A study has found that children with psoriasis are higher risk than those without it to develop comorbidities. Children who are obese are at significantly higher risk than those with psoriasis alone for developing other comorbidities.
Recent research suggests that the presence of psoriasis is associated with a higher risk for the development of comorbidities in children. Most of the current evidence on associations between psoriasis and comorbidities in children has based on small case series or small population-based studies, and large-scale studies evaluating this link are lacking. “There are questions about how much comorbidity development is due to psoriasis versus how much of it might be due to obesity,” explains Megha M. Tollefson, MD. “Children with psoriasis are much more likely to be obese than those without psoriasis, but it is unknown if psoriasis is an independent risk factor for the development of metabolic syndrome, cardiovascular disease, and other related comorbidities in children.”
Important New Data
Dr. Tollefson and colleagues had a study published in JAMA Dermatology that looked at the risk of elevated lipid levels, hypertension, metabolic syndrome, polycystic ovarian syndrome, diabetes, nonalcoholic liver disease, and elevated liver enzyme levels in a large group of children with and without psoriasis. The investigators also explored the relative contribution of obesity to the risk of developing comorbidities in children with and without psoriasis. “This information could assist clinicians during dermatologic and primary care visits because it may guide and prioritize treatment decisions,” says Dr. Tollefson.
The retrospective review of claims data assessed two cohorts of nearly 60,000 children, about 30,000 of which had psoriasis. The first cohort included children with psoriasis whereas the second consisted of age-, sex-, and race-matched children without psoriasis who were divided into 4 groups: 1) nonobese without psoriasis, 2) nonobese with psoriasis, 3) obese without psoriasis, and 4) obese with psoriasis. More children with psoriasis were obese when compared with those without psoriasis (2.9% vs 1.5%).
Children with psoriasis were significantly more likely to develop high lipid levels, hypertension, diabetes, metabolic syndrome, and other comorbidities than those without psoriasis (Table). “While psoriasis and obesity both contributed to comorbidity development in children with psoriasis, obesity was a much larger contributing factor,” Dr. Tollefson says. The study also showed risks of comorbidities were 40% to 75% higher among nonobese children with psoriasis when compared with those without it.
“Based on our results, clinicians who see children in the clinical setting should have greater comfort with addressing and managing comorbidities, especially among those who are overweight,” says Dr. Tollefson. “To decrease risks for developing comorbidities, one strategy may be to reduce obesity, but further studies are needed to investigate this possibility. We need data on the effect of weight loss and dietary improvement on risks for comorbidity development in children with psoriasis who are obese.”
The investigation also discovered several new comorbidities in pediatric psoriasis. For example, polycystic ovarian syndrome and nonalcoholic liver disease have been identified as comorbidities in adults with psoriasis, but the findings of these risk factors among pediatric patients are novel. More research is needed to determine how much of this risk is attributable to the psoriasis itself.
According to Dr. Tollefson, physicians should recognize that overweight children with psoriasis are at the greatest risk of comorbidity development and be aware that normal weight children with psoriasis are also at slightly increased risk for developing comorbidities. “The indication for treatment with systemic medications should be the severity of the psoriasis itself rather than the risk of comorbidity development,” she says. “Clinicians should be vigilant and evaluate all children with psoriasis for comorbidities, but our results highlight the importance of screening all overweight patients because obesity appears to be a much larger contributor to comorbidity development.”
Tollefson MM, Van Houten HK, Asanta D, Yao X, Maradit Kremers H. Association of psoriasis with comorbidity development in children with psoriasis. JAMA Dermatol. 2018;154:286-292. Available at: https://jamanetwork.com/journals/jamadermatology/fullarticle/2667768
Augustin M, Radtke MA, Glaeske G, et al. Epidemiology and comorbidity in children with psoriasis and atopic eczema. Dermatology. 2015; 231:35-40.
Paller AS, Mercy K, Kwasny MJ, et al. Association of pediatric psoriasis severity with excess and central adiposity: an international cross-sectional study. JAMA Dermatol. 2013;149:166-176.