1
|
Joseph RE, Sathishkumar D, Gupta A, Korula S. Metabolic Comorbidities in Pediatric Psoriasis-A Comparative Cross-Sectional Study in South-Asian Children. Indian Dermatol Online J 2024; 15:605-611. [PMID: 39050071 PMCID: PMC11265755 DOI: 10.4103/idoj.idoj_729_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/21/2024] [Accepted: 01/21/2024] [Indexed: 07/27/2024] Open
Abstract
Background There is only limited data on the association between psoriasis and metabolic comorbidities in South-Asian children. Objective To examine metabolic comorbidities among South-Asian children with and without psoriasis. Materials and Methods A hospital-based, comparative, cross-sectional study was conducted in children with and without psoriasis over 19 months. Anthropometric, clinical, and metabolic comorbidity details (including disease extent and severity scores, obesity, systemic hypertension, diabetes mellitus, lipid abnormalities, and metabolic syndrome) were obtained in both groups according to standard criteria. Results Fifty-eight children with psoriasis (25 males/33 females, age 11.3 ± 3.0 years, range 4 to 17 years) and 62 children without psoriasis (37 males/25 females, age 11.0 ± 3.6 years, range 4 to 18 years) were recruited. The prevalence of obesity (31.0% versus 14.5%, P = 0.031, odds ratio 2.65) and metabolic syndrome (18.6% versus 4.6%, P = 0.044, odds ratio 4.68) were higher in children with psoriasis than without. The prevalence of other metabolic comorbidities (systemic hypertension, pre-diabetes, lipid abnormalities, elevated serum alanine aminotransferase, and non-alcoholic fatty liver disease) was not different between children with and without psoriasis and between obese and non-obese children with psoriasis. Among children with psoriasis, those with abdominal obesity had significantly lower disease severity and extent scores than those without. Conclusion Psoriasis is associated with a significantly higher prevalence of obesity and close to significantly higher prevalence of metabolic syndrome in South-Asian children. Screening for metabolic comorbidities is essential even in non-obese children with psoriasis. Disease extent and severity are less in obese compared to non-obese South-Asian children with psoriasis.
Collapse
Affiliation(s)
- Ranjana E. Joseph
- Department of Dermatology, Paediatric Endocrinology and Metabolism Division, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dharshini Sathishkumar
- Department of Dermatology, Paediatric Endocrinology and Metabolism Division, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ankan Gupta
- Department of Dermatology, Paediatric Endocrinology and Metabolism Division, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sophy Korula
- Department of Pediatrics, Paediatric Endocrinology and Metabolism Division, Christian Medical College, Vellore, Tamil Nadu, India
| |
Collapse
|
2
|
De Simoni E, Rizzetto G, Molinelli E, Capodaglio I, Offidani A, Simonetti O. The Role of Diet in Children with Psoriasis: Emerging Evidence and Current Issues. Nutrients 2023; 15:nu15071705. [PMID: 37049545 PMCID: PMC10097110 DOI: 10.3390/nu15071705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/17/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Psoriasis is an immune-mediated inflammatory systemic disease with skin tropism and chronic relapsing course; it is associated with an increased cardiovascular risk and with many metabolic comorbidities, emerging during childhood in 22–33% of cases. Diet influences the presentation and the clinical course of inflammatory diseases, including psoriasis; in particular, it was shown that a Mediterranean, gluten-free, or low-calorie diet may positively affect disease control in adult patients with psoriasis and adequate pharmacological therapy. These three dietary regimens may play a role also in children with psoriasis. It has been demonstrated that pediatric psoriasis is associated with psychological stress, celiac disease, and obesity, which may be positively influenced by these dietary regimens, respectively. Therefore, the expertise of multiple health figures (gastroenterologists, nutritionists, pediatricians, dermatologists) is required to plan a tailor-made dietary strategy, ensuring good growth, through an adequate intake of essential micro- and macronutrients and, at the same time, impacting the pro-inflammatory biochemical profile and on the associated cardiovascular risk of psoriasis disease.
Collapse
Affiliation(s)
- Edoardo De Simoni
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Giulio Rizzetto
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60126 Ancona, Italy
- Correspondence:
| | - Elisa Molinelli
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Irene Capodaglio
- Hospital Cardiology and UTIC, Ospedali Riuniti di Ancona, 60126 Ancona, Italy
| | - Annamaria Offidani
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Oriana Simonetti
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60126 Ancona, Italy
| |
Collapse
|
3
|
Ornelas J, Cordoro KM. Clinical Decisions in Pediatric Psoriasis. Dermatol Clin 2022; 40:145-166. [DOI: 10.1016/j.det.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
4
|
Abstract
Psoriasis is a chronic inflammatory and immune-mediated condition, which is no longer considered as being limited to the skin, but may affect the entire body. Epidemiological studies have shown that certain disorders, including obesity, diabetes, liver abnormalities, elevated lipid levels in the blood and metabolic syndrome, may occur more frequently in patients with psoriasis compared with the general population. As psoriasis is a chronic disease, the frequently associated comorbidities must be identified early to ensure timely treatment and, possibly, their prevention. Comorbidities often manifest clinically 1-2 years after the onset of psoriasis and are commonly seen in patients with severe forms of the disease. The association between psoriasis and its comorbidities is not coincidental, but rather based on common pathophysiological mechanisms and risk factors that underlie the increased frequency of comorbidities in patients with psoriasis. The aim of the present review was to emphasize the important role of dermatologists in the early recognition of comorbidities in patients with psoriasis, with a focus on metabolic comorbidities, precisely because the dermatologists are usually the first medical contact due to the predominance of skin lesions. Therefore, these specialists have the responsibility to inform patients on the association between psoriasis and possible multiple comorbidities, devise prevention and treatment plans, or even redirect patients to other specialists.
Collapse
|
5
|
Cather JC, Young CT, Young MS, Cather JC. Ixekizumab for the treatment of pediatric patients with moderate to severe plaque psoriasis. Expert Opin Biol Ther 2021; 21:983-990. [PMID: 34106794 DOI: 10.1080/14712598.2021.1931679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Ixekizumab (IXE), a high affinity humanized monoclonal antibody that selectively targets interleukin-17A, is approved in the United States (US) and the European Union (EU) for pediatric patients with moderate to severe plaque psoriasis. This review summarizes ixekizumab use in the phase 3, randomized, double-blind, placebo-controlled study in pediatric patients with moderate to severe plaque psoriasis and provides some clinical pearls we have learned after using the drug in the pediatric population for the past 3 years.Areas covered: Review of IXORA-PEDS trial data, general literature review pertaining to the systemic treatment of pediatric psoriasis as well as our clinical experience with IXEExpert opinion: IXE is the only IL17 antagonist for pediatric psoriasis and is a welcome addition to our armamentarium.
