AAD Releases First-Ever Guidelines for Treating Paediatric Patients With Psoriasis

November 7, 2019

The American Academy of Dermatology (AAD) and the National Psoriasis Foundation (NPF) have released guidelines to help ensure that paediatric psoriasis patients receive the best possible treatment and care.

The joint AAD/NPF guidelines, published in the Journal of the American Academy of Dermatology, outline best practices for treatment of the disease in this vulnerable population. Developed by board-certified dermatologists, the guidelines are based on the most up-to-date scientific evidence for managing the disease.

“Compared with adults, paediatric patients with psoriasis have a unique physiology, drug tolerance, and patient/caregiver/physician interaction dynamic that can make it more challenging to manage,” said Alan Menter, MD, Baylor University Medical Center, Dallas Texas. “Our goal with the guidelines was to compile the latest research and provide recommendations to help secure the best course of care for this young population, which has to deal with not only skin issues, but also the psychological aspects so common in the paediatric group.”

Because psoriasis can increase a person’s risk of developing certain diseases, like diabetes, the new guidelines address some of those comorbidities in young people:
· The link between obesity and psoriasis is greater for children than adults.
· There may be a link between type 1 diabetes and psoriasis, as insulin resistance in children with psoriasis is estimated to be approximately twice that of children without the condition.
· Inflammatory bowel disease is 3 to 4 times more common in paediatric patients with psoriasis than in kids who don’t have psoriasis.
· Unlike adults with psoriasis, there’s not enough evidence to support a relationship between psoriasis and heart disease in young patients, though experts recommend that children with psoriasis undergo appropriate cardiovascular screening, regardless.

“In the young population, psoriasis flare-ups can be associated with emotional stress, increased body mass index, second-hand cigarette smoke, strep infection, and corticosteroid withdrawal,” said Craig Elmets, MD, University of Alabama at Birmingham, Birmingham, Alabama.

That emotional stress can also manifest psychosocially in children with visible skin disease.

“We’ve found that pediatric psoriasis patients have higher rates of depression and anxiety than their peers and use psychiatric medications more frequently,” said Dr. Menter. “Those are all addressed in these guidelines in the hopes that more people will recognise the seriousness of this disease in young people.”

Also outlined in the guidelines are the physical symptoms of the disease, which can include pain and itchiness along with stinging, burning, and tightening sensations. Itch is highlighted as an under-recognised, serious symptom that plagues paediatric patients with psoriasis and aggravates and spreads the psoriasis lesions.

Reference: https://www.jaad.org/article/S0190-9622(19)32655-6%20/fulltext

SOURCE: American Academy of Dermatology