The assessment of the magnitude and associated factors of psoriasis

doi:10.21203/rs.3.rs-3645188/v1

Background: Psoriasis is a chronic, inflammatory skin disorder resulting from a genetic predisposition combined with environmental triggers characterized by sharply demarcated erythematosus whitish scaly plaques. May be associated with psoriatic arthritis, metabolic syndrome, and other diseases. The prevalence is about 2% of the world’s population. Two peaks in the age of onset have been reported: Early-onset psoriasis at 20-30 years of age and Late-onset psoriasis at 50-60 years of age & equal in both sexes.

Objectives: This study aimed to assess the magnitude and associated factors of psoriasis from October 2021 to June 2022 at Saint Paul’s Hospital Millennium Medical College Addis Ababa.

Methods: A hospital-based cross-sectional prospective study was conducted from October 2021 to June 2022. A total sample size of 422 patients aged from 11 and above years was included in the study. Then using SPSS version 21.0 The data was entered and analyzed. Descriptive analysis was done to characterize the study participants. Bivariate and multivariable logistic regression was performed to determine the crude and independent predictors of the dependent variable. AOR with 95% CI was used to determine the independent predictors of psoriasis. Statistically, a significant association was considered at a p-value <0.05.

Result: In this study, the magnitude of psoriasis was found to be 6.01% (95% CI:11.6,18.7). Moreover, in the multivariable logistic regression model educational status AOR (95% CI): =0.054, (0.01-0.30). And patients themselves AOR (95%CI): =34.90, (8.27-147.30) stress history were significant predictors of psoriasis.

Conclusion: In this study 6.01% of patients were found to have psoriasis disease. Therefore, the finding needs to give great attention to strengthening national skin disease prevention and control services and implementation of public health policies on awareness, prevention, and treatment of psoriasis patients to keep care of skin and not neglect the disease contact health facility services.

Psoriasis

inflammatory skin disease

prevalence

plaque psoriasis

cross-sectional study

1.1 Background

Psoriasis is a chronic, inflammatory skin disease that results from a genetic predisposition combined with environmental triggers characterized by sharply demarcated erythematosus whitish scaly plaques. may be associated with psoriatic arthritis, metabolic syndrome and other diseases. The prevalence is about 2% of the world’s population. psoriasis can first appear at any age, from infancy to the eighth decade. Two peaks in the age of onset have been reported: Early-onset psoriasis at 20-30 years of age and Late-onset psoriasis at 50-60 years of age. equal in both sexes (age of onset is earlier in women than in men). Psoriasis can also be provoked by external and internal triggers, including mild trauma, sunburn, and QoL, in general, which is often significantly impaired [8]. Disfiguration, disability, and marked loss of productivity are common challenges for people with psoriasis. There is also a significant cost to mental well-being, such as higher rates of depression, leading to a negative impact on individuals and society.

1.2. Statement of the problem

Skin issues square measure typically the foremost common diseases seen in medical care settings everywhere in the world and its prevalence ranges from 20-50% in developing countries. Compared with different diseases, skin diseases have a lower death rate however will have an effect on the welfare, quality of life and health conditions [20]. within the case of African country, drawback skin condition disease is taken into account as a standard problem in each urban and rural area and is additionally among the leading causes of patient attending [30]. Studies conducted on skin diseases by the ministry of health indicated that skin diseases were the eighth explanation for patient visits in African countries, in each 2004/05 and 2006/07 (FMOH, 2005; FMOH 2007). several parts influence the pattern and burden of skin diseases in resource-poor settings, together with financial condition, environmental, and climatic factors [20]. sickness disease of the skin disorder skin problem skin condition} is one such kind of a disease among numerous skin diseases touching over one hundred twenty-five million individuals, or nearly three-D of the world's population (IFPA 2015) [6]. Sadly, Ethiopian specific data concerning truth medicine of skin condition is very restricted. This implies that we tend to square measure inadequately knowing to manage a silent epidemic with sizable social group impact, each socially and economically. Certainly, proof has shown that skin conditions will have an effect on a patient’s quality of life to tier comparable different chronic conditions, together with infarct and a few cancers.

1.3. Significance of the study

Although psoriasis is rarely life threatening, its morbidity and associated comorbidities have a severe negative impact on the quality of life of the patients and also confer a certain socioeconomic burden. Especially in developing countries, people with psoriasis have to face severe problems with stigmatization, embarrassment, discrimination, low self-esteem and negative attitudes in general among the public, and often bear the brunt of public rejection. This research project helps to improve the current health level status of psoriatic patients by assessing the magnitude of the diseases. Also this finding of this study directly benefited patients as well as indirectly the public health by reduction of further disabilities and the burden of health care resources by knowing how the magnitude and associated factors of psoriatic patients in SPHMMC.

