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      New-Onset Guttate Psoriasis: A Long-Term Follow-Up Study

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          Abstract

          Background

          Guttate psoriasis (GP), a distinct variant of psoriasis, is more common in children and adolescents. The long-term course of these patients has sparsely been examined, with few studies reporting the rates of relapse, persistence, and further development of the psoriasis vulgaris phenotype.

          Objectives

          The objective of this study was to characterize the long-term outcomes of new-onset GP and elucidate the potential factors associated with a persistent disease course.

          Methods

          This was a retrospective cohort study. Patients diagnosed with new-onset GP between 2009 and 2020 with a follow-up period of at least 1 year, were enrolled. The examinees were evaluated by dermatologists. Detailed data retrieved from the examinees' medical files included demographics, disease characteristics, treatment, and comorbidities. A structured telephone questionnaire was used to determine the current psoriasis status: type, severity, and extent. At the end of follow-up, patients with a persistent disease course, defined as having lesions at least a year after disease onset, were compared with patients in complete remission without further psoriasis symptoms.

          Results

          A total of 120 patients (mean age 28.8 years [±15.2], 58.3% women) with new-onset GP flare were identified. At the end of follow-up period (mean 6.2 years [±3.1]), 49.1% ( n = 59) of the patients reported active persistent psoriasis. A switch to the psoriasis vulgaris phenotype occurred in 17.5% ( n = 21) of the study cohort. Persistent psoriasis was associated with male sex (OR = 2.1, p < 0.05), multiple disease flares (>3; OR = 9.1, p < 0.001), switch to the vulgaris phenotype (OR = 4.16, p < 0.001), and palmoplantar involvement (OR = 5.2, p < 0.01).

          Conclusion

          A persistent disease course is common among patients with new-onset GP, with most retaining their guttate phenotype throughout the disease course. Persistency was associated with male sex, multiple GP flares, switching to the vulgaris phenotype, and palmoplantar involvement.

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          Most cited references17

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          Psoriasis: epidemiology, clinical features, and quality of life.

          Psoriasis is a common chronic, recurrent, immune mediated disease of the skin and joints. It can have a significant negative impact on the physical, emotional, and, psychosocial wellbeing of affected patients. Psoriasis is found worldwide but the prevalence varies among different ethnic groups. It has a strong genetic component but environmental factors such as infections can play an important role in the presentation of disease. There are several clinical cutaneous manifestations of psoriasis but most commonly the disease presents as chronic, symmetrical, erythematous, scaling papules and plaques. The epidemiology, clinical features, and impact on quality of life of psoriasis are reviewed.
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            Diagnosis and classification of psoriasis.

            Psoriasis is a chronic inflammatory multi organ disease with well characterized pathology occurring in the skin and often the joints. Although the disease has many characteristic and even pathognomonic features, no established diagnostic criteria exist for cutaneous psoriasis and there is no unified classification for the clinical spectrum of the disease. Prior approaches that have been taken to classify psoriasis include age of onset, severity of the disease, and morphologic evaluation. The latter has yielded plaque, guttate, pustular, and erythrodermic as subtypes of psoriasis. Unlike other autoimmune diseases, histopathological examination and blood tests are generally not valuable tools in making the diagnosis of psoriasis. However, on occasion, dermatopathologic evaluation may be helpful in confirming the diagnosis of psoriasis. Thus, in most cases the diagnosis of psoriasis is dependent primarily on pattern recognition that is morphologic evaluation of skin lesions and joints. Published by Elsevier B.V.
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              Family history of psoriasis, stressful life events, and recent infectious disease are risk factors for a first episode of acute guttate psoriasis: results of a case-control study.

              L Peli, L Naldi, (2001)
              The association of guttate psoriasis with streptococcal pharyngitis is well accepted. The association of other risk factors is less well defined. We attempted to provide an estimate of the risk for guttate psoriasis associated with a recent infectious disease and to explore other potential risk factors, including family history of psoriasis and psychologic stress. This was a case-control study. Cases were patients with a first diagnosis ever of acute guttate psoriasis, made by a dermatologist. Controls were patients newly diagnosed as having dermatologic conditions other than psoriasis and seen in the same outpatient services as the cases. Inclusion of cases and controls was restricted to patients older than 16 years. The Holmes and Rahe Social Readjustment Rating Scale was used to assess stressful life events during the 6 months before diagnosis. A total of 73 cases (median age, 26 years) and 430 controls (median age, 28 years) were included in the analysis. A family history of psoriasis was strongly associated with guttate psoriasis, the multivariate odds ratio being 7.0 (95% confidence interval, 3.7-13.5) for subjects who reported a history of the disease in parents or siblings. Stressful life events were also associated with guttate psoriasis. The multivariate odds ratio was 1.7 (95% confidence interval, 0.8-3.6) for subjects scoring 41 to 100 and 2.6 (95% confidence interval, 1.3-5.2) for those scoring more than 100 on the Holmes and Rahe Scale. The risk increased with the reported history of any infectious disease. The analysis of specific diagnoses documented a high and significant association with acute pharyngitis, the adjusted odds ratio being 7.8 (95% confidence interval, 1.8-32.5). The study confirmed that recent pharyngeal infection is a risk factor for guttate psoriasis. It also documented the strong association between guttate psoriasis and a family history of psoriasis. Finally, the study added evidence to the belief that stressful life events may represent risk factors for the onset of psoriasis. By relying on the clinical diagnosis we possibly underestimate the association of guttate psoriasis with infection.
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                Author and article information

                Journal
                Dermatology
                Dermatology
                DRM
                Dermatology (Basel, Switzerland)
                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.com )
                1018-8665
                1421-9832
                March 2023
                8 December 2022
                8 December 2022
                : 239
                : 2
                : 188-194
                Affiliations
                Department of Dermatology, Tel Aviv University, Tel Aviv, Israel
                Author notes
                Article
                drm-0239-0188
                10.1159/000527737
                10015744
                36481593
                7eca4b36-7724-458b-afc2-c7cb64df4e1a
                Copyright © 2022 by The Author(s). Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission.

                History
                : 1 February 2022
                : 20 October 2022
                : 2023
                Page count
                Figures: 1, Tables: 2, References: 17, Pages: 7
                Funding
                The study was conducted without funding sources.
                Categories
                Research Article

                Dermatology
                guttate psoriasis,psoriasis vulgaris,autoimmune disease
                Dermatology
                guttate psoriasis, psoriasis vulgaris, autoimmune disease

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