Childhood Psoriasis Research Articles

Oral Investigation in Childhood Psoriasis: Correlation With Geographic Tongue and Disease Severity

Background: Childhood psoriasis affects 2% of the world pediatric population. An association between psoriasis and geographic tongue (GT) in adults has been suggested, but there are no studies in children. Objective: This study aimed to compare the prevalence of oral lesions in pediatric patients with psoriasis (PP) and healthy controls and investigate the correlation between GT, severity, and age of psoriasis onset. Methods: The participants were 17 PP aged <18 years and 91 HC. The severity of vulgaris psoriasis was determined according to Psoriasis Area and Severity Index (PASI) and all patients underwent an oral examination. Results: Oral findings were present in 43% of the participants and the most common lesions were candidiasis and GT. There was a mean earlier onset in psoriasis with GT (3 years old) compared to psoriasis without GT (10 years old). The mean PASI scores in psoriasis with GT and psoriasis without GT were 9 and 3, respectively. Conclusion: Geographic tongue and candidiasis were frequently found in PP. Patients with psoriasis with GT are younger and have earlier onset of the disease, a positive family history of psoriasis, and a severe form of the disease. The present study is the first of its type to demonstrate clinical differences in pediatric PP with and without GT.

Nail dermoscopy findings in childhood psoriasis

Nail dermoscopy findings in childhood psoriasis

Proactive treatment in childhood psoriasis

Psoriasis affects 0.5% of children. The current therapeutic arsenal includes local treatments, phototherapies and systemic treatments (conventional systemic therapy and biotherapy), which, in most cases, are sufficient to control this skin disease. Subsequent management of these children should focus on maintaining therapeutic efficacy and preventing relapse by reducing any treatment-related toxicity in order to improve their quality of life. It would therefore appear useful to adopt a "proactive" attitude. To be proactive is to anticipate disease progression in order to limit both the severity and the incidence of new flare-ups. This approach must be distinguished from reactive support. Based on our experience of atopic dermatitis and data on adult psoriasis, in the absence of publications specific to childhood-onset psoriasis, herein we propose to provide an overview of this proactive approach in paediatric psoriasis. This proactive management approach concerns four key precepts: therapeutic education: explanation of the disease, its pathophysiology and the various possible therapeutic approaches; prevention of factors triggering flare-ups or worsening psoriatic infections, such as stress, trauma, diet (mainly reduction of obesity); a proactive approach to topical therapy: skin hygiene and use of emollients, but also limitation of active therapies, use of dosing intervals and "weekend therapy" to reduce the risk of relapse; a proactive approach to systemic therapies: improved therapeutic safety, reduced cumulative doses, through reduced doses, use of dosing intervals and weekend therapy. Care for children with psoriasis must be comprehensive and include their environment. The concept of "proactive" treatment in childhood-onset psoriasis can help limit the duration and severity of flare-ups while improving quality of life. Simple measures can in fact ensure effective maintenance of treatments over the long term.

The use of biologics for childhood psoriasis.

Linked article: C. Phan et al. J Eur Acad Dermatol Venereol 2019; 33: 1984–1992. https://doi.org/10.1111/jdv.15579.

Severe childhood psoriasis: need for safety and efficacy data on long-term treatment with biologics.

Severe childhood psoriasis: need for safety and efficacy data on long-term treatment with biologics.

Scores de sévérité dans le psoriasis de l’enfant : revue systématique de la littérature

