See related commentary on pg 287

ORIGINAL ARTICLE

Global Epidemiology of Psoriasis: A Systematic Review

of Incidence and Prevalence
Rosa Parisi1, Deborah P.M. Symmons2,3, Christopher E.M. Griffiths4, Darren M. Ashcroft1 on behalf of the
Identification and Management of Psoriasis and Associated ComorbidiTy (IMPACT) project team
The worldwide incidence and prevalence of psoriasis is poorly understood. To better understand this, we
performed a systematic review of published population-based studies on the incidence and prevalence of
psoriasis. Three electronic databases were searched from their inception dates to July 2011. A total of 385 papers
were critically appraised; 53 studies reported on the prevalence and incidence of psoriasis in the general
population. The prevalence in children ranged from 0% (Taiwan) to 2.1% (Italy), and in adults it varied from 0.91%
(United States) to 8.5% (Norway). In children, the incidence estimate reported (United States) was 40.8/100,000
person-years. In adults, it varied from 78.9/100,000 person-years (United States) to 230/100,000 person-years (Italy).
The data indicated that the occurrence of psoriasis varied according to age and geographic region, being more
frequent in countries more distant from the equator. Prevalence estimates also varied in relation to demographic
characteristics in that studies confined to adults reported higher estimates of psoriasis compared with those
involving all age groups. Studies on the prevalence and incidence of psoriasis have contributed to a better
understanding of the burden of the disease. However, further research is required to fill existing gaps in
understanding the epidemiology of psoriasis and trends in incidence over time.
Journal of Investigative Dermatology (2013) 133, 377385; doi:10.1038/jid.2012.339; published online 27 September 2012

INTRODUCTION
Psoriasis is a chronic, immune-mediated inflammatory skin
disease. It ranges in severity from a few scattered red, scaly
plaques to involvement of almost the entire body surface. It may
progressively worsen with age, or wax and wane in its severity;
the degree of severity depends on inheritance and environmental
factors (Lebwohl, 2003). Psoriasis causes considerable psychosocial disability and has a major impact on patients quality of life
(Rapp et al., 1999). The cost to both patients and health-care
systems is high (Javitz et al., 2002). Psoriasis is associated with
cardiovascular disease, depressive illness, and psoriatic arthritis
(Griffiths and Barker, 2007). The causes of psoriasis are not fully
understood, but a number of risk factors are recognized, including
family history and environmental risk factors, such as smoking,
stress, obesity, and alcohol consumption (Huerta et al., 2007).
Psoriasis is estimated to affect about 24% of the population
in western countries (Stern et al., 2004; Gelfand et al., 2005b;
1

School of Pharmacy and Pharmaceutical Sciences, University of Manchester,

Manchester, UK; 2Arthritis Research UK Epidemiology Unit, School of
Translational Medicine, Manchester, UK; 3NIHR Manchester Musculoskeletal
Biomedical Research Unit, Manchester, UK and 4The Dermatology Centre,
Salford Royal NHS Foundation Trust, The University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK
Correspondence: Darren M. Ashcroft, School of Pharmacy and Pharmaceutical
Sciences, University of Manchester 1st Floor, Stopford Building, Oxford Road,
Manchester M13 9PT, UK. E-mail: Darren.Ashcroft@manchester.ac.uk
Abbreviation: CI, confidence interval
Received 2 April 2012; revised 17 July 2012; accepted 23 July 2012;
published online 27 September 2012

& 2013 The Society for Investigative Dermatology

Kurd and Gelfand, 2009). Important factors in the variation of

the prevalence of psoriasis include age, gender, geography, and
ethnicity, probably due to genetic and environmental factors.
Higher prevalence rates have been reported at higher latitudes,
and in Caucasians compared with other ethnic groups (Farber
and Nall, 1998). In addition, the wide variation in prevalence
estimates may be influenced by aspects of psoriasis such as its
remittingrelapsing course, diversity of clinical presentations
(Griffiths et al., 2007), and variation in severity (Griffiths and
Barker, 2007). Aspects of study design may also be important.
These include different definitions of prevalence, case
definitions (Gelfand et al., 2005b), sampling frames and
methods, and age groups studied.
Although several studies, dating back to the 1960s1970s,
have reported the prevalence of psoriasis (Lomholt, 1964;
Hellgren, 1967; Rea et al., 1976; Johnson and Roberts, 1978),
incidence studies are few, probably because of the difficulty in
accurately identifying and documenting such cases.
Despite a number of narrative reviews of the epidemiology
of psoriasis (Farber and Nall, 1998; Plunkett and Marks, 1998;
Christophers, 2001; Naldi, 2004; Neimann et al., 2006;
Gudjonsson and Elder, 2007; Chandran and Raychaudhuri,
2010), a systematic review has not been performed.
Furthermore, many of the earlier reviews included studies
that combined data from general population, hospital, or
dermatology clinics with no clear distinction in the results,
and no review has looked at the variation of psoriasis
according to age and method of case definition. Therefore,
the aim of this systematic review was to evaluate the
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prevalence and incidence of psoriasis from studies in the

