Psoriasis vulgaris in children

Pediatric psoriasis.

Childhood psoriasis.

Cases of plaque psoriasis in children <2 years of age have also been published.

Tendentially, the prevalence increases with age.

A prevalence of about 1% is assumed for all children and adolescents.

Multifactorial

Genetic predisposition

Triggers, e.g. infections, Köbner phenomenon, emotional stress, obesity, passive smoking, paradoxical reaction under tumour necrosis factor (TNF) α-blockers. Otherwise, drug triggers in children are rather rare.

Sharply demarcated, erythematous plaques with whitish-silvery scaling.

The diagnosis can be made clinically.

A thorough family history is useful.

In some cases, a biopsy must be done to confirm the diagnosis.

If tinea corporis cannot be clearly ruled out clinically, a mycology should be done.

It is important to take a history of joint complaints, GI complaints and diabetes mellitus.

If the diagnosis of tinea corporis cannot be clearly ruled out clinically, mycology should be performed

Poriatic nail changes are already possible in childhood.

Mostly on the capillitium, elbows, periumbilical, knee and rima ani. However, almost any localisation can be affected

In young children, nappy psoriasis may occur.

-Psoriatic arthritis

-Chronic inflammatory bowel disease is associated

-Adult metabolic syndrome

General measures:

We recommend consistent re-lubrication. This can be done, for example, with Excipial U Lipolotio®, Antidry® or Dexeryl® (1-2 times a day) and moisturising shower solution (1x a day DerMed®).

For people with a bath, we recommend Balneum Hermal Plus®, or alternatively Soufrol® bath solution for severe scaling.

Topical therapy

• Combination preparations are preferable to isolated steroids. We use vitamin D analogue / class III dermocorticoids (calcipotriol & betamethasone) as foam (Enstilar®) 1x tgl, ointment (Daivobet®) 1x tgl, lipogel (Daivobet®) 1x tgl
• Dermocorticoids
  • Class II: (medium strength) clobetasone (clobetasone-17 butyras) (Emovate®) cream / ointment. If possible, do not use stronger preparations on the face.
  • Class III (strong-acting) mometasone furoate (mometasoni-17 furoas) (Elocom®) cream / solution / ointment. Mometasone has a lower atrophy risk than other class III steroids such as triamcinolone.
• Calcipotriol and calcipotriene in isolation are of very slow benefit, may cause intertriginous irritation and we only prescribe on request.
• In young children, the cortisone creams can be mixed with e.g. Dexeryl® to prevent skin atrophy
• Alternatively, calcineurin inhibitors such as tacrolimus ointment 0.03% or 0.1% 2x daily (Protopic®) or pimecrolimus (Elidel®) can be used.

Phototherapy

• More cautious with children, but depending on skin type. The Joint American Academy of Dermatology primarily recommends the use of UVB 311 nm.

Systemic therapy (small molecules, for prescribing see the chapter on the drugs themselves)

According to the guidelines of the American Academy of Dermatology, methotrexate, ciclosporin, acitretin, as well as fumaric acid esters are all recommended.

• Methotrexate s.c. 15 mg 1x weekly. Start with 10 mg 1x weekly. Weekly increase by 2.5 mg until 15 mg is reached. Folic acid p.o. 5 mg 1-0-0 the following day to reduce side effects.
• Ciclosporin p.o. 3-5 mg/kg bw daily to be taken independently of meals. Can only be used in the short term because of nephrotoxicity and other side effects, but is very good as a rapid intervention.
• Acitretin 0.1-1 mg/kg bw daily.
• Fumaric acid ester (Skilarence®): creeping oral dosing.

Biologics (for prescription, see the chapter on the medicines themselves)

• Phosphodiesterase 4 inhibitors. Apremilast p.o.-insufficient data
• According to the American Academy of Dermatology guidelines, etanercept, adalimumab, infliximab and Stelara are recommended.
• IL12/23 antibody
  • Ustekinumab s.c.: At weeks 0, 4, and 16, then every 3 months
    • 0.75 mg/kg <60 kg
    • 45 mg ≤ 100 kg
    • 90 mg > 100 kg.
• TNF-alpha antibody
  • Etanercept 1x weekly 0.8 mg/kg bw,max 50mg weekly
  • Adalimumab (biosimilars) s.c. 0.8 mg/kg (max, 40 mg) at week 0.1, and then every 2 weeks
  • Infliximab 5 mg/kg at weeks 0, 2, and 6 and then every 8 weeks.

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