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Psoriasis Is Common in Children

Pediatric psoriasis was associated with increased rates of serious comorbidities.

Psoriasis is a widespread disease affecting all age groups. Many clinicians believe that psoriasis is rare in children, but epidemiologic studies in this population are sparse. Researchers in Germany assessed the prevalence and comorbidities of juvenile psoriasis. Using a national database of 1.3 million nonselected patients covered by national health insurance, the investigators identified psoriasis and comorbidities by ICD-10 codes assigned during patient visits made in 2005.

In all, 33,981 patients received a diagnosis of psoriasis; the overall prevalence was 2.5%, and the prevalence in children younger than 18 years was 0.71%. The pediatric prevalence rates increased linearly with age, from 0.2% at age 1 year to 1.2% at 18 years. Among patients younger than 20, 2549 patients had psoriasis and 331,758 did not. The overall rate of other illnesses was twice as high in patients with psoriasis as in those without. Pediatric psoriasis was associated with increased rates of hyperlipidemia, obesity, hypertension, diabetes mellitus, and Crohn disease.

The authors identify limitations of the study, including limited evaluation by dermatologists and lack of information about psoriasis type or severity. Guttate psoriasis, which is more common in children and has a more transient course, may be overrepresented. However, the prevalence data appear to be consistent with previous studies. The authors conclude that psoriasis is common in children and that, as in adults, it is associated with considerable comorbidity.

Comment: Diagnosis often does require a dermatologist's eye. For example, diaper-area psoriasis is often underdiagnosed, whereas plaque psoriasis is often misdiagnosed as eczema. Treatment of childhood psoriasis is confounded by a lack of clinical trials and by an absence of FDA labeling of medications for young children. We also need a higher awareness of comorbidities in both children and adults with psoriasis.

— Mary Wu Chang, MD

Published in Journal Watch Dermatology December 18, 2009

Citation(s):

Augustin M et al. Epidemiology and comorbidity of psoriasis in children. Br J Dermatol 2009 Nov 18; [e-pub ahead of print]. (http://dx.doi.org/10.1111/j.1365-2133.2009.09593.x)

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