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Psoriasis in children: a guide to its diagnosis and management
Insights
Childhood psoriasis diagnosis can be difficult, but various forms exist. Management involves patient/parent education, trigger avoidance, and tailored topical or systemic treatments for effective psoriasis control.
Area of Science:
- Pediatric Dermatology
- Immunodermatology
Background:
- Psoriasis commonly manifests in childhood, presenting diagnostic challenges in mild or atypical cases.
- All adult psoriasis forms, including plaque, guttate, erythrodermic, and pustular, are observed in children, with guttate and flexural types being frequent.
Purpose of the Study:
- To outline the diagnostic considerations and management strategies for pediatric psoriasis.
- To emphasize the importance of patient and parental education and environmental trigger identification.
Main Methods:
- Review of clinical presentations and treatment modalities for childhood psoriasis.
- Discussion of topical therapies (emollients, coal tar, anthralin, calcipotriol), phototherapy, and systemic agents.
Main Results:
- Most children respond to topical treatments; however, daycare or inpatient care may be necessary for non-responders.
- Phototherapy (UVB) can augment topical treatments.
- Systemic therapy is reserved for severe, resistant, or specific forms like erythrodermic, pustular, and psoriatic arthritis.
Conclusions:
- Successful pediatric psoriasis management hinges on comprehensive education and tailored treatment plans.
- Retinoids are often the preferred systemic option, though data on methotrexate and cyclosporine in children is limited.
Abstract:
Psoriasis often presents in childhood. The diagnosis may be challenging if the disease is mild or the presentation is atypical. All of the forms recognised in adults are encountered in childhood (plaque, guttate, erythrodermic and pustular). Guttate and flexural forms are particularly common in children. Successful management requires education of the child and parents regarding the course of the disease and treatment options. Environmental triggers should be sought out and eliminated where possible. Most patients respond to topical treatment with emollients, coal tar, anthralin (dithranol) or calcipotriol. Treatment is tailored according to patient age, extent and distibution of psoriasis. For those who fail to respond, daycare or inpatient care is appropriate. Phototherapy with UVB may be combined with topical agents. Systemic therapy is required in a minority, usually those with resistant or erythrodermic disease, pustular psoriasis and arthropathic psoriasis. Retinoids are probably the systemic agent of choice. There are few data regarding the use of methotrexate or cyclosporin in childhood psoriais.