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Exploring the spectrum of psoriasis: Clinical and demographic perspectives in the Indian Context – An observational study
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Received: ,
Accepted: ,
How to cite this article: Vedamurthy M, Varada S, Chandrasekar N. Exploring the spectrum of psoriasis: Clinical and demographic perspectives in the Indian Context – An observational study. CosmoDerma. 2025;5:87 doi: 10.25259/CSDM_77_2025
Abstract
Objectives:
This study aimed to analyze the demographic profile, clinical characteristics, and comorbid conditions associated with psoriasis, with a particular focus on its relationship with metabolic syndrome and other systemic conditions.
Materials and Methods:
This cross-sectional study included 63 patients receiving treatment for psoriasis at a skin and laser clinic, Chennai, between January 2024 and June 2024. Data on sociodemographic characteristics, clinical features, comorbidities, and treatment modalities were collected. Disease severity was assessed using the Psoriasis Area and Severity Index (PASI).
Results:
Psoriasis predominantly affected adults, with a slight male predominance observed (58.7% men). The highest age of onset was >40 years, and the majority (63.4%) had a disease duration of 1–5 years. Comorbidities were prevalent, with diabetes mellitus and metabolic syndrome observed in 31.7% of cases and vitamin D deficiency in 41% of cases. Psoriasis vulgaris was the most common clinical type (58.7%), and PASI scores were <7 in 31.7% of patients. Most patients (65%) required combination therapy with systemic and topical agents, 28.5% used topical treatments alone, and 7.7% were on biologic therapy.
Conclusion:
This study highlights the demographic distribution, clinical characteristics, and comorbid associations of psoriasis in this population. These findings reinforce the strong link between psoriasis and metabolic disorders, particularly diabetes mellitus and metabolic syndrome. Given the high prevalence of vitamin D deficiency, further investigation of its role in disease pathogenesis is warranted.
Keywords
Chronic inflammatory skin disease
Metabolic syndrome
Psoriasis Area and Severity Index score
Psoriasis vulgaris
Psoriasis
INTRODUCTION
Psoriasis is a routinely encountered, T-cell-mediated, and genetically determined dermatological condition that affects around 1–4% of the general population. It commonly affects the skin, nails, and joints.[1] Psoriasis is not predisposed toward one particular gender and affects both genders equally.[2] Psoriasis has been classified into five classical types: plaque (also the usually noted type known as psoriasis vulgaris), guttate psoriasis, inverse psoriasis, pustular psoriasis, and erythrodermic type.[2] The Psoriasis Area and Severity Index (PASI) score is used to assess the severity of the disease.[1]
Due to its chronic nature and tendency to extensively affect all parts of the skin, it can also prove to be a source of societal discomfort, resulting in psychological distress for the affected individual. More so, it is associated with various systemic conditions, namely several metabolic disorders such as diabetes mellitus, obesity, dyslipidemia, metabolic syndrome, and non-alcoholic fatty liver disease.[3,4] Various treatment modalities include topical therapy, systemic drugs, biologicals, and phototherapy. Topical therapy includes topical steroids and vitamin D analogues, while methotrexate, cyclosporine, acitretin, and apremilast are the commonly used systemic agents, and the biologicals used are secukinumab, infliximab, adalimumab, and ixekizumab.[5]
MATERIALS AND METHODS
This cross-sectional study included 63 patients undergoing treatment for psoriasis at an outpatient department in Chennai from January 2024 to June 2024.
Inclusion and exclusion criteria
Patients of diverse age groups and genders, each presenting with different forms of psoriasis according to the PASI score, were included, whereas pregnant and lactating women were excluded from the study.
Materials and methods
Qualified dermatologists conducted this study by clinically recruiting patients diagnosed with psoriasis. To minimize bias affecting the study outcomes, the investigators employed a random sampling method to enroll patients with psoriasis without exclusion based on age, gender, city of residence, or socioeconomic status.
A comprehensive examination was performed for each participant, during which data were recorded. Sociodemographic characteristics, including age, gender, marital status, occupation, and educational background, were collected for epidemiological evaluation. Clinically relevant variables, such as age at disease onset, disease duration, comorbidities, and other dermatological conditions, were also documented.
