A retrospective study of psoriasis over five years at a tertiary hospital

Abstract

Background Psoriasis is an inflammatory immune-mediated polygenic disease manifesting in the skin and/or joints. South African epidemiological data for this condition is minimal, although previous local studies have indicated ethnic bias and an association with cardiometabolic diseases. Methods A descriptive retrospective case cohort study of psoriasis at the Helen Joseph Hospital (HJH), Johannesburg, South Africa. Adult patients with psoriasis attending the HJH dermatology outpatient clinic from 01/01/2015 to 31/12/2019 were included in the study. Epidemiological and clinical data was extracted from patient records. Results The prevalence of psoriasis in the clinic over the five-year period was 1.1%. A bimodal peak was noted in age at diagnosis. There was no significant gender difference. The most common clinical presentation was plaque type psoriasis. The following co-morbidities were noted in our cohort: 31% were hypertensive, 9% had dyslipidemia, and 3% had ischemic heart disease. HIV prevalence was 17% amongst those tested. Conclusion It is evident that psoriasis in our community is aligned with published data about gender representation and prevalence in the dermatology OPD setting. Cardiometabolic diseases were unexpectedly low in this cohort, possibly a consequence of the lack of acute coronary care facilities at HJH. Unfortunately, our sample size was too small to comment meaningfully on the impact of ethnicity. The relatively higher prevalence of HIV infection is reflective of the national prevalence. The management of psoriasis at our clinic is consistent with recommended practice. Continued research on this disease should be a priority due to its association with major cardiovascular diseases. Improving record keeping and screening for associated diseases will assist in ongoing research and reducing prevalence of co-morbidities. This may also provide the motivation required for newer targeted immunological therapies.