Childhood psoriasis

Contains fulltext : 83268.pdf (publisher's version ) (Open Access)Radboud Universiteit Nijmegen, 11 februari 2011Promotor : Kerkhof, P.C.M. van de Co-promotores : Jong, E.M.G.J. de, Seijger, M.M.B.182 p

Epidemiology and prescribed treatments in childhood psoriasis: a survey among medical professionals.

Item does not contain fulltextINTRODUCTION: A study was conducted to explore the epidemiology of childhood psoriasis in general practitioners (GPs) and dermatological practice in the region of our academic medical centre. The treatments used by GPs and dermatologists in juvenile psoriasis were investigated. METHODS: A questionnaire was sent to 229 GPs and 73 dermatologists. Questions were addressed about the prevalence of childhood psoriasis and treatments used in this disease. RESULTS: Seventy-three questionnaires were completed. The response rate was 17.0% for GPs and 46.6% for dermatologists. Almost one-third of all GPs have seen one or more patients with juvenile psoriasis under the age of 11 in their own patient population, in contrast to more than 80% of the dermatologists. Extrapolating the results implied an estimated prevalence of childhood psoriasis of 0.17% in the overall Dutch population. Topical corticosteroids were used by 46.2% of GPs and by 91.2% of dermatologists. Vitamin D analogues were prescribed by GPs and dermatologists in 15.4% and 73.5% of cases, respectively. Systemic medication for juvenile psoriasis was only used by 20.6% of dermatologists. CONCLUSIONS: Calculated for the Dutch population, there should be approximately 27,500 children with psoriasis in The Netherlands. Topical corticosteroids were the first-choice treatment for both GPs and dermatologists, whereas vitamin D analogues were used as a second-choice topical therapy. Systemic medication was only sparsely prescribed by dermatologists

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

Contains fulltext : 88710.pdf (publisher's version ) (Closed access)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.1 juni 201

A cross-sectional study using the Children's Dermatology Life Quality Index (CDLQI) in childhood psoriasis: negative effect on quality of life and moderate correlation of CDLQI with severity scores.

Contains fulltext : 89309.pdf (publisher's version ) (Closed access)BACKGROUND: Juvenile psoriasis is a chronic and incurable skin disease that affects approximately 0.7% of children. OBJECTIVES: To achieve more insight into the quality of life (QoL) in childhood psoriasis and to investigate whether disease severity scores correlate with QoL scores. METHODS: All consecutive patients with juvenile plaque psoriasis (</= 18 years old) who visited our outpatient department were included. At baseline, the Children's Dermatology Life Quality Index (CDLQI) questionnaire was completed and disease severity was assessed by the Psoriasis Area and Severity Index (PASI) and the Physician Global Assessment (PGA). RESULTS: Thirty-nine patients were included in the study. A median CDLQI of 6 [interquartile range (IQR) 5-9] was reported. Median PASI was 6.3 (IQR 3.3-8.2) and median PGA was 2 (IQR 1-3). The correlation coefficient between PASI and CDLQI was 0.47 (P = 0.003), whereas the correlation coefficient between PGA and CDLQI was 0.51 (P = 0.001). CONCLUSIONS: The negative effect on QoL in juvenile psoriasis was confirmed in the largest cohort presented up to now. The correlation between disease severity scores and disease-related QoL in children with psoriasis is only moderate. Therefore, both clinical outcome parameters (PASI, PGA) and measures of QoL (CDLQI) should be included in adequate, patient-oriented clinical decision making.1 november 201

Dithranol therapy in childhood psoriasis: unjustifiably on the verge of falling into oblivion.

Contains fulltext : 88843.pdf (publisher's version ) (Closed access)BACKGROUND: In childhood psoriasis, physicians aim for an effective and safe treatment such as with dithranol. This study presents the largest study of dithranol-treated patients described in the literature. OBJECTIVE: The aim of the study was to determine the position of dithranol in the treatment strategy for psoriasis. METHODS: All juvenile patients receiving dithranol treatment at our center were evaluated retrospectively. RESULTS: Sixty patients (with 82 treatment episodes in total) were included. The mean age at the start of dithranol treatment was 11.1 years (range: 3.7-17.9 years). The result of the treatment was: excellent (3.7%), good (69.5%), moderate (8.5%), reasonable (13.4%) or disappointing (4.9%). Mild irritation was seen in 39%, and severe irritation in 63% of the patients. CONCLUSIONS: Dithranol can be regarded as an efficacious and safe topical therapy for the treatment of childhood psoriasis. It is a valuable alternative topical treatment which should not be disregarded in the treatment regimen for childhood psoriasis and should be commenced before ultraviolet or systemic treatments are initiated

