For Parents: Comorbidities

A comorbidity is a disease or condition that relates to a health condition your child has, such as psoriasis. An example of this is when someone who has psoriasis also has diabetes. Being aware of the risks and what you as a parent can do early to intervene will help ensure your child lives a long and healthy life.

Get your comorbidities guide

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Why is There an Increased Risk of Comorbidities?

While the cause of psoriasis isn't known for sure, growing evidence suggests that the overactive immune system, associated with the increased rate of skin growth in psoriasis, results in inflammation that occurs not only on the skin but also throughout the body. Signs of inflammation could be plaques on the skin or swelling of the joints such as in psoriatic arthritis. This inflammation could also affect other organs and tissues that can’t be seen. Because of this, psoriasis is sometimes referred to as a systemic disease meaning it affects the whole body and not just a single body part.

Factors that contribute to the development of comorbidities include:

Genetics or family health history
Severity of psoriasis (the more psoriasis is present, the higher inflammation is in the body)
Environmental factors such as diet or lack of physical activity
Emotional factors such as bullying, feeling self-conscious, anxious, or depressed

The good news is such factors can be addressed by treatment or lifestyle changes which help reduce the inflammation in the body.

What Are the Comorbidities Found in Children and Teens?

While research continues to expand our knowledge of comorbidities and why they occur, in 2020 the National Psoriasis Foundation and the American Academy of Dermatology published “Guidelines of Care for the Management and Treatment of Psoriasis in Pediatric Patients” [1] which identified the following comorbidities that also impact children and teens:

Psoriatic Arthritis

Psoriatic arthritis (PsA) affects less than 1% of youth with psoriasis and is the most common comorbidity associated with psoriasis. Psoriatic arthritis and joint inflammation can develop 2 to 3 years prior to having signs of psoriasis [1]. PsA causes swelling, pain, and stiffness in joints and areas where tendons and ligaments connect to bone, also called the entheses. Joints that are affected in children include the knee, elbow, ankle, wrist, jaw, and spine, and in some cases could cause pain in the rib cage.

Although psoriatic arthritis can occur at any age, two common age groups when children tend to develop symptoms of arthritis occur around ages 2 or 3 and ages 10 to 12 [1]. It’s important to know what the symptoms are (like swelling of the fingers or toes or stiffness in the morning or after inactivity) and alert your child’s health care provider when they are present. A couple of markers that may identify a higher risk of psoriatic arthritis include scalp psoriasis, nail involvement, and inverse psoriasis. It's important to receive the appropriate screening and treatment early to help minimize or prevent the joint damage that can result from letting PsA go untreated. Learn more about psoriatic arthritis in kids and teens.

Heart Disease

The inflammation associated with psoriasis is thought to increase the risk for heart or cardiovascular disease especially when a child may be considered overweight or obese, has high cholesterol (also known as hyperlipidemia), or has metabolic syndrome. Research has shown in children with psoriasis higher rates of ischemic heart disease occur which is when the heart’s blood supply is diminished due to plaque build-up in the arteries (atherosclerosis). [1,2] Other cardiovascular disease risks include irregular heart rhythm, heart valve issues, and heart conduction disorder. Cardiovascular disease risk increases with skin severity and may present more of an acute risk factor as a teen transitions to early adulthood, especially if psoriatic arthritis is present. Given the higher risk for heart disease when psoriasis is present, it is recommended that children and teens be screened early for cardiovascular disease, obesity, and metabolic syndrome to help intervene with appropriate actions that improve overall health and decrease risks for such diseases.

Metabolic Disease

Metabolic disease is a term used when at least three of the five following diseases occur together - excess body fat or obesity, high blood pressure or hypertension, high blood sugar (insulin-resistant diabetes), abnormal cholesterol levels or hypercholesterolemia, and hypertriglyceridemia (high levels of triglycerides in the blood). [1] High cholesterol in children is often due to unhealthy eating habits and being inactive but it can genetically run in families.

