Proactive treatment in childhood psoriasis

Psoriasis affects 0.5% of children. The current therapeutic arsenal includes local treatments, phototherapies and systemic treatments (conventional systemic therapy and biotherapy), which, in most cases, are sufficient to control this skin disease. Subsequent management of these children should focus on maintaining therapeutic efficacy and preventing relapse by reducing any treatment-related toxicity in order to improve their quality of life. It would therefore appear useful to adopt a "proactive" attitude. To be proactive is to anticipate disease progression in order to limit both the severity and the incidence of new flare-ups. This approach must be distinguished from reactive support. Based on our experience of atopic dermatitis and data on adult psoriasis, in the absence of publications specific to childhood-onset psoriasis, herein we propose to provide an overview of this proactive approach in paediatric psoriasis. This proactive management approach concerns four key precepts: therapeutic education: explanation of the disease, its pathophysiology and the various possible therapeutic approaches; prevention of factors triggering flare-ups or worsening psoriatic infections, such as stress, trauma, diet (mainly reduction of obesity); a proactive approach to topical therapy: skin hygiene and use of emollients, but also limitation of active therapies, use of dosing intervals and "weekend therapy" to reduce the risk of relapse; a proactive approach to systemic therapies: improved therapeutic safety, reduced cumulative doses, through reduced doses, use of dosing intervals and weekend therapy. Care for children with psoriasis must be comprehensive and include their environment. The concept of "proactive" treatment in childhood-onset psoriasis can help limit the duration and severity of flare-ups while improving quality of life. Simple measures can in fact ensure effective maintenance of treatments over the long term.