|Year : 2013 | Volume
| Issue : 1 | Page : 23-25
A study of childhood psoriasis
R Manoharan, Jayakar Thomas, PK Raneesha, Sindhu Ragavi, D Manoharan, S Cynthia
Department of Skin and Sexually Transmitted Diseases, Sree Balaji Medical College and Hospital, Chromepet, Chennai, Tamil Nadu, India
|Date of Web Publication||23-Aug-2013|
27, Janaranjani Block, Ragamalika Phase I, Medavakkam, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Aims and Objectives: This study attempts to find out the incidence of childhood psoriasis and the mean age of onset of the disease in children.
Materials and Methods: A complete analysis of the out patient records of patients with psoriasis who had attended the Dermatology out-patient department for a period of 8 months between September 2011 and April 2012 was done. All the demographic details were collected and the age at presentation of the disease was also noted.
Observation and Results: The incidence of childhood psoriasis was thus observed to be 17.15%. The incidence of psoriasis in male children and female children was thus observed to be 49.15% and 50.84% respectively. The mean age of onset of childhood psoriasis in boys was observed to be 12.8 years and in girls, it was observed to be 13.8 years. The male female ratio was observed to be 1:1.03.
Conclusion: The incidence of childhood psoriasis is thus seen to have an increasing trend in recent times. Whether this translates into an increase in morbidity needs to be analyzed further through a larger study.
Keywords: Childhood psoriasis, demography of psoriasis, psoriasis in children
|How to cite this article:|
Manoharan R, Thomas J, Raneesha P K, Ragavi S, Manoharan D, Cynthia S. A study of childhood psoriasis. Indian J Paediatr Dermatol 2013;14:23-5
|How to cite this URL:|
Manoharan R, Thomas J, Raneesha P K, Ragavi S, Manoharan D, Cynthia S. A study of childhood psoriasis. Indian J Paediatr Dermatol [serial online] 2013 [cited 2019 Jul 17];14:23-5. Available from: http://www.ijpd.in/text.asp?2013/14/1/23/116851
| Introduction|| |
Psoriasis is a common genetically determined chronic inflammatory skin disease characterized by complex alteration in epidermal proliferation and differentiation. It exhibits a bimodal age distribution - childhood psoriasis that occurs before 18 years and adult psoriasis that occurs after 18 years. Psoriasis is not uncommon in childhood.  The childhood psoriasis is a well-recognized entity; however, its true prevalence is not exactly known yet.  Childhood psoriasis can be further classified as (i) congenital psoriasis, (ii) Infantile psoriasis, (iii) psoriasis with early onset and (iv) pediatric psoriasis with psoriatic arthritis.  Congenital psoriasis may be associated with a lower prevalence of a positive family history and a higher fraction of erythrodermic and pustular forms of the disease with a poorer prognosis. Infantile psoriasis usually has its onset within the 1 st year of life and has got a better prognosis. The other subtypes have their onset during adolescence and teenage years.
Psoriasis in children can be a life changing disease with profound physical and psychosocial impact on the quality-of-life.  It has been aptly said that children are not little adults. This is very true for childhood psoriasis as compared with that in adults as it differs in epidemiology, clinical features, treatment and long-term clinical and psychological outcome.  Study of the disease in the pediatric age group is thus very important because of the psychological problems, dangers inherent to therapy and alteration of the natural course of the disease by injury to the skin.
| Aims and Objectives|| |
This study attempts to find out the
- Incidence of childhood psoriasis
- Mean age of onset of the disease in children.
| Materials and Methods|| |
This is a retrospective study done at the Department of Skin and Sexually Transmitted diseases of a tertiary care hospital in South India. A complete analysis of the out-patient records of patients with psoriasis who had attended the Dermatology out-patient department for a period of 8 months between September 2011 and April 2012 was done. The demographic details were collected, which include age and sex of the patients and the age at presentation of the disease.
| Observation and Results|| |
A total of 344 patients were seen with psoriasis during this period. Among them, there were 59 pediatric patients. The incidence of childhood psoriasis was thus observed to be 17.15%. Among the 344 patients, there were 160 males including 29 male children and 184 females including 30 female children. The incidence of psoriasis in male children and female children was thus observed to be 49.15% and 50.84% respectively [Table 1].