2.1 Magnitude and socio-demographic of psoriasis

Psoriasis is a relatively common condition, affecting between 1-3% of the population worldwide (2-4% of the European and North American population), numbers that have been increasing during the past forty years [ 1]. There is a marked prevalence variation in which genetic and environmental factors such as age, gender, race, ethnicity and geographic location (climate and sun exposure) contribute. Two clinical types of psoriasis can be considered relating to the age of onset: Type I – Early onset (≤ 40 years) and Type II – Late onset (> 40 years). Regarding type, I, which accounts for 70% of all cases, the highest incidence rates are seen between 16 and 22 years, while on type II, the peak occurs amongst 57 and 60 years (3). Psoriasis causes sizable psycho-social incapacity and encompasses a major impact on patients’ quality of life [ 4]. the value to each patients and health-care systems is high skin disorder is related to upset, depressive wellness, and rheumatoid arthritis [6]. Higher prevalence rates are rumored at higher latitudes, and in Caucasians compared with different ethnic teams [ 8]. additionally, the wide variation in prevalence estimates could also be influenced by aspects of disease of the skin like its remitting–relapsing course, diversity of clinical displays and variation in severity complete of seven.2 million North American nation adults had skin problems in two010; Associate in Nursing calculable seven.4 million North American nation adults were affected in 2013. The prevalence of psoriasis among US adults has not changed significantly since 2003 to 2004 [14]. When stratifying the sample by race among those between ages 20 and 59 years, the psoriasis prevalence was highest in Caucasians at 3.6% followed by African Americans 1.9%, Hispanics 1.6% and others 1.4%. Study done in Norway prevalence of was 1.4%, with no difference between males and females. A higher prevalence of psoriasis among females was found in urban areas and higher prevalence in females. No difference in prevalence was found between various socio-economic groups [15].

Another study at a dermatology Clinic in a General Hospital in Port-of Spain, Trinidad and Tobago, three hundred and seventy-nine cases (5.1% of the total cases) of psoriasis were diagnosed. There were 183 females (48%) and 196 males (52%). The mean age at presentation for females was 44 years and that for males was 43 years. The majority of cases (77%) presented between 20–69 years (16). Contrarily, studies from Denmark, Germany and Sweden reported a prevalence measure that was slightly higher in girls than in boys. Study conducted in Taiwan showed that (prevalence=0.235%; mean age=46.4±18.6; male: female=1.6:1). Other studies in Taiwan showed that prevalence of psoriasis was 0.23% for men and 0.16% for women, respectively. The prevalence of psoriasis increased more rapidly in male patients aged 30years. [17]. There was no difference in the prevalence of psoriasis between boys and girls in Brazil and Taiwan. Population-based surveys from China and Japan have given a similar low prevalence ranging respectively from 0.05 to 1.23% and 0.29 to 1.18%. The same rates were found in India 0.5%-2.3%. Population-based survey conducted in China at six cities, out of 17,345 subject showed that 102 subjects (0.59%) were found to have psoriasis. The prevalence of psoriasis in males and females were 0.54% and 0.44% respectively. Community based study conducted at Japan showed that shows males (65.8%) and females (34.2%). Six studies according to the prevalence of skin disorder in youngsters (deﬁned as those aged¸< eighteen years) in Europe or Asia. In general, the prevalence of skin disorder in youngsters was up to zero.71% in Europe and virtually absent in Asia [19]. One exception was a study of 13- to 14-year-old youngsters in Italy that found a lifespan prevalence of specialist diagnosed skin disorder of two.15% (95% conﬁdence interval (CI): one.59 -- 2.61). A German study, supported associate insurance information and conﬁned to those aged underneath eighteen years, according a coffee overall prevalence of skin disorder in youngsters (0.71% (95% CI: zero.68– 0.74)) associated an increasing prevalence with age (0.37% for 0–9 years and one.01% for 10–18 years) [20]. Not amazingly, studies supporting lifespan prevalence typically yielded higher estimates than those supported purpose prevalence. Study conducted in Egypt at the Medicine Clinic, AL Hussein University Hospital shows fifty-two.0% of the cases were females and four hundred and forty yards of cases occur 25-45 years followed by thirty-seven.0% (45 years severally the typical age of onset was thirty-one years [30]. Curiously, clinic and population surveys have shown nice variability between totally different desert African populations. These counsel that West African countries like Nigeria, Ghana, Mali, Senegal, Angola etc., have a lower prevalence of skin disorder zero.05 you have to 1 Chronicles than three-D within the jap countries like Republic of Kenya, Republic of Uganda and African country [21]. data on the prevalence of skin disorder in African countries is extraordinarily limited; but, knowledge on the incidence of skin disorder at a given clinic or hospital over an outlined amount of your time are additional oft out there. whereas absolutely the incidence rate at a clinic could fail to mirror the native prevalence of skin disorder, the relative rates of skin disorder incidence, obtained from clinics were retrieved and reviewed. A complete 2342 medicine cases were diagnosed at ALERT pathology laboratory from January 2007 to December 2010 that represent a large variety of inflammatory, infectious, and growth diseases. Throughout this era out of twenty seventh (632) inflammatory dermatoses half-dozen.64% were diagnosed with skin disorder [27]. The magnitude of skin disorder in ARH, Mekele, North African country was five.4% [17].

