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Ruggiero A, Portarapillo A, Megna M, Patruno C, Napolitano M. Management Strategies for Pediatric Moderate-to-Severe Plaque Psoriasis: Spotlight on Biologics. Pediatric Health Med Ther 2023; 14:435-451. [PMID: 38024562 PMCID: PMC10656860 DOI: 10.2147/phmt.s389108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Although psoriasis onset has been reported at any ages, in up to one-third of cases, it begins during childhood, with an estimated prevalence of about 2% in pediatric population. The management of moderate-to-severe forms of childhood psoriasis may represent a challenge for dermatologists, especially for parents' concerns about the need of systemic treatments. However, a prompt safe and effective treatment is mandatory in these patients, due to the significative impact that psoriasis may have on their quality of life, with well-known consequences on psychological health of both patients and caregivers. Due to the relatively frequent parents' refusal of systemic treatments, probably due to the fear of eventual adverse events, difficulties of oral or injective route, the management of moderate-to-severe forms still represents a challenge. Herein, we report a narrative review, aiming to resume the systemic treatments for pediatric psoriasis, focusing on the use of biologics and small molecules in the pediatric ages. The most widely used therapeutic strategies today for the pediatric population with moderate-severe psoriasis are traditional systemic therapies, while more innovative drugs such as biologics and small molecules now represent a somewhat unexplored but certainly promising field for unresponsive patients.
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Affiliation(s)
- Angelo Ruggiero
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, 80131, Italy
| | - Antonio Portarapillo
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, 80131, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, 80131, Italy
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Maddalena Napolitano
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, 80131, Italy
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Seyger MMB, Augustin M, Sticherling M, Bachhuber T, Fang J, Hetherington J, Lucas J, Meakin S, Richardson C, Paller AS. Physician-reported Clinical Unmet Needs, Burden and Treatment Patterns of Paediatric Psoriasis Patients: a US and EU Real-world Evidence Study. Acta Derm Venereol 2021; 102:adv00660. [PMID: 34935993 PMCID: PMC9631255 DOI: 10.2340/actadv.v101.981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study is a retrospective analysis using data collected from the Adelphi Paediatric Psoriasis Disease-Specific Programme cross-sectional survey. Despite being treated for their psoriasis, a substantial proportion of paediatric patients presented with moderate (18.3%) or severe (1.3%) disease at sampling; 42.9% and 92.0% had a body surface area (BSA) of >10%, and 38.8% and 100.0% had a Psoriasis Area Severity Index (PASI) score >10, respectively. Overall, 69.9% of patients had only ever been treated with a topical therapy for their psoriasis. For patients with moderate or severe disease at sampling, 16.3% and 14.4% were currently receiving conventional systemics or biologic therapy, respectively. There is a clinical unmet need in this paediatric population; a considerable percentage of patients still experienced moderate or severe disease and persistent psoriasis symptoms, with numerous body areas affected. A significant proportion of patients were undertreated, which may explain the high burden of disease observed.
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Affiliation(s)
- Marieke M B Seyger
- Department of Dermatology, Radboud University Nijmegen Medical Centre, NL-6500 HB Nijmegen, the Netherlands.
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Rajagopalan M, Chatterjee M, De A, Dogra S, Ganguly S, Kar BR, Madnani N, Neema S, Parasramani SG, Patel K, Tahiliani S. Systemic Management of Psoriasis Patients in Indian Scenario: An Expert Consensus. Indian Dermatol Online J 2021; 12:674-682. [PMID: 34667752 PMCID: PMC8456263 DOI: 10.4103/idoj.idoj_113_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/07/2021] [Accepted: 08/19/2021] [Indexed: 01/14/2023] Open
Abstract
Background: Psoriasis is a common inflammatory disease with significant comorbidities, and regardless of its extent, it affects the patients' quality of life. The various modalities of treating psoriasis comprise topical or systemic medications, phototherapy, and an array of biologic agents. There is a lack of Indian recommendations on the management of psoriasis with these different modalities and challenges faced by the clinicians in day-to-day practice. Aim: To develop India-specific consensus for systemic management of patients with moderate-to-severe psoriasis. Method and Results: A panel of dermatology experts, based on the evidence and international recommendations, coupled with their own clinical experience, developed recommendations for systemic management of patients with moderate-to-severe psoriasis. Conclusion: These recommendations are meant to provide guidance in terms of choice of systemic therapies, dosing, effectiveness, and safety. It also addresses clinical challenges that may be experienced during psoriasis management.