Psoriasis affects 0.5to 1% of children in Europe. It has a significant impact on quality of life. Recently, systemic treatments have been licensed for children with moderate-to-severe psoriasis. While scores to assess the severity of the disease are thus important for the management of these children, there is no standardization or consensus concerning their use in childhood psoriasis. The aim of this study was to examine the use of clinical severity scores and quality of life in children with psoriasis. A systematic literature review was conducted on PubMed and Embase. Further research was carried out using the bibliographic references in selected articles. The following keywords were used: "psoriasis" with "pediatric", "childhood", "infant", "child" or "adolescent", and "Severity of Illness Index", "sickness impact profile", "quality of life", "index", "measure" or "score". A first selection was made from the titles and abstracts of the selected articles. After evaluating 1712articles on Medline and 233on Embase, 78were finally selected. The Psoriasis Area Severity Index (PASI: 74.4%) was the most frequently found score followed by the Body Surface Area (BSA: 48.7%) and the Physician's Global Assessment (PGA: 29.5%). Recourse to systemic therapies and failure of topical treatments were also used as severity criteria. Over half the studies did not define a severity threshold. We also observed extensive heterogeneity in the definition of psoriasis severity. The same scores were often used regardless of psoriasis type or patient age. Regarding quality of life, most studies used the Children's Dermatology Life Quality Index (CDLQI: 23.1%) and DLQI (5.1%). Non-specific quality-of-life scores for psoriasis were also used, such as the Pediatric Quality of Life Inventory (Peds-QL: 6.4%) and Skindex (2.6%). Here again, no severity threshold was defined for these scores. Severity scores are chiefly used by analogy with adults but without validation in the pediatric population. They do not consider pediatric specificities such as progression of BSA according to age, clinical aspect, clinical types, etc. Severity thresholds are rarely defined in children, whether in terms of clinical score or quality of life. This can constitute a limitation in terms of both prescription of systemic treatments and comparison between different studies. Our study demonstrates the need to validate severity and quality-of-life scores and to define child-specific thresholds.

Assessment of cardiac and vessel functions in childhood psoriasis

Background/aim Psoriasis is a chronic inflammatory disease. The effect of psoriasis on the cardiovascular system has not been studied in children before. We studied ventricular strain and vascular functions to assess early cardiovascular effects of psoriasis during childhood. Materials and methods The study population consisted of 20 psoriatic and 20 age- and sex-matched control subjects. Two-dimensional echocardiography images, longitudinal and global strain, and carotid and brachial ultrasound studies were performed. Results The mean age of psoriatic children was 14 ± 0.89 years and that of the controls was 14.05 ± 0.88. There were significant increases in terms of interventricular septum diastolic and left ventricular posterior wall diastolic diameter and decreases in mitral E, mitral A, and E/A values between groups. Tissue Doppler imaging revealed significant differences between groups in terms of lateral annulus E’, A’, E’/A, isovolumetric contraction time, and ejection time. Aortic stiffness was significantly higher and global circumferential strain and longitudinal strain were significantly lower in the psoriasis group. Carotid intima media thickness and flow-mediated dilatation did not differ significantly between the groups. Conclusion Cardiac left ventricular and arterial functions are affected in psoriatic children and may be an alarming sign of atherosclerotic heart disease in the long term. Early detection of these changes may be helpful for eliminating other risk factors.

Psoriasis de l’enfant vu en milieu libéral : les aspects cliniques et épidémiologiques diffèrent des données habituellement publiées

Psoriasis affects 0.2-0.7% of children and is associated with obesity. Published studies have been conducted in hospital settings (tertiary care). The PsoLib study evaluated childhood psoriasis in private practice (secondary care) in terms of epidemiology, clinical aspects and comorbidities. This was a non-interventional, cross-sectional, multicenter study of children with psoriasis performed by 41dermatologists working in private practice. The clinical and therapeutic aspects and comorbidities were systemically evaluated. We compared data to the χ-Psocar study performed in hospitals using the same methodology. In all, 207children (girls: 60.4%; mean age: 10.5±4.2years) were included. Scalp psoriasis (40.6%) was the most frequent clinical type, while plaque psoriasis represented 26% of cases. Nail, tongue, and arthritic involvement were rare. Less than 1% of children suffered from hypertension, diabetes or dyslipidemia, but 16.4% were overweight and 7.0% were obese. Severity (PG≥4at peak) was associated with excess weight (P=0.01). Scalp psoriasis is the most frequent clinical type of psoriasis in childhood. Comorbidities and extracutaneous localization are rare. Even in private practice, the severity of the disease is associated with excess weight.

