Psoriasis in children: an insight

Generalized pustular psoriasis in a toddler with IL36RN mutation: a case report

Generalized Pustular Psoriasis (GPP) is a dermatological autoinflammatory disease that rarely occurs in children and is associated with complex genetic factors. GPP pathogenesis has been associated with mutations in IL36RN gene, which encodes an interleukin-36 receptor antagonist. GPP usually occurs without a history of psoriasis in the patients or their family members. This case report describes the clinical course of a 3-year-old toddler with GPP. The diagnosis of GPP was confirmed through a comprehensive series of examinations, and genetic testing revealed an IL36RN mutation, providing further insight into the genetic basis of the condition. This case highlights the importance of a genetic perspective for diagnosing GPP, particularly in children.

Pediatric psoriasis: Understanding pathological conditions and advances in treatment

Psoriasis is a long-lasting skin disease that primarily affects the skin, nails, and joints and is characterized by inflammation. Genetic factors contribute to its development and environmental triggers can worsen symptoms. Pathologically, psoriasis is characterized by uncontrolled keratinocyte proliferation and abnormal differentiation, and histological features include acanthosis with inflammatory cell infiltration and neovascularization. Psoriasis often starts in childhood, with about one-third of cases beginning during this time. Its prevalence steadily increases from the ages of 1 to 18 years in a linear fashion. Young people with psoriasis often require treatment throughout their childhood and adolescence, and into adulthood. However, prolonged treatment may increase the risk of complications and adverse events, so it is important to adopt an effective treatment approach that minimizes this risk. In addition, psoriasis is often associated with various comorbidities that may place a great burden on the physical and mental health of the children beyond those due to psoriasis itself. To ensure good long-term health outcomes, individuals with psoriasis should undergo regular screening. Treatment should be provided not only for skin lesions, but also for any comorbidities; however, currently there is not enough evidence on the treatment of pediatric psoriasis and no globally agreed-on guidelines exist for treating psoriasis in children. This article describes the etiology, clinical symptoms, and disease burden of pediatric psoriasis, the pathological conditions and diagnosis of plaque psoriasis, psoriatic arthritis, and generalized pustular psoriasis, and the available treatments for these conditions in Japan.

A Diagnostic Challenge of Oral Psoriasis in a Pediatric Patient: A Case Report and Review of the Literature

Congenital psoriasis is a rare skin disease that can clinically manifest in the oral cavity in many ways. Although manifestations over the skin are frequent, oral manifestations are rare, especially in pediatric patients. A clear family history, proper examination, and investigations are essential to diagnose this condition. This case report aims to highlight the oral and systemic manifestations of a case of psoriasis in a male pediatric patient.

Orchestrated Cytokines Mediated by Biologics in Psoriasis and Its Mechanisms of Action

Psoriasis is an autoimmune disease mediated by disturbed T cells and other immune cells, and is defined by deep-red, well-demarcated skin lesions. Due to its varied etiologies and indefinite standard pathogenesis, it is challenging to consider the right treatment exclusively for each psoriasis patient; thus, researchers yearn to seek even more precise treatments other than topical treatment and systemic therapy. Using biologics to target specific immune components, such as upregulated cytokines secreted by activated immune cells, is the most advanced therapy for psoriasis to date. By inhibiting the appropriate pro-inflammatory cytokines, cellular signaling can be altered and, thus, can inhibit further downstream inflammatory pathways. Herein, the roles of cytokines with their mechanisms of action in progressing psoriasis and how the usage of biologics alleviates cellular inflammation are discussed. In addition, other potential pro-inflammatory cytokines, with their mechanism of action, are presented herein. The authors hope that this gathered information may benefit future research in expanding the discovery of targeted psoriasis therapy.

Pattern of Papulosquamous Disorders in Children: A Clinico-Epidemiological Study

Introduction

Skin disorders are a major health problem in the pediatric age group and are associated with significant morbidity. Papulosquamous disorders, forming a major part of the skin diseases in children, present in a variety of clinical pattern. This study is conducted in order to study the hospital-based prevalence of papulosquamous disorders in the pediatric age group (2-14 years) and to determine the morphology and clinical patterns with respect to their age and sex distribution.

