Conventional and biologic therapy in pediatric psoriasis

Abstract

Psoriasis is a chronic, Th17 immune-mediated, inflammatory skin disease, affecting 1–3% of the population. About one third of disease develops during childhood. At the time there are no international guidelines for pediatric psoriasis. The majority of children with mild disease are successfully treated with topical agents. If topical treatment is not sufficient, narrowband UVB can be introduced. In children with severe forms of psoriasis systemic therapy is indicated. Acitretin is not approved in pediatrics, but can be considered especially in rare erythrodermic or pustular forms. Methotrexate (MTX) and biologic drugs are effective and well tolerated for the treatment of moderate to severe pediatric psoriasis. At the time we have treated two adolescent girls with adalimumab for severe psoriasis. One was overweight (BMI 25.0), while other patient have grade II obesity (BMI 35.5). One patient received adalimumab at the age of almost 18 years old starting with dose of 40 mg every other week. After 16 weeks of treatment response was insufficient (PASI decreased from 24.3 to 14.4, DLQI from 13 to 20), therefore the dosage of adalimumab was increased to 40 mg every week for 13 weeks. However, PASI did not improve (increased up to 18), accordingly patient was suggested to add narrowband UVB phototherapy and MTX 7.5 mg once a week and to return to the standard dosage of adalimumab (40 mg every other week). Although the treatment response has not improved and biologic therapy was discontinued. Other 14 years old patient received standard adalimumab dosage for 2 years. PASI and DLQI scores improved from 32.2 to 8 and from 13 to 1, respectively. In conclusions, our experience show good results of biologic therapy in treatment of pediatric psoriasis, but without achievement of full clear skin in adolescence with overweight.[...].