2.2 Clinical and behavioral characteristic of psoriasis

Psoriasis vulgaris accounts 97.06% and family history of psoriasis accounted (28.43%) [18]. The vast majority of cases (86.0%) had plaque-form of psoriasis vulgaris, and 812 cases (2.8%) were guttate psoriasis. Psoriatic erythroderma (0.8%), generalized pustular psoriasis (0.9%), and localized pustular psoriasis (0.5%) were rare (19). Also another Study conducted at dermatology clinic in Hospital Tengku Ampuan Rahimah, Klang Malaysia, and the prevalence of 9.5% was by psoriasis. In this study psoriasis was found to be more common in males 11.6% (316/2613) than females 7.2% (215/2994). The most common affected sites were arms (53%) followed by legs (44%) and also it involves trunk (15.9%), genital region (12.4%), scalp (11.8%), eyebrows (6.8%) and face (2.4%) (20). there's an outsized body of literature associating stress and also the development or exacerbation of psoriatic lesions [26]. From the literature, it's doable to spot a sub cluster of psoriatic patients United Nations agency seem to be high stress reactors. These patients report that psychosocial stress exacerbates their skin disorder. In a survey involving 2144 psoriatic patients, four-hundredth indicated that psoriatic lesions appeared at “times of worry" [27]. In a very n plan to additional characterize patients United Nations agency report a n increase in psoriatic symptoms in response to fret, Gupta established a broad sufferer body covering profile of patients United Nations agency were using low frequency according to high stress reactors versus those that were low-stress reactors [28]. They were asked to reply to the subsequent statement: " nerve-racking things often create my skin disorder worse." The patients were asked to record their responses on an associated 0-point scale with one denoting "not at all" and ten "very markedly." The median score was seven. Patients with various seven or higher were classified as “high-stress reactors" and people with ratings of I to six as " low-stress factors." in a very study of 127 consecutive psoriatic patients, high-stress reactors exhibited additional cosmetically disfiguring illness in conspicuous areas (i.e., scalp, face, neck, forearms, hands, sex organ region) [29]. The magnitude of skin disorder in ARH, Mekele, North African country was five.4%wherever majorities (81%) of skin disorder cases were chronic plaque. Multiple website involvement (42.9%) (arms, trunk and leg) were the most characteristics [17]. In past surveys from 1982 to 2012, the exasperating factors for the Japanese population were determined to be stress (6.4% to 16.6%), seasonal factors (9.7% to 13.3%), infection (3.5% to 8.3%), sun exposure (1.3% to 3.5%), and β-blockers (0.9% to 2.3%) [ 10–12]. The comorbidities included cardiovascular disease (1.1% to 27.8%), diabetes (DM) (7.0% to 13.9%), vas diseases (4.2% to 8.1%), and inflammation (3.5% to 5.4%) 1 [13–14].

3.1 General objective

To assess the magnitude and associated factors of psoriasis at Saint Paul’s hospital millennium medical college among patients attending dermatology clinic, Addis Ababa, Ethiopia.

3.2 Specific objective

To describe the magnitude of psoriasis at Saint Paul's hospital millennium medical college among patients attending dermatologic clinics. Addis Ababa, Ethiopia.

To determine associated factors of psoriasis at Saint Paul's hospital millennium medical college among patients attending dermatologic clinics. Addis Ababa, Ethiopia.

To assess clinical features and clinical variants of psoriasis at Saint Paul's hospital millennium medical college among patients attending dermatologic clinics. Addis Ababa, Ethiopia.

4.1. Study area.

The study was conducted in St. Paul’s Hospital which is one of the second largest specialized tertiary referral hospitals in the country. It is located in Addis Ababa.

It was established in 1969 by Emperor Haile Selassie I with the help of the German Evangelical Church with the objective of serve poor. Medical college was formed in 2007. The hospital currently provides a wide range of services in the various departments. The Dermatolovenereolgy department is one of the various departments that provide a wide range of services in dermatology outpatients clinics. The Dermatology clinic sees an average of 60-80 outpatient clients daily.

4.2. Study design

A hospital based cross sectional study was used at Saint Paul’s hospital millennium medical college, Addis Ababa.

4.3. Study period.

The study period was conducted from October 15,2021 to June 1, 2022 at Saint Paul’s hospital millennium medical college, Addis Ababa.

4.4. Population.

4.4.1. Source Population

All patients visited dermatology Clinic of Saint Paul’s hospital millennium medical college whose age above 1o years old.

4.4.2. Study Population

All psoriatic patients visited dermatology Clinic of Saint Paul’s hospital millennium medical college whose fulfil inclusion criteria were selected during the study period.

4.5. Inclusion and Exclusion criteria

4.5.1. Inclusion criteria

All patients whose age above 10-year-old visited dermatology clinic of Saint Paul’s hospital millennium medical college were included during Study period (October 15, 2021 -June 1, 2022).

4.5.2. Exclusion criteria

All patients whose age below 10-year-old visited dermatology clinic of Saint Paul’s hospital millennium medical college were included during Study period (October 15, 2021 -June 1, 2022).

