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Psoriasis in Children: Features and Treatments

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Updated April 08, 2008

Psoriasis in childhood may sometimes differ from adult psoriasis in its presentation and treatment. For the youngest infants, a difficult diaper rash may in fact be a form of psoriasis. Older children may fist experience guttate psoriasis after a bout of streptococcal pharangitis or "strep throat." Strep cellulits of the perianal area may be a trigger which can escape detection unless proper bacterial cultures are performed.

Oftentimes, psoriasis in children presents just as in adults with thick red scaly plaques. Occasionally, these are seen in flexural areas mimicking eczema rather than in the more commonly seen elbow and knee areas. Psoriasis of the flexures is often moist rather than scaly and is termed "inverse psoriasis." For the unfortunate few, severe whole-body erythrodermic psoriasis or pustular psoriasis is the form seen.

Treatment of childhood psoriasis is confounded by the lack of clinical trials and FDA approval of many psoriasis drugs for children. Simple measures such as generous moisturizer use and judicious exposure to natural sunlight can be helpful. Dovonex is approved for use in children 6 years of age and older. Protopic is currently approved for atopic dermatitis (eczema) in children, but is often useful for psoriasis as well, especially facial and inverse psorasis (an off-label use). Phototherapy with NB-UVB has been used in children as young as 14 for severe psoriasis.

Systemic treatments are usually reserved for severe psoriasis due to side effects and the lack of controlled studies with these drugs in children. Psoriasis treatments including retinoids like Soriatane, methotrexate and cyclosporine have been used for pustular psoriasis in children. Biologic drugs represent a quantum leap in the therapy of childhood psoriasis. Enbrel has been approved for use in children as young as 2 for idiopathic arthritis. A study showed that Enbrel was highly effective for children with plaque type psoriasis as well, however it has not yet been approved by the FDA for this indication.

Sources:

Skin & Aging - ISSN: 1096-0120 - Volume 12 - Issue 1_2004 - January 2004 - Pages: 70 - 76.

Paller A, et al "Etanercept treatment for children and adolescents with plaque psoriasis" N Engl J Med 2008; 358: 241-51.

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