Retrospective Review of Pediatric Psoriasis and TNF-Inhibitor Induced Psoriasiform Disease in Patients With Skin of Color

BACKGROUND: Psoriasis affects ~3% of the adult U.S. population, with known differences in prevalence, presentation, and treatment outcomes across racial and ethnic groups. In pediatric populations, disparities in psoriasis recognition may lead to delayed diagnosis and undertreatment, especially in patients with skin of color (SoC). OBJECTIVES: To compare clinical presentation and treatment patterns in pediatric patients with psoriasis with and without SoC at a single tertiary-care pediatric center. METHODS: We conducted a retrospective, case-control cohort study of patients diagnosed with psoriasis (including TNF-associated psoriasis) before age 18 at SickKids Hospital (January 2008-March 2024). Inclusion criteria were systemic treatment before or after diagnosis of psoriasis and available photo documentation. Patients were stratified by skin phototype based on the Massey-Martin Scale for SoC. Demographics, clinical features, and treatment patterns were compared between SoC and non-SoC groups. RESULTS: = .05), and arthritis were more common in non-SoC patients. SoC patients had a shorter time to diagnosis and were more likely to receive cyclosporine initially and methotrexate overall. Non-SoC patients had higher biologic use throughout care (77.2% vs 63.2%). Topical corticosteroids were the most prescribed treatment across both groups. CONCLUSIONS: Pediatric patients with and without SoC showed distinct trends in disease presentation and management. Differences in clinical presentation and medication use highlight the need for increased awareness of psoriasis manifestations in diverse skin types. Prospective studies with standardized assessment tools could help addressing the differences described in this study.