Systemic therapy and beyond
AAD, San Francisco – Psoriasis affects approximately 1% of children in the U.S. and, although pediatric psoriasis may not be as common as other inflammatory diseases and conditions in this age group such as atopic dermatitis, psoriasis in children can be devastating. It is associated with far-reaching psychosocial stigma and significantly reduces the patients’ quality of life. Having a better understanding of the nuances of the disease and the potential therapeutic hurdles with children can assist clinicians in better treating and managing their patients.
“There are many challenges in the management of pediatric psoriasis, but lack of comparative efficacy and safety data resulting in lack of FDA approved systemic and biologic therapies for severe psoriasis in the pediatric age group is a big one. We often rely on case series, expert consensus and data from use in other childhood diseases to make very important decisions about care,” says Kelly M. Cordoro, M.D., Associate Professor of Dermatology and Pediatrics, University of California, San Francisco.
Individually tailored treatments
Treatment of psoriasis in pediatric patients must be individualized and specifically tailored to each patient, Dr. Cordoro says: “The risks and benefits of potential treatments must always be weighed against the risks of undertreated disease. In the case of children, this is additionally challenging given our uncertainty about the natural history of treated or untreated pediatric-onset psoriasis. Many children will likely endure a lifetime of waxing and waning disease and the treatments required to manage it. With this in mind, optimal management calls for therapeutic choices that will maximize outcomes while minimizing cumulative toxicities.”
According to Dr. Cordoro, the choice of treatment must be influenced by a number of factors, including: the primary morphology and presentation of the disease, health history, speed of progression, patient age, the presence of comorbidities such as psoriatic arthropathy or obesity, impact on quality of life, patient/family preference for treatment, and level of disability. Although there is no “one size fits all” treatment choice, Dr. Cordoro said that certain therapies work best for certain presentations.
“Importantly, severity is not limited to body surface area of involvement because even very limited disease, if in a visible or challenging location such as the face or on the genitals, can create a tremendous impact on self-esteem and therefore may warrant more aggressive treatment,” Dr. Cordoro says.