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The prevalence of psoriasis among elderly individuals: more questions than answers

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Contact Dermatitis 1992;27:269-70. 3. Bibgefors K, Lindberg M, Isacson D. Selfreported dermatological problems and use of prescribed topical drugs correlate with decreased quality of life: an epidemiological survey. Br J Dermatol 2002;147:285-90. 4. Schaefer I, Rustenbach SJ, Zimmer L, Augustin M. Prevalence of skin diseases in a cohort of 48,665 employees in Germany. Dermatology 2008;217:169-72. 5. Yalçin B, Tamer E, Gür Toy G et al. The prevalence of skin diseases in the elderly: analysis of 4099 geriatric patients. Int J Dermatol 2006;45:672-6. 6. Weismann K, Krakauer R, Wanscher B. Prevalence of skin diseases in the old. Acta Derm Venereol 1980;60:352-3. 7. Johnson MLT. Skin Conditions and Related Need for Medical Care among Persons 1- 74 years, United States, . Vital and Health Statistics: Series 11, No 212. US Department of Health, Education and Welfare publication No. (PHS) 79-1660; National Center for Health Statistics 1978:1-72. 8. Basra MK, Shahrukh M. Burden of skin diseases. Expert Rev Pharmacoecon Outcomes Res 2009;9:271-83. 9. Beauregard S, Gilchrest BA. A survey of skin problems and skin care regimens in the elderly. Arch Dermatol 1987;123:1638- 43. 10. Farber EM, Nail L. Epidemiology: natural history and genetics. In: Roenigk HR Jr, Maibach HI (eds), Psoriasis, 3rd ed., New York: Marcel Dekker; 1998. p. 107-57. 11. Naldi L. Inflammatory skin diseases IV: Psoriasis. In: HC Williams, DP Strachan (eds) The Clallenge of DermatoEpidemiology., Boca Raton-New York: CRC Press; 1997. p.175-90. 12. Gundjonsson JE, Elder JT. Psoriasis: epidemiology. Clin Dermatol 2007;25:535-46. 13. Lowes MA, Bowcock AM, Krueger JG. Pathogenesis and therapy of psoriasis. Nature 2007;445:866-73. 14. Finlay AY, Coles EC. The effect of severe psoriasis on the quality of life of 369 patients. Br J Dermatol 1995;132:236-44. 15. Sambogna F, Gisondi P, Melchi CF et al. Prevalence of symptoms experienced by patients with different clinical types of psoriasis. Br J Dermatol 2004;151:594-9. 16. annex 3_02_. Accessed:October 26, 2010 17. Ferrándiz C, Bordas X, García-Patos V et al. Prevalence of psoriasis in Spain (Epiderma Project: phase I). J Eur Acad Dermatol Venereol 2001;15:20-3. 18. Bell LM, Sedlack R, Beard MC et al. Incidence of psoriasis in Rochester, Minn . Arch De

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Ageing Research 2011; volume 3:e1

The prevalence of psoriasis health-related quality of life in a substantial
degree.13-15 Psoriasis is not curable, yet data on Correspondence: Ioannis D. Bassukas, Dept Skin &
among elderly individuals: the burden of psoriasis in elderly people are Venereal Diseases, Univ. Ioannina Medical School,
more questions than answers scanty and controversial.11 Herein we report Univ. Campus, GR-45110 Ioannina, Greece.
the results of a survey on the prevalence of Tel. +30.2651.007425 - Fax: +30.2651.007031.
Ioannis D. Bassukas, psoriasis in non-permanently hospitalized, eld- E-mail:
Konstantina A. Mavridou, erly (70-89 year old) individuals.
Key words: skin diseases, psoriasis, prevalence,
Theocharis Evangelou, Georgios Gaitanis elderly, proxies.
Department of Skin and Venereal
Diseases, University of Ioannina Medical Acknowledgments: the authors gratefully
Materials and Methods acknowledge the contribution of M.S. Bakola,
School, Ioannina, Greece
MD, to the electronic data processing.
The study was performed by the method of
the face-to-face interview with a structured Contributions: IBD, GG study concept; KAM, TE
questionnaire in a KAPI unit located in data collection; IBD statistical analysis perform-
Abstract Ioannina, an urban community in Greece. ing and first draft of the manuscript writing.
KAPI is an Open Care Community Center for Conflict of interest: the authors report no con-
Knowledge of epidemiological data of psori- Older People which in Greece represents a flicts of interest.
asis among elderly people is limited. Herein nationwide network of multidisciplinary cen-
the prevalence of psoriasis among non-perma- ters, providing social and primary health serv- Received for publication: 10 December 2010.
nently hospitalized, elderly (70-89 year old) ices to older members of the local community, Accepted for publication: 6 March 2011.




