Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, 3020 Children's Way, San Diego, CA, 92123, USA.
Departments of Dermatology and Pediatrics, School of Medicine, University of California, San Diego, San Diego, CA, USA.
Paediatr Drugs. 2024 Jan;26(1):9-18. doi: 10.1007/s40272-023-00592-9. Epub 2023 Oct 17.
Psoriasis is a chronic immune-mediated disorder that commonly affects adults and children. In recent years, pediatric psoriasis has increased in prevalence and the disease is often associated with various comorbidities and psychological distress. The conventional topical treatments for psoriasis, such as corticosteroids, calcineurin inhibitors, vitamin D analogs, anthralin, and coal tar, are often limited by their side effects, tolerability, and/or efficacy, particularly for use in children and on sensitive and intertriginous areas. Recently, the US Food and Drug Administration approved two new topical non-steroidal agents for treating psoriasis that target different pathogenic pathways than the conventional treatments. Roflumilast is a phosphodiesterase type 4 inhibitor approved for the treatment of plaque psoriasis in patients aged 12 years and older. Tapinarof is a novel aryl hydrocarbon receptor modulator approved for adult psoriasis and currently undergoing studies for pediatric psoriasis. Ongoing efforts are also being made to optimize conventional treatments, for instance, a new foam formulation of halobetasol propionate was recently approved for pediatric psoriasis. Clinical trials of various new drugs targeting one or multiple pathogenic pathways of psoriasis, such as Janus kinase inhibitors, different formulations of phosphodiesterase type 4 inhibitors, and aryl hydrocarbon receptor modulators have also been explored. The recent emergence of novel topical agents provides promising new options for managing pediatric psoriasis with the potential to improve clinical outcomes and quality of life. In this article, we review the mechanism of action, efficacy, and safety profile of novel topical agents and discuss their potential roles in the management of pediatric psoriasis.
银屑病是一种常见于成人和儿童的慢性免疫介导性疾病。近年来，儿童银屑病的患病率有所增加，且该疾病常与多种合并症和心理困扰相关。传统的银屑病局部治疗药物，如皮质类固醇、钙调磷酸酶抑制剂、维生素 D 类似物、蒽林和煤焦油，常因副作用、耐受性和/或疗效受限，尤其是在儿童和敏感及皱褶部位的应用。最近，美国食品和药物管理局批准了两种用于治疗银屑病的新型非甾体类局部药物，它们针对的是与传统治疗不同的致病途径。罗氟司特是一种磷酸二酯酶 4 抑制剂，被批准用于治疗 12 岁及以上斑块状银屑病患者。他卡西醇是一种新型的芳烃受体调节剂，被批准用于成人银屑病，目前正在进行儿童银屑病的研究。此外，还在努力优化传统治疗方法，例如，最近批准了一种新的卤倍他索丙酸泡沫制剂用于儿童银屑病。针对银屑病一个或多个致病途径的各种新药临床试验，如 Janus 激酶抑制剂、不同剂型的磷酸二酯酶 4 抑制剂和芳烃受体调节剂也在探索中。新型局部药物的出现为儿童银屑病的治疗提供了有前景的新选择，有可能改善临床结局和生活质量。本文综述了新型局部治疗药物的作用机制、疗效和安全性，并讨论了它们在儿童银屑病治疗中的潜在作用。
