Compounded Topical Therapy for Pediatric Psoriasis Provides Tailored Treatment for Optimal Results
Raising happy and well-adjusted children is the goal of most parents, but there can often be heartbreaking and unavoidable challenges in achieving this. Outbreaks of pediatric psoriasis can make it difficult for many kids to socialize and keep up with their peers, and too often parents don’t know how to make the situation better or easier. Pediatric psoriasis is a very specific condition with specific needs, and shouldn’t be treated exactly like the adult version. These parents and kids desperately need advice and tailored topical treatments—roles that are perfectly filled by compounding pharmacists.
Facts About Psoriasis in Children and Adolescents
The estimated prevalence of pediatric psoriasis ranges from 0.5 to 2 percent.1 The good news is that many of the patients in this young group experience minor outbreaks. Then again, most adolescents don’t consider plaque-type lesions over their face to be minor. The chronic nature of the disease is definitely not minor—one-third of all adult cases of psoriasis began in childhood. These kids face a lifelong struggle with a potentially disfiguring disease. It’s not hard to understand how pediatric psoriasis can impact socialization or that it’s associated with psychological disorders like depression and anxiety.
Evidence points to a genetic component, but environmental factors that precipitate and exacerbate outbreaks have a larger role in children and adolescents than in adults. Pediatric cases present with the same subtypes as adults, but lesions tend to have a different distribution and clinical symptoms are often different in children.2
Triggers and Comorbidities Associated with Pediatric Psoriasis
One of the most frustrating aspects of pediatric psoriasis—for parents and patients—is the seemingly random outbreaks. It’s important to remind them that psoriasis flares occur in response to:
- Upper respiratory tract infection – the most common trigger
- Skin injury
- Emotional stress
- Drugs – systemic steroids, lithium, beta-blockers and antimalarial agents can worsen symptoms
Parents often try old-fashioned bed rest and OTC pain relief when their kids come down with an earache, a sore throat or tummy ache. But these common aches and pains are psoriasis triggers and early treatment may prevent a flare-up of symptoms. Encourage them to take common childhood illnesses seriously and follow treatment recommended by their physician.
As if having psoriasis in childhood isn’t traumatic enough, juvenile psoriasis is also associated with chronic comorbidities. Compared to healthy children, those with psoriasis have a higher prevalence of:3
- Allergic rhinitis
- Bronchial asthma
- Diabetes mellitus
- Rheumatoid arthritis
- Crohn’s disease
The incidence of some comorbidities increases along with the severity of psoriasis. For example, children with severe psoriasis are more likely to be obese than those with moderate psoriasis. More research is needed to clarify cause and effect, but experts believe that psoriasis is either a complication of childhood obesity, or that physical activities are curtailed in kids with psoriasis. Sweating during exercise may be a trigger or aggravate existing lesions, and embarrassment due to their appearance may prevent some children from interacting with friends.
- Symptoms appear as a psoriatic diaper rash—minimally elevated erythematous plaques—that don’t respond to typical diaper rash treatment.
- Lesions are often macerated and can develop into a widespread eruption within 1 to 2 weeks.
- Diagnosing psoriasis in infants is controversial.
- Up to 75 percent develop plaque psoriasis consisting of well-defined erythematosquamous papules or plaques overlying silvery-white scale.
- Lesions primarily develop on the face and scalp, followed by the elbow and knee.
- Guttate psoriasis is the second most common type. In this form, acute papules appear on the trunk about two weeks after beta-hemolytic streptococcal or viral infection. It usually resolves in three to four months, but some patients will go on to develop plaque psoriasis.
- Pustular psoriasis only occurs in 1 to 5 percent of children with psoriasis. Localized or generalized pustules are sometimes accompanied by fever, malaise and arthralgias.
- Less common subtypes include inverse, palmoplantar and linear psoriasis. Erythrodermic psoriasis is very rare in children, but can be life threatening.
First Line Topical Treatments
The field of pediatric psoriasis falls short on research into the safety and efficacy of systemic treatments in children. A recent study in Pediatric Dermatology found that biologic and immunomodulating therapies were well-tolerated and effective for cases of moderate to severe psoriasis in children.4 Luckily, most outbreaks of pediatric psoriasis are mild and first line therapy focuses on topical treatments.
- Topical corticosteroids – High-potency steroids are most often prescribed, although the potency is adjusted for more sensitive skin such as the face. Compounding pharmacists can tailor the strength and delivery vehicle for each child. Topical steroids should be used intermittently and rotated with other topical treatment to reduce the risk of side effects.
- Vitamin D analogs – Calcipotriol and calcitriol are effective when used alone or in combination with topical corticosteroids, which offers the benefit of a steroid-sparing effect. Compounding pharmacists should let pediatricians know they can formulate combinations that aren’t available commercially. Mild side effects include skin irritation and pruritus, so vitamin D analogs aren’t used in the face, genital and flexural areas. They’re not recommended for children under the age of two years.
- Calcineurin inhibitors – Topical tacrolimus and pimecrolimus effectively treat lesions on the face, genitalia and flexures in adults. While studies suggest these treatments are safe for children, experts still don’t know much about potential long-term adverse effects.
- Dithranol – Also called anthralin, this anti-inflammatory and anti-proliferative agent is effective and safe for pediatric psoriasis. Short-contact dithranol used in a higher concentration of 0.1 to 3 percent and applied for a shorter duration lowers the risk of irritation and staining.
Pharmacists Are Key Resources for Pediatric Psoriasis Patients
Pharmacists are always expert resources when it comes to discussing treatment options, but you have other opportunities to reach out. For starters, don’t hesitate to bring up the benefits of compounded topical treatments. The ability to tailor doses for young children is invaluable. Stay on the lookout for parents frequently buying OTC products to treat what they think is a normal rash. You can intervene, teach that psoriasis can occur in children, and encourage them to see their doctor. Finally, be sure to offer information about triggers and comorbidities to patients currently being treated for psoriasis. Your ability and willingness to help parents navigate this complex and incurable disease will significantly improve their child’s quality of life.
Pharmaceutica North America provides prescription products, bulk active pharmaceutical ingredients and custom compounding kits to treat pediatric patients with psoriasis. Contact us today to learn more about dermatology compounding and how we can support your pharmaceutical needs.
- “Management of Psoriasis in Adolescence,” March 2014, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3961070/ ↩
- “Psoriasis in Children and Adolescents: Diagnosis, Management and Comorbidities,” June 2015, http://link.springer.com/article/10.1007/s40272-015-0137-1 ↩
- “Epidemiology and Comorbidity in Children with Psoriasis and Atopic Eczema,” June 2015, http://www.karger.com/Article/FullText/381913 ↩
- “Treatment of Moderate to Severe Pediatric Psoriasis: A Retrospective Case Series,” March 2016, http://www.ncbi.nlm.nih.gov/pubmed/26871417 ↩