Refractory Pediatric Psoriasis and Atopic Dermatitis: The Importance of Therapeutical Adherence and Biological Management

Abstract

The rates of refractory pediatric psoriasis and atopic dermatitis (AD) have steadily risen over the last few decades, demanding newer and more effective therapies. This review aims to explore the reasons for resistant disease, as well as its management; this includes the indications for, efficacy of, and safety of current therapies for refractory pediatric dermatologic disease. A PubMed search for key phrases was performed. Poor medication adherence is the most common cause of resistant disease and may be managed with techniques such as simplified treatment regimens, more follow-ups and educational workshops, as well as framing and tailoring. Once problems with adherence are ruled out, escalating treatment to stronger biologic therapy may be indicated. Development of anti-drug antibodies (ADAs) can cause patients’ disease to be refractory in the presence of potent biologics, which may be addressed with regular medication use or concomitant methotrexate. If patients with AD fail to respond to biologic therapy, a biopsy to rule out mycosis fungoides, or patch testing to rule out allergic contact dermatitis, may be indicated. A limitation of this study is the absence of more techniques for the management of poor medication adherence. Managing medication adherence, escalating treatment when appropriate, and addressing possible anti-drug antibodies will help assure control and relief for patients with resistant disease.

Recent insights into the management of treatment-resistant pediatric atopic dermatitis

“…Considering all treatment options and scenarios mentioned above, a review of the literature has identified the following guidelines and strategies to successfully manage treatment-resistant or refractory cases of AD in pediatric patients. 6,9,77,78 (Fig. 2).…”

Biologic treatment in atopic dermatitis: Can the interaction between hospitals and local dermatologists improve treatment compliance?

“…Despite their efficacy and safety, in France, the current initial prescription (the first biological therapy) and annual hospital renewal policy may impact patient adherence, especially that of patients who have difficulties accessing hospital services. Apart from one study which assessed the importance of therapeutical adherence and biological management in paediatric patients with psoriasis or AD, we have not found any investigation or research on this subject in existing literature for AD 3 …”