Update on the Management of Pediatric Psoriasis: An Italian Consensus.

Adolescents Biologics Children Corticosteroid-sparing Health-related quality of life Pediatric psoriasis Plaque psoriasis Systemic therapy Topical corticosteroids

Journal

Dermatology and therapy

ISSN: 2193-8210

Titre abrégé: Dermatol Ther (Heidelb)

Pays: Switzerland

ID NLM: 101590450

Informations de publication

Date de publication:
Aug 2022

Historique:

received: 29 04 2022

accepted: 08 06 2022

pubmed: 2 7 2022

medline: 2 7 2022

entrez: 1 7 2022

Statut: ppublish

Résumé

Psoriasis affects children with a considerable burden in early life. Treating pediatric psoriasis is challenging also because of the lack of updated specific guidelines. With the recent approval of several biologics for pediatric psoriasis and the ongoing COVID-19 pandemic, the management of young psoriatic patients is facing major changes. A revision of treatment recommendations is therefore needed. In September 2021, a board of six Italian dermatologists convened to update treatment recommendations. The board issued evidence- and consensus-based statements covering relevant areas of pediatric psoriasis, namely: assessment of psoriasis severity, management of children with psoriasis, and treatment of pediatric psoriasis. To reach consensus, the statements were submitted to a panel of 24 experts in a Delphi process performed entirely via videoconference. A treatment algorithm was produced. There was full consensus that psoriasis severity is determined by the extension/severity of skin lesions, site of lesions, and impact on patient quality of life. Agreement was reached on the need for a multidisciplinary approach to pediatric psoriasis and the importance of patient/parents education. The relevance of vaccinations, including COVID-19 vaccination, for psoriatic children was acknowledged by all participants. Management issues that initially failed to reach consensus included the screening for psoriasis comorbidities and early treatment with biologics to prevent them and the use of telemedicine to facilitate patient follow-up. There was full consensus that topical corticosteroids are the first choice for the treatment of mild pediatric psoriasis, while phototherapy and systemic therapy are used in children with moderate-severe psoriasis. According to the proposed treatment algorithm, biologics are the first line of systemic therapy. Targeted systemic therapies are changing the treatment of moderate-severe pediatric psoriasis, while topical corticosteroids continue to be the first choice for mild disease. Children-centered research is needed to further improve the treatment of pediatric psoriasis.

Identifiants

DOI: 10.1007/s13555-022-00758-2 PMID: 35776408 PMC: PMC9247936

pubmed: 35776408

doi: 10.1007/s13555-022-00758-2

pii: 10.1007/s13555-022-00758-2

pmc: PMC9247936

doi:

Types de publication

Journal Article

Langues

eng

Pagination

1753-1775

Informations de copyright

Références

Megna M, Napolitano M, Balato A, et al. Psoriasis in children: a review. Curr Pediatr Rev. 2015;11(1):10–26.

doi: 10.2174/1573400511666150504125456

Griffiths CEM, Armstrong AW, Gudjonsson JE, Barker JNWN. Psoriasis. Lancet. 2021;397(10281):1301–15.

pubmed: 33812489 doi: 10.1016/S0140-6736(20)32549-6

Bronckers IMGJ, Paller AS, van Geel MJ, van de Kerkhof PCM, Seyger MMB. Psoriasis in children and adolescents: diagnosis, management and comorbidities. Pediatr Drugs. 2015;17:373–84.

doi: 10.1007/s40272-015-0137-1

Gelfand JM, Weinstein R, Porter SB, Neimann AL, Berlin JA, Margolis DJ. Prevalence and treatment of psoriasis in the United Kingdom: a population-based study. Arch Dermatol. 2005;141(12):1537–41.

pubmed: 16365254 doi: 10.1001/archderm.141.12.1537

De Jager MEA, van de Kerkhof PCM, De Jong EMGJ, Seyger MMB. Epidemiology and prescribed treatments in childhood psoriasis: a survey among medical professionals. J Dermatol Treat. 2009;20(5):254–8.

