Systemic Treatment of Pediatric Psoriasis: A Review

Abstract

Psoriasis is a chronic, immune-mediated, inflammatory skin disease, affecting 1–3% of the white population. Although the existence of two psoriasis incidence peaks has been suggested (one in adolescence before 20 years of age and another in adulthood), its onset may occur at any age, including childhood and adolescence, in which the incidence is now estimated at 40.8 per 100,000. As for adult psoriasis, pediatric psoriasis has recently been associated with obesity, metabolic syndrome, increased waist circumference percentiles and metabolic laboratory abnormalities, warranting early monitoring and lifestyle modifications. In addition, due to psoriasis' chronic nature and frequently occurring relapses, psoriatic patients tend to have an impaired quality of life, often requiring long-term treatment. Therefore, education of both pediatric patients and their parents is essential to successful and safe disease management. Given the lack of officially approved therapies, the very limited evidence-based data from randomized controlled trials, and the absence of standardized guidelines, to date, pediatric psoriasis treatment is primarily based on published case reports, case series, guidelines for adult psoriasis, expert opinions and experience with these drugs in other pediatric disorders coming from the disciplines of rheumatology, gastroenterology and oncology. This review focuses on the use of systemic treatments in pediatric psoriasis and their specific features, analyzing the few literature evidences available, expanding the treatment repertoire and guiding dermatologists in better managing of recalcitrant pediatric psoriasis.

Childhood psoriasis

“…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].…”

“…Podobne zalecenia dotyczą stosowania kwasu salicylowego ze względu na duże ryzyko wystąpienia niepożądanych działań ubocznych. Stosowanie go u dzieci przed osiągnięciem wieku szkolnego dopuszczalne jest wyłącznie na małe powierzchnie i w stężeniu nieprzekraczającym 0,5%, zwłaszcza w przypadku niemowląt i dzieci poniżej 3. roku życia [14,[35][36][37][38][39][40][41].…”

“…This method is normally contraindicated in children under 12 years of age due to its adverse effects that include nausea, vomiting, hepatic toxicity, burn risk, and a longterm increase of skin cancer risk [40,41].…”

“…None of these medications are approved by the Food and Drug Administration (FDA) for treatment of psoriasis in children due to the lack of randomized trials in this age group. Evidence of risks and benefits of the drugs is derived from their use in other conditions, such as ichthyosis and juvenile arthritis, or in patients after organ transplantations [40,41].…”

“…Jest to metoda zazwyczaj przeciwwskazana u dzieci młodszych niż 12 lat z powodu działań niepożądanych, do których nale-żą nudności, wymioty, hepatotoksyczność, ryzyko oparzeń oraz jako powikłanie odległe -zwiększone ryzyko wystąpienia raka skóry [40,41].…”