Collapse
Affiliation(s)
- Jennifer Clay Cather
- Mindful Dermatology, Dallas, TX, USA.,Modern Research Associates, Dallas, TX, USA
| | | | - Melody S Young
- Mindful Dermatology, Dallas, TX, USA.,Modern Research Associates, Dallas, TX, USA
| | | |
Collapse
|
6
|
Cho SI, Kim YE, Jo SJ. Association of Metabolic Comorbidities with Pediatric Psoriasis: A Systematic Review and Meta-Analysis. Ann Dermatol 2021; 33:203-213. [PMID: 34079179 PMCID: PMC8137323 DOI: 10.5021/ad.2021.33.3.203] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/20/2020] [Accepted: 10/05/2020] [Indexed: 01/19/2023] Open
Abstract
Background An evident relationship has been shown between psoriasis and metabolic comorbidities. However, the results in pediatric psoriasis vary from study to study, and no meta-analysis exists on the association of metabolic comorbidities with pediatric psoriasis. Objective To evaluate the association between psoriasis and metabolic comorbidities in pediatric patients. Methods We searched articles published in PubMed, EMBASE, and Cochrane Library databases from inception to April 30, 2019. All observational studies reporting the prevalence of obesity or metabolic comorbidities in pediatric patients with psoriasis were included. Results The meta-analysis included 16 unique studies meeting the inclusion criteria. The pooled odds ratios in pediatric patients with psoriasis was 2.40 (95% confidence interval [CI], 1.60~3.59) for obesity (13 studies), 2.73 (95% CI, 1.79~4.17) for hypertension (8 studies), 2.01 (95% CI, 1.09~3.73) for diabetes mellitus (8 studies), 1.67 (95% CI, 1.42~1.97) for dyslipidemia (7 studies), and 7.49 (95% CI, 1.86~30.07) for metabolic syndrome (4 studies). Conclusion Pediatric patients with psoriasis showed a significantly higher prevalence of obesity, hypertension, diabetes, dyslipidemia, and metabolic syndrome. Adequate monitoring and timely management of metabolic comorbidities should be considered in these patients.
Collapse
Affiliation(s)
- Soo Ick Cho
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Ye Eun Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Seong Jin Jo
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
7
|
Caroppo F, Galderisi A, Ventura L, Belloni Fortina A. Metabolic syndrome and insulin resistance in pre-pubertal children with psoriasis. Eur J Pediatr 2021; 180:1739-1745. [PMID: 33483797 PMCID: PMC8105196 DOI: 10.1007/s00431-020-03924-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 02/07/2023]
Abstract
Psoriasis in adults is associated with an increased risk of metabolic disease. Various cardiometabolic comorbidities have been reported in childhood psoriasis, but only a few studies have analyzed the prevalence of metabolic syndrome. We performed a single-center prospective study investigating the prevalence of metabolic syndrome and insulin resistance in children with psoriasis. The prevalence of metabolic syndrome was evaluated in 60 pre-pubertal children with psoriasis (age: 3-10 years), accordingly to recently established criteria for the diagnosis of metabolic syndrome in children. Insulin resistance was considered altered when the homeostatic model assessment (HOMA-IR) for insulin resistance was ≥ 90th sex- and age-specific percentile and HOMA 2-IR was > 1.8. Eighteen (30%) children with psoriasis were found to have metabolic syndrome. Sixteen (27%) children were found to have insulin resistance.Conclusion: Our data underline the importance of assessing metabolic syndrome not only in adults and adolescents but also in young children with psoriasis. What is Known: • Psoriasis in adults is strongly associated with metabolic disease and insulin resistance. • Very limited data are available on the prevalence of metabolic syndrome and insulin resistance in pre-pubertal children with psoriasis. What is New: • This study reports that in pre-pubertal children with psoriasis, there is a high prevalence of metabolic syndrome and insulin resistance. • In children with psoriasis metabolic syndrome risk factors should be assessed.
Collapse
Affiliation(s)
- Francesca Caroppo
- Pediatric Dermatology Unit – Department of Medicine DIMED, University of Padova, Via Gallucci, 4, 35128 Padova, Italy
| | - Alfonso Galderisi
- Department of Woman and Child’s Health, University of Padova, Padova, Italy
| | - Laura Ventura
- Department of Statistics, University of Padova, Padova, Italy
| | - Anna Belloni Fortina
- Pediatric Dermatology Unit – Department of Medicine DIMED, University of Padova, Via Gallucci, 4, 35128 Padova, Italy
| |
Collapse
|
8
|
Phan K, Lee G, Fischer G. Pediatric psoriasis and association with cardiovascular and metabolic comorbidities: Systematic review and meta-analysis. Pediatr Dermatol 2020; 37:661-669. [PMID: 32436322 DOI: 10.1111/pde.14208] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 04/11/2020] [Accepted: 04/27/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND/OBJECTIVES There is an increasing volume of evidence which supports the link between psoriasis and cardiometabolic risk including obesity, metabolic syndrome, diabetes, hyperlipidemia, and myocardial infarction. Although one-third to one-half of psoriasis cases start during childhood, it is unclear whether childhood psoriasis is similarly associated with a cardiometabolic risk profile. METHODS Electronic database searches were performed to identify studies comparing the proportion of pediatric psoriasis cases with controls in terms of dichotomous outcomes including the proportion of patients with overweight BMI, obese BMI, metabolic syndrome, diabetes, hypertension, hyperlipidemia, ischemic heart disease, or heart failure; continuous outcomes recorded include BMI, systolic blood pressure, diastolic blood pressure, HDL, LDL, triglycerides, and total cholesterol. RESULTS A statistically significant association was found between pediatric psoriasis and overweight/obesity as well as waist:height ratio >0.5, in addition to metabolic syndrome, diabetes, hyperlipidemia, hypertension, and cardiac ischemia and failure. The association with obesity is dependent on the severity of disease, where moderate-severe psoriasis patients have higher odds of obesity compared to mild psoriasis. CONCLUSIONS Our systematic review and pooled meta-analysis demonstrate a significant association between childhood psoriasis and obesity, central adiposity, and other cardiometabolic comorbidities. Clinicians should consider the assessment of comorbidities in children with psoriasis, which may allow for early lifestyle interventions and education.