Both obesity and psoriasis cause systemic inflammation and those with more severe psoriasis tend to have higher rates of being overweight. Being obese, especially in the abdomen or central area, increases the risk of chronic diseases such as heart disease, high blood pressure, and diabetes. There’s also a higher incidence of insulin resistance in youth with psoriasis who are considered to be obese vs those at normal weight. [1]

Mental or Emotional Health

Psoriasis not only affects your child’s physical well-being but may also impact their emotional health. Children and teens with psoriasis are known to have a higher risk of developing anxiety and depression. While it’s not clear if depression is related to the inflammation associated with the development of psoriasis and psoriatic arthritis, having a visible skin disease can be very distressing for your child. Being perceived as different can lead to the development of anxiety, social withdrawal, and depression due to potential bullying, name-calling, or discriminatory attitudes which can impact your child’s self-esteem and emotional health.

Watch for changes in your child’s behavior, signs of anxiety and depression, or risk-taking behavior like substance abuse. If you are concerned about your child’s behavior, talk with your child’s health care provider and consider screening for depression and anxiety. You can also seek support through the One to One program. Seek professional counseling if needed.

Inflammatory Bowel Disease (IBD)

Research indicates a change in the gut microbiome may play a role in the development of psoriasis. The two most common inflammatory bowel diseases associated with psoriasis are ulcerative colitis and Crohn’s Disease. Symptoms may include stomachache, diarrhea, bleeding, weight loss, anemia, and food intolerance. Other symptoms specific to children could include poor growth and development, as well as an impact on bone health. If you suspect your child may have IBD speak with your health care provider about screening for IBD and a referral to see a gastroenterologist, a doctor who specializes in issues affecting the digestive system. Once IBD is diagnosed, treatment for your child will focus on improving or eliminating symptoms and restoring growth and development.

If you notice symptoms that could relate to other health diseases, discuss what screenings are needed to confirm a diagnosis with your child’s health care provider. For example, the American Diabetes Association recommends screening for pre-diabetes or type 2 diabetes should occur after age 10 especially if a child is overweight and has a family history of diabetes [4]. Find information about healthy living tips and what you can do to help your child reduce their risks for comorbidities.

These are some of the more prevalent comorbidities and not all may be associated with psoriasis. Talk with your child’s health care provider about the risks and if you suspect your child may have symptoms of a comorbidity. Your child may need to see another health care provider who specializes in that condition (such as a rheumatologist to address joint pain and inflammation). If you need help finding a health care provider contact our Patient Navigation Center.

As research continues to uncover the association between children with psoriasis and comorbidities, it will become clearer what steps can be taken to help prevent or decrease your child’s risk of developing such health conditions. For now, focus on factors you can control to reduce related risks. While your child can’t always control factors that impact the severity of their psoriasis, do what you can to help reduce the impact and keep their lives healthy as they grow from a child to an adult.

Additional Resources

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Psound Bytes™ Podcast: Pediatric Guidelines

Dr. Lara Wine Lee presents an overview of the AAD-NPF Management and Treatment of Pediatric Psoriasis Guidelines, including a discussion about related conditions.

Listen to the episode

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Patient Navigation Center

Contact the Patient Navigation Center if you need help adding a rheumatologist, mental health care provider, or other specialists to your child’s health care team.

Get in touch

Healthier Together: Learning for All Ages conference. Michel, Michelle, Leah, Skylar.

Connect with Someone Who Understands

Talk to a parent whose child has psoriatic disease through our One to One mentor program.

Learn more and sign up

References

Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients. J Am Acad Dermatol. Jan. 2020;82(1):161-201. doi:10.1016/j.jaad.2019.08.049
Epidemiology and comorbidity in children with psoriasis and atopic eczema. Dermatology. Augustin M., Radtke MA., Glaeske Gl., et al. 2015:231(1):35-40. doi: 10.1159/000381913
Cardiovascular Risk in Patients with Psoriasis. J Am Coll Cardiol. Garsick, M., Ward, N., Krueger, J.G., Berger, J. Apr 6 2021; 77(13): 1670-1680. doi: 10.1016/j.jacc.2021.02.009
American Diabetes Association Professional Practice Committee; 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2024. Diabetes Care 1 January 2024; 47 (Supplement_1): S20–S42. https://doi.org/10.2337/dc24-S002