Systemic Treatment of Psoriasis in Children

Abstract

Childhood psoriasis has a significant impact on the child´s quality of life and those who cannot be managed with topical treatment should be considered for systemic treatment. The majority of systemic therapies used for childhood psoriasis are off-label drug therapies. Evidence-based studies on systemic treatment of childhood psoriasis are scarce, and treatment algorithms are generally based on low-level evidence. A literature search was performed and updated to October 2015 to obtain an up to date overview of relevant systemic treatment in childhood psoriasis. Methotrexate is the conventional first-line of systemic treatment, but the level of evidence for its use is low. Etanercept is FDA approved for psoriasis vulgaris in children, has a documented efficacy and a good safety profile, and is currently the drug for which most evidence for the use in children has been accumulated. Adalimumab and ustekinumab have both recently completed large double-blinded controlled trials testing in childhood psoriasis and both have recently been approved for psoriasis vulgaris in children. Thus a wider range of approved systemic treatment options is becoming available.