Impact of Pediatric Psoriasis on Child and Caregiver Health-Related Quality of Life: A Systematic Review and Meta-Analysis.

BACKGROUND

Pediatric psoriasis is a chronic inflammatory skin disease that affects both physical and psychosocial well-being. The impact of the disease extends beyond the patient, significantly affecting caregivers' emotional and functional quality of life.

OBJECTIVES

This systematic review and meta-analysis aimed to evaluate the health-related quality of life (HrQOL) burden of pediatric psoriasis on children and their caregivers. The study also sought to identify clinical and child-related factors associated with increased impairment in HrQOL.

METHODS

A systematic search of MEDLINE and Embase databases was conducted according to PRISMA guidelines. Studies included children under 18 years of age with a diagnosis of psoriasis and/or their caregivers, reporting outcomes using validated HrQOL measures. Two reviewers independently screened studies, extracted data, and assessed quality using the Mixed Methods Appraisal Tool. Where appropriate, correlation coefficients were pooled using random-effects meta-analysis after Fisher's Z-transformation.

RESULTS

Twenty-one studies were included, encompassing 1038 children and 1161 caregivers. The most commonly used instruments were the Children's Dermatology Life Quality Index (CDLQI) and Family Dermatology Life Quality Index (FDLQI). Across studies, 84.8% of children and 96.1% of caregivers experienced some degree of HrQOL impairment. Meta-analysis revealed a moderate positive correlation between child disease severity (PASI scores) and caregiver HrQOL burden (r = 0.463), while no significant correlation was found with child age or disease duration. Amongst children, HrQOL was most affected in the domains of symptoms, leisure, and treatment-related concerns.

CONCLUSIONS

Pediatric psoriasis exerts a substantial impact on both child and caregiver quality of life, with greater burden associated with more severe disease. These findings highlight the need for early intervention and psychosocial support targeting families. Clinicians should consider the broader family context when managing pediatric psoriasis and prioritize counseling during disease flares to mitigate emotional and functional strain.