Skip to main content
Log in

Pediatric Psoriasis

  • Review Article
  • Published:
American Journal of Clinical Dermatology Aims and scope Submit manuscript

Abstract

Psoriasis is a chronic inflammatory systemic disease associated with an important physical and physiological burden. It primarily affects the skin, but it is associated with several serious medical co-morbidities. One third of total psoriatic cases have their onset during the pediatric age, although some of them may not be diagnosed until the patient reaches adulthood. Additionally, in the pediatric age, there is an association with several medical co-morbidities; thus, an early recognition of the disease and a subsequent appropriate approach may delay or even prevent considerable co-morbidities. Because children are not just ‘small adults’, specific guidelines for the diagnosis, management, and treatment of psoriasis are of extreme importance. However, these guidelines are still lacking in this age group. Most of the psoriasis treatments used in adults are not officially approved for the pediatric age and require off-label prescription. Moreover, efficacy and safety studies are lacking in this population, especially with long-term follow-up and outcomes. Many biologic agents have been recently approved for the treatment of psoriasis in children, while others are currently being studied. This bibliographic review aims to summarize the most relevant aspects, as well as updated information about the epidemiology, pathogenesis, clinical features, diagnosis, co-morbidities and treatment of pediatric psoriasis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Matteo M, Maddalena N, Balato A, et al. Psoriasis in children: a review. Curr Pediatr Rev. 2015;11(1):10–26.

    Article  Google Scholar 

  2. Boehncke WH, Schon MP. Psoriasis. Lancet. 2015;386(9997):983–94.

    Article  CAS  PubMed  Google Scholar 

  3. Henseler T, Christophers E. Psoriasis of early and late onset: characterization of two types of psoriasis vulgaris. J Am Acad Dermatol. 1985;13(3):450–6.

    Article  CAS  PubMed  Google Scholar 

  4. Tollefson MM, Crowson CS, McEvoy MT, Maradit Kremers H. Incidence of psoriasis in children: a population-based study. J Am Acad Dermatol. 2010;62(6):979–87.

    Article  PubMed  Google Scholar 

  5. Silverberg NB. Update on pediatric psoriasis. Cutis. 2015;95(3):147–52.

    PubMed  Google Scholar 

  6. Augustin M, Glaeske G, Radtke MA, et al. Epidemiology and comorbidity of psoriasis in children. Br J Dermatol. 2010;162(3):633–6.

    Article  CAS  PubMed  Google Scholar 

  7. Parisi R, Symmons DP, Griffiths CE, Ashcroft DM. Identification and Management of Psoriasis and Associated ComorbidiTy (IMPACT) project team. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol. 2013;133(2):377–85.

    Article  CAS  PubMed  Google Scholar 

  8. Chiam LY, de Jager ME, Giam YC, et al. Juvenile psoriasis in European and Asian children: similarities and differences. Br J Dermatol. 2011;164(5):1101–3.

    Article  CAS  PubMed  Google Scholar 

  9. Choon SE, Ngim CF, Premaa S, et al. Clinico-epidemiological profile, including body mass index of Malaysian children with psoriasis. Med J Malays. 2016;71(4):171–6.

    CAS  Google Scholar 

  10. Griffiths CE, Barker JN. Pathogenesis and clinical features of psoriasis. Lancet. 2007;370(9583):263–71.

    Article  CAS  PubMed  Google Scholar 

  11. Bronckers IM, Paller AS, van Geel MJ, et al. Psoriasis in children and adolescents: diagnosis, management and comorbidities. Pediatr Drugs. 2015;17(5):373–84.

    Article  CAS  Google Scholar 

  12. Roberson ED, Bowcock AM. Psoriasis genetics: breaking the barrier. Trends Genet. 2010;26(9):415–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Farber EM, Nall ML. The natural history of psoriasis in 5,600 patients. Dermatologica. 1974;148(1):1–18.

    Article  CAS  PubMed  Google Scholar 

  14. Veal CD, Capon F, Allen MH, et al. Family-based analysis using a dense single-nucleotide polymorphism-based map defines genetic variation at PSORS1, the major psoriasis-susceptibility locus. Am J Hum Genet. 2002;71(3):554–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Nair RP, Stuart PE, Nistor I, et al. Sequence and haplotype analysis supports HLA-C as the psoriasis susceptibility 1 gene. Am J Hum Genet. 2006;78(5):827–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Romiti R, Maragno L, Arnone M, Takahashi MD. Psoriasis in childhood and adolescence. An Bras Dermatol. 2009;84(1):9–20.

    Article  PubMed  Google Scholar 

  17. Gudjonsson JE, Karason A, Runarsdottir EH, et al. Distinct clinical differences between HLA-Cw*0602 positive and negative psoriasis patients: an analysis of 1019 HLA-C- and HLA-B-typed patients. J Invest Dermatol. 2006;126(4):740–5.

