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 language | English |
|---|---|
| Pages (from-to) | 1339–1354 |
| Number of pages | 16 |
| Journal | European Journal of Pediatrics |
| Volume | 176 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - 2017 |
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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 journal › Article
}
TY - JOUR
T1 - Treatment of severe psoriasis in children
T2 - recommendations of an Italian expert group
AU - Fortina, Anna Belloni
AU - Bardazzi, Federico
AU - Berti, Samantha
AU - Carnevale, Claudia
AU - Di Lernia, Vito
AU - El Hachem, Maya
AU - Neri, Iria
AU - Gelmetti, Carlo Mario
AU - Lora, Viviana
AU - Mazzatenta, Carlo
AU - Milioto, Mirella
AU - Moretta, Gaia
AU - Patrizi, Annalisa
AU - Peris, Ketty
AU - Villani, Alberto
PY - 2017
Y1 - 2017
N2 - 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.)
AB - 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.)
KW - Biologics
KW - Consensus
KW - Pediatric
KW - Psoriasis
KW - Systemic therapy
UR - http://www.scopus.com/inward/record.url?scp=85028020602&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85028020602&partnerID=8YFLogxK
U2 - 10.1007/s00431-017-2985-x
DO - 10.1007/s00431-017-2985-x
M3 - Article
AN - SCOPUS:85028020602
VL - 176
SP - 1339
EP - 1354
JO - European Journal of Pediatrics
JF - European Journal of Pediatrics
SN - 0340-6199
IS - 10
ER -