Review article
https://doi.org/10.26800/LV-146-supl1-28
New insights into pediatric and adolescent psoriasis treatment
Suzana Ožanić Bulić
*
Nives Pustišek
Luka Bulić
Eva Brenner
* Corresponding author.
Abstract
Psoriasis is a chronic, systemic, inflammatory dermatosis characterized by increasing prevalence from childhood to adolescence. Risk factors for psoriasis, especially in genetically predisposed children, are Streptococcal pharyngitis, Kawasaki disease, skin trauma (Koebner phenomenon), and emotional stress. Paediatric psoriasis is directly linked to increased body mass index, passive smoking, sudden cessation of systemic corticosteroid treatment, and paradoxically, with use of TNF alpha antagonists in the treatment of psoriatic arthritis and inflammatory bowel disease. Psoriasis treatment algorithm includes timely disease diagnosis, screening for comorbidities and risk factors, and assessment of disease severity by clinicians and patients using validated tools. In the majority of paediatric patients, psoriasis is well controlled by topical corticosteroid treatment in monotherapy or in combination with vitamin D analogue calcipotriol. Calcineurin inhibitors, topical tacrolimus and pimecrolimus are the treatment of choice for face and genital psoriasis due to favourable safety profile. The treatment of choice for moderate-to-severe psoriasis are systemic drugs. Methotrexate, cyclosporine and acitretin are most common conventional systemics used in the treatment of paediatric psoriasis, although all are used offlabel. The European Medicines Agency has approved five biologics for treatment of moderate-to-severe chronic plaque psoriasis in children, candidates for systemic treatment – adalimumab from the age of four and etanercept, ustekinumab, ixekizumab, and secukinumab for children from the age six. Excellent efficacy and favourable safety profile made biologics the first-line treatment of paediatric psoriasis in various countries. Choosing the right treatment is not the last step in psoriasis management. Due to its active nature, various modifications might be necessary to reach goals and monitor treatment outcomes.
Keywords
PAEDIATRIC PSORIASIS; COMORBIDITIES; BIOLOGIC TREATMENT
Hrčak ID:
315856
URI
Publication date:
11.4.2024.
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