Management of Paediatric Psoriasis by Paediatricians: A Questionnaire-Based Survey

Abstract

Introduction Paediatric plaque psoriasis (PedPso) in children and adolescents is often diagnosed and treated for the first time by paediatricians. An early onset of psoriasis is associated with a genetic family burden, higher severity of disease and increased risk of comorbidities, sometimes starting in childhood. However, little information is available on prevalence data and the clinical management of PedPso by paediatricians. Methods A total of 191 questionnaires were sent out to paediatricians regarding their management of PedPso, with a focus on prevalence, diagnosis, initiation of therapies, screening for comorbidities and collaboration with dermatologists. Of these, 95 (49.7%) were returned and evaluated anonymously. Results Only about one-half of the responding paediatricians reported being certain in their diagnosis of PedPso, even though they regularly see moderate-to-severely affected patients. The questionnaire revealed that there are clear differences in the general management of PedPso if the paediatrician is not certain of the diagnosis of psoriasis. Compared to paediatricians certain of their diagnosis, those who are uncertain less frequently perform whole-body inspection, screen for relevant comorbidities, such as psoriasis arthritis, metabolic syndrome or mental disorders, and prescribe the use of topical or systemic therapies. No responding paediatrician reported the use of modern systemic therapies, such as biologicals, even in severely affected children. The majority of respondents rated their cooperation with dermatologists as good. Conclusion The certainty of the diagnosis, the use of system therapies and the screening for comorbidity could improve the care of PedPso through targeted training of paediatricians and intensified interdisciplinary cooperation with dermatologist. Electronic supplementary material The online version of this article (10.1007/s13555-020-00390-y) contains supplementary material, which is available to authorized users.

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.…”

“…The finding that pediatric patients with psoriasis were most likely to be prescribed topical treatments was supported by the results of a survey of 92 German pediatricians who were treating patients with psoriasis [ 40 ]. In this survey, 53% of German pediatricians would prescribe topical treatment for confirmed psoriasis and 10% would recommend conventional systemics.…”

Physician-reported Clinical Unmet Needs, Burden and Treatment Patterns of Paediatric Psoriasis Patients: A US and EU Real-world Evidence Study

“…Dermatologists showed more congruence between their subjective ratings of disease severity and the more objective scores, which could be due to their diseasespecific training and experience with BSA, PASI and PGA assessment tools. Similarly, a recent physician questionnaire reporting that less than half of paediatricians surveyed were certain in their diagnosis of paediatric PsO, and 80% would refer a paediatric PsO patient to a dermatologist (to confirm diagnosis, initiate therapy or continue treatment with a specialist) (24). Previously published studies have also emphasized the need for specialized care for paediatric PsO patients, citing a lack of knowledge and expertise in the management of PsO from GP/PCPs, who often fail in managing PsO as a long-term condition (25)(26)(27).…”