The Role of Stress in Children with Psoriasis

Abstract

Background

Stress could be involved as a precipitating or aggravating factor in psoriasis. In the literature, few sources refer to this subject in the pediatric field and even fewer to case-control studies.

Objective

The purpose of the study was to note any stressful situations that occur before the onset or extension of psoriasis in children aged 16 years and younger.

Methods

The study comprised 41 children (23 girls, 18 boys) with psoriasis who were enrolled in a comparative study.

Results

Between March 2001 and December 2007, 9,940 children (≤16 years old) were examined. The incidence of psoriasis among new dermatologic conditions was 0.43%. The mean age of the children was 11.97 years. There was a family history of the disease in 29.26% of cases; 31% of children with psoriasis had onset of psoriasis less than 3 months before the evaluation, and 38% had recent extensions or recurrence. In 14.6% of psoriasis cases, an inflammatory focus was identified. Stressful events had occurred in 41% of the psoriasis group, compared with 17% of controls. The difference was statistically significant (χ² = 4.77, P = .028). The odds ratio was 3.44 (95% CI, 1.23–9.57). Most of these children had mentioned one event that may have had an impact on the development of psoriasis. Girls with psoriasis vulgaris and boys with guttate lesions were most often affected by stressful situations. Family problems (death, illnesses, disputes, parents working abroad, financial restrictions) were more often described in psoriatic cases. Also, school situations were often mentioned as influencing the psoriatic lesions.

Conclusions

The recollection of past events within the patient's family or by the patient and the dimensions of the sample could be considered limitations of the study. However, the presence of stressful events could be taken in consideration as influencing the onset, recurrence, or extension of psoriasis in children.