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JAMA Dermatol. 2017 May 17. doi: 10.1001/jamadermatol.2017.0499. [Epub ahead of print]

Pediatric Psoriasis Comorbidity Screening Guidelines.

Author information

1
Department of Dermatology, Eastern Virginia Medical School, Norfolk.
2
Division of Dermatology, Sharp Rees-Stealy Medical Group, San Diego, California.
3
Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota.
4
Division of Pediatric Dermatology, Department of Dermatology, University of California San Francisco, San Francisco.
5
Section of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Aurora.
6
Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, College of Physicians and Surgeons of Columbia University, New York, New York.
7
Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
8
Department of Dermatology at New York Medical College, Valhalla.
9
Department of Dermatology, Harvard Medical School, Boston, Massachusetts.
10
Department of Dermatology, Mount Sinai Medical Center, New York, New York.
11
Division of Intramural Research, Section of Inflammation and Cardiometabolic Diseases, National Institutes of Health/National Heart, Lung, and Blood Institute, Bethesda, Maryland.
12
Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
13
Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Rady Children's Hospital San Diego, University of California San Diego School of Medicine, San Diego.
14
Department of Pediatrics, University of California, Davis School of Medicine, Sacramento.
15
Departments of Dermatology and Pediatrics, Rady Children's Hospital San Diego and University of California, San Diego School of Medicine, San Diego.

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.

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