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ORIGINAL ARTICLE
Year : 2017  |  Volume : 18  |  Issue : 3  |  Page : 187-190

Clinicoepidemiological study of childhood psoriasis in a tertiary care center


Department of Dermatology, Madurai Medical College, Madurai, Tamil Nadu, India

Date of Web Publication7-Jun-2017

Correspondence Address:
S G Suganya
Department of Dermatology, Government Rajaji Hospital, Madurai Medical College, Madurai - 625 020, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_76_16

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  Abstract 

Context: Psoriasis is a chronic immune-mediated disease. Although common in children, true incidence and prevalence are not exactly known. There is a paucity of data on childhood psoriasis in India.
Aims and Objectives: To study the age and gender distribution, mean age of onset, family history, precipitating factors, seasonal variation, clinical pattern, and nail changes in childhood psoriasis.
Study Design: This was a prospective, observational study.
Materials and Methods: All children with psoriasis under the age of 18 years were enrolled in the study, and detailed evaluation was done.
Statistical Analysis Used: SPSS 20 (IBM SPSS statistics for Windows, version 20.0: IBM Corp., Armonk, NY) and SIGMA STAT 3.5 (Sigma stat 3.5, Systat Software Inc., Richmond, CA.) by applying one-way ANOVA and Chi-square test.
Observations and Results: Childhood psoriasis comprised 17.8% of total psoriatic patients. Male to female ratio was 1:1.4. Girls had higher mean age and delayed age of onset (P 0.028). Nearly one-third had positive family history of psoriasis. Trauma was the most common precipitating factor. Anti-streptolysin-O titer was positive in 10.18% of cases, out of which 72.72% belonged to guttate psoriasis. The most common clinical type was plaque psoriasis. Extremities were the most frequently involved site and also the most common site of onset. Pitting was the most common nail change.
Conclusion: In our study, a considerable proportion of the psoriatic patients were children (17.8%). Infection was one of the common triggering factors in children; hence, early control of infection may help in reducing the severity and frequency of the disease. Further follow-up of these children is needed to know the outcome and prognosis of the disease.

Keywords: Childhood psoriasis, epidemiology, psoriasis in children


How to cite this article:
Suganya S G, Kothandaramasamy R, Rani G G. Clinicoepidemiological study of childhood psoriasis in a tertiary care center. Indian J Paediatr Dermatol 2017;18:187-90

How to cite this URL:
Suganya S G, Kothandaramasamy R, Rani G G. Clinicoepidemiological study of childhood psoriasis in a tertiary care center. Indian J Paediatr Dermatol [serial online] 2017 [cited 2017 Sep 26];18:187-90. Available from: http://www.ijpd.in/text.asp?2017/18/3/187/206084


  Introduction Top


Psoriasis is an immunologically mediated genetic disease affecting 0.5%–1.5% of individuals worldwide. Around one-third of them are below the age of 18 years.[1]

There is considerable variation in epidemiology, clinical presentation,[2],[3] and treatment of psoriasis in children from adults. The common environmental triggers in children are trauma and infection. Positive family history is common in childhood psoriasis.

Psoriasis, being a chronic disease characterized by exacerbations and remissions, can be life-challenging with impact on quality of life.[4] There is a paucity of data on childhood psoriasis in India. Thus, a study on childhood psoriasis is important to find out the recent trend.


  Materials and Methods Top


This is a prospective observational study done from January 2015 to December 2015 in our dermatology outpatient department.

Inclusion Criteria

  • Children of age group 18 years and below diagnosed as psoriasis where the diagnosis is made mainly based on history and clinical examination
  • Cases confirmed histopathologically in case of clinical dilemma.


Exclusion Criteria

  • Patients in whom clinical diagnosis was doubtful and could not be confirmed with biopsy
  • Patients not willing to take part in the study.


Detailed history taking and clinical examination were done to all the consenting patients. Investigations including complete blood count, anti-streptolysin-O (ASO) titer, throat swab, serum calcium, serum uric acid, fasting lipid profile, serum proteins, and skin biopsy (in doubtful cases) were done.


  Observations and Results Top


We included 108 psoriatic patients of both genders <18 years of age. Epidemiological and clinical profiles were studied among these patients. Childhood psoriasis comprised 0.6% of total dermatology outpatient department patients and 17.8% of total psoriatic patients. Majority (59.25%) of the patients were in the first decade. Overall mean age was 10.39 ± 4.03 years. Mean age in boys and girls was 9.89 ± 3.99 and 10.74 ± 4.03 years, respectively. Boys were 41.67% and girls were 58.33%. Male to female ratio was 1:1.4. Girls had significantly (P = 0.028) delayed age of onset when compared to boys [Table 1].
Table 1: Mean age of onset

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Most (85.18%) of them had pruritus. Thirty percent had positive family history of psoriasis. The precipitating factors were present in 44.45%, out of which trauma was the most common one. Forty-seven percent of guttate psoriasis patients had history of pharyngitis, which is high when compared to other types [Table 2]. Forty-four percent had winter exacerbation. One child with erythrodermic psoriasis had summer exacerbation.
Table 2: Precipitating factors

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The most common initial site of onset was extremities (58.33%), followed by scalp (25.92%) and trunk (15.74%). The most common type (56.48%) was chronic plaque psoriasis [Table 3]. Congenital nevoid psoriasis following Blaschko's lines was present in one child. Infantile psoriasis was present in 1.85%. Extremities were involved in 73.14%, trunk in 36.11%, scalp in 32.40%, and face in 8.33%. In two children, diaper region was involved. Koebnerization was seen in 28.70%. Based on the psoriasis area and severity index (PASI), 75% had mild disease, 20% had moderate, and 5% had severe disease. Mean PASI was 6.62 ± 8.13. Nail changes were seen in 44.44%, out of which pitting was the most common change, followed by leukonychia, onycholysis, Beau's lines, subungual hyperkeratosis, and ridging [Table 4].
Table 3: Clinical pattern

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Table 4: Nail changes

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ASO titer was positive in 10.18% of cases, out of which 72.72% belonged to guttate psoriasis. In our study, 5.55% of children with psoriasis demonstrated positive throat culture for streptococci. It was as high as 26.7% in children with guttate psoriasis. Six percent had low serum proteins.

