Accurately Discriminating Psoriasis From Other Inflammatory Skin Disorders

Findings from the DIPSOC study reveal 7 criteria that could prove useful in discriminating psoriasis from other inflammatory skin disorders in children and adolescents. These criteria were summarized in a commentary article published in the British Journal of Dermatology.

The 3-year case-control DIPSOC study included 300 children and adolescents who were enrolled from 12 UK pediatric dermatology departments. The presence or absence of 16 diagnostic signs of psoriasis were recorded by investigators. In addition, the researchers assessed whether patients had a family history of psoriasis or a history of Köbner phenomenon.

Given that psoriasis can exert substantial psychological and physical impacts on patients, especially when the disorder develops at an early age, criteria that can accurately identify psoriasis early in children and adolescents are needed. The researchers note that “the DIPSOC study is the first of a number of planned studies by the same investigators aimed at further refining the diagnostic criteria for psoriasis in children and adolescents in the hope that this will result in more timely recognition and management.”

A total of 170 participants in the study had a dermatologist-recorded diagnosis of psoriasis, and 160 participants had received a different diagnosis (eg, atopic eczema). The investigators were blinded to all diagnoses.

In an analysis that examined the sensitivity and specificity of each of the 18 diagnostic criteria, the investigators selected 7 criteria that were considered most useful for the discrimination of psoriasis between other inflammatory skin conditions: scaling and erythema involving the hairline; external auditory canal or extensor surfaces of the elbows and knees; persistent well-demarcated erythematous rash anywhere on the body; persistent well-demarcated erythema involving the umbilicus or napkin area and crural folds; and family history of psoriasis.

According to the investigators, the presence of any 2 of the 7 identified diagnostic criteria could accurately identify psoriasis in four-fifths of children and adolescents with the condition (78%) and may eliminate an alternative diagnosis in 71% of cases.

Reference

Chalmers RJG. Recognizing psoriasis in children and adolescents: the DIPSOC study. Br J Dermatol. Published online November 22, 2021. doi:10.1111/bjd.20825