Q&A: Treating psoriasis in pediatric patients

In approximately one-third of cases, psoriasis begins in pediatric patients, according to the American Academy of Dermatology.

Children with psoriasis deal with unique problems such as the treatment and burden of a life-long disease, along with accompanying mental health issues.

Healio Psoriatic Disease spoke with A. Yasmine Kirkorian, MD, interim chief of the division of dermatology at Children’s National Hospital and associate professor of dermatology and pediatrics at George Washington University School of Medicine & Health Sciences, about these issues and how clinicians and parents can help navigate psoriasis treatment in a pediatric population.

Q: What are some of the unique issues for patients with pediatric psoriasis?

Answer: Pediatric psoriasis is less common than adult psoriasis, so patients may face a delay in diagnosis if clinicians are unfamiliar with pediatric psoriasis. For example, many pediatric patients with psoriasis in my practice have facial involvement as well as inverse psoriasis that may have been mistaken for eczema or irritant dermatitis, especially in the absence of a family history of psoriasis to clue in the diagnosis. Once pediatric patients are diagnosed, treatment can be challenging because there are limited FDA-approved options for systemic treatment of severe disease, and doctors may be hesitant to treat children with systemic medications. Thankfully, pediatric psoriasis has been recognized as an important burden of disease by the FDA, and more clinical trials are taking place in children. Finally, it is critical to take into account the unique psychosocial burden chronic skin disease plays in children.

Q: How do clinicians address these unique issues?

A: Clinicians address the concerns above by being familiar with the clinical presentations of pediatric psoriasis, by being comfortable with a treatment ladder that includes systemic agents and by remaining cognizant of the child’s experience of their disease in the context of their age and psychosocial status.

Q: At school, what social issues can children be exposed to if they have psoriasis?

A: Psoriasis can be well-controlled and does not need to place a burden on children in terms of looking or feeling different from their peers. It is important not to undertreat children, by sticking to topical treatments alone, for example, just because they are children. In the era of COVID, parents have concerns about the risks for immunosuppression with the use of systemic medications in the treatment of psoriasis. Preliminary studies suggest that patients on biologics for treatment of psoriasis do not appear to have a risk for more severe disease associated with COVID infection. This is reassuring to our patients and supports continued treatment of their psoriasis.

Q: How can clinicians help parents and patients navigate these socialissues?

A: It is useful to have parents and children involved with the National Psoriasis Foundation. Children often get more out of meeting peers who have experienced a similar life path than from adults giving advice and reassurance. Camp Discovery is also an incredible resource for our patients.

Q: What advice would you give your fellow clinicians in treating patients with pediatric psoriasis?

A: Children should be treated as aggressively as adults. The treatment should be calibrated based on the same criteria (body surface area, special site involvement, presence of psoriatic arthritis, impact on quality of life, and patient and family preference). Engage patients and their parents in discussions regarding quality of life, self-esteem, pruritus, sleep and treatment goals from the first visit. Be prepared to have these discussions change over time and allow for a dynamic plan as the child ages.

For more information:

A. Yasmine Kirkorian, MD, can be reached at email: glittle@childrensnational.org.