Psoriasis In Children Research Articles

Clinical features and management of childhood psoriasis: Retrospective analysis among 171 children from North India

Introduction: Psoriasis is a common chronic inflammatory disease of the skin which is relatively less studied in children. Materials and Methods: A retrospective analysis of records of children (≤18 years of age) with psoriasis over a period of 5 years was conducted in the department of Dermatology of a tertiary care center. The results were described as percentages. Results: Out of a total of 1350 cases of psoriasis attending the Dermatology department, there were 171 (12.7%) children ≤ 18 years of age. Mean age of the cases was 12.0 ± 5.0 years. Mean duration of illness was 24.7 ± 32.9 weeks. Infection was the most common (8.8%) aggravating factor. Plaque-type psoriasis (60.2%) was the most common type of psoriasis, followed by guttate psoriasis (11.7%). Erythrodermic and pustular psoriasis were seen in 5.8% and 2.3% of the patients, respectively. Lower limb (67.2%) was the most commonly involved site followed by upper limb (55.5%). Nails were involved in 38% of the patients, pitting being the most common finding. Joint involvement was present in 3.5% of the patients. The body surface area involvement ranged from 0.3 to 95% (10.5 ± 21.9). The psoriasis area and severity index ranged from 0.3 to 39.2 (6.5 ± 7.9). Most of the patients (37.4%) were managed with topical therapy alone. Systemic therapy was used in the form of methotrexate in 5.3% patients and oral antibiotics in 4.6% patients. Conclusion: Psoriasis in children is not very common. In children also, plaque-type psoriasis is the most common presentation. Severe forms of psoriasis and joint involvement are less frequent. In general, psoriasis is relatively mild in children. Topical treatment is sufficient to control the disease in most of the cases.

Adalimumab: A Review in Chronic Plaque Psoriasis.

Adalimumab (Humira(®)) is a fully human monoclonal antibody against tumour necrosis factor (TNF), formulated for subcutaneous administration. It is well established in the treatment of adults with moderate-to-severe chronic plaque psoriasis and has recently received approval in the EU for the treatment of severe chronic plaque psoriasis in children and adolescents from 4 years of age. In a phase III trial in paediatric patients, a significantly greater proportion of patients receiving adalimumab 0.8 mg/kg (to a maximum of 40 mg) every other week (eow) achieved a ≥75 % improvement from baseline in Psoriasis Area and Severity Index than those receiving methotrexate after 16 weeks of treatment. In adults, well-designed randomized clinical trials demonstrated that adalimumab 40 mg eow effectively reduced the signs and symptoms of psoriasis and improved dermatology-specific and general measures of health-related quality of life, with these benefits sustained during long-term treatment. Adalimumab was generally well tolerated, compared with placebo or methotrexate, during clinical trials in paediatric and adult patients with chronic plaque psoriasis. Thus, adalimumab remains an important treatment strategy in adults with moderate-to-severe chronic plaque psoriasis and provides a promising new systemic treatment option for children and adolescents from 4 years of age with severe psoriasis.

Role of Narrowband Ultraviolet B Phototherapy in the Treatment of Childhood Psoriasis in Asian Children.

Narrowband ultraviolet B (NBUVB) phototherapy is a well-established treatment modality for psoriasis. We performed a retrospective analysis of children of East Asian descent with psoriasis treated with NBUVB phototherapy at the National Skin Centre, Singapore, over a 5-year period between 2004 and 2008 and found that NBUVB phototherapy is safe and effective for the treatment of psoriasis in children of East Asian descent.

Psoriasis in Children and Adolescents: Diagnosis, Management and Comorbidities.

Psoriasis is a common chronic immune-mediated inflammatory skin disorder and begins in childhood in almost one-third of the cases. Although children present with the same clinical subtypes of psoriasis seen in adults, lesions may differ in distribution and morphology, and their clinical symptoms at presentation may vary from those reported by adult patients. Nevertheless, diagnosis of psoriasis is primarily based on clinical features. Pediatric psoriasis can have a profound long-term impact on the psychological health of affected children. Additionally, pediatric psoriasis has been associated with certain comorbidities, such as obesity, hypertension, hyperlipidemia, diabetes mellitus and rheumatoid arthritis, making early diagnosis and management essential. As guidelines are lacking and most (systemic) treatments are not approved for use in children, treatment of pediatric psoriasis remains a challenge. A prospective, multicenter, international registry is needed to evaluate these treatments in a standardized manner and ultimately to develop international guidelines on pediatric psoriasis. This article reviews current concepts in pediatric psoriasis including epidemiology, clinical features, diagnosis, the role of topical and systemic agents and the association with other morbidities in childhood.

