Key Pediatric Clinical Practice Guidelines in 2017

John Anello; Brian Feinberg; John Heinegg; Yonah Korngold; Richard Lindsey; Cristina Wojdylo; Olivia Wong, DO


January 10, 2018

In This Article

Psoriasis Comorbidities in Children

Pediatric Dermatology Research Alliance and National Psoriasis Foundation

Overweight or obesity

  • Screen for overweight and obesity using body mass index criteria starting at age 2 yr (overweight: ≥85th percentile to <95th percentile; obese: ≥95th percentile).

Type 2 diabetes

  • Screen every 3 yr starting at age 10 yr or the onset of puberty in overweight patients who have two risk factors for type 2 diabetes.

  • Screen obese patients every 3 yr starting at age 10 yr or puberty onset, regardless of risk factors.

  • Screen using fasting serum glucose.

  • Screening is not recommended in prepubertal children, as there is a very small risk for type 2 diabetes in this group.


  • Perform universal lipid screening for children aged 9-11 yr and again between ages 17-21 yr.

  • Outside these age ranges, screen children who have cardiovascular risk factors.

  • A fasting lipid panel is recommended.


  • Screen yearly starting at age 3 yr, using age, sex, and height reference charts.

Nonalcoholic fatty liver disease (NAFLD)

  • Screen with alanine aminotransferase starting at age 9-11 yr in all children with obesity or overweight with risk factors including central adiposity, insulin resistance and associated conditions, prediabetes or diabetes, dyslipidemia, obstructive sleep apnea, or family history of NAFLD/NASH (nonalcoholic steatohepatitis).

  • Consider earlier screening in younger patients with risk factors such as severe obesity, family history of NAFLD or NASH, or hypopituitarism.

  • After initial normal screen, consider repeat aminotransferase screening every 2-3 yr if risk factors stay the same, or sooner if they increase in number or severity.

Polycystic ovary syndrome

  • Providers should be aware of the possible coexistence of polycystic ovary syndrome; consider testing in patients with symptoms (oligomenorrhea, hirsutism).

Gastrointestinal disease

  • Children with psoriasis have an increased risk for inflammatory bowel disease; consider gastrointestinal evaluation in patients with decreased growth rate, unexplained weight loss, or symptoms of inflammatory bowel disease.


  • Screen with review of systems and physical exam.

  • Screen for arthritis at time of psoriasis diagnosis and periodically thereafter.


  • Screening with routine ophthalmology exams is only warranted in patients with psoriatic arthritis.

Mood disorders and substance abuse

  • Conduct annual screening for depression and anxiety regardless of age.

  • Conduct annual screening for substance abuse starting at age 11 yr.

Quality of life (QOL)

  • Screen for QOL issues; consider using a formalized QOL instrument such as the Children's Dermatology Life Quality Index.

Systemic therapy

  • Before starting systemic therapy, consider comorbidities, which can affect medication choice, tolerability, and adverse effects; perform baseline and monitoring tests (eg, lipids or liver enzyme tests) as needed.



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