Methodology

An analytical cross-sectional study was conducted from December 1, 2019, to May 30, 2021, in the outpatient department of the Department of Dermatology, Venereology, and Leprology, JK Hospital and LN Medical College, Bhopal, India. Ninety-five consecutive patients belonging to the age group of 2-14 years, attending the Dermatology OPD and also referred cases from the Pediatrics Department were enrolled in the study. A detailed history of illness, regarding age, duration, onset, symptoms, recurrence, family history of the disease, pre-existing medical conditions, and drug intake history was taken. Information regarding the history of fever, sore throat, and vaccination was noted. Clinical and dermatological examination including hair, nail, and mucosal examination was done for all the cases. Necessary investigations were ordered for relevant cases and the data was recorded in a form specially designed for the study.

Results

In the present study, papulosquamous disorders constituted 2.9% of all pediatric (2-14 years) dermatosis. Of the various papulosquamous disorders found, psoriasis was the most common disease that was found (in 31.6%) followed by Gianotti-Crosti syndrome (18.9%), and lichen planus (18.9%). Males outnumbered females with a ratio of 1.48:1. The incidence of papulosquamous disorders was highest in 11-14 years of age in the present study.

Conclusion

Papulosquamous disorders account for a large number of the overall dermatoses, belonging to both the adult and pediatric populations. Due to significant changes in clinical presentation, geographical and environmental influences, treatment, and prognosis; the papulosquamous group of disorders in children require a varying approach than adult dermatoses. More studies are required in this field to appropriately diagnose and manage pediatric papulosquamous disorders in order to reduce the disease burden and as a key to better patient care.

A phase 3 open-label, randomized multicenter study to evaluate efficacy and safety of secukinumab in pediatric patients with moderate to severe plaque psoriasis: 24-week results

BACKGROUND

Psoriasis affects 0.13%-2.1% of children and adolescents. Despite a high unmet need, the current treatment options approved for pediatric psoriasis are limited.

OBJECTIVE

To evaluate the efficacy and safety of 2 secukinumab dosage regimens (low dose: 75/75/150 mg; high dose: 75/150/300 mg) stratified and randomized by weight (<25 kg, 25 to <50 kg, ≥50 kg) and disease severity (moderate, severe) in pediatric patients aged 6-<18 years with moderate to severe plaque psoriasis.

METHODS

This is a phase 3, open-label, randomized, multicenter study (NCT03668613).

RESULTS

Both secukinumab doses were superior to historical placebo with respect to psoriasis area and severity index (PASI)-75/90 and investigator global assessment 0/1 responses at week 12. The estimated probability of a positive treatment effect (ie, log odds ratio > 0) for low- or high-dose secukinumab compared to historical placebo is 1 (ie, 100%). For the low and high doses at week 12, the investigator global assessment 0/1 response rates were 78.6% and 83.3%, respectively, and the PASI-90 response rates were 69% and 76.2%, respectively. The PASI-75 response rate was 92.9% for both the doses.

LIMITATIONS

This is an open-label study design without a control arm.

CONCLUSION

Secukinumab dosing regimens were efficacious and well tolerated in pediatric patients with moderate to severe plaque psoriasis.

Tofacitinib in Pediatric Psoriasis: An Open-Label Trial to Study Its Safety and Efficacy in Children

Introduction: Psoriasis is a chronic, multifactorial, inflammatory disorder, with an estimated prevalence of 0.71% in children. The commonly used therapeutic agents target the underlying inflammation. Tofacitinib has demonstrated efficacy in adult psoriasis. Aim: To study the efficacy, safety, and tolerability of tofacitinib in pediatric patients with moderate to severe chronic plaque psoriasis. Methods: The study included children aged between 8 and 17 years, with moderate to severe psoriasis, given tofacitinib 5 mg orally twice daily for at least 36 weeks. The clinical response was estimated using the Psoriasis Area and Severity Index (PASI) score, Physician’s Global Assessment (PGA), and the Children’s Dermatology Life Quality Index (CDLQI). The incidence and severity of adverse events (AEs) were meticulously recorded in each case. Results: A total of 47 patients, with a median age of 12.3 years, completed the study. At week 12, 55.32% achieved PASI 75, and 70.21% at week 36. PGA of clear or almost clear responses at week 12 were 59.57 and 65.96%, ­respectfully, at week 36. Relatively few and mostly minor ­adverse effects were noted. No severe AEs were reported. ­Conclusion: The treatment with tofacitinib was safe and well tolerated, and led to significant improvement of their disease and quality of life as reflected in CDLQI scores. However, the results need to be validated in larger multicenter trials.

