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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Onset of psoriasis in childhood and adolescence has a significant impact on the patient&#39;s physical and psychological health&#46; The disease is associated with decreased quality of life and reduced self confidence&#44; and therefore requires specific management&#46; Patients and their parents must receive detailed information about the disease and its course&#46; While most of these patients present mild forms of psoriasis that can be controlled with topical treatments&#44; systemic therapy is required in some cases&#46; There is scant evidence in the literature on the use in children of the classic systemic therapies &#40;ciclosporin&#44; methotrexate&#44; and acitretin&#41;&#46; Moreover&#44; because these drugs are not approved for use in pediatric patients&#44; their use in this setting is deemed off-label despite the considerable experience accumulated by dermatologists&#46; The biologic agents that have demonstrated efficacy and safety in randomized clinical trials and are currently approved for use in children are etanercept &#40;from age 6&#41;&#44; adalimumab &#40;from age 4&#41;&#44; and ustekinumab &#40;from age 12&#41;&#46; The use of other molecules in patients aged under 18 is currently under study&#44; and more drugs will very likely become available in the coming years&#46; Immunological differences between pediatric and adult psoriasis are also being studied and the results of that research may open the way to new therapeutic approaches&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">It is important to understand the management in clinical practice of this disease in Spain since there are few studies in the literature and there are no guidelines for clinical dermatologists&#46; The study reported in this issue analyzed data from 40 patients with psoriasis aged under 18 years who were treated with phototherapy or systemic drugs in 7 hospitals in Galicia over a 12-year period&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> It is interesting to note that 30&#37; of those patients had guttate psoriasis&#44; a high proportion that reflects the greater frequency of this form of the disease in the pediatric population&#46; The treatment most often prescribed was phototherapy&#44; followed by methotrexate&#44; acitretin&#44; ciclosporin&#44; etanercept and adalimumab&#44; in that order&#46; In total&#44; 88&#37; of the patients had a good or partial response at week 12&#44; a percentage that fell to 68&#37; &#40;excluding phototherapy&#41; at week 24&#46; Phototherapy was effective in 80&#37; of the patients treated&#44; demonstrating good safety and effectiveness&#46; It is&#44; therefore&#44; important to highlight the need for measures that will improve accessibility to this resource in Spain&#46; Six patients were treated with biologic drugs&#58; 4 with etanercept &#40;75&#37; with a good response at week 24&#41; and 2 with adalimumab &#40;good response in both patients at week 24&#41;&#46; All the treatments were well tolerated&#46; Adverse events were scarce and in no case led to withdrawal of treatment&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The study did not include any patients with psoriatic arthritis and 10&#37; of the patients were obese&#59; these proportions were lower than those reported in the literature for similar groups&#46; One aspect of great importance is the systemic nature of psoriasis and the need for multidisciplinary management starting in childhood&#44; with particular emphasis on psychiatric disorders &#40;anxiety and depression&#41;&#44; metabolic syndrome&#44; and joint involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> It is essential that our healthcare system provide these patients and their families maximum social support so that they can&#44; as far as is possible&#44; achieve a return to normality in their daily lives&#46;</p></span>"
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Commentary
Moderate to Severe Psoriasis in Childhood and Adolescence: A Therapeutic Challenge
Psoriasis moderada-grave en la infancia y la adolescencia: un reto terapéutico
P. de la Cueva Dobao
Servicio de Dermatología, Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Onset of psoriasis in childhood and adolescence has a significant impact on the patient&#39;s physical and psychological health&#46; The disease is associated with decreased quality of life and reduced self confidence&#44; and therefore requires specific management&#46; Patients and their parents must receive detailed information about the disease and its course&#46; While most of these patients present mild forms of psoriasis that can be controlled with topical treatments&#44; systemic therapy is required in some cases&#46; There is scant evidence in the literature on the use in children of the classic systemic therapies &#40;ciclosporin&#44; methotrexate&#44; and acitretin&#41;&#46; Moreover&#44; because these drugs are not approved for use in pediatric patients&#44; their use in this setting is deemed off-label despite the considerable experience accumulated by dermatologists&#46; The biologic agents that have demonstrated efficacy and safety in randomized clinical trials and are currently approved for use in children are etanercept &#40;from age 6&#41;&#44; adalimumab &#40;from age 4&#41;&#44; and ustekinumab &#40;from age 12&#41;&#46; The use of other molecules in patients aged under 18 is currently under study&#44; and more drugs will very likely become available in the coming years&#46; Immunological differences between pediatric and adult psoriasis are also being studied and the results of that research may open the way to new therapeutic approaches&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">It is important to understand the management in clinical practice of this disease in Spain since there are few studies in the literature and there are no guidelines for clinical dermatologists&#46; The study reported in this issue analyzed data from 40 patients with psoriasis aged under 18 years who were treated with phototherapy or systemic drugs in 7 hospitals in Galicia over a 12-year period&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> It is interesting to note that 30&#37; of those patients had guttate psoriasis&#44; a high proportion that reflects the greater frequency of this form of the disease in the pediatric population&#46; The treatment most often prescribed was phototherapy&#44; followed by methotrexate&#44; acitretin&#44; ciclosporin&#44; etanercept and adalimumab&#44; in that order&#46; In total&#44; 88&#37; of the patients had a good or partial response at week 12&#44; a percentage that fell to 68&#37; &#40;excluding phototherapy&#41; at week 24&#46; Phototherapy was effective in 80&#37; of the patients treated&#44; demonstrating good safety and effectiveness&#46; It is&#44; therefore&#44; important to highlight the need for measures that will improve accessibility to this resource in Spain&#46; Six patients were treated with biologic drugs&#58; 4 with etanercept &#40;75&#37; with a good response at week 24&#41; and 2 with adalimumab &#40;good response in both patients at week 24&#41;&#46; All the treatments were well tolerated&#46; Adverse events were scarce and in no case led to withdrawal of treatment&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The study did not include any patients with psoriatic arthritis and 10&#37; of the patients were obese&#59; these proportions were lower than those reported in the literature for similar groups&#46; One aspect of great importance is the systemic nature of psoriasis and the need for multidisciplinary management starting in childhood&#44; with particular emphasis on psychiatric disorders &#40;anxiety and depression&#41;&#44; metabolic syndrome&#44; and joint involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> It is essential that our healthcare system provide these patients and their families maximum social support so that they can&#44; as far as is possible&#44; achieve a return to normality in their daily lives&#46;</p></span>"
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