4.6. Sample size determination

The sample size for this particular study was calculated using a formula for a single population proportion considering the following assumptions: A 95% confidence level, margin of err. (0.05 and assumed maximum variability (p=0.5). These parameters substituted in the following single population proportion formula

Where:

n: the desired sample size

P: Assume maximum variability (50%). critical value for normal distribution at 95%

Z) 2: confidence level which equals to 1.96 (z value at =0.05)

D: The margin of error taken as 0.05

With the assumptions of the 95% confidence interval (CI) and 10% non-responsive rate, the total sample size will be 422.

4.7. Sampling procedure

In this study at least for 8 months was estimated that <40 psoriatic patients. I used all the samples until it fulfill the calculated sample size during the time of data collection. (take all over approach).

4.8. Operational definition of variables

Psoriasis: A skin lesion which is presented with characteristic features of well demarcation adherent silvery scaly and erythematous background on the skin or Diagnosed as psoriasis by dermatologist. Psoriatic nail change: Pits range from 0.5 to 2.0 mm in size, oil spots and salmon patches on the nail of psoriatic patients.

Alcohol use: respondent who answered YES to a question “have you used/drunk at least one of the alcoholic beverages (beer, wine, whiskey, Areke, Tela, Tej, etc.) for nonmedical purposes within the last 3 months?” were considered as alcohol users.

Current smoker: respondent who answered YES to a question “have you used/ smoked more than 100 cigarettes (including hand-rolled cigarettes, cigars, cigarillos, etc) in their lifetime and has smoked in the last 28 days” were considered as current smokers

Ex-smoker: respondent who answered YES to a question “have you used/ smoked more than 100 cigarettes (including hand-rolled cigarettes, cigars, cigarillos, etc) in their lifetime but has not smoked in the last 28 days” were considered as a smoker

Never smoke: respondent who answered No to a question “have you used/ smoked more than 100 cigarettes in their lifetime and does not currently smoke” were considered as non-smokers

4.9. Study Variables.

4.9.1. Dependent variables

Psoriatic disease

4.9.2. Independent variables

Age, Sex, Marital status, residence, occupation, educational status, alcohol, drugs, stress family history, DM, hypertension and smoking.

4.10. Data collection methods

A structured interview questionnaire was conducted among paients or family on Opd visit. The questionnaire were adopted from eviewing different literature.Some modification were done based on the research objective. Two dermatology residents and one nurse supervisor working in the OPD of dermatology clinic in St. Paul’s hospital millennium medical college were recruited for data collection purpose. The data collectors and supervisors were receiving a daylong training on the objectives and benefits of the study, individuals’ rights, and informed consent. Close–ended questions was used to collect data. On the daily basis, a filled questionnaire was checked for completeness and consistency by the supervisor.

4.10.1. Data quality management.

The socio demographic factors, personal disease, skin physical examination, and personal associated factors were assessed using standardized questionnaire from eviewing different literature The questionnaire was prepared in English and translated to Amharic version and later translated back to English using a standard translation procedure to keep its consistency. Appropriate training was given for both data collectors and supervisor. Prior to the actual data collection, the questionnaire was pretested on 5% participants. Based on the pretest necessary modification was done on the questionnaire. In addition, the supervisor was conduct supervision each day. The completed questionnaires were handled properly and checked for completeness, clarity and logical consistency by the principal investigator and supervisor.

4.10.2. Data analysis.

Immediately after the data collection was completed data was coded and entered into Statistical Package for Social Science (SPSS) version 21.0 software for analysis. Statistical significance of binary logistic Regression cut point P <0.05 was used, bivariate logistic regression P <0.05 was used as cut off point to select and transfer variables into multivariate logistic regression. COR, AOR was used to determine association between dependent & independent variables. Results were presented using descriptive statistics such as frequency, tables, graphs, and percentages.

4.11. Ethical consideration

Ethical approval was obtained from the department & SPHMMC Research Ethics Committee (REC). The study was conducted in St. Paul’s Hospital aafter obtaining permission from St. Paul’s hospital Ethics Review Committee. Verbal consent was obtained from patients & to keep the confidentiality and for children’s parental consent and asset of the study subject were obtained. no personal identifiers were used in the data collection format.

5.1 Socio-Demographic Characteristics

From the total of 422 identified dermatologic cases at dermatologic OPD, 416 were included in the analysis making the response rate 98.5%. 189 (45.4%) were males and females respectively and Two hundred forty-five (58.9%) were at the age interval of 30–40 years old. Three hundred eighty (91.3%) of the study participants were from urban whereas 36 (8.7%) were from rural areas. 191 (45.9%) and 225 (54.1%) were married and unmarried. One hundred forty-five (34.9%) respondents have attended primary school, 193 (46.4%) secondary school, 67 (16.1%) diploma and above level of education, and 11 (2.6%) were unable to read and write. One hundred sixty (38.5%) were government employees by occupation and nearly one-fourth of the respondent patients were unemployed 105 (25.2%) (Table1)

Table 1 Socio-Demographic characteristics of patients in St. Paul’s hospital millennium medical college, Addis Ababa, Ethiopia, 2022 (n=416).

