Juvenile Psoriasis Research Articles

Psoriasis: Management and self-care

Psoriasis is a common skin condition that affects an estimated 3% of the population. In one third of cases, psoriasis will develop during childhood or adolescence. Juvenile psoriasis is also associated with other co-morbidities such as hyperlipidaemia, obesity, hypertension, diabetes mellitus, rheumatoid arthritis and Crohn's disease. Understanding this illness means that health-care professionals such as school nurses can help by providing schools with appropriate information about the condition, improving its management and providing education to help reduce stigma.

Epidemiology and Comorbidities of Psoriasis among Israeli Adolescents: A Large Cross-Sectional Study

Background and Aims: Although psoriasis can develop at any age, the data regarding its characteristics in adolescents are sparse. This study was designed to determine the psoriasis prevalence and its associations with the body mass index (BMI), lipid profile, and comorbidities in adolescents. Methods: This was a nationwide population-based cross-sectional retrospective study of adolescents (16–18 years old) evaluated for military service between January 1999 and January 2014. Results: Our database included 887,765 adolescents (57.1% males), of whom 3,112 (0.35%) were diagnosed with psoriasis. During the 15-year study period, the psoriasis prevalence increased by 1.4-fold, from 0.3 to 0.42% (1.25-fold for the males and 1.63-fold for the females). Certain comorbidities, such as contact dermatitis, hyperhidrosis, and arthritis, were significantly associated with psoriasis (odds ratios [ORs] of 2.26, 1.51, and 5.3, respectively). The adolescents with psoriasis had significantly elevated BMI and triglyceride values. We found increased ORs of 1.34 (95% confidence interval [CI] = 1.25–1.56) and 1.56 (95% CI = 1.32–1.83) for the overweight and obese adolescents, respectively, while a lower BMI (<20) had an opposite effect with psoriasis (OR = 0.8). Conclusions: Based on our results, the psoriasis prevalence in Israeli adolescents is rising. Dermatological comorbidities and an increased BMI were associated with psoriasis in these adolescents. A better understanding of the distinctive epidemiological characteristics of juvenile psoriasis may allow for the early detection of comorbidities and improve its management.

SB4 (Benepali®; an etanercept biosimilar): a profile of its use

SB4 [Benepali® (EU); Brenzys™ (Australia, Canada, Korea)] is an etanercept biosimilar approved for all indications for which reference etanercept is approved, including rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, axial spondyloarthritis, plaque psoriasis and paediatric plaque psoriasis. In a phase 3 trial in patients with moderate to severe rheumatoid arthritis receiving methotrexate, the efficacy of subcutaneous SB4 was equivalent to that of reference etanercept, and both agents had a similar tolerability profile, except for a higher incidence of injection-site reactions with reference etanercept. In patients switched from reference etanercept to SB4, there was no loss of efficacy or an increase in adverse events or immunogenicity. Switching to treatment with SB4, using a well-designed communication strategy, may potentially result in cost savings for healthcare budgets, thereby improving patient access to treatment.

The association of ERAP1 and ERAP2 single nucleotide polymorphisms and their haplotypes with psoriasis vulgaris is dependent on the presence or absence of the HLA-C*06:02 allele and age at disease onset

The aim of this case-control study was to elucidate the role of some single nucleotide polymorphisms (SNPs) in the ERAP1 (rs27524, rs27044, rs30187, rs2287987 and rs26653) and ERAP2 (rs2248374) genes in predicting the risk for psoriasis vulgaris in the Polish population. ERAP1, ERAP2 and HLA-C*06:02 typing was done using the TaqMan SNP genotyping assays. We confirmed a strong association of the HLA-C*06:02 allele with early-onset psoriasis. In ERAP1, rs30187T increased the risk of psoriasis in HLA-C*06:02-positive patients, most strongly in late onset psoriasis, whereas it was protective when the HLA-C*06:02 allele was absent. We also found a protective effect of the ERAP2 rs2248374A allele and rs2248374AA genotype only in HLA-C*06:02 carriers, especially in the subgroup of patients with juvenile psoriasis. Analysis of combined haplotypes for ERAP1 and ERAP2 also revealed differences when the patients and controls were stratified by HLA-C*06:02. An ERAP1 haplotype known to possess high enzymatic activity was associated with psoriasis if HLA-C*06:02 was present and a functional ERAP2 allele was absent. In the absence of HLA-C*06:02, an ERAP1 haplotype of low activity was conducive to psoriasis if a functional ERAP2 allele was present, but the same ERAP1 haplotype was protective if the ERAP2 allele was defective.

