Key Pediatric Clinical Practice Guidelines in 2017

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

Disclosures

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.

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

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....