The Evolving Role of Biologics in the Treatment of Pediatric Psoriasis.
ABSTRACT The exact role of biologics in the treatment of pediatric psoriasis remains undefined but is evolving. Biologics are an attractive option for use in children in part because they offer more convenient dosing regimens and less frequent laboratory monitoring than traditional systemic agents. Further, because their action is targeted, they theoretically lack many of the potential end-organ toxicities of traditional agents. However, compared to adult psoriasis populations, there is a relative lack of long-term safety data specific to the pediatric psoriasis population. Thus, the clear advantages of using biologic agents must be balanced with a measure of caution. This article will provide a summary of the cumulative pediatric safety and efficacy data for the anti-tumor necrosis factor-alpha (TNF-α) agents and interleukin (IL)-12 and IL-23 (IL12/23) pathway inhibitor and suggestions for a rational clinical approach to their use in children with psoriasis.
Article: [Childhood psoriasis.][Show abstract] [Hide abstract]
ABSTRACT: Psoriasis is a chronic inflammatory skin disease that can affect nearly 1% of children, even during the first months of life. Recently, a link with obesity has been demonstrated by a few studies. The most common clinical form is the plaque psoriasis type, which only affects 50% of children. Napkin psoriasis, guttate psoriasis, and palmoplantar keratoderma appear to have specific aspects in childhood. Although benign, the social impact induced by psoriasis can be major, especially in children, if the disease is poorly understood or inadequately treated. First-line treatment should always include local treatments. In severe cases as assessed by clinical appearance or impact on quality of life, initiation of systemic treatments should not be delayed.Archives de pediatrie : organe officiel de la Societe francaise de pediatrie. 06/2014;
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ABSTRACT: Psoriasis is a chronic inflammatory cutaneous disorder affecting 2%-4% of the world's population. The prevalence of the disease in childhood and adolescence ranges between 0.5% and 2%. The management of psoriasis in adolescence is an intriguing and complicated task. Given the paucity of officially approved therapies, the very limited evidence-based data from randomized controlled trials, and the absence of standardized guidelines, physicians must rely on published experience from case reports both from the field of dermatology as well as from the application of these drugs for other pediatric conditions coming from the disciplines of rheumatology, gastroenterology, and oncology. Psoriatic adolescents deal with a potentially disfiguring and lifelong disease that could permanently impair their psychological development. It must be clarified to them that psoriasis does not have a permanent cure, and therefore the main goal of treatments is to establish disease control and prolonged periods between flares. The majority of adolescents suffer from mild psoriasis, and thus they are treated basically with topical treatment modalities. Phototherapy is reserved for adolescents with mild-to-moderate plaque disease and/or guttate psoriasis when routine visits to specialized centers do not create practical problems. Systemic agents and biologics are administered to patients with moderate-to-severe plaque psoriasis, pustular psoriasis, or erythrodermic psoriasis.Adolescent Health, Medicine and Therapeutics 01/2014; 5:25-34.