doi: 10.1080/09546630902911847

Augustin M, Glaeske G, Radtke MA, Christophers E, Reich K, Schafer I. Epidemiology and comorbidity of psoriasis in children. Br J Dermatol. 2010;162(3):633–6.

pubmed: 19922529 doi: 10.1111/j.1365-2133.2009.09593.x

Augustin M, Radtke MA, Glaeske G, et al. Epidemiology and comorbidity in children with psoriasis and atopic eczema. Dermatology. 2015;231(1):35–40.

pubmed: 25966818 doi: 10.1159/000381913

Eisert L, Augustin M, Bach S, et al. S2k guidelines for the treatment of psoriasis in children and adolescents—short version part 1. J Dtsch Dermatol Ges. 2019;17(8):856–70.

pubmed: 31437372

Morris A, Rogers M, Fischer G, Williams K. Childhood psoriasis: a clinical review of 1262 cases. Pediatr Dermatol. 2001;18(3):188–98.

pubmed: 11437997 doi: 10.1046/j.1525-1470.2001.018003188.x

Osier E, Wang AS, Tollefson MM, et al. Pediatric psoriasis comorbidity screening guidelines. JAMA Dermatol. 2017;153(7):698–704.

pubmed: 28514463 pmcid: 5748031 doi: 10.1001/jamadermatol.2017.0499

Todberg T, Egeberg A, Jensen P, Gislason G, Skov L. Psychiatric comorbidities in children and adolescents with psoriasis: a population-based cohort study. Br J Dermatol. 2017;177(2):551–3.

pubmed: 27681652 doi: 10.1111/bjd.15095

Paller AS, Schenfeld J, Accortt NA, Kricorian G. A retrospective cohort study to evaluate the development of comorbidities, including psychiatric comorbidities, among a pediatric psoriasis population. Pediatric Dermatol. 2019;36:290–7.

doi: 10.1111/pde.13772

Edson-Heredia E, Anderson S, Guo J, et al. Real-world claims analysis of comorbidity burden, treatment pattern, healthcare resource utilization, and costs in pediatric psoriasis. Adv Ther. 2021;38(7):3948–61.

pubmed: 34091866 doi: 10.1007/s12325-021-01795-7

de Jager ME, De Jong EM, Evers AW, Van De Kerkhof PC, Seyger MM. The burden of childhood psoriasis. Pediatr Dermatol. 2011;28(6):736–7.

pubmed: 21692835 doi: 10.1111/j.1525-1470.2011.01489.x

Na CH, Chung J, Simpson EL. Quality of life and disease impact of atopic dermatitis and psoriasis on children and their families. Children. 2019;6:133.

pmcid: 6955769 doi: 10.3390/children6120133

Varni JW, Globe DR, Gandra SR, Harrison DJ, Hooper M, Baumgartner S. Health-related quality of life of pediatric patients with moderate to severe plaque psoriasis: comparisons to four common chronic diseases. Eur J Pediatr. 2012;171(3):485–92.

pubmed: 21960290 doi: 10.1007/s00431-011-1587-2

Tollefson MM, Finnie DM, Schoch JJ, Eton DT. Impact of childhood psoriasis on parents of affected children. J Am Acad Dermatol. 2017;76(2):286–9.

pubmed: 27865579 doi: 10.1016/j.jaad.2016.09.014

Napolitano M, Megna M, Balato A, et al. Systemic treatment of pediatric psoriasis: a review. Dermatol Ther. 2016;6:125–42.

doi: 10.1007/s13555-016-0117-6

Belloni Fortina A, Bardazzi F, Berti S, et al. Treatment of severe psoriasis in children: recommendations of an Italian expert group. Eur J Pediatr. 2017;176(10):1339–54.

doi: 10.1007/s00431-017-2985-x

Eisert L, Augustin M, Bach S, et al. S2k guidelines for the treatment of psoriasis in children and adolescents—short version part 2. J Dtsch Dermatol Ges. 2019;17(9):959–74.

pubmed: 31538739

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;82:161–201.

