Key takeaways from new pediatric psoriasis guidelines

MAUI, HAWAII — The triggers of pediatric psoriasis, assessments of the condition’s severity and details about treatments, are among some of the most important takeaways from the recently published American Academy of Dermatology/National Psoriasis Foundation pediatric psoriasis guidelines, according to a speaker here at Maui Derm for Dermatologists 2020.

“There were no big surprises in the guideline,” Lawrence Eichenfield, MD, professor of dermatology and pediatrics, University of California San Diego and Healio Dermatology Peer Perspective Board Member, said. “It’s a nice gift and there is some information that you should know because it does differentiate between pediatric and adult forms of the disease.”

Triggers

He began by discussing triggers for the condition, including emotional stress, BMI, group A Streptococcus, Kawasaki disease and second-hand smoke. Eichenfield also pointed out some of the best questions that dermatologists can ask pediatric patients with psoriasis involving bone stiffness, swelling and limpness.

Monitoring, management

According to Eichenfield, dermatologists should monitor their patients’ lipids and glucose levels if his or her primary care physician does not, and suggest interventions if the patient is obese. He also shared a clinical pearl based on recent studies since the guidelines’ publication: screen for depression.

Additionally, he noted that body surface area should not be the sole factor in determining the severity of a patient’s psoriasis.

“You should also consider the disease’s location on the body, the disease’s impact on social activities and activities that are part of their daily routine as well as the patient’s overall quality of life,” he said.

Treatments

“The topical area of discussion in the guidelines on topicals is pretty straightforward,” Eichenfield said.

Topical corticosteroids, though off-label, are an acceptable form of treatment, he said, as is tacrolimus in the genital and facial areas.

“One thing that is nice within the guidelines document is that there's as a listing of biologics in pediatric psoriasis. Though this list will likely go out of date very quickly, I want you to know it's there.”

Healio has previously reported on other parts of the guidelinnes, including knowledge gaps surrounding the mechanisms of disease onset; etiology; development of comorbidities; systemic treatment options, their ideal dosage and adverse effect profiles; the use of combination therapy and transition between treatment options. – by Janel Miller

Reference: Eichenfield L. Pediatric inflammatory skin disease update. Presented at: Maui Derm for Dermatologists; Jan. 25-29, 2020; Maui, Hawaii.

Disclosures: Eichenfield reports serving as an advisor or investigator for 21 companies, including AbbVie, Allergan and Almirall.