WebMD Medical News
Laura J. Martin, MD
May 20, 2011 -- Overweight and obese children are at greater risk for developing psoriasis, according to a new study. And teens who have the inflammatory skin condition are more likely to have high blood cholesterol levels regardless of their body weight.
The findings, which appear online in the Journal of Pediatrics, add to a growing body of evidence linking heart disease and its risk factors to psoriasis. Exactly how the two conditions are connected is not fully understood, but it’s likely that slow, simmering inflammation is the common denominator.
Affecting more than 7 million Americans, psoriasis is marked by skin changes such as thick, silver, itchy plaques commonly seen on the elbows, knees, and scalp.
“Our findings may change the way we look at psoriasis in youth,” says Corinne Koebnick, PhD, a research scientist at the Kaiser Permanente Southern California's Department of Research & Evaluation in Pasadena. “We should monitor kids with psoriasis for cardiovascular risk factors, especially if the child is obese."
“Adults with psoriasis have a higher risk of cardiovascular disease, diabetes, and stroke and have a higher mortality, which means these conditions apparently shorten their lives,” she says. “If these risk factors start in childhood, we need to monitor children with psoriasis more closely for heart disease risk factors.”
In the study of 710,949 children, obese children were almost 40% more likely to have psoriasis than were normal-weight children. Extremely obese children were almost 80% more likely to have psoriasis than were normal-weight children.
Psoriasis was more likely to be severe in children who were obese, as compared with their normal-weight peers, the study showed.
Regardless of body weight, teens with psoriasis had 4% to 16% higher blood cholesterol levels and liver enzymes than teens without psoriasis. Levels of so-called “bad” or low-density lipoprotein (LDL) cholesterol were higher among teens with psoriasis that were also obese.
“Teens with psoriasis have higher cholesterol, regardless of weight, and that is a significant risk factor for future cardiovascular disease,” Koebnick says.
Because of the childhood obesity epidemic, diseases and risk factors once seen only in adults, such as high blood pressure and high cholesterol, are now increasingly being seen in children. And psoriasis in kids should raise a doctor’s index of suspicion and prompt further investigation, says Rubin S. Cooper, MD, chief of pediatric cardiology at Steven and Alexandra Cohen Children's Medical Center of New York in New Hyde Park. “It is another marker to drill down and make sure you are looking at lipids and get the kids on an appropriate diet and exercise program."
“Psoriasis in children is hard to miss and a red flag that could be another marker of inflammation and is worth pursuing,” Cooper says.
This study may well be a game-changer, says Robin P. Gehris, MD, the chief of pediatric dermatologic surgery at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center.
“It is going to change how we manage psoriasis and how and when we talk to families about heart disease prevention,” she says.
There is a wide range of severity when it comes to psoriasis. “I would have a conversation about cholesterol screening with families of children with more widespread disease, especially if they were overweight or obese,” she says.
“Even in the mildly overweight kids with psoriasis, lipid and liver enzymes should be checked yearly,” she says.
Heart disease is preventable, and now doctors may be able to intervene earlier. “This is ammunition for us to be able to refer children to weight loss centers and this can help control psoriasis and heart disease risk factors,” she says.
In addition, treating psoriasis will hopefully reduce inflammation in other body areas, she says.
SOURCES:Corinna Koebnick, PhD, research scientist, Kaiser Permanente Southern California's Department of Research & Evaluation, Pasadena.Rubin S. Cooper, MD, chief of pediatric cardiology, Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park.Robin P. Gehris, MD, chief, pediatric dermatologic surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh.Koebnick, C. Journal of Pediatrics, 2011.
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