Study Proposes Best Predictive Diagnostic Criteria for Paediatric Psoriasis

Pavankumar Kamat

September 14, 2021

A development study has proposed seven diagnostic criteria for paediatric psoriasis with favourable discriminatory ability in secondary care patients. The formula may not yet be ready for implementation in routine clinical practice but could serve as a starting point for further exploration and evolution of the diagnostic criteria.

Diagnosis of psoriasis can be more complicated in children and young people than in adults, primarily due to its subtler presentation and inadequate recognition in primary and secondary care.

DIPSOC was a case-control study involving participants aged 0-18 years from 12 UK paediatric dermatology departments, designed to test the diagnostic accuracy of consensus-agreed criteria for paediatric plaque psoriasis and further shortlist the 'best predictive diagnostic criteria'. The study recruited 170 individuals with a confirmed diagnosis of psoriasis (cases) and 160 individuals who had been diagnosed with a different inflammatory skin disease (control participants).

There were 16 consensus-agreed criteria, with one major and/or three or more minor criteria as the proposed cut-off for a diagnosis of psoriasis. The consensus-agreed criteria demonstrated a higher sensitivity (82.9%) than specificity (65%) and a moderate area under curve (AUC) of 0.7397 (95% CI, 0.693-0.786) for discrimination between cases and control participants.

Seven criteria were selected from the consensus-agreed criteria as the ‘best predictive criteria’, using logistic regression modelling. These were:

  1. Scaly and erythematous scalp involving the hairline.

  2. Scaly erythema within the external auditory meatus.

  3. Persistent well-demarcated erythematous rash anywhere on the body.

  4. Scaly erythematous plaques involving extensor surfaces of the elbows and/or knees.

  5. Persistent erythema in the umbilicus.

  6. Well-demarcated erythematous rash in the napkin area involving the crural folds.

  7. Family history of psoriasis.

The best predictive diagnostic criteria demonstrated good diagnostic accuracy overall (sensitivity, 76.8%; specificity, 72.7% and AUC, 0.84; 95% CI, 0.79-0.88). The presence of two or more diagnostic criteria could correctly identify paediatric psoriasis cases with a sensitivity of 78.4% and a specificity of 71.2%.

Presenting their findings in the  British Journal of Dermatology,  the authors stated: "Three of the best predictive criteria involve skin in hidden sites, such as umbilicus, groin flexures and external auditory meatus. These criteria will therefore be helpful to prompt examination of these specific areas to determine whether a patient has psoriasis or not." They call for further validation of the criteria in an external cohort.

Burden-The E, Murphy R, Gran S, Nijsten T, Hughes C, Abdul-Wahab A, Bewley A, Burrows N, Darne S, Gach JE, Katugampola R, Jury CS, Kuet K, Llewellyn J, McPherson T, Ravenscroft JC, Taibjee S, Wilkinson C, Thomas KS. Identifying the best predictive diagnostic criteria for psoriasis in children (<18 years): A UK multicenter case-control diagnostic accuracy study (DIPSOC study). Br J Dermatol. 2021 Sep 03 [Epub ahead of print]. doi: 10.1111/bjd.20689. PMID: 34477218

This article originally appeared on Univadis, part of the Medscape Professional Network.

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