Phototherapy and photochemotherapy in childhood psoriasis

Abstract

Psoriasis affects approximately 2% of the general population and in approximately a third of patients psoriasis starts in the first two decades. Treatment of childhood psoriasis represents a special challenge, since many therapeutic agents are not approved and guidelines are frequently lacking for this age group. It is, however, suggested that calcipotriene with or without topical corticosteroids, followed by dithranol, should be used for topical treatment. For systemic treatment, methotrexate is the first choice followed by etanercept. Phototherapy can be employed without age restrictions if the child is mentally and psychologically able to tolerate the procedure and accepts eye protection. Topical photochemotherapy, such as psoralen plus UVA (PUVA)-bath or cream-PUVA, are preferred over oral PUVA, but should be restricted to those aged over 10 or 16 years, respectively. It is generally agreed upon that phototherapy and photochemotherapy in childhood is effective and well tolerated, but must be employed carefully in selected patients only. Concerns remain regarding long-term side effects. This article reviews available data on UVB phototherapy and photochemotherapy in childhood psoriasis and discusses guidelines consented by dermatologic societies in Europe and the USA. Specific recommendations for the use of UV therapy in childhood are given. © 2011 Expert Reviews Ltd.