Collapse
Affiliation(s)
- Kevin Phan
- Department of Dermatology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Geoffrey Lee
- Department of Dermatology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Gayle Fischer
- Department of Dermatology, Royal North Shore Hospital, Sydney, NSW, Australia
| |
Collapse
|
9
|
Blegvad C, Nybo Andersen AM, Groot J, Zachariae C, Barker J, Skov L. Clinical characteristics including cardiovascular and metabolic risk factors in adolescents with psoriasis. J Eur Acad Dermatol Venereol 2020; 34:1516-1523. [PMID: 31989688 DOI: 10.1111/jdv.16229] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Clinical studies on psoriasis in adolescents have mainly been performed in patients with severe psoriasis. Population-based studies of clinical characteristics and risk factors for later cardiovascular and metabolic disease in children and adolescents are lacking. OBJECTIVES To examine the clinical characteristics of adolescents with psoriasis nested in a general population cohort. Furthermore, to investigate cardiovascular and metabolic risk factors in the adolescents with psoriasis compared to parentally predisposed and non-predisposed adolescents without psoriasis from the same birth cohort. METHODS We identified adolescents with and without psoriasis using a nationwide general population birth cohort in Denmark. A clinical examination included skin inspection and scoring of psoriasis severity, completion of a questionnaire on psoriasis and comorbidities, physical measurements, and blood sampling. Participants also completed self-administered questionnaires on quality of life and mental health. RESULTS We included 81 adolescents with psoriasis and 234 controls (110 with genetic predisposition for psoriasis and 124 without predisposition). Median age was 15.6 (13.5-18.5) years, and in those with active psoriasis, median Psoriasis Area and Severity Index score was 1.2 (0.1-11.4). The scalp was the most common site of psoriasis, both at debut and at time of examination. Diaper rash in infancy was more frequent in the psoriasis group. No significant differences regarding quality of life, anxiety and depression were found. More adolescents with psoriasis were obese (8.6% vs. 1.7%, P = 0.008), and physical measures of abdominal obesity were also significantly higher. HbA1c was significantly higher (31.55 vs. 30.81 mmol/mol, P = 0.048), while no differences were found for blood pressure, lipids or high-sensitivity C-reactive protein. In a subgroup analysis, this was evident in the non-predisposed psoriasis-free controls only. CONCLUSIONS Overall, adolescents with psoriasis from this general population had mild disease. Still, early markers of cardiovascular and metabolic disease were elevated.
Collapse
Affiliation(s)
- C Blegvad
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - A-M Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - J Groot
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - C Zachariae
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J Barker
- St John's Institute of Dermatology, King's College London, London, UK
| | - L Skov
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
10
|
Aalemi AK, Hamdard AG, Chen H. Association of metabolic syndrome with pediatric psoriasis: a case‐control study in Kabul, Afghanistan. Int J Dermatol 2020; 59:451-456. [PMID: 32043572 DOI: 10.1111/ijd.14805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/06/2019] [Accepted: 01/13/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Ahmad Khalid Aalemi
- Department of Dermatology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
- Department of Epidemiology Kabul University of Medical Sciences Kabul Afghanistan
| | - Abdul Ghafar Hamdard
- Department of Dermatology Maiwand Teaching Hospital Kabul University of Medical Sciences Kabul Afghanistan
| | - Hongxiang Chen
- Department of Dermatology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| |
Collapse
|
11
|
Menter A, Cordoro KM, Davis DM, Kroshinsky D, Paller AS, Armstrong AW, Connor C, Elewski BE, Gelfand JM, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kiselica M, Kivelevitch D, Korman NJ, Lebwohl M, Leonardi CL, Lichten J, Lim HW, Mehta NN, Parra SL, Pathy AL, Farley Prater EA, Rupani RN, Siegel M, Stoff B, Strober BE, Wong EB, Wu JJ, Hariharan V, Elmets CA. Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients. J Am Acad Dermatol 2020; 82:161-201. [DOI: 10.1016/j.jaad.2019.08.049] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 12/29/2022]
|
12
|
Lavaud J, Mahé E. Scores de sévérité dans le psoriasis de l’enfant : revue systématique de la littérature. Ann Dermatol Venereol 2019; 146:771-782. [DOI: 10.1016/j.annder.2019.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 12/31/2018] [Accepted: 03/06/2019] [Indexed: 12/11/2022]
|
13
|
Blegvad C, Andersen AMN, Groot J, Zachariae C, Skov L. Cohort profile: the clinical 'Psoriasis in Adolescents' (PIA) cohort in Denmark. BMJ Open 2019; 9:e031448. [PMID: 31551390 PMCID: PMC6773347 DOI: 10.1136/bmjopen-2019-031448] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/29/2019] [Accepted: 09/10/2019] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Psoriasis is a chronic inflammatory skin disease that frequently debuts in childhood and adolescence. We wished to determine environmental and genetic risk factors for the development of psoriasis in children and adolescents, as well as to investigate debut type, trigger factors, course of disease, nature and influence of stress related to both child and family and risk factors for comorbidity. The 'Psoriasis in Adolescents' (PIA) cohort will provide data on the relationship between psoriasis and, respectively, genetic disposition, early-life exposures, quality of life and comorbidity. PARTICIPANTS The PIA cohort is nested in the large general population Danish National Birth Cohort (DNBC). We invited 390 adolescents with psoriasis and corresponding maternally predisposed and non-predisposed controls. Participants underwent an interview and a clinical examination consisting of a skin inspection and physical measurements including blood sampling and microbiological swabs. Additionally, four self-administered questionnaires on physical and mental health were completed. FINDINGS TO DATE The final PIA cohort consists of 81 adolescents with psoriasis, 110 parentally predisposed and 124 non-predisposed psoriasis-free adolescents. The validity of the maternally reported psoriasis status from the DNBC was found to be low on clinical examination (47.5%). In contrast, the self-reported psoriasis status of the DNBC mothers was clinically confirmed in 80.8% of the cases. FUTURE PLANS The PIA cohort offers the possibility of assessing the clinical characteristics, course of psoriasis and development of comorbidities in adolescents with clinically confirmed disease from a general population. Comparison with predisposed and non-predisposed controls is possible and genetic analyses are scheduled. We plan to invite the participants for a follow-up in 5-10 years. Furthermore, we plan to include newly diagnosed adolescents with psoriasis from the 18-year DNBC follow-up. All information is linkable on the individual level with data from the DNBC and nationwide registries in Denmark.
