PracticeUpdate Dermatology May 2019

EDITOR’S PICKS 10

Evaluating the Development of Comorbidities Among ChildrenWith Psoriasis Pediatric Dermatology Take-home message

conditions were higher for patients with pediatric psoriasis compared with patients without pedi- atric psoriasis, and similar between patients with moderate-to-severe and mild pediatric psoriasis. A Retrospective Cohort Study to Evaluate the Development of Comorbidities, Including Psychiatric Comorbidities, Among a Pediatric Psoriasis Population. Pediatr Dermatol 2019 Feb 21;[EPub Ahead of Print], AS Paller, J Schen- feld, NA Accortt, et al. www.practiceupdate.com/c/80304 Although these screening recommen- dations may be time-consuming and seemingly outside the usual toolbox of a dermatologist, pediatric patients with psoriasis are seeing their dermatologist much more often than their primary care providers. We are in an important front- line position to identify comorbidities early in this vulnerable population. COMMENT By Sarah L. Chamlin MD C ompared with adults with pso- riasis, limited data exist for the comorbidities associated with pediatric psoriasis in the United States. This claims-based retrospective study describes comorbidities for children with psoriasis. Of note, the study used a control group and the mean age in the group with psoriasis was 12.9 years. Obesity, juvenile idiopathic arthropa- thy, and serious infections were more common in the psoriatic group. In addi- tion, ulcerative colitis, Crohn’s disease, and psychiatric comorbidities, such as depression, anxiety, and suicidal idea- tion, were also more common. Findings are consistent with the comor- bidities seen in adults with psoriasis, and children with psoriasis should also be screened yearly for overweight/obe- sity using BMI percentile, hypertension starting at 3 years of age, and type 2 diabetes every 3 years starting at age 10. Universal lipid screening should be performed as well. Depression and anx- iety screening is suggested yearly as well as substance abuse screening for patients over 11 years of age.

• This retrospective study assessed the prevalence and incidence of comorbidities, including psychiatric comorbidities, in children with psoriasis. As compared with children from a matching non-psoriasis cohort, those in the psoriasis cohort had higher prevalence and incidence rates of obesity, serious infection, and juvenile idiopathic arthropathy. Psychiatric comorbidities, ulcerative colitis, and Crohn’s disease were also more common in the psoriasis cohort. • There were no significant differences in the incidence of comorbidities between the two subsets after stratifying the psoriasis cohort according to the severity of disease. InYoung Kim MD, PhD

Abstract BACKGROUND/OBJECTIVE Compared with the adult psoriasis population, knowledge about the inci- dence of comorbidities in the pediatric psoriasis population is limited. The objective of this study was to assess the prevalence and incidence of comorbidities, including psychiatric comorbidi- ties, in patients with pediatric psoriasis. METHODS In this claims-based, retrospective cohort study, patients with pediatric psoriasis were matched 1:3 with a nonpsoriasis cohort based on age, sex, and index date (the earliest of inpatient claims or the latter of two outpatient claims).

RESULTS Obesity, serious infection, and juvenile idiopathic arthropathy had higher prevalence and incidence rates in the psoriasis cohort than the nonpsoriasis cohort. Psychiatric comorbid- ities were also more common in the psoriasis cohort than the nonpsoriasis cohort, as were ulcerative colitis and Crohn disease. Stratifying the psoriasis cohort by disease severity-mild and moderate-to-severe-found no differences in incidence rates of comorbidities between the two subsets. CONCLUSION The incidence rates ofmany comorbid

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