Psoriasis in Children: A Review.

Psoriasis is a chronic, immune-mediated, inflammatory systemic disease which targets primarily the skin. It presents a genetic basis, affecting 1 to 3% of the white population. Nevertheless, the existence of two psoriasis incidence peaks has been suggested (one in adolescence before 20 years of age and another in adulthood) onset may occur at any age, including childhood and adolescence, in which its prevalence ranges between 0.7% and 1.2%. As for adult psoriasis, pediatric psoriasis has recently been associated with obesity, metabolic syndrome, increased waist circumference percentiles, and metabolic laboratory abnormalities, warranting early monitoring and lifestyle modifications. In addition, due to psoriasis chronic nature and frequently occurring relapses, psoriatic patients tend to have an impaired quality of life, often requiring long-term treatment. Therefore, education of both pediatric patients and their parents is essential to successful and safe disease management. However, systemic treatment of children is challenging as the absence of standardized guidelines and the fact that evidence-based data form randomized controlled trials are very limited. This review shows an overview of the current understanding of the pathogenesis, comorbidities, differential diagnosis, treatment and prevention of pediatric psoriasis, also presenting with an emphasis on the necessity of an integrated treatment approach involving different specialists such as dermatologist, pediatricians, rheumatologists, etc.

Nail Psoriasis in Children: Common or Uncommon Results from a 10-Year Double-Center Study

Purpose of the Study: Our aim was to perform an extensive search of the literature on the prevalence of nail psoriasis in the pediatric population and to estimate it on our own database. Procedures: Searching the most important databases yielded results of 16 papers published in a 40-year period which reported the prevalence of nail psoriasis in children. Furthermore, data gathered between 2004 and 2013 at two centers specialized in nail disorders were analyzed. Results: The selected papers encompassed a total of 4,853 psoriatic children, of whom 762 (15.7%) had nail involvement. Concerning our data, a total of 68,839 children were seen in pediatric skin consultation in both clinics over a period of 10 years, 0.11% of which had nail involvement. The rate of psoriatic children presenting nail alterations was 19.4% in the Greek and 15.5% in the Italian patient groups. Conclusions and Message: This is the retrospective study including the largest number of cases of nail psoriasis in the pediatric population. Our data are in line with the incidence estimation of the rest of Europe.

Biologic response modifiers and pediatric psoriasis.

The efficacy and safety of biologic response modifiers such as etanercept, adalimumab, infliximab, and ustekinumab have been demonstrated in the treatment of psoriasis in adults, but none are currently approved for the treatment of psoriasis in children in the United States, and only etanercept is approved for the treatment of psoriasis in children in the European Union. Through case reports, case series, and a large clinical trial of the use of etanercept, the literature supports the use of these agents to treat psoriasis in children. Data on the use of the tumor necrosis factor-α antagonists etanercept, adalimumab, and infliximab in the treatment of other inflammatory diseases in children-namely Crohn's disease, juvenile arthritis, and uveitis--support their safety profile in children.

Management of Psoriasis in Children: a Narrative Review

Psoriasis is an inherited chronic inflammatory papulosquamous disorder with a variable clinical spectrum affecting about 0.5% to 2% of children and adolescence. In spite of all performed researches around the world for seeking better treatments with fewer adverse effects to control the disease, there is still no cure for psoriasis. Treatment of psoriasis in children is very conservative and many therapies used for adults may not be appropriate for children due to possible long-term or delayed adverse effects. A wide range of therapeutic options are existed including; topical therapy, phototherapy, chemotherapy, systemic therapies and biologic therapies. Here in, because of the lack of data in this specific field of dermatology, we decided to review the current therapies of childhood psoriasis.

