The geriatric population is growing steadily worldwide; therefore, greater emphasis on optimizing care for this patient population is needed. Psoriasis in particular has the highest rate of occurrence in the geriatric age group compared with younger cohorts. It also has a significant negative impact, both physically and psychologically, on the geriatric population. Psoriasis therapies that include immunosuppressive agents can be more risky to the elderly patients with age-related comorbidities.
Objective
We present a literature review of the unique impact of psoriasis on older patients.
Methods
A search of PubMed's MEDLINE database of articles published from 2000 to 2011 was performed, and 57 articles were included in the review.
Results
Multiple unique physical and psychological challenges from psoriasis affecting the geriatric population were identified. The use of systemic immunosuppressive therapies requires special consideration for the less healthy segment of the elderly population.
Conclusions
Very little research specifically examining the geriatric population with psoriasis has been performed. More focused research is needed to determine how to treat these patients optimally and improve the quality of life for this unique subset of patients with psoriasis.
YosipovitchG., TangM.B.Y.Practical management of psoriasis in the elderly: epidemiology, clinical aspects, quality of life, patient education, and treatment options. Drugs Aging.2002; 19: 847–63.
2.
U.S. Census Bureau [online]. Available from URL: www.census.gov. Accessed Sept 9, 2011.
3.
DrakeL.A., CeilleyR.I., CornelisonR.L.Guidelines of care for psoriasis. J Am Acad Dermatol.1993; 28: 632–7.
4.
KooJ.Y.M., LeeC.S., LebwohlM.G., WeinsteinG.D., GottliebA.Moderate to Severe Psoriasis. 3rd ed. New York: Informa Healthcare; 2009.
5.
BellL.M., SedlackR., BeardC.M., PerryH.O., MichetC.J., KurlandL.T.Incidence of psoriasis in Rochester, Minn, 1980–1983. Arch Dermatol.1991; 127: 183–7.
6.
GrozdevI.S., Van VoorheesA S., GottliebA.B.Psoriasis in the elderly: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol.2011; 65: 537–45.
7.
YosipovitchG., GoonA., WeeJ., ChanY.H., GohC.L.The prevalence and clinical characteristics of pruritus among patients with extensive psoriasis. Br J Dermatol.2000; 143: 969–73.
8.
BergerT.G., SteinhoffM.Pruritus in elderly patients: eruptions of senescence. Semin Cutan Med Surg2011; 30: 113–7.
GelfandJ.M., GladmanD.D., MeaseP.J.Epidemiology of psoriatic arthritis in the population of the United States. J Am Acad Dermatol.2005; 53: 573–7.
11.
Center on Aging. Geriatric Assessment Tools.The University of Utah, Salt Lake City, UT; 2008.
12.
SongJ., ChangR.W., DunlopD.D.Population impact of arthritis on disability in older adults. Arthritis Rheum.2006; 55: 248–55.
13.
WarrenR.B., KleynC.E., GullivertW.P.Cumulative life course impairment in psoriasis: patient perception of disease-related impairment throughout the life course. Br J Dermatol.2011; 164(suppl 1): 1–14.
14.
MaginP., AdamsJ., HeadingG., PondD., SmithW.The psychological sequelae of psoriasis: results of a qualitative study. Psychol Health Med.2009; 14: 150–61.
15.
SampognaF., ChrenM.M., MelchiC.F., PasquiniP., TabolliS., AbeniD., and The Italian Multipurpose Psoriasis Research on Vital Experiences (Improve) Study Group. Age, gender, quality of life and psychological distress in patients hospitalized with psoriasis. Br J Dermatol.2006; 154: 325–31.
16.
CoskeyR.J.Adverse effects of corticosteroids, I: topical and intralesional. Clin Dermatol.1986; 4: 155–60.
17.
KligmanA.M.Adverse effects of topical corticosteroids. In: ChristophersE., SchopfE., KligmanA.M. editors. Topical Corticosteroid Therapy: A Novel Approach to Safer Drugs.New York: Raven Press; 1988: 181–7.
18.
du VivierA., StoughtonR.B.Tachyphylaxis to the actin of topically applied corticosteroids. Arch Dermatol.1975; 111: 581–3.
19.
SinghG., SinghP.K.Tachyphylaxis to topical steroid measured by histamine-induced wheal suppression. Int J Dermatol.1986; 25: 324–26.
20.