    Article  CAS  PubMed  Google Scholar 

  18. Asumalahti K, Ameen M, Suomela S, et al. Genetic analysis of PSORS1 distinguishes guttate psoriasis and palmoplantar pustulosis. J Invest Dermatol. 2003;120(4):627–32.

    Article  CAS  PubMed  Google Scholar 

  19. Ferrandiz C, Pujol RM, Garcia-Patos V, et al. Psoriasis of early and late onset: a clinical and epidemiologic study from Spain. J Am Acad Dermatol. 2002;46(6):867–73.

    Article  PubMed  Google Scholar 

  20. Silverberg NB. Update on pediatric psoriasis, part 1: clinical features and demographics. Cutis. 2010;86(3):118–24.

    PubMed  Google Scholar 

  21. Li Y, Begovich AB. Unraveling the genetics of complex diseases: susceptibility genes for rheumatoid arthritis and psoriasis. Semin Immunol. 2009;21(6):318–27.

    Article  CAS  PubMed  Google Scholar 

  22. Sugiura K. The genetic background of generalized pustular psoriasis: IL36RN mutations and CARD14 gain-of-function variants. J Dermatol Sci. 2014;74(3):187–92.

    Article  CAS  PubMed  Google Scholar 

  23. Marrakchi S, Guigue P, Renshaw BR, et al. Interleukin-36-receptor antagonist deficiency and generalized pustular psoriasis. N Engl J Med. 2011;365(7):620–8.

    Article  CAS  PubMed  Google Scholar 

  24. Gudjonsson JE, Thorarinsson AM, Sigurgeirsson B, et al. Streptococcal throat infections and exacerbation of chronic plaque psoriasis: a prospective study. Br J Dermatol. 2003;149(3):530–4.

    Article  CAS  PubMed  Google Scholar 

  25. Perez-Lorenzo R, Zambrano-Zaragoza JF, Saul A, et al. Autoantibodies to autologous skin in guttate and plaque forms of psoriasis and cross-reaction of skin antigens with streptococcal antigens. Int J Dermatol. 1998;37(7):524–31.

    Article  CAS  PubMed  Google Scholar 

  26. Besgen P, Trommler P, Vollmer S, Prinz JC. Ezrin, maspin, peroxiredoxin 2, and heat shock protein 27: potential targets of a streptococcal-induced autoimmune response in psoriasis. J Immunol. 2010;184(9):5392–402.

    Article  CAS  PubMed  Google Scholar 

  27. Santamaria-Babi LF. CLA(+) T cells in cutaneous diseases. Eur J Dermatol. 2004;14(1):13–8.

    PubMed  Google Scholar 

  28. Ferran M, Galvan AB, Rincon C, et al. Streptococcus induces circulating CLA(+) memory T-cell-dependent epidermal cell activation in psoriasis. J Invest Dermatol. 2013;133(4):999–1007.

    Article  CAS  PubMed  Google Scholar 

  29. Nograles KE, Zaba LC, Shemer A, et al. IL-22-producing “T22” T cells account for upregulated IL-22 in atopic dermatitis despite reduced IL-17-producing TH17 T cells. J Allergy Clin Immunol. 2009;123(6):1244–1252 e2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Thorleifsdottir RH, Sigurdardottir SL, Sigurgeirsson B, et al. HLA-Cw6 homozygosity in plaque psoriasis is associated with streptococcal throat infections and pronounced improvement after tonsillectomy: a prospective case series. J Am Acad Dermatol. 2016;75(5):889–96.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Rachakonda TD, Dhillon JS, Florek AG, Armstrong AW. Effect of tonsillectomy on psoriasis: a systematic review. J Am Acad Dermatol. 2015;72(2):261–75.

    Article  PubMed  Google Scholar 

  32. Gupta MA, Gupta AK, Watteel GN. Cigarette smoking in men may be a risk factor for increased severity of psoriasis of the extremities. Br J Dermatol. 1996;135(5):859–60.

    Article  CAS  PubMed  Google Scholar 

  33. Ozden MG, Tekin NS, Gurer MA, et al. Environmental risk factors in pediatric psoriasis: a multicenter case–control study. Pediatr Dermatol. 2011;28(3):306–12.

    Article  PubMed  Google Scholar 

  34. Gul Mert G, Incecik F, Gunasti S, et al. Psoriasiform drug eruption associated with sodium valproate. Case Rep Pediatr. 2013;2013:823469.

    PubMed  PubMed Central  Google Scholar 

  35. Busch AL, Landau JM, Moody MN, Goldberg LH. Pediatric psoriasis. Skin Ther Lett. 2012;17(1):5–7.

    Google Scholar 

  36. Basavaraj KH, Ashok NM, Rashmi R, Praveen TK. The role of drugs in the induction and/or exacerbation of psoriasis. Int J Dermatol. 2010;49(12):1351–61.