Comparative Evaluation of the Treatment Efficacy and Safety of TNFα and IL12/23 Inhibitors in Children With Psoriasis

Background.Therapy of psoriasis in children is an urgent problem of dermatology and paediatrics. The present-day knowledge of the disease pathogenesis defines the focus of therapeutic interventions causing rapid relief of disease symptoms, prevention of complications and the achievement of a complete skin resurfacing from psoriatic lesions as well as long-term retention of the effect. These requirements are largely met by therapy with genetically engineered biological drugs.Our aim wasto study the clinical efficacy and safety of treating children suffering from moderate and severe psoriasis with genetically engineered biological drugs.Patients and Methods.The study included children with moderate and severe psoriasis. Four groups were formed: in the first and second groups, the children were treated with ustekinumab and etanercept, respectively, without prior methotrexate, in the third group — with ustekinumab after methotrexate, in the fourth group — with etanercept after methotrexate. The efficacy of therapy with ustekinumab and etanercept was evaluated using the PASI and CDLQI indices, their impact on the quality of life of patients was studied, the adverse events were registered.Results.The study involved 98 children aged from 6 to 17 years: 23 children in the first group, 26 — in the second group, 24 — in the third group, and 25 — in the fourth group. The arithmetic mean of the PASI index during the initial examination ranged from 23.7 ± 1.27 in patients of the second group to 31.9 ± 1.68 in the first group. The minimum value of the index was 10.5, the maximum one — 58.5. The CDLQI index at the first visit ranged from 14.8 ± 0.95 in patients of the fourth group to 17.0 ± 0.99 in the first group, which showed no statistically significant differences.Conclusion.Genetically engineered biological therapy with ustekinumab and etanercept is an effective and safe method for treating moderate and severe psoriasis in childhood, but ustekinumab compared to etanercept leads to a more pronounced decrease in the PASI index.Nikolay N. Murashkin — receiving research funding from pharmaceutical companies Jansen, Eli Lilly. Receiving fees for scientific advice from Galderma, Pierre Fabre, Bayer, Astellas, Libriderm.Eduard T. Ambarchian — receiving research funding from pharmaceutical company Eli Lilly. Receiving fees for scientific advice from Jansen, Libriderm.

Childhood psoriasis: Disease spectrum, comorbidities, and challenges

Psoriasis is a chronic, inflammatory, papulosquamous disorder with a variable clinical spectrum. Although it affects population of all age groups, the significance and negative impact of childhood psoriasis is often neglected worldwide. In nearly one-third of the psoriatic population, psoriasis appears during the childhood. In this article, we have focused on different issues and challenges faced during the management of childhood psoriasis. In addition to the varied clinical spectrum and associated comorbidities, in this article, we have given emphasis on the following real needs for childhood psoriasis: (i) psychological and social effects on the affected children, (ii) impact on their family members, and (iii) early diagnosis and management of psoriasis on children with psoriasis. We have concluded the article with the “concept of total care,” which is a third dimension for the management of psoriasis.

A Study of Childhood Psoriasis

This study attempts to find out the incidence of childhood psoriasis and the mean age of onset of the disease in children. Psoriasis is a chronic immune mediated inflammatory disease.

Diagnosis and management of childhood psoriasis: A prospective study

Diagnosis and management of childhood psoriasis: A prospective study

A hospital-based clinical study of childhood psoriasis in a tertiary care center of Northeast India

