Derm Appeal Blog

Pediatric Psoriasis and Obesity

A recent study published in JAMA Dermatology has found that children with psoriasis are at an increased risk of developing comorbidities compared to children without psoriasis, and obesity appears to be an important independent risk factor for the development of these cooccurring disorders.

The study indicates that in addition to needing to manage the cutaneous symptoms of the disease, patients with psoriasis are also at a higher risk for developing a number of comorbidities including obesity, hyperlipidemia, hypertension, diabetes, metabolic syndrome, polycystic ovarian syndrome, nonalcoholic liver disease, and elevated function enzyme levels.

“The existence of these comorbidities in children with psoriasis is not really new to us. After the associations with these comorbidities were recognized in adult psoriasis patients, we began to recognize these associations in the pediatric population as well. What’s striking is the importance of obesity as an independent risk factor for the development of these comorbidities,” said Megha M. Tollefson, MD, the study’s corresponding author.

Dr. Tollefson and colleagues at the Mayo Clinic have determined the risk of elevated lipid levels (hyperlipidemia/hypertriglyceridemia), hypertension, metabolic syndrome, polycystic ovarian syndrome, diabetes, nonalcoholic liver disease, and elevated liver enzyme levels in children with and without psoriasis, after accounting for obesity.

The research found that children with psoriasis were significantly more likely to develop each of the comorbidities than those without psoriasis; obesity was found to be a strong risk factor for the development of each comorbidity–even in those children without psoriasis.

“We’ve been aware for quite some time of the association between obesity and psoriasis. It is very important that we recognize how much of a role obesity and psoriasis plays in the development of comorbidities,” Dr. Tollefson said. “While we found that psoriasis certainly does play a bit of a role in the development of these comorbidities, obesity is a much larger issue in relation to the development of these comorbidities.”

In addition to managing symptoms, physicians should focus on additional factors frequently associated with preventing and identifying the onset of comorbid conditions. Of paramount importance includes recognizing that obesity is likely a much larger factor in children who have psoriasis, and spending time discussing that issue with families.

“Even though our focus is typically the skin, obesity arguably is going to cause a much longer-term impact. So, in addition to speaking with the families during the consultations, it is very important to bring in the primary care specialist or pediatrician in a multidisciplinary forum to appropriately and effectively address the different comorbidities that can occur in this patient population,” Dr. Tollefson said.

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