    Article  CAS  PubMed  Google Scholar 

  37. Shah KN. Diagnosis and treatment of pediatric psoriasis: current and future. Am J Clin Dermatol. 2013;14(3):195–213.

    Article  PubMed  Google Scholar 

  38. Tollefson MM. Diagnosis and management of psoriasis in children. Pediatr Clin North Am. 2014;61(2):261–77.

    Article  PubMed  Google Scholar 

  39. Koebnick C, Black MH, Smith N, et al. The association of psoriasis and elevated blood lipids in overweight and obese children. J Pediatr. 2011;159(4):577–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Bryld LE, Sorensen TI, Andersen KK, et al. High body mass index in adolescent girls precedes psoriasis hospitalization. Acta Derm Venereol. 2010;90(5):488–93.

    Article  PubMed  Google Scholar 

  41. Becker L, Tom WL, Eshagh K, et al. Excess adiposity preceding pediatric psoriasis. JAMA Dermatol. 2014;150(5):573–4.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Mahil SK, Capon F, Barker JN. Update on psoriasis immunopathogenesis and targeted immunotherapy. Semin Immunopathol. 2016;38(1):11–27.

    Article  CAS  PubMed  Google Scholar 

  43. Kim J, Krueger JG. The immunopathogenesis of psoriasis. Dermatol Clin. 2015;33(1):13–23.

    Article  CAS  PubMed  Google Scholar 

  44. Chiricozzi A, Suarez-Farinas M, Fuentes-Duculan J, et al. Increased expression of interleukin-17 pathway genes in nonlesional skin of moderate-to-severe psoriasis vulgaris. Br J Dermatol. 2016;174(1):136–45.

    Article  CAS  PubMed  Google Scholar 

  45. Chiricozzi A. Pathogenic role of IL-17 in psoriasis and psoriatic arthritis. Actas Dermosifiliogr. 2014;105(Suppl. 1):9–20.

    Article  PubMed  Google Scholar 

  46. Lee E, Trepicchio WL, Oestreicher JL, et al. Increased expression of interleukin 23 p19 and p40 in lesional skin of patients with psoriasis vulgaris. J Exp Med. 2004;199(1):125–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Lowes MA, Bowcock AM, Krueger JG. Pathogenesis and therapy of psoriasis. Nature. 2007;445(7130):866–73.

    Article  CAS  PubMed  Google Scholar 

  48. Buchau AS, Gallo RL. Innate immunity and antimicrobial defense systems in psoriasis. Clin Dermatol. 2007;25(6):616–24.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Howard R, Tsuchiya A. Adult skin disease in the pediatric patient. Dermatol Clin. 1998;16(3):593–608.

    Article  CAS  PubMed  Google Scholar 

  50. Mercy K, Kwasny M, Cordoro KM, et al. Clinical manifestations of pediatric psoriasis: results of a multicenter study in the United States. Pediatr Dermatol. 2013;30(4):424–8.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Reich K. Approach to managing patients with nail psoriasis. J Eur Acad Dermatol Venereol. 2009;23(Suppl. 1):15–21.

    Article  PubMed  Google Scholar 

  52. Honig PJ. Guttate psoriasis associated with perianal streptococcal disease. J Pediatr. 1988;113(6):1037–9.

    Article  CAS  PubMed  Google Scholar 

  53. Hani AF, Prakasa E, Nugroho H, et al. Body surface area measurement and soft clustering for PASI area assessment. Conf Proc IEEE Eng Med Biol Soc. 2012;2012:4398–401.

    PubMed  Google Scholar 

  54. Walsh JA, McFadden M, Woodcock J, et al. Product of the Physician Global Assessment and body surface area: a simple static measure of psoriasis severity in a longitudinal cohort. J Am Acad Dermatol. 2013;69(6):931–7.

    Article  PubMed  Google Scholar 

  55. Finlay AY. Avoiding palmar ambiguity in the PREPI: a handprint is approximately 1% body surface area. Br J Dermatol. 2011;164(3):679 (author reply 80).

    CAS  PubMed  Google Scholar 

  56. Boehncke WH, Boehncke S, Schon MP. Managing comorbid disease in patients with psoriasis. BMJ. 2010;340:b5666.

    Article  PubMed  Google Scholar 

  57. Stahle M, Atakan N, Boehncke WH, et al. Juvenile psoriasis and its clinical management: a European expert group consensus. J Dtsch Dermatol Ges. 2010;8(10):812–8.

    PubMed  Google Scholar 

  58. Murphy M, Kerr P, Grant-Kels JM. The histopathologic spectrum of psoriasis. Clin Dermatol. 2007;25(6):524–8.

    Article  PubMed  Google Scholar 

  59. Lallas A, Kyrgidis A, Tzellos TG, et al. Accuracy of dermoscopic criteria for the diagnosis of psoriasis, dermatitis, lichen planus and pityriasis rosea. Br J Dermatol. 2012;166(6):1198–205.

    Article  CAS  PubMed  Google Scholar 

  60. Chang MW, Nakrani R. Six children with allergic contact dermatitis to methylisothiazolinone in wet wipes (baby wipes). Pediatrics. 2014;133(2):e434–8.