Background: Childhood psoriasis has been reported to differ from that among adults. There are a limited number of studies on childhood psoriasis and none from the north-eastern part of India. A detailed clinical study will help to understand better the disease profile in children, thereby assisting in better diagnosis and treatment. Objective: The objective of this study was the clinical profile of childhood psoriasis. Materials and Methods: The present observational study was conducted in the Dermatology Outpatient Department of Assam Medical College and Hospital, Dibrugarh, during 12 months from June 2014 to May 2015. All children up to 13 years presenting with psoriasis during 1 year were taken as study participants after obtaining the written consent from the sole guardian. A detailed examination and relevant investigations were done, whenever necessary. The findings were recorded in a pro forma for the analysis and interpretation of data. Results: A total of 26 cases of childhood psoriasis were recorded during the study. The prevalence of childhood psoriasis in our outpatient pediatric population was 1.24%. Female cases (19; 73.08%) outnumbered male cases (7; 26.92%). A maximum number of cases were noted in 9–13 years of age group. The lower extremities (11; 42.31%) were the most common site of onset. Plaque type (14; 53.85%) was found to be the most common type. About 7.69% cases had a positive family history. Conclusion: Frequent involvement of soles was noted in childhood psoriasis similar to other parts of India but unlike other parts of the world. Pediatric patients had significantly more involvement of the trunk, face, and groin than did adult patients.

Childhood psoriasis: What is new and what is news

Psoriasis is a chronic inflammatory disorder that affects around 2%–4% of the general population, and the prevalence can be higher in selected populations. About one-third of the people affected with psoriasis have the onset of their disease in the first and second decades of life. Of the pediatric population, about 0.5%–2% is affected. Infants are affected rarely. The incidence increases with age and is reported to be ~0.55% in the age group of 0–9 years and 1.37% in the age group of 10–19 years. Flexures, face, periauricular area and medial aspect of the upper eyelid are commonly involved in children. In infants, there is predilection for diaper area. Overall, plaque psoriasis is the most common type, followed by guttate and pustular psoriasis. Lesions are more pruritic, but thinner, less erythematous, and less scaly. Follicular lesions are common. Treating psoriatic erythroderma can pose difficulties, especially in pediatric population. Some cases achieve rapid control of disease activity, while others develop chronic erythroderma with frequent disease flares. The impact of disease on psychosocial parameters is significant in this subgroup of psoriasis and affects patients and parents alike with significantly high rates of absenteeism from school. Pediatric psoriasis therefore needs to be managed effectively. However, effective treatment also poses the risk of producing adverse effects, more so in pediatric age group. A delicate balance therefore should be maintained and overzealous treatment should be avoided.

Abordare diferenţiată a psoriazisului în funcţie de vârsta pacientului

Psoriasis is no longer an unknown disease; it has been studied extensively worldwide. It can affect people of all ages, making it necessary to differentiate between the childhood and adult forms of the disease. Based on the debut age, one can determine the prognosis, the different immunopathologies, differential diagnosis and treatment, thereby requiring a different approach and special attention in childhood psoriasis. Being a mutilating disease, the quality of life of the children become a big challenge for both the patient and their family. The multidisciplinary team is a necessity because of the possible comorbidities that can occur in the case of children. The family doctor is the first point of contact for the patient, followed by a paediatrician and then a dermatologist.

Quoi de neuf en dermatologie pédiatrique ?

The year 2017 in pediatric dermatology was marked by several consensus recommendations and meta analyzes on childhood psoriasis, atopic dermatitis or PHACE syndrome, case series on the role of anti-JAK treatment in adolescent with alopecia areata, sirolimus for vascular malformations, ivermectine for rosacea, inhibitors of MEK for type 1 neurofibromatosis or on the side effects of the oral isotretinoin for acne or propranolol for immature hemangioma. Only few randomized controlled studies have been published on the interest of adalimumab in the treatment of psoriasis or topical sirolimus for angiofibroma in tuberous sclerosis complex for example. There were also clinical articles on various affections such as the sign of the scalp hair collar sign, childhood prurigo, ichthyosis, atopic dermatitis, warts or Zika virus infection. Finally, numerous publications reported new genes responsible for dermatosis in mosaics with new questionings and perspectives.

Management of childhood psoriasis in France. A national survey among general practitioners, pediatricians, and dermatologists.

