Children with psoriasis should be monitored for cardiometabolic comorbidities which may allow for early lifestyle interventions and education, new research suggests.
A systematic review and pooled meta-analysis of the evidence by Australian investigators found 17 studies comprising about 44,000 paediatric patients with psoriasis and 5.4 million controls. Patients and controls had a mean age of 11 years.
The study, published in Paediatric Dermatology and co-authored by dermatologist Associate Professor Gayle Fischer, found a statistically significant association between paediatric psoriasis and obesity – OR 2.45 although with significant heterogeneity.
Paediatric psoriasis was also associated with diabetes (OR 2.32), hypertension (OR 2.19), hyperlipidemia (OR 2.01), metabolic syndrome (OR 1.75) and cardiovascular disease (OR 3.15).
Patients with psoriasis were also more likely to have an increased waist to high ratio than controls (OR 1.87).
There was no significant difference in individual levels of lipids – HDL, LDL, triglycerides or total cholesterol.
“For children with psoriasis with abnormal waist-to-height ratio indicating abdominal adiposity, this may be an opportunity for the treating clinician to pursue further cardiometabolic screening testing as well as provide counselling and intervention to mitigate future risks of comorbidities,” the study said.
The researchers said evidence for the association was inconsistent across previous studies and whether the extent of any association was influenced by psoriasis severity was unclear.
As well, the analysis did not account for potential confounding factors including prior treatments and lifestyle habits.
However they recommended early and frequent monitoring for cardiovascular and metabolic risk which could start as early as 2 years of age for obesity and 10 years for type 2 diabetes.
“Closer surveillance may lead to lifestyle modifications, educational interventions for both children and their parents in terms of diet, physical activity and behavioural changes in terms of smoking and alcohol consumption,” they said.
They added that there were also clinical implications in terms of treatment options as medications such as acitretin and cyclosporine can have a direct impact on comorbidities.