Clinical assessments included recording the family history, type of psoriasis, additional clinical findings, and treatment methods. Disease activity was evaluated using the PASI score, with classifications of mild, moderate, and severe psoriasis. Waist circumference, triglyceride levels, high-density lipoprotein (HDL) cholesterol, blood pressure, and fasting glucose levels were measured to assess the presence of metabolic syndrome, defined as meeting at least three of the following five criteria: Waist circumference >40 inches in men and >35 inches in women; serum triglyceride levels >150 mg/dL; HDL cholesterol levels <40 mg/dL in men and <50 mg/dL in women; fasting glucose levels ≥100 mg/dL; and blood pressure >130/85 mm Hg.[6] Data on disease activity and sociodemographic characteristics were collected at baseline and were presented as frequencies and percentages.
RESULTS
Regarding age distribution, the mean age of onset was 44.2 ± 13.6 years, with 17 (26.9%) aged 41–50 years, followed by those aged >60 years with 14 (22.2%). Patients aged 51– 60 years were 13 (20.6%), while 7 (11.1%) were in the 31– 40-year range. In addition, 7 (11.1%) patients were aged 11– 20 years, and 5 (7.9%) were in the 21–30 years range. Notably, none of the patients were aged <10 years. Males accounted for 37 (58.7%) and females for 26 (41.2%) of the patients.
Regarding marital status, 50 (80%) patients were married, and 13 (20%) were unmarried. Regarding education level, 5 (7.9%) were illiterate, 4 (6.4%) completed primary school, 9 (14.3%) completed secondary school, and 12 (19%) had a higher secondary education. Furthermore, 24 (38.1%) attained graduation and 9 (14.3%) achieved post-graduation. Regarding job status, 34 (53.96%) were in the software field, followed by 12 (19.4%) students, 10 (15.87%) housewives, and 7 (11%) unemployed [Table 1].
| n(%) | |
|---|---|
| Age | |
| 0–10 | 0 |
| 11–20 | 7 (11.11) |
| 21–30 | 5 (7.93) |
| 31–40 | 7 (11.11) |
| 41–50 | 17 (26.98) |
| 51–60 | 13 (20.63) |
| >60 | 14 (22.22) |
| Sex | |
| Male | 37 (58.73) |
| Female | 26 (41.26) |
| Marital status | |
| Unmarried | 12 (19.04) |
| Married | 51 (80.95) |
| Education status | |
| Illiterate | 5 (7.93) |
| Primary school | 4 (6.34) |
| Secondary school | 9 (14.28) |
| Higher secondary | 12 (19.04) |
| Graduate | 24 (38.09) |
| Postgraduate | 9 (14.28) |
| Job-status | |
| Housewife | 10 (15.87) |
| Software | 34 (53.96) |
| Student | 12 (19.04) |
| Unemployed | 7 (11.11) |
The age group >40 years had the highest age of onset of psoriasis symptoms, accounting for 33 (52.3%) patients, followed by those aged 21–40 years at 20 (31.7%). In terms of disease duration, the mean duration of disease was 5.28 years, with 40 (63.4%) having a disease duration of 1–5 years, followed by 13 (20.6%) with a duration of 6–10 years. Those with a duration of >10 years constituted 9 (14.2%), and 1 (1.5%) had the disease for less than a year. Seasonal variation in psoriasis was found, with 30 (47.6%) patients experiencing exacerbation of disease severity in winter, while 33 (52.3%) reported no seasonal variation in disease severity.
Regarding pre-existing comorbidities, diabetes and metabolic syndrome were the most prevalent, affecting 20 (31.7%) patients, followed by hypertriglyceridemia in 10 (15.8%) patients. Hypertension and thyroid disorders were found in 6 (9.5%) patients, while alcohol use was reported in 13 (20.6%) and smoking in 12 (19.04%) patients. Eight (12.6%) patients had no comorbid diseases.