general population and to explore variations in epidemiology
on the basis of geographical location, age, and, where
possible, on study design (survey, primary-care data, or
other registries), case definition (self-reported, physicians, or
dermatologists diagnosis), and definition of prevalence
(lifetime, period, or point prevalence).
RESULTS
Supplementary Figure S1 online summarizes the results of the
search strategy. Papers were mainly excluded from the search
because (i) they did not provide any measure of prevalence
or incidence of psoriasis, (ii) subjects were identified from
dermatology clinics, and (iii) the study focused on specific
subgroups of the population. In all, we identified 46 studies
that reported on the prevalence of psoriasis (Supplementary
Tables S1S3 online) and 7 studies that focused on the
incidence of psoriasis in the general population (Table 1).
Prevalence of psoriasis

Most studies of the prevalence of psoriasis were conducted in

Europe or United States, but there were also studies from
Australia, China, Egypt, Latin America, Sri Lanka, Taiwan, and
Tanzania. Key differences in prevalence rates depended on
whether the study population included only children, only
adults, or individuals of all ages, as well as on the underlying
age and sex structure of the whole population. Further
variation was related to the following: the definition of
prevalence, such as point (15 studies), period (9 studies), or
lifetime (19 studies); methodology used, such as survey (30
studies), administrative database (11 studies), or insurance
database (4 studies); and case definition, such as self-report,
physicians, or dermatologists diagnosis.
Prevalence of psoriasis in children

Six studies reported the prevalence of psoriasis in children

(defined as those aged o18 years) in Europe or Asia (Figure 1).
In general, the prevalence of psoriasis in children was up to
0.71% in Europe (Augustin et al., 2010) and almost absent in
Asia (Yang et al., 2007; Chen et al., 2008). One exception was
a study of 13- to 14-year-old children in Italy that found a
lifetime prevalence of dermatologist diagnosed psoriasis of
2.15% (95% confidence interval (CI): 1.592.61) (Naldi et al.,
2009). A German study, based on an insurance database and
confined to those aged under 18 years, reported a low overall
prevalence of psoriasis in children (0.71% (95% CI: 0.68
0.74)) and an increasing prevalence with age (0.37% for 09
years and 1.01% for 1018 years) (Augustin et al., 2010)
(Supplementary Table S1 online). Not surprisingly, studies
based on lifetime prevalence generally yielded higher estimates than those based on point prevalence.
Prevalence of psoriasis in adults

Studies of the prevalence of psoriasis in adults (Figure 2)

yielded higher prevalence estimates than studies in children.
However, there appeared to be little consistency within or
between countries. In Europe, the United Kingdom had one of
the lowest and most consistent estimates, probably due to the
378