Systemic Treatment of Psoriasis in Children

Childhood psoriasis has a significant impact on the child´s quality of life and those who cannot be managed with topical treatment should be considered for systemic treatment. The majority of systemic therapies used for childhood psoriasis are off-label drug therapies. Evidence-based studies on systemic treatment of childhood psoriasis are scarce, and treatment algorithms are generally based on low-level evidence. A literature search was performed and updated to October 2015 to obtain an up to date overview of relevant systemic treatment in childhood psoriasis. Methotrexate is the conventional first-line of systemic treatment, but the level of evidence for its use is low. Etanercept is FDA approved for psoriasis vulgaris in children, has a documented efficacy and a good safety profile, and is currently the drug for which most evidence for the use in children has been accumulated. Adalimumab and ustekinumab have both recently completed large double-blinded controlled trials testing in childhood psoriasis and both have recently been approved for psoriasis vulgaris in children. Thus a wider range of approved systemic treatment options is becoming available.

Calcipotriol/betamethasone dipropionate ointment in mild-to-moderate paediatric psoriasis: long-term daily clinical practice data in a prospective cohort

Psoriasis in children has a significant negative impact on the quality of life (QoL) and effective treatment can improve this. The two-compound ointment calcipotriol 50μgg(-1) and betamethasone dipropionate 0·5mgg(-1) is an effective treatment option for moderate-to-severe psoriasis in adults. To study prospectively the effectiveness and safety of calcipotriol/betamethasone dipropionate ointment in paediatric patients with mild-to-moderate plaque psoriasis in daily clinical practice and to investigate the influence on QoL. Data were obtained from a prospective, longitudinal paediatric psoriasis registry, called Child-CAPTURE. Severity was assessed using the Psoriasis Area and Severity Index (PASI) and body surface area (BSA). The Children's Dermatology Life Quality Index (CDLQI) was used to assess QoL and visual analogue scores (VAS) for pain and itch were collected. For safety data the number of (serious) adverse events was recorded. Seventy-three patients (mean age 10·8years, range 3-18) were treated for a median time of 35·0weeks (range 1·0-176·0). At week 12, mean PASI decreased 15·4% (from 5·2 to 4·4), BSA barely changed, and median CDLQI decreased significantly from 5·5 to 4·0. VAS scores for pain and itch declined. At week 24, mean PASI decreased to 4·3 (17·3%). No related serious adverse events were observed. In this daily clinical practice study in paediatric psoriasis, calcipotriol/betamethasone dipropionate ointment initially improved mild-to-moderate psoriasis and then maintained its effect. In addition, it improved QoL, with few adverse events.

Psoriasis in Children and Women: Addressing Some Special Needs

Psoriasis in Children and Women: Addressing Some Special Needs

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.

Managing psoriasis in children and young people

Psoriasis is an inflammatory condition which manifests in the skin and joints. Psoriasis can affect children and young people; the late teens and early twenties are a peak time for psoriasis developing for the first time. Psoriasis can affect quality of life in children and young people. Nurses can support children, young people and their families in managing psoriasis, supporting and educating on general skin and joint care and topical treatments to manage the condition. Psoriasis treatments for children and young people often have licensing restrictions, but National Institute for Health and Care Excellence guidelines on the assessment and management of psoriasis give guidance on all treatments for psoriasis.

Juvenile generalized pustular psoriasis treated with etanercept

An 8-year-old boy with general pustular psoriasis (GPP) and iatrogenic secondary Cushing syndrome was treated successfully with etanercept after he had failed on acitretin, methotrexate, and methylprednisolone therapy. GPP is a severe and very rare variant of psoriasis in children often accompanied by life-threatening complications. Retinoids, cyclosporine, methotrexate, or dapsone used in a small number of case series and case reports were effective. Etanercept is a recombinant human tumor necrosis factor-alpha (TNF-alpha) receptor protein fused with Fc portion of IgG1 that binds to TNF-alpha, approved by Food and Drug Administration for the treatment of moderate-to-severe plaque psoriasis in children and teens who have not responded to other psoriasis treatments. In our patient, etanercept demonstrated significant clinical response associated with long-term efficacy without acute exacerbation, excellent tolerability, and good safety profile.

Infliximab-Associated Psoriasis in Children With Crohn’s Disease May Require Withdrawal of Anti–Tumor Necrosis Factor Therapy

Infliximab-Associated Psoriasis in Children With Crohn’s Disease May Require Withdrawal of Anti–Tumor Necrosis Factor Therapy

Psoriasis in children: should we be worried about comorbidities?

