Does childhood psoriasis increase the risk of adverse psychosocial and physical consequences adulthood?

Psoriasis affects 0.5–2% of European children, and in roughly one-third of cases of plaque psoriasis, the disease starts during childhood.  Interestingly, recent evidence suggests that the onset of psoriasis in childhood, does not seem to influence either the severity of disease in adulthood, the risk of psoriatic arthritis or cardiovascular disease.  On the other hand, nail psoriasis in children does appear to increase the risk of more severe psoriatic disease in later life – including psoriatic arthritis. 

Aside from its physical impact, psoriasis in childhood adversely affects quality of life, including participation in sports and recreational activities.  It is also associated with several cognitive problems, including attention deficit disorder and – somewhat later – the development of sexual problems and addictions (smoking and excessive alcohol consumption and drug abuse).  These observations raise the question of whether early onset psoriasis may negatively affect a young person’s educational development and social/professional outcomes in adulthood. 

There is also the separate but related question of whether early-onset psoriasis increases the risk of physical diseases – specifically cardiovascular (heart and circulation) and metabolic (hypertension, diabetes etc) – in adulthood. 

Two studies have addressed each of these questions:

Study 1

The aim of this large-scale, real-life study was to investigate the relationship between childhood-onset psoriasis (COP) educational attainment, socioeconomic characteristics, and addictive behaviours in adulthood¹.  The dataset used for this study was from the French PSOBIOTEQ registry of 1,960 patients, being treated for moderate to severe cutaneous psoriasis.  Of these, 513 (26.2%) had childhood onset psoriasis (COP), defined as disease onset before the age of 18 years.  There were 1447 (73.8%) with adult-onset psoriasis (AOP), defined as disease onset after the age of 18 years. The mean age at psoriasis onset was 11.4 years in COP and 36.6 in AOP.

Self-reported data in adulthood included: educational achievement (baccalaureate); socioeconomic (employment) categories; smoking status; alcohol consumption and living conditions (alone/family/social institutions).  Aside from tobacco and alcohol, no other forms of drug abuse were included. 

Study 2

A similar study in 2013, examined the association between COP and the risk of cardiovascular and metabolic diseases (e.g., diabetes, hypertension etc) in adulthood².  This was a multicentre study from 29 dermatology centres across France, with 2201 subjects. 

Results

In Study 1, found no statistically significant association between COP and a range of psychosocial outcomes in adulthood - including educational attainment, socioeconomic status, living conditions or alcohol consumption. 

Similar findings were observed in Study 2; there was no association between adult cardiovascular or metabolic diseases and onset of psoriasis in childhood.   

Conclusion

Both studies have their methodological limitations, but these findings are – nevertheless – reassuring to parents, educators, and clinicians alike.  They suggest that with regard to both psychosocial and physical outcomes, COP does not appear to have any serious adverse consequences in adulthood.   

Dr David Ashton MD PhD
June 2023

References:

1. Emmanuel Mahé , Florence Tubach, Denis Jullien et al.  Impact of Childhood Onset Psoriasis on Addictive Behaviours, Socioeconomic and Educational Data in Adulthood. Acta Derm Venereol; 2022; 102. adv00733.
2. E Mahé , F Maccari, A Beauchet, et al.  Childhood-onset psoriasis: association with future cardiovascular and metabolic comorbidities. Br J Dermatol 2013;169 :889-95.