AAD
Author: Willhemenia Loremipsum Special session: Lorem ipsum dolor sit amet Category: Lorem ipsum View all results

Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.

  • Presentation

Update on Pediatric Psoriasis: New Topical and Systemic Treatment Options

Description

The talk reviewed pediatric psoriasis as a systemic inflammatory disease with major skin, psychosocial, and comorbidity burdens, emphasizing the need for thorough screening for obesity, lipid abnormalities, metabolic syndrome, arthritis, psychiatric issues, and infection triggers such as streptococcal disease. It highlighted the wide range of pediatric presentations, including diaper, guttate, scalp/facial, plaque, pustular, and erythrodermic psoriasis, and noted that disease severity, distribution, impact on quality of life, comorbidities, age, prior treatment response, and family preferences should guide treatment rather than a stepwise "ladder" approach alone. New topical options include roflumilast cream, which showed good efficacy and low systemic exposure in children, while tapinarof remains not approved for pediatric psoriasis. On the systemic side, the speaker reviewed established therapies such as methotrexate, cyclosporine, acitretin, and phototherapy, but noted that biologics often have better persistence and safety profiles. Newer advances include apremilast as the first modern oral systemic option for pediatric psoriasis, a newly approved IL-23 biologic for adolescents, and icotrokinra, an oral IL-23–targeted peptide with strong efficacy and a favorable safety profile that may offer an alternative to injections. The talk closed by stressing the importance of balancing undertreatment against adverse effects through shared decision-making, while also recognizing psoriasiform eruptions from other biologic therapies as a common clinical challenge.

View more

Conclusions

  • Pediatric psoriasis should be treated more aggressively when disease burden, psychosocial impact, comorbidities, or special sites of involvement make the condition high impact rather than merely mild by surface area.
  • Psoriasis in children is a systemic inflammatory disease, so management should include routine screening for obesity/metabolic risk, arthritis, and psychiatric comorbidity.
  • Early and effective control of pediatric psoriasis may be important not only for skin outcomes but also for limiting downstream cardiometabolic risk.
  • Topical therapy still has a role, but the field is moving toward earlier use of systemic treatment when indicated.
  • Newer topical roflumilast appears safe and effective in children older than 6 years with plaque psoriasis.
  • Pediatric treatment options have expanded substantially with multiple approved biologics and newer targeted oral agents.
  • Biologic therapies generally offer better persistence and favorable tolerability compared with older conventional systemic agents.
  • Traditional options such as methotrexate, cyclosporine, acitretin, and phototherapy remain useful, especially for rapid rescue or in combination strategies.
  • Disease subtype, age, access, comorbidities, and family preferences should guide systemic drug choice rather than a rigid step-ladder approach.
  • Recent data suggest that shorter disease duration may predict better responses to apremilast, raising the possibility that earlier systemic treatment may be beneficial.
  • Guselkumab and icotrokinra add highly effective IL-23-targeted options for pediatric psoriasis, including an oral targeted peptide approach.
  • Adolescent icotrokinra data suggest high efficacy with an excellent short-term safety profile and the potential to reduce reliance on injections.
  • Psoriasiform eruptions related to biologics are a practical management issue and often require topical treatment or reconsideration of the underlying systemic regimen.
  • Overall, the best approach is shared decision-making that balances treatment risks against the harms of undertreated disease over the child’s life course.
  • J Clin Med. 2023 Feb 1;12(3):1162.
  • Sajja A, et al. JCI Insight 2020;5:e142534.
  • Tom WL, et al. J Invest Dermatol 2016;136:67-73.
  • Osier E, Wang AS, Tollefson MM, Cordoro KM et al. Pediatric Psoriasis Comorbidity Screening Guidelines. JAMA Dermatol. 2017;153(7):698-704.#10.1001/jamadermatol.2017.0499
  • JAMA Dermatol. 2017 Jul 1;153(7):698-704.
  • Strober B et al. JAAD 2020: Delphi Consensus Classification from the International Psoriasis Council.
  • Honig P.J. J Pediatr. 1988 Dec;113(6):1037-9.
  • Trends Immunol. 2009 Oct;30(10):494-501.
  • JID (2009) 129, 2653–2660.
  • Herbert AA et al., Pediatric Dermatology, 2026; 43:105–108.
  • Langley RG, Arkin L et al. J Am Acad Dermatol. 2026 Feb 3:S0190-9622(26)00125-8.
  • Prajapati VH et al. Br J Dermatol 2025;192:618-28.
  • N Engl J Med 2024;390:510-2.