Impact of Psychological Factors on Early vs. Late-Onset Psoriasis: A Comparative Analysis

Abstract

Introduction: Psoriasis is a chronic inflammatory disease that significantly impacts psychosocial well-being. This study compared the clinical and psychosocial characteristics of early-onset (<40 years) and late-onset (≥40 years) psoriasis. Methods: This cross-sectional study included 190 patients with psoriasis categorized as early-onset (n=135) and late-onset (n=55). Data on demographics, clinical features, comorbidities, and psychosocial factors were collected. The Hospital Anxiety and Depression Scale (HADS) and the Dermatology Life Quality Index (DLQI) assessed psychological impact and quality of life. Statistical analyses included chi-squared tests, t-tests, and correlation analyses. Results: Early-onset patients were more likely to have a family history of psoriasis (43.7% vs. 16.4%, P<0.001), while pustular psoriasis was more common in the late-onset group (27.3% vs. 11.1%, P=0.006). A significant positive correlation was observed between DLQI scores and HADS-Total, HADS-Anxiety, and HADS-Depression scores (P<0.001). Psychological stress was reported as a disease trigger by 63.1% of patients, with a higher proportion in the early-onset group (P=0.025). Although initial comparisons revealed no significant difference in DLQI or HAD scores between groups, an additional analysis limited to chronic plaque psoriasis revealed significantly higher anxiety and total HADS scores in the early-onset group (P=0.002 and P=0.035, respectively), suggesting a stronger psychological burden when clinical subtype is controlled. Conclusions: Early-onset psoriasis patients are more likely to report stress as a trigger and have a family history, while late-onset patients exhibit higher rates of pustular psoriasis and increased body mass index. Early-onset patients with chronic plaque psoriasis experience greater psychological burden, particularly anxiety. These findings highlight the importance of age of onset in tailoring psychosocial support and treatment strategies in psoriasis care. © 2025 Elsevier B.V., All rights reserved.