Collapse
Affiliation(s)
- Christoffer Blegvad
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jonathan Groot
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Claus Zachariae
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Lone Skov
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| |
Collapse
|
14
|
Abstract
PURPOSE OF REVIEW Several chronic inflammatory skin disorders have been linked to metabolic syndrome (MetS) and an increased risk for cardiovascular disease. In this review, we will summarize the recent evidence on the association between psoriasis, hidradenitis suppurativa (HS), and atopic dermatitis (AD) and metabolic syndrome with careful attention to this association among the pediatric population. RECENT FINDINGS Historically, psoriasis has exhibited the most robust association with MetS in the literature. Recent studies show that the prevalence of MetS appears to be higher among patients with HS and can be associated with MetS even in mild disease. A relationship between AD and MetS is still under debate, but research has shown a clear link between pediatric AD and being overweight or obese. SUMMARY There are no current consensus guidelines for metabolic syndrome in the pediatric population, and its clinical implications in children are still unclear. Nevertheless, providers should be aware of the shared underlying inflammatory state and link between several cutaneous disorders and metabolic syndrome. Early diagnosis and proper disease management of these at risk populations has the potential to assist in disease control and mitigate future cardiovascular disease.
Collapse
|
15
|
Tollefson MM, Van Houten HK, Asante D, Yao X, Maradit Kremers H. Association of Psoriasis With Comorbidity Development in Children With Psoriasis. JAMA Dermatol 2019; 154:286-292. [PMID: 29322175 DOI: 10.1001/jamadermatol.2017.5417] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Importance Children with psoriasis are at increased risk for comorbidities. Many children with psoriasis are also overweight or obese; it is unknown whether the increased risk of comorbidities in these children is independent of obesity. Objective To determine 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. Design, Setting, and Participants This was a retrospective cohort study of claims data from Optum Laboratories Data Warehouse (includes 150 million privately insured and Medicare enrollees). A cohort of 29 957 children with psoriasis (affected children) and an age-, sex-, and race-matched comparator cohort of 29 957 children without psoriasis were identified and divided into 4 groups: (1) nonobese, without psoriasis (reference cohort); (2) nonobese, with psoriasis; (3) obese, without psoriasis; and (4) obese, with psoriasis. Main Outcomes and Measures Risk of developing comorbidities (Cox proportional hazards regression). Results The overall mean (SD) age of those included in the cohort was 12.0 (4.4) years, and 16 034 (53.5%) were girls. At baseline, more affected children were obese (862 [2.9%] vs 463 [1.5%]; P < .001 for all comparisons). Children with psoriasis were significantly more likely to develop each of the comorbidities than those without psoriasis (P < .01). Obesity was a strong risk factor for development of each comorbidity, even in those without psoriasis (hazard ratios [HRs] ranging from 2.26 to 18.11). The risk of comorbidities was 40% to 75% higher among nonobese children with vs without psoriasis: elevated lipid levels (HR, 1.42; 95% CI, 1.25-1.62), hypertension (HR, 1.64; 95% CI, 1.40-1.93), diabetes (HR, 1.58; 95% CI, 1.27-1.95), metabolic syndrome (HR, 1.62; 95% CI, 1.13-2.33), polycystic ovarian syndrome (HR, 1.49; 95% CI, 1.18-1.88), nonalcoholic liver disease (HR, 1.76; 95% CI, 1.16-2.65), and elevated liver enzyme levels (HR, 1.46; 95% CI, 1.27-1.67). Except for hypertension (P = .03), no significant interaction occurred between psoriasis and obesity on the risk of comorbidities. Conclusions and Relevance Children with psoriasis are at greater risk of developing obesity, hyperlipidemia, hypertension, diabetes, metabolic syndrome, polycystic ovarian syndrome, nonalcoholic liver disease, and elevated liver function enzyme levels than children without psoriasis. While psoriasis is a small independent risk factor for the development of these comorbidities, obesity is a much stronger contributor to comorbidity development in children with psoriasis.
Collapse
Affiliation(s)
- Megha M Tollefson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota.,Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Holly K Van Houten
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.,OptumLabs, Cambridge, Massachusetts
| | - Dennis Asante
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Xiaoxi Yao
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | |
Collapse
|
16
|
Paller AS, Schenfeld J, Accortt NA, Kricorian G. A retrospective cohort study to evaluate the development of comorbidities, including psychiatric comorbidities, among a pediatric psoriasis population. Pediatr Dermatol 2019; 36:290-297. [PMID: 30791141 PMCID: PMC6593789 DOI: 10.1111/pde.13772] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND/OBJECTIVE Compared with the adult psoriasis population, knowledge about the incidence of comorbidities in the pediatric psoriasis population is limited. The objective of this study was to assess the prevalence and incidence of comorbidities, including psychiatric comorbidities, in patients with pediatric psoriasis. METHODS In this claims-based, retrospective cohort study, patients with pediatric psoriasis were matched 1:3 with a nonpsoriasis cohort based on age, sex, and index date (the earliest of inpatient claims or the latter of two outpatient claims). RESULTS Obesity, serious infection, and juvenile idiopathic arthropathy had higher prevalence and incidence rates in the psoriasis cohort than the nonpsoriasis cohort. Psychiatric comorbidities were also more common in the psoriasis cohort than the nonpsoriasis cohort, as were ulcerative colitis and Crohn disease. Stratifying the psoriasis cohort by disease severity-mild and moderate-to-severe-found no differences in incidence rates of comorbidities between the two subsets. CONCLUSION The incidence rates of many comorbid conditions were higher for patients with pediatric psoriasis compared with patients without pediatric psoriasis, and similar between patients with moderate-to-severe and mild pediatric psoriasis.