ly
individuals was assessed by a face-to-face together with recreational and group activities
interview using a structured questionnaire This work is licensed under a Creative Commons
on a volunteer basis.16 After permission from




on
adapted from an earlier telephone survey else- Attribution 3.0 License (by-nc 3.0).
the Municipal Authorities and following oral
where. 450 individuals 70-89 years old con- consent all individuals, that personally contact- ©Copyright I.D. Bassukas et al., 2011
sented to contribute. Psoriasis was found in ed the KAPI medical service between March 01 Ageing Research 2011; 3:e1




e
15/450 individuals [life-long prevalence: and April 30, 2010 were interviewed for the doi:10.4081/ar.2011.e1
3.33%; (95% confidence intervals: 1.99-
5.47%)]; 1/450 individuals have ever required
systemic treatment (0.2% [0.01-1.4%]). This
us
presence (active disease) or personal history
of psoriasis using a structured questionnaire
adapted according to that used previously by presently in remission, reported recurrent
al
prevalence is about ten times higher than cor- Ferrándiz et al. in a telephone psoriasis survey moderate-to-severe disease flairs in the past
responding results of the aforementioned tele- in Spain.17 For the probands, main reasons for that needed systemic treatment (PUVA,
ci

phone survey with the same questionnaire. In attending the medical service of KAPI were to methotrexate and retinoids on different occa-
conclusion this study: i) Provides the first esti- sions). To the rest of the patients (14/15) pso-
er


renew prescriptions of routine medications
mation of psoriasis prevalence in Greece, and/or to carry out simple periodic examina- riasis was adequately controlled throughout
albeit focused in a particular age group and their lifetime with topical medications.
m



tions, like blood pressure measurements. The
demonstrates a relatively high life-long preva- files of all contacted individuals were addition-
om




lence, however with minimal morbidity among ally reviewed for past prescriptions ascribed to
older people; ii) Underscores the need for stud- the treatment of psoriasis. SPSS 17.0
ies to evaluate the impact of proxy effects (e.g. (Chicago, IL, USA) was employed to calculate Discussion
-c




telephone information) in assessing skin mor- core demographic data and prevalence rates
bidity of older probands. with 95% confidence intervals. This is the first study that appraises the
on




prevalence of psoriasis in Greece, albeit
focused in an age group with limited and nev-
ertheless controversial reported prevalence
N




Introduction Results data in the literature.10,11 To date, some sur-
veys have measured the highest age-specific
Skin diseases are a quite common health A total of 628 individuals attended the med- prevalence of psoriasis in older individu-
problem with a high need for treatment among ical service of KAPI during the survey period als,18,19 as expected for a chronic disease with
adults worldwide.1-4 Epidemiological studies of and were asked to participate to this study. onset throughout life and almost negligible
dermatological entities in elderly people are From the 601 individuals (96%), who consent- disease-specific excess mortality.19 Yet other
limited although the burden of skin related ed to participate, 450 (75%) aged between 70- studies found leveling off or even drastically
complains and disorders increases significant- 89 years (mean/median age: 78/77 years declining rates of psoriasis prevalence for indi-
ly as a function of age to become a consider- respectively). Sixty-three percent (63%) of the viduals beyond the age of 70 years compared to
able source of disability for the oldest.4-9 probands were females, roughly reflecting gen- younger age classes.17,21-25 Thus, in contrast to
Psoriasis, as a consequence of its chronicity der composition of the Greek population at this the relatively high prevalence measured here-
and lack of definitive cure, is worldwide one of age group. Psoriasis was identified in 15/450 in, a nation-wide telephone survey in Spain
the most prevalent immune-mediated skin dis- individuals (prevalence: 3.33%; [95% confi- applying essentially the same structured ques-
ease in adults.10-12 The severity and course of dence intervals (95% CI): 1.99-5.47%]; Table tionnaire recorded only 0.33% age-specific
psoriasis, a papulosquamous inflammatory 1). Psoriasis tended to be more frequent prevalence in persons >70 years old. This was
disease with variable clinical morphology, among men. The life-long prevalence of psori- only a quarter of the average psoriasis preva-
depends on both genetic and environmental asis episodes requiring systemic treatment lence measured in the whole target population
factors.13 Direct morbidity of psoriasis is mod- was quite low (1/450 individuals or about 0.2% of this latter study or just one seventh of the
erate, however the disease negatively impacts [95% CI: 0.01-1.4%]): Only one patient, though highest prevalence rate that was found for age


[Ageing Research 2011; 3:e1] [page 1]

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