Neuropsychiatric comorbidity among adolescents with psoriasis

Summary Psoriasis is a common skin disease, typically presenting as a red scaly rash. In mild cases it can be treated with creams, while in patients with so called “moderate to severe psoriasis”, where it is extensive or cannot be controlled with creams only, a systemic treatment, such as pills and phototherapy, is necessary. Psoriasis affects about 2% of adults. It commonly develops in adulthood, but can also be seen in children and adolescents. As might be expected, psoriasis may be physically and emotionally disabling. Growing data suggests that psoriasis patients are at risk of suffering from multiple medical conditions, including mental health disorders (e.g depression) and neurological disorders (e.g migraine). This study, from Israel, aimed to find out whether psoriasis carries a risk of suffering from mental health and neurological disorders, focusing on adolescents, an age group which was previously less studied for these conditions. Data were retrieved from records of recruits evaluated for military service. The study included 1746 and 1366 adolescents (aged 16 to 18) with mild and moderate to severe psoriasis, respectively, and compared them to 884653 healthy adolescents. Differences in the prevalence of the following medical conditions were found between adolescents with moderate to severe psoriasis and healthy adolescents: Overall chronic headaches (8.1% vs. 3.4%), intermediate frequency migraine (4.8% vs. 1.6%), low frequency migraine and non‐migraine headaches (3.4% vs. 1.8%), anxiety (2.1% vs. 0.7%) and social adjustment disabilities (7.5% vs. 4.2%). Interestingly, mild psoriasis was not shown to carry a risk for these conditions. The authors conclude that adolescents with psoriasis, especially those with a moderate to severe disease, are at risk of neurological and mental health disorders. The authors call for physicians’ awareness of these conditions, alongside the need for psychological counselling. Linked Article: Galili et al. Br J Dermatol 2018; 178:910–916