    Article  PubMed  Google Scholar 

  61. Pietrzak A, Grywalska E, Walankiewicz M, et al. Psoriasis and metabolic syndrome in children: current data. Clin Exp Dermatol. 2017;42(2):131–6.

    Article  CAS  PubMed  Google Scholar 

  62. Boehncke WH, Boehncke S, Tobin AM, Kirby B. The ‘psoriatic march’: a concept of how severe psoriasis may drive cardiovascular comorbidity. Exp Dermatol. 2011;20(4):303–7.

    Article  PubMed  Google Scholar 

  63. Mahe E, Maccari F, Beauchet A, et al. Childhood-onset psoriasis: association with future cardiovascular and metabolic comorbidities. Br J Dermatol. 2013;169(4):889–95.

    Article  CAS  PubMed  Google Scholar 

  64. Au SC, Goldminz AM, Loo DS, et al. Association between pediatric psoriasis and the metabolic syndrome. J Am Acad Dermatol. 2012;66(6):1012–3.

    Article  PubMed  Google Scholar 

  65. Paller AS, Mercy K, Kwasny MJ, et al. Association of pediatric psoriasis severity with excess and central adiposity: an international cross-sectional study. JAMA Dermatol. 2013;149(2):166–76.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Neimann AL, Shin DB, Wang X, et al. Prevalence of cardiovascular risk factors in patients with psoriasis. J Am Acad Dermatol. 2006;55(5):829–35.

    Article  PubMed  Google Scholar 

  67. Love TJ, Qureshi AA, Karlson EW, et al. Prevalence of the metabolic syndrome in psoriasis: results from the National Health and Nutrition Examination Survey, 2003–2006. Arch Dermatol. 2011;147(4):419–24.

    Article  PubMed  Google Scholar 

  68. Prahalad S, McCracken CE, Ponder LA, et al. Familial autoimmunity in the childhood arthritis and rheumatology research alliance registry. Pediatr Rheumatol Online J. 2016;14(1):14.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Gladman DD, Antoni C, Mease P, et al. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis. 2005;64(Suppl. 2):ii14–7.

    PubMed  PubMed Central  Google Scholar 

  70. Burgos-Vargas R. Juvenile onset spondyloarthropathies: therapeutic aspects. Ann Rheum Dis. 2002;61(Suppl. 3):iii33–9.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Langenbruch A, Radtke MA, Krensel M, et al. Nail involvement as a predictor of concomitant psoriatic arthritis in patients with psoriasis. Br J Dermatol. 2014;171(5):1123–8.

    Article  CAS  PubMed  Google Scholar 

  72. Pourchot D, Bodemer C, Phan A, et al. Nail psoriasis: a systematic evaluation in 313 children with psoriasis. Pediatr Dermatol. 2017;34(1):58–63.

    Article  PubMed  Google Scholar 

  73. Tan AL, Benjamin M, Toumi H, et al. The relationship between the extensor tendon enthesis and the nail in distal interphalangeal joint disease in psoriatic arthritis: a high-resolution MRI and histological study. Rheumatology (Oxford). 2007;46(2):253–6.

    Article  CAS  PubMed  Google Scholar 

  74. Raposo I, Torres T. Nail psoriasis as a predictor of the development of psoriatic arthritis. Actas Dermosifiliogr. 2015;106(6):452–7.

    Article  CAS  PubMed  Google Scholar 

  75. Wilson FC, Icen M, Crowson CS, et al. Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population-based study. Arthritis Rheum. 2009;61(2):233–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Mercan S, Kivanc Altunay I. Psychodermatology: a collaboration between psychiatry and dermatology. Turk Psikiyatri Derg. 2006;17(4):305–13.

    PubMed  Google Scholar 

  77. de Jager ME, De Jong EM, Evers AW, et al. The burden of childhood psoriasis. Pediatr Dermatol. 2011;28(6):736–7.

    Article  PubMed  Google Scholar 

  78. Beattie PE, Lewis-Jones MS. A comparative study of impairment of quality of life in children with skin disease and children with other chronic childhood diseases. Br J Dermatol. 2006;155(1):145–51.

    Article  CAS  PubMed  Google Scholar 

  79. Kimball AB, Wu EQ, Guerin A, et al. Risks of developing psychiatric disorders in pediatric patients with psoriasis. J Am Acad Dermatol. 2012;67(4):651–657 e1–2.

    Article  PubMed  Google Scholar 

  80. Akay A, Pekcanlar A, Bozdag KE, et al. Assessment of depression in subjects with psoriasis vulgaris and lichen planus. J Eur Acad Dermatol Venereol. 2002;16(4):347–52.

    Article  CAS  PubMed  Google Scholar 

  81. Russo PA, Ilchef R, Cooper AJ. Psychiatric morbidity in psoriasis: a review. Australas J Dermatol. 2004;45(3):155–9 (quiz 60–1).

    Article  PubMed  Google Scholar 

  82. Manzoni AP, Weber MB, Nagatomi AR, et al. Assessing depression and anxiety in the caregivers of pediatric patients with chronic skin disorders. An Bras Dermatol. 2013;88(6):894–9.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Lin VW. Tough-skinned kids: identifying psychosocial effects of psoriasis and helping pediatric patients and families cope. J Pediatr Nurs. 2012;27(5):563–72.