Seventy-five percent of children were treated by topical therapy and 25% required other modalities (narrowband ultraviolet B [NBUVB] - 12.96%, oral antibiotics - 12.96%, oral methotrexate - 4.62%).


  Discussion Top


Childhood psoriasis comprised 17.8% of total psoriatic patients, which is similar to the study by Manoharan et al.,[4] who reported 17.15%, and it is high when compared to the study by Kumar et al.[5] done in North India in 2004, which was 12.5%. Majority (59.25%) of the patients were in the first decade. Around 1.85% was infants which are comparable with the Indian study by Kumar et al.[5] (3.5%), whereas an Australian study by Morris et al.[6] reported 16% of infantile psoriasis. Overall mean age was 10.39 ± 4.03 years. Mean age in boys and girls was 9.89 ± 3.99 and 10.74 ± 4.03 years, respectively. Report from Seyhan et al.'s study [7] from Turkey showed the similar overall mean age (9.96 years) as this study, but boys had higher mean age. Girls had higher mean age than boys in this study. Boys were 41.67% and girls were 58.33%. Male to female ratio was 1:1.4, which is in concurrence with the studies by Mercy et al.[8] and Al-Mutairi et al.,[9] and it differs from the studies by Kumar et al.[5] and Manoharan et al.,[4] which reported the almost equal male to female ratio. Girls had significantly delayed age of onset when compared to boys (P = 0.028). This is similar to the study by Kumar et al.[5] but varies from the study by Seyhan et al.,[7] whose report showed delayed onset in boys.

Eighty-five percent had pruritus which is similar to the Kumar et al.'s study.[5] Thirty percent had positive family history of psoriasis. This is similar to the studies by Kwon et al.[10] and Alsuwaidan et al.[11] It is low when compared to the Morris et al.'s study.[6] However, it is significantly high when compared to the study by Kumar et al.,[5] who reported positive family history in only 4.5%. The precipitating factors were trauma in 23.14%, stress in 11.11%, and pharyngitis in 10.18%. Kumar et al.'s study [5] also reported trauma as the most common precipitating factor. 46.67% of guttate psoriasis patients had a history of pharyngitis, which is high when compared to other types. Forty-four percent had winter exacerbation. Only one child (0.92%) with erythrodermic psoriasis had summer exacerbation. Kumar et al.[5] reported winter exacerbation in 31.9% and summer worsening in 1.9%.

The most common initial site of onset was extremities (58.33%), which is similar to the reports from many studies.[7],[12] The most common type was chronic plaque psoriasis, which is similar to the studies by Kumar et al.,[5] Al-Mutairi et al.,[9] Kwon et al.,[10] Alsuwaidan et al.,[11] and Wu et al.[13] The erythrodermic psoriasis comprised 1.85%, which is similar to study by Fan et al.[12] from China. Congenital nevoid psoriasis following Blaschko's lines was present in one child in our study. Alsuwaidan et al.,[11] from Saudi in 2011, also reported congenital psoriasis in one child. The most frequently involved site was extremities (73.14%), which is similar to the studies by Fan et al.,[12] Tollefson et al.,[14] and Al-Fouzan et al.[15] Face was involved in 8.33% which is low when compared to studies by Fan et al.,[12] Morris et al.,[6] and Kwon et al.[10] Kumar et al.[5] reported facial involvement in 4.7% and two children in their study had diaper area involved. The present study also observed two children with diaper region involved. Koebnerization was seen in 28.70% similar to the study by Kumar et al.[5] Mean PASI was 6.62 ± 8.13, which is low when compared to study by Kwon et al.,[10] who reported mean PASI to be 17.2 ± 12.7. Forty-four percent had nail changes similar to study by Mercy et al.[8] (39.2%) and Al-Mutairi et al.[9] (37.81%). Kumar et al.[5] reported nail involvement in 31%. Pitting was the most common nail change (42.59%) observed as in the observations made in the studies by Al-Mutairi et al.,[9] Kumar et al.,[5] and Nanda et al.[16]

ASO was positive in 10.18% of all the psoriatic patients and most of them (72.72%) belonged to guttate psoriasis similar to the studies by Telfer et al.,[17] Zhao et al.,[18] and Kim et al.[19] In our study, 5.55% children with psoriasis demonstrated positive throat culture for streptococci. It was as high as 26.7% in children with guttate psoriasis similar to Telfer et al.'s study.[17]

All children were treated by topical modes (emollients/keratolytics/steroids). Additional NBUVB therapy was given to 12.96%, oral antibiotics to another 12.96%, and methotrexate to 4.62%.


  Conclusion Top


In our study, 17.8% of the psoriatic patients were children, which is a considerable proportion. Infection is one of the common triggering factors in children; hence, early control of infection may help in reducing the severity and frequency of the disease. Further follow-up of these children is needed to know the outcome and prognosis of the disease. There are limitations in the treatment of childhood psoriasis which needs to be addressed.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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