Biologics and Pediatric Generalized Pustular Psoriasis: An Emerging Therapeutic Trend.

Sami K Saikaly,Monica Mattes

doi:10.7759/cureus.652

Abstract

Generalized pustular psoriasis (GPP) is a rare form of childhood psoriasis, often requiring systemic therapy, which is challenging as there is a paucity of randomized controlled trials and standardized guidelines. Biologic agents have been used in adults and in pediatric plaque psoriasis, but evidence regarding their efficacy in pediatric GPP has slowly become available. The objective of this study is to summarize and compare the efficacy and safety of biologic agents, such as etanercept, infliximab, and adalimumab, in the treatment of pediatric GPP. A PubMed literature review was conducted and 12 studies met the inclusion criteria for analysis. After reviewing the efficacy of these drugs in pediatric GPP patients and their safety in the use of other pediatric conditions, etanercept was identified as a possible first-line biologic agent for pediatric psoriasis, including GPP, followed by infliximab and adalimumab. In conclusion, several case reports have documented the successful use of biologic agents in refractory cases of pediatric GPP, but clinical trials are needed to gain a better understanding of the efficacy and side effect profile in this population.

Highlights

BackgroundPsoriasis, affecting 2 to 4% of the world’s population [1,2], is a chronic T-cell-mediated inflammatory disease marked by keratinocyte hyperproliferation [2]
Plaque and Guttate psoriasis have been described as the most common childhood psoriasis types [4,5], while generalized pustular psoriasis (GPP) is a rare form of childhood psoriasis [3, 6,7], affecting 3% of psoriasis patients [8]
After review of the available literature, three biologic agents have been described for the treatment of pediatric generalized pustular psoriasis: etanercept, infliximab, and adalimumab

Summary

Introduction

Psoriasis, affecting 2 to 4% of the world’s population [1,2], is a chronic T-cell-mediated inflammatory disease marked by keratinocyte hyperproliferation [2]. After review of the available literature, three biologic agents have been described for the treatment of pediatric generalized pustular psoriasis: etanercept, infliximab, and adalimumab. Et al described that 63% of the patients treated with infliximab experienced an adverse effect in comparison to 54.3% in the etanercept treatment group [40] Additional immunosuppressive agents, such as methotrexate, are sometimes given to prevent the development of antibodies to infliximab [2, 18]. Pediatric GPP patients may begin therapy with one of the “traditional treatments” If these are contraindicated, not successful, or undesired (i.e. etretinate in a reproductive-aged female), biologic agents, such as etanercept, infliximab, or adalimumab, may prove to be an effective alternative, as evidenced by the available literature. The literature on biologics use in pediatric GPP is slowly growing, and additional testing is still required to determine efficacy in a larger population, proper dosing, and adverse effect profiles [30]

Conclusions

Findings

Disclosures