    Article  PubMed  Google Scholar 

  84. Sticherling M, Augustin M, Boehncke WH, et al. Therapy of psoriasis in childhood and adolescence: a German expert consensus. J Dtsch Dermatol Ges. 2011;9(10):815–23.

    PubMed  Google Scholar 

  85. Bhutani T, Kamangar F, Cordoro KM. Management of pediatric psoriasis. Pediatr Ann. 2012;41(1):e1–7.

    Article  PubMed  Google Scholar 

  86. Kiken DA, Silverberg NB. Atopic dermatitis in children, part 2: treatment options. Cutis. 2006;78(6):401–6.

    PubMed  Google Scholar 

  87. Silverberg NB. Update on pediatric psoriasis. Part 2: therapeutic management. Cutis. 2010;86(4):172–6.

    PubMed  Google Scholar 

  88. Cornell RC, Stoughton RB. Correlation of the vasoconstriction assay and clinical activity in psoriasis. Arch Dermatol. 1985;121(1):63–7.

    Article  CAS  PubMed  Google Scholar 

  89. O’Neill JL, Feldman SR. Vitamine D analogue-based therapies for psoriasis. Drugs Today (Barc). 2010;46(5):351–60.

    Article  PubMed  CAS  Google Scholar 

  90. Darley CR, Cunliffe WJ, Green CM, et al. Safety and efficacy of calcipotriol ointment (Dovonex) in treating children with psoriasis vulgaris. Br J Dermatol. 1996;135(3):390–3.

    Article  CAS  PubMed  Google Scholar 

  91. van Geel MJ, Mul K, Oostveen AM, et al. Calcipotriol/betamethasone dipropionate ointment in mild-to-moderate paediatric psoriasis: long-term daily clinical practice data in a prospective cohort. Br J Dermatol. 2014;171(2):363–9.

    Article  PubMed  CAS  Google Scholar 

  92. Oostveen AM, de Jong EM, Donders AR, et al. Treatment of paediatric scalp psoriasis with calcipotriene/betamethasone dipropionate scalp formulation: effectiveness, safety and influence on children’s quality of life in daily practice. J Eur Acad Dermatol Venereol. 2015;29(6):1193–7.

    Article  CAS  PubMed  Google Scholar 

  93. Gooderham M, Debarre JM, Keddy-Grant J, et al. Safety and efficacy of calcipotriol plus betamethasone dipropionate gel in the treatment of scalp psoriasis in adolescents 12–17 years of age. Br J Dermatol. 2014;171(6):1470–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  94. Cordoro KM. Topical therapy for the management of childhood psoriasis: part I. Skin Ther Lett. 2008;13(3):1–3.

    Google Scholar 

  95. Brune A, Miller DW, Lin P, et al. Tacrolimus ointment is effective for psoriasis on the face and intertriginous areas in pediatric patients. Pediatr Dermatol. 2007;24(1):76–80.

    Article  PubMed  Google Scholar 

  96. Steele JA, Choi C, Kwong PC. Topical tacrolimus in the treatment of inverse psoriasis in children. J Am Acad Dermatol. 2005;53(4):713–6.

    Article  PubMed  Google Scholar 

  97. Nghiem P, Pearson G, Langley RG. Tacrolimus and pimecrolimus: from clever prokaryotes to inhibiting calcineurin and treating atopic dermatitis. J Am Acad Dermatol. 2002;46(2):228–41.

    Article  PubMed  Google Scholar 

  98. Fluhr JW, Cavallotti C, Berardesca E. Emollients, moisturizers, and keratolytic agents in psoriasis. Clin Dermatol. 2008;26(4):380–6.

    Article  PubMed  Google Scholar 

  99. Diluvio L, Campione E, Paterno EJ, et al. Childhood nail psoriasis: a useful treatment with tazarotene 0.05%. Pediatr Dermatol. 2007;24(3):332–3.

    Article  PubMed  Google Scholar 

  100. Cram DL. Psoriasis: treatment with a tar gel. Cutis. 1976;17(6):1197–8, 202–3.

  101. Paghdal KV, Schwartz RA. Topical tar: back to the future. J Am Acad Dermatol. 2009;61(2):294–302.

    Article  CAS  PubMed  Google Scholar 

  102. Cordoro KM. Systemic and light therapies for the management of childhood psoriasis: part II. Skin Ther Lett. 2008;13(4):1–3.

    Google Scholar 

  103. Dawe RS, Wainwright NJ, Cameron H, Ferguson J. Narrow-band (TL-01) ultraviolet B phototherapy for chronic plaque psoriasis: three times or five times weekly treatment? Br J Dermatol. 1998;138(5):833–9.