Variables

Category

Number

Percent

Has anyone in your family had psoriasis?

Yes

No

4

21

16

84

Does the medication exacerbate your skin lesion?

Yes

No

1

24

4

96

stress exacerbate your skin lesion

Yes

No

14

11

56

44

RTI exacerbate your skin lesion

Yes

No

7

18

28

72

Pregnancy exacerbate your skin lesion

Yes

No

2

23

8

92

Do you have diabetes mellitus

Yes

No

1

24

4

96

Do you have hypertension?

Yes

No

1

24

4

96

Do you smoke cigarettes?

Yes

No

2

23

8

92

Do you drink alcohol

Yes

No

4

21

16

84

5.4 Factors Related to Psoriasis

Using binary logistic regression, the relationship between socio-demographic factors and psoriasis was assessed. Accordingly, sex, age, residency, marital status, educational status and occupational status were assessed with psoriasis. In a crude analysis, psoriasis was significantly associated only with educational status. Besides, respondents whose secondary school level of education were 0.56 times COR (95% CI): =0.56, (0.10-0.325) more likely to develop psoriasis compared to those with primary school and diploma and above educational status. Psoriasis was not statistically associated with sex, age, residency, marital status and occupational status (Table 5).

In this study, Stress, upper respiratory tract infection, pregnancy, cigarette smoking and alcohol drinking behaviors were found to be significantly associated with development of psoriasis disease in participants. Psoriasis patient who had stress history were 34.27 times COR (95% CI): =34.27, (13.21-88.88) more likely to have psoriasis disease compared to those who did not have stress history, participants who have had upper respiratory tract infection had also 50.29 times higher odds of developing psoriasis disease compared to with those who were free of history of upper respiratory tract infection COR, (95% CI): =50.29, (12.004-210.73). Pregnancy history had 6.7 times COR (95% CI): =6.71, (1.23-36.487) higher odds of having psoriasis compared to those who did not have history of pregnancy. Moreover, cigarette smoking and alcohol drinking behaviors were significantly associated with development of psoriasis. Cigarette smoking history of behavior were 8.41 times COR (95%CI): =8.41, (1.46-48.35) higher odds of having psoriasis disease as compared to those patients who were free of cigarette smoking behavior. Alcohol drinking history of behavior were 12.22 times COR (95% CI): =12.22, (3.20-46.64) higher odds of having psoriasis disease as compared to those patients who were free of alcohol drinking history behavior. However, family history of psoriasis, lesions exacerbated by drug using behavior, history of diabetes mellitus and history of hypertension were not associated with psoriasis disease in this study (Table 4).

5.5 Multivariable Analysis

In order to identify independent predictors of psoriasis disease, those variables that showed statistically significant association in a crude analysis were included in a multivariable logistic regression model. Accordingly, among socio-demographic factors only educational status was found to be independent predictors for development of psoriasis disease. In this study secondary school levels of education were 0.054 times AOR (95% CI): =0.054, (0.01-0.30) more likely to have patients who developed psoriasis disease than their counterparts. Among clinical and behavioral related factors, patients who have had stress history were 34.90 times AOR (95% CI): = 34.90, (8.27-147.30) more likely to develop psoriasis compared to those who did not have. However, in this study psoriasis disease was not statistically associated with age, upper respiratory infection, pregnancy history, cigarette smoking behavioral history and alcohol drinking behavioral history in a multivariable logistic regression model (Table 5).

Table 5. Factors associated with psoriasis among patients in St. Paul’s hospital, Addis Ababa, Ethiopia,

Variable

Psoriasis

COR(95%CI)

AOR(95%CI)

P-VALUE

Yes No

n(%) n(%)

Educational status

Diploma & above

secondary school

primary school

unable to read write

4 59

15 180

3 144

3 8

0.16 (0.32-0.89)

0.56 (0.10-0.32)*

0.22 (0.54-0.93)

1.00

0.19 (0.03-1.05)

0.054 (0.01-0.30)*

0.17 (0.02-0.14)

1.00

0.057

0.001**

0.138

Stresss

Yes

No

14 14

11 377

34.27(13.21-88.88)*

1.00

34.90 (8.27-147.30)*

1.00

0.000**

Upper respiratory infection

Yes

No

7 3

18 388

50.29 (12.00-210.73)

1.00

4.34 (0.70-26.92)

1.00

0.115

Pregnancy

Yes

No

2 5

23 386

6.71 (1.23-36.48)

1.00

5.35 (0.32-87.21)

1.00

0.239

Cigarrate smoking

Yes

No

2 4

23 387

8.41(1.46-48.35)

1.00

1.86 (0.12-27.47)

1.00

0.650

Alchol drinking

Yes

No

4 6

21 385

12.2(3.20-46.64)

1.00

2.76 (0.38-19.93)

