Advancements in Pediatric Psoriasis Treatment, with Lisa Swanson, MD

In pediatric dermatology, it is crucial providers identify and diagnose psoriasis accurately, as children are indeed affected by this condition, contrary to some misconceptions. Psoriasis in children often gets misdiagnosed, especially in primary care, highlighting the importance of proper recognition and treatment initiation with topical steroids or calcineurin inhibitors for sensitive areas. Additionally, the non-steroidal topical treatment, roflumilast, offers a once-daily application for children 6 and older.

In an interview with HCPLive, Lisa Swanson, MD, pediatric dermatologist at St Luke’s Children’s Hospital and Summer 2024 Conference Medical Director, discusses her SDPA Annual Summer Dermatology Conference presentation on dermatologic conditions among the pediatric population.

When treating pediatric patients with psoriasis, and topical treatments are insufficient, it is important to not shy away from using systemic treatments for severe cases. Currently, 4 FDA-approved biologics—etanercept, ustekinumab, secukinumab, and ixekizumab—and the recently approved oral medication, apremilast, are available, ensuring children have access to effective treatments to enhance their quality of life and potentially reduce psoriasis-related comorbidities.

Moreover, understanding tinea faciei is essential, as an asymmetrical, pink, scaly facial rash in children is often fungal until proven otherwise. Swanson explained early treatment with topical antifungals can be effective, but oral medications like terbinafine and griseofulvin are usually necessary once the fungus has penetrated deeper. Griseofulvin, available in liquid form, requires a longer treatment duration and must be taken with fatty foods, whereas terbinafine, typically a shorter course, is available only in pill form, though it can be compounded into a liquid.

Pediatric patients can also suffer from tinea capitis and onychomycosis. Effective treatment requires oral antifungals, and awareness of potential sources like pet guinea pigs or hamsters is crucial. Terbinafine and efinaconazole, the latter being a topical treatment for toenail fungus, are used, although oral terbinafine is often preferred due to its efficacy.

Swanson emphasized that during discussions on Janus kinase (JAK) inhibitors for conditions like alopecia areata and vitiligo, it is important to address the boxed warnings associated with these medications. Understanding the origins and implications of these warnings allows for informed patient discussions and appropriate prescribing. Despite the warnings, she said, JAK inhibitors represent significant advancements for chronic autoimmune conditions, offering hope and improved quality of life for patients. Ultimately, it is essential to respect the warnings but also to leverage the benefits of these treatments by thoroughly understanding and communicating the risks and benefits to patients.

Disclosures: Swanson is a consultant for Abbvie, Alphyn, Arcutis, Boehringer Ingelheim, Castle, Dermavant, Galderma, Incyte, Janssen, Leo, Lilly, Novan, Pfizer, Sanofi-Regeneron, and Verrica.