Although one-third of diagnosed cases of psoriasis are pediatric, clinical guidelines addressing the unique physiology, treatments, and patient-parent-provider interactions experienced by pediatric patients with psoriasis have not previously existed. To fill this void, the American Academy of Dermatology (AAD) and the National Psoriasis Foundation (NPF) co-developed a guideline for the management and treatment of psoriasis in pediatric patients, published in the Journal of the American Academy of Dermatology. “We know that the incidence of pediatric psoriasis increases with increasing age, making the need for guidelines of care for the management and treatment of psoriasis in pediatric patients an important asset for dermatologists, their pediatric patients, and their patients’ families and caregivers,” explains the guideline co-chair Alan Menter, MD.

A multidisciplinary workgroup of dermatologists (including pediatric dermatologists), a rheumatologist, a cardiologist, and representatives from a patient advocacy organization with expertise in psoriasis was formed to develop the recommendations. Dr. Menter cites that “Pediatric Psoriasis: Evolving Perspectives” by Amy Paller, MD, et al, was a catalyst for the development of the guidelines. “The guideline gives dermatologists access to the latest recommendations on all forms of therapy for children, including topicals, phototherapies, systemic therapies, and biologic therapies,” emphasizes Dr. Menter.

Triggers

The recommendations in the guideline highlight the multitude of triggers of psoriasis in pediatric patients, including emotional stress, increased body mass index, second-hand cigarette smoke, pharyngeal and perianal group A β-hemolytic Streptococcus infection, Kawasaki disease, and withdrawal of systemic corticosteroids (Table). Since the triggers for pediatric patients are broad, Dr. Menter recommends “a robust physician-patient-caregiver relationship to facilitate a collaborative decision-making model.”

Comorbidities

As with adults, pediatric patients with psoriasis are at risk for numerous comorbidities that could affect their overall health and quality of life. Common comorbidities for pediatric patients with psoriasis include arthritis, heart disease, dyslipidemia, obesity, metabolic syndrome, and depression (Table).

Dr. Menter highlights the emotional impact psoriasis can have on pediatric patients. “The guideline goes a step further than providing recommendations for common clinical questions that arise among physicians, patients, and caregivers in psoriasis management,” she says; “they address the emotional toll that psoriasis has on pediatric patients, many of whom are bullied and teased by their peers. Pediatric and clinical dermatologists alike must recognize the mental health aspect that is common among children and adolescents, because it is equally important to address the emotional and physical symptoms pediatric patients can face on a day-to-day basis.”

More to Come

Dr. Menter believes there is more to be done for pediatric patients with psoriasis now that the guideline has been published. “We still have some work to do and research to uncover to better and fully understand how such systemic and biologic therapies work in children and adolescent patients with psoriasis.”

References

Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients
https://www.jaad.org/article/S0190-9622(19)32655-6/fulltext