1.00

0.313

Psoriasis is a common chronic inflammatory and recurrent condition of skin, these disease associations may be due to the combination of systemic inflammatory mediators generated in psoriasis and environmental influences (i.e. Stress, smoking, alcohol consumption) (Ni and Chiu, 2014), It affects 0.1%-11% of populations worldwide. The present study revealed that the prevalence of psoriasis 6.0% based on typical clinical feature and site among patients in St. Paul’s hospital millennium medical college. In addition, educational status, clinical and behavioral related factors were found to be independent predictors for psoriasis. This study found a slightly higher prevalence of psoriasis disease than studies conducted in Spain 5.1% and Mekele 5.4%. But the result of this study is lower than the study in Malaysia 9.5%. Likewise, the prevalence of psoriasis in this study was still higher than the studies conducted in 0.59 China ,1.18% Japan, 0.23 Taiwan [10],2.3% India ,0.8%Nigeria [7],0.4% Ghana and 3.15% Kenya. The difference may be due to the geographical difference, age group considered, and use of different diagnostic criteria, study period and season. The possible reason for the higher magnitude compared to studies conducted in Ethiopia could be study setting since the study is done at St. Paul’s Hospital Millennium Medical College which is the referral hospital providing dermatologic services to patients in the capital city of Ethiopia.

The socio-demographic variation might have contributed to the discrepancy with that of the different studies finding. In this study psoriasis was found to be more common in males accounted that 60 %, this result is in agreement with studies conducted in General Hospital in Port-of Spain, Trinidad and Tobago 52 % males [9], Japan 65.8% males, India 63.57% [16] and Mekele 62% males. On the other hand, it is not similar finding the study conducted in Egypt 52% females [ 15]. This difference might be due to the differences in the age group considered and methodological between the studies. On comparison of urban and rural residents a higher prevalence of psoriasis among patients was found in urban residents 88%. It is consistent with the study done in Norway and 71.4% in Mekele [ 17]. Also in this study most of the case of psoriasis lay in age group of 30-40 years (60.0%) .It is similar with the studies conducted in Egypt found out that the mean age of onset was 31 years and in Mekele research reported that the mean age of onset was 35 years (71%),but not similar findings with the Malaysia study which is the onset of disease age group of 40-60 years [6 ] and Taiwan study reported that 50% psoriasis patients aged 70 years and older[10].The possible reason for the difference with Malaysia and Taiwan might be due to delay to treatment. Regarding associated factor for development of psoriasis disease only educational status was independently associated with development of psoriasis from socio demographic factors when added in multivariable analysis model. Secondary school respondents had 0.054 times more likely of having psoriasis than primary and diploma and above level of education respondents. This result is consistent with study done by Mekele [17]. This might be related to lack of awareness of the disease trigger factor as well as perception to delay on treatment.

Moreover, based on typical clinical feature in this study almost all psoriasis diagnosed patients commonly represent erythematous plaque/ papule with supporter silvery scaly lesion and was found that 100%.This finding is similar fashion with the studies done at Pakistan [11].According to clinical type of psoriasis, in this study most of psoriasis diagnosed patients were chronic plaque psoriasis which is found that 68.0%.This result is consistent that the studies done at Korea reported that Plaque psoriasis 83.8% [13] ,72.14% in India [16] and 88.1% in Nigeria [7].The sites highly affected by psoriasis lesion were mostly found on extensor surface of extremities 48.0% and also found in 24.0%scalps ,20.0% trunk and 8.0% palm and sole surface area. This finding is in agreement with the studies done in Malaysia and Mekele [ 20]. On the other hand, family history of psoriasis if one and both parents are affected it is 14% and 41% respectively, while in this study it was 21% from psoriatic cases, it is in agreement on the study conducted 28% in China [3], not agree with in the studies 13.8% in Nigeria [7],15% in India [16] and 9.5% in Mekele. The variation could be due to control of confounding effects.

In Addition, clinical and behavioral related factors stress exacerbate history showed statistically significant association with the development of psoriasis when taken in to multivariable analysis model. Patients who have stressful history were 34.90 higher odds of developing psoriasis than those who were free of stressful situation history. This result is consistent with studies conducted in Italian case-control study which illustrated that psoriasis patients were more likely to involve a stressful situation that preceded the onset and exacerbation of the disease as compared to patients with other skin disease [5] and same as reported in cross sectional studies in Pakistan [11] and India [16].

All of these studies reported that stressful situations were some independent predictors for the development of psoriasis. This implies that a stressful situation risks the existing psoriasis disease in patients. Furthermore, the present study found no association among sex, marital status, occupational status, residency, family history of psoriasis, medication history, diabetes mellitus history, hypertension history, however, in other studies variables such as marital status [9] and history of diabetes mellitus [2] and history of hypertension [8] were significantly associated with psoriasis cases.

7.1. Strength of the study

7.2. Limitation of the study

The study while used in hospital setting it suffers the usual limitation such as sample was taken only from hospital, the study findings may not be generalized strong cause effect relationship among the magnitude of psoriasis disease and its associated factors.

