6 Conditions Connected With Pediatric Psoriasis
As if the painful lesions or bumps associated with pediatric psoriasis aren’t enough for kids to contend with, there are often other issues that come with the disorder, too. Kids with the skin disease are significantly more likely to develop certain health conditions (such as diabetes and depression) than those without it, according to a study in JAMA Dermatology. “Psoriasis is an inflammatory disorder, and that inflammation is not limited to the skin; it’s systemic,” says Brittany Craiglow, M.D., pediatric dermatologist and associate adjunct professor of dermatology at Yale Medical School in New Haven, CT. Because of this, parents should look out for these common complications.
The Factor You Need to Know About
There’s a common link between psoriasis and many of its complications: weight. “There’s some evidence to suggest that kids with a higher BMI are more likely to have more body surface areas involved, and more severe disease,” says Dr. Craiglow. “We know these two things amplify each other, but we don’t know why.” It’s a chicken-or-egg scenario: weight gain may increase inflammation. Or, it can also be that a child with psoriasis may feel self-conscious about his skin and so he’s less active, and that may lead weight gain. “There’s not a direct line,” she says.
Why You May Need to Worry About Weight
Regardless of weight, children with psoriasis are at risk of developing other health conditions. Obesity may just make it more so, according to research published in JAMA Dermatology. Because of that, the weight of children with psoriasis should be monitored closely, and parents of kids who are already overweight should be provided with referrals and resources for weight management, says Saakshi Khattri, M.D., a dermatologist, rheumatologist, and internist at Mount Sinai Doctors in New York City.
Heart Disease Isn’t Just for Grownups
Research has shown that regardless of body weight, children with psoriasis have higher blood lipids—think the various types of cholesterol levels and triglycerides. High lipids put kids at risk for cardiovascular disease—and having psoriasis seems to increase these blood fat levels. “For sure, obesity is a contributor to that, too, but psoriasis seems to be an independent risk associated with this,” says Dr. Craiglow. Conversely, some kids with psoriasis may have a normal lipid profile but have markers that contribute to a buildup in coronary arteries, she says.
Monitor Your Little One’s Lipids
To stay on top of your child’s heart health, regular lipid screenings are essential. “Children with psoriasis may benefit from early and frequent monitoring for cardiovascular and metabolic risk,” says Dr. Khattri. Still, the current pediatric psoriasis guidelines mirror that of the American Academy of Pediatrics (AAP): fasting lipid screenings are done between 9 and 11 years old, and then from ages 17 to 21 regardless of risk factors. Beyond that, parents should keep an eye on risk factors such as poor diet, lack of physical activity, and lifestyle behaviors such as smoking.
There’s a Psoriasis-Diabetes Connection
The skin condition may put kids at risk for another disease marked by chronic inflammation: type 2 diabetes. The common connection here? Obesity. “Patients with pediatric psoriasis with obesity are more likely to have insulin resistance relative to patients with pediatric psoriasis of normal weight,” says Dr. Khattri. Recent research also suggests that the inflammatory skin disease may be linked to type 1 diabetes, which is thought to have genetic and autoimmune components.
Develop Diabetes Awareness
Screening for diabetes in kids with psoriasis is the same as it is for all children: testing fasting glucose serum every three years starting at age 10, or the onset of puberty if your child is overweight and has other risk factors, such as a strong family history. Outside of the doctor’s office, there are warning signs to lookout for: increased thirst, frequent urination, fatigue, blurred vision, etc. In addition, Dr. Craiglow says darker, thicker skin around the back of the neck is caused by too much insulin and a sign of prediabetes.
Do a Mental Health Check
If your child seems down more often than not, know this: Kids with psoriasis were more likely to have mental health conditions—such as anxiety, bipolar disorder, and depression, than those without the disease, according to research published in Pediatric Dermatology. The reason why is unclear, but Dr. Craiglow points out that severe disease can have a huge impact on a child’s quality of life. “That alone can lead to depression, anxiety, and social withdrawal,” she says.
