Systemic Treatment of Psoriasis in Children

Childhood psoriasis has a significant impact on the child ́s quality of life and those who cannot be managed with topical treatment should be considered for systemic treatment. The majority of systemic therapies used for childhood psoriasis are off-label drug therapies. Evidence-based studies on systemic treatment of childhood psoriasis are scarce, and treatment algorithms are generally based on low-level evidence. A literature search was performed and updated to October 2015 to obtain an up to date overview of relevant systemic treatment in childhood psoriasis. Methotrexate is the conventional first-line of systemic treatment, but the level of evidence for its use is low. Etanercept is FDA approved for psoriasis vulgaris in children, has a documented efficacy and a good safety profile, and is currently the drug for which most evidence for the use in children has been accumulated. Adalimumab and ustekinumab have both recently completed large double-blinded controlled trials testing in childhood psoriasis and both have recently been approved for psoriasis vulgaris in children. Thus a wider range of approved systemic treatment options is becoming available.