Management of psoriasis in children (Review)

Abstract

Psoriasis is a common long-lasting, inflammatory disease that mainly affects the skin. The incidence of this condition has increased significantly over time and at this point, it affects approximately 1% of children. Psoriasis can appear at any age, including childhood and adolescence, with a higher frequency in girls, an earlier onset being associated with severe psoriasis. The pathology is the result of the interaction between genetics and trigger factors such as infections, stress, diet, obesity, and chemical irritants. Paradoxically, tumor necrosis factor (TNF)-α inhibitors (infliximab, adalimumab) may induce psoriasis in children. Psoriasis is a long-term condition with periods of exacerbation; thus, the quality of life can be affected and patients should receive psychosocial support. Although most children have mild disease and topical treatment is efficient, some cases are challenging to treat. The aim of this review was to provide an overview of the current knowledge concerning the epidemiology, etiology, pathogenesis, clinical features, comorbidities, and treatment of psoriasis in children and also to emphasize the need for a multidisciplinary approach to this complex pathology.

Pediatric psoriasis: Understanding pathological conditions and advances in treatment

“…7 Immunological factors include interactions between various kinds of immune cells, such as T-helper cell 1 (Th1), Th17, Th22, mast cells, and neutrophils, and abnormal expression of cytokines. 6 One review reported that the onset of psoriasis primarily involves the cytokines such as interferon (IFN)-γ, tumor necrosis factor (TNF)-α, and interleukin (IL)-17, IL-22, and IL-23 and that an imbalance between effector T cells, such as Th-17, and regulatory T cells plays a role in the etiology of psoriasis. 7,18 Moreover, the onset of psoriasis may involve LL-37, an antimicrobial peptide that activates plasmacytoid dendritic cells and keratinocytes, leading to the production of various inflammatory cytokines.…”

“…The onset of pediatric psoriasis involves various factors, including the stress associated with starting school, separation from parents, mechanical trauma, and infection 7 . Immunological factors include interactions between various kinds of immune cells, such as T‐helper cell 1 (Th1), Th17, Th22, mast cells, and neutrophils, and abnormal expression of cytokines 6 . One review reported that the onset of psoriasis primarily involves the cytokines such as interferon (IFN)‐γ, tumor necrosis factor (TNF)‐α, and interleukin (IL)‐17, IL‐22, and IL‐23 and that an imbalance between effector T cells, such as Th‐17, and regulatory T cells plays a role in the etiology of psoriasis 7,18 .…”

“…In addition, patients with psoriasis are likely to have various comorbidities. 6 The prevalence of comorbidities in patients with psoriasis younger than 20 years old (14.4%) is nearly twice that of children without psoriasis (7.2%), including those with hyperlipidemia, hypertension, diabetes mellitus, rheumatoid arthritis, and Crohn's disease. 7 Additionally, long-term comorbidities associated with psoriasis may place a great burden on the physical and mental health of children with psoriasis beyond the effects of psoriasis itself.…”

Administration Details of Genetically Engineered Biologic Drug (Ustekinumab) in Children with Psoriasis and Comorbid Metabolic Syndrome or in Case of Previous Biological Therapy Failure: Case Studies

“…Распространенность псориаза в детской популяции составляет 0,7% и линейно увеличивается с возрастомот 0,2% в возрасте до 1 года и до 2,5% в возрасте 18 лет [7,8]. За последние 50 лет показатель заболеваемости псориазом детей увеличился более чем вдвое [9,10]. Вместе с этим установлено, что ранняя манифестация псориаза связана с более тяжелым течением болезни, высоким риском развития коморбидных патологий (инсулинорезистентность, сахарный диабет 2-го типа, эндотелиальная дисфункция, артрит), в том числе сердечно-сосудистых заболеваний, особенно при наличии отягощенного семейного анамнеза [2,10].…”

Manifestation of anxiety and depression among pediatric patients with psoriasis: A review

“…Psoriasis is a chronic, papulosquamous, inflammatory skin disease that presents with abnormal hyperproliferation of the epidermis, morphologically resulting in well‐demarcated, scaly pink‐colored plaques in white skin and hyperpigmented, brownish‐gray plaques in the skin of color 1,2 . Though any skin surface may be involved, psoriatic plaques most often occur on the scalp and extensor aspects of knees and elbows with characteristic bilateral symmetry 1 .…”