Therapies for childhood psoriasis

Abstract

With a prevalence of 2% of the general population of Europe and North America, psoriasis represents one of the most common and significant dermatologic disorders. While it has been claimed that psoriasis is uncommon in children, in fact 27% of cases manifest before the age of 16 years; moreover, psoriasis represents 4.1% of all dermatoses seen in children under the age of 16 years. Both recognition and treatment of psoriasis in children represent unique challenges. Early diagnosis and appropriate management are particularly important in children to lessen long-term disease-related psychosocial problems and comorbidities. Psoriasis in childhood is a disease of many forms, which may change over time. It may be difficult to recognize, since the frequencies of some types of patterns of psoriasis differ between adults and children, and some clinical features are distinctive to the pediatric age group. Management involves education of the child and parents concerning the nature of the disease and the effects of treatment. Environmental triggers should be sought and eliminated, particularly infection, trauma, and stress. The treatment options available are basically the same as for adults, but special care should be taken in order not to endanger the development or the future health of the child. In children, treatment modalities are limited because of safety concerns and/or poor compliance associated with messy and time-consuming therapies. Randomized controlled clinical trials involving children under the age of 12 years suffering from psoriasis have been reported only for 2 topical treatments, namely, calcipotriol and corticosteroids. Phototherapy and systemic therapy with methotrexate, acitretin and cyclosporin have limited use because of lower tolerability in children and cumulative toxicities. For this reason, treatments of psoriasis with the newer biologic agents, particularly the soluble tumor necrosis factor receptor fusion protein etanercept, are emerging. Finally, it is important to acknowledge that topical and systemic treatments are only part of a 'total care' package combining treatment, disease-specific education, and psychological support to cope with a possible lifelong skin condition.