“Statistically, a large number of people with psoriasis are elderly, due to both genetic and environmental factors, and these patients tend to have higher rates of systemic complications and even life-threatening sequelae, including heart failure, respiratory tract infections, psoriatic arthritis, and electrolytic disturbance,” explains Nasim Tootoonchi, MD. “Accordingly, managing and treating psoriasis should be tailored to the geriatric population as compared with younger patients. In order to do this, it is first necessary to obtain information about the epidemiological, demographic, and clinical features of the disease in each age group. Unfortunately, no thorough research exists on the incidence of psoriasis among patients older than 60.”
For a study published Dermatologic Therapy, Dr. Tootoonchi and colleagues conducted a cross-sectional analysis of 156 geriatric patients (>60; median age, 67) with a definitive diagnosis of psoriasis who were referred to a tertiary center between 2015 and 2019. Baseline characteristics were obtained, including age of disease onset, underlying comorbidities, clinical manifestations, clinical type of the disease, and therapeutic approaches.
Plaque Psoriasis Most Common Type in Geriatric Cohort
“We found that the most common type of psoriasis was plaque psoriasis (73.1%), followed by the pustular type (10.9%),” Dr. Tootoonchi says. “Regarding underlying comorbidities, the correlation of hypertension and diabetes mellitus with psoriasis were more prevalent than other conditions. Among older adults, topical medications were favorable to systemic treatments. Sex differences in disease characteristics are related to mean age at disease onset, disease duration, plaque type, and the risk for nail involvement.”
Most patients received topical treatment (87.1%), while the most common systemic approaches, acitretin and methotrexate, were considered for 60.3% and 74.4%, respectively. Considerably higher mean age at disease onset was observed in females compared with males. Plaque type psoriasis occurred more often in men than in women. Interestingly, the odds of nail involvement were 2.43 times higher in male patients than in female patients (P=0.011; 95% CI, 1.22-4.84). In patients suffering from plaque psoriasis, disease duration was notably longer compared with those without this psoriasis type. Conversely, a shorter disease duration was observed in those with palmoplantar type disease. Psoriatic arthritis was also noted in younger patients.
Patients With Earlier Onset More Likely to Receive Adalimumab or Phototherapy
Patients who had earlier disease onset were more likely to be treated with adalimumab or phototherapy, Dr. Tootoonchi notes. “This is due to them having a milder Psoriasis Area and Severity Index (PASI) score at earlier onset that allows for the implementation of less aggressive therapy, such as phototherapy. If patients present with fewer comorbidities, they can be started on biologic treatment.” The study team observed that the mean age of patients treated with methotrexate was significantly lower than that of other patients and slightly higher in those patients treated with topical therapy (Table).
Clinicians need to view chronic diseases such as psoriasis differently in the geriatric population, con-sidering the prevalence of comorbidities that exist within this group, Dr. Tootoonchi concludes. “In addition, disease management and therapeutic approaches for psoriasis in an older patient population should differ from that of a younger patient population. Topical therapy and phototherapy remain the initial approaches, but as this chronic disease can be overwhelming for patients, physicians should not hesitate to consider more aggressive treatments. However, dermatologists treating the geriatric community should be familiar with how the disease manifests itself in this population, as treatments in geriatric patients can be complicated.”
Dr. Tootoonchi also suggests that further studies should aim to determine which drug therapies are more effective for geriatric patient with psoriasis.
