Management of Pediatric PsO
Pediatricians can initiate first-line treatment for children with PsO beginning with a topical corticosteroid applied no more than once a day. In many cases, topical corticosteroid therapy will yield improvement but not clearing, and rebound worsening once treatment is stopped is common. A corticosteroid-sparing topical medication can be added to address either of these suboptimal responses. These medications include synthetic vitamin D analogs (calcipotriol and calcitriol) alone or as 2-ingredient combination vitamin D/corticosteroid products, as well as calcineurin inhibitors (tacrolimus and pimecrolimus), retinoids (tazarotene), coal tar, salicylic acid, and anthralin. A dermatologist is typically more familiar with second-line topical choices and indications for systemic treatment and can also provide access to phototherapy (Table 4).
Successful treatment requires shared medical decision-making so that patients and their families are comfortable with the treatment plan, including the relative risks and benefits of available options and long-term safety.13,72,73 Dosing schedules or treatment reminders can support medication adherence.74,75 In addition to treating skin signs and symptoms, successful management of pediatric PsO requires consideration of other aspects of the disease, including triggers and associated mental health issues.7,13,45 Ideal long-term management depends on choosing a medication that will not worsen or optimally will improve coexisting medical conditions.7 Children and adolescents with psychiatric comorbidities can benefit from counseling to help manage the negative mental components of the disease.7,13
For pediatric patients with PsO and their families, several informational, emotional, and social support resources are available (Table 5). The NPF provides useful information for how pediatric patients can manage their PsO, including diet and lifestyle changes, such as increased physical activity, that
