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The Association of Psoriasis and Bacterial Infections in Pediatric Patients: A Retrospective Review
Manisha Ravi1, Kelly M Cordoro2, Kristen E Holland3
1The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio, USA.
Insights
Pediatric psoriasis may be linked to bacterial infections. Investigations for anogenital and pharyngeal infections are recommended, especially for inverse psoriasis, as bacterial cultures did not directly correlate with psoriasis treatment response.
Area of Science:
- Pediatric Dermatology
- Infectious Diseases
- Microbiology
Background:
- Guttate psoriasis and plaque psoriasis flares are linked to streptococcal pharyngitis.
- Limited literature exists on anogenital bacterial dermatitis and pediatric psoriasis.
- This study evaluates pediatric patients with psoriasis and concurrent bacterial infections.
Purpose of the Study:
- To assess clinical characteristics of pediatric psoriasis with bacterial infections.
- To identify microbiology of associated pharyngeal and anogenital infections.
- To analyze treatment courses and outcomes.
Main Methods:
- Multicenter retrospective review of patients 18 years or younger.
- Included patients with psoriasis/psoriasiform dermatitis and positive bacterial cultures.
- Evaluated demographics, clinical features, microbiology, treatments, and outcomes.
Main Results:
- 166 pediatric patients evaluated; Staphylococcus and Streptococcus species identified in anogenital cultures.
- Inverse psoriasis associated with positive anogenital culture (p=0.0356).
- Guttate psoriasis more common with positive pharyngeal culture (p<0.0001). Bacterial treatment did not correlate with psoriasis response.
Conclusions:
- Consider investigating anogenital and pharyngeal infections in pediatric psoriasis patients.
- Maintain high suspicion for anogenital infection in pediatric inverse psoriasis.
- Bacterial infection treatment does not predict psoriasis treatment response.
Background/Objectives:
Guttate psoriasis onset and plaque psoriasis flares are associated with streptococcal pharyngitis. Literature regarding the relationship between anogenital bacterial dermatitis and psoriasis in pediatric patients is limited. We aimed to evaluate the clinical characteristics, microbiology, and treatment course of patients with psoriasis/psoriasiform dermatitis and concomitant pharyngeal and/or anogenital bacterial infections.
Methods:
A multicenter retrospective review of patients ≤ 18 years of age with psoriasis/psoriasiform dermatitis and bacterial infection, defined by positive culture results, was performed. Demographic characteristics, clinical features, microbiology, treatment recommendations, and outcomes were evaluated. Comparisons were made between pharyngeal and anogenital culture groups.
Results:
A total of 166 unique patients with psoriasis/psoriasiform dermatitis and suspected pharyngeal and/or anogenital infection were evaluated between 2011 and 2021. Staphylococcus sp. and Streptococcus sp. were isolated in anogenital cultures. Inverse psoriasis was associated with a positive anogenital culture (p = 0.0356). Guttate psoriasis was more common in patients with a positive pharyngeal culture (p < 0.0001). Treatment of a positive bacterial culture did not correlate with the treatment response of psoriasis/psoriasiform dermatitis.
Conclusions:
Investigations for anogenital and pharyngeal infections should be considered in pediatric patients presenting with new-onset or worsening psoriasis. A high clinical suspicion should be maintained for anogenital infection in patients with inverse psoriasis, specifically.
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