Tollefson MM, Van Houten HK, Asante D, Yao X, Kremers HM. Association of Psoriasis with Comorbidity Development in Children with Psoriasis. JAMA Dermatol. 2018;154:286-292. DOI: 10.1001/jamadermatol.2017.5417.
Psoriasis -- a common inflammatory condition primarily affecting skin, nails, and joints -- is rising in incidence among children. In small prior studies, psoriasis has been associated with a higher risk of metabolic syndrome and high cholesterol among children. In this population-based study, 29,957 individuals with psoriasis <19 years old and 29,957 controls (without psoriasis) were matched on age, sex, and race. Children with psoriasis were significantly more likely than those without to develop elevated lipids, hypertension, diabetes, metabolic syndrome, polycystic ovarian syndrome, nonalcoholic liver disease, and elevated liver enzyme levels during the 3-year follow-up period.
The source of data for this retrospective cohort study was the Optum Laboratories Data Warehouse, which includes data on more than 150 million privately insured individuals and also Medicare Advantage enrollees in the US. Children in the dataset are the dependents of adults who have private insurance. The study period was January 2004 through December 2013; the mean age was 12 years, and the mean follow-up time for the cohort was about 3 years. Diagnoses were based on insurance claims for medical visits and procedures. The first claim for psoriasis was used as the date when the condition began for each subject. At baseline, a higher proportion of children with psoriasis had obesity (2.9%) compared to children without psoriasis (1.5%). Independent of obesity status, the risk of medical conditions ("comorbidities") was approximately 40%-75% higher among children with psoriasis. Overall, obesity was a stronger risk factor for the development of comorbidities than was psoriasis. These findings are a reminder that psoriasis is more than "skin-deep" and is associated with comorbidities in childhood that are typically associated with obesity.