Psoriasis is a skin disorder that results in the rapid, uncontrolled multiplication of skin cells. The use of systemic therapies to treat psoriasis in children has increased, but its safety and efficacy are unclear. The objective of this study is to analyze the safety of systemic treatments for pediatric psoriasis. 

This is a retrospective review conducted across 20 centers in North America and Europe. The study included a total of 390 children (203 girls and 187 boys) with moderate to severe psoriasis who used phototherapy or systemic therapy for at least three months. Out of 390 participants, 270 were assigned to methotrexate, 106 to biological agents, acitretin to 57, cyclosporine to 30, and fumaric acid esters to 19. 73 participants used more than one medication. The primary outcome of the study was the severity of psoriasis and the onset of adverse events.

48.1% of participants in the methotrexate group reported one or more adverse events, mainly gastrointestinal. Hepatic transaminase elevations were common in the methotrexate group. On the other hand, injection site reactions occurred in 18.9% of patients treated with tumor necrosis factor inhibitors.

The research concluded that the risk of medication-related adverse events was higher in methotrexate treatment than in tumor necrosis factor inhibitors.