Pediatric Psoriasis Comorbidities

Nicole W. Kittler, MD; Kelly M. Cordoro, MD

Disclosures

Skin Therapy Letter. 2020;25(5):1-6. 

In This Article

Obesity

There is a strong association between psoriasis and obesity in children, though the evidence for this link is less robust than in adults.[14–18] Compared to children presenting to pediatric dermatologists for non-inflammatory skin conditions such as warts, the odds ratio for obesity (defined as waist circumference >90th percentile) for children with psoriasis is 2.52, and 3 for patients with severe psoriasis, with the greatest risk occurring in Hispanic and African American children.[17]

The nature of the association between psoriasis and obesity is complex and likely bidirectional. Obesity predates psoriasis by at least 2 years in >90% of children, with a mean delay in onset of psoriasis of >4 years.[18] Children with higher body mass indices (BMI) are more likely to have greater body surface area of involvement of their psoriasis[18] and more severe disease.[16] Children with psoriasis have increased central adiposity, even in the absence of obesity.[19,20] It has been hypothesized that excess adipose tissue contributes to a proinflammatory state and the development of psoriasis.[21] Psoriasis leads to decreased physical activity due to embarrassment over appearance and increased itching from heat and sweat during exercise,[22] which can amplify the psoriasis-obesity cycle. However, a recent study demonstrated that children with psoriasis who are not obese at the time of diagnosis are just as likely to develop obesity after diagnosis as those without psoriasis.[23]

Obesity may be the strongest contributor to the development of other comorbidities in children with psoriasis including hyperlipidemia, hypertension, diabetes, metabolic syndrome, polycystic ovarian syndrome and nonalcoholic liver disease.[24] It is therefore critical that providers screen for, and manage, obesity and overweight in children with psoriasis. Because psoriasis is an independent risk factor for subsequent cardiovascular disease, providers providers should aim to minimize any additional risk through lifestyle modifications that control weight gain. Weight loss may also have a positive impact on the severity of psoriasis.[25] The AAP recommends annual BMI screening for all children beginning at age 2 years.[3] Providers should discuss the importance of maintaining healthy weight with patients and their families and, if available, consider referrals for nutritional counseling or to a weight management center.

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