Extrapolation or controlled trials in paediatrics: the current dilemma

Historically, it has been difficult to conduct controlled studies in children because of the paucity of large collaborative research networks, scarce availability of funding and lack of interest from pharmaceutical...

A Preliminary Clinical Study on 100 Egyptian Psoriatic Patients

Background: Psoriasis is a chronic, immune-mediated, inflammatory condition frequently seen in the clinical practice with a reported prevalence of 0.6 to 4.8 percent in the general population. However, data on psoriasis in Egypt are scarce. So, our aim was to investigate the clinical characterization of psoriasis in 100 Egyptian patients. Method: One hundred Egyptian psoriasis patients were enrolled in this study. A detailed questionnaire was filled including demographic and clinical aspects of the disease. Some laboratory tests were done to search for associated diseases like diabetes, metabolic syndrome and hepatitis C virus (HCV) and to correlate them with the disease severity. The collected data were analyzed by SPSS version 17. Results: Thirty seven patients were diagnosed with juvenile-onset psoriasis. There was no significant difference between the mean PASI score for adult versus juvenile onset psoriasis. Pustular psoriasis affected 15% of the patients including children and infants. Metabolic syndrome was absent in juvenile onset psoriatic patients and wasn’t associated with a significantly higher PASI score in the adults affected. PASI score was significantly high in the HCV positive and the hypertensive patients. Conclusion: Although the study sample is quite small to reach definite judgments on psoriasis in Egypt, yet we noticed that early onset psoriasis is quite a common and challenging disease. Metabolic syndrome is not common in the studied children with psoriasis. Pustular psoriasis is a common entity even in children and infants. HCV is associated with a severe disease and might be an inducing factor for psoriasis.

Epidemiology and Comorbidity in Children with Psoriasis and Atopic Eczema

Background: First studies have shown that juvenile psoriasis is associated with an increased prevalence of comorbidity. Objectives: We carried out a data analysis to characterise the profiles of comorbidity in children with psoriasis and atopic eczema. Methods: Prevalence data were derived from the database of a German statutory health insurance company according to ICD-10 codes L40 (psoriasis) and L20 (atopic eczema) of children up to 18 years insured in 2009. Results: Data sets included 1.64 million persons and 293,181 children. 1,313 children = 0.45% (0.42-0.47) had a diagnosis of psoriasis and 30,354 = 10.35% (10.24-10.47) had a diagnosis of atopic eczema. Obesity, hyperlipidaemia, arterial hypertension and diabetes were more often diagnosed in children with psoriasis in comparison to all children without psoriasis and to those with atopic eczema. Conclusion: Children with psoriasis and atopic eczema show different and specific patterns of comorbidity which should be detected early and treated adequately.

Juvenile psoriasis: a case report

Psoriasis is a chronic inflammatory immunologically mediated dermatoses characterized by erythematous plaque covered by loosely adherent scales. Psoriasis in children is a rare entity which may lead to psychological impairment and complications, hence early recognition and management of psoriasis in children is crucial. Here we present a case of 2 year old boy with multiple erythematous scaly plaques over lower back, gluteal region, elbows, knees and lower legs. Biopsy from gluteal region showed microscopic features of psoriasis. This case is presented here to highlight the importance of early recognition and management of juvenile psoriasis.

Childhood Psoriasis—An Analysis of German Health Insurance Data

This study explored the epidemiology, treatment, and comorbidities of juvenile psoriasis in Germany using health insurance data. Psoriasis is a chronic inflammatory skin condition that affects approximately 2% to 3% of the world's population. Data were obtained from a database of approximately 6.7 million individuals registered with health insurance organizations throughout Germany. The analysis considered all individuals age 18 years and younger with psoriasis who were registered in 2007. Comorbidities were identified using software based on a morbidity-based risk adjustment model. A total of 138,338 patients with a diagnosis of psoriasis were identified in the database, yielding a prevalence of 2.1%. Within this group there were 4,499 children and adolescents (≤ 18 years of age), a prevalence of 0.4%. The prevalence ranged from 0.1% at the age of 1 year to 0.8% at the age of 18 years. Most of the patients were treated with topical corticosteroids (72.2%) and antipsoriatics (e.g., tars, psoralen; 20.0%). Immunosuppressants were used in 3.3% of the cases. Juvenile psoriasis was associated with numerous significant comorbidities such as rheumatoid arthritis and inflammation (2.1%); delirium, psychosis, and psychotic and dissociative disorder (1.1%); and heart disease (0.6%). Our study demonstrated that psoriasis is more prevalent in children and adolescents than some older international investigations have documented. Analysis of the health insurance data showed that juvenile psoriasis is associated with a range of comorbidities. The data also may suggest an unrecognized burden of mental health problems in young persons with psoriasis.

