New Pediatric Psoriasis Guideline Released

Information sourced from NEJM Journal Watch:

New Pediatric Psoriasis Guideline

Recommendations address disease severity, screening and treatment related to comorbidities, and therapies for psoriatic symptoms.

Sponsoring Organizations: The American Academy of Dermatology and the National Psoriasis Foundation

Background and Objective: An expert group was convened to answer three primary clinical questions and make recommendations for each based on available evidence. The three questions were:

What are the available screening tools used to effectively measure psoriasis severity and response to therapy in children with psoriasis? (2 recommendations)

What are the available screening and/or therapeutic interventions used to manage comorbidities in children with psoriasis? (23 recommendations)

What are the efficacy, effectiveness, and adverse events of treatments for psoriasis (topical, phototherapy and photochemotherapy, nonbiologic systemic treatments, biologic therapy) in pediatric and adolescent patients? (44 recommendations)

Key Points

Disease severity measurement should include quality of life in addition to traditional measures based on amount of affected body surface area. The Children's Dermatology Life Quality Index (CDLQI) is a 10-question survey that can be used during clinical visits.

Comorbidities known to affect adults with psoriasis may also affect children. Signs and symptoms of the following should be sought routinely [through] history and physical exam, with specialty referrals made as appropriate: psoriatic arthritis, cardiovascular disease, metabolic syndrome, mental health, and inflammatory bowel disease.

Although strong evidence for topical treatments was lacking, corticosteroids and vitamin D analogues (alone or in combination), as well as anthralin, received the strongest recommendations.

Specific photochemotherapeutic, nonbiologic systemic, and biologic treatments received recommendations of varying strengths, but typically would not be used by primary care clinicians.

Due to the potential impact of psoriasis on child and adolescent psycho-emotional development, there should be close partnership between the dermatologist, the patient/family, and the patient's primary care provider.

Patient and family education are essential to effective treatment decisions and disease outcomes.

Substantial gaps in research exist; only 5% of recommendations are based on consistent and good-quality patient-oriented evidence.

COMMENT

While these recommendations will be most relevant to dermatologists, they provide general pediatricians and other child health clinicians with knowledge of current standards and the general lack of strong evidence behind them. Families commonly turn to primary care providers with questions and requests for advice when faced with challenging decisions about their children's chronic illnesses. Staying up to date with current specialty guidelines allows generalists to give informed advice.

John D. Cowden, MD, MPH reviewing Menter A et al. J Am Acad Dermatol 2020 Jan

CITATION(S):

Menter A et al. Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients. J Am Acad Dermatol 2020 Jan; 82:161.
[PubMed® abstract]

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