Abstract
Systemic therapies commonly used in adult psoriasis are mostly used only off-label in children and little is known about the efficacy and tolerability of these drugs in this population. In this study, we aimed to evaluate the efficacy and safety of systemic treatments in pediatric patients with psoriasis. Data were obtained retrospectively from the Department of Dermatology, Ondokuz Mayis University, School of Medicine between 2010-2019. Our study consisted of 742 pediatric patients (age ≤18 years) with psoriasis. Demographic data, adverse events of systemic treatments and healing periods were considered. A total of 195 patients received systemic treatment. The mean age of onset of disease and the initiation of systemic therapy were 9.68±4.62 and 11.33±4.38 years, respectively. Patients received methotrexate (n=52, 26.67%), cyclosporine (n=18, 9.24%), acitretin (n=106, 54.35%) and others (biologics and/or one of conventional treatments) (n=19, 9.74%) as systemic therapy. Adverse events occurred in 12 patients (incidence of 6.15%, and its related 95% confidence interval of 2.75%, 9.56%) and nine of them had to discontinue the medication due to those adverse events. Healing periods calculated in the remaining 186 patients were 13.25±5.87, 10.85±5.67, 11.05±7.00, and 9.41±4.16 (mean±SD) weeks for acitretin, methotrexate, cyclosporine, and others, respectively. No statistically significant differences were noted between the treatments regarding the healing periods. All treatments were effective and none of them was superior in terms of the healing period. Systemic treatments used in adults can also be used in pediatric patients with psoriasis with similar efficacy and safety rates as long as routine monitoring is provided.
Highlights
Psoriasis is a chronic and complex autoimmune inflammatory skin disease.[1,2] It may present at any age, but less commonly in children than adults.[3]
Except etanercept, adalimumab and ustekinumab, systemic treatments have not been approved for childhood psoriasis
Management of these patients is based on experiences with adult psoriasis, case series, expert opinions and the use of these drugs for other indications in pediatric patients.[11]
Summary
Psoriasis is a chronic and complex autoimmune inflammatory skin disease.[1,2] It may present at any age, but less commonly in children than adults.[3]. Systemic therapies commonly used in adult psoriasis are mostly used only off-label in children and little is known about the efficacy and tolerability of these drugs in this population. We aimed to evaluate the efficacy and safety of systemic treatments in pediatric patients with psoriasis Methods: Data were obtained retrospectively from the Department of Dermatology, Ondokuz Mayis University, School of Medicine between 2010–2019. Healing periods calculated in the remaining 186 patients were 13.25 ± 5.87, 10.85 ± 5.67, 11.05 ± 7.00, and 9.41 ± 4.16 (mean ± SD) weeks for acitretin, methotrexate, cyclosporine, and others, respectively. Systemic treatments used in adults can be used in pediatric patients with psoriasis with similar efficacy and safety rates as long as routine monitoring is provided.
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