Journal of Investigative Dermatology (2013), Volume 133

same methodology (primary-care database). Here, prevalence

of psoriasis in adults was estimated as 1.30% (95% CI:1.21
1.39) (ONeill and Kelly, 1996), 2.60% (95% CI: 2.472.78)
(Kay et al., 1999), and 2.20% (95% CI: 2.192.21) (Seminara
et al., 2011), respectively. A study from Croatia in the late
1980s reported a psoriasis prevalence (1.21% (95% CI: 0.95
1.47)) similar to that of the United Kingdom (Barisic-Drusko
et al., 1989). Other countries, in North-East and South Europe,
reported higher values than the United Kingdom, specifically
of 3.73% (95% CI: 3.134.32) in Denmark (Brandrup and
Green, 1981), 4.82% (95% CI: 4.475.17) (Kavli et al., 1985)
and 8.50% (95% CI: 8.038.97) in Norway (Bo et al.,
2008), 3.10% (95% CI: 2.543.66) in Italy (Naldi et al.,
2004), and 5.20% (95% CI: 4.685.72) in France
(Wolkenstein et al., 2009).
Estimates of prevalence of psoriasis in Australia ranged from
2.30% (95% CI: 1.393.21) to 6.6% (95% CI: 5.47.9) (Quirk,
1979; Kilkenny et al., 1998; Plunkett et al., 1999), whereas
rates in United States ranged from 2.2% (95% CI: 2.02.4) to
3.15% (95% CI: 2.603.70) (Stern et al., 2004; Kurd and
Gelfand, 2009) and were similar to those from United
Kingdom. Exceptions were two studies in the United States,
one collecting data on African Americans and the other study
from two medical insurance databases, which reported a
prevalence of 1.3% (95% CI: 0.71.8) (Gelfand et al.,
2005a) and 0.91% (95% CI: 0.900.92) and 1.06% (95% CI:
1.051.07), respectively (Robinson et al., 2006). Qureshi et al.
(2009) reported a prevalence of psoriasis (2.58% (95% CI:
2.472.69)) only in women, which was consistent with other
studies conducted in the United States (Stern et al., 2004; Kurd
and Gelfand, 2009).
Only in the reports from Europe it appeared that studies
based on self-reported diagnoses had higher prevalence rates
than physicians diagnoses ((Brandrup and Green, 1981; Kavli
et al., 1985; ONeill and Kelly, 1996; Kay et al., 1999; Naldi
et al., 2004; Bo et al., 2008; Wolkenstein et al., 2009;
Seminara et al., 2011); Supplementary Table S2 online).
Prevalence of psoriasis for individuals of all ages

On examining individuals of all ages, in Europe, prevalence

rates varied between 0.73% (in Scotland) and 2.9% (in Italy).
However, although most of the studies reported a prevalence
above 1%; specifically 2.00% (95% CI: 1.862.14) in Sweden
(Hellgren, 1967), 1.10% (95% CI: 0.112.09), 1.40% (95% CI:
0.941.86), and 1.40% (95% CI: 1.181.62) in Norway
(Braathen et al., 1989; Falk and Vandbakk, 1993), 2.84%
(95% CI: 2.533.15) in Denmark (Lomholt, 1964), 1.58%
(95% CI: 0.003.35) in Yugoslavia (Arzensek et al., 1984),
1.48% (95% CI: 1.201.80), 1.52% (95% CI: 1.511.53), and
1.87% (95% CI: 1.891.91) in United Kingdom (Nevitt and
Hutchinson, 1996; Gelfand et al., 2005b; Seminara et al.,
2011), 1.43% (95% CI: 1.231.63) in Spain (Ferrandiz
et al., 2001), 2.90% (95% CI: 2.393.41) in Italy (Saraceno
et al., 2008), and 2.00% (95% CI: 1.982.20) and 2.53%
(95% CI: 2.502.56) in Germany (Schlander et al., 2008;
Augustin et al., 2010), two studies from Scotland and
United Kingdom showed lower estimates of psoriasis equal
to 0.73% (95% CI: 0.690.76) (Simpson et al., 2002) and

R Parisi et al.
Global Epidemiology of Psoriasis

Table 1. List of studies providing incidence rates in children, adults, and all ages

Study

Country

Time

Diagnostic
method

Age

19701999

N/D

o18

People
with Ps

Incidence rate per

100,000 personyears (95% CI)

Incidence rate
per 100,000
person-years
(95% CI) female

Incidence rate
per 100,000
person-years
(95% CI) male

40.8 (36.645.1)1,2

43.9 (37.650.2)1,2

37.9 (32.243.6)1,2

73.2 (68.078.4)1,3

85.5 (79.591.6)1,3

Children
Tollefson et al.
(2010)

USA

357

19701974

29.6 (20.938.3)

19751979

35.7 (25.945.5)

19801984

31.4 (22.040.8)

19851989

42.7 (31.853.7)

19901994

40.0 (29.750.3)

19951999

62.7 (50.465.0)

Adult
Icen et al. (2009);
Shbeeb et al. (1995)

USA

19702000

D/Ph

X18

1,633

78.9 (75.082.9)1,3

19701974

50.8 (41.959.6)