In addition to existing comorbidities, patients were assessed for other conditions coexisting with psoriasis. Decreased vitamin D levels were found in 26 (41%) patients, while 2 (3%) had vitiligo and 1 (1.5%) had alopecia areata. Myasthenia gravis and bronchial asthma were observed in one (1.5%) patient each [Table 2].
| n(%) | |
|---|---|
| Age (in years) | |
| 0–10 | 5 (7.93) |
| 11–20 | 5 (7.93) |
| 21–40 | 20 (31.74) |
| >40 | 33 (52.38) |
| Duration of disease (in years) | |
| <1 | 1 (1.58) |
| 1–5 | 40 (63.49) |
| 6–10 | 13 (20.63) |
| >10 | 9 (14.28) |
| Seasonal variation | |
| Winter exacerbation | 30 (47.6) |
| No seasonal variation | 33 (52.3) |
| Comorbidities in patients | |
| Nil | 8 (12.6) |
| Diabetes | 20 (31.74) |
| Hypertension | 6 (9.52) |
| Hypertriglyceridemia | 10 (15.87) |
| Thyroid | 6 (9.52) |
| Metabolic syndrome | 20 (31.74) |
| Smoking | 12 (19.04) |
| Alcoholic | 13 (20.6) |
| Other conditions associated with patients | |
| Vitiligo | 2 (3.1) |
| Alopecia areata | 1 (1.5) |
| Myasthenia gravis | 1 (1.5) |
| Decreased vitamin D levels | 26 (41.2) |
| Bronchial asthma | 1 (1.5) |
A family history of psoriasis was observed in 10 (15.8%) patients, while the remaining 53 (84.2%) did not report any family history.
The most common type of psoriasis was psoriasis vulgaris, found in 37 (58.7%) patients, followed by palmoplantar psoriasis in 16 (25.3%). Scalp psoriasis was present in eight (12.7%) patients, while pustular and erythrodermic psoriasis were present in one (1.6%) patient each.
The PASI score was calculated for chronic plaque psoriasis, showing a score of <7 in 20 (31.7%) patients, 7–12 in 12 (19%), and >12 in 5 (7.9%) patients.
Regarding treatment type, most patients required both systemic and topical treatments, 41 (65%). Only topical treatments were administered to 18 (28.5%) patients, biological treatments were administered to 5 (7.7%) patients, and phototherapy was administered to 3 (4.7%) patients [Table 3].
| n(%) | |
|---|---|
| Family history of psoriasis | |
| Present | 10 (15.87) |
| Absent | 53 (84.12) |
| Type of psoriasis | |
| Psoriasis vulgaris | 37 (58.73) |
| Palmoplantar psoriasis | 16 (25.39) |
| Scalp psoriasis | 8 (12.69) |
| Erythrodermic psoriasis | 1 (1.58) |
| Pustular psoriasis | 1 (1.58) |
| PASI score | |
| <7 | 20 (51.28) |
| 7–12 | 13 (33.33) |
| >12 | 6 (15.3) |
| Type of treatment | |
| Only topicals | 18 (28.57) |
| Systemic+topicals | 41 (65.07) |
| Phototherapy | 3 (4.76) |
| Biologicals | 3 (7.76) |
PASI: Psoriasis area and severity index
DISCUSSION
Psoriasis is currently understood as a more comprehensive systemic condition, with cutaneous manifestations representing only one facet of the disease spectrum. Our study found that the majority of patients were aged >40 years, which is similar to Sayami et al. in their study.[6] The male-to-female ratio was found to be 1.4:1 in our study, whereas Sayami et al. reported a ratio of 1.7:1.[6]
Our study found a high occurrence of psoriasis among individuals working in the software industry, with 51 (80.95%) of those affected being in marital relationships. These results are consistent with those of Aboeldahab et al., who found that most psoriasis patients were married.[7] Similarly, Lee et al.’s study reported that 97 (70.3%) of their patients were married.[8] We found that approximately 15% of patients had a family history of psoriasis and 19% patients with smoking, but the findings of Manoj and Tanaji, who reported that 12 (25%) were smokers, 47% of smokers in Aboeldahab et al., which is higher than our study.[7,9]
In our study, the most common type of psoriasis observed was psoriasis vulgaris, followed by palmoplantar psoriasis, which is similar to the findings of Sayami et al., who found that the most common clinical type of psoriasis was chronic plaque psoriasis, 45 (86.54%).[6] Our findings show a prevalence of metabolic comorbidities in patients with psoriasis, diabetes mellitus, and metabolic syndrome observed in 31.7% of cases. This is lower than the prevalence reported by Aftab et al. among diabetes mellitus cases (45.3%) and Al-Mutairi et al. reported in diabetes mellitus type II cases (37.4%-41%), suggesting possible regional variations or differences in study populations.[10,11] Similarly, our reported prevalence of hypertension (9.5%) is considerably lower than that found in Al-Mutairi et al.’s study (32%-40.3%), which highlights the well-established link between psoriasis and cardiovascular risk factors.[11]