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Affiliation(s)
| | - Manas Chatterjee
- Department of Dermatology, Command Hospital, Kolkata, West Bengal, India
| | - Abhishek De
- Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Raipur, Chhattisgarh, India
| | - Satyaki Ganguly
- Department of Dermatology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Bikash Ranjan Kar
- Department of Dermatology, Institute of Medical Sciences and Sum Hospital, Siksha 'O' Anusandhan, Bhubaneshwar, Odisha, India
| | - Nina Madnani
- Visiting Dermatology Consultant, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Shekhar Neema
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
| | - S G Parasramani
- Department of Dermacosmetology, Lilavati Hospital, Mumbai, Maharashtra, India
| | - Krina Patel
- Department of Dermatology, Gujarat Medical Education and Research Society Medical College, Sola, Gujarat, India
| | - Sushil Tahiliani
- Consultant Skin and S.T.D. Specialist, Dermatosurgeon, Dr. Tahiliani's Clinic, Bandra West, Mumbai, Maharashtra, India
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Mohd Nordin UU, Ahmad N, Salim N, Mohd Yusof NS. Lipid-based nanoparticles for psoriasis treatment: a review on conventional treatments, recent works, and future prospects. RSC Adv 2021; 11:29080-29101. [PMID: 35478537 PMCID: PMC9038133 DOI: 10.1039/d1ra06087b] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/19/2021] [Indexed: 12/19/2022] Open
Abstract
Psoriasis is a lingering inflammatory skin disease that attacks the immune system. The abnormal interactions between T cells, immune cells, and inflammatory cytokines causing the epidermal thickening. International guidelines have recommended topical treatments for mild to moderate psoriasis whilst systemic and phototherapy treatments for moderate to severe psoriasis. However, current therapeutic approaches have a wider extent to treat moderate to severe type of psoriasis especially since the emergence of diverse biologic agents. In the meantime, topical delivery of conventional treatments has prompted many unsatisfactory effects to penetrate through the skin (stratum corneum). By understanding the physiology of stratum corneum barrier functions, scientists have developed different types of lipid-based nanoparticles like solid lipid nanoparticles, nanostructured lipid carriers, nanovesicles, and nanoemulsions. These novel drug delivery systems help the poorly solubilised active pharmaceutical ingredient reaches the targeted site seamlessly because of the bioavailability feature of the nanosized molecules. Lipid-based nanoparticles for psoriasis treatments create a paradigm for topical drug delivery due to their lipids' amphiphilic feature to efficiently encapsulate both lipophilic and hydrophilic drugs. This review highlights different types of lipid-based nanoparticles and their recent works of nano formulated psoriasis treatments. The encapsulation of psoriasis drugs through lipid nanocarriers unfold numerous research opportunities in pharmaceutical applications but also draw challenges for the future development of nano drugs.
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Affiliation(s)
- Ummu Umaimah Mohd Nordin
- Department of Chemistry, Faculty of Science, University of Malaya 50603 Kuala Lumpur Malaysia +603-79674193 +603-79674008
| | - Noraini Ahmad
- Department of Chemistry, Faculty of Science, University of Malaya 50603 Kuala Lumpur Malaysia +603-79674193 +603-79674008
| | - Norazlinaliza Salim
- Integrated Chemical Biophysics Research, Faculty of Science, Universiti Putra Malaysia 43400 UPM Serdang Selangor Malaysia
| | - Nor Saadah Mohd Yusof
- Department of Chemistry, Faculty of Science, University of Malaya 50603 Kuala Lumpur Malaysia +603-79674193 +603-79674008
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Pediatric Psoriasis: From New Insights into Pathogenesis to Updates on Treatment. Biomedicines 2021; 9:biomedicines9080940. [PMID: 34440145 PMCID: PMC8393839 DOI: 10.3390/biomedicines9080940] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 01/08/2023] Open
Abstract
Psoriasis is a chronic inflammatory systemic disease primarily affecting the skin, but which often involves considerable comorbidities as well. One-third of psoriasis cases start during childhood. In pediatric psoriasis, an association with several medical comorbidities is also indicated. Furthermore, because of its chronic nature and frequent relapses, psoriatic patients tend to require long-term treatment and experience negative impacts on their quality of life. Considering the different clinical characteristics of pediatric psoriasis, it has recently been presented that the pathogenesis of pediatric psoriasis is distinct from adult psoriasis. Treatment for pediatric psoriasis usually involves the same methods as for adults. However, most treatments in pediatric psoriasis are used off-label and research in this regard is still lacking. Targeted therapies involving newly developed biologics are also increasingly being applied to psoriasis in children. This review summarizes the clinical characteristics of pediatric psoriasis and focuses mainly on the updated concepts of pathogenesis and treatments in pediatric psoriasis. This was undertaken to widen the understanding of these relevant aspects and to provide better management of pediatric psoriasis by clinicians.