    Article  CAS  PubMed  Google Scholar 

  104. Leenutaphong V, Nimkulrat P, Sudtim S. Comparison of phototherapy two times and four times a week with low doses of narrow-band ultraviolet B in Asian patients with psoriasis. Photodermatol Photoimmunol Photomed. 2000;16(5):202–6.

    Article  CAS  PubMed  Google Scholar 

  105. Holme SA, Anstey AV. Phototherapy and PUVA photochemotherapy in children. Photodermatol Photoimmunol Photomed. 2004;20(2):69–75.

    Article  CAS  PubMed  Google Scholar 

  106. Marqueling AL, Cordoro KM. Systemic treatments for severe pediatric psoriasis: a practical approach. Dermatol Clin. 2013;31(2):267–88.

    Article  CAS  PubMed  Google Scholar 

  107. de Jager ME, de Jong EM, van de Kerkhof PC, Seyger MM. Efficacy and safety of treatments for childhood psoriasis: a systematic literature review. J Am Acad Dermatol. 2010;62(6):1013–30.

    Article  PubMed  CAS  Google Scholar 

  108. Coven TR, Burack LH, Gilleaudeau R, et al. Narrowband UV-B produces superior clinical and histopathological resolution of moderate-to-severe psoriasis in patients compared with broadband UV-B. Arch Dermatol. 1997;133(12):1514–22.

    Article  CAS  PubMed  Google Scholar 

  109. Lara-Corrales I, Ramnarine S, Lansang P. Treatment of childhood psoriasis with phototherapy and photochemotherapy. Clin Med Insights Pediatr. 2013;7:25–33.

    PubMed  PubMed Central  Google Scholar 

  110. al-Fouzan AS, Nanda A. UVB phototherapy in childhood psoriasis. Pediatr Dermatol. 1995;12(1):66.

    Article  CAS  PubMed  Google Scholar 

  111. Jain VK, Aggarwal K, Jain K, Bansal A. Narrow-band UV-B phototherapy in childhood psoriasis. Int J Dermatol. 2007;46(3):320–2.

    Article  PubMed  Google Scholar 

  112. Pasic A, Ceovic R, Lipozencic J, et al. Phototherapy in pediatric patients. Pediatr Dermatol. 2003;20(1):71–7.

    Article  PubMed  Google Scholar 

  113. Tay YK, Morelli JG, Weston WL. Experience with UVB phototherapy in children. Pediatr Dermatol. 1996;13(5):406–9.

    Article  CAS  PubMed  Google Scholar 

  114. Diffey BL, Farr PM. The challenge of follow-up in narrowband ultraviolet B phototherapy. Br J Dermatol. 2007;157(2):344–9.

    Article  CAS  PubMed  Google Scholar 

  115. Woo WK, McKenna KE. Combination TL01 ultraviolet B phototherapy and topical calcipotriol for psoriasis: a prospective randomized placebo-controlled clinical trial. Br J Dermatol. 2003;149(1):146–50.

    Article  CAS  PubMed  Google Scholar 

  116. Behrens S, Grundmann-Kollmann M, Schiener R, et al. Combination phototherapy of psoriasis with narrow-band UVB irradiation and topical tazarotene gel. J Am Acad Dermatol. 2000;42(3):493–5.

    Article  CAS  PubMed  Google Scholar 

  117. Carrozza P, Hausermann P, Nestle FO, et al. Clinical efficacy of narrow-band UVB (311 nm) combined with dithranol in psoriasis: an open pilot study. Dermatology. 2000;200(1):35–9.

    Article  CAS  PubMed  Google Scholar 

  118. Berne B, Blom I, Spangberg S. Enhanced response of psoriasis to UVB therapy after pretreatment with a lubricating base: a single-blind controlled study. Acta Derm Venereol. 1990;70(6):474–7.

    CAS  PubMed  Google Scholar 

  119. Wolff K. Side-effects of psoralen photochemotherapy (PUVA). Br J Dermatol. 1990;122(Suppl. 36):117–25.

    Article  PubMed  Google Scholar 

  120. Schiener R, Brockow T, Franke A, et al. Bath PUVA and saltwater baths followed by UV-B phototherapy as treatments for psoriasis: a randomized controlled trial. Arch Dermatol. 2007;143(5):586–96.

    Article  CAS  PubMed  Google Scholar 

  121. Delrosso G, Bornacina C, Farinelli P, et al. Bath PUVA and psoriasis: is a milder treatment a worse treatment? Dermatology. 2008;216(3):191–3.

    Article  CAS  PubMed  Google Scholar 

  122. National Psoriasis Foundation. Light therapy. OR, USA, 2014.

  123. Wright NA, Piggott CD, Eichenfield LF. The role of biologics and other systemic agents in the treatment of pediatric psoriasis. Semin Cutan Med Surg. 2010;29(1):20–7.

    Article  CAS  PubMed  Google Scholar 

  124. Paller AS. Dermatologic uses of methotrexate in children: indications and guidelines. Pediatr Dermatol. 1985;2(3):238–43.