pubmed: 31703821 doi: 10.1016/j.jaad.2019.08.049

Hasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs. 2000;32(4):1008–15.

pubmed: 11095242

Richards H, Fortune D, Griffiths C, Main C. The contribution of perceptions of stigmatisation to disability in patients with psoriasis. J Psychosom Res. 2001;50:11–5.

pubmed: 11259795 doi: 10.1016/S0022-3999(00)00210-5

Caroppo F, Zacchino M, Milazzo E, et al. Quality of life in children with psoriasis: results from a monocentric study. Ital J Dermatol Venerol. 2021;156(3):374–7.

pubmed: 31797650

Lewis-Jones MS, Finlay AY. The Children’s Dermatology Life Quality Index (CDLQI): initial validation and practical use. Br J Dermatol. 1995;132(6):942–9.

pubmed: 7662573 doi: 10.1111/j.1365-2133.1995.tb16953.x

de Jager ME, van de Kerkhof PC, de Jong EM, Seyger MM. A cross- sectional study using the Children’s Dermatology Life Quality Index (CDLQI) in childhood psoriasis: negative effect on quality of life and moderate correlation of CDLQI with severity scores. Br J Dermatol. 2010;163(5):1099–101.

pubmed: 20716218 doi: 10.1111/j.1365-2133.2010.09993.x

Holme SA, Man I, Sharpe JL, Dykes PJ, Lewis-Jones MS, Finlay AY. The Children’s Dermatology Life Quality Index: validation of the cartoon version. Br J Dermatol. 2003;148(2):285–90.

pubmed: 12588381 doi: 10.1046/j.1365-2133.2003.05157.x

Slattery MJ, Essex MJ, Paletz EM, et al. Depression, anxiety, and dermatologic quality of life in adolescents with atopic dermatitis. J Allergy Clin Immunol. 2011;128(3):668–71.

pubmed: 21684588 pmcid: 3164894 doi: 10.1016/j.jaci.2011.05.003

Salek MS, Jung S, Brincat-Ruffini LA, et al. Clinical experience and psychometric properties of the Children’s Dermatology Life Quality Index (CDLQI), 1995–2012. Br J Dermatol. 2013;169(4):734–59.

pubmed: 23679682 doi: 10.1111/bjd.12437

Mrowietz U, Kragballe K, Reich K, et al. Definition of treatment goals for moderate to severe psoriasis: a European consensus. Arch Dermatol Res. 2011;303:1–10.

pubmed: 20857129 doi: 10.1007/s00403-010-1080-1

Girolomoni G, Griffiths CEM, Krueger J, et al. Early intervention in psoriasis and immune-mediated inflammatory diseases: a hypothesis paper. J Dermatol Treat. 2015;26(2):103–12.

doi: 10.3109/09546634.2014.880396

Korman NJ. Management of psoriasis as a systemic disease: what is the evidence? Br J Dermatol. 2020;182:840–8.

pubmed: 31225638 doi: 10.1111/bjd.18245

McInnes IB, Sieper J, Braun J, et al. Efficacy and safety of secukinumab, a fully human anti-interleukin-17A monoclonal antibody, in patients with moderate-to-severe psoriatic arthritis: a 24-week, randomised, double-blind, placebo-controlled, phase II proof of concept trial. Ann Rheum Dis. 2014;73:349–56.

pubmed: 23361084 doi: 10.1136/annrheumdis-2012-202646

Kampylafka E, Simon D, d’Oliveira I, et al. Disease interception with interleukin-17 inhibition in high-risk psoriasis patients with subclinical joint inflammation—data from the prospective IVEPSA study. Arthritis Res Ther. 2019;21(1):178.

pubmed: 31349876 pmcid: 6659205 doi: 10.1186/s13075-019-1957-0

Savage L, Goodfield M, Horton L, et al. Regression of peripheral subclinical enthesopathy in therapy-naïve patients treated with ustekinumab for moderate-to-severe chronic plaque psoriasis: a fifty-two-week prospective, open-label feasibility study. Arthritis Rheumatol. 2019;71(4):626–31.

