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The American Academy of Dermatology and the National Psoriasis Foundation have published joint guidelines of care for the treatment of pediatric psoriasis, with focus placed on topical and systemic therapies, comorbidities, psychosocial wellness, and shared decision making. The guidelines were published in the Journal of the American Academy of Dermatology.
In pediatric patients with psoriasis who are receiving cyclosporine, the guideline recommends regular clinical and laboratory blood pressure monitoring during therapy (strength A recommendation). Treatment with cyclosporine is recommended for moderate to severe plaque psoriasis and pustular psoriasis in pediatric patients (strength B recommendation). Methotrexate therapy is recommended as systemic treatment of moderate to severe plaque psoriasis, as well as pustular psoriasis (strength B recommendation).
Strength A recommendations also suggest the use of etanercept for moderate to severe psoriasis in patients ≥6 years of age. The recommended dose of etanercept is 0.8 mg/kg when administered subcutaneously once a week (maximum, 50 mg/week). A strength A recommendation for ustekinumab for adolescents ≥12 years of age with moderate to severe plaque psoriasis was also noted. Several other biologics are discussed in the guidelines, including adalimumab and infliximab, as well as recommended strategies for identifying response.
The dermatologist’s role in communicating and collaborating with the patient’s primary care provider is emphasized throughout the guidelines. Discussions with the primary care provider could be related to the complexity of the disease, managing comorbidities, and risks associated with potential therapies. Emotional elements of psoriasis in children should also be kept in mind, and dermatologists should focus on facilitating shared decision-making with the patient and/or caregiver.
Patients and their families should also receive appropriate education regarding their disease, including how the disease can affect quality of life. Triggers, risk profiles and precautions, potential comorbidities, and management should all be incorporated into the education program. Cartoon models, pictures, and simple language can be used to educate pediatric patients, and support groups should be recommended to the patient’s caregivers and family members.
Recommendations are also made for pediatric patients with psoriasis and obesity, particularly as these patients “may require a higher dose of medication than the maximum suggested pediatric dose.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Reference
Menter A, Cordoro KM, Davis DMR, et al. Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients. J Am Acad Dermatol. 2020;82(1):161-201.