The study has found that a magnitude of 6.01% of patients in the study population had psoriasis disease., In Addition educational status, clinical and behavioral related factors that stressful situation event history of were found an independent predictor of development of psoriasis disease among patients. Furthermore, the present study found no association among sex, marital status, occupational status, residency, family history of psoriasis, medication history, diabetes mellitus history, and hypertension history.

Based on the results of the study the following recommendations were made. For ministry of health: The Ethiopian ministry of health should give a great attention towards strengthening national skin disease prevention and control services on creating awareness, prevention and treatment of psoriasis at institutional and community household level such as, to develop a Primary health care management strategies and short courses on psoriasis for health extension worker to improve the knowledge biases on psoriasis and to give evidence based health education to the communities. To dermatologists and clinicians: Educate patients to consult health professionals when they feel lesion and do not neglect the disease. To provide collaborated emotional and psychological support to patients to decrease stress for researchers: Further research on psoriasis disease must be done to see the clear picture at regional and national level. In addition, it is better to conduct a prospective cohort study which is undertaken in order to characterize the association between clinical and behavioral related factors and psoriasis.

ALERT All Africa leprosy, TB and HIV Research, Rehabilitation and training center

ARH Ayder Referral Hospital

AOR Adjusted odd ratio

COR Crud odd ratio

PSO Psoriasis

OPD Outpatient Department

QoL Quality of life

SPHMMC Saint Paul’s Hospital Millennium Medical College

SPSS Statistical packages for social science

The authors declare no competing interests.

Acknowledgement

First I would like to thank Saint Paul’s Hospital Millennium Medical College Department of Dermatovenereology for giving me an opportunity to deal with this research program as it is a great experience for me. As an early stage researcher working on my research project I am in need of guidance. In this regard I am grateful to my supervisor Dr. Samia Metena and Dr. Fufa Hunduma for their effort in giving me guidance, comments, suggestions, for being patient with my mistakes and encouraging me and helping me out at each step. In addition, I would like to extend my grateful thanks and appreciation to all consultants as well as dermatovenereology residents and nurse staffs of Saint Paul’s Hospital Millennium Medical College for their cooperation during searching of some of the literature, documents and books I used as a guide. Finally, I also want to thank Dr. Hailemichael Bizuneh, for his brilliant comments and suggestions, thanks to you.