In our study, psoriasis was most frequently associated with metabolic syndrome and diabetes, affecting approximately 30% of the cases. Sekar and Daniel found that dyslipidemia was present in 72% of individuals with moderate psoriasis and 73.33% of those with severe psoriasis (67.5%).[12] We also observed a 15.8% prevalence of hypertriglyceridemia, which aligns with previous studies that emphasize the metabolic implications of psoriasis. The strong association between psoriasis and insulin resistance, as confirmed by Djohar and Setiyarso, supports the idea that metabolic disturbances are integral to psoriasis pathophysiology.[13]
Our study found thyroid disorders in 9.5% of cases, which is consistent with the findings of Hakami et al., who reported hypothyroidism in 6.8% of psoriasis patients.[14] The association between psoriasis and gender, age, and Hashimoto’s thyroiditis has been reported (Kiguradze et al.; odds ratio = 2.49, P < 0.0001) and further supports the autoimmune association between the two conditions.[15]
Our study found that 41% of patients had Vitamin D deficiency, which was associated with the development and severity of psoriasis. In addition, this study emphasized the seasonal nature of psoriasis exacerbation, with nearly half (47.6%) of the patients reporting worsened symptoms during the winter months. This finding is consistent with that of AlMutairi et al., who showed that cold weather, reduced sunlight exposure, and low humidity contribute to psoriasis.[11] Kemeriz et al. emphasized that UV radiation from sunlight modulates immune responses and reduces inflammation in patients with psoriasis.[16] Therefore, seasonal variations may influence disease severity and treatment needs.[16]
Regarding disease severity, 31.7% of patients had mild psoriasis, 19% had moderate psoriasis, and 7.9% had severe psoriasis, based on PASI scores. This distribution aligns with the findings of Al-Mutairi et al., who reported that 92.8% of patients had mild-to-moderate disease, although our study reported a slightly higher percentage of severe cases (7.9% vs. 7.03%).[11] In addition, recent research has associated psoriasis severity with inflammatory markers. Kemeriz et al. reported a correlation between PASI scores and neopterin levels, reinforcing the role of systemic inflammation in disease progression.[16] Moreover, Yumnam et al. found that patients with thyroid dysfunction showed more severe psoriasis, which aligns with our findings on the co-occurrence of thyroid disorders and psoriasis severity.[17]
In our study, combination therapy (systemic + topical) was the most commonly used regimen (65%), followed by topical therapy alone (28.5%). Biologic agents were prescribed in 7.7% of cases, which remains relatively low compared to global trends but reflects accessibility and cost. This finding aligns with previous research demonstrating the efficacy of combination therapies. Deepthi et al. reported that methotrexate combined with calcipotriol provided superior outcomes compared to monotherapy, further supporting the use of systemic-topical combinations.[18] Similarly, Senna et al. studied alopecia areata, a related autoimmune condition, and found that 80.3% of patients received topical corticosteroids, showing the heavy reliance on topical treatments in psoriasis.[19]
Limitations
The relatively small sample size and single-center design may limit the generalizability of our findings to the broader population. In addition, potential recall bias in patient-reported data and the lack of long-term follow-up restricts our ability to assess disease progression and treatment responses over time. Future multicenter studies with larger cohorts and longitudinal assessments are warranted to validate these findings.