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Haulrig MB, Zachariae C, Skov L. Off-Label Treatments for Pediatric Psoriasis: Lessons for the Clinic. PSORIASIS (AUCKLAND, N.Z.) 2021; 11:1-20. [PMID: 33604269 PMCID: PMC7886293 DOI: 10.2147/ptt.s268462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/14/2021] [Indexed: 11/23/2022]
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 off-label 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.
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Affiliation(s)
- Morten B Haulrig
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, DK-2900, Denmark
| | - Claus Zachariae
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, DK-2900, Denmark
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
| | - Lone Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, DK-2900, Denmark
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
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Abstract
Therapeutic management of pustular psoriasis remains a challenge despite the rapid advance in psoriasis research and the development of drugs, especially biologics. Treatment guidelines have been established for pustular psoriasis, but no controlled studies are present for juvenile pustular psoriasis (JPP). Search of the literature reveals that current evidence of JPP treatment is limited to case reports and case series. Among the conventional drugs for JPP, oral retinoid is the most commonly used, yet concerns for growth disturbance exist. Cyclosporine and methotrexate have also been administered as first-line treatment. Etanercept is the first biological agent approved for juvenile plaque psoriasis, followed by adalimumab. However, infliximab is usually recommended for JPP because of the rapidity of onset, despite not being approved for use in pediatric psoriasis patients. More recently, secukinumab, ixekizumab, brodalumab, guselkumab, and risankizumab have been approved for adult pustular psoriasis in selected countries. Controlled studies are needed to prove the efficacy and long-term safety of the therapeutic treatments currently used for JPP.
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Affiliation(s)
- Yi-Wei Huang
- Department of Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital, No. 7 Chung San South Road, Taipei, Taiwan.
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Menter A, Cordoro KM, Davis DM, Kroshinsky D, Paller AS, Armstrong AW, Connor C, Elewski BE, Gelfand JM, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kiselica M, Kivelevitch D, Korman NJ, Lebwohl M, Leonardi CL, Lichten J, Lim HW, Mehta NN, Parra SL, Pathy AL, Farley Prater EA, Rupani RN, Siegel M, Stoff B, Strober BE, Wong EB, Wu JJ, Hariharan V, Elmets CA. Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients. J Am Acad Dermatol 2020; 82:161-201. [DOI: 10.1016/j.jaad.2019.08.049] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 12/29/2022]
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Lavaud J, Mahé E. Scores de sévérité dans le psoriasis de l’enfant : revue systématique de la littérature. Ann Dermatol Venereol 2019; 146:771-782. [DOI: 10.1016/j.annder.2019.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 12/31/2018] [Accepted: 03/06/2019] [Indexed: 12/11/2022]
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Frantz T, Wright EG, Balogh EA, Cline A, Adler-Neal AL, Feldman SR. Topical and Oral Therapies for Childhood Atopic Dermatitis and Plaque Psoriasis. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E125. [PMID: 31694234 PMCID: PMC6915686 DOI: 10.3390/children6110125] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/24/2019] [Accepted: 11/01/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Treatment of atopic dermatitis and psoriasis in children is difficult due to lack of standardized treatment guidelines and few FDA-approved treatment options. Treatments approved for adults may be used off-label in pediatric patients. OBJECTIVE This review evaluates the topical and oral treatment options available, including off-label uses, and provides a basic therapeutic guideline for pediatric atopic dermatitis and psoriasis. METHODS A PubMed review of topical and systemic treatments for pediatric psoriasis and atopic dermatitis with information regarding age, efficacy, dosing, contra-indications, adverse events, and off-label treatments. RESULTS The search identified seven topical and five systemic treatments that are routinely employed to treat pediatric atopic dermatitis and psoriasis. LIMITATIONS Standardized guidelines regarding treatment choice, dosing, and long-term safety are scarce. Reviews may be subject to ascertainment bias. CONCLUSIONS Current treatment guidelines are based on clinical experience and expert advice with few treatments officially approved for atopic dermatitis and psoriasis in children.
