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Clinical profile of childhood-onset psoriasis and prevalence of HLA-Cw6: a hospital-based study from India
  1. Dharshini Sathishkumar1,
  2. Renu George1,
  3. Dolly Daniel2,
  4. John Victor Peter3
  1. 1Department of Dermatology, Venereology and Leprosy, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
  2. 2Department of Transfusion Medicine and Immunohaematology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
  3. 3Department of Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
  1. Correspondence to Professor Renu George, Department of Dermatology Venereology and Leprosy, Christian Medical College and Hospital, Vellore, Tamil Nadu 632 004, India; renuegeorge{at}gmail.com

Abstract

Background Childhood-onset psoriasis (COP), a distinct clinical entity, may be associated with HLA-Cw6 positivity and metabolic and cardiovascular complications. There is some evidence that HLA-Cw6 positivity is associated with more extensive or severe disease and that positivity is lower in Asian patients than in Caucasians. We describe the clinical profile, prevalence of the HLA-Cw6 allele, metabolic syndrome (MetS) and vitamin D deficiency in Indian patients with COP.

Methods In this cross-sectional hospital-based study over 15 months (June 2010–August 2011), 108 consecutive patients with disease onset ≤16 years were enrolled. Demographic, clinical and laboratory data were collected. Patients were categorised as children with COP (CCOP; n=69) or adults with COP (ACOP; n=39). Disease severity was assessed using body surface area (BSA) involved and Psoriasis Area and Severity Index (PASI) score.

Results The most common morphological type was chronic plaque psoriasis; follicular psoriasis was seen only in children. Adults with disease onset in childhood, when compared with CCOP, had later disease onset (11.0±4.0 vs 6.9±3.8 (mean±SD) years; p<0.0001) of greater severity (p=0.021) based on BSA involved. PASI scores were, however, similar in ACOP and CCOP. Body mass index was not associated with disease severity. Of the 83 who underwent HLA-C typing, 46 (55.4%) were positive; positivity was associated with guttate lesions (p=0.031), scalp involvement (p=0.004), greater BSA involvement (p=0.002) and higher PASI scores (p=0.013). Vitamin D deficiency, obesity and MetS were present in 77.4%, 10.7% and 14.5% of patients, respectively.

Conclusions Among Indian patients, CCOP have earlier disease onset than ACOP. HLA-Cw6 was associated with guttate psoriasis, scalp involvement and disease severity. Vitamin D deficiency was common.

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