New-Onset Guttate Psoriasis: A Long-Term Follow-Up Study

Abstract

<b><i>Background:</i></b> Guttate psoriasis (GP), a distinct variant of psoriasis, is more common in children and adolescents. The long-term course of these patients has sparsely been examined, with few studies reporting the rates of relapse, persistence, and further development of the psoriasis vulgaris phenotype. <b><i>Objectives:</i></b> The objective of this study was to characterize the long-term outcomes of new-onset GP and elucidate the potential factors associated with a persistent disease course. <b><i>Methods:</i></b> This was a retrospective cohort study. Patients diagnosed with new-onset GP between 2009 and 2020 with a follow-up period of at least 1 year, were enrolled. The examinees were evaluated by dermatologists. Detailed data retrieved from the examinees’ medical files included demographics, disease characteristics, treatment, and comorbidities. A structured telephone questionnaire was used to determine the current psoriasis status: type, severity, and extent. At the end of follow-up, patients with a persistent disease course, defined as having lesions at least a year after disease onset, were compared with patients in complete remission without further psoriasis symptoms. <b><i>Results:</i></b> A total of 120 patients (mean age 28.8 years [±15.2], 58.3% women) with new-onset GP flare were identified. At the end of follow-up period (mean 6.2 years [±3.1]), 49.1% (<i>n</i> = 59) of the patients reported active persistent psoriasis. A switch to the psoriasis vulgaris phenotype occurred in 17.5% (<i>n</i> = 21) of the study cohort. Persistent psoriasis was associated with male sex (OR = 2.1, <i>p</i> &#x3c; 0.05), multiple disease flares (&#x3e;3; OR = 9.1, <i>p</i> &#x3c; 0.001), switch to the vulgaris phenotype (OR = 4.16, <i>p</i> &#x3c; 0.001), and palmoplantar involvement (OR = 5.2, <i>p</i> &#x3c; 0.01). <b><i>Conclusion:</i></b> A persistent disease course is common among patients with new-onset GP, with most retaining their guttate phenotype throughout the disease course. Persistency was associated with male sex, multiple GP flares, switching to the vulgaris phenotype, and palmoplantar involvement.