INTRODUCTION
Psoriasis (PsO) is a chronic, inflammatory skin disease characterized by cutaneous features, extracutaneous comorbidities, and an unpredictable course.1,2 PsO is the second most common chronic pediatric skin disorder after atopic dermatitis (AD) and is reported to affect 0.05% to 2.15% of children,3 compared with a 15% to 20% prevalence of eczema.4 PsO is often mistaken for eczema because both are chronic diseases that feature red, scaly skin, suggesting that the true prevalence of pediatric PsO may be higher.5 The mean age of onset of PsO is between 8 and 11 years, and the prevalence increases with age, estimated at 0.13% in those under the age of 2 years and 0.67% in teenagers.6,7 Approximately 30% of adults with PsO experienced symptoms before the age of 20 years.8
Clinical features of PsO in infants and children are somewhat different from those of adults, which may also make distinguishing pediatric PsO from eczema more difficult. In an anonymous survey, 53.7% of pediatricians (n=95) reported being uncertain or very uncertain about their ability to diagnose pediatric PsO, despite regularly seeing pediatric patients with PsO.1 Pediatricians who are less confident in their diagnostic ability are also less likely to perform total skin examinations, screen for relevant comorbidities, and prescribe disease-specific treatment. None of the pediatricians surveyed prescribed standard-of-care systemic immunomodulating agents (eg, methotrexate and/ or cyclosporine) or US Food and Drug Administration (FDA)-approved therapies labeled for this condition (including targeted biologics or retinoids) for their patients with PsO. A French national survey of clinicians who treat children with PsO found a much lower use of severity scores and systemic treatments among general practitioners and pediatricians compared with dermatologists, thereby limiting treatment options for pediatric patients.9 Dermatologists more frequently prescribed topical corticosteroids and vitamin D analogs for pediatric patients with PsO than general practitioners, suggesting a reluctance to prescribe or lack of awareness of preferred treatments for pediatric PsO.10
Early intervention in pediatric PsO can reduce the impact and burden of the disease and possibly its comorbidities, emphasizing the need for accurate and early diagnosis of pediatric PsO. This review describes the features and triggers that distinguish PsO
Clinical features of PsO in infants and children are somewhat different from those of adults, which may also make distinguishing pediatric PsO from eczema more difficult. In an anonymous survey, 53.7% of pediatricians (n=95) reported being uncertain or very uncertain about their ability to diagnose pediatric PsO, despite regularly seeing pediatric patients with PsO.1 Pediatricians who are less confident in their diagnostic ability are also less likely to perform total skin examinations, screen for relevant comorbidities, and prescribe disease-specific treatment. None of the pediatricians surveyed prescribed standard-of-care systemic immunomodulating agents (eg, methotrexate and/ or cyclosporine) or US Food and Drug Administration (FDA)-approved therapies labeled for this condition (including targeted biologics or retinoids) for their patients with PsO. A French national survey of clinicians who treat children with PsO found a much lower use of severity scores and systemic treatments among general practitioners and pediatricians compared with dermatologists, thereby limiting treatment options for pediatric patients.9 Dermatologists more frequently prescribed topical corticosteroids and vitamin D analogs for pediatric patients with PsO than general practitioners, suggesting a reluctance to prescribe or lack of awareness of preferred treatments for pediatric PsO.10
Early intervention in pediatric PsO can reduce the impact and burden of the disease and possibly its comorbidities, emphasizing the need for accurate and early diagnosis of pediatric PsO. This review describes the features and triggers that distinguish PsO
