Neuropsychiatric comorbidity among adolescents with psoriasis

Summary Background Psoriasis is a known risk factor for neuropsychiatric diseases among adults. Less is known about the impact on adolescents. Objectives To investigate the association between psoriasis and neuropsychiatric comorbidity and social skills among adolescents. Methods A population‐based cross‐sectional study between 1 January 1999 and 1 January 2014 was conducted. The study included 1746 and 1366 adolescents (aged 16 to 18) with mild and moderate‐to‐severe psoriasis, respectively. The psoriasis patients were diagnosed by a dermatologist. Neuropsychiatric diseases were diagnosed by a neurologist and a psychiatrist, as appropriate. Social skills were evaluated using psychosocial assessment. Patients with psoriasis were compared with 884 653 healthy controls by a multivariate analysis adjusted for age, sex, country of origin, socioeconomic status, cognitive skills and body mass index. A subgroup evaluation was done for comorbidity that could only be evaluated for part of the recruitment years, using a univariate analysis. Results Overall chronic headaches (8·1% vs. 3·4%), intermediate frequency migraine (4·8% vs. 1·6%), low‐frequency migraine and nonmigraine headaches (3·4% vs. 1·8%) were associated with moderate‐to‐severe psoriasis only compared with healthy controls [adjusted odds ratios (OR) 1·9, 95% confidence interval (CI) 1·6–2·4; 2·3, 95% CI 1·8–3·0 and 1·5, 95% CI 1·1–2·1, respectively]. Anxiety disorders (2·1% vs. 0·8%) and impaired social adjustment skills (7·5% vs. 4·2%) were also associated with moderate‐to‐severe psoriasis only compared with healthy controls [adjusted ORs 2·9, 95% CI 1·6–5·5 and 1·9, 95% CI 1·3–2·6 (of 466 vs. 265 023), respectively]. Conclusions Psoriasis among adolescents is associated with neuropsychiatric comorbidity and impaired adjustment skills, depending on disease severity. What's already known about this topic? Adult psoriasis is a risk factor for psychiatric and neurological diseases, including migraines. Few studies have linked childhood psoriasis to anxiety, depression and impaired social skills. What does this study add? In this population‐based cross‐sectional study, psoriasis in adolescence was associated with migraine and nonmigraine headaches, as well as psychological symptoms, including anxiety and impaired social adjustment skills. These findings were related to moderate‐to‐severe psoriasis only and not mild psoriasis. Linked Comment: Mrowietz. Br J Dermatol 2018; 178:830–831. Plain language summar