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.
Dyslipidemia
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.
Hypertension
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.
Arthritis
Screen with review of systems and physical exam.
Screen for arthritis at time of psoriasis diagnosis and periodically thereafter.
Uveitis
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.
References
Hackethal V. Guidelines on Psoriasis Comorbidity Screening in Kids Issued. Medscape. WebMD Inc. May 23, 2017. http://www.medscape.com/viewarticle/880462
Osier E, Wang AS, Tollefson MM, et al. Pediatric Psoriasis Comorbidity Screening Guidelines. JAMA Dermatol. May 17, 2017. http://jamanetwork.com/journals/jamadermatology/article-abstract/2627297
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Key Pediatric Clinical Practice Guidelines in 2017 - Medscape - Jan 10, 2018.
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