Pediatric Psoriasis: From New Insights into Pathogenesis to Updates on Treatment.

Hye One Kim,Chun Wook Park,Bo Young Chung,Seok Young Kang,Jin Cheol Kim

doi:10.3390/biomedicines9080940

Hye One Kim, Chun Wook Park + Show 3 more

Open Access

https://doi.org/10.3390/biomedicines9080940

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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.

Highlights

Psoriasis is a chronic immune-mediated inflammatory disease that mostly affects the skin, nails, and joints
Psoriasis in children poses a number of challenges: it has age-specific clinical characteristics, the appearance of which can change with time
There have been limited studies, recent research proposed a difference in the expressions of tumor necrosis factor (TNF)-α-IL-17-IL-22 in pediatric psoriasis patients compared to those of adult psoriasis patients

Summary

Introduction

Psoriasis is a chronic immune-mediated inflammatory disease that mostly affects the skin, nails, and joints. Girls have a slightly higher prevalence of pediatric psoriasis than boys [1,2]. Pediatric psoriasis patients have a twoto-four–fold higher risk of hyperlipidemia, hypertension, diabetes mellitus, rheumatoid arthritis, and Crohn’s disease [4,5,6]. Psoriatic arthritis is a well-documented comorbidity in children, with a confirmed prevalence ranging from 6% to 41% in those with psoriasis [7,8]. Detecting this disease early in life and applying appropriate treatment may delay or even prevent serious impacts on a child’s quality of life and comorbidities. Having an accurate understanding the various aspects of this disease in this age group is paramount

Clinical Presentation of Pediatric Psoriasis

Etiopathogenesis

Treatments of Pediatric Psoriasis

Topical Treatments

Emollients and Keratolytics

Topical Corticosteroids

Topical Vitamin D Analogues