Challenges in Pediatric Plaque Psoriasis

Pediatric Psoriasis: A Growing Understanding and Need for More Options

Psoriasis, often mistakenly assumed to be an adult-only condition, is surprisingly prevalent in children. In fact, approximately 30% of children develop psoriasis, with unique presentations often seen in this younger demographic.

This was the focus of a recent Dermatology Times DermView video series, “Advancing Care in Pediatric Plaque Psoriasis: Emerging Treatments and Management Strategies,” featuring Karan Lal, DO, and Helen Shin, MD. Both experts shed light on the challenges and advancements in treating pediatric psoriasis.

Psoriasis Longevity and Presentation

Dr. Shin, who specializes in pediatric dermatology, notes that while some children experience temporary psoriasis, many others face ongoing challenges with the disease. She emphasizes the importance of recognizing the diversity of presentations, particularly in children with skin of color, to ensure accurate diagnosis and tailored treatment.

“It changes the whole discussion and management pattern,” says Dr. Lal, highlighting the need for a multidisciplinary approach to pediatric psoriasis.

Addressing the Psychological Impact

Beyond the physical symptoms, psoriasis can significantly impact a child’s social and emotional well-being. Dr. Shin emphasizes the importance of addressing the psychosocial aspects of the disease, noting that children may feel embarrassed, ashamed, or experience anxiety and depression.

She recommends connecting with pediatric or adolescent psychiatrists for specialized support, acknowledging that access to such services can be challenging.

Personalized Treatment Plans

Dr. Shin prioritizes a safe and effective approach to treatment, often starting with low-potency topical steroids and calcineurin inhibitors. She shares her positive experiences with roflumilast cream (Zoryve), a recent FDA-approved treatment for children 6 years and older, especially its effectiveness and ease of use.

While advancements in biologics have revolutionized treatment, both doctors acknowledge the need for more options. Liquid formulations, oral systemics, and therapies requiring less monitoring are high on their wish list.

Challenges in Treating Comorbidities

Overlapping conditions like eczema and psoriasis present unique challenges for treatment. Dr. Shin describes the difficulty of managing both concurrently, as treating one condition can exacerbate the other. Phototherapy, both natural and artificial, emerges as a valuable tool in these complex cases.

Early Diagnosis: Benefits and Research Gaps

Dr. Shin emphasizes the potential benefits of early diagnosis, particularly for the psychosocial well-being of children. Dr. Lal agrees, highlighting how early diagnosis opens the door to support resources and empowers patients to take control of their condition.

Despite the progress made, both doctors identify the need for more research, particularly on the long-term effects of early intervention and comorbidity rates. They also advocate for data on malignancy risk associated with psoriasis treatments, a concern shared by many patients.