Use of topical therapies for pediatric psoriasis: A systematic review

Abstract

Psoriasis is one of the most common chronic skin diseases, affecting 1%-3% of the general population. It can have a significant negative impact on a patient's quality of life, and in approximately 30% of patients first symptoms can be traced back to childhood. We have performed a comprehensive literature search using the MEDLINE database in order to ascertain the efficacy and adverse reactions of topical treatments in pediatric psoriasis. A total of 13 relevant articles were identified on the following topical agents: corticosteroids, calcineurin inhibitors, vitamin D analogs, and dithranol. Corticosteroids achieved clearance in 72.7% of patients. Calcitriol lead to a 57.2%-100% mean improvement in severity, and calcipotriol to 52%-64%. Combination of calcipotriol and corticosteroids achieved an improvement in mean severity ranging between 32.1% and 80%. Treatment with tacrolimus lead to an >50% improvement. Finally, short contact dithranol lead to a variable response in clearance between different studies, ranging between 3.7% and 81%. No serious adverse reactions were documented, the most common local reaction being irritation. Pediatric psoriasis is a common and challenging condition with no easy and definitive solution. Topical agents are safe, easy to use, readily available and cheap. However, they need to be applied repeatedly, may cause skin irritation, and can be messy. Based on the results presented above, we recommend utilizing all the available topical options before escalating to systemic treatments.

Off-Label Use of Topical Calcineurin Inhibitors in Dermatologic Disorders

“…The use of TCS on certain body areas that have thin skin, such as the face, folds, and genital areas, is limited by their risk of skin atrophy, telangiectasia, and striae. 12,13 There is high-quality evidence supporting the efficacy and tolerability of TCIs applied to plaque psoriasis of the face and intertriginous and genital areas in pediatric 49,50 and adult patients, 51 -54 and their use on these areas is supported by treatment guidelines. 55 -57…”

“…The use of TCS on certain body areas that have thin skin, such as the face, folds, and genital areas, is limited by their risk of skin atrophy, telangiectasia, and striae. 12,13 There is high-quality evidence supporting the efficacy and tolerability of TCIs applied to plaque psoriasis of the face and intertriginous and genital areas in pediatric 49,50 and adult patients, [51][52][53][54] and their use on these areas is supported by treatment guidelines. [55][56][57] There is also evidence from meta-analyses 58,59 and double-blind RCTs 60,61 supporting the use of TCIs for the treatment of genital lichen sclerosus, although TCIs have generally been found to be less effective than TCS in comparative trials.…”

Long noncoding RNAs in autoimmune diseases

“…The pathogenesis of psoriasis is complex, with both genetic and environmental factors. 80 Real-time reverse transcription PCR analysis showed that psoriasis-associated nonprotein coding RNA induced by stress (PRINS), a novel psoriasis susceptibility-related lncRNA gene, is expressed at higher levels in the uninvolved epidermis of psoriatic patients compared with the level in both psoriatic lesioned tissue and healthy epidermal tissue, suggesting a role for PRINS in psoriasis susceptibility. 13,81 G1P3 (also named IFI6, interferon alpha inducible protein 6) inhibits spontaneous keratinocyte apoptosis, and its high expression in psoriatic skin may thus contribute to the development of psoriatic lesions.…”

“…Psoriasis is a common chronic inflammatory disease characterized by abnormal keratinocyte proliferation. The pathogenesis of psoriasis is complex, with both genetic and environmental factors …”

Targeting the IL-17 Receptor Using Liposomal Spherical Nucleic Acids as Topical Therapy for Psoriasis

“…However, the high cost and increased risk of infection associated with the systemic delivery of these drugs restricts their use to moderate-to-severe cases of psoriasis. For milder forms of psoriasis (more than 80% of patients), topical corticosteroids remain the predominant option (Greb et al, 2016;Kravvas and Gholam, 2018). Monoclonal antibodies are unable to penetrate the psoriatic epidermis for topical use, and topical approaches using small molecule inhibitors have not advanced for psoriasis.…”