The youngest patient was a male child 2½ years old. Among female children, the youngest patient was 3½ years old. The mean age of onset of childhood psoriasis in boys was observed to be 12.8 years and in girls, it was observed to be 13.8 years. Thus, the mean age of onset of childhood psoriasis among both sexes was found to be 13.3 years. The male female ratio was observed to be 1:1.03. Among adults, there was a slightly more female preponderance (M:F ratio-1:1.17).
| Discussion|| |
The incidence of childhood psoriasis was observed to be 17.15% in our study. In a study of 419 patients of childhood psoriasis at a tertiary care hospital in North India, it constituted 12.57% of the total psoriasis patients. Burden had reported that 10% of all cases occur before the age of 10 years.  Our study has thus revealed an increase in the incidence of childhood psoriasis.
In our study, the male: Female ratio was observed to be 1:1.03. In a study undertaken with 277 childhood psoriatic patients from China, the male female ratio was observed to be 1:1.13.  In a study carried out by Lomholt, the male female ratio was found to be equal.  However, certain studies from Denmark and Middle East have shown female preponderance. , In a study from USA, females were found to be twice as much affected than males.  However, other studies done at India and Australia have documented equal sex distribution. ,, Our study is concordant with the findings of the above studies. An Indian appraisal on the subject also highlights the same about childhood psoriasis. 
The mean age of onset of the disease was found to be 12.8 years in males and 13.8 years in females. Thus, females are seen to have a higher age at the onset of the disease than males. These findings are seen to vary between different studies. In studies from India and Denmark, most patients were reported to have presented with the disease between the ages of 6-10 years. In another study from India, the mean age of onset of the disease was observed to be 8.1 ± 2.1 years for boys and 9.3 ± 2.3 years for girls. The peak age of onset in boys was 6-10 years and in girls it was 10-14 years.  In the study from China, the median age of onset was seen to be 10 years.  Our finding of higher age of onset in girls is concordant with most other studies.
| Conclusion|| |
The incidence of childhood psoriasis is thus seen to have an increasing trend with time. This could be because of increase in incidence of the disease in recent times due to changes in the life-style and environmental conditions. This could also be because of improved clinical and better facilities for laboratory diagnosis of the disease. Though, the disease is seen to have an equal sex pre-disposition, the age of onset is earlier in boys than in girls. Whether this translates into an increase in morbidity needs to be analyzed further through a larger study.
| References|| |
|1.||Farber EM, Carlsen RA. Psoriasis in childhood. Calif Med 1966;105:415-20. |
|2.||Dogra S, Kaur I. Childhood psoriasis. Indian J Dermatol Venereol Leprol 2010;76:357-65. |
|3.||Marcoux D, Prost Y. Pediatric psoriasis revisited. J Cutan Med Surg 2002;6:22-8. |
|4.||Benoit S, Hamm H. Childhood psoriasis. Clin Dermatol 2007;25:555-62. |
|5.||Burden AD. Management of psoriasis in childhood. Clin Exp Dermatol 1999;24:341-5. |
|6.||Fan X, Xiao FL, Yang S, Liu JB, Yan KL, Liang YH, et al. Childhood psoriasis: A study of 277 patients from China. J Eur Acad Dermatol Venereol 2007;21:762-5. |
|7.||Lumholt G. Psoriasis, Prevalence, Spontaneous Course and Genetics. Copenhagen: G.E.C., Gad; 1963. p. 31-6. |
|8.||Nyfors A, Lemholt K. Psoriasis in children. A short review and a survey of 245 cases. Br J Dermatol 1975;92:437-42. |
|9.||al-Fouzan AS, Nanda A. A survey of childhood psoriasis in Kuwait. Pediatr Dermatol 1994;11:116-9. |
|10.||Kumar B, Jain R, Sandhu K, Kaur I, Handa S. Epidemiology of childhood psoriasis: A study of 419 patients from northern India. Int J Dermatol 2004;43:654-8. |
|11.||Morris A, Rogers M, Fischer G, Williams K. Childhood psoriasis: A clinical review of 1262 cases. Pediatr Dermatol 2001;18:188-98. |
|12.||Nanda A, Kaur S, Kaur I, Kumar B. Childhood psoriasis: An epidemiologic survey of 112 patients. Pediatr Dermatol 1990;7:19-21. |
|13.||Dhar S, Banerjee R, Agarwal N, Chatterjee S, Malakar R. Psoriasis in children: An insight. Ind J Dermatol 2012;56:262-5 |