WestonW.L., FennesseyP.V., MorelliJ.Comparison of hypothalamus-pituitary-adrenal axis suppression from superpotent topical steroids by standard endocrine function testing and gas chromatographic mass spectrometry. J Invest Dermatol.1988; 90: 532–5.
21.
MayP., SteinE.S., RylerR.J.Cushing syndrome from percutaneous absorption of triamcinolone cream. Arch Intern Med.1976; 136: 612–3.
22.
GomezE.C., FrostP.Induction of glycosuria and hyperglycemia by topical corticosteroid therapy. Arch Dermatol.1976; 112: 1559–62.
23.
YosipovitchG., TanS.H., GohC.L.Suggested rationale for prevention and treatment of glucocorticoid-induced bone loss in dermatologic patients. Arch Dermatol.2001; 137: 477–81.
24.
CerulloM.A.Expect psychiatric side effects from corticosteroid use in the elderly. Geriatrics.2008; 63: 15–8.
25.
ParslewR., TraulsenJ.Efficacy and local safety of a calcipotriol/betamethasone dipropionate ointment in elderly patients with psoriasis vulgaris. Eur J Dermatol.2005; 15: 37–9.
26.
JahnkeK., KorfelA., WellerM.High dose methotrexate toxicity in elderly patients with primary central nervous system lymphoma. Ann Oncol.2005; 16: 445–9.
27.
BoffaM., ChalmersR.Methotrexate for psoriasis. Clin Exp Dermatol.1996; 21: 399–408.
28.
TungJ.P., MaibachH.I.The practical use of methotrexate in psoriasis. Drugs.1990; 40: 697–712.
29.
EllisC.N.Etretinate therapy causes increased lipid levels in patients with psoriasis. Arch Dermatol.1981; 117: 160–80.
30.
WiederJ.M., LoweN.J.Systemic retinoids for psoriasis. Dermatol Clin.1995; 13: 891–6.
31.
LebwohlM., EllisC., GottliebA., KooJ., KruegerG., LindenK.Cyclosporine consensus conference: with emphasis on the treatment of psoriasis. J Am Acad Dermatol.1998; 39: 464–75.
32.
GriffithsC.E.Systemic and local administration of cyclosporine in the treatment of psoriasis. J Am Acad Dermatol.1990; 23: 1242–7.
33.
PaulC.F., HoV.C., McGeownC.Risk of malignancies in psoriasis patients treated with cyclosporine: a 5 y cohort study. J Invest Dermatol.2003; 120: 211–6.
34.
McElhaneyJ.E., EffrosR.B.Immunosenescence: what does it mean to health outcomes in older patients?Curr Opin Immunol.2009; 21: 418–24.
35.
GallowayJ.B., HyrichK.L., MercerL.K., and the BSRBR Control Centre Consortium, on behalf of the British Society for Rheumatology Biologics Register. Anti-TNF therapy is associated with an increased risk of serious infections in patients with rheumatoid arthritis especially in the first 6 months of treatment: updated results from the British Society for Rheumatology Biologics Register with special emphasis on risks in the elderly. Rheumatology.2011; 50: 124–31.
36.
FleischmannR., BaumgartnerS.W., WeismanM.H., LiuT., WhiteB., PelosoP.Long term safety of etanercept in elderly subjects with rheumatic diseases. Ann Rheum Dis.2006; 65: 370–84.
37.
GottliebA.B., BoehnckeW.H., DarifM.Safety and efficacy of alefacept in elderly and other special populations. J Drugs Dermatol.2005; 4: 718–24.
KatugampolaG., KatagampolaS.Chloroquine and psoriasis. Int J Dermatol.1990; 29: 153–4.
43.
SlagelG.A., JamesW.D.Plaquenil induced erythroderma. J Am Acad Dermatol.1985; 12: 857–62.
44.
AbelE.A., DiciccoL.M., OrenbergE.K.Drugs in exacerbation of psoriasis. J Am Acad Dermatol.1986; 15: 1007–22.
45.
HengM.C.Y., HengM.K.Beta-adrenoreceptor antagonist-induced psoriasiform eruption: clinical and pathogenetic aspects. Int J Dermatol.1988; 27: 619–27.
46.
GoldM.H., HolyA.K., RoenigkH.H.Beta-blocking drugs and psoriasis: a review of cutaneous side effects and retrospective analysis of their effects on psoriasis. J Am Acad Dermatol.1988; 19: 837–41.
47.
SkottA., MobackenH., StarmarkJ.E.Exacerbation of psoriasis during lithium treatment. Br J Dermatol.1977; 96: 445–8.
