Management of psoriasis in adolescence

Abstract

Psoriasis is a chronic inflammatory cutaneous disorder affecting 2%–4% of the world’s population. The prevalence of the disease in childhood and adolescence ranges between 0.5% and 2%. The management of psoriasis in adolescence is an intriguing and complicated task. Given the paucity of officially approved therapies, the very limited evidence-based data from randomized controlled trials, and the absence of standardized guidelines, physicians must rely on published experience from case reports both from the field of dermatology as well as from the application of these drugs for other pediatric conditions coming from the disciplines of rheumatology, gastroenterology, and oncology. Psoriatic adolescents deal with a potentially disfiguring and lifelong disease that could permanently impair their psychological development. It must be clarified to them that psoriasis does not have a permanent cure, and therefore the main goal of treatments is to establish disease control and prolonged periods between flares. The majority of adolescents suffer from mild psoriasis, and thus they are treated basically with topical treatment modalities. Phototherapy is reserved for adolescents with mild-to-moderate plaque disease and/or guttate psoriasis when routine visits to specialized centers do not create practical problems. Systemic agents and biologics are administered to patients with moderate-to-severe plaque psoriasis, pustular psoriasis, or erythrodermic psoriasis.

Childhood psoriasis

“…Other important information includes the possible need for psychological support, regular dental or ENT check-ups, and a balanced diet. As there are no guidelines for treatment, and most (systemic) psoriasis treatment methods have not been approved for use in children, treatment of childhood psoriasis remains a challenge [35][36][37][38][39]. In children, systemic treatments are prescribed more often than in adults, as they are typically better tolerated, produce prompt remissions, and are more consistent with the treatment model.…”

“…When choosing treatment options, the following factors must be considered: patient age, clinical form of psoriasis, location of lesions, disease severity, concurrent psoriatic arthritis, previous treatment, comorbidities, medication availability, possibilities for application (including treatment cost), complication risk analysis, and impact on quality of life (exercise, functional complications, emotional and social factors) [14,[35][36][37][38][39].…”

“…Similar caution is advised with regard to salicylic acid due to the considerable risk of adverse side-effects. In pre-school children, especially infants and children below 3 years of age, salicylic acid should only be applied on small areas and at a concentration not exceeding 0.5% [14,[35][36][37][38][39][40][41].…”

“…Wskazane jest poinformowanie o możliwej potrzebie wsparcia psychologicznego, konieczności regularnych kontroli stomatologicznych i laryngologicznych oraz włączenie diety o zrównoważonych proporcjach. Ponieważ nie istnieją wytyczne dotyczące terapii, a więk-szość metod leczenia (ogólnego) nie została zaaprobowana do stosowania u dzieci, terapia łuszczycy wieku dziecięcego stanowi wyzwanie [35][36][37][38][39]. U dzieci chętniej niż u dorosłych sięga się po leki ogólne, ponieważ zazwyczaj są lepiej tolerowane, dają szybką remisję i są bardziej akceptowane przez pacjentów.…”

The role of Toll-like receptors in skin diseases

“…choroby Autoimmunologiczne łuszczyca Łuszczyca jest przewlekłą chorobą skóry, dotyczącą 2-4% populacji rasy kaukaskiej [48]. Na ke ra tynocytach ze zmian łuszczycowych wykazano zwiększoną ekspresję TLR2, TLR3, TLR4, ich aktywacja prowadzi do syntezy prozapalnych cytokin IFNγ i TNFα [49].…”