From the Guidelines
The best treatment for psoriasis in a 9-year-old is etanercept, which is recommended as an effective therapy for moderate to severe psoriasis in children 6 years of age and older, with a dosing regimen of 0.8 mg/kg subcutaneously once weekly, with a maximum of 50 mg weekly. According to the joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients 1, etanercept has a strength of recommendation of A, indicating high-quality evidence.
When considering treatment options, it's essential to weigh the potential benefits and risks. The major risk for biologics in children is injection site reaction, but patients should be monitored for their increased risk of infection 1.
Some key points to consider when treating psoriasis in a 9-year-old include:
- Etanercept is a preferred biologic option due to its established safety and efficacy profile in pediatric patients 1
- Topical therapies, such as moisturizers, mild topical corticosteroids, and vitamin D analogues, can be used as adjunctive treatments or for mild cases
- Phototherapy, such as narrowband UVB, may be considered for moderate to severe cases that don't respond to topicals
- Lifestyle modifications, including regular bathing with lukewarm water, gentle soaps, and immediate application of moisturizers after bathing, can help maintain skin hydration and reduce symptoms.
It's crucial to tailor treatment to the individual patient's needs and response, and to closely monitor for potential side effects and adjust the treatment plan as necessary.
From the FDA Drug Label
Psoriasis: Methotrexate is indicated in the symptomatic control of severe, recalcitrant, disabling psoriasis that is not adequately responsive to other forms of therapy, but only when the diagnosis has been established, as by a biopsy and/or after dermatologic consultation Pediatric Use Safety and effectiveness in pediatric patients have been established only in cancer chemotherapy and in polyarticular-course juvenile rheumatoid arthritis.
The best treatment for psoriasis in a 9-year-old is not explicitly stated in the provided drug labels. However, methotrexate is indicated for the symptomatic control of severe, recalcitrant, disabling psoriasis.
- Key considerations:
- The diagnosis of psoriasis should be established by a biopsy and/or after dermatologic consultation.
- Safety and effectiveness of methotrexate in pediatric patients have been established only in cancer chemotherapy and in polyarticular-course juvenile rheumatoid arthritis.
- The use of methotrexate in pediatric patients with psoriasis should be approached with caution, considering the potential risks and benefits 2. It is essential to consult a dermatologist or a qualified healthcare professional to determine the best course of treatment for a 9-year-old with psoriasis.
From the Research
Treatment Options for Psoriasis in a 9-Year-Old
- The treatment of psoriasis in children can be challenging due to the lack of approved systemic treatments for pediatric use 3.
- According to a study published in the European journal of pediatrics, adalimumab, etanercept, and ustekinumab have a grade A recommendation for the treatment of severe chronic plaque psoriasis in children 3.
- Narrow-band-ultraviolet B phototherapy is also an effective treatment option for psoriasis, with a good safety profile and can be used in combination with topical treatments such as emollients, calcipotriene, and corticosteroids 4, 5.
- A study published in the International journal of dermatology found that the combination of narrowband ultraviolet B phototherapy and methotrexate was more effective than either treatment alone in achieving clearance of psoriasis lesions 6.
Recommended Treatments
- Adalimumab is approved by the European Medicines Agency as a first-line treatment for severe chronic plaque psoriasis in children aged 4 years and older 3.
- Etanercept and ustekinumab are approved as second-line therapy in children aged 6 years and older, and 12 years and older, respectively 3.
- Narrow-band-ultraviolet B phototherapy can be used as a first-line therapy for generalized plaque psoriasis, with treatment protocols including initiation, maintenance, and dose increases 5.
Considerations for Treatment
- The treatment of psoriasis in children should be individualized, taking into account the severity of the disease, the patient's age, and the potential side effects of treatment 3, 7.
- A treatment algorithm and practical tools, such as tabular summaries of differential diagnoses and treatment mechanisms, can assist in therapeutic reasoning and decision-making for individual patients 3.