Anna Belloni Fortina1, Federico Bardazzi2, Samantha Berti3, Claudia Carnevale4, Vito Di Lernia5, Maya El Hachem4, Iria Neri2, Carlo Mario Gelmetti6, Viviana Lora7, Carlo Mazzatenta8, Mirella Milioto9, Gaia Moretta10, Annalisa Patrizi2, Ketty Peris10, Alberto Villani11. 1. Pediatric Dermatology Unit, Department of Medicine, University of Padua, Via Gallucci, 4, 35128, Padova, Italy. anna.bellonifortina@gmail.com. 2. Dermatology Unit, Department of Specialistic, Diagnostic and Experimental Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. 3. Dermatology Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy. 4. Dermatology Unit, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy. 5. Dermatology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy. 6. Pediatric Dermatology Unit, Fondazione IRCCS Ca' Granda "Ospedale Maggiore Policlinico", Milan Department of Pathophysiology and Transplantation, University of Milan, Milano, Italy. 7. Center for the Study and Treatment of Psoriasis, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy. 8. Dermatology Unit, "Campo di Marte" Hospital, Azienda USL 2, Lucca, Italy. 9. Dermatology Unit, Ospedale Civico di Cristina Benfratelli, Palermo, Italy. 10. Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy. 11. General Pediatrics and Infectious Disease, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy.
Abstract
This article provides comprehensive recommendations for the systemic treatment of severe pediatric psoriasis based on evidence obtained from a systematic review of the literature and the consensus opinion of expert dermatologists and pediatricians. For each systemic treatment, the grade of recommendation (A, B, C) based on the treatment's approval by the European Medicines Agency for childhood psoriasis and the experts' opinions is discussed. The grade of recommendation for narrow-band-ultraviolet B phototherapy, cyclosporine, and retinoids is C, while that for methotrexate is C/B. The use of adalimumab, etanercept, and ustekinumab has a grade A recommendation. No conventional systemic treatments are approved for pediatric psoriasis. Adalimumab is approved by the European Medicines Agency as a first-line treatment for severe chronic plaque psoriasis in children (≥ 4 years old) and adolescents. Etanercept and ustekinumab are approved as second-line therapy in children ≥ 6 and ≥ 12 years, respectively. CONCLUSION: A treatment algorithm as well as practical tools (i.e., tabular summaries of differential diagnoses, treatment mechanism of actions, dosing regimens, control parameters) are provided to assist in therapeutic reasoning and decision-making for individual patients. These treatment recommendations are endorsed by major Italian Pediatric and Dermatology Societies. What is Known: • Guidelines for the treatment of severe pediatric psoriasis are lacking and most traditional systemic treatments are not approved for use in young patients. Although there has been decades of experience with some of the traditional agents such as phototherapy, acitretin, and cyclosporine in children, there are no RCTs on their pediatric use while RCTs investigating new biologic agents have been performed. What is New: • In this manuscript, an Italian multidisciplinary team of experts focused on treatment recommendations for severe forms of psoriasis in children based on an up-to-date review of the literature and experts' opinions.
This article provides comprehensive recommendations for the systemic treatment of severe pediatric psoriasis based on evidence obtained from a systematic review of the literature and the consensus opinion of expert dermatologists and pediatricians. For each systemic treatment, the grade of recommendation (A, B, C) based on the treatment's approval by the European Medicines Agency for childhood psoriasis and the experts' opinions is discussed. The grade of recommendation for narrow-band-ultraviolet B phototherapy, cyclosporine, and retinoids is C, while that for methotrexate is C/B. The use of adalimumab, etanercept, and ustekinumab has a grade A recommendation. No conventional systemic treatments are approved for pediatric psoriasis. Adalimumab is approved by the European Medicines Agency as a first-line treatment for severe chronic plaque psoriasis in children (≥ 4 years old) and adolescents. Etanercept and ustekinumab are approved as second-line therapy in children ≥ 6 and ≥ 12 years, respectively. CONCLUSION: A treatment algorithm as well as practical tools (i.e., tabular summaries of differential diagnoses, treatment mechanism of actions, dosing regimens, control parameters) are provided to assist in therapeutic reasoning and decision-making for individual patients. These treatment recommendations are endorsed by major Italian Pediatric and Dermatology Societies. What is Known: • Guidelines for the treatment of severe pediatric psoriasis are lacking and most traditional systemic treatments are not approved for use in young patients. Although there has been decades of experience with some of the traditional agents such as phototherapy, acitretin, and cyclosporine in children, there are no RCTs on their pediatric use while RCTs investigating new biologic agents have been performed. What is New: • In this manuscript, an Italian multidisciplinary team of experts focused on treatment recommendations for severe forms of psoriasis in children based on an up-to-date review of the literature and experts' opinions.
Authors: D Thaçi; K Papp; D Marcoux; L Weibel; A Pinter; P-D Ghislain; I Landells; P H Hoeger; K Unnebrink; M M B Seyger; D A Williams; S Rubant; S Philipp Journal: Br J Dermatol Date: 2019-07-25 Impact factor: 9.302
Authors: C Bodemer; A Kaszuba; K Kingo; A Tsianakas; A Morita; E Rivas; P Papanastasiou; D Keefe; M Patekar; P Charef; L Zhang; S Cafoncelli; C Papavassilis Journal: J Eur Acad Dermatol Venereol Date: 2021-01-19 Impact factor: 6.166
Authors: Bhumesh Kumar Katakam; Malathi Munisamy; T Narayana Rao; Minu Jose Chiramel; Maitreyee Panda; Sandeep Gupta; Ranugha Pss; K A Seetharam Journal: Indian Dermatol Online J Date: 2021-11-25