pubmed: 30468001 doi: 10.1002/art.40778

Van Geel MJ, Spillekom-Van Kouli S, Oostveen AM, et al. An outpatient multidisciplinary training programme for children and adolescents with psoriasis and their parents: a pilot study. Eur J Dermatol. 2016;26(4):393–5.

pubmed: 27099228 doi: 10.1684/ejd.2016.2785

Staub D, Diepgen L, Fartasch M, et al. Age related, structured educational programmes for the management of atopic dermatitis in children and adolescents: multicentre, randomized controlled trial. BMJ. 2006;332:933–8.

doi: 10.1136/bmj.332.7547.933

Williams HC. Educational programmes for young people with eczema. One size does not fit all. BMJ. 2006;332:923–4.

pubmed: 16627489 pmcid: 1444879 doi: 10.1136/bmj.332.7547.923

Ricci G, Bendandi B, Aiazzi R, Patrizi A, Masi M. Three years of Italian experience of an educational program for parents of young children affected by atopic dermatitis: improving knowledge produces lower anxiety levels in parents of children with atopic dermatitis. Pediatr Dermatol. 2009;26(1):1–5.

pubmed: 19250397 doi: 10.1111/j.1525-1470.2008.00813.x

Barbarot S, Bernier S, Deleuran M, et al. Oriented patient-education network in dermatology. Therapeutic patient education in children with atopic dermatitis: position paper on objectives and recommendations. Pediatr Dermatol. 2013;30(2):199–206.

pubmed: 23461685 doi: 10.1111/pde.12045

Oostveen AM, Spillekom-van Koulil S, Otero ME, Klompmaker W, Evers AWM, Seyger MMB. Development and design of a multidisciplinary training program for outpatient children and adolescents with psoriasis and their parents. J Dermatol Treat. 2013;24(1):60–3.

doi: 10.3109/09546634.2012.672707

Wack S, Patton T, Ferris L. COVID-19 vaccine safety and efficacy in patients with immune-mediated inflammatory disease: review of available evidence. J Am Acad Dermatol. 2021;85:1274–84.

pubmed: 34363909 pmcid: 8336973 doi: 10.1016/j.jaad.2021.07.054

Beer J, Hadeler E, Calume A, Gitlow H, Nouri K. Teledermatology: current indications and considerations for future use. Arch Dermatol Res. 2021;313(1):11–5.

pubmed: 33074356 doi: 10.1007/s00403-020-02145-3

Ministero della Salute. Indicazioni Nazionali per l’erogazione di prestazioni di telemedicina. 27 Oct 2020. Versione 4.4. https://www.quotidianosanita.it/allegati/allegato2602365.pdf . Accessed Mar 2022.

Armstrong AW, Chambers CJ, Maverakis E, et al. Effectiveness of online vs in-person care for adults with psoriasis. A randomized clinical trial. JAMA Netw Open. 2018;1(6):e183062.

pubmed: 30646223 pmcid: 6324453 doi: 10.1001/jamanetworkopen.2018.3062

Armstrong AW, Ford AR, Chambers CJ, et al. Online care versus in-person care for improving quality of life in psoriasis: a randomized controlled equivalency trial. J Investig Dermatol. 2019;139(5):1037–44.

pubmed: 30481495 doi: 10.1016/j.jid.2018.09.039

Dahy A, El-Qushavri AE, Mahmoud AR, Mahmoud AR, Al-Kelany TA, Salman S. Telemedicine approach for psoriasis management, time for application? A systematic review of published studies. Dermatol Ther. 2020;33(6): e13908.

pubmed: 32592525 doi: 10.1111/dth.13908

Gisondi P, Bellinato F, Piaserico S, Di Leo S, Cazzaniga S, Naldi L. Preference for telemedicine versus in-person visit among patients with psoriasis receiving biological drugs. Dermatol Ther. 2021;11:1333–43.

