Department of Dermatology, Venereology & Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Indian J Dermatol Venereol Leprol. 2010 Jul-Aug;76(4):357-65. doi: 10.4103/0378-6323.66580.
Psoriasis is a common dermatosis in children with about one third of all patients having onset of disease in the first or second decade of life. A chronic disfiguring skin disease, such as psoriasis, in childhood is likely to have profound emotional and psychological effects, and hence requires special attention. Psoriasis in children has been reported to differ from that among adults being more frequently pruritic; plaque lesions are relatively thinner, softer, and less scaly; face and flexural involvement is common and guttate type is the characteristic presentation. Whether onset in childhood predicts a more severe form of psoriasis is a matter of controversy, it may cause significant morbidity particularly if it keeps relapsing. Most children have mild form of psoriasis which can be generally treated effectively with topical agents such as emollients, coal tar, corticosteroids, dithranol, calcipotriol etc. according to age and the sites affected. Narrow band UVB is the preferred form of phototherapy in children for moderate to severe disease or in patients not responding to topical therapy alone. Systemic therapies are reserved for more severe and extensive cases that cannot be controlled with topical treatment and/or phototherapy such as severe plaque type, unstable forms like erythrodermic and generalized pustular psoriasis and psoriatic arthritis. There are no controlled trials of systemic therapies in this age group, most experience being with retinoids and methotrexate with favorable results. Cyclosporine can be used as a short-term intermittent crisis management drug. There is an early promising experience with the use of biologics (etanercept and infliximab) in childhood psoriasis. Systemic treatments as well as phototherapy have limited use in children due to cumulative dose effects of drugs, low acceptance, and risk of gonadal toxicity. More evidence-based data is needed about the effectiveness and long-term safety of topical, phototherapy and systemic therapies in children.
银屑病是儿童中常见的皮肤病,约三分之一的患者在生命的第一个或第二个十年发病。像银屑病这样的慢性毁容性皮肤病,在儿童时期很可能会产生深远的情绪和心理影响,因此需要特别关注。据报道,儿童银屑病与成人银屑病不同,儿童银屑病更常伴有瘙痒;斑块病变相对较薄、较软、鳞屑较少;面部和屈侧受累常见,点滴状型是其特征性表现。儿童银屑病发病是否预示着更严重的银屑病形式存在争议,它可能会导致显著的发病率,特别是如果它反复发作的话。大多数儿童患有轻度银屑病,可根据年龄和受累部位,通过使用外用药物(如保湿剂、煤焦油、皮质类固醇、蒽林、卡泊三醇等)进行有效治疗。窄谱 UVB 是儿童中中度至重度疾病或对单独外用治疗无反应的患者的首选光疗形式。对于无法通过外用治疗和/或光疗控制的更严重和广泛的病例,如严重斑块型、不稳定型如红皮病型和泛发性脓疱型银屑病和银屑病关节炎,保留了全身治疗。在这个年龄段,没有系统治疗的对照试验,大多数经验来自于类视黄醇和甲氨蝶呤,效果良好。环孢素可用作短期间歇性危机管理药物。在儿童银屑病中使用生物制剂(依那西普和英夫利昔单抗)的早期经验令人鼓舞。由于药物的累积剂量效应、低接受度和性腺毒性风险,全身治疗和光疗在儿童中的应用有限。需要更多关于儿童中局部、光疗和全身治疗的有效性和长期安全性的循证数据。