Drug supply for children with psoriasis in Germany

In Germany there is a lack of robust nationwide data on psoriasis therapy in children. Secondary data from the statutory health insurance Gmnder Ersatzkasse (GEK) of the year 2009 were analyzed. Continuously insured children with psoriasis vulgaris were identified by ICD-10 codes (L 40. X). Their treatment was determined on the basis of prescriptions according to ATC code. 1,313 of 293,181 children and adolescents had psoriasis (0.45%). Of these, n = 651 (49.6%) received at least one medication during the observation period. Topical and systemic corticosteroids were most frequently prescribed (70.8% and 4.0% respectively). The relative frequency of prescription of systemic corticosteroids was higher in children treated by pediatricians and family physicians (by a factor of 3 and 5, respectively) than in those treated by dermatologists. Vitamin D analogs were the second most frequently prescribed drugs, used far more often by dermatologists (14.7%) than by general practitioners (1.7%) and pediatricians (0.9%). Drug supply for children with psoriasis in Germany appears to be inadequate. The consensus guidelines are not sufficiently considered and the use of systemic corticosteroids is still too high, even after adjustment for steroid-dependent indications. The data underline the necessity of guideline-oriented therapy and implementation of current therapeutic evidence in juvenile psoriasis.

Juvenile Psoriasis: A Systematic Review of Comorbid Diseases

ObjectiveTo systematically summarize the literature examining comorbidities associated with juvenile psoriasis.Data SourcesOvid MEDLINE articles published between January 1, 1946, and January 21, 2012, and a manual search. Results were limited to English publications and human, “all child” patients, ages 0 to 18 years.Study SelectionAll investigations that examined the presence or prevalence of comorbidities associated with juvenile psoriasis were included.Data ExtractionStudy design, patient characteristics, psoriasis comorbidities, relevant outcomes, and measures of association were extracted.Data SynthesisThe search resulted in 20 articles. Obesity, hyperlipidemia, hypertension, diabetes, depression, and Crohn's disease occur more frequently in patients with juvenile psoriasis than in their disease-free counterparts. Although the overall rate of comorbidities among patients with juvenile psoriasis appears twice that of children without psoriasis, this rate does not include psychiatric diseases.ConclusionThe literature exploring relationships between juvenile psoriasis and comorbid conditions is sparse, and the evidence for these associations is lacking. The strongest evidence supports an association between obesity and juvenile psoriasis. Support for many other comorbidities was predominantly anecdotal. Additional research assessing physical and psychiatric comorbid conditions among the juvenile psoriasis population is required if clinicians are to make recommendations regarding prevention and management of comorbidities associated with juvenile psoriasis.

The influence of treatments in daily clinical practice on the Children’s Dermatology Life Quality Index in juvenile psoriasis: a longitudinal study from the Child-CAPTURE patient registry

Juvenile psoriasis has a negative effect on the quality of life (QoL). The influence of treatments on QoL of these children has never been investigated before in a prospective observational study. To assess the Children's Dermatology Life Quality Index (CDLQI) in a cohort of patients with juvenile psoriasis and to evaluate the influence of treatments in daily clinical practice on CDLQI. We conducted a prospective observational study of children with psoriasis from a registry containing daily clinical practice data. Before and after treatment, QoL was assessed by the CDLQI and disease severity was documented by the Psoriasis Area and Severity Index (PASI). Three clusters of treatments were analysed: topical, dithranol and systemic therapy. In total, 125 patients were enrolled in the registry. Cross-sectionally, a mean ± SD CDLQI score of 7·5 ± 5·0 and a mean ± SD PASI of 7·0 ± 5·8 were recorded. Itching and problems with treatment had the highest impact on the children's QoL. Longitudinally, 85 patients were analysed with a total of 137 treatment episodes. All treatments contributed to a significant decline in total CDLQI score, with the largest decrease seen in dithranol and systemic treatments. A significant correlation was found between ΔCDLQI and ΔPASI for all treatment modalities. The highest positive impact of treatments was found in a decline of itch and sleep disturbance. In this first prospective observational study on CDLQI in juvenile psoriasis, a positive influence of treatments in daily clinical practice on QoL was demonstrated.

