, and intertriginous psoriasis. Indian J Dermatol 2017; 62(2): 113-122.
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