    Article  CAS  PubMed  Google Scholar 

  125. Rahman SI, Siegfried E, Flanagan KH, Armbrecht ES. The methotrexate polyglutamate assay supports the efficacy of methotrexate for severe inflammatory skin disease in children. J Am Acad Dermatol. 2014;70(2):252–6.

    Article  CAS  PubMed  Google Scholar 

  126. Dervieux T, Orentas Lein D, Marcelletti J, et al. HPLC determination of erythrocyte methotrexate polyglutamates after low-dose methotrexate therapy in patients with rheumatoid arthritis. Clin Chem. 2003;49(10):1632–41.

    Article  CAS  PubMed  Google Scholar 

  127. Kremer JM, Hamilton RA. The effects of nonsteroidal antiinflammatory drugs on methotrexate (MTX) pharmacokinetics: impairment of renal clearance of MTX at weekly maintenance doses but not at 7.5 mg. J Rheumatol. 1995;22(11):2072–7.

    CAS  PubMed  Google Scholar 

  128. Wallace CA, Smith AL, Sherry DD. Pilot investigation of naproxen/methotrexate interaction in patients with juvenile rheumatoid arthritis. J Rheumatol. 1993;20(10):1764–8.

    CAS  PubMed  Google Scholar 

  129. Thomas DR, Dover JS, Camp RD. Pancytopenia induced by the interaction between methotrexate and trimethoprim-sulfamethoxazole. J Am Acad Dermatol. 1987;17(6):1055–6.

    Article  CAS  PubMed  Google Scholar 

  130. van Geel MJ, Mul K, de Jager ME, et al. Systemic treatments in paediatric psoriasis: a systematic evidence-based update. J Eur Acad Dermatol Venereol. 2015;29(3):425–37.

    Article  PubMed  Google Scholar 

  131. Lee CS, Koo J. A review of acitretin, a systemic retinoid for the treatment of psoriasis. Expert Opin Pharmacother. 2005;6(10):1725–34.

    Article  CAS  PubMed  Google Scholar 

  132. Di Lernia V, Bonamonte D, Lasagni C, et al. Effectiveness and safety of acitretin in children with plaque psoriasis: a multicenter retrospective analysis. Pediatr Dermatol. 2016;33(5):530–5.

    Article  PubMed  Google Scholar 

  133. Pereira TM, Vieira AP, Fernandes JC, Sousa-Basto A. Cyclosporin A treatment in severe childhood psoriasis. J Eur Acad Dermatol Venereol. 2006;20(6):651–6.

    Article  CAS  PubMed  Google Scholar 

  134. Alli N, Gungor E, Karakayali G, et al. The use of cyclosporin in a child with generalized pustular psoriasis. Br J Dermatol. 1998;139(4):754–5.

    Article  CAS  PubMed  Google Scholar 

  135. Perrett CM, Ilchyshyn A, Berth-Jones J. Cyclosporin in childhood psoriasis. J Dermatol Treat. 2003;14(2):113–8.

    Article  CAS  Google Scholar 

  136. Mahe E, Bodemer C, Pruszkowski A, et al. Cyclosporine in childhood psoriasis. Arch Dermatol. 2001;137(11):1532–3.

    CAS  PubMed  Google Scholar 

  137. Kilic SS, Hacimustafaoglu M, Celebi S, et al. Low dose cyclosporin A treatment in generalized pustular psoriasis. Pediatr Dermatol. 2001;18(3):246–8.

    Article  CAS  PubMed  Google Scholar 

  138. Kim HS, Kim GM, Kim SY. Two-stage therapy for childhood generalized pustular psoriasis: low-dose cyclosporin for induction and maintenance with acitretin/narrowband ultraviolet B phototherapy. Pediatr Dermatol. 2006;23(3):306–8.

    Article  PubMed  Google Scholar 

  139. Celgene. A phase 2, multicenter, open-label study to assess the safety, tolerability and pharmacokinetics of apremilast (CC-10004) in pediatric subjects with moderate to severe plaque psoriasis. https://clinicaltrials.gov/ct2/show/NCT02576678. Accessed 19 Apr 2017.

  140. Bianchi L, Del Duca E, Romanelli M, et al. Pharmacodynamic assessment of apremilast for the treatment of moderate-to-severe plaque psoriasis. Expert Opin Drug Metab Toxicol. 2016;12(9):1121–8.

    Article  CAS  PubMed  Google Scholar 

  141. Smith RL. Pediatric psoriasis treated with apremilast. JAAD Case Rep. 2016;2(1):89–91.

    Article  PubMed  PubMed Central  Google Scholar 

  142. Hashkes PJ, Uziel Y, Laxer RM. The safety profile of biologic therapies for juvenile idiopathic arthritis. Nat Rev Rheumatol. 2010;6(10):561–71.

    Article  CAS  PubMed  Google Scholar 

  143. Hawrot AC, Metry DW, Theos AJ, Levy ML. Etanercept for psoriasis in the pediatric population: experience in nine patients. Pediatr Dermatol. 2006;23(1):67–71.

