The Role of Biologics and Other Systemic Agents in the Treatment of Pediatric Psoriasis

Psoriasis is a chronic inflammatory disease that is not uncommon
in children and adolescents. While exact prevalence
rates of pediatric psoriasis have not been determined,
30% to 40% of adults with psoriasis report onset of their
signs and symptoms before age 16.1-4 Although the diagnosis
of pediatric psoriasis remains predominantly clinical, its presentation
varies in clinical course, distribution, and morphology.
The management of psoriasis in children ranges from
topical medications for mild and moderate disease to the use
of systemic immunomodulatory agents for more severe disease.
None of the systemic medications, including methotrexate,
cyclosporine, and biological agents, such as etanercept,
infliximab, adalimumab, and ustekinumab have
specific indication by the United States Food and Drug Administration
(FDA) for pediatric psoriasis. The pediatric dermatologic
literature has limited studies in which investigators
examine the use of these therapies, unlike the corresponding
adult literature. Subsequently, experts rely on unpublished clinical
experience and studies of these systemic medications for
other pediatric conditions, such as those published in the rheumatologic,
transplant, oncological, and gastroenterologic
literature. In this article, we discuss the systemic treatment
options for pediatric psoriasis, including drug mechanism of
action and associated risks and benefits of treatment, to aid
dermatologists in treating psoriasis in this special population.

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