Review
Efficacy and safety of treatments for childhood psoriasis: A systematic literature review

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Background

Evidence-based recommendations for therapeutic decision making in childhood psoriasis are lacking.

Objectives

We sought to systematically review all available literature concerning treatment efficacy and safety in childhood psoriasis and to propose a recommendation for topical and systemic treatment of childhood psoriasis.

Methods

Databases searched were PubMed, EMBASE, and the Cochrane Controlled Clinical Trial Register. All studies reporting on efficacy and safety of all treatment options in childhood psoriasis were obtained and a level of evidence was determined.

Results

Literature search revealed 2649 studies, of which 64 studies met the inclusion criteria. The majority of topical and systemic therapies given in childhood psoriasis are efficacious. Short-term side effects were usually mild; long-term side effects were not described.

Limitations

Most conclusions formulated are not based on randomized controlled trials.

Conclusions

A rough summary of the proposed algorithm is as follows: first, calcipotriene with/without topical corticosteroids, followed by dithranol. Methotrexate is considered to be the systemic treatment of choice.

Section snippets

Methods

Three bibliographic databases were searched for articles published from January 1980 to September 2008: PubMed, EMBASE, and the Cochrane Controlled Clinical Trial Register. “Psoriasis,” “child,” and “treatment” were used as main key words, including all possible synonyms and antipsoriatic treatments (generic names and brand names). Languages were limited to English, German, and Dutch. Full details on the search strategy are available from the corresponding author on request. Because the

Results

In the results, all 116 full text articles are presented, as are the reasons for exclusion of 52 articles. The details on the 64 studies included are summarized in Table III.

Discussion

Literature concerning treatment efficacy and safety in childhood psoriasis is diverse. After thorough inspection of all literature, 64 studies could be included, describing 646 children in total. Of these 64 studies, only 6 were RCTs. Because of the paucity of RCTs, all LOEs were included in this study.

Most literature concerns induction of remission, rather than maintenance therapy. Although some studies describe treatment durations of up to almost 3.5 years,87 these are exceptional and

References (129)

  • A.D. Burden

    Management of psoriasis in childhood

    Clin Exp Dermatol

    (1999)
  • K. Zappel et al.

    Therapy options for psoriasis in childhood and adolescence [in German]

    J Dtsch Dermatol Ges

    (2004)
  • Oxford Center for Evidence-based Medicine Levels of Evidence. Home page (May 2001). Available from: URL:...
  • J.P. Rattet et al.

    Diaper dermatitis with psoriasiform ID eruption

    Int J Dermatol

    (1981)
  • M. Watanabe et al.

    Explosive diaper pustular psoriasis

    Pediatr Dermatol

    (2002)
  • L. Carnero et al.

    Psoriasis in a 5-month-old girl with HIV infection

    Pediatr Dermatol

    (2001)
  • H. Watabe

    Childhood psoriasis associated with Turner syndrome

    J Dermatol

    (2006)
  • H.G. Berzel

    Psoriasis vulgaris: the case of a 5 year old child [German]

    TW Padiatrie

    (1992)
  • H.B. Allen et al.

    Scaling scalp diseases in children

    Clin Pediatr (Phila)

    (1983)
  • C.L. Guill et al.

    Primary annular plaque-type psoriasis

    Pediatr Dermatol

    (2005)
  • A.B. Kimball et al.

    Clobetasol propionate emulsion formulation foam 0.05%: review of phase II open-label and phase III randomized controlled trials in steroid-responsive dermatoses in adults and adolescents

    J Am Acad Dermatol

    (2008)
  • P. McAleer et al.

    Psoriasis associated with human immunodeficiency virus in an infant

    Pediatr Dermatol

    (1999)
  • G. Feicht

    Psoriasis pustulosa in children [German]

    Z Hautkr

    (1982)
  • A.P. Oranje et al.

    Topical calcipotriol in childhood psoriasis

    J Am Acad Dermatol

    (1997)
  • G. Saggese et al.

    Topical application of 1,25-dihydroxyvitamin D3 (calcitriol) is an effective and reliable therapy to cure skin lesions in psoriatic children

    Eur J Pediatr

    (1993)
  • A. Perez et al.

    Pilot study of topical calcitriol (1,25-dihydroxyvitamin D3) for treating psoriasis in children

    Arch Dermatol

    (1995)
  • C.R. Darley et al.