doi: 10.1007/s13555-021-00555-3

Beytout Q, Pepiot J, Maruani A, et al. Impact of the COVID-19 pandemic on children with psoriasis. Ann Dermatolog Vénérélog. 2021;148:106–11.

doi: 10.1016/j.annder.2021.01.005

Herz G, Blum G, Yawalkar S. Halobetasol propionate cream by day and halobetasol propionate ointment at night for the treatment of pediatric patients with chronic, localized plaque psoriasis and atopic dermatitis. J Am Acad Dermatol. 1991;25(6 Pt 2):1166–9.

pubmed: 1757611 doi: 10.1016/0190-9622(91)70319-W

Frangos JE, Kimball AB. Clobetasol propionate emollient formulation foam in the treatment of corticosteroid-responsive dermatoses. Expert Opin Pharmacother. 2008;9(11):2001–7.

pubmed: 18627337 doi: 10.1517/14656566.9.11.2001

Hengge UR, Ruzicka T, Schwartz RA, Cork MJ. Adverse effects of topical glucocorticoids. J Am Acad Dermatol. 2006;54(1):1–15.

pubmed: 16384751 doi: 10.1016/j.jaad.2005.01.010

Di Lernia V, Neri I. Clobetasol, acitretin, and Cushing’s syndrome. Pediatr Dermatol. 2017;34(2):221.

pubmed: 28297151 doi: 10.1111/pde.13042

de Jager ME, de Jong EM, van de Kerkhof PC, Seyger MM. Efficacy and safety of treatments for childhood psoriasis: a systematic literature review. J Am Acad Dermatol. 2010;62(6):1013–30.

pubmed: 19900732 doi: 10.1016/j.jaad.2009.06.048

Eichenfield LF, Ganslandt C, Kurvits M, Schlessinger J. Safety and efficacy of calcipotriene plus betamethasone dipropionate topical suspension in the treatment of extensive scalp psoriasis in adolescents ages 12 to 17 years. Pediatr Dermatol. 2015;32(1):28–35.

pubmed: 25412565 doi: 10.1111/pde.12429

Brune A, Miller DW, Lin P, Cotrim-Russi D, Paller AS. Tacrolimus ointment is effective for psoriasis on the face and intertriginous areas in pediatric patients. Pediatr Dermatol. 2007;24:76–80.

pubmed: 17300658 doi: 10.1111/j.1525-1470.2007.00341.x

Steele JA, Choi C, Kwong PC. Topical tacrolimus in the treatment of inverse psoriasis in children. J Am Acad Dermatol. 2005;53:713–6.

pubmed: 16198804 doi: 10.1016/j.jaad.2005.05.036

Ersoy-Evans S, Altaykan A, Sahin S, Kolemen F. Phototherapy in childhood. Pediatr Dermatol. 2008;25(6):599–605.

pubmed: 19067863 doi: 10.1111/j.1525-1470.2008.00773.x

Pavlovsky M, Baum S, Shpiro D, Pavlovsky L, Pavlotsky F. Narrow band UVB: is it effective and safe for paediatric psoriasis and atopic dermatitis? J Eur Acad Dermatol Venereol. 2011;25(6):727–9.

pubmed: 20726938 doi: 10.1111/j.1468-3083.2010.03832.x

Seccombe E, Wynne MD, Clancy C, Godfrey KM, Fityan A. A retrospective review of phototherapy in children, at a tertiary paediatric unit. Photodermatol Photoimmunol Photomed. 2021;37(1):34–8.

pubmed: 32860720 doi: 10.1111/phpp.12604

Jain VK, Bansal A, Aggarwal K, Jain K. Enhanced response of childhood psoriasis to narrow-band UV-B phototherapy with preirradiation use of mineral oil. Pediatr Dermatol. 2008;25(5):559–64.

pubmed: 18950402 doi: 10.1111/j.1525-1470.2008.00729.x

Paller AS, Siegfried EC, Langley RG, et al. Etanercept treatment for children and adolescents with plaque psoriasis. N Engl J Med. 2008;358(3):241–51.

