Treatment of severe psoriasis in children: recommendations of an Italian expert group

Anna Belloni Fortina, Federico Bardazzi, Samantha Berti, Claudia Carnevale, Vito Di Lernia, Maya El Hachem, Iria Neri, Carlo Mario Gelmetti, Viviana Lora, Carlo Mazzatenta, Mirella Milioto, Gaia Moretta, Annalisa Patrizi, Ketty Peris, Alberto Villani

Research output: Contribution to journalArticle

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.(Table presented.)

Original languageEnglish
Pages (from-to)1339–1354
Number of pages16
JournalEuropean Journal of Pediatrics
Volume176
Issue number10
DOIs
Publication statusPublished - 2017

Fingerprint

Psoriasis
Therapeutics
Expert Testimony
Pediatrics
Phototherapy
Retinoids
Dermatology
Methotrexate
Cyclosporine
Consensus
Decision Making
Differential Diagnosis

Keywords

  • Biologics
  • Consensus
  • Pediatric
  • Psoriasis
  • Systemic therapy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Treatment of severe psoriasis in children : recommendations of an Italian expert group. / Fortina, Anna Belloni; Bardazzi, Federico; Berti, Samantha; Carnevale, Claudia; Di Lernia, Vito; El Hachem, Maya; Neri, Iria; Gelmetti, Carlo Mario; Lora, Viviana; Mazzatenta, Carlo; Milioto, Mirella; Moretta, Gaia; Patrizi, Annalisa; Peris, Ketty; Villani, Alberto.

In: European Journal of Pediatrics, Vol. 176, No. 10, 2017, p. 1339–1354.

Research output: Contribution to journalArticle

Fortina, AB, Bardazzi, F, Berti, S, Carnevale, C, Di Lernia, V, El Hachem, M, Neri, I, Gelmetti, CM, Lora, V, Mazzatenta, C, Milioto, M, Moretta, G, Patrizi, A, Peris, K & Villani, A 2017, 'Treatment of severe psoriasis in children: recommendations of an Italian expert group', European Journal of Pediatrics, vol. 176, no. 10, pp. 1339–1354. https://doi.org/10.1007/s00431-017-2985-x
Fortina, Anna Belloni ; Bardazzi, Federico ; Berti, Samantha ; Carnevale, Claudia ; Di Lernia, Vito ; El Hachem, Maya ; Neri, Iria ; Gelmetti, Carlo Mario ; Lora, Viviana ; Mazzatenta, Carlo ; Milioto, Mirella ; Moretta, Gaia ; Patrizi, Annalisa ; Peris, Ketty ; Villani, Alberto. / Treatment of severe psoriasis in children : recommendations of an Italian expert group. In: European Journal of Pediatrics. 2017 ; Vol. 176, No. 10. pp. 1339–1354.
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