According to a report published Online First by Archives of Dermatology, one of the JAMA/Archives journals, most outpatient for pediatric psoriasis in the U.S. who visit dermatologists and pediatricians consist of white children aged 8 years and older, however, treatment approaches seem to vary according to physician specialty and patient age.
Background information in the article states that in the U.S. approximately 2.5 % of the population is affected by psoriasis, with 1% being children from birth to 18 years. A third of all patients develop first signs and symptoms by the age of 20 years. Health professionals consider various factors, such as disease severity, presentation and distribution of lesions, patient age and the presence of concurrent conditions in determining patients’ treatment. While topical medications are generally used for mild, localized cases in pediatric patients, more complex cases are usually treated with phototherapy and systemic medication. The authors state that, “Management of psoriasis in children can be challenging owing to a paucity of data and lack of standardized guidelines specific to the pediatric population.”
Sinae A. Vogel, B.S., from the University of California at the San Francisco School of Medicine and her team carried out a retrospective, cross-sectional examination based on data from the National Ambulatory Medical Care Survey. They evaluated outpatient-visit data from dermatologists and non-dermatologists from 1979 to 2007 of children from birth 18 years with a diagnosis of psoriasis. Data was not collected between the periods of 1982-1984 and 1987-1988.
They charted the frequency of medications in the database and divided them into three categories, i.e. topical corticosteroid group, topical non-corticosteroid and systemic. The corticosteroid category was further subdivided into a relative potency value from one (super potent) to seven (very weak).
Over the 28-year study period, an estimated 3.8 million pediatric psoriasis visits occurred in total, with a median (midpoint) of 123,420 visits per year. Almost two-thirds of patients (63%) visited dermatologists for the condition while 17% of psoriasis visits were made to pediatricians and 14 % to internists. Numbers of male and female patient visits were equal, with 93% of patients being white.
47% of visiting patients were aged between 13 to 18 years, with 35% of visits being made by children aged 8 to 12 years and 18% aged between 0 to 7 years respectively.
Researchers found that the most commonly prescribed medications consisted of topical corticosteroids with equal potency levels in younger and older children. In general, both younger and older age groups were commonly administered with betamethasone, a topical coricosteroid.
According to the findings, dermatologists and internists mostly prescribed high-potency steroids, while pediatricians most commonly prescribed the topical immunosuppressant tacrolimus. According to the study, dermatologist’s top 20 most-prescribed medications did not include topical calcineurin inhibitors, a medication preventing inflammation and the top 20 most-prescribed medications in any age group did not include systemic antipsoriatic agents.
The authors write, “This study confirms that pediatric psoriasis visits are frequent and represent a substantial burden of disease in the United States, validating the social, economic, and medical impact of this disease.” They highlight the age differences in office visits for the condition as well as trends in medication usage, and are especially concerned about the frequency of strong corticosteroid use in patients younger than 8 years. They comment: “In our experience, the highest potency topical corticosteroids are not commonly needed for psoriasis in young children.”
Trends like this indicate a need for treatment guidelines that address the condition in children. The authors conclude saying:
“The current state-of-the-art care for pediatric psoriasis is based primarily on experience and expert consensus. Some clinicians may not be anticipated to change even if standardized treatment guidelines existed, as such, education of our dermatology and non-dermatology colleagues about unique clinical and treatment aspects of pediatric psoriasis, rather than guidelines alone, may decrease the treatment gap by creating more comfortable, safe, and effective use of topical and systemic regimens for children with psoriasis.”
Written by Petra Rattue