FC28 Age-related changes in psoriasis severity and morphology

Abstract The natural progression of psoriasis with age remains under-researched despite the ageing population and the increasing prevalence of this chronic condition. In this study, we examined how psoriasis changes over time, particularly in older adults. An online survey was conducted among members of the UK Psoriasis Association aged 65 years and older who had any symptoms of psoriasis before the age of 40. Participants rated their psoriasis severity on a scale from 0 (none) to 10 (severe) and provided details about their psoriasis treatments, lifestyle habits, medications, and associated medical conditions at different life stages in 20-year intervals from birth up to 60 years, and 5-year intervals from the age of 61 and beyond. Open-ended questions were included to explore changes in psoriasis morphology and distribution over time. Generalized Estimating Equations model analysed changes in disease severity, using ages 21–40 as reference. Predictors of high disease severity (≥5) were identified and validated via logistic regression and backward stepwise selection. Thematic qualitative analysis was conducted by a dermatologist and a behavioural sciences scholar. Of 615 eligible members of the Psoriasis Association, 194 completed the survey (response rate 31.5%). The final analysis included 180 participants who met the inclusion criteria (56.1% male, 43.9% female, median age of 73 years). Results showed a significant decrease in self-rated psoriasis severity with age, reaching the lowest severity in individuals over 80 years old (mean severity, 2.8), with a highly significant reduction across all age categories over 60 (P < 0.001). Less severe disease in individuals over 65 was associated with longer disease duration (P = 0.012) and statin use (P = 0.029), while more severe disease correlated with itch (P = 0.003). Qualitative analysis identified three main themes: reduced severity (less redness, smaller and thinner plaques, decreased scaliness and itch), changes in distribution (from widespread to localized, with decreased scalp involvement and increased truncal involvement), and retirement as a factor in disease improvement. Our findings indicate that psoriasis severity reduces with age, particularly after 60, and that psoriasis morphology and distribution change over time, from large to smaller and thinner plaques, and from widespread to localized disease. The reduction in severity was associated with longer disease duration and might be attributed to the waning of the immune system and immunosenescence. Immunosenescence primarily affects T cells, which are integral to the pathogenesis of psoriasis, with evidence suggesting that inflammageing involves a shift towards a Th2 immune profile, which could be disease-ameliorating in psoriasis.