Off-Label Treatments for Pediatric Psoriasis: Lessons for the Clinic

Abstract

Psoriasis is a chronic inflammatory skin disease that affects up to 1.2% of children and adolescents. The treatment options for childhood psoriasis are often based on the same principles as in adults. However, most data on safety and efficacy derive from adult studies, and only a few of the frequently used treatments have achieved approval for use in children. The aim of this study was to review the current literature on off-label treatments for psoriasis in children and adolescents. We searched PubMed and identified 50 studies on offlabel treatments. Of these, 23 studies were clinical trials (four randomized). There are only a small number of available studies on off-label treatments for children and adolescents with psoriasis, and many of these are retrospective reviews with few participants. Despite the current lack of studies, we still recommend the use of unapproved treatments since we have clinical experience with treatments such as topical corticosteroids, vitamin D analogs, and methotrexate that have shown promising effects. Regular clinical trials are needed to investigate the safety and efficacy of unapproved treatments. Due to The Pediatric Investigation Plans issued by The European Union, new drugs developed by pharmaceutical companies are required to undergo clinical trials in a pediatric population to get their application for marketing authorization processed. This will hopefully lead to much more data on the efficacy and safety of the new treatments, including treatments for children and adolescents with psoriasis.

Secukinumab: A Review in Moderate to Severe Pediatric Plaque Psoriasis

“…Plaque psoriasis is a chronic, immune-mediated, inflammatory disease [1,2] affecting approximately 1% of children [3][4][5]. It is often associated with metabolic, cardiovascular, gastrointestinal, and psychological comorbidities [1,4], and can have a significant negative impact on quality of life (QOL) [3][4][5].…”

“…Plaque psoriasis is a chronic, immune-mediated, inflammatory disease [1,2] affecting approximately 1% of children [3][4][5]. It is often associated with metabolic, cardiovascular, gastrointestinal, and psychological comorbidities [1,4], and can have a significant negative impact on quality of life (QOL) [3][4][5]. In pediatric patients, the impact of psoriasis on QOL is estimated to be greater than that of diabetes or epilepsy and comparable to that of asthma or arthritis [6].…”

Pediatric Psoriasis: From New Insights into Pathogenesis to Updates on Treatment

“…Most of the medications approved for adult psoriasis can be used in children as well, although it is required that an off-label prescription is needed in pediatric cases. Not only efficacy and safety studies, but the outcomes from long-term follow-up are insufficient in this population [29,30].…”

“…Topical corticosteroids are commonly used as a first-line treatment for pediatric psoriasis with localized disease [30,37]. The selection of topical preparations should take into account a number of factors, including the area and extent of the lesion, the type and thickness of the psoriasis skin lesion, and the patient's age [30].…”

“…Topical corticosteroids are commonly used as a first-line treatment for pediatric psoriasis with localized disease [30,37]. The selection of topical preparations should take into account a number of factors, including the area and extent of the lesion, the type and thickness of the psoriasis skin lesion, and the patient's age [30]. Recently, two studies elucidated the efficacy and adverse effects of high-potency topical corticosteroids: halobetasol cream 0.05% and clobetasol propionate emulsion 0.05%.…”