The burden of childhood psoriasis

Contains fulltext : 98412.pdf (publisher's version ) (Closed access)A pilot study of the effect on quality of life of childhood psoriasis is presented. Of the children interviewed, 65% experienced stigmatization to a certain extent, 71% reported itching, and 43% complained about fatigue. Clinicians should pay attention to these items to initiate patient-tailored treatment

An intrapatient comparison of quality of life in psoriasis in childhood and adulthood

BACKGROUND: Chronic diseases can have a great influence on health-related quality of life. Nevertheless, only little research has been carried out on childhood psoriasis. The perception of quality of life by adults with psoriasis of their childhood psoriasis has never been investigated. OBJECTIVES: The aims of this study were to (i) investigate retrospectively the influence of psoriasis as experienced in childhood as compared with the current quality of life in adulthood; (ii) assess retrospectively the impact of childhood psoriasis on daily life; and (iii) compare the current quality of life in patients with childhood onset psoriasis (COP) and adult onset psoriasis (AOP). METHODS: A survey was performed among all members of the Dutch Psoriasis Society. Validated questionnaires on quality of life, impact on daily life and clinical severity were used. RESULTS: Questionnaires of 1762 patients were suitable for analysis. Adults with an onset of psoriasis before the age of 18 years retrospectively rate their quality of life during childhood much less as compared with their current quality of life (intrapatient comparison). Influence of psoriasis in childhood particularly had a high degree of limitations on recreational and social activities in 15-30% of patients. Quality of life in adulthood is not determined by age of onset of psoriasis. CONCLUSIONS: In childhood, the quality of life is greatly influenced by psoriasis. The social development domain, which is one of the developmental milestones in a child, is particularly impaired. The current quality of life of patients with COP is equal to that of patients with AOP

No evidence found that childhood onset of psoriasis influences disease severity, future body mass index or type of treatments used.

Contains fulltext : 89755.pdf (publisher's version ) (Closed access)BACKGROUND: In more than one-third of the psoriatic population, the first manifestations occur in childhood. Whether the age of onset of psoriasis influences the march of psoriasis is not known. OBJECTIVES: To describe the epidemiology and clinical features as well as prescribed treatments and familial distribution in psoriasis depending on the age of onset of the disease. METHODS: A structured questionnaire was sent to 5300 adult psoriatic patients. Respondents were divided into two groups: patients who experienced an onset of disease before the age of 18 [childhood onset psoriasis (COP)] and patients with an onset of disease from the age of 18 [adult onset psoriasis (AOP)]. RESULTS: Questionnaires of 1926 (36.3%) patients were suitable for analysis. In 37.1% of patients, first signs of the disease occurred before the age of 18. COP occurs predominantly in females, has a longer delay in diagnosis and a higher frequency of familial distribution. The development of guttate and erythrodermic psoriasis in adulthood is more frequently seen in COP. In contrast to common belief, type of psoriasis in COP often remains the same from childhood to adulthood. There was no evidence found that getting psoriasis before the age of 18 years influences development of high body mass index in adulthood, disease severity in later life or type of treatments used. CONCLUSIONS: The age of onset of psoriasis essentially does not influence the subsequent course of the disease in adulthood.1 november 201

Juvenile psoriasis in European and Asian children: similarities and differences

BACKGROUND: The first manifestations of psoriasis begin in childhood in more than one-third of patients. However, epidemiological data of juvenile psoriasis are lacking. OBJECTIVES: To compare Dutch (NL group) and Singaporean (SG group) children with psoriasis with the aim of studying the characteristics of juvenile psoriasis and to highlight similarities and differences between these different ethnic groups. METHODS: Data were collected from 207 patients younger than 18 years diagnosed with psoriasis from Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands and the National Skin Centre, Singapore. Results : A striking difference in familial distribution was found, with more Dutch children having an affected family member (73.3% vs. 13.6%). Presence of itch and triggering factors were more common among Dutch children (80% vs. 14.2% and 33.3% vs. 7.4%, respectively). However, both groups shared similar triggering factors like stress and infections. Other similarities included mean age at presentation (NL group 11.3 years; SG group 14.1 years) and gender ratio (NL group, M/F 1 : 1.1; SG group, M/F 1 : 1.4). Plaque psoriasis was the most common type in both cohorts while guttate and pustular psoriasis were rare. In both groups, the head, followed by the limbs, was the most common site involved. Similar proportions of children in both countries had nail involvement and psoriatic arthritis was rare. CONCLUSIONS: The disparity in familial distribution may point to genetic differences between the two groups. Further studies to evaluate this difference in familial distribution may contribute to the understanding of the pathogenesis of psoriasis