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Affiliation(s)
- Travis Frantz
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Ellen G Wright
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Esther A Balogh
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Abigail Cline
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Adrienne L Adler-Neal
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
- Department of Dermatology, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
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Berth-Jones J, Exton LS, Ladoyanni E, Mohd Mustapa MF, Tebbs VM, Yesudian PD, Levell NJ. British Association of Dermatologists guidelines for the safe and effective prescribing of oral ciclosporin in dermatology 2018. Br J Dermatol 2019; 180:1312-1338. [PMID: 30653672 DOI: 10.1111/bjd.17587] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2018] [Indexed: 02/06/2023]
Affiliation(s)
- J Berth-Jones
- Department of Dermatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, U.K
| | - L S Exton
- British Association of Dermatologists, Willan House, London, W1T 5HQ, U.K
| | - E Ladoyanni
- Department of Dermatology, Dudley Group NHS Foundation Trust, Dudley, DY1 2HQ, U.K
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, London, W1T 5HQ, U.K
| | - V M Tebbs
- formerly of George Eliot Hospital, College Street, Nuneaton, CV10 7DJ, U.K
| | - P D Yesudian
- Wrexham Maelor Hospital, Croesnewydd Road, Wrexham, LL13 7TD, U.K
| | - N J Levell
- Dermatology Department, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, U.K
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Mahé E, Bursztejn AC, Phan A, Corgibet F, Beauchet A. Management of childhood psoriasis in France. A national survey among general practitioners, pediatricians, and dermatologists. Dermatol Ther 2017; 31. [DOI: 10.1111/dth.12567] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 09/18/2017] [Accepted: 10/02/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Emmanuel Mahé
- Dermatology Department; Hôpital Victor Dupouy; Argenteuil France
| | | | - Alice Phan
- Nephrology-Rheumatology-Dermatology Department; Hôpital Femme Mère Enfant, Hospices Civiles de Lyon; Bron France
| | | | - Alain Beauchet
- Public Health Department; Centre Hospitalier Universitaire Ambroise Paré, Université Versailles-Saint-Quentin-en-Yvelines, Assistance Publique-Hôpitaux de Paris; Boulogne-Billancourt France
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Niculescu L, Rothenberger C, Pinarci M, Peric J, Alharbi R, Wollenberg A. New Perspectives in the Treatment of Atopic Dermatitis in the Pediatric Population. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2016; 29:189-195. [PMID: 35923062 DOI: 10.1089/ped.2016.0720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Treatment of children diagnosed with atopic dermatitis (AD) is an art. Age-dependent barrier function, skin physiology, body surface:weight ratio, the compliance of patient and caregivers, and legal considerations related to the license status of topical and systemic drugs must be considered. Mild to moderate AD can usually be treated sufficiently with a personalized regimen of emollients and topical anti-inflammatory therapy consisting of topical corticosteroids (TCSs) or topical calcineurin inhibitors. Emollients containing bacterial lysates, tailored wet wrap regimen, and proactive therapy with tacrolimus ointment or some TCSs are new developments in the field. Severe AD may need systemic therapy, but all currently available systemic agents for severe AD are either not licensed for children or not advisable on the long term, or both. Therapeutic patient education based on structured, interactive sessions with patients or caregivers and a multidisciplinary team is highly effective. This publication summarizes the current therapeutic options used in the pediatric AD population.
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Affiliation(s)
- Luana Niculescu
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
| | | | - Melda Pinarci
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
| | - Jelena Peric
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
- Department of Dermatovenerology, Clinical Center of Serbia, Belgrade, Serbia
| | - Rehab Alharbi
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
- Department of Dermatology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Andreas Wollenberg
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
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Napolitano M, Megna M, Balato A, Ayala F, Lembo S, Villani A, Balato N. Systemic Treatment of Pediatric Psoriasis: A Review. Dermatol Ther (Heidelb) 2016; 6:125-42. [PMID: 27085539 PMCID: PMC4906111 DOI: 10.1007/s13555-016-0117-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Indexed: 12/02/2022] Open
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.
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Affiliation(s)
| | - Matteo Megna
- Department of Dermatology, University of Naples Federico II, Naples, Italy.
| | - Anna Balato
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - Fabio Ayala
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - Serena Lembo
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - Alessia Villani
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - Nicola Balato
- Department of Dermatology, University of Naples Federico II, Naples, Italy
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