Pediatric Psoriasis Comorbidities

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

Disclosures

Skin Therapy Letter. 2020;25(5):1-6. 

In This Article

Other Comorbidities

Several other comorbidities have been reported in association with psoriasis in adults, but whether the same exists in pediatric patients remains unknown.

Gastrointestinal Disease

Inflammatory Bowel Disease. Psoriasis has been associated with both inflammatory bowel disease (IBD) and celiac disease. Adults with psoriasis have an increased risk of developing IBD, in particular Crohn's disease;[54] that risk is greatest among patients with psoriatic arthritis.[55] The association between IBD and psoriasis may stem from a shared genetic susceptibility.[56–58] The use of anti-tumor necrosis factor (TNF) agents to treat pediatric IBD adds another layer to the association between IBD and psoriasis. These biologic therapies may result in new onset or exacerbation of psoriasis or psoriasiform eruptions, an effect that has been well documented among adult and pediatric patients.

Celiac Disease. Patients with psoriasis may be at increased risk of developing celiac disease, a chronic immune-mediated gluten-dependent enteropathy. And psoriasis may be more prevalent among children and adolescents with celiac disease.[59] The nature of this association remains unclear. A gluten-free diet may benefit a subset of psoriatic patients with elevated anti-gliaden antibodies.[60]

Providers should inquire about gastrointestinal symptoms and growth during clinical visits with pediatric psoriasis patients and pursue further evaluation as indicated. Currently, there is insufficient data to suggest universal screening for IBD or celiac disease among pediatric patients with psoriasis.

Type 1 Diabetes

There may be an increased risk of psoriasis among children with type 1 diabetes.[61] Whether children with psoriasis carry an increased risk of type I diabetes is not known, and additional studies are needed to delineate this relationship.

Polycystic Ovarian Syndrome (PCOS)

Adult women with PCOS have an increased risk of severe psoriasis,[62,63] which may compound the risk of metabolic syndrome. There is to date no evidence linking PCOS with psoriasis in pediatric patients.

Risk of Malignancy

Adults with psoriasis have an increased risk of malignancy, in particular lymphoma, with a relative risk of 2.95.[29] One retrospective review suggested that pediatric psoriasis patients may also have an increased risk of developing malignancy, although this difference was not statistically significant.[64] As there may be an additional risk of malignancy conferred by the use of conventional and biologic systemic therapies, the independent risk of psoriasis on development of cancer is difficult to determine.

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