Psoriasis in children: should we be worried about comorbidities?

Pustular Psoriasis in Children- a Review

DOI: http://dx.doi.org/10.3126/njdvl.v10i1.6416NJDVL 2012; 10(1): 1-10

Plaque psoriasis in children and adolescents – the role of etanercept

Correspondence: Francesca Prignano Division of Clinical, Preventive and Oncology Dermatology, Department of Critical Care Medicine and Surgery, University of Florence, Piazza Indipendenza, 11 50129 Firenze, Italy Tel +39 055 693 9624 Fax +39 055 503 8506 Email francesca.prignano@unifi.it Background: Childhood-onset psoriasis affects approximately one-third of the psoriatic population. Among many potential treatments of childhood psoriasis, biological agents are emerging as a valuable option in the management of this disease. In Europe, etanercept has recently been approved for children aged 6 years and over. Data from a well-designed clinical trial indicate that in children, etanercept effectively reduces psoriasis symptoms, with beneficial effects evident as early as 4 weeks after the onset of therapy. The treatment is generally well tolerated; mild injection site reactions are the most common adverse events reported in the literature. Published data of etanercept use in children show promising results, but further clinical studies are necessary to confirm its long-term efficacy and safety.

Treatment of pustular psoriasis: From the Medical Board of the National Psoriasis Foundation

A task force of the National Psoriasis Foundation Medical Board was convened to evaluate treatment options for pustular psoriasis. Meetings were held by teleconference. Consensus on treatment of pustular psoriasis was achieved. Pustular psoriasis has been classified into localized and generalized forms. There are a number of treatment modalities, but there is little evidence-based information to guide the management of this type of psoriasis. The purpose of this article was to present treatment recommendations to aid in the treatment of patients with pustular psoriasis. A literature review was conducted to examine treatment options for pustular psoriasis and assess the strength of the literature for each option. Overall the quality of the literature about the treatment of pustular psoriasis is weak. Treatment should be governed by the extent of involvement and severity of disease. Acitretin, cyclosporine, methotrexate, and infliximab are considered to be first-line therapies for those with generalized pustular psoriasis. Adalimumab, etanercept, and psoralen plus ultraviolet A are second-line modalities in this setting. Pustular psoriasis in children, in pregnant women, and in localized forms alter which agents are first-line modalities as concerns such as teratogenicity need to be factored into the decisionmaking for the individual patient. There are few high-quality studies examining treatment options for pustular psoriasis. Treatment of patients with pustular psoriasis depends on the severity of presentation and patient's underlying risk factors. The data are extremely limited for this type of psoriasis and we encourage further exploration.

The Role of Stress in Children with Psoriasis

Background Stress could be involved as a precipitating or aggravating factor in psoriasis. In the literature, few sources refer to this subject in the pediatric field and even fewer to case-control studies. Objective The purpose of the study was to note any stressful situations that occur before the onset or extension of psoriasis in children aged 16 years and younger. Methods The study comprised 41 children (23 girls, 18 boys) with psoriasis who were enrolled in a comparative study. Results Between March 2001 and December 2007, 9,940 children (≤16 years old) were examined. The incidence of psoriasis among new dermatologic conditions was 0.43%. The mean age of the children was 11.97 years. There was a family history of the disease in 29.26% of cases; 31% of children with psoriasis had onset of psoriasis less than 3 months before the evaluation, and 38% had recent extensions or recurrence. In 14.6% of psoriasis cases, an inflammatory focus was identified. Stressful events had occurred in 41% of the psoriasis group, compared with 17% of controls. The difference was statistically significant (χ2 = 4.77, P = .028). The odds ratio was 3.44 (95% CI, 1.23–9.57). Most of these children had mentioned one event that may have had an impact on the development of psoriasis. Girls with psoriasis vulgaris and boys with guttate lesions were most often affected by stressful situations. Family problems (death, illnesses, disputes, parents working abroad, financial restrictions) were more often described in psoriatic cases. Also, school situations were often mentioned as influencing the psoriatic lesions. Conclusions The recollection of past events within the patient's family or by the patient and the dimensions of the sample could be considered limitations of the study. However, the presence of stressful events could be taken in consideration as influencing the onset, recurrence, or extension of psoriasis in children.