A common skin disorder with potential multisystem implications

it can be managed well if recognised and treated correctly. With evidence increasing that children with psoriasis are at greater risk of cardiovascular disease, obesity and metabolic syndrome later in life, a young patient with this chronic skin disorder presents an important opportunity for preventive action to reduce future health risks. Psoriasis is a common chronic skin condition that affects around 3% of all people. Retrospective studies indicate that one-third of adult patients recall a childhood onset, and two-thirds of patients have a family history of psoriasis. The results of twin studies are suggestive of a strong genetic component.1 A number of chromosomal loci have been linked to an increased susceptibility for psoriasis.2-4 The typical age of onset for psoriasis is in late childhood and early adulthood, but psoriasis can start at any time in life. Exacerbations and acute attacks may be triggered by certain events, such as trauma or infections, including viral upper respiratory tract infections. Group A streptococcal throat and skin infections are one of the most common causes of acute guttate psoriasis and can worsen pre-existing psoriasis. In susceptible children, streptococcal genital infections often precipitate genital psoriasis. Psoriasis may also be precipitated by certain drugs, particularly beta blockers, antiepileptic drugs, antimalarial agents and lithium. The pathophysiology of psoriasis is related to an excessively rapid turnover of keratinocytes. Recent studies in adults suggest it to be an immune-mediated condition that is associated with a number of autoimmune disorders and can have systemic implications, particularly arthritis and metabolic syndrome. Studies suggest that children with psoriasis are more likely to be overweight and may be at risk for metabolic syndrome from adolescence onwards.5-7 Psoriasis is therefore increasingly viewed as being a skin disorder that has potential multisystem implications.