Collapse
Affiliation(s)
- Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | |
Collapse
|
17
|
Badaoui A, Tounian P, Mahé E. Psoriasis and metabolic and cardiovascular comorbidities in children: A systematic review. Arch Pediatr 2019; 26:86-94. [PMID: 30638928 DOI: 10.1016/j.arcped.2018.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/13/2018] [Accepted: 12/11/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Psoriasis is associated with a higher risk of cardiovascular and/or metabolic comorbidity in adults, but discordant data have been reported in children. OBJECTIVE To evaluate the frequency of metabolic and cardiovascular comorbidity in children with psoriasis and to establish whether age at onset of psoriasis correlates with metabolic and cardiovascular comorbidity in adulthood. MATERIAL AND METHODS We conducted a systematic review on MEDLINE, using PubMed and Ovid. The search was limited to children (<18 years). The following key words were used: "psoriasis" with "children or childhood or adolescent" and "obesity" or "hypertension" or "diabetes" or "dyslipidemia" or "cardiovascular risk factor" or "myocardial infarction" or "stroke" or "coronaropathy" or "comorbidity". The reference lists of the articles retrieved were checked for additional relevant studies. RESULTS A total of 377 potential citations were analyzed. After removing duplicate articles and reviewing eligibility in titles and abstracts, 16 articles remained. The studies analyzed revealed significantly higher risk of overweight and obesity in children with psoriasis, despite the numerous definitions used. Four studies reported higher risk of abdominal obesity in children with psoriasis. Data on hypertension, diabetes, dyslipidemia, metabolic syndrome, and major cardiovascular events suggested there was no higher risk of these comorbidities in children with psoriasis. Two studies suggested that age at onset of psoriasis did not increase the frequency of comorbidity in adulthood. CONCLUSION This systematic review suggests that psoriasis in children is not associated with metabolic and cardiovascular comorbidities, except overweight and obesity, for which higher prevalence is clearly demonstrated in the literature.
Collapse
Affiliation(s)
- A Badaoui
- Service de Dermatologie, Centre Hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95100 Argenteuil, France
| | - P Tounian
- Service de nutrition et gastro-entérologie pédiatriques, Hôpital Trousseau, Assistance publique-Hôpitaux de Paris, Université Pierre-et-Marie-Curie, Paris VI, 75012 Paris, France
| | - E Mahé
- Service de Dermatologie, Centre Hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prud'hon, 95100 Argenteuil, France.
| |
Collapse
|
18
|
Al Mutairi N, Alrqobah D, Haji Hussain N. Prevalence of metabolic syndrome in children with moderate to severe psoriasis treated with TNF inhibitors in comparison to conventional agents. Dermatol Ther 2018; 31. [DOI: 10.1111/dth.12566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 10/02/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Nawaf Al Mutairi
- Department of Medicine, Faculty of Medicine; Kuwait University, Jabriya, Kuwait
| | - Dhuha Alrqobah
- Department of Dermatology; Farwaniya Hospital, Ardiya, Kuwait
| | | |
Collapse
|
19
|
Abstract
PURPOSE OF REVIEW Psoriasis is a multifactorial, chronic, inflammatory skin disease that may represent a therapeutic challenge in children. This review aims to provide a framework for the management of pediatric psoriasis, emphasizing in new insights and considerations for management. It will focus on new disease associations and innovative treatment modalities that challenge current approach of psoriasis in children. RECENT FINDINGS There is an increasing body of literature both in adults and in children linking psoriasis with different comorbidities. This new evidence points to the need of addressing psoriasis as a systemic disease and suggests the need for screening and creating awareness of possible associations. In a similar manner, newer medications are also being investigated in children. Recent publications report on the efficacy and safety of biologics for psoriasis in pediatric patients. SUMMARY The review provides better understanding of present and future risks of untreated and uncontrolled psoriasis in children and at the same time the benefits and risks of new treatments available.
Collapse
|
20
|
Kelati A, Baybay H, Najdi A, Zinoune S, Mernissi FZ. Pediatric psoriasis: Should we be concerned with comorbidity? Cross-sectional study. Pediatr Int 2017; 59:923-928. [PMID: 28452100 DOI: 10.1111/ped.13309] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/09/2017] [Accepted: 04/06/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Similarly to psoriasis in adults, recent research has linked psoriasis to several comorbidities in children. The aim of this study was therefore to describe comorbidities associated with pediatric psoriasis, to investigate their relationship with psoriasis characteristics and severity, and to perform a review of the literature. METHODS A cross-sectional study was performed on a sample of Moroccan children with psoriasis, in 2014-2016. RESULTS A total of 64 pediatric psoriasis patients had metabolic comorbidities in association with psoriasis; 20 children had non-metabolic comorbidities; and 76 children had no comorbidity. The metabolic comorbidities were as follows: abdominal obesity, 40% (n = 64); overweight, 12.5% (n = 20); metabolic syndrome, 3.7% (n = 6); and dyslipidemia, 3.1% (n = 5); the non-metabolic comorbidities were atopy, 4.3% (n = 7); epilepsy, 3.1% (n = 5); celiac disease, 1.8% (n = 3); vitiligo, 1.8% (n = 3); alopecia ariata, 0.6% (n = 1); and valvular cardiopathy, 0.6% (n = 1). No cases of diabetes mellitus, obesity, or high blood pressure were recorded. Significant factors associated with metabolic comorbidity were extended psoriasis vulgaris >10% (P = 0.01; OR, 2.19), severe psoriasis especially pustular and erythroderma (P = 0.018; OR, 2), nail involvement (P = 0.016; OR, 1.5), face involvement (P = 0.01; OR, 1,59), resistance to topical treatment (P = 0.003; OR, 2.5) and alteration of quality of life (P = 0.02; OR, 1,7). There was no significant risk factor associated with non-metabolic comorbidity. CONCLUSIONS Given the frequent association of pediatric psoriasis with many disorders, these comorbidities should be investigated and identified so that they can be taken into account in the management of psoriasis in order to avoid treatment failure. Regular follow up should be carried out in patients at risk of metabolic comorbidity.
