Psoriasis is a persistent inflammatory disorder driven by immune mechanisms, affecting the skin, nails, and joints. Its onset is influenced by both genetic predisposition and environmental factors. [1] Clinically, it presents as a papulosquamous condition characterized by distinct erythematous, scaly, and well-demarcated plaques, commonly found on extensor surfaces and the scalp. The global prevalence of psoriasis is estimated to be between 2% and 3%.[2] Pediatric psoriasis often exhibits unique clinical features compared to adult-onset psoriasis, including more pronounced pruritus, thinner and less scaly plaques, and increased likelihood of facial and flexural involvement. [3]

This condition significantly affects the physical, emotional, and social well-being of children, leading to considerable distress for both patients and their families. [1] Despite its impact, there is a scarcity of research on childhood psoriasis, particularly in eastern India. To bridge this gap, the present study is being conducted at SLN Medical College and Hospital in Koraput, Odisha, to comprehensively analyze the clinical profile of pediatric psoriasis in this region.

Objective

The objective of this study is to evaluate and document the clinical characteristics of childhood psoriasis in patients attending SLN Medical College and Hospital, Koraput, Odisha.

This observational study was conducted in the Department of Dermatology at SLN Medical College and Hospital, Koraput, Odisha, over a duration of 12 months, from July 2021 to June 2022. The study focused on pediatric psoriasis and included all children up to 14 years of age who visited the Dermatology Outpatient Department during this period.

A thorough assessment was performed for each participant, which included a detailed general, systemic, and dermatological examination. Additionally, relevant laboratory investigations were conducted as required to support clinical findings and eliminate differential diagnoses. All collected data were systematically documented in a structured pro forma for further analysis.

For statistical evaluation, R software was utilized to manage data preprocessing, conduct descriptive statistics, and perform inferential analysis. Statistical techniques such as frequency distribution, measures of central tendency, and correlation analyses were employed to extract meaningful insights from the data. This methodical analytical approach ensured the precision and credibility of the study results.

Demographic Characteristics

A total of 38 pediatric psoriasis cases were analyzed. The age group most commonly affected was 9-13 years, comprising 50% (n=19) of the total cases, followed by the 5-8 years group at 28.9% (n=11) and the 0-4 years group at 21.1% (n=8). Female predominance was observed, with 60.5% (n=23) of cases occurring in females compared to 39.5% (n=15) in males.

Seasonal Variation

Psoriasis cases exhibited seasonal variation, with the highest frequency observed in spring (March-April) at 36.8% (n=14), followed by autumn (September-November) at 28.9% (n=11). The lowest incidence was recorded in winter (December-February) at 13.2% (n=5), while summer (May-August) accounted for 21.1% (n=8) of cases.

Site of Onset

The most common initial site of psoriasis onset was the lower extremities, affecting 39.5% (n=15) of cases, followed by the scalp at 36.8% (n=14). Upper extremities accounted for 15.8% (n=6) of cases, while the trunk was the least common site at 7.9% (n=3).

Sites Involved

The most frequently affected site in pediatric psoriasis was the extremities, observed in 68.4% (n=26) of cases. Scalp involvement was noted in 60.5% (n=23), followed by facial and truncal involvement at 28.9% (n=11) each. Intertriginous area involvement was relatively uncommon, recorded in only 5.3% (n=2) of cases

Pediatric psoriasis is a significant dermatological condition, yet limited epidemiological data exist. The prevalence of childhood psoriasis in our outpatient pediatric population was 1.24%. A study conducted by Dogra and Kumar [2] in North India among school children aged 6–14 years found a point prevalence of 0.02%. Similarly, Karthikeyan et al. [3] reported that psoriasis constituted 1.4% of all pediatric dermatoses in children under 14 years attending a referral hospital in South India. Studies from other regions have reported varying incidence rates, such as Gül et al. [4] who found a 5.4% incidence in children, while Sardana et al. [5] recorded a 0.54% prevalence in a tertiary care center in India. Tollefson et al. [6] reported a much higher prevalence of 3.8% in children.

Age of onset varies across studies. While several studies, including those from India and Denmark, observed peak onset between 6–10 years [7], others report an onset between 15–25 years [8]. Nyfors and Lemholt [9] noted a mean onset age of 8.1 years in Denmark, whereas Morris et al. [10] found peak onset in the 0–2 years age group. Kumar et al. [11] observed a range of 4 days to 14 years, with a mean age of onset at 8.1 ± 2.1 years in boys and 9.3 ± 2.3 years in girls. Our study aligns with these findings, reporting a peak age of onset at 9–13 years and a mean onset of 8.4 years, with the youngest patient being one year old.

Gender distribution in psoriasis is often skewed towards females. In our study, females (73.08%) outnumbered males (26.92%) with a ratio of 2.71:1, similar to most reports [14,15]. However, Nanda et al. [16] did not observe female predominance, and Morris et al. [10] reported a male-to-female ratio of 0.9:1.0. Studies by Kumar et al. [11] and Wu et al. [17] also presented varying gender distributions.

Seasonal exacerbations were observed, with the highest cases reported in spring and autumn, a finding consistent with Wu et al. [17], who noted exacerbations in spring and winter.

A positive family history was noted in 7.69% of cases. Previous studies, including Morris et al. [10], have documented a significantly higher familial association.

Plaque-type psoriasis was the most common presentation in our study (53.85%), followed by plantar psoriasis (30.77%) and scalp psoriasis (15.38%). This is consistent with previous studies where plaque psoriasis was the predominant type [10,11,17].

The most frequently affected sites were the lower extremities (42.31%) and scalp (34.62%), with extremities (65.38%) being the most involved site, followed by the scalp (57.69%). Our findings align with those reported by Tollefson et al. [6], who found extremities (59.9%) and the scalp (46.8%) to be most commonly affected.

Nail involvement was noted in 15.38% of cases, comparable to reports from Kumar et al. [11] (31%) and Tollefson et al. [6] (17%). Pruritus was the most frequent symptom, observed in 92.31% of our cases, which is higher than the 87.1% reported by Kumar et al. [11].

Our study also found plantar involvement in 30.77% of cases, a rate higher than that reported by Morris et al. [10] (4%) but similar to Kumar et al. [11] (12.8%). The increased incidence in Indian children may be attributed to barefoot walking and open footwear, leading to Koebnerization

Our findings suggest that childhood psoriasis is more prevalent in females than males, differing from adult-onset psoriasis. Plantar involvement was notably higher compared to studies outside India, while chronic plaque psoriasis remained the most common subtype. Pediatric psoriasis also showed greater involvement of the trunk, face, and groin compared to adult patients. Further long-term clinico-epidemiological studies are needed to better understand the unique characteristics of childhood psoriasis and regional variations influenced by genetic and environmental factors.

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