From the Guidelines
Diagnosis and Treatment of Infantile Psoriasis
Infantile psoriasis is a rare condition characterized by scaly, erythematous plaques on the skin of infants. The diagnosis is primarily clinical, based on the appearance of the skin lesions and the patient's medical history.
Treatment Options
Treatment typically involves topical corticosteroids, such as hydrocortisone butyrate 0.1% ointment, applied twice daily for 2-4 weeks 1, or topical calcineurin inhibitors, such as pimecrolimus 1% cream, applied twice daily for 2-4 weeks 1. In some cases, a combination of topical corticosteroids and vitamin D analogues may be used 1.
- Topical Corticosteroids: These are the first-line treatment for infantile psoriasis, due to their anti-inflammatory properties. However, their use should be carefully monitored, especially in infants, due to the risk of HPA axis suppression and other adverse effects 1.
- Topical Calcineurin Inhibitors: These are alternative treatments for infantile psoriasis, particularly for sensitive areas such as the face and folds. They have a different side effect profile compared to topical corticosteroids, with a lower risk of HPA axis suppression but a potential for burning and stinging at the application site 1.
- Other Treatments: In severe cases, or when the disease is not responsive to topical treatments, other options such as phototherapy or systemic treatments may be considered. However, these are typically reserved for older children or for cases where the disease has a significant impact on the quality of life.
Important Considerations
- The choice of treatment should be individualized based on the severity of the disease, the age of the patient, and the location of the lesions.
- Emollients can be used to help manage the symptoms of psoriasis and reduce the need for other treatments.
- Parents and caregivers should be educated on the safe use of topical corticosteroids and the importance of monitoring for adverse effects.
Given the potential for adverse effects and the importance of individualized treatment plans, it is crucial that infants with psoriasis are managed by a healthcare provider with experience in treating pediatric skin conditions.
From the Research
Diagnosis of Infantile Psoriasis
- The diagnosis of psoriasis in infants is primarily clinical, with no definitive test available 2
- Noninvasive tools such as dermoscopy can aid in diagnosis, while biopsy is reserved for difficult-to-characterize psoriatic-like lesions 2
- The presentation of psoriasis in infants can be different from that in adults, with unique symptoms and patterns on the skin 2
Treatment Options for Infantile Psoriasis
- Topical therapies are often used as the first line of treatment for mild to moderate psoriasis in infants 3
- Systemic therapies, such as biologics, may be considered for more severe cases or those that do not respond to topical treatments 3, 4
- Biologic agents, such as ixekizumab, have shown efficacy in treating pediatric psoriasis, including linear psoriasis 5
- Adalimumab, an anti-tumor necrosis factor-alpha (TNF-α) agent, has also shown promise in treating pediatric generalized pustular psoriasis 6
Challenges in Treating Infantile Psoriasis
- The limited therapeutic armamentarium for children with psoriasis, due to differences in inherent risks and lack of pre- and postmarketing studies 3
- The need for a partnership between the patient, caregivers, and primary care providers to manage the challenges of this chronic and incurable disease 3
- The importance of considering the financial status of the patient when selecting a treatment modality, as many effective treatments can be costly 4