Etanercept in der Therapie der juvenilen Psoriasis

With a prevalence of 0.71%, psoriasis represents one of the most frequent dermatoses in childhood. Eight children with severe psoriasis who failed to respond to other therapy received a weight- adapted treatment with etanercept (0.8mg/kg body) administered subcutaneously once weekly after latent tuberculosis had been excluded. Follow-up visits were at week 4 and 12, subsequently every 12 weeks. Mean age at the start of treatment was 11.8 (range 7-16), six patients were boys. Within three months, six patients reached Psoriasis Area and Severity Index (PASI) reduction of 75%. Two patients stopped use at week 12 because of ineffectiveness. Apart from local side reactions and minor infections, no adverse events were observed. In our case series, etanercept proved to be an efficient drug in juvenile psoriasis without serious adverse events. However, patient registries and further randomized, double-blinded control studies are crucial to evaluate long-term efficacy and safety of etanercept.

Management of childhood psoriasis

Childhood psoriasis although a well known entity, isn't a frequently reported one. Childhood psoriasis has a better prognosis as compared to adult onset psoriasis. Management of psoriasis in children is almost on similar lines as that for adults. But management of generalized disease remains a challenge as systemic therapies are to be used with caution in children. The medicines used most commonly for the management of psoriasis are highly toxic and thus require stringent monitoring. This article will discuss the various treatment modalities used for the management of juvenile psoriasis.

Treatment plan of juvenile psoriasis

The treatment of juvenile psoriasis is challenging. The article addresses the various aspects of management including the laboratory diagnosis and general principles. The treatment of the different types of psoriasis is outlined.

Juvenile psoriasis in European and Asian children: similarities and differences

The first manifestations of psoriasis begin in childhood in more than one-third of patients. However, epidemiological data of juvenile psoriasis are lacking. To compare Dutch (NL group) and Singaporean (SG group) children with psoriasis with the aim of studying the characteristics of juvenile psoriasis and to highlight similarities and differences between these different ethnic groups. Data were collected from 207 patients younger than 18 years diagnosed with psoriasis from Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands and the National Skin Centre, Singapore. A striking difference in familial distribution was found, with more Dutch children having an affected family member (73·3% vs. 13·6%). Presence of itch and triggering factors were more common among Dutch children (80% vs. 14·2% and 33·3% vs. 7·4%, respectively). However, both groups shared similar triggering factors like stress and infections. Other similarities included mean age at presentation (NL group 11·3 years; SG group 14·1 years) and gender ratio (NL group, M/F 1 : 1·1; SG group, M/F 1 : 1·4). Plaque psoriasis was the most common type in both cohorts while guttate and pustular psoriasis were rare. In both groups, the head, followed by the limbs, was the most common site involved. Similar proportions of children in both countries had nail involvement and psoriatic arthritis was rare. The disparity in familial distribution may point to genetic differences between the two groups. Further studies to evaluate this difference in familial distribution may contribute to the understanding of the pathogenesis of psoriasis.

A cross-sectional study using the Children’s Dermatology Life Quality Index (CDLQI) in childhood psoriasis: negative effect on quality of life and moderate correlation of CDLQI with severity scores

Juvenile psoriasis is a chronic and incurable skin disease that affects approximately 0·7% of children. To achieve more insight into the quality of life (QoL) in childhood psoriasis and to investigate whether disease severity scores correlate with QoL scores. All consecutive patients with juvenile plaque psoriasis (≤ 18 years old) who visited our outpatient department were included. At baseline, the Children's Dermatology Life Quality Index (CDLQI) questionnaire was completed and disease severity was assessed by the Psoriasis Area and Severity Index (PASI) and the Physician Global Assessment (PGA). Thirty-nine patients were included in the study. A median CDLQI of 6 [interquartile range (IQR) 5–9] was reported. Median PASI was 6·3 (IQR 3·3–8·2) and median PGA was 2 (IQR 1–3). The correlation coefficient between PASI and CDLQI was 0·47 (P = 0·003), whereas the correlation coefficient between PGA and CDLQI was 0·51 (P = 0·001). The negative effect on QoL in juvenile psoriasis was confirmed in the largest cohort presented up to now. The correlation between disease severity scores and disease-related QoL in children with psoriasis is only moderate. Therefore, both clinical outcome parameters (PASI, PGA) and measures of QoL (CDLQI) should be included in adequate, patient-oriented clinical decision making.

