First-ever guidelines for pediatric psoriasis treatment released

American Academy of DermatologyNov 5 2019

One-third of psoriasis cases begin in the pediatric years, and onset is most common during adolescence for the chronic, multisystem, inflammatory skin disease that causes the skin to develop new skin cells too rapidly. That's why the American Academy of Dermatology (AAD) and the National Psoriasis Foundation (NPF) are releasing guidelines to help ensure that pediatric psoriasis patients receive the best possible treatment and care.

The joint AAD/NPF 'Guidelines of Care for the Management and Treatment of Psoriasis in Pediatric Patients,' published today in the Journal of the American Academy of Dermatology, outline best practices for treatment of the disease in this vulnerable population. Developed by board-certified dermatologists, the guidelines are based on the most up-to-date scientific evidence for managing the disease.

Compared to adults, pediatric psoriasis patients have a unique physiology, drug tolerance and patient/caregiver/physician interaction dynamic that can make it more challenging to manage. Our goal with the guidelines was to compile the latest research and provide recommendations to help secure the best course of care for this young population, which has to deal with not only skin issues, but also the psychological aspects so common in the pediatric group."

Alan Menter, MD, FAAD, board-certified dermatologist, co-chair of the AAD's Psoriasis Guideline Workgroup

Because psoriasis can increase a person's risk of developing certain diseases, like diabetes, the new guidelines address some of those comorbidities in young people:

• The link between obesity and psoriasis is greater for children than adults.
• There may be a link between type 1 diabetes and psoriasis, as insulin resistance in children with psoriasis is estimated to be approximately twice that of children without the condition.
• Inflammatory bowel disease is three to four times more common in pediatric psoriasis patients than in kids who don't have psoriasis.
• Unlike adult psoriasis patients there's not enough evidence to support a relationship between psoriasis and heart disease in young patients, though experts recommend that children with psoriasis undergo appropriate cardiovascular screening, regardless.

In general, psoriasis can be exacerbated by multiple factors, including infections, stressors and skin trauma. "Specifically in the young population, psoriasis flare-ups can be associated with emotional stress, increased body mass index, second-hand cigarette smoke, strep infection and corticosteroid withdrawal," said board-certified dermatologist and AAD Psoriasis Guideline Workgroup co-chair Craig Elmets, MD, FAAD.

That emotional stress can also manifest psychosocially in children with visible skin disease. Dr. Menter points out that kids with psoriasis are susceptible to bullying, name-calling and shaming at school and in other social settings.

"We've found that pediatric psoriasis patients have higher rates of depression and anxiety than their peers and use psychiatric medications more frequently," he said. "Those are all addressed in these guidelines in the hopes that more people will recognize the seriousness of this disease in young people."

Also outlined in the guidelines are the physical symptoms of the disease, which can include pain and itchiness along with stinging, burning and tightening sensations. Itch is highlighted as an under-recognized, serious symptom that plagues pediatric psoriasis patients and aggravates and spreads the psoriasis lesions. As president and CEO of the National Psoriasis Foundation Randy Beranek notes, these burdens take a heavy toll on children with the disease.

"The physical and emotional impact of psoriasis is tremendous, especially for our most vulnerable population: children. Treating pediatric patients with guidelines based on the most recent scientific information gives health care providers the best chance at finding the most successful course of treatment that enables children to live a healthy life," said Beranek.

There's no cure for psoriasis; however, getting treatment from a board-certified dermatologist and making lifestyle changes can help control the condition. Dr. Elmets recommends these tips to help manage psoriasis:

• Identify (and avoid) the patients' triggers
• Stick to a good psoriasis skin care routine
• Live a healthy lifestyle
• Use appropriate medications as needed

"Psoriasis is a life-long condition, so as dermatologists, it's imperative to empower and educate patients, caregivers and primary care providers regarding this disease," said board-certified dermatologist George J. Hruza, MD, MBA, FAAD, president of the AAD. "These guidelines were created to help optimize patient care outcomes, ensure patient satisfaction and afford pediatric psoriasis patients a better quality of life."