Epidemio-clinical features of psoriasis in Tunisia through a multicentre study

Background: Psoriasis is a common, chronic and recurrent, inflammatory disease of the skin. It is a worldwide disease that affects most races with no sexual predilection and can manifest at any age of life.

Methods: we conducted an analytic, cross-sectional, multicentre study from January 2006 to December 2006 in seven Tunisian departments of dermatology. The geographical distribution of these centers was reasonably uniform. Each center was asked to complete and return a previously designed questionnaire detailing clinical, epidemiologic and therapeutic features and impact of psoriasis on the quality of life.

Results: 467 patients were included, 60% were male and 40% were female with a sex ratio of 1.45. The average age at onset of disease was 31±16 years. It was 30±17 in females and 32±16 in males with no significant difference (p=0.28).

A family history of psoriasis was observed in 21% of cases. A family history of atopy was recorded in 10% of cases. The age at onset of disease was significantly earlier when a family history of psoriasis was found (26±14 years versus 32±16 years) (p=0.001). This difference was found in males (p=0.0018) but females did not show such a difference (p=0.15). The most frequent co-morbitidies found where hypertension, diabetes mellitus and dyslipidaemia (respectively 9.4%, 7.7% and 3.2%). Overweight (BMI: body mass index 26 to 29) was found in 33% of cases and obesity (BMI>29) in 10% of our patients.

Common psoriasis was the most frequent form (93%). 63% of patients complained of itching. Among patients for whom stress was a triggering factor, pruritus was more significantly recorded. 10% of patients had symptoms pertaining to the joints. The most frequent incriminated triggering factors were stress, climate changes and traumatic events.

Average duration of disease, pruritus and joint manifestations were significantly correlated to a greater impairment in health-related quality of life.

Local anti-psoriasis treatment was administered more frequently than systemic therapy. Patients reported best results with acitretin, methotrexate and UV rays. Among patients who have been previously treated, 23% were dissatisfied with all the anti-psoriatic therapies. For this group of patients, the mean duration of psoriasis was significantly shorter (p = 0.00007) and the disease had more frequently a continuous evolution (p = 0.5x10-7).

For further details, please go to http://www.atlas-dermato.org/stdv/pso/index.htm (French version).