Juvenile psoriasis and its clinical management: a European expert group consensus

Psoriasis, an inflammatory disorder of the skin, can significantly impact on a patient's quality of life, affecting their daily activities and families. The onset of psoriasis in childhood is quite common; however, the treatment of moderate-to-severe disease in this population is challenging, with a paucity of data reported and few licensed agents available. A Delphi survey was conducted among a panel of European expert dermatologists and physicians with a particular interest in pediatric inflammatory disorders. The survey covered the aspects of psoriasis types, psoriatic arthritis, diagnosis and treatment options in childhood. A series of consensus opinions were reached, detailing the current practice in Europe for the diagnosis and treatment of psoriasis in childhood. These opinions are presented in the context of evidence from the literature and the current licensure status and indications of therapies for psoriasis in childhood. These data provide detailed information on the current practices in Europe for treating psoriasis in childhood.

Epidemiology and comorbidity of psoriasis in children

Psoriasis is a common disease affecting all age groups. In contrast to adult psoriasis, only few studies on the epidemiology of childhood psoriasis have been published. Assessment of prevalence and comorbidities of juvenile psoriasis in Germany based on health insurance data. Data were collected from a database of about 1.3 million nonselected individuals from a German statutory health insurance organization which covers all geographical regions. Individuals with psoriasis were identified by ICD-10 codes applied to all outpatient and inpatient visits. The present analysis consists of all patients who were enlisted throughout the year 2005. The diagnosis of psoriasis was registered whenever there was at least one documented patient contact using code L40.* and subcodes. Comorbidities were also evaluated by ICD-10 diagnoses. In total, 33 981 patients with the diagnosis of psoriasis were identified. The prevalence in 2005 was 2.5%. The total rate of psoriasis in children younger than 18 years was 0.71%. The prevalence rates increased in an approximately linear manner from 0.12% at the age of 1 year to 1.2% at the age of 18 years. The overall rate of comorbidity in subjects with psoriasis aged under 20 years was twice as high as in subjects without psoriasis. Juvenile psoriasis was associated with increased rates of hyperlipidaemia, obesity, hypertension, diabetes mellitus, rheumatoid arthritis and Crohn disease. Psoriasis is a common disease in children. Like in adults, it is associated with significant comorbidity. Increased attention should be paid to the early detection and treatment of patients affected.

Epidemiology and prescribed treatments in childhood psoriasis: A survey among medical professionals

Introduction: A study was conducted to explore the epidemiology of childhood psoriasis in general practitioners (GPs) and dermatological practice in the region of our academic medical centre. The treatments used by GPs and dermatologists in juvenile psoriasis were investigated. Methods: A questionnaire was sent to 229 GPs and 73 dermatologists. Questions were addressed about the prevalence of childhood psoriasis and treatments used in this disease. Results: Seventy-three questionnaires were completed. The response rate was 17.0% for GPs and 46.6% for dermatologists. Almost one-third of all GPs have seen one or more patients with juvenile psoriasis under the age of 11 in their own patient population, in contrast to more than 80% of the dermatologists. Extrapolating the results implied an estimated prevalence of childhood psoriasis of 0.17% in the overall Dutch population. Topical corticosteroids were used by 46.2% of GPs and by 91.2% of dermatologists. Vitamin D analogues were prescribed by GPs and dermatologists in 15.4% and 73.5% of cases, respectively. Systemic medication for juvenile psoriasis was only used by 20.6% of dermatologists. Conclusions: Calculated for the Dutch population, there should be approximately 27 500 children with psoriasis in The Netherlands. Topical corticosteroids were the first-choice treatment for both GPs and dermatologists, whereas vitamin D analogues were used as a second-choice topical therapy. Systemic medication was only sparsely prescribed by dermatologists.