Kamiya K, Kishimoto M, Sugai J, Komine M, Ohtsuki M. Risk Factors for the Development of Psoriasis. 2019;(DM):1–14.
El-komy MHM, Mashaly H, Sayed KS. Clinical and epidemiologic features of psoriasis Patients in an Egyptian medical center. JAAD International [Internet]. 2020;1(2):81–90. Available from: https://doi.org/10.1016/j.jdin.2020.06.002
Germain N, Augustin M, François C, Legau K, Bogoeva N, Desroches M, et al. Stigma in visible skin diseases–A literature review and development of a conceptual model. Journal of the European Academy of Dermatology and Venereology.
Carrillo JM, Venereology PG of the SA of D and. PASI 100 response rates in moderate to severe psoriasis: a systematic literature review and analysis of clinical practice guidelines. Journal of Dermatological Treatment. 2021;1–9.
Peng C, Xu X, Chen W, Li X, Yi X, Ding Y, et al. Epidemiological Variations in the Global Burden of Psoriasis, an Analysis with Trends from 1990 to 2017. Frontiers in medicine. 2021; 8:24.
Bhutto AM. Childhood psoriasis: A review of literature. Journal of Pakistan Association of Dermatology. 2016;21(3):190–7. Chaiyabutr C, Silpa-archa N, Wongpraparut C, Chularojanamontri L.
The Increasing Risk of Dementia in Psoriasis: A Systematic Review and Meta-Analysis. Siriraj Medical Journal. 2021;73.
De Korte J, Mombers FMC, Bos JD, Sprangers MAG. Quality of life in patients with psoriasis: a systematic literature review. In: Journal of Investigative Dermatology Symposium Proceedings. Elsevier; 2004. p. 140–7.
Article Text-163830-1-10-20080507.pdf. Hamed A, Alobaidi A, Alsamarai AM, Salih MA. Psoriasis Beyond Local Skin Disease.
Medico-Legal Update. 2021;21(1):1409–17. Theses NS, Devera G. Dominican Scholar the Effects of Moderate-Severe Plaque Psoriasis on Patient Well- Being and Prevention of Flares.
British Journal of Dermatology. 2021;184(2):237–42.
Alexis AF, Blackcloud P. Psoriasis in skin of color: Epidemiology, genetics, clinical presentation, and treatment nuances. Journal of Clinical and Aesthetic Dermatology. 2014;7(11):16–24.
Barrea L, Nappi F, Di Somma C, Savanelli MC, Falco A, Balato A, et al. Environmental risk factors in psoriasis: The point of view of the nutritionist. International Journal of Environmental Research and Public Health. 2016;13(7).
Lee EB, Wu KK, Lee MP, Bhutani T, Wu JJ. Psoriasis risk factors and triggers. Cutis. 2018;102(5):18–20.
Ferrándiz C, Bordas X, García-Patos V, Puig S, Pujol R, Smandía A. Prevalence of psoriasis in Spain (epiderma project: Phase I). Journal of the European Academy of Dermatology and Venereology. 2001;15(1):20–3.
Tseng IL, Yang CC, Lai ECC, Lee CN. Psoriasis in the geriatric population: A retrospective study in Asians. Journal of Dermatology. 2021; Description O, Responses N, The TO, Poll D. 731: T. 2010;2010(Quarter 3):1–3.
Aynalem SW. Psoriasis at Ayder Referral Hospital among Patients Attending Dermatology Clinic, Mekelle, North Ethiopia. Science Journal of Clinical Medicine. 2014;3(6):106. Getnet Tsegaw M, Getinet Tsegaw M, Bezabih Ayele D.
FREQUENCIES OF PSORIASIS AND ITS COMPLICATIONS AMONG TYPE-II DIABETES CASES: A META-ANALYSIS OF SHORT CRITICAL CORRELATIONAL REVIEWS FROM 2010 THROUGH 2016.
Gelfand JM, Weinstein R, Porter SB, Neimann AL, Berlin JA, Margolis DJ. Prevalence and treatment of psoriasis in the United Kingdom: A population-based study. Archives of Dermatology. 2005;141(12):1537–41.
Verhagen AR. Psoriasis in Kenya. Archives of Dermatology. 1967;96(1):39–41.
In I, Issue T. Psoriasis review. 2013;12(1):1–36.
Brenaut E, Horreau C, Pouplard C, Barnetche T, Paul C, Richard MA, et al. Alcohol consumption and psoriasis: A systematic literature review. Vol. 27, Journal of the European Academy of Dermatology and Venereology. 2013.
Chiu HY, Wang TS, Chen PH, Hsu SH, Tsai YC, Tsai TF. Psoriasis in Taiwan: From epidemiology to new treatments. Vol. 36, Dermatologica Sinica. 2018.
Michalek IM, Loring B, John SM. A systematic review of worldwide epidemiology of psoriasis. Vol. 31, Journal of the European Academy of Dermatology and Venereology. 2017.
Schonmann Y, Ashcroft DM, Iskandar IYK, Parisi R, Sde-Or S, Comaneshter D, et al. Incidence and prevalence of psoriasis in Israel between 2011 and 2017. Journal of the European Academy of Dermatology and Venereology. 2019;33(11).
Parisi R, Symmons DPM, Griffiths CEM, Ashcroft DM. Global epidemiology of psoriasis: A systematic review of incidence and prevalence. Journal of Investigative Dermatology. 2013;133(2).
Egeberg A, Skov L, Gislason GH, Thyssen JP, Mallbris L. Incidence and prevalence of psoriasis in Denmark. Acta Dermato-Venereologica. 2017;97(7).
Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. Journal of the American Academy of Dermatology. 2014;70(3).
psoriasis-literature-review-2000.
Lee JY, Kang S, Park JS, Jo SJ. Prevalence of psoriasis in Korea: A population-based epidemiological study using the Korean national health insurance database. Annals of Dermatology. 2017;29(6).
WHO. Global report on. Global Report on Psoriasis [Internet]. 2016; 978:1–26. Available from:http://www.who.int/about/licensing/copyright_form/index.html%0Ahttp://www.who.int/ about/licensing/

Annex1and2.docx

Variables	Category	Number	Percent
Psoriasis	Yes	25	6.01
Psoriasis	No	391	93.99
How long have you had skin lesion	<1year	356	85.6
How long have you had skin lesion	Greater than or equal to 1	60	14.4
Skin lesions itchy	Yes	356	85.6
Skin lesions itchy	No	60	14.4
Erythematous plaque/ papule with silvery scaly lesion	Yes	25	6.0
Erythematous plaque/ papule with silvery scaly lesion	No	391	94.0
Lesions involved area	Extensor surface of extremities	86	20.7
	Face	90	21.6
	Scalp	110	26.4
	Trunk	99	23.8
	Palm and sole	31	7.5
Chronic plaque psoriasis	Yes	17	4.1
Chronic plaque psoriasis	No	399	95.9
Guttate psoriasis	Yes	7	1.7
Guttate psoriasis	No	409	98.3
Erythroderma psoriasis	Yes	0	0
Erythroderma psoriasis	No	416	100
Pustular psoriasis	Yes	1	0.2
Pustular psoriasis	No	415	99.8

The assessment of the magnitude and associated factors of psoriasis

Status:

Version 1

Abstract

Figures

1. INTRODUCTION

2. LITERATURE REVIEW

3. OBJECTIVE

4. METHODOLOGY

5. RESULT

6. DISCUSSION

7. STRENGTH AND LIMITATION OF THE STUDY

8. CONCLUSION

9. RECOMMENDATION

ABBREVIATIONS AND ACRONYMS

Declarations

Acknowledgement

References

Supplementary Files

Status:

Version 1