Conference Coverage

Psoriasis duration reflects cardiovascular event risk


 

EXPERT ANALYSIS FROM SDEF HAWAII DERMATOLOGY SEMINAR

– The recent report that the risk of a major adverse cardiovascular event increases by 1% more than in the general population for each additional year of psoriasis duration is sobering news for physicians who treat pediatric psoriasis.

“If I have a 16-year-old who has a 5-year history of psoriasis, what does that mean for when she’s 30 or 40? And should we be intervening more aggressively?” Lawrence F. Eichenfield, MD, asked at the Hawaii Dermatology Seminar provided by the Global Academy for Medical Education/Skin Disease Education Foundation.

Dr. Lawrence F. Eichenfield, chief of pediatric and adolescent dermatology at Rady Children’s Hospital–San Diego and professor of dermatology and pediatrics at the University of California, San Diego Bruce Jancin/MDedge News

Dr. Lawrence F. Eichenfield

The question was rhetorical. As lead author of the first-ever pediatric psoriasis comorbidity screening guidelines, he is an advocate for a proactive approach. The published screening guidelines (JAMA Dermatol. 2017 Jul 1;153[7]:698-704), largely based upon expert consensus, were a joint project of the Pediatric Dermatology Research Alliance and the National Psoriasis Foundation.

“Even though there’s not a great deal of evidence, there’s some evidence to rationalize early screening in psoriasis,” according to Dr. Eichenfield, chief of pediatric and adolescent dermatology at Rady Children’s Hospital–San Diego and professor of dermatology and pediatrics at the University of California, San Diego.

Psoriasis develops during childhood in almost one-third of patients.

The pediatric psoriasis screening guidelines describe a simple routine screening program and timeline for early identification of overweight or obesity, type 2 diabetes, hypertension, nonalcoholic fatty liver disease, anxiety, depression, substance abuse, inflammatory bowel disease, and quality of life issues, all of which are encountered with increased frequency in pediatric psoriasis patients. A fasting lipid panel is recommended in children aged 9-11 years with psoriasis and again at age 17-21 years.

“Don’t forget arthritis. For a kid with psoriasis, at every office visit, I ask about morning stiffness or limp. Those are probably the two most sensitive questions in screening for psoriatic arthritis,” according to Dr. Eichenfield.

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