Psoriasis in Children

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Numerous studies in adults have shown that patients with psoriasis have a significantly increased risk of developing a variety of metabolic conditions, including heart disease, diabetes, hypertension and stroke. These metabolic conditions are also strongly associated with obesity in adults. Unsurprisingly, therefore, studies have shown a strong and consistent association between obesity and psoriasis in adults. Now a study in children has shown a similar association.

Researchers at the US-based Kaiser Permanente organization, examined the electronic health records of 710,949 racially and ethnically diverse children and teenagers aged between 2 and 19 years. They found that obese children were almost 40 percent more likely to have psoriasis than normal weight children and that the percentage rose to almost 80% in extremely obese children.

Furthermore, psoriasis in obese children was four times more likely to be severe and/or more widespread than psoriasis in normal weight children. The researchers also measured cholesterol levels and found that regardless of their weight, children with psoriasis had cholesterol levels that were up to 16% higher than those without psoriasis, thereby increasing their risk of heart disease in later life.

Comment

The Kaiser study is important because for the first time it identifies a link between psoriasis, obesity and the risk of heart disease in children. But why should these apparently quite different conditions be so closely associated? The most likely explanation is that both obesity and psoriasis are related to a third underlying factor; inflammation. There is good scientific evidence to show that this inflammation is caused by increased levels of blood proteins called inflammatory cytokines. These cytokines are found in patients with psoriasis, but they are also found in obese subjects. It seems most likely, therefore, that because obesity increases underlying inflammation, it simultaneously increases the risk of psoriasis. The fact that when obese subjects lose weight their psoriasis improves, suggests that this is the likely mechanism.

Whatever the mechanism, the Kaiser study will surely result in a re-assessment of our attitude towards psoriasis in children. We can no longer simply regard it as a rather troublesome skin disease, but as a potentially important metabolic predictor of heart disease in later life. Even normal weight children have an increased risk of heart disease if they have psoriasis.

In obese children with psoriasis, the risk of cardiovascular disease is especially high. Hence public health strategies aimed at the prevention of heart disease, will need to closely closely these at-risk groups.

Dr WD Ashton MD PhD

About the author:

Dr Ashton is widely recognised as a leading international expert on the treatment of obesity and its co-morbidities. He is unique in having expertise across the entire spectrum of weight management, including behavioural interventions, pharmacotherapy and all aspects of weight loss surgery.

Unsurprisingly, he is much in demand as a key opinion leader and is a clinical advisor to several major international companies involved in the development of innovative surgical weight loss devices.

Dr Ashton is also a medical advisor to the PAPAA Board of Trustees.