Pharmacotherapeutic management of psoriasis in adolescents and children

ABSTRACT

Introduction: Psoriasis is a relatively common condition, with a lot of discordance in studies about the peak of onset. In a large German study, an almost linear prevalence increase was reported during childhood, ranging from 0.12% at 1 year to 1–2% at 18 years. According to recent studies, plaque psoriasis is the most common variant in childhood disease.

Areas covered: This article focuses on topical, systemic and biologic therapies used in childhood psoriasis. The authors performed a full literature PubMed research, while incorporating case reports and experience. Topical agents are considered the first step, but they always have little efficacy in the extensive form of the disease. In this case, systemic and particularly biological therapy must be evaluated. The most studied treatment in the pediatric population is etanercept, but adalimumab and ustekinumab are also approved in pediatric and adolescent populations.

Expert opinion: Larger studies are needed to further investigate the use of new compounds in childhood psoriasis. Recent evidence suggests that practitioners should consider interceding in the early immunologic psoriatic process to halt this march and stunt immunological scar development. An early investment would provide lasting effects and serious impact in long-term disease modification.

KEYWORDS:

• Paediatric psoriasis
• psoriasis in adolescent
• psoriasis in children
• IL-17
• IL-22
• early intervention

Article highlights

• Almost one-third of the cases of psoriasis show up in childhood and, due to the increasing prevalence and incidence, it’s necessary to build up guidelines always up-to-date.

• Childhood psoriasis represents a special challenge in terms of clinical features, genetic risk variants, triggering factors, and disease course.

• Pediatric psoriasis is associated with higher levels of IL-22 producing T cells and relatively less IL-17 producing T cells compared with adult psoriasis.

• The psychosocial impact of a chronic disease in childhood has more severe implications for general function in all spheres of adult life.

• A more aggressive approach in psoriasis, as early intervention, with systemic agents or biologicals used earlier in the treatment paradigm with the goal of complete clearance, may change the natural history of the disease, control comorbidities, help more patients to achieve long-term remission, improve long-term outcomes with reduction of stigmatization.

Declaration of interest

L Bianchi has served as a speaker and a consultant for AbbVie, Novartis, Janssen-Cilag, Pfizer, UCB Pharma, Leo Pharma all outside the submitted work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.