Screening guidelines for pediatric psoriasis comorbidities

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Pediatric psoriasis patients should receive routine screenings for associated comorbidities.
Pediatric psoriasis patients should receive routine screenings for associated comorbidities.

Patients with pediatric psoriasis should receive routine screenings to identify risk factors for associated psoriasis comorbidities, according to a consensus guideline published in JAMA Dermatology.

An expert panel in psoriasis, pediatric dermatology, pediatric rheumatology, pediatric gastroenterology, pediatric endocrinology, and adult and pediatric cardiology used the Strength of Recommendation Taxonomy (SORT) to evaluate 153 manuscripts to develop the first guidelines for comorbidity screenings among patients with pediatric psoriasis.

“Educating patients and their families about associated conditions, improving their lifestyle choices early, and providing a supportive environment are key components to their overall health management,” the authors of the guideline wrote.

“Communication and collaboration between dermatologists, primary care providers, and other pediatric specialists will be critical to accomplish the recommended screenings and to limit the sequelae of this disorder.”

The strength of the guidelines is classified as SORT level C expert consensus recommendations, due to the limited number of pediatric studies that are currently published. Most of the panel's recommendations coincide with those that are endorsed by the American Academy of Pediatrics, with added attention to signs and symptoms of arthritis, depression, and anxiety.

The panel's recommendations for each pediatric psoriasis comorbidity are as follows:

Obesity

  • Clinicians should screen for overweight and obesity every year using body mass index (BMI) percentile, starting at 2 years of age.

Type 2 diabetes

  • Clinicians should screen every 3 years starting at 10 years of age, or at the onset of puberty if the patient is overweight and has at least 2 risk factors for type 2 diabetes.
  • Screen patients with obesity every 3 years starting at 10 years of age or at the onset of puberty regardless of risk factors.
  • Screenings should be performed by measuring fasting glucose serum.

Dyslipidemia

  • Patients between 9 and 11 years of age and between 17 and 21 years of age should receive universal lipid screenings.
  • Screenings are also recommended in patients with any additional cardiovascular risk factors.
  • The recommended lipid screening is a fasting lipid panel.

Hypertension 

  • Clinicians should screen for hypertension every year starting at 3 years of age, using age, sex, and height reference charts.

Nonalcoholic fatty liver disease

  • Children with obesity or who are overweight with additional risk factors (central adiposity, insulin resistance, prediabetes or diabetes, dyslipidemia, obstructive sleep apnea, or a family history of nonalcoholic fatty liver disease) should be screened with alanine aminotransferase measurements at 9 to 11 years of age.
  • Screening before 9 years of age can be considered in patients with risk factors such as severe obesity, family history, or hypopituitarism.

Arthritis 

  • Patients with pediatric psoriasis should be screened for the development of arthritis by a directed review of systems and physical examination.

Mood disorders and substance abuse

  • Screen every year for depression and anxiety regardless of age.
  • Screen every year for substance abuse starting at 11 years of age.

In addition to these screening recommendations, the panel notes that clinicians should be aware of the possible coexistence of polycystic ovary syndrome and consider directed testing if symptoms are present. The panel also found that screening for uveitis is only warranted for patients with psoriatic arthritis. Formal gastrointestinal evaluation should be considered among patients with decreased growth rate, unexplained weight loss, or symptoms consistent with irritable bowel syndrome.

Reference

  1. Osier E, Wang AS, Tollefson MM, et al. Pediatric psoriasis comorbidity screening guidelines. JAMA Dermatol. 2017;153(7):698-704. doi:10.1001/jamadermatol.2017.0499
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