19751979

53.2 (44.861.6)

19801984

80.9 (70.891.1)

19851989

78.9 (69.588.4)

19901994

88.7 (79.198.3)

19951999

100.5 (90.8110.2)

Setty et al. (2007)

USA

19912005

SR

2542

Vena et al. (2010)

Italy

20012005

Ph

X18

82 (7789)1

892
5,792

2001

3211

2911

3571

2005

2301

2071

2541

63.6 (48.978.3)1,2

58.4 (42.874.1)1,2

All ages
o2070

132

59.9 (49.570.3)1,2

Ph

065

106

130 (120140)1,2

1995

Ph

065

24

120 (70190)1,2

19961997

Ph

080

3,994

Bell et al. (1991)

USA

19801983

D/Ph

Donker et al. (1998)

The
Netherlands

19871988

Donker et al. (1998)

The
Netherlands

Huerta et al. (2007)

UK

1401

Abbreviations: CI, confidence interval; Ps, psoriasis; diagnostic methods: D, dermatologist; N, nurse; Ph, physician; SR, self-reported diagnosis.
1
Value reported from the study.
2
Age and/or sex adjusted.
3
Rate adjusted with linear interpolation between census years.

0.80% (95% CI: 0.780.82) (Gillard and Finlay, 2005),

respectively. The only study from European Russia
reported a prevalence of 0.72% (95% CI: 0.700.74)
(Osmanova, 1985). Rates in United States varied from
0.7% to 2.6%. However, whereas Johnson and Roberts
(1978) and Koo (1996) reported rates similar to those of
Europe (1.43% (95% CI: 1.271.59) and 2.60% (95% CI:
2.432.77) respectively), Javitz et al. (2002) showed a
prevalence of 0.70% (95% CI: 0.670.73). The
prevalence rates reported in Latin Americans-Indians,
from Africa (Egypt and Tanzania) and Asia (China, Sri
Lanka and Taiwan) varied from no cases detected to
estimates below 0.5% (Convit, 1963; Yip, 1984;

Cooperative Psoriasis Study Group, 1986; Gibbs, 1996;

Perera et al., 2000; Abdel-Hafez et al., 2003; Tsai et al.,
2011).
Prevalence of psoriasis by gender

There was no agreement about whether the prevalence of

psoriasis differed between men and women (Supplementary
Tables S1S4 online). No differences in the frequency of
psoriasis between genders were found in Taiwanese children
(Yang et al., 2007; Tsai et al., 2011), in the United States and
Norway in adults (Kavli et al., 1985; Bo et al., 2008; Kurd and
Gelfand, 2009), and in the United States, United Kingdom,
Norway, Spain, Scotland, and Taiwan in individuals of all ages
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379

R Parisi et al.
Global Epidemiology of Psoriasis

Europe

Asia

Europe

Larsson et al., 1980 Sweden

Popescu et al., 1999 Romania
Naldi et al., 2009
ltaly
Augustin et al., 2010 Germany
Yang et al., 2007
Chen et al., 2008

Taiwan
Taiwan
0

0.5 1 1.5 2 2.5

Prevalence %

Figure 1. Studies providing information on the prevalence of psoriasis in

children. Square, lifetime prevalence; triangle, point prevalence.

combined (Braathen et al., 1989; Ferrandiz et al., 2001; Javitz

et al., 2002; Simpson et al., 2002; Gelfand et al., 2005b; Chang
et al., 2009; Seminara et al., 2011; Tsai et al., 2011). Other
studies reported a slightly higher prevalence of psoriasis in
female subjects than male subjects in Swedish children (0.5%
vs 0.1%) (Larsson and Liden, 1980) and in Germany (0.76% vs
0.66%) (Augustin et al., 2010); in the United States (2.5% vs
1.9% with an odds ratio 1.37 (95% CI: 1.141.64)) (Stern
et al., 2004) and in Norway (1.6% vs 1.2% (Lapps) and 1.4% vs
0.9% (non-Lapps)) (Falk and Vandbakk, 1993) in adults and in
all ages, respectively. In contrast, psoriasis was more frequent in
men than in women in Denmark (4.2% vs 3.3%, not significant)
(Brandrup and Green, 1981) and in Australia, where it was
reported to be almost twice as high in men as in women (8.9%
vs 4.5% (Plunkett et al., 1999), and in individuals of all ages in
Sweden (2.3% vs 1.5%) (Hellgren, 1967) and China (0.17% vs
0.12%) (Cooperative Psoriasis Study Group, 1986).
Prevalence of psoriasis by age group