pubmed: 18199863 doi: 10.1056/NEJMoa066886

Paller AS, Siegfried EC, Pariser DM, et al. Long-term safety and efficacy of etanercept in children and adolescents with plaque psoriasis. J Am Acad Dermatol. 2016;74(2):280–7.

pubmed: 26775775 doi: 10.1016/j.jaad.2015.09.056

Papp K, Thaci D, Marcoux D, et al. Efficacy and safety of adalimumab every other week versus methotrexate once weekly in children and adolescents with severe chronic plaque psoriasis: a randomised, double-blind, phase 3 trial. Lancet. 2017;390(10089):40–9.

pubmed: 28478975 doi: 10.1016/S0140-6736(17)31189-3

Landells I, Marano C, Hsu MC, et al. Ustekinumab in adolescent patients age 12 to 17 years with moderate-to-severe plaque psoriasis: results of the randomized phase 3 CADMUS study. J Am Acad Dermatol. 2015;73(4):594–603.

pubmed: 26259989 doi: 10.1016/j.jaad.2015.07.002

Thaci D, Papp K, Marcoux D, et al. Sustained long-term efficacy and safety of adalimumab in paediatric patients with severe chronic plaque psoriasis from a randomized, double-blind, phase III study. Br J Dermatol. 2019;181:1177–89.

pubmed: 31017657 pmcid: 6916374 doi: 10.1111/bjd.18029

Paller AS, Seyger MMB, Alejandro Magarinos G, et al. Efficacy and safety of ixekizumab in a phase III, randomized, double-blind, placebo-controlled study in paediatric patients with moderate-to-severe plaque psoriasis (IXORA-PEDS). Br J Dermatol. 2020;183:231–41.

pubmed: 32316070 pmcid: 7496501 doi: 10.1111/bjd.19147

Bodemer C, Kaszuba A, Kingo K, et al. Secukinumab demonstrates high efficacy and a favourable safety profile in paediatric patients with severe chronic plaque psoriasis: 52-week results from a phase 3 double-blind randomized, controlled trial. JEADV. 2021;35:938–47.

pubmed: 33068444

Di Lernia V, Stingeni L, Boccaletti V, et al. Effectiveness and safety of cyclosporine in pediatric plaque psoriasis: a multicentric retrospective analysis. J Dermatol Treat. 2016;27(5):395–8.

doi: 10.3109/09546634.2015.1120852

Di Lernia V, Bonamonte D, Lasagni C, et al. Effectiveness and safety of acitretin in children with plaque psoriasis: a multicenter retrospective analysis. Pediatr Dermatol. 2016;33(5):530–5.

pubmed: 27443789 doi: 10.1111/pde.12940

Thatiparthi A, Martin A, Liu J, Egeberg A, Wu JJ. Biologic treatment algorithms for moderate-to-severe psoriasis with comorbid conditions and special populations: a review. Am J Clin Dermatol. 2021;22(4):425–42.

pubmed: 33861409 pmcid: 8051287 doi: 10.1007/s40257-021-00603-w

FDA label of combination calcipotriol-betamethasone dipropionate (Enstilar

Adalimumab. EMA summary of product characteristics. https://www.ema.europa.eu/en/documents/product-information/humira-epar-product-information_en.pdf . Accessed Mar 2022.

Ixekizumab. EMA summary of product characteristics. https://www.ema.europa.eu/en/documents/product-information/taltz-epar-product-information_en.pdf . Accessed Mar 2022.

Secukinumab. EMA summary of product characteristics. https://www.ema.europa.eu/en/documents/product-information/cosentyx-epar-product-information_en.pdf . Accessed Mar 2022.

Etanercept. EMA summary of product characteristics. https://www.ema.europa.eu/en/documents/product-information/enbrel-epar-product-information_en.pdf . Accessed Mar 2022.

Ustekinumab. EMA summary of product characteristics. https://www.ema.europa.eu/en/documents/product-information/stelara-epar-product-information_en.pdf . Accessed Mar 2022.