Management of childhood psoriasis in France. A national survey among general practitioners, pediatricians, and dermatologists

Abstract

Psoriasis affects 0.5-2% of children. Severe forms required use of systemic treatments. Few studies are published on efficiency and tolerance of systemic treatments in children. We conducted a survey in France to better understand management of children with psoriasis. A survey on childhood psoriasis management was sent by e-mail to GPs, pediatricians, and dermatologists. The survey included 384 physicians. Respectively 53.1%, 49.8%, and 83.3% of GPs, pediatricians, and dermatologists declare to have seen at least one child with psoriasis during the 3 previous months. Less than 5% of GPs and pediatricians used severity score versus 23.7% of dermatologists. If most of physicians declare to use local treatments, less than 5% of GPs and pediatricians used systemic treatments. 32.4% of dermatologists declared to use at least one systemic treatment, but only 2.9% to use the 4 systemic treatments available in France. This survey shows that only half of GPs and pediatricians see children with psoriasis, but most of dermatologists. However, the management of severe forms seems limited by the underuse of severity scores and systemic treatments. These results should stimulate dermatology societies to promote prospective studies and guidelines in young populations with psoriasis.

Patient Characteristics and Treatment Patterns in European Pediatric Patients with Psoriasis: A Real-World, Cross-Sectional Study

“…In the study by Bronckers et al [43], 20% of patients were treated exclusively with biologics, while 10% received methotrexate and biologics sequentially. The previously mentioned survey of French physicians found that 5.2% had prescribed etanercept to their pediatric patients with psoriasis, similar to the 7.9% in France in our study [41], while the survey of German pediatricians mentioned above found that none had prescribed a biologic in children with psoriasis, even in those with severe disease [40]. By comparison, 8.7% of patients prescribed a biologic in Germany had received their prescription from a pediatrician in our study.…”

“…In this survey, 53% of German pediatricians would prescribe topical treatment for confirmed psoriasis and 10% would recommend conventional systemics. Similarly, a survey of 384 French physicians (PCPs, pediatricians, and dermatologists) showed that topical corticosteroids were the most prescribed agents (by 88% of physicians) for children with psoriasis, while the prescribing of systemic treatments was limited [ 41 ]. In our study, the use of topical treatments was greater among lower- than higher-weight patients, possibly reflecting physician reluctance to prescribe systemic treatments in lower-weight patients who are also likely to be younger.…”

“…Likewise, in a French retrospective observational study of biologic drug survival in 134 pediatric patients with psoriasis, factors significantly associated with the choice of first-line biologic were age at onset of psoriasis, age at biologic initiation, PASI, and physician global assessment [ 46 ]. Conversely, a survey of 384 French physicians treating children with psoriasis showed that severity scores were underused, with only 4% of PCPs and pediatricians and 24% of dermatologists reporting the use of severity measures [ 41 ].…”

Topical medications for chronic plaque psoriasis: A 3‐year longitudinal study in France

“…Thus, real‐life information regarding the relative roles of topical treatments, non‐biological systemic treatments and biological therapies within the various countries is useful. Studies have helped to identify that patients with moderate‐to‐severe psoriasis were being undertreated in the US and Belgium, 20,21 as well as differences in prescribing practices between dermatologists and non‐dermatologists 16,22 . Other studies have highlighted suboptimal management of UK patients with psoriasis and under‐use of biologics in Taiwan compared with other countries 17,19 …”

“…Studies have helped to identify that patients with moderate-tosevere psoriasis were being undertreated in the US and Belgium, 20,21 as well as differences in prescribing practices between dermatologists and non-dermatologists. 16,22 Other studies have highlighted suboptimal management of UK patients with psoriasis and under-use of biologics in Taiwan compared with other countries. 17,19 There are real-life data regarding drug survival of biologics, 23,24 but none regarding topical treatments, notably the delay before switching from topical to systemic therapies.…”