Cutaneous biomarkers of advanced glycation in paediatric psoriasis: a comparative study

Background: Psoriasis is a chronic, immune-mediated inflammatory skin disease. Although often considered an adult condition, it begins in childhood or adolescence in around one-third of cases. Increasingly recognised as a systemic disease, psoriasis is associated with early metabolic and cardiovascular alterations. Paediatric psoriasis is characterised by distinct clinical features and burden of disease compared with the adult-onset forms. The identification of early, non-invasive biomarkers is crucial to gain a better understanding of the early systemic involvement of psoriasis and to monitor the long-term risk in young patients. Advanced Glycation End-products (AGEs) are a heterogeneous group of molecules formed through irreversible non-enzymatic reactions between reducing sugars and proteins or nucleic acids. Oxidative stress and chronic inflammation drive the production of AGEs, which in turn exacerbate these processes. Increased cutaneous and serum AGE levels have been reported in adults with psoriasis; however, data in paediatric populations remains limited. Aim of the study: This study aims to evaluate cutaneous Advanced Glycation End-products (AGEs) in paediatric psoriasis compared to healthy controls, using non-invasive Skin Autofluorescence (SAF) measurements. The objective was to explore associations between AGE levels and demographic, anthropometric and disease-specific variables, and to assess the potential of cutaneous AGEs as a non-invasive biomarker of systemic involvement and cardiovascular risk in paediatric psoriasis. Materials and methods: A single-centre comparative study was conducted at the UOS Women’s and Children’s Dermatology “Regional Centre of Paediatric Dermatology and Genodermatoses” of the University Hospital of Padua, involving 69 participants aged 5-18 years (34 with psoriasis and 35 healthy controls). Cutaneous Advanced Glycation End-products (AGEs) were measured non-invasively using the AGE Reader, a device that quantifies skin autofluorescence (SAF), providing an indirect measure of AGE accumulation. Demographic, anthropometric and clinical data were collected and analysed in relation to cutaneous AGE values. Results: A total of 69 children and adolescents were included in the study, comprising 34 psoriasis patients and 35 healthy controls, with a mean age of 11.4 ± 3.5 years. Psoriasis patients exhibited significantly higher cutaneous AGE levels compared to controls (1.16 ± 0.17 vs 1.02 ± 0.13, p = 0.001). This association remained significant after adjustment for age, sex, and BMI (both raw and percentiles), with psoriasis status being an independent predictor of elevated cutaneous AGEs (β = 0.15, p < 0.001). Age showed a positive association with cutaneous AGEs (β = 0.022, p = 0.002), while BMI demonstrated a slightly negative relationship. No significant associations were observed between cutaneous AGE levels and psoriasis specific variables, including Psoriasis Area and Severity Index (PASI), disease duration, psoriasis subtype, nail involvement or comorbidities. A higher proportion of psoriasis patients were classified in the increased AGE-dependent cardiovascular risk category compared to controls (24% vs 9%), although this difference did not reach statistical significance. Logistic regression confirmed the discriminative ability of cutaneous AGEs to distinguish psoriasis patients from controls (AUC = 0.78). Conclusions: Paediatric psoriasis patients showed significantly higher cutaneous AGE levels compared to healthy controls, independently of age, sex, and BMI, with psoriasis status identified as the strongest predictor of elevated cutaneous AGEs. These findings suggest that, in psoriasis patients, cutaneous AGE accumulation may occur early in life. Cutaneous AGEs could serve as a non-invasive biomarker for the early detection of systemic involvement and for cardiovascular risk assessment in paediatric psoriasis.