Perspectives on the pharmacological management of psoriasis in pediatric and adolescent patients

ABSTRACT

Introduction

Psoriasis affects about 0.5% of children and adolescents, it has a high impact of social life. Management can be difficult. The beginning of the 21st century has been an interesting period for the management of pediatric psoriasis, with access to new topical and systemic treatments including several biotherapies.

Areas covered

Herein, we analyze the current therapeutic strategies for managing psoriasis in young patients, ranging from infants to adolescents, in a holistic approach. Usual treatment but also new galenics, new topical associations, and biological (anti-TNF-alpha, anti-interleukin 12/23, anti-interleukin 17) recently developed are presented. Results from clinical trials are detailed, but also real-world evaluations, and recent guidelines. Practical tips for day-to-day management are finally proposed.

Expert opinion

Currently, we have a wide range of treatments, which we can adapt to all types of psoriasis, depending on the demands of the child and his parents. The near future also looks promising with new topical combinations, new oral therapies (apremilast) and biologics (anti-interleukin 23), as well as genetically targeted therapies for pustular psoriasis.

KEYWORDS:

• Psoriasis
• infant
• children
• adolescents
• treatment
• topical steroids
• calcipotriol
• methotrexate
• acitretin
• cyclosporine
• biotherapies

Article highlights

• Topical treatments have seen interesting advances recently with new combination treatments and new galenics.

• For a few years, the arrival of several biotherapies, licensed from the age of 4-6 years, has made it possible to control all severe paediatric psoriasis.

• Up to 100% of children receive unlicensed topical and systemic medications, but the tolerance of these medications is known in this population and allows their use when necessary.

• Main limits for use of treatments are cost of new treatments, and making all these therapeutic advances available in all countries.

• Near future is promising with evaluation of many drugs in childhood: topical oral treatments, and biologics.

Declaration of interest

E. Mahé has declared consultant, advisor, or speaker fees for AbbVie, Janssen, Celgene, Leo Pharma, Lilly, Amgen, and Novartis. 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer has declared research, speaking and/or consulting support from Galderma, GSK/Stiefel, Almirall, Alvotech, Leo Pharma, BMS, Boehringer Ingelheim, Mylan, Celgene, Pfizer, Ortho Dermatology, Abbvie, Samsung, Janssen, Lilly, Menlo, Merck, Novartis, Regeneron, Sanofi, Novan, Qurient, National Biological Corporation, Caremark, Advance Medical, Sun Pharma, Helsinn, Arena, Forte, Informa, UpToDate and National Psoriasis Foundation. They have consulted through Guidepoint Global, and Gerson Lehrman. They are currently employed by www.DrScore.com, and Causa Research. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose

Additional information

Funding

This paper was not funded.