    Safety and efficacy of calcipotriol ointment (Dovonex) in treating children with psoriasis vulgaris

    Br J Dermatol

    (1996)
  • G. Fabrizi

    Calcipotriol and psoriasis in children

    J Dermatolog Treat

    (1997)
  • S.B. Park et al.

    A pilot study to assess the safety and efficacy of topical calcipotriol treatment in childhood psoriasis

    Pediatr Dermatol

    (1999)
  • L.B. Travis et al.

    Psoriasis in infancy: therapy with calcipotriene ointment

    Cutis

    (2001)
  • A. Patrizi et al.

    Topical calcipotriol in childhood psoriasis

    Acta Derm Venereol

    (1999)
  • Y.J. Choi et al.

    Infantile psoriasis: successful treatment with topical calcipotriol

    Pediatr Dermatol

    (2000)
  • A. Patrizi et al.

    Psoriasiform acral dermatitis: a peculiar clinical presentation of psoriasis in children

    Pediatr Dermatol

    (1999)
  • A. Perez

    Calcitriol cream shows promise for psoriasis in children

    Am Fam Physician

    (1994)
  • A. Brune et al.

    Tacrolimus ointment is effective for psoriasis on the face and intertriginous areas in pediatric patients

    Pediatr Dermatol

    (2007)
  • B. Amichai

    Psoriasis of the glans penis in a child successfully treated with Elidel (pimecrolimus) cream

    J Eur Acad Dermatol Venereol

    (2004)
  • P. Mansouri et al.

    Pimecrolimus 1 percent cream in the treatment of psoriasis in a child

    Dermatol Online J

    (2006)
  • T.H. Clayton et al.

    Topical tacrolimus for facial psoriasis

    Br J Dermatol

    (2003)
  • S.J. Ahn et al.

    A case of infantile psoriasis with pseudoainhum successfully treated with topical pimecrolimus and low-dose narrowband UVB phototherapy

    J Eur Acad Dermatol Venereol

    (2006)
  • A. Zvulunov et al.

    Efficacy of short-contact therapy with dithranol in childhood psoriasis

    Int J Dermatol

    (1994)
  • C.J. Guerrier et al.

    An open assessment of 0.1% dithranol in a 17% urea base ('Psoradrate' 0.1%) in the treatment of psoriasis of children

    Curr Med Res Opin

    (1983)
  • B. Schubert et al.

    Exanthematous infantile psoriasis [German]

    J Dtsch Dermatol Ges

    (2007)
  • A. Ghorpade

    Linear nevoid psoriasis along lines of Blaschko

    J Eur Acad Dermatol Venereol

    (2004)
  • A.S. al-Fouzan

    Nanda A. UVB phototherapy in childhood psoriasis

    Pediatr Dermatol

    (1995)
  • V.K. Jain et al.

    Narrow-band UV-B phototherapy in childhood psoriasis

    Int J Dermatol

    (2007)
  • C.S. Jury et al.

    Narrowband ultraviolet B (UVB) phototherapy in children

    Clin Exp Dermatol

    (2006)
  • A. Pasic et al.

    Phototherapy in pediatric patients

    Pediatr Dermatol

    (2003)
  • Y.K. Tay et al.

    Experience with UVB phototherapy in children

    Pediatr Dermatol

    (1996)
  • M.K. Kim et al.

    Psoriasis and glomerulonephritis

    Clin Exp Dermatol

    (1998)
  • D.M. Thappa et al.

    Suit PUVA as an effective and safe modality of treatment in guttate psoriasis

    J Eur Acad Dermatol Venereol

    (2006)
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    Supported by University Medical Center St Radboud Foundation, which received funding from Wyeth Pharmaceuticals for the project. Wyeth Pharmaceuticals played no role in the design and execution of the study or in data collection, data management, data analysis, interpretation of the data, manuscript preparation, manuscript review, or manuscript approval.

    Conflicts of interest: None declared.

    Disclosure: Dr de Jager participated in trials funded by Schering Plough and Abbott. Dr de Jong served as consultant for Biogen, Serono, Wyeth, and Abbott. She also received research grants from Merck Serono and Wyeth. Dr van de Kerkhof served as consultant for Schering Plough, Cellgene, Centocor, Allmirall, UCB, Wyeth, Pfizer, Soffinova, Abbott, Actelion, Galderma, Novartis, Janssen Cilag, and Leo Pharma. He also received research grants from Centocor, Wyeth, Schering Plough, Merck Serono, Abbott, and Philips Lighting. Dr Seyger has served as a consultant for Wyeth and participated in trials funded by Schering Plough and Wyeth.

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