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 Subsequently, experts rely on unpublished clinical experience and studies of these systemic medications for other pediatric conditions, such as those published in the rheumatologic, transplant,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.
*For a PDF of the full article, click on the link to the left of this introduction.