Recognition and treatment of psoriasis in children

Psoriasis is not uncommon in childhood. The diagnosis may be challenging if the disease is mild or the presentation atypical. There are many clinical patterns, facial involvement, guttate lesions and napkin area psoriasis particularly prominent in this age group. It is a lifelong disease; hence children and parents need to be educated about disease chronicity and treatment options. Most patients with localised disease respond to topical treatment with emollients, coal tar, dithranol or calcipotriol. However, for extensive involvement, supervision of the application of topical medicaments in a daycare setting or by admission to a hospital ward may be necessary. In older children with generalised disease, ultraviolet B phototherapy is an effective treatment that permits rapid clearance. A minority of children with particularly severe disease require systemic therapy, usually with acitretin or methotrexate. In recent years, targeted immunomodulatory biological agents such as etanercept, a tumour necrosis factor-α antagonist, have been approved for the treatment of juvenile idiopathic arthritis in children and psoriasis in adults. Formal studies of safety and efficacy for psoriasis in childhood are awaited.