    Article  PubMed  Google Scholar 

  144. Papoutsaki M, Costanzo A, Mazzotta A, et al. Etanercept for the treatment of severe childhood psoriasis. Br J Dermatol. 2006;154(1):181–3.

    Article  CAS  PubMed  Google Scholar 

  145. Paller AS, Siegfried EC, Langley RG, et al. Etanercept treatment for children and adolescents with plaque psoriasis. N Engl J Med. 2008;358(3):241–51.

    Article  CAS  PubMed  Google Scholar 

  146. European Medicines Agency. Human medicines: CHMP post-authorisation summary of positive opinion for Enbrel. http://www.ema.europa.eu/ema/index.jsp%3Fcurl%3dpages/medicines/human/medicines/000262/smops/Positive/human_smop_000264.jsp&mid%3dWC0b01ac058001d127&murl%3dmenus/medicines/medicines.jsp. Accessed 15 Apr 2016.

  147. European Medicines Agency. Human medicines: remicade therapeutic indication. http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/000240/human_med_001023.jsp&mid=WC0b01ac058001d124. Accessed 15 Apr 2016.

  148. European Medicines Agency. Human medicines: CHMP post-authorisation summary of positive opinion for Humira. http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/000481/smops/Positive/human_smop_000940.jsp&mid=WC0b01ac058001d127. Accessed 15 Apr 2016.

  149. Malkonen T, Wikstrom A, Heiskanen K, et al. Skin reactions during anti-TNFalpha therapy for pediatric inflammatory bowel disease: a 2-year prospective study. Inflamm Bowel Dis. 2014;20(8):1309–15.

    Article  PubMed  Google Scholar 

  150. AbbVie. A multicenter, randomized, double-dummy, double-blind study evaluating two doses of adalimumab versus methotrexate (MTX) in pediatric subjects with chronic plaque psoriasis (Ps). https://clinicaltrials.gov/ct2/show/NCT01251614. Accessed 19 Apr 2017.

  151. Kimball AB, Gordon KB, Fakharzadeh S, et al. Long-term efficacy of ustekinumab in patients with moderate-to-severe psoriasis: results from the PHOENIX 1 trial through up to 3 years. Br J Dermatol. 2012;166(4):861–72.

    Article  CAS  PubMed  Google Scholar 

  152. Kimball AB, Gordon KB, Langley RG, et al. Safety and efficacy of ABT-874, a fully human interleukin 12/23 monoclonal antibody, in the treatment of moderate to severe chronic plaque psoriasis: results of a randomized, placebo-controlled, phase 2 trial. Arch Dermatol. 2008;144(2):200–7.

    Article  CAS  PubMed  Google Scholar 

  153. Gordon KB, Papp KA, Langley RG, et al. Long-term safety experience of ustekinumab in patients with moderate to severe psoriasis (part II of II): results from analyses of infections and malignancy from pooled phase II and III clinical trials. J Am Acad Dermatol. 2012;66(5):742–51.

    Article  CAS  PubMed  Google Scholar 

  154. European Medicines Agency. Human medicines: Stelara. EPAR product information. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000958/WC500058513.pdf. Cited 15 Apr 2016.

  155. Landells I, Marano C, Hsu MC, et al. Ustekinumab in adolescent patients age 12 to 17 years with moderate-to-severe plaque psoriasis: results of the randomized phase 3 CADMUS study. J Am Acad Dermatol. 2015;73(4):594–603.

    Article  CAS  PubMed  Google Scholar 

  156. Pharmaceuticals N. A randomized, double-blind, placebo- and active controlled multicenter trial to demonstrate efficacy of subcutaneous secukinumab compared to placebo and etanercept (in a single-blinded arm) after twelve weeks of treatment, and to assess the safety, tolerability, and long-term efficacy in subjects from 6 to less than 18 years of age with severe chronic plaque psoriasis. https://clinicaltrials.gov/ct2/show/NCT02471144. Cited 2017 April 19.

  157. Eli-Lilly C. Multicenter, double-blind, randomized, placebo-controlled study to evaluate safety, tolerability, and efficacy of ixekizumab in patients from 6 to less than 18 years of age with moderate-to-severe plaque psoriasis. https://clinicaltrials.gov/ct2/show/NCT03073200. Accessed 19 Apr 2017.

Download references

Acknowledgements

The authors thank Susana Machado MD and Manuela Selores MD for the clinical images.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tiago Torres.

Ethics declarations

Funding

No sources of funding were received for the preparation of this article.

Conflict of interest

Maria Relvas has no conflicts of interest to disclose. Tiago Torres has participated in clinical trials sponsored by AbbVie, Amgen, and Novartis and has received honoraria for acting as a consultant and/or as a speaker at events sponsored by AbbVie, Boehringer Ingelheim, Janssen, Leo-Pharma, MSD, Novartis, and Pfizer.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Relvas, M., Torres, T. Pediatric Psoriasis. Am J Clin Dermatol 18, 797–811 (2017). https://doi.org/10.1007/s40257-017-0294-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40257-017-0294-9

Navigation