Collapse
Affiliation(s)
- Awatef Kelati
- Department of Dermatology, University Hospital Hassan II, Fez, Morocco
| | - Hanane Baybay
- Department of Dermatology, University Hospital Hassan II, Fez, Morocco
| | - Adil Najdi
- Department of Epidemiology and Public Health, University of Medicine and Pharmacy of Tangier, Tangier, Morocco
| | - Safae Zinoune
- Department of Dermatology, University Hospital Hassan II, Fez, Morocco
| | - Fatima Z Mernissi
- Department of Dermatology, University Hospital Hassan II, Fez, Morocco
| |
Collapse
|
21
|
Pietrzak A, Grywalska E, Walankiewicz M, Lotti T, Roliński J, Myśliński W, Chabros P, Piekarska-Myślińska D, Reich K. Psoriasis and metabolic syndrome in children: current data. Clin Exp Dermatol 2017; 42:131-136. [PMID: 28044372 DOI: 10.1111/ced.13014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND The prevalence of cardiovascular and metabolic disorders in paediatric patients with psoriasis is not well established. AIM To conduct a meta-analysis of previously published studies dealing with the occurrence of metabolic disorders in children with psoriasis. METHODS Data from 7 studies with a total of 965 children with psoriasis were analysed using a random effects model. RESULTS Prevalence of metabolic syndrome (MetS) was significantly higher in patients with psoriasis than in healthy controls (HCs). In most studies, significantly decreased levels of high-density lipoprotein (HDL) cholesterol were found in children with psoriasis. Mean level of HDL cholesterol in patients with psoriasis was 2.05 mg/dL lower than in HCs. Patients with psoriasis and HCs did not differ significantly in their mean triglyceride levels, although the difference was at a threshold of statistical significance. Mean level of fasting glucose in children with psoriasis was 5.75 mg/dL higher than in HCs (P < 0.01). The two groups did not differ significantly in mean waist circumference or in systolic and diastolic arterial pressures. CONCLUSIONS Decreased levels of HDL cholesterol and increased concentrations of fasting glucose may represent very early stages of MetS in children with psoriasis. However, a large population-based study is needed to establish the relationship between psoriasis and MetS in children, including the environmental, genetic and immunological factors leading to their co-occurrence.
Collapse
Affiliation(s)
- A Pietrzak
- Department of Dermatology, Venereology and Paediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - E Grywalska
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, Lublin, Poland.,St. John's Cancer Center, Lublin, Poland
| | - M Walankiewicz
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, Lublin, Poland
| | - T Lotti
- Department of Dermatology, University of Rome G. Marconi, Rome, Italy
| | - J Roliński
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, Lublin, Poland.,St. John's Cancer Center, Lublin, Poland
| | - W Myśliński
- Department of Internal Diseases, Medical University of Lublin, Lublin, Poland
| | - P Chabros
- Department of Dermatology, Venereology and Paediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - D Piekarska-Myślińska
- Department of Dermatology, Venereology and Paediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - K Reich
- Dermatologikum Hamburg and SCIderm Research Institute, Hamburg, Germany
| |
Collapse
|
22
|
Abstract
There has been a surge of new data regarding the pathophysiology of skin diseases. We are appreciating the sophisticated interplay among the skin, the immune system, and the environment. More elegant and highly specific medicines have been designed to target certain immune mediators of the adaptive immune system. In parallel fashion, we are learning more about the elegance of the innate immune system and how nutrition as early as the prenatal period can affect the priming of other immune cells. Concerns about the long-term impact of new immune-modulating medicines-especially in the pediatric population-have patients asking their dermatologists for nutritional alternatives to medical therapies. Nutrients and nutritional therapies appear to play a role at different ages for different dermatoses. Probiotics are showing promise as a therapeutic option for patients older than 1 year for atopic dermatitis. Systemic contact allergens appear to be a bigger burden on the adult population with atopic dermatitis. Obesity is a growing concern for both children and adults with psoriasis. Milk and high glycemic foods have a strong impact on the teenage acne population. Vitamins A and D are addressed as piece of the alopecia areata puzzle. Zinc and homeopathy are presented finally as possible treatments to the everlasting wart.
Collapse
Affiliation(s)
- Meagen McCusker
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT.
| | - Robert Sidbury
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| |
Collapse
|
23
|
Burden‐Teh E, Thomas K, Ratib S, Grindlay D, Adaji E, Murphy R. The epidemiology of childhood psoriasis: a scoping review. Br J Dermatol 2016; 174:1242-57. [DOI: 10.1111/bjd.14507] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2016] [Indexed: 12/13/2022]
Affiliation(s)
- E. Burden‐Teh
- Centre of Evidence Based Dermatology University of Nottingham Nottingham U.K
| | - K.S. Thomas
- Centre of Evidence Based Dermatology University of Nottingham Nottingham U.K
| | - S. Ratib
- Centre of Evidence Based Dermatology University of Nottingham Nottingham U.K
| | - D. Grindlay
- Centre of Evidence Based Dermatology University of Nottingham Nottingham U.K
| | - E. Adaji
- Division of Epidemiology & Public Health University of Nottingham Nottingham U.K
| | - R. Murphy
- Sheffield Teaching Hospitals NHS Foundation Trust Sheffield U.K
| |
Collapse
|
24
|
Robberecht H, Hermans N. Biomarkers of Metabolic Syndrome: Biochemical Background and Clinical Significance. Metab Syndr Relat Disord 2016; 14:47-93. [PMID: 26808223 DOI: 10.1089/met.2015.0113] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Biomarkers of the metabolic syndrome are divided into four subgroups. Although dividing them in groups has some limitations, it can be used to draw some conclusions. In a first part, the dyslipidemias and markers of oxidative stress are discussed, while inflammatory markers and cardiometabolic biomarkers are reviewed in a second part. For most of them, the biochemical background and clinical significance are discussed, although here also a well-cut separation cannot always be made. Altered levels cannot always be claimed as the cause, risk, or consequence of the syndrome. Several factors are interrelated to each other and act in a concerted, antagonistic, synergistic, or modulating way. Most important conclusions are summarized at the end of every reviewed subgroup. Genetic biomarkers or influences of various food components on concentration levels are not included in this review article.
