Obesity may intensify other risk factors in pediatric psoriasis

Obesity appears to be an important independent risk factor for children with psoriasis who go on to develop cormorbidities, such as hypertension and diabetes. (©Andrey2017/Shutterstock.com)

A recent study 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 comorbidities.

The study, published in JAMA Dermatology, shows 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, M.D., the study’s corresponding author.

Dr. Tollefson and Mayo Clinic colleagues 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.

Children with psoriasis were significantly more likely to develop each of the comorbidities than those children without psoriasis, and 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 other factors associated with preventing and identifying the onset of comorbid conditions. Recognizing that obesity is probably a much larger factor in children who have psoriasis and are obese, and spending time talking about that with families is paramount.

“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.

REFERENCE

Tollefson MM, Van Houten HK, Asante D, Yao X, Maradit Kremers H. “Association of psoriasis with comorbidity development in children with psoriasis,” JAMA Dermatology. March 1, 2018. DOI:10.1001/jamadermatol.2017.5417