Fourteen studies examined the prevalence (mostly lifetime

prevalence) of psoriasis by age. As one would expect, there
was an increasing trend with age (Figure 3, Supplementary
Table S4 online).
Psoriasis was uncommon before the age of 9 years, varying
from 0% (Norway) to 0.55% (United Kingdom).
In adults (Supplementary Table S4 online), studies from
Norway, Scotland, Spain, and Taiwan showed a first peak of
psoriasis at either 2029 or 3039 years of age (Brandrup and
Green, 1981; Kavli et al., 1985; Braathen et al., 1989; Falk and
Vandbakk, 1993; Ferrandiz et al., 2001; Simpson et al., 2002;
Tsai et al., 2011), whereas in the remaining studies from the
United Kingdom, Germany, Russia, and United States there
was an increasing trend with age until around 60 years, after
which the prevalence reduced (Osmanova, 1985; Javitz et al.,
2002; Stern et al., 2004; Gelfand et al., 2005b; Schlander
et al., 2008; Seminara et al., 2011; Tsai et al., 2011).
Incidence of psoriasis

Seven studies examined the incidence of psoriasis in the

general population. These studies were conducted in the
United States, the Netherlands, United Kingdom, and Italy.
All the studies in the United States, except Setty et al. (2007),
used the Rochester Epidemiology Project database, often
looking at different groups of the population (children or
adults or all ages) and different time periods.
380

Journal of Investigative Dermatology (2013), Volume 133

Brandrup et al., 1981

Kavli et al.,1985
Bo et al., 2008
Barisic-Drusko et al., 1989
Naldi et al., 2004
Wolkenstein et al., 2009
ONeill et al., 1996
Kay et al., 1999
Seminara et al., 2011

Denmark
Norway
Norway
Croatia
ltaly
France
Uk
Uk
Uk

Australia Quirk et al., 1979

Kilkenny et al., 1998
Plunkett et al., 1999

Australia
Australia
Australia

America

USA
USA
USA
USA
USA

Stern et al., 2004

Gelfand et al., 2005
Robinson et al., 2006
Robinson et al., 2006
Kurd et al., 2009

4
6
8
Prevalence %

10

Figure 2. Studies providing information on prevalence of psoriasis in adults.

The study by Qureshi et al. (2009) has been removed because data were
collected on women only, whereas Gelfand et al. (2005a) examined African
Americans in the United States. Circle, period prevalence; square, lifetime
prevalence; triangle, point prevalence.

Incidence of psoriasis in children

There was only one study of the incidence of psoriasis in

children; this was conducted in the United States over a
30-year period (Tollefson et al., 2010) (Table 1). It found that
the incidence of psoriasis was slightly higher in girls than in
boys (43.9/100,000 person-years (95% CI: 37.650.2) vs 37.9/
100,000 person-years (95% CI: 32.243.6)), although it was
not statistically significant. The data showed a rise in the
incidence of psoriasis between 1970 and 2000.
Incidence of psoriasis in adults

Three studies reported the incidence of psoriasis in adults

(Table 1)two from the United States and one from Italy. The
two estimates in the United States were similar (78.9/100,000
person-years (95% CI: 75.082.9; Icen et al., 2009) and
82/100,000 person-years (95% CI: 7789; Setty et al., 2007),
the last one being confined to women). Icen et al. (2009)
found a higher incidence of psoriasis in men than in women
(85.5/100,000 person-years vs 73.2/100,000 person-years).
Combining the two studies from the United States, which
both used the Rochester Epidemiology Project database, it
appeared that whereas the incidence was higher in girls than
in boys until 18 years of age, thereafter psoriasis affected men
more frequently than women. In the same study, data showed
an increasing trend in the incidence of psoriasis in adults over
a 30-year period (Table 1) (Icen et al., 2009). The Italian study
reported a much higher incidence rate of 230/100,000 personyears in 2005 (Vena et al., 2010).
Incidence of psoriasis in all ages combined

Finally, three studies examined the incidence of psoriasis in all

ages. Bell et al. (1991), using the Rochester Epidemiology
Project database, reported an overall incidence of 59.9/
100,000 person-years (95% CI: 49.570.3). The two