Collapse
Affiliation(s)
- Harry Robberecht
- Department of Pharmaceutical Sciences, NatuRA (Natural Products and Food Research and Analysis), University of Antwerp , Wilrijk, Antwerp, Belgium
| | - Nina Hermans
- Department of Pharmaceutical Sciences, NatuRA (Natural Products and Food Research and Analysis), University of Antwerp , Wilrijk, Antwerp, Belgium
| |
Collapse
|
25
|
Abstract
There is evidence that patients with moderate to severe psoriasis have an increased risk of conditions such as cardiovascular disease, obesity, diabetes mellitus, and metabolic syndrome. The precise mechanisms underlying the observed increase in cardiovascular disease in psoriasis remain to be defined but inflammatory pathways mutual to both conditions are probably involved. Suppression of systemic inflammation in psoriasis could help reduce cardiovascular inflammation but robust evidence is still lacking evidence is lacking. This article summarizes the current literature on cardiovascular and metabolic comorbidities in psoriasis, identifies research gaps, and suggests management strategies to reduce cardiovascular risk in patients with moderate to severe psoriasis.
Collapse
|
26
|
Sathishkumar D, George R, Daniel D, Peter JV. Clinical profile of childhood-onset psoriasis and prevalence of HLA-Cw6: a hospital-based study from India. Postgrad Med J 2015; 91:309-14. [DOI: 10.1136/postgradmedj-2014-133188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 04/19/2015] [Indexed: 12/27/2022]
|
27
|
Mahé E, Beauchet A, Bodemer C, Phan A, Bursztejn AC, Boralevi F, Souillet AL, Chiaverini C, Bourrat E, Miquel J, Vabres P, Barbarot S, Bessis D, Eschard C, Hadj-Rabia S. Psoriasis and obesity in French children: a case-control, multicentre study. Br J Dermatol 2015; 172:1593-1600. [PMID: 25363889 DOI: 10.1111/bjd.13507] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Obesity is more common in adults with psoriasis than in the general population, but there is a lack of data available regarding this association in children. OBJECTIVES To evaluate whether obesity was more common in French children with psoriasis of any clinical type or severity. METHODS A multicentre case-control study was performed in 23 French dermatology centres. Children without chronic or genetic inflammatory disease were selected as controls and matched for age, sex and dermatology centre. We used three weight cut-off categories to compare the two groups: overweight, overweight with abdominal obesity and overweight with obesity according to the French Health Authority guidelines. RESULTS A total of 261 children with psoriasis were included. The mean age was 9.8 years, 126 were boys and 135 were girls. Overall, 42.5% of these children had plaque psoriasis and 32.2% had severe psoriasis. There was no difference between the psoriasis and control groups when the frequency of children who were overweight was compared (20·7% in psoriasis group vs. 17·1% in control group; P = 0·18). Overweight with abdominal obesity including obesity (18·4% vs. 10·4%; P = 0·009) and obesity alone (10·0% vs. 3·1%; P = 0·001) were more common in the psoriasis group. CONCLUSIONS This study shows that being overweight with abdominal obesity and being obese is more common in children with psoriasis than in controls. The risk factors are the same as those that affect the French general population, i.e. female sex and having a parent who was overweight. The severity and clinical type of psoriasis do not affect overweight and obesity.
Collapse
Affiliation(s)
- E Mahé
- Service de Dermatologie, Hôpital Victor Dupouy, 69 rue du Lieutenant-Colonel Prud'hon, 95100, Argenteuil, France
| | - A Beauchet
- Département de Santé Publique, Centre Hospitalier Universitaire Ambroise Paré, Université Versailles-Saint-Quentin-en-Yvelines, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France
| | - C Bodemer
- Service de Dermatologie, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes Sorbonne Paris Cité, Paris, France
| | - A Phan
- Service de néphro-rhumato-dermatologie pédiatrique, Hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69500, Bron, France
| | - A-C Bursztejn
- Service de Dermatologie, Hôpital Brabois, 54000, Vandœuvre Les Nancy, France
| | - F Boralevi
- Unité de Dermatologie Pédiatrique, Hôpital Pellegrin-Enfants, Bordeaux, France
| | - A-L Souillet
- Service de néphro-rhumato-dermatologie pédiatrique, Hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69500, Bron, France
| | - C Chiaverini
- Service de Dermatologie, Hôpital Archet 2, ESPIC CHU-Lenval, Nice, France
| | - E Bourrat
- Service de Pédiatrie Générale, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - J Miquel
- Service de Dermatologie, Centre Hospitalier Universitaire Pontchaillou, Rennes, France.,Service de Pédiatrie, Centre Hospitalier Universitaire Sud, Saint Pierre de la Réunion, France
| | - P Vabres
- Service de Dermatologie, Centre Hospitalier Universitaire Hôpital du Bocage, Dijon, France
| | - S Barbarot
- Service de Dermatologie, Hôtel Dieu, Nantes, France
| | - D Bessis
- Service de Dermatologie, Centre Hospitalier Saint Eloi, Montpellier, France
| | - C Eschard
- Service de Dermatologie, Hôpital Robert Debré, Reims, France
| | - S Hadj-Rabia
- Service de Dermatologie, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes Sorbonne Paris Cité, Paris, France
| | | |
Collapse
|
28
|
Santos-Juanes J, Coto-Segura P, Fernández-Vega I, Armesto S, Martínez-Camblor P. Psoriasis vulgaris with or without arthritis and independent of disease severity or duration is a risk factor for hypercholesterolemia. Dermatology 2015; 230:170-6. [PMID: 25634083 DOI: 10.1159/000369884] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 11/10/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Psoriasis (Ps) has been associated with an increased incidence of cardiovascular disease. Interesting epidemiological evidence suggests associations between Ps and dyslipidemia (DL), a well-established risk factor for cardiovascular disease. OBJECTIVE This study aimed to investigate the association between Ps and multiple measurements of DL, which include levels of triglycerides (TGs), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and total cholesterol (TCh). We also studied the relationship between DL and disease duration. METHODS A prospective hospital-based study was conducted. A total of 661 Caucasian patients with chronic plaque Ps and 661 sex- and age-matched controls were enrolled. RESULTS Multivariate analysis showed that in psoriatic patients the odds ratio (OR) of TCh >200 mg/dl was 1.406 (95% confidence interval 1.115-1.173), the OR of LDL cholesterol >130 mg/dl was 1.375 (95% confidence interval 1.088-1.738), the OR of HDL cholesterol <40 mg/dl was 0.881 (95% confidence interval 0.599-1.297), and the OR of TGs >150 mg/dl was 1.041 (95% confidence interval 0.783-1.385). We did not find a relationship between lipid levels and disease duration. CONCLUSION Based on our population Ps is associated with alterations in TCh and LDL cholesterol, but not in TGs and HDL cholesterol, when ATP III panel levels are used. These alterations are not related to disease duration.
