The American Academy of Dermatology (AAD), in conjunction with the National Psoriasis Foundation (NPF), has released the first guidelines to help pediatric psoriasis patients receive proper care. The ‘Guidelines of Care for the Management and Treatment of Psoriasis in Pediatric Patients,’ were published online ahead of print in the Journal of the American Academy of Dermatology (Nov. 5, 2019).
According to the AAD, one-third of psoriasis cases begin in the pediatric years, and onset is most common during adolescence for the chronic, multisystem, inflammatory skin disease. Developed by board-certified dermatologists, the guidelines outline best practices for treatment of the disease in pediatric psoriasis patients.
“Compared to adults, pediatric psoriasis patients have a unique physiology, drug tolerance and patient/caregiver/physician interaction dynamic that can make it more challenging to manage,” said Dr. Alan Menter, co-chair of the AAD’s psoriasis guideline workgroup, in a press release.
“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 pediatric group.”
Since psoriasis can increase a patient’s risk of developing other diseases such as 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 three to four times more common in pediatric psoriasis patients than in kids who don’t have psoriasis.
Unlike adult psoriasis patients, 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.
Multiple factors can exacerbate psoriasis symptoms, including infections, stressors and skin trauma.
“Specifically 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 AAD psoriasis guideline workgroup co-chair, Dr. Craig Elmets.
Since emotional stress can develop psychosocially in pediatric patients with visible skin disease, children with psoriasis are also more susceptible to bullying, name-calling and shaming at school and other social settings, noted Dr. Menter.
“We’ve found that pediatric psoriasis patients have higher rates of depression and anxiety than their peers and use psychiatric medications more frequently,” Dr. Menter said. “Those are all addressed in these guidelines in the hopes that more people will recognize the seriousness of this disease in young people.”
Additionally, the guidelines outline the physical symptoms of the disease which can include pain, itchiness along with stinging, burning and tightening sensations. Itch is highlighted as an under-recognized, serious symptom that plagues pediatric psoriasis patients and aggravates as well as spreads the psoriasis lesions.
These burdens take a heavy toll on pediatric psoriasis patients said Randy Beranek, president and CEO of the NPF.
“The physical and emotional impact of psoriasis is tremendous, especially for our most vulnerable population: children. Treating pediatric patients with guidelines based on the most recent scientific information gives health care providers the best chance at finding the most successful course of treatment that enables children to live a healthy life,” said Beranek.
While there is no cure for psoriasis, receiving treatment from a board-certified dermatologist along with changes in lifestyle can help with control of the condition.
Dr. Elmets recommends the following tips to assist with the management of psoriasis:
Identify (and avoid) the patients’ triggers
Stick to a good psoriasis skin care routine
Live a healthy lifestyle
Use appropriate medications as needed
“Psoriasis is a life-long condition, so as dermatologists, it’s imperative to empower and educate patients, caregivers and primary care providers regarding this disease,” said Dr. George J. Hruza, president of the AAD.
“These guidelines were created to help optimize patient care outcomes, ensure patient satisfaction and afford pediatric psoriasis patients a better quality of life.”
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