Experts Warn Climate Change May Lead to More Childhood Psoriasis Cases

Pediatric psoriasis | Image credit: DermNet

When we think of psoriasis, the image that often comes to mind is of a middle-aged adult struggling with patches of red, scaly skin. However, a surprising trend is emerging worldwide: an increasing number of children are being diagnosed with this chronic inflammatory condition. Pediatric psoriasis, once considered rare, is now a growing concern that’s catching many parents and even experts off guard. But why is this happening, and what can we do about it?

Potential Causes and Climate Change Connection

The global rise in inflammatory and autoimmune cases has prompted researchers to investigate potential causes for this alarming trend. A prominent theory suggests that climate change could be altering the human microbiome, contributing to the increase in pediatric psoriasis cases. The theory suggests that rising CO2 levels on Earth degrade air quality and diminish the nutritional value of food. This, in turn, can influence the gut, changing our species' microbiome to a more proinflammatory state. The human gut is home to trillions of microorganisms that play important roles in our overall health, including immune system regulation. Growing evidence suggests that changes in the gut microbial community are associated with the development and progression of various inflammatory diseases, including psoriasis.^{1, 2}

An imbalance in gut bacteria can lead to a more active pro-inflammatory state in the body, potentially triggering or exacerbating psoriasis in genetically predisposed children. The combination of these factors creates a perfect storm for inflammatory skin conditions. The combined effect of altered gut health and environmental stressors lowers the threshold for psoriasis development in children who are genetically susceptible.²

Systemic Impact and Comprehensive Care

Once viewed primarily as a mere cosmetic skin condition, psoriasis is now recognized as a systemic inflammatory disease that can have far-reaching effects throughout the body. In the context of pediatric psoriasis, early recognition and management of these systemic effects can significantly impact a child's overall health and development. In children, it can affect multiple organ systems, leading to cardiovascular issues, metabolic syndrome, gastrointestinal diseases, joint problems, and immune dysfunction.³ Comprehensive screening and management are vital, including:

• Cardiovascular Health: Monitor blood pressure and lipid levels.
• Metabolic Health: Screen for diabetes and obesity.
• Gastrointestinal Health: Be vigilant for signs of inflammatory bowel disease.
• Joint Health: Regularly check for symptoms of psoriatic arthritis.
• Immune Function: Monitor overall immune health.

Immediate Interventions

Given the slow pace of addressing climate change, fortunately, treatment options for pediatric psoriasis have expanded significantly, offering a range from topical treatments to biologics. Traditional topical steroids remain common, but new topical non-steroidals such as tapinarof cream (patients aged 18 years and older) and roflumilast cream (patients aged 6 years and older) provide effective alternatives. For moderate to severe cases, oral medications such as apremilast (patients aged 6 years and older) have shown great promise. Additionally, biologics, including etanercept (TNF), ustekinumab (IL-12, IL-23), ixekizumab (IL-17A), and secukinumab (IL-17A), are now approved for children as young as 4 to 6 years old, offering powerful treatment options for moderate to severe cases.

Of note, the IL-17 inhibitors require careful screening for potential risks like inflammatory bowel disease. This diverse array of options allows for tailored treatment plans, balancing effectiveness with safety for each child's unique needs.

Whole Person Approach to Care

The JAMA Dermatology guidelines from July 2017 provide a framework for comprehensive care for our pediatric psoriasis population. This includes monitoring for obesity, diabetes, hypertension, hyperlipidemia, nonalcoholic fatty liver disease, arthritis, and psychological issues. Address the psychological impact of psoriasis, including self-esteem, body image, and mental health, while providing support for social challenges and bullying.⁴

Conclusion

While compelling, the true effects of climate change on inflammatory and autoimmune diseases require more direct evidence to establish a definitive causal link. Nonetheless, the rise in pediatric psoriasis cases presents unique challenges and opportunities in the realm of children’s health. The rising prevalence of this condition underscores the need for increased awareness, early diagnosis, and comprehensive management. Key takeaways include understanding that pediatric psoriasis affects multiple body systems and requires a holistic approach to care. Early detection and regular screening for associated conditions are key for optimal health outcomes. With proper care, support, and a positive outlook, children with psoriasis can lead full, healthy lives. The medical community continues to make strides in understanding and treating pediatric psoriasis, offering hope for a brighter future.

Encourage young patients and their parents or caregivers to stay informed by working closely with their health care team. Each small step in managing psoriasis is a victory.

Michael Rubio, PA-C, is a dermatology physician associate (PA) at Infinity Dermatology in Brooklyn, NY. He is the vice co-chair of the Society of Dermatology PAs (SDPA) Communication Committee and a contributor to the National Commission on Certification of Physician Assistants (NCCPA) development of the Certificate of Added Qualifications (CAQ) in Dermatology. He is also a co-founder of Well Revolution (www.wellrevolution.com), a same-day direct primary care platform helping to address the primary care shortage crisis in the United States.

References

1. Maciel-Fiuza MF, Muller GC, Campos DMS, et al. Role of gut microbiota in infectious and inflammatory diseases. Front Microbiol. 2023;14:1098386. doi:10.3389/fmicb.2023.1098386
2. Ray C, Ming X. Climate change and human health: a review of allergies, autoimmunity and the microbiome. Int J Environ Res Public Health. 2020;17(13):4814. Published 2020 Jul 4. doi:10.3390/ijerph17134814
3. Tashiro T, Sawada Y. Psoriasis and systemic inflammatory disorders. Int J Mol Sci. 2022;23(8):4457. Published 2022 Apr 18. doi:10.3390/ijms23084457
4. Osier E, Wang AS, Tollefson MM, et al. Pediatric psoriasis comorbidity screening guidelines. JAMA Dermatol. 2017;153(7):698. doi:10.1001/jamadermatol.2017.0499