Trends in Pediatric Psoriasis Outpatient Health Care Delivery in the United States

Abstract

Patients: Children with psoriasis ages 0 (birth) to 18 years. Main Outcome Measures: Demographics, physician specialty, and medications prescribed. Results: There were an estimated 3.8 million visits for psoriasis over the study interval with a median of 123 420 visits per year. Dermatologists saw 63% of patients, pediatricians saw 17%, and internists, 14%. The numbers of visits were equal between sexes but ranged by age group: patients ages 13 to 18 years accounted for 47% of visits, those ages 8 to 12 years for 35%, and those ages 0 to 7 for 18%. Ninety-three percent of patients were white. Topical corticosteroids were the most commonly prescribed medications. Children 0 to 9 years old received equally potent corticosteroids as children 10 to 18 years old. Among all patients, the most prescribed medication was topical betamethasone; among those ages 0 to 9 years, tacrolimus; and among those ages 10 to 18 years, betamethasone. By physician specialty, the most prescribed medications were high-potency steroids for dermatologists and internists, and topical tacrolimus for pediatricians. Topical calcineurin inhibitors were not among the top 20 most prescribed medications by dermatologists, and systemic antipsoriatic agents were not among the top 20 most prescribed medications in any age group. Conclusions: Over the 28-year interval, outpatient visits for pediatric psoriasis were attended primarily by white children older than 8 years in equal number by sex. Dermatologists and pediatricians saw the majority, and treatment approach differed by physician specialty and patient age. Treatment guidelines for childhood psoriasis may help reduce treatment variability.

Management of psoriasis in adolescence

“…Topical corticosteroids remain the first-line treatment agents for psoriasis among adolescents as well as among all other age groups 23. The role of corticosteroids is based on their anti-inflammatory and antiproliferative properties, which ultimately reduce erythema, scaling, and pruritus 12,24.…”

“…According to a recent study from the US, calcipotriene has been the second-most prescribed medication for childhood psoriasis for almost 30 years (1979–2007) 23. Furthermore, a systematic review of all treatments for childhood plaque psoriasis recommends calcipotriene and calcitriol as effective and well-tolerated treatments (level of evidence A and B, respectively) 26.…”

“…These agents are officially approved for the intermittent treatment of atopic dermatitis, but not for the treatment of childhood psoriasis 23. In everyday practice, they are used most of the time for the treatment of psoriasis in areas with a high risk of skin atrophy, such as the face, genitalia, and flexures 12.…”

“…The retinoid tazarotene 0.05% is used relatively rarely due to its local irritating properties 23. It has been described in cases of childhood nail psoriasis 35.…”

Pediatric Psoriasis

“…In the United States, high-potency topical corticosteroids were the most frequently prescribed outpatient treatment for pediatric patients overall from 1979 to 2007 [ 6 ]. Few therapies for psoriasis are approved by the FDA for the pediatric age group, and drug dosages must be altered based on weight and/or age in children.…”