What comorbidities are associated with psoriasis?
This month, the National Psoriasis Foundation and the Pediatric Dermatology Research Alliance jointly released the first set of comorbidity screening guidelines for pediatric psoriasis. The guidelines were published as a consensus statement in JAMA Dermatology this month.1
“Pediatricians may not be aware of the very strong literature of psoriasis being associated with comorbidities. It’s very clear in adults that there are significant health issues that are associated with psoriasis, including increased incidence of myocardial infarction, diabetes, hypertension, hyperlipidemia, arthritis, obesity, metabolic syndrome, and liver disease.” 2 -Lawrence Eichenfield, MD, lead author and professor of Dermatology and Pediatrics at the University of San Diego School of Medicine, California
Who developed the guidelines?
The guidelines were created by a wide range of experts including pediatric dermatologists, pediatric rheumatologists, pediatric gastroenterologists, adult and pediatric cardiologists, pediatric endocrinologists, and specialists on pediatric liver disease. The consensus guidelines are intended for use by primary care providers, dermatologists, and other specialists who work with children, and stress early intervention and routine screening procedures for potential comorbidities to psoriasis in children. The goal of these guidelines is to help providers assess and identify potential risk factors in children with psoriasis, who could carry these increased risks into adulthood. The authors believe that if these risks are identified and followed, an improvement in long-term health could be possible.
“These mainly consensus-based recommendations provide a starting point for screening that will be refined as more is learned. As studies further detail the comorbidity risks in children, there may be a need to further stratify screening (eg, by age group, disease subtype, severity).” 1
How are the guidelines developed?
The authors utilized 153 previously published articles on psoriasis, including 26 centered specifically on pediatric psoriasis, to create the guidelines. They gave the guidelines a grading of C, which means they were created using information on usual practice, opinion, disease-oriented evidence, consensus, and/or case series. As a whole, the guidelines aren’t incredibly different from the current recommendations for children and adolescents without psoriasis, as set forth by the American Academy of Pediatrics. Ultimately, the guidelines suggest that providers treating children with psoriasis should be aware and cautious of comorbidities that exist with the condition, however, they do not support more intensive screening at this time.
The research that informed these guidelines, as well as research on pediatric psoriasis in general, is currently slim and features many gaps in content. The researchers hope that as more information becomes available in the near future, the guidelines can be adjusted. Right now, new treatment options are in testing and development for pediatric psoriasis. Currently, much research is underway for biologic treatments indicated for use in children, with only one biologic, Enbrel (etanercept) made by Amgen, Inc, on the market currently.
What are some of the comorbidities included?
Potential comorbidities that could affect children with psoriasis, especially as they move into adulthood, include psoriatic arthritis, depression, anxiety, early myocardial infarction, decreased quality of life, experience as a victim of bullying, and impaired school, social, or emotional functioning.
The full guidelines can be found by clicking here, and surround the following:
-Type 2 Diabetes
-Nonalcoholic Fatty Liver Disease
-Polycystic Ovary Syndrome
-Mood Disorders and Substance Abuse
-Quality of Life