Collapse
Affiliation(s)
- Jorge Santos-Juanes
- Department of Pathology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | | |
Collapse
|
29
|
Danielsen K, Wilsgaard T, Olsen AO, Eggen AE, Olsen K, Cassano PA, Furberg AS. Elevated odds of metabolic syndrome in psoriasis: a population-based study of age and sex differences. Br J Dermatol 2014; 172:419-27. [PMID: 25059341 PMCID: PMC4338759 DOI: 10.1111/bjd.13288] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Questions remain concerning to what extent age and sex may modify the suggested association between psoriasis and the metabolic syndrome in the general population. OBJECTIVES To investigate the association between psoriasis and the metabolic syndrome within a large population-based cohort by age and sex. METHODS A cross-sectional study including 10 521 participants aged 30-79 years from the Tromsø Study cohort was performed; 1137 participants reported lifetime psoriasis of a mainly mild character. The new harmonized definition of metabolic syndrome was used in the multivariable logistic regression analysis. RESULTS There was a uniformly higher prevalence of metabolic syndrome in men and women with psoriasis compared with those without across all age groups. In women, psoriasis was associated with a 3·8-times higher odds of metabolic syndrome at age 30 years (95% confidence interval 1·5-9·7), with a decreasing odds ratio with increasing age. In men, psoriasis was associated with a stable 1·35-times higher odds of metabolic syndrome (95% confidence interval 1·1-1·6) at all ages. Abdominal obesity was the most frequent metabolic syndrome component in women in this study, and there was indication of a dose-response relationship between psoriasis severity, indicated through treatment, and having a high waistline in women. CONCLUSIONS This study suggests age and sex variations in the risk of metabolic syndrome among individuals with psoriasis. Given the high prevalence of psoriasis and the significantly elevated burden of metabolic syndrome in this patient group, there may be a benefit from targeted screening of metabolic syndrome among individuals with psoriasis regardless of age and disease severity.
Collapse
Affiliation(s)
- K Danielsen
- Department of Dermatology, Neuro and Orthopaedic Clinic, University Hospital of North Norway, Tromsø, Norway; Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
Psoriasis is a common, chronic inflammatory dermatosis that often has its onset during childhood. There is increasing evidence that psoriasis in adults is associated with obesity, the metabolic syndrome, and associated comorbidities, including insulin resistance/type 2 diabetes, dyslipidemia, hypertension, and cardiovascular disease. This association is postulated to arise, at least in part, as a result of a systemic proinflammatory state that is mediated by adipose tissue. Several recent observational studies suggest that children and adolescents with psoriasis may be at increased risk of being overweight and obese as well as having an increased risk for features of the metabolic syndrome. Such an association raises concern with regards to the long-term health implications for children and adolescents with psoriasis and suggests that better awareness, evaluation, and management of overweight and obese patients and associated metabolic disease are warranted in this population.
Collapse
Affiliation(s)
- Iris Gutmark-Little
- Division of Pediatric Endocrinology, Cincinnati Children's Hospital, Cincinnati, OH
| | - Kara N Shah
- Division of Pediatric Dermatology, Cincinnati Children's Hospital, 3333 Burnet Avenue, MLC 3004, Cincinnati, OH 45229.
| |
Collapse
|
31
|
Mrowietz U, Steinz K, Gerdes S. Psoriasis: to treat or to manage? Exp Dermatol 2014; 23:705-9. [PMID: 24815425 DOI: 10.1111/exd.12437] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2014] [Indexed: 12/14/2022]
Abstract
The recognition of psoriasis as a systemic disorder with characteristic skin symptoms and associated diseases has changed treatment concepts substantially. The complexity of psoriasis disease not only requires appropriate therapy but also weight-loss and smoking cessation programmes as well as trigger factor elimination. The term 'management' may better reflect the aim for a holistic approach of disease control. Comorbidity and the presence of psoriatic arthritis are important denominators for drug selection. However, there is a lack of prospective data substantiating a benefit of associated diseases by antipsoriatic therapy. Securing success using treatment goals helps to establish an efficacious therapy and to control inflammation. A regular scoring of disease severity, patients' quality of life and assessment of other clinically relevant conditions are mandatory to closely follow the disease course. There is debate whether an early treatment may modulate the future course of psoriasis. Concepts of minimal disease activity have not been implemented in psoriasis yet. There is a lack of evidence how long any treatment should be given and when and how to terminate. Finally, outcome tools should specifically be tailored for psoriasis to evaluate disease-related items as well as the benefit of management from the patient's perspective.
Collapse
Affiliation(s)
- Ulrich Mrowietz
- Psoriasis-Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
| | | | | |
Collapse
|
32
|
Le psoriasis de l’enfant. Arch Pediatr 2014; 21:778-86. [DOI: 10.1016/j.arcped.2014.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 03/19/2014] [Accepted: 04/23/2014] [Indexed: 01/20/2023]
|
33
|
Lacour JP. [What’s new in pediatric dermatology?]. Ann Dermatol Venereol 2013; 140 Suppl 3:S273-82. [PMID: 24365499 DOI: 10.1016/s0151-9638(13)70143-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article is a selection of the most significant developments in the field of pediatric dermatology through an analysis of the articles published between October 2012 and October 2013. In the field of vascular anomalies, propranolol remains a topic of interest for infantile hemangiomas. New clinical concepts appear in the field of vascular malformations in parallel to genetic progress in this area. New epidemiological data or new pathophysiological concepts apply to atopic dermatitis. Congenital or atypical nevi of the child benefit from genetic progress or improvement of clinical knowledge. Although rare, melanoma of the child concerns by its increasing incidence and its misleadingclinical characteristics. Other data reported here relate to infectious skin of the child, morpheas, neurofibromatosis type 1, psoriasis and other commonly seen dermatoses in children.
Collapse
Affiliation(s)
- J-Ph Lacour
- Service de dermatologie, Hôpital Archet-2, CS 23079, 06202 Nice, Cedex 3, France
| |
Collapse
|