Mind Your Child’s Mood
Kids with psoriasis may be subjected to bullying, which can affect their emotional health. Keep an eye out for changes in your child’s mood, behavior, self-esteem, and social experiences and have your child screened annually for depression and anxiety regardless of age (this is a departure from the AAP’s recommendation for screening all children at age 12). Something else to keep in mind: Adolescents and teens look for different ways to cope with their condition and the challenges it brings; therefore, also have your child screened for substance abuse starting at age 11.
Psoriasis vs Psoriatic Arthritis: Chicken or the Egg?
Achy, swollen, or inflamed joints can be a sign of psoriatic arthritis—a form of arthritis that tends to co-occur and share a genetic basis with psoriasis. Unlike other associated conditions, the arthritis may actually show up before the psoriasis, says Dr. Craiglow. The timing of these arthritic flares tends to happen twice in childhood: first, around ages two or three, and then again at ages 10 to 12.
In about 80% of the cases, it occurs two to three years prior to the appearance of skin lesions, but this doesn’t mean one leads to the other. Only a third of kids with psoriasis will experience psoriatic arthritis.
Become an Arthritis Spotter
There’s no lab test for psoriatic arthritis; if your child has any of the symptoms below, bring them to their doctor’s attention as they are potential signs for psoriatic arthritis:
- Swelling of the fingers and toes
- Red, tender, and/or swollen joints
- Morning stiffness
- Avoidance of physical activity or difficulty walking or holding toys
- Seeming more tired than usual or irritability
- Eye pain or redness
The Weird Connection Between the Gut and Psoriasis
Inflammation is a funny thing. It occurs in one area of the body and can affect other areas. Case in point, research suggests that a disruption in gut bacteria is associated with inflammatory skin disorders, including psoriasis. This may explain the strong link between pediatric psoriasis and digestive disorders. A study in Pediatric Dermatology found that ulcerative colitis and Crohn’s disease were more common in kids with psoriasis than in those who didn’t have the skin disease. In addition, kids with psoriasis also have higher rates of inflammatory bowel disease.
Keep Tabs on Tummy Troubles
Abdominal pain, vomiting, nausea, and chronic diarrhea can all be signs of a digestive disorder. You also want to keep an eye on your child’s growth. A slowdown in her growth rate or unexplained weight loss can also point to inflammatory bowel diseases, such as Crohn’s or ulcerative colitis. If you notice any of these signs, it’s time to see a pediatric gastroenterologist for an evaluation.
Comorbidities and Psoriasis: The Dermatology Times. (2020). “Comorbidities More Prevalent in Pediatric Psoriasis Patients.” https://www.dermatologytimes.com/view/comorbidities-more-prevalent-pediatric-psoriasis-patients
Comorbidities and Obesity in Psoriasis: JAMA Dermatology. (2018). “Association of Psoriasis with Comorbidity Development in Children With Psoriasis.” https://jamanetwork.com/journals/jamadermatology/fullarticle/2667768
Lipid Levels in Obese Children with Psoriasis: Journal of Pediatrics. (2011). “The Association of Psoriasis and Elevated Blood Lipids in Overweight and Obese Children.” https://pubmed.ncbi.nlm.nih.gov/21524758/
Psoriasis Screening Guidelines: JAMA Dermatology. (2017). “Pediatric Psoriasis Comorbidity Screening Guidelines.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5748031/
Psoriasis and Type 1 Diabetes: Acta Diabetologica. (2017). “Psoriasis in Children with Type 1 Diabetes: A New Comorbidity To Be Considered?” https://link.springer.com/article/10.1007/s00592-017-1000-3
Psoriasis and Psychiatric Disorders: Pediatric Dermatology. (2019). “A Retrospective Cohort Study to Evaluate the Development of Comorbidities, Including Psychiatric Comorbidities, Among a Pediatric Psoriasis Population.” https://onlinelibrary.wiley.com/doi/full/10.1111/pde.13772
Psoriatic Arthritis Facts: Children’s Hospital of Philadelphia. (n.d.). “Psoriatic Arthritis in Children.” https://www.chop.edu/conditions-diseases/psoriatic-arthritis-children
Psoriasis and Digestive Disorders: Journal of Family Medicine and Primary Care. (2019). “The Role of Gut Microbiome in the Pathogenesis of Psoriasis and the Therapeutic Effects of Probiotics.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6881942/