R Parisi et al.
Global Epidemiology of Psoriasis

Europe

North America

Latin America

Lomholt et al., 1964

Hellegren et al., 1967
Braathen 1989
Falk et al., 1993
Falk et al., 1993
Arzensek et al., 1984
Simpson et al., 2002
Nevitt et al., 1996
Gillard et al., 2005
Gelfand et al., 2005
Seminara et al., 2011
Ferrandiz et al., 2001
Saraceno et al., 2008
Schlander et al., 2008
Augustin et al., 2010
Osmanova et al., 1985

Denmark
Sweden
Norway
Norway
Norway
Yugoslavia
Scotland
UK
UK
UK
UK
Spain
ltaly
Germany
Germany
Russia

Johnson et al., 1978

Koo et al., 1996
Javitz et al., 2002

USA
USA
USA

Convit, 1962 Latin America Andes, (Indians)

Gibbs et al., 1996
Abdel-Hafez et al., 2003

Tanzania
Egypt

Perera et al., 2000

Yip, 1984
Cooperative Psoriasis Study Group, 1986
Tsai et al., 2011

Sri Lanka
China
China
Taiwan

Africa

Asia

0.5

1
1.5
2
Prevalence %

2.5

Figure 3. Studies providing information on the prevalence of psoriasis in all ages. Circle, period prevalence; diamond, not specified; square, lifetime prevalence;
triangle, point prevalence.

European studies used data from primary-care databases. They

reported incidences of 120130/100,000 person-years (the
Netherlands) (Donker et al., 1998) and 140/100,000 personyears (United Kingdom) (Huerta et al., 2007) (Table 1).
Variation by age and gender

The incidence of psoriasis in children increased with age (from

13.5/100,000 person-years (03 years old) to 53.1/100,000
person-years (1418 years old) (Tollefson et al., 2010);
Table 2).
Table 2 summarizes the remaining studies of the incidence
of psoriasis by age. Despite higher estimates of psoriasis
incidence from the United Kingdom (Huerta et al., 2007)
than the United States (Bell et al., 1991; Icen et al., 2009), all
these studies showed a similar trend of increasing psoriasis
incidence with age up to 39 years. The incidence of psoriasis
then reduced at 4049 years of age before increasing again
with a second peak at around 5059 years of age in the United
Kingdom (Huerta et al., 2007) and around 6069 years of age
in the two studies in United States (Bell et al., 1991; Icen et al.,
2009). Age-specific estimates of incidence decreased toward
the end of life.
There was a lack of agreement in the published studies
about variation by gender for incidence rates. Although the
reported overall incidence was slightly higher in girls compared with boys aged under 18 years (43.9/100,000 personyears vs 37.9/100,000 person-years), this pattern was not
constant across all age bands (Tollefson et al., 2010). Some
studies showed a higher incidence in women than in men
(Bell et al., 1991; Vena et al., 2010), whereas others presented
the opposite results (Icen et al., 2009; Vena et al., 2010).
When looking at gender by age bands, the two peaks for age
at onset in women were more frequently around 2029 and

5059 years of age, whereas in men they occurred around 30

39 and 6069/7079 years of age (Huerta et al., 2007; Icen
et al., 2009).
DISCUSSION
This systematic review provides a detailed critique of the
existing data on the worldwide incidence and prevalence of
psoriasis. Comparison between studies was attempted in relation to geography, age, and gender. In addition, we investigated
whether observed differences in disease occurrence might have
been due to varying study methodologies used, such as types of
measure, case definition, and study design.
The results from the systematic review confirmed that
psoriasis is a common disease, less common in children and
more common in adults; prevalence rates showed a worldwide geographic variation that probably reflects the fact that
psoriasis is a complex disease influenced by both genetic and
environmental factors. Worldwide, on examining the North
and South hemispheres, variation in prevalence of psoriasis
appeared to depend on the distance from the equator, with
populations located closer to the equator (Egypt, Tanzania, Sri
Lanka, Taiwan) being less affected by psoriasis compared with
countries more distant from it (Europe and Australia). The
higher reported prevalence of psoriasis in Australia was also
likely to be influenced by other factors such as European
migration and the resulting population genetic case-mix.
Within Europe, North-East (Norway, Denmark) and Southern
(Italy and France) countries showed higher prevalence estimates compared with the United Kingdom; however, the
differences between these studies may relate to different case
definition (self-reported vs physicians diagnosis) rather than
solely geographic variation. There were no clear conclusions
about whether the disease varied according to gender.
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Table 2. Incidence rates by gender and age group

