Epidemiology of moderate-to-severe psoriasis: a comparison between psoriasis patients treated with biological agents, conventional systemic drugs and topical agents.

Introduction: Understanding how different comorbidities and epidemiological factors are related to psoriasis severity can help us estimating patients' clinical outcome.

Aim: Establish possible prognostic factors of severe psoriasis.

Methods: Three groups of patients were included: 118 were on topical therapy, 83 used conventional systemic drugs, and 112 were treated with biological agents. Based on the fact that patients on topical therapy have a lower grade of disease severity than patients treated systemically, we compared a variety of comorbidities and epidemiological parameters between the three groups.

Results: Patients treated more aggressively have an increased risk of cardiovascular disease ( = .044), suffer more from depression ( = .020), hyperuricemia ( = .031) and nonspecific noninfectious liver disease ( = .005). Male gender ( < .001), increased height ( < .001), early age of disease onset ( < .001), viral upper respiratory infections ( = .049) and periods of hormonal changes ( = .045) are associated with these therapies.

Conclusion: Psoriasis severity is directly related to an increased risk of cardiovascular disease, depression, hyperuricemia and nonspecific noninfectious liver disease. Male gender, increased height, early age of disease onset, viral upper respiratory infections and periods of hormonal changes seem to be prognostic of higher degrees of psoriasis severity. We are pioneering the use of increased height and puberty, menopause/andropause as independent prognostic factors of psoriasis severity.