Update on Systemic Therapies for Psoriasis in Childhood
The session 'Update on systemic therapies for psoriasis in childhood' was presented by Jeffrey M Weinberg from St Luke's Roosevelt and Beth Israel Medical Centers (NY, USA). Psoriasis affects greater than 7 million Americans, with 200,000 new cases diagnosed per year. The peak age of onset is 15–35 years of age.
Within the pediatric population, 10–15% of patients have an onset before the age of 10 years, and more than 70% of patients have a positive family history. Within the pediatric population, there are a number of underappreciated sites of predilection. In total, 38% of patients have facial involvement, and 26% have psoriatic diaper rash, in addition to glossitis and mucositis. The course of psoriasis in the pediatric population is difficult to predict – some children will remit, while others will persist.
Current treatments for psoriasis include topical therapy, phototherapy, oral therapy and parenteral therapy. With regards to parenteral therapy, the following biologic agents have been approved by the FDA for the treatment of psoriasis: etanercept, adalimumab, infliximab, alefacept and, most recently, ustekinumab.
Etanercept has been approved for juvenile idiopathic arthritis (JIA) in children older than the age of 2 years. Adalimumab has been approved for pediatric patients with JIA above the age of 4 years, while infliximab has been approved for children with JIA above the age of 6 years. Etanercept is the initial biologic agent of choice for psoriasis vulgaris in the pediatric population given its low risk-to-benefit ratio. Live vaccines (flumist, smallpox, MMR, oral polio, varivax, BCG, rotavirus, dengue virus and hepatitis A) are contraindicated in pediatric patients on immunosuppressive therapy. Killed vaccines are not contraindicated; however, their efficacy may be diminished.