Psoriasis affects 0.5-2% of children. Severe forms required use of systemic treatments. Few studies are published on efficiency and tolerance of systemic treatments in children. We conducted a survey in France to better understand management of children with psoriasis. A survey on childhood psoriasis management was sent by e-mail to GPs, pediatricians, and dermatologists. The survey included 384 physicians. Respectively 53.1%, 49.8%, and 83.3% of GPs, pediatricians, and dermatologists declare to have seen at least one child with psoriasis during the 3 previous months. Less than 5% of GPs and pediatricians used severity score versus 23.7% of dermatologists. If most of physicians declare to use local treatments, less than 5% of GPs and pediatricians used systemic treatments. 32.4% of dermatologists declared to use at least one systemic treatment, but only 2.9% to use the 4 systemic treatments available in France. This survey shows that only half of GPs and pediatricians see children with psoriasis, but most of dermatologists. However, the management of severe forms seems limited by the underuse of severity scores and systemic treatments. These results should stimulate dermatology societies to promote prospective studies and guidelines in young populations with psoriasis.

Management of pediatric psoriasis with acitretin: A review

Psoriasis is a chronic inflammatory disease of the skin which can occur at any age-group. Psoriasis in childhood is not uncommon and has genetic susceptibility but usually, an environmental trigger such as infection is thought to initiate the disease process. Pediatric psoriasis has profound effects on both physical and psychosocial health of the patient. Treatment of mild psoriasis can be done with topical therapies but those which do not respond to topical therapies can be treated with phototherapy and systemic therapies. The use of systemic therapies in childhood is mainly based on the published data, case series, expert opinion and the experience as there is the lack of controlled trials in the age group. Based on the experience retinoids are probably the second line drugs for the treatment of pediatric psoriasis which do not respond to topical therapies and phototherapy. Using acitretin in a low dose and with proper physical examinations and laboratory investigations will reduce the hazard of potential serious adverse events. This article gives the review of the use of acitretin in pediatric psoriasis.

Adalimumab for treating childhood plaque psoriasis: a clinical trial evaluation

ABSTRACTIntroduction: Most systemic therapies have not been systematically investigated in moderate to severe childhood plaque psoriasis. Evidence on the efficacy and safety of systemic treatments is limited and therapeutic guidelines are lacking. Recently adalimumab, a fully human monoclonal antibody that binds tumor necrosis factor (TNF)- alpha, was investigated in childhood psoriasis. Adalimumab is licensed for many inflammatory conditions including chronic plaque psoriasis in adults.Areas covered: A randomized phase III study published provided favourable efficacy and safety data of adalimumab in childhood psoriasis. The active comparator was methotrexate. After 16 weeks of treatment, a PASI 75 score was achieved in 58% of patients within the adalimumab 0.8 mg/kg group compared with 32% of patients within the methotrexate group. Safety data gave no evidence of drug-related serious adverse events and no organ toxicity. This is the first randomised controlled study of either adalimumab or methotrexate in children and adolescents with psoriasis.Expert opinion: The aforementioned trial was the first to provide clinical data on adalimumab’s efficacy and safety in the short term when treating children and adolescents with psoriasis. Through the use of an active comparator, this study has opened the way for the future assessment of systemic therapies in children and adolescent with this condition.

Clinico-epidemiological study of childhood psoriasis

The clinico-epidemiological data of 276 childhood psoriasis were studied. The mean age was 7.64 years (range 1 day to 15 years). There was no complain of any discomfort in 198 cases. Itching was present in 67 cases and burning in 11 cases. Plaque psoriasis was the most common type (68.8%) followed by guttate (18.8%). Erythrodermic and pustular psoriasis were found in 2.2% and 1.5% cases. Scalp was the most frequently affected site (75.36%) followed by extensors of extremities (41.3%), trunk (37.7%), palm and/or sole (13.0%) and diaper area (11.6%). Nail involvement was found only in 8%, joint was affected in 3.6% and only 2.2% children with psoriasis were erythrodermic. In Bangladeshi children with psoriasis, plaque is the most common type and scalp is the mostly affect site. Nail and joint involvement is less common. Pustular and erythrodermic psoriasis is rare.