Pediatric psoriasis comorbidity screening guidelines

Emily Osier, Audrey S. Wang, Megha M. Tollefson, Kelly M. Cordoro, Stephen R. Daniels, Andrew Eichenfield, Joel M. Gelfand, Alice B. Gottlieb, Alexa B. Kimball, Mark Lebwohl, Nehal N. Mehta, Amy S. Paller, Jeffrey B. Schwimmer, Dennis M Styne, Abby S. Van Voorhees, Wynnis L. Tom, Lawrence F. Eichenfield

Research output: Contribution to journalReview article

19 Scopus citations

Abstract

IMPORTANCE Psoriasis is a complex inflammatory skin condition associated with serious medical comorbidities in adults, including obesity, hypertension, dyslipidemia, type 2 diabetes mellitus, psoriatic arthritis, nonalcoholic fatty liver disease, depression, anxiety, and decreased quality of life. Because psoriasis begins in childhood in almost one-third of patients, early identification of risk may be critical to minimizing effects on future health. OBJECTIVE To develop the first set of guidelines for comorbidity screening for patients with pediatric psoriasis based on current evidence. EVIDENCE REVIEW A literature review was performed using PubMed from January 1999 through December 2015. Limiting the search to human studies published in English and removing reviews and editorials produced 153 relevant manuscripts. An expert panel in psoriasis, pediatric dermatology, pediatric rheumatology, pediatric gastroenterology, pediatric endocrinology, and adult and pediatric cardiology used the patient-centered Strength of Recommendation Taxonomy (SORT) method to evaluate and grade the quality of evidence. FINDINGS Because of the limited number of pediatric studies published on these topics, the strength of the panel's recommendations is classified as SORT level C expert consensus recommendations. The majority of recommendations coincide with those endorsed by the American Academy of Pediatrics for the general pediatric patient but with added attention to signs and symptoms of arthritis, depression, and anxiety. The panel also identified key areas for further investigation. CONCLUSIONS AND RELEVANCE Patients with pediatric psoriasis should receive routine screening and identification of risk factors for associated comorbidities. These guidelines are relevant for all health care providers caring for patients with pediatric psoriasis, including primary care clinicians, dermatologists, and pediatric specialists. Because these are the first pediatric guidelines, re-review and refinement will be necessary as studies further detail, and possibly stratify, risk in affected children.

Original languageEnglish (US)
Pages (from-to)698-704
Number of pages7
JournalJAMA Dermatology
Volume153
Issue number7
DOIs
StatePublished - Jul 1 2017

ASJC Scopus subject areas

  • Dermatology

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    Osier, E., Wang, A. S., Tollefson, M. M., Cordoro, K. M., Daniels, S. R., Eichenfield, A., Gelfand, J. M., Gottlieb, A. B., Kimball, A. B., Lebwohl, M., Mehta, N. N., Paller, A. S., Schwimmer, J. B., Styne, D. M., Van Voorhees, A. S., Tom, W. L., & Eichenfield, L. F. (2017). Pediatric psoriasis comorbidity screening guidelines. JAMA Dermatology, 153(7), 698-704. https://doi.org/10.1001/jamadermatol.2017.0499