Study

N people with incident Ps Gender

Incidence of Ps (per 100,000

person-years) by age bands

Children
Tollefson et al. (2010)

357

USA

03

47

810 1113 1418

13.5 42.2

52.2

53.1

13.2 40.2 55.7

44

49.6

61.9

13.7 44.1 33.2

54.6

44.7

Adults
Icen et al. (2009)

1,633

USA

1829 3039 4049 5059 6069 7079 80

T

77.4

81.1

71.3

88.0

94.2

73.8

51.4

75.6

69.2

69

90.7

76.2

71.2

39.8

79.4

93.3

73.6

85.2

115.3

77.9

80

2029 3039 4049 5059 6069

70

All ages
Bell et al. (1991)

USA

Huerta et al. (2007)

o20

132
T

30.9

49.1

71.7

51.4

94.6

112.6

47.1

41.3

61.2

58.6

109.1

126.5

54.9

14.8

59.5

82.9

43.8

78.3

93.8

130.6

3,994

UK

019

77.4

2029 3039 4049 5059 6069 7079 80

116

134

155

116

167

164

163

100

121

155

131

105

172

144

118

82

110

111

174

128

161

186

224

173

Abbreviations: F, female; M, male; Ps, psoriasis; T, total.

The main purpose of this investigation, and also the main

difference from other reviews, was to analyze only data from
the general population and to cluster studies on whether their
focus was children, adults, or individuals of all ages. We
found that psoriasis was less common in children than in
adults; therefore, studies estimating prevalence for all ages
showed a much lower rate compared with those calculating
the prevalence in adults especially in countries with a high
proportion of children and young people.
Other sources of heterogeneity in the results were likely to
be due to different methodologies, namely types of measure
(point, period, or lifetime prevalence) and case definition (selfreported, physicians, or dermatologists diagnosis). Point,
period, or lifetime prevalence may give different rates, as
psoriasis is subject to periods of remission and relapse;
however, the variation among studies according to this
criterion was present only in the United Kingdom, Germany,
and the United States. In contrast, the findings consistently
showed differences according to case definition. Specifically,
self-reported diagnosis gave higher rates compared with
physicians and dermatologists diagnoses.
Prevalence estimates using data from insurance databases
were generally lower than studies based on registries or
primary-care databases. This may be because insurance
databases likely represented only a proportion of the general
382

Journal of Investigative Dermatology (2013), Volume 133

population (e.g., employed), but underrepresented other subgroups (e.g., unemployed, retired, and disabled people).
Although there were a number of studies on the prevalence
of psoriasis, research on incidence was limited. Incidence
appeared to be higher in Europe than in the United States and
increased with age. Studies reporting age-specific incidence
rates showed a dual peak of psoriasis around 3039 years of
age and a second peak around 5059 or 6069 years of age
(Bell et al., 1991; Huerta et al., 2007; Icen et al., 2009). It is
believed that the bimodal distribution of psoriasis incidence
represents two clinical presentations of the disease, type I
(early-onset) and type II (late-onset), which are defined as
presenting at p40 and 440 years of age, respectively
(Henseler and Christophers, 1985). Furthermore, on combining the results of the two studies using the Rochester
Epidemiology Project database, it appeared that the incidence
of psoriasis was higher in females o18 years old, but was
higher in males X18 years old (Icen et al., 2009; Tollefson
et al., 2010). The same studies reported an increasing
incidence in children and adults over a 30-year period (Icen
et al., 2009; Tollefson et al., 2010). However, it was unclear
whether this represented a real increase, probably because
of a concomitant increase in risk factors (obesity, stress,
psychological conditions) for psoriasis, or improved
diagnostic methods, better collection of data, and more

