Psoriasis in children: Management of chronic plaque psoriasis
- Amy S Paller, MD
Amy S Paller, MD
- Walter J. Hamlin Professor and Chair of Dermatology
- Professor of Pediatrics
- Director, Northwestern University Skin Disease Research Center
- Northwestern University Feinberg School of Medicine
- Emily Broun Lund, MD
Emily Broun Lund, MD
- University of Chicago
- Section Editors
- Kristina Callis Duffin, MD
Kristina Callis Duffin, MD
- Section Editor — Psoriasis
- Associate Professor, Department of Dermatology
- University of Utah
- Moise L Levy, MD
Moise L Levy, MD
- Section Editor — Pediatric Dermatology
- Professor of Pediatrics and Medicine (Dermatology)
- Dell Medical School, University of Texas, Austin
- Clinical Professor of Dermatology and Pediatrics
- Baylor College of Medicine
Psoriasis is a systemic immune-mediated disease that can negatively impact the quality of life of affected children and their families (picture 1A-F). In most children, psoriasis can be adequately treated with topical medications. However, children with moderate to severe psoriasis often require phototherapy or systemic therapy.
Although many of the therapies commonly administered for psoriasis in children and adults are similar, high-quality efficacy and safety trials to guide the best approach to psoriasis in children are more limited. As a result, the development of guidelines for the treatment of pediatric psoriasis is challenging. In clinical practice, consideration of patient-specific factors, such as patient age, severity of disease, comorbidities, and tolerance of the risks and side effects of specific medications, guides the approach to treatment.
The management of chronic plaque psoriasis, the most common clinical variant of psoriasis in children, will be reviewed here. The diagnosis of psoriasis in children and the approach to treatment of other clinical variants of psoriasis and psoriatic arthritis are reviewed separately.
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- PATIENT ASSESSMENT
- MILD TO MODERATE PLAQUE PSORIASIS IN CHILDREN AT LEAST FOUR YEARS OF AGE
- First-line therapies
- - Topical corticosteroids
- - Topical calcineurin inhibitors
- - Topical vitamin D analogs
- - Emollients
- Other therapies
- Special sites
- - Face and intertriginous skin
- - Scalp
- MODERATE TO SEVERE PLAQUE PSORIASIS IN CHILDREN AT LEAST FOUR YEARS OF AGE
- Our approach
- Treatment options
- - Methotrexate
- - Phototherapy
- - Biologic agents
- - Cyclosporine
- - Retinoids
- Other therapies
- - Fumaric acid esters
- - Apremilast
- CHILDREN WITH PSORIATIC ARTHRITIS
- VERY YOUNG CHILDREN
- PATIENT SUPPORT
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS