Efficacy and safety of treatments for childhood psoriasis: a systematic literature review.

BACKGROUND Evidence-based recommendations for therapeutic decision making in childhood psoriasis are lacking. OBJECTIVES We sought to systematically review all available literature concerning treatment efficacy and safety in childhood psoriasis and to propose a recommendation for topical and systemic treatment of childhood psoriasis. METHODS Databases searched were PubMed, EMBASE, and the Cochrane Controlled Clinical Trial Register. All studies reporting on efficacy and safety of all treatment options in childhood psoriasis were obtained and a level of evidence was determined. RESULTS Literature search revealed 2649 studies, of which 64 studies met the inclusion criteria. The majority of topical and systemic therapies given in childhood psoriasis are efficacious. Short-term side effects were usually mild; long-term side effects were not described. LIMITATIONS Most conclusions formulated are not based on randomized controlled trials. CONCLUSIONS A rough summary of the proposed algorithm is as follows: first, calcipotriene with/without topical corticosteroids, followed by dithranol. Methotrexate is considered to be the systemic treatment of choice.