R Parisi et al.
Global Epidemiology of Psoriasis

awareness of the disease (Tollefson et al., 2010). Nevertheless,

the findings from these two studies cannot be confirmed
because of the lack of similar research. It is recommended
that future studies focus on the incidence of psoriasis over a
long period of time.
Unfortunately, we were unable to compare age-standardized prevalence and incidence rates from the studies
included in this systematic review, as this level of data was
not included in many of the original studies. Comparison of
unadjusted rates within countries over time and between
countries should be interpreted cautiously if the underlying
age composition is likely to differ. Future studies examining
the epidemiology of psoriasis should routinely provide information on the prevalence and incidence of psoriasis by age
bands and gender in a standardized way to facilitate the
comparison of results between different studies.
Studies on the occurrence of psoriasis have contributed to
a greater appreciation of its burden and recognition of the
role of geography and ethnicity on the likelihood of developing the disease. Epidemiological studies are an important
contributor to our understanding of psoriasis, and there is a
need for future international research collaborations using
standardized methodology to address knowledge gaps that still
exist on the disease and potential trends in prevalence and
incidence over time.
MATERIALS AND METHODS
Search strategy
Three electronic databases (MEDLINE, EMBASE, and Web of Science)
were systematically searched from their respective inception dates to
July 2011. The main keywords used were psoriasis (psoriases,
psorias?s, psoriatic skin, pustulosis), psoriatic arthritis (arthritis, psoriatic, psoriatic arthritis, arthritis psoriatica, psoriatic
arthropathy, psoriatic rheumatism, psoriatic polyarthritis), incidence (incident studies or cohort studies), and prevalence
(prevalent studies or cross-sectional studies). In the final selection,
studies only focusing on psoriatic arthritis were excluded. There were
no language restrictions and studies were limited to humans.

Inclusion and exclusion criteria

Inclusion criteria were that all studies collected empirical data on
cases of psoriasis from a sample of the general population. Studies
estimating prevalence or/and incidence of other skin or autoimmune
diseases, but also providing data on psoriasis epidemiology, were
included. Conversely, exclusion criteria included studies not carried
out on the general population (such as dermatology clinics, data
collected from hospital admissions/visits or specific subgroups of the
population) and studies not providing sufficient information to
calculate prevalence or/and incidence rates for psoriasis.

Data extraction
In the first stage, all study titles and abstracts obtained from the
database searches were reviewed for eligibility by one of the authors
(RP); papers successfully passing through into the second stage were
appraised and those meeting the inclusion criteria were selected for
data extraction. The references of all included studies and review
articles identified were also screened to identify any additional
eligible studies.

Information extracted from each study included citation data

(authors, publication year), study design (study-period and setting),
population (country, age group), study methods (case definition, case
validation), type of prevalence (point, period, or lifetime), and
findings (number of patients with psoriasis, number of people at risk,
values of the prevalence and/or incidence reported and their 95%
CIs). All extracted data were double-checked by a coauthor (DMA) to
ensure its accuracy.

Data analysis
Measures of prevalence and/or incidence presented are those
reported in the individual studies; however, rates are presented as
percentage values for prevalence and rate/100,000 person-years for
incidence. Values were checked for potential errors (when possible)
on the basis of the number of cases of psoriasis and population
sample size. Missing information, such as prevalence and/or incidence rate and CIs were calculated when not reported in the study.
However, it was not possible to estimate CIs for some studies because
of lack of sufficient information. In addition, negative lower bounds of
CIs were replaced by zero.
Results were analyzed by country and age category (children, adult,
or all ages). Children were defined as being in the age group o18
years old. Within each country and category, study design (case
definition (self-reported vs dermatologist vs general practitioner diagnosis) and type of prevalence (point vs period vs lifetime prevalence))
were explored for possible differences. When multiple studies collected data from the same data set and time period, only the most
recent or the most complete articles were reported. When the same
study presented measures of prevalence and/or incidence of psoriasis
from different databases or populations, all results were reported.

CONFLICT OF INTEREST
The authors state no conflict of interest.

ACKNOWLEDGMENTS
This paper presents independent research funded by the National Institute for
Health Research (NIHR) under its Programme Grants for Applied Research
Programme (grant reference number RP-PG-0608-10163). The views expressed
are those of the author(s) and not necessarily those of the NHS, the NIHR, or
the Department of Health. We are grateful to Dr Elena Bichenkova, Dr
Suzanne Verstappen, and Dr Yu-Mei Chang for translation of articles in
Russian, Dutch, and Chinese, respectively.
SUPPLEMENTARY MATERIAL
Supplementary material is linked to the online version of the paper at http://
www.nature.com/jid

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