Effects of Weight Loss on Psoriasis: A Review of Clinical Trials

Psoriasis is a chronic autoimmune disease that affects the skin and joints. It typically presents as abnormal skin patches characterized by red, scaly, and very itchy spots. It affects patients in different manners with different severities ranging from small spots or spots that cover a larger area of the skin. Due to the negative impact psoriasis has on the quality of life, many patients are exploring other options that can help improve their symptoms. Among those is weight reduction. This review is aimed at providing an overview of the published clinical literature to give physicians an indication of what the answer could be. Moreover, since obesity is correlated with psoriasis vulgaris it is thus also the subject of investigation in this review.

This is a literature review conducted to answer the following question: what are the effects of weight loss on the degree of plaque psoriasis recorded in clinical trials published from 1990 to December 2017. The objective of this study is to find the relationship between the severity of psoriasis and weight.

Ten clinical trials met the inclusion criteria of this review and were included in the final analysis.

Diet and exercise are worthy of consideration as adjunct treatments for psoriasis. Diet and exercise improve the overall health of the patients, are effective in combating oxidative stressors, and also show a positive impact on the Psoriasis Area and Severity Index (PASI) scores of patients with psoriasis.

Use of topical therapies for pediatric psoriasis: A systematic review

Psoriasis is one of the most common chronic skin diseases, affecting 1%-3% of the general population. It can have a significant negative impact on a patient's quality of life, and in approximately 30% of patients first symptoms can be traced back to childhood. We have performed a comprehensive literature search using the MEDLINE database in order to ascertain the efficacy and adverse reactions of topical treatments in pediatric psoriasis. A total of 13 relevant articles were identified on the following topical agents: corticosteroids, calcineurin inhibitors, vitamin D analogs, and dithranol. Corticosteroids achieved clearance in 72.7% of patients. Calcitriol lead to a 57.2%-100% mean improvement in severity, and calcipotriol to 52%-64%. Combination of calcipotriol and corticosteroids achieved an improvement in mean severity ranging between 32.1% and 80%. Treatment with tacrolimus lead to an >50% improvement. Finally, short contact dithranol lead to a variable response in clearance between different studies, ranging between 3.7% and 81%. No serious adverse reactions were documented, the most common local reaction being irritation. Pediatric psoriasis is a common and challenging condition with no easy and definitive solution. Topical agents are safe, easy to use, readily available and cheap. However, they need to be applied repeatedly, may cause skin irritation, and can be messy. Based on the results presented above, we recommend utilizing all the available topical options before escalating to systemic treatments.

Psoriasis therapy by Chinese medicine and modern agents

Psoriasis is a chronic, painful, disfiguring and non-contagious skin disease that has globally affected at least 200 million patients. In general, mild to moderate psoriasis patients will be treated by chemical drugs or Chinese medicine, while targeting systemic biological drugs have been successfully developed with good efficacy but high cost burden to patients with severe psoriasis. Since the underlying mechanisms of psoriasis are not well understood, in this review, psoriasis pathogenesis and clinical therapeutic principles by modern medicine and Chinese medicine are extensively described. Based on the data from the China Food and Drug Administration, the majority of chemical drugs are utilized as the topical formulations, while Chinese medicines are mainly delivered by an oral route, suggesting that the market for topical preparations of Chinese medicine to treat psoriasis is worth to exploration. Moreover, considering the unique clinical therapeutic theory and successful clinical application of Chinese medicine in the treatment of psoriasis, we believe that development of new small molecule drugs based on Chinese medicine will be a promising strategy to reduce therapeutic costs and improve safety for psoriatic patients.

Treatment of childhood psoriasis with phototherapy and photochemotherapy

Phototherapy and photochemotherapy are well-described treatment modalities for psoriasis in adults. Like many other treatments, the experience and long-term safety of their use in children is limited. We conducted a literature search and identified publications reporting the use of phototherapy and photochemotherapy in pediatric populations. This article summarizes the existing literature on this topic. Although many studies report good improvement with these treatment modalities, long-term safety data on their use is lacking for pediatric patients.