(LifeWire) - For many people afflicted with psoriasis, relief has finally arrived from a group of drugs called biologics - injectable medications developed over the last decade that are hailed for their ability to clear up even severe cases of psoriasis.
But biologics are among several successful psoriasis treatments for adults that have yet to be approved for children.
Approximately 10% of the 6 million psoriasis patients in the United States are children age 17 or younger. Usually, the red, scaly patches associated with psoriasis appear on the knees, elbows and lower back, or the scalp and face. In children, these lesions are often confused with other skin conditions, such as diaper rash.
As with adults, children who develop psoriasis have a genetic predisposition to the chronic immune system disorder, and can expect to suffer outbreaks that vary in length and severity throughout their lives.
Topical creams and ointments are the first choice treatments for outbreaks, followed by phototherapy, which uses ultraviolet light to slow down the overproduction of skin cells. But if these remedies do not work - and the stubborn nature of psoriasis means that even if they do, they might not work for long - doctors often turn to medications such as pills or biologics that treat the entire body.
Biologics have not yet been approved for use by children by the FDA, requiring physicians who choose to prescribe this class of drugs to do so "off-label." However, a 2008 study published in the New England Journal of Medicine showed that one biologic drug -- Enbrel (etanercept) -- significantly improved psoriasis symptoms in children with moderate or severe cases.
In this study, the first such trial of biologics done with children, researchers found that 57% of the 211 child subjects experienced at least a 75% reduction in their symptoms and an improved quality of life. Only 11% of children who received a placebo had the same result.
Enbrel hinders both the overproduction of skin cells and the inflammation of the skin that's seen with psoriasis, much like Amevive (alefacept). The medication is injected with a pre-dosed, pen-like syringe that a psoriasis sufferer can give him- or herself.
Since biologics act by suppressing some functions of the immune system, doctors must take care in prescribing them for certain people, including those whose immune systems are already weakened because of other illness or infection. Potential side effects of these medications include injection-site reactions (redness, swelling), flu-like symptoms and respiratory infections, though these tend to be mild.
Another reason biologics are prescribed with care is that long-term side effects are still being studied. In June 2008, the FDA announced that it was investigating the development of cancers in 30 children and young adults who use a class of drugs called tumor necrosis factor (TNF) inhibitors, which includes Enbrel. The youths were taking the TNF inhibitor drugs to treat a form of juvenile arthritis and Crohn's disease.
The Dermatologic FDA Advisory Committee has recommended Enbrel for approval for the treatment of psoriasis in children age 4 to 17. However, because its safety in children is still under review, final FDA approval is still pending.
Only a few psoriasis therapies are FDA-approved for pediatric use, including Dovonex (calcipotriene) and Protopic (tacrolimus), which are topical ointments, and ultra violet B (UVB) phototherapy, which is permitted for use in children as young as age 14.Sources:
"Children and Psoriasis." Psoriasis-Association.org. 2008. The Psoriasis Association. 17 Jun 2008 <http://www.psoriasis-association.org.uk/children.html>.
Paller, AS., et. al.. "Etanercept Treatment for Children and Adolescents with Plaque Psoriasis." New England Journal of Medicine. 358:17(2008): 241-251. 17 Jun 2008. <http://content.nejm.org/cgi/content/full/358/3/241>. (subscription)
"Taking Biologics." Psoriasis.org. Nov 2006. National Psoriasis Foundation. 20 Jun 2008. <http://www.psoriasis.org/treatment/psoriasis/biologics/taking.php>.
"Treating Children with Psoriasis." Psoriasis.org. Nov 2006. National Psoriasis Foundation. 17 Jun 2008. <http://www.psoriasis.org/publications/advance/200606_kids.php.>.
