Pediatric Psoriasis: A Peek into the Comorbidity Profile

Psoriasis is a multifactorial immune-mediated inflammatory disorder in which the involvement of the skin is merely the tip of the iceberg. It poses a significant global problem affecting both children and adults, with childhood onset occurring in almost one-third of the cases. Early diagnosis of pediatric psoriasis is crucial to address, identify, and manage the growing list of established extracutaneous manifestations and comorbidities.

To study the clinico-epidemiological profile of pediatric psoriasis and determine the prevalence of various comorbidities associated with it.

This was a cross sectional observational study conducted at the Department of Dermatology of a tertiary care hospital of North India over a period of 36 months and included all patients aged 9 months to 18 years with a clinical diagnosis of psoriasis. A predesigned structured proforma was used to collect the required information from the study subjects.

Eighty-six patients were recruited in this study, of which 47 (54.65%) were males and 39 (45.34%) were females. The most common type of psoriasis seen in this study was chronic plaque psoriasis (63%). Eight (9.30%) patients had evidence of psoriatic arthritis at presentation. Abnormal waist circumference was observed in 26 (30.23%) of the 86 patients recruited in the study. Abnormal BMI was recorded in 49 (56.97%) patients, of which 27 (31.39%) were overweight and 22 (25.58%) were obese. Ten (11.62%) patients had evidence of impaired fasting glucose, while 1 (1.16%) patient had type 2 diabetes mellitus. Increased levels of total cholesterol were observed in 13 (15.11%) patients involved in the study. Fifty-nine (68.60%) patients had at least 1 lipid profile abnormality. Eight (9.30%) participants fulfilled the criteria for metabolic syndrome. Concomitant autoimmune diseases were seen in 42 (48.83%) patients, of which hypothyroidism was the most common, followed by vitiligo, alopecia areata, type 1 diabetes mellitus, systemic lupus erythematosus, and juvenile rheumatoid arthritis.

Although the association between psoriasis and various comorbidities is well documented in adults, studies demonstrating the same relationship in children are still lacking. However, psoriasis begins in childhood or adolescence in approximately 40% of patients, suggesting that the risk of comorbidities may also begin early in life. This presents an opportunity for prevention, early detection, and intervention for children who may suffer from or be at a risk of comorbidities, especially metabolic ones.