Introduction
Methods
Management of Pediatric Psoriasis: Systemic Therapy
General approach to pediatric psoriasis treatment | |
---|---|
Factors to consider | Special issues |
Patient age | Girls of childbearing potential (avoid retinoids) |
Type of psoriasis (guttate, plaque, pustular or erythrodermic) | Unstable disease (consider cyclosporine) |
Clinical severity of the disease | Presence of psoriatic arthritis (consider methotrexate or biologics) |
Location of psoriasis | Intense physical activity (avoid retinoids) |
Impact on quality of life | |
Psychological burden of the condition | |
Comorbidities (psoriatic arthritis, obesity, etc.) | |
Patient’s previous treatments | |
Patient’s preferences |
Phototherapy
Non-Biologic Systemic Drugs
Drug | Dosage | Side effects | Laboratory monitoring |
---|---|---|---|
Cyclosporine | 1.5 to 5 mg/kg/day | Renal toxicity, hypertension nausea, diarrhea, myalgias, headache, electrolyte abnormalities (hyperkalemia and hypomagnesemia), hyperlipidemia, hypertrichosis, and gingival hyperplasia | Blood count, creatinine, urea, cholesterol, triglycerides, electrolytes |
Fumaric acid esters | ≤720 mg/day | Gastrointestinal complaints, flushes, hematological abnormalities (lymphocytopenia and eosinophilia) | Blood count, liver enzymes |
Methotrexate | 0.2 to 0.7 mg/kg/week | Nausea, vomiting, fatigue, hematological abnormalities, hepatotoxicity, pulmonary toxicity | Blood count, liver enzymes |
Retinoids | ≤0.5 to 1 mg/kg/day | Cheilitis, xerosis, epistaxis and increase of serum lipids and hepatic enzymes Skeletal abnormalities Teratogenicity | Serum lipids and liver enzymes Radiographs of the spine |
Acitretin
Methotrexate
Cyclosporine
Etretinate
Fumaric Acid Esters
Biologic Drugs
Drug | Dosage | Side effects | Laboratory monitoring |
---|---|---|---|
Etanercept | 0.8 mg/kg/week or 0.4 mg/kg twice weekly | Increased risk of infection, injection-site reaction, anaphylaxis, development of anti-nuclear antibodies, lupus-like syndrome, pancytopenia | Blood count, liver enzymes, PPD test annually |
Infliximab | 3–5 mg/kg at weeks 0, 2 and 6 then every 8 weeks | Increased risk of infection, acute infusion reaction, delayed hypersensitivity reaction, anaphylaxis, development of anti-nuclear antibodies, lupus-like syndrome, pancytopenia New onset or exacerbation of demyelinating disorder | Blood count, liver enzymes more frequently than with other TNF-blockers, PPD test annually |
Adalimumab | 0.8 mg/kg (up to maximum 40 mg in total) at week 0 and 1 and then every 2 weeks | Increased risk of infection, injection-site reaction, anaphylaxis, development of anti-nuclear antibodies, lupus-like syndrome, pancytopenia New onset or exacerbation of demyelinating disorder | Blood count, liver enzymes, PPD test annually |
Ustekinumab | 0.750 mg/kg (for patients ≤60 kg; otherwise same dosage for adults) at week 0 and 4 then every 12 weeks | No specific adverse effects reported in clinical trials | Blood count, liver enzymes, PPD test annually |