Biological Treatments for Pediatric Psoriasis: State of the Art and Future Perspectives

Abstract

Psoriasis is a chronic systemic inflammatory disease that primarily affects the skin and is associated with multiple comorbidities with a considerable reduction in quality of life of affected patients. One-third of psoriasis cases begin in childhood and are associated with significant medical comorbidities such as obesity, metabolic syndrome, arthritis, and psychiatric disorders. In addition, because of its chronic nature and frequent relapses, psoriasis tends to require long-term treatment. Treatment of pediatric psoriasis usually involves the same methods used for adults. However, most treatments for pediatric psoriasis are used off-label, and research in this regard is still lacking. Targeted therapies involving the use of newly developed biologic drugs are also increasingly being applied to childhood psoriasis. This review summarizes the clinical features of pediatric psoriasis and focuses mainly on the updated concepts of pathogenesis and biological treatments of pediatric psoriasis.

Secukinumab for the Treatment of Psoriasis in Pediatrics: Patient Selection and Acceptability

“… 4 , 5 The most common variant of psoriasis, plaque psoriasis is characterized by red plaques covered with silver or white scales localized mainly around elbows, knees, scalp and trunk. 6 Psoriasis may also affect nails and scalp. In one-third of patients, the first symptoms of PsO manifest in childhood, with a mean age of nine years.…”

“… 8–12 Triggering factors in children psoriasis slightly differ from adults and include trauma, stress and bacterial infections. 6 …”

“…Therapy, mainly due to the necessity of treating children off-label, may be more challenging. 6 , 26 Treatment for psoriasis consists of a range of topical medications, phototherapy, non-biologic and biologic systemic therapies. Topical treatment of PsO is mostly based on corticosteroids, calcineurin inhibitors, and vitamin D3 analogues.…”

“…Combination of topical medications, including also topical tazarotene, anthralin and coal tar, which are still available in some countries, may be also an option. 6 , 19 Another treatment used in pediatric psoriasis is narrow band-UVB therapy (NB-UVB). The course of NB-UVB includes around 30 short sessions of exposure to the UV wavelength of 311–313 nm and is considered safe and effective.…”

“…Depending on the country, there may be different approvals for biological treatment in children, however it is the first group of medications with clinical trials and registrations in this group of patients. 6 , 31 The availability of biological treatment in many countries may still be limited to referential medical facilities which in consequence reduces its accessibility for pediatric patients. Approved biologics for PsO in pediatric patients (depending on the country and medical agency) are etanercept, adalimumab, ustekinumab, ixekizumab and secukinumab ( Table 2 ).…”