Cyclosporin A treatment in severe childhood psoriasis

Abstract

Though used occasionally, systemic therapies in severe childhood psoriasis have not been systematically investigated. Cyclosporin A (CysA) is effective in adults with severe psoriasis but there are no extensive data regarding the efficacy and safety of its use in childhood psoriasis. In this paper, we describe six children aged between 11 months and 13 years (average: 7.6 years) treated with CysA microemulsion formulation for severe psoriasis, who had been unresponsive to other treatments. The CysA dose ranged from 2 to 4 mg/kg/day, for periods varying from 8 to 105 weeks (mean: 54 weeks). Dose tapering was gradual after lesion improvement and adjusted according to clinical response. Adjuvant therapy with topical steroids, vitamin D3 ointments, coal tar preparations or anthralin was used in all children. Acitretin was used in three patients for short periods. The children were regularly monitored for serum renal and liver function and blood pressure. Improvement of skin lesions was achieved after between 4 and 30 (mean: 12) weeks of treatment, with complete remission in three children. Relapse of lesions occurred in the other children during CysA reduction, but they responded to a dose increase. The treatment was found to be well tolerated and with no significant side-effects. CysA can be used in carefully selected and monitored patients and may represent an alternative tool for severe episodes of psoriasis in children, when other therapies are unsuccessful.

Efficacy and safety of treatments for childhood psoriasis: A systematic literature review

“…Three case series [78][79][80] and 6 case reports 81-86 were identified. Five studies were excluded because of the use of antipsoriatic combination therapies.…”

“…Five studies were excluded because of the use of antipsoriatic combination therapies. 80,[83][84][85][86] Of the remaining 4 articles, two were classified as LOE 4 78,79 and two were classified as LOE 5. 81,82 A case series of 3 patients with pustular psoriasis was described in which the administered dose was 1 to 2 mg/kg/d.…”

Kinder und Jugendliche mit Psoriasis

“…Einerseits setzen die pädiatri-schen Rheumatologen bereits seit vielen Jahren und mit gutem Erfolg und Verträglichkeit Methotrexat in der Therapie der juvenilen idiopathischen Arthritis, also auch der juvenilen psoriatischen Arthritis ein [14,22]. Der Einsatz von Ciclosporin ist bei der Organtransplantation im Kindesalter gut bekannt und unter dieser Indikation vergleichsweise unproblematisch [25,31,36]. Ebenso liegen Daten verschiedener kleinerer Studien und Fallserien zum Einsatz von Retinoiden bei kindlichen Psoriasisformen vor, die sogar eine eher bessere Verträglichkeit des Präparates verglichen mit Erwachsenen belegen [1,6,16,28].…”

“…Die initial erforderlichen Laborkontrollen von Blutbild, Leber-und Nierenparameter in 2-, dann 4-wöchentli-chen Abständen sind sicherlich gerade für Kinder einschränkend und daher häufig therapielimitierend. Ciclosporin wird je nach Schwere des Krankheitsbildes zwischen 2,5 und 5 mg/kg KG appliziert und erfordert ebenfalls initial kurzfristige Laborkontrollen, insbesondere von Nierenparametern sowie Kontrolle des Blutdruckes [25,31,36]. Das allgemein empfohlene Dosierungsschema für Fumarsäurees-ter sollte an die individuelle Verträglich-keit angepasst werden.…”

Prise en charge du psoriasis de l’enfant

“…La dose initiale recommandée chez l'enfant est de 3 à 4 mg/kg par jour en ne dépassant pas 5 mg/kg par jour. Les traitements topiques sont poursuivis en association [68]. Ce traitement fait partie des traitements de première ligne du psoriasis pustuleux avec une rapidité et efficacité démontrées sur plusieurs cas [32].…”