CONCLUSION
Our findings indicate that psoriasis predominantly affects adults, with a slight male predominance, and is frequently associated with metabolic comorbidities such as diabetes mellitus and metabolic syndrome. In addition, vitamin D deficiency was prevalent in patients, highlighting a potential link between psoriasis and systemic inflammation in patients with psoriasis. The most common clinical type observed was psoriasis vulgaris, with seasonal exacerbations frequently reported during winter. Treatment patterns demonstrated a preference for combination therapy involving both systemic and topical agents.
Ethical approval:
As it is observational study, no interventions are done, did not take ethics committee approval.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript, and no images were manipulated using AI.
Financial support and sponsorship: Nil.
References
- Unconventional treatment options in psoriasis: A review. Indian J Dermatol Venereol Leprol. 2022;88:137-43.
- [CrossRef] [PubMed] [Google Scholar]
- Pathogenesis-oriented therapy of psoriasis using biologics. Expert Opin Biol Ther. 2022;22:1463-73.
- [CrossRef] [PubMed] [Google Scholar]
- Psoriasis and the metabolic syndrome. Clin Dermatol. 2018;36:21-8.
- [CrossRef] [PubMed] [Google Scholar]
- Psoriasis in India: Prevalence and pattern. Indian J Dermatol Venereol Leprol. 2010;76:595-601.
- [CrossRef] [PubMed] [Google Scholar]
- Systemic management of psoriasis patients in Indian scenario: An expert consensus. Indian Dermatol Online J. 2021;12:674-82.
- [CrossRef] [PubMed] [Google Scholar]
- Clinico-epidemiological profile of patients with psoriasis in a tertiary care hospital of western Nepal. J Univers Coll Med Sci. 2021;9:41-4.
- [CrossRef] [Google Scholar]
- Clinicodemographic and laboratory features of 200 Egyptian psoriatic patients. Egypt J Dermatol Venereol. 2023;43:15-23.
- [CrossRef] [Google Scholar]
- Impact of psoriasis on quality of life: Relationship between clinical response to therapy and change in health-related quality of life. Ann Dermatol. 2010;22:389-96.
- [CrossRef] [PubMed] [Google Scholar]
- A study of clinico-demographic profile of patients with psoriasis at tertiary health care centre. MedPulse Int J Med. 2018;5:15-8.
- [Google Scholar]
- Medical co-morbid conditions associated with psoriasis; psoriasis beyond skin. Prof Med J. 2020;27:511-6.
- [CrossRef] [Google Scholar]
- Comorbidities associated with psoriasis: An experience from the Middle East. J Dermatol. 2010;37:146-55.
- [CrossRef] [PubMed] [Google Scholar]
- A clinical-epidemiological study of psoriasis patients with moderate to severe plaque-type in a tertiary care centre in South India. Int J Res Dermatol. 2020;7:1-6.
- [CrossRef] [Google Scholar]
- A study of association of psoriasis and type 2 diabetes mellitus: A comprehensive systematic review. J Sehat Indones. 2024;6:719-31.
- [CrossRef] [Google Scholar]
- Prevalence of autoimmune diseases among patients with psoriasis: A single tertiary center experience. Cureus. 2024;16:e60455.
- [CrossRef] [Google Scholar]
- Evidence for the association of Hashimoto's thyroiditis with psoriasis: A cross-sectional retrospective study. Int J Dermatol. 2017;56:553-6.
- [CrossRef] [PubMed] [Google Scholar]
- Evaluation of neopterin level and disease severity in patients with psoriasis vulgaris treated with narrowband UVB. Indian J Dermatol. 2019;64:447-50.
- [CrossRef] [PubMed] [Google Scholar]
- Association of psoriasis with thyroid disorders: A hospital-based, cross-sectional study. Cureus. 2022;14:e22987.
- [CrossRef] [Google Scholar]
- Evaluation of therapeutic response of methotrexate and calcipotriol combination compared with methotrexate alone in plaque psoriasis. Our Derm Online. 2014;5:118-23.
- [CrossRef] [Google Scholar]
- Alopecia areata treatment patterns, healthcare resource utilization, and comorbidities in the US population using insurance claims. Adv Ther. 2021;38:4646-58.
- [CrossRef] [PubMed] [Google Scholar]