Just like all people who have psoriasis, children and teens are at risk of developing other health conditions, also known as comorbidities. A comorbidity is a disease that relates to a health condition your child has, such as psoriasis. 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.
Why is There an Increased Risk of Related Health Conditions?
While the cause 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 include 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 related health conditions include:
Genetics or family health history
The 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 or depressed
The good news is such factors can be addressed or controlled by treatment or lifestyle changes which help reduce the inflammation in the body.
What Are the Related Health Conditions Found in Children and Teens?
While research continues to expand our knowledge of related health conditions and why this occurs, 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 related health conditions that also impact children and teens:
Psoriatic Arthritis
Psoriatic arthritis (PsA) affects less than 1% of youth with psoriasis and is the most common related health condition associated with psoriasis. It is possible psoriatic arthritis and joint inflammation will 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 (such as 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 psoriasisincreases the risk for heart or cardiovascular disease especially when a child may be considered overweight or obese, have high cholesterol, or have metabolic syndrome. Cardiovascular disease includes stroke, heart failure, irregular heart rhythm, heart valve issues, or heart attack. Cardiovascular disease may present more of an acute risk factor as teens transition to early adulthood, especially if psoriatic arthritis is present. Given the high risk for heart disease and psoriasis, 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 when high blood pressure, high blood sugar, excess body fat, and abnormal cholesterol levels occur together. Having metabolic disease increases the risk for heart disease and type 2 diabetes. Factors associated with metabolic disease include:
Obesity: Being obese, especially in the abdominal area, increases the risk of chronic diseases such as heart disease and diabetes. There are many reasons why a child may be obese. Talk with your child’s health care provider to determine if the reason might be physical and/or emotional and what steps can be taken to help your child.
Dyslipidemia: This means cholesterol and other lipids (fats) in the blood are high, which may increase the risk for heart disease. High cholesterol in children is often due to unhealthy eating habits and being inactive but can genetically run in families.
Hypertension (high blood pressure): Refers to the pressure of the blood pushing against the walls of the arteries. High blood pressure increases the risk of heart disease and stroke.
Type 2 Diabetes (insulin resistance):
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.
How do you know if it’s anxiety or depression? Anxiety can bring intense feelings of worry, fear, uneasiness and/or panic that can disrupt everyday activities. Symptoms could include irritability, nausea, rapid heartbeat, sweating or shaking, trouble sleeping, and feeling tense. While some symptoms of depression may be similar to anxiety, like irritability and trouble sleeping, they are two different conditions that can occur together. Symptoms of depression include persistent feelings of sadness and hopelessness, sensitivity to rejection and feeling like they are not good at anything or everything is their fault, outbursts or crying, social withdrawal, loss of friends or lack of interest in school or recreational activities, changes in appetite, and feeling shaky or dizzy.
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)
Refers to health conditions characterized by inflammation in the gastrointestinal tract. The two most common inflammatory bowel diseases associated with psoriasis are ulcerative colitis and Crohn’s Disease. Ulcerative colitis or UC causes inflammation and ulcers inside the large intestine. Symptoms include rectal bleeding, bloody diarrhea, and abdominal cramping. Crohn’s Disease affects the entire gastrointestinal tract from the mouth down through the small and large intestine. Symptoms may include stomach ache, diarrhea, bleeding, weight loss, anemia, and food intolerance. Other symptoms specific to children could include poor growth and development and an impact on bone health. Research indicates a change in the gut microbiome may play a role in the development of psoriasis. 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 diagnosed, treatment for your child will focus on improving or eliminating symptoms and restoring growth and development.
These are some of the more prevalent comorbidities and not all related health conditions are 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 related health condition. 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). As research continues to uncover the association between children with psoriasis and related health conditions, it will become clearer what steps can be taken to help prevent or decrease your child’s risk of developing such health conditions.
Additional Resources
Comorbidities Quick Guide
Learn more about related health conditions associated with psoriasis through this quick guide that also offers tips to help manage overall health and emotional well-being.
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.
1. 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
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