The safety and efficacy of biologics in the treatment of pediatric psoriasis were demonstrated in several case studies published in the Journal of Drugs in Dermatology.

Currently, there is a lack of literature on the use of biologics in pediatric psoriasis. There are also no systemic drugs approved by the Food and Drug Administration (FDA) for the treatment of pediatric psoriasis.

Researchers from the Department of Dermatology Research at Tufts Medical Center and colleagues conducted a literature review on pediatric patients with moderate-to-severe psoriasis treated with systemic medications from 2008–2014. A total of 27 patients aged 5–18 years old were included and 56 treatment courses were reviewed. Efficacy was assessed via the validated simple measure for assessing psoriasis activity (S-MAPA), and the product of the body surface area and Physician Global Assessment.

The analysis showed methotrexate (70%) and etanercept (59%) were the most frequently prescribed systemics. Biologic medications exhibited the highest clearance rates with 67% for etanercept and adalimumab, and 33% for ustekinumab. Phototherapy, cyclosporine, and methotrexate successfully improved  S-MAPA ≥50% from baseline 100%, 67%, and 36% of the time, respectively, but were less effective in clearing psoriasis overall.

Sunburn for patients on narrowband ultraviolet B phototherapy (14%), gastrointestinal intolerance (16%) and minor infections (16%) for patients on methotrexate, and minor infections for patients on etanercept (25%) and adalimumab (33%) were the most commonly reported adverse events.

Long-term safety concerns with phototherapy, methotrexate, and cyclosporine have led clinicians to consider biologics instead. Study findings support the safety and efficacy of biologics such as etanercept, adalimumab, and ustekinumab in pediatric psoriasis, helping dermatologists better manage recalcitrant pediatric psoriasis.

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