From the Guidelines
Pediatric psoriasis should be treated with topical calcineurin inhibitors, such as tacrolimus 0.1%, as the preferred first-line therapy for psoriasis of the face, genitalia, and body folds, due to their efficacy and safety profile in children 1. The treatment of pediatric psoriasis should be individualized based on disease severity, location, and impact on quality of life.
- For mild cases, topical calcineurin inhibitors like tacrolimus 0.1% can be used off-label, as recommended by the joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients 1.
- The level of evidence for pediatric psoriasis and topical calcineurin inhibitors is II-III, based on studies such as the systematic review by de Jager et al, which recommends TCIs as the preferred first-line therapy for psoriasis of the face, genitalia, and body folds 1.
- Topical corticosteroids, such as hydrocortisone 2.5% for the face and intertriginous areas, and medium-potency steroids like triamcinolone 0.1% for the body, can also be used, but with caution, especially in younger patients, due to the risk of HPA suppression and rebound flare 1.
- Regular follow-up is essential to monitor for disease progression and treatment side effects, and to address mental health concerns and provide education about the non-contagious nature of the condition 1.
From the Research
Overview of Pediatric Psoriasis
- Pediatric psoriasis is a chronic immune-mediated disorder that affects children and is often associated with comorbidities and psychological distress 2, 3, 4.
- The disease can have a profound long-term impact on the psychological health of affected children and is associated with certain comorbidities, such as obesity, hypertension, and diabetes mellitus 3.
Diagnosis and Treatment
- Diagnosis of psoriasis is primarily based on clinical features, and treatment remains a challenge due to the lack of guidelines and limited approval of systemic treatments for use in children 5, 3, 6.
- Topical treatments, such as corticosteroids, calcineurin inhibitors, and vitamin D analogs, are commonly used, but may have limitations due to side effects, tolerability, and efficacy 2.
- Systemic treatments, including phototherapy, acitretin, methotrexate, and cyclosporine, have been used to manage severe pediatric psoriasis, and newer biologic agents are being explored 5, 6.
Emerging Therapies
- Novel topical agents, such as roflumilast and tapinarof, have been approved or are being studied for the treatment of pediatric psoriasis, offering promising new options for management 2.
- Ongoing efforts are being made to optimize conventional treatments, including the development of new formulations, such as a foam formulation of halobetasol propionate 2.
Comorbidities and Quality of Life
- Pediatric psoriasis is associated with significant medical, social, financial, and psychological burdens, and affected individuals may experience a decreased quality of life 3, 4.
- Early diagnosis and management are essential to mitigate the impact of the disease on affected children and their caregivers 3, 4.