背景:银屑病影响早期生活负担相当大的儿童。由于缺乏更新的具体指南,治疗小儿牛皮癣也具有挑战性。随着最近批准了几种治疗小儿银屑病的生物制剂和正在进行的COVID-19大流行,年轻银屑病患者的管理正面临重大变化。因此,需要修订治疗建议。
方法:2021年9月,由六名意大利皮肤科医生组成的委员会召开会议,更新治疗建议。董事会发布了基于证据和共识的声明,涵盖了小儿牛皮癣的相关领域,即:评估银屑病的严重程度,治疗儿童牛皮癣,和治疗小儿牛皮癣。达成共识,在完全通过视频会议进行的Delphi过程中,将陈述提交给由24名专家组成的小组.产生了治疗算法。
结果:人们一致认为,银屑病的严重程度取决于皮肤病变的范围/严重程度,病变部位,以及对患者生活质量的影响。就小儿牛皮癣需要采用多学科方法以及患者/父母教育的重要性达成了共识。疫苗接种的相关性,包括COVID-19疫苗接种,对于牛皮癣儿童,所有参与者都承认。最初未能达成共识的管理问题包括筛查银屑病合并症和早期生物制剂治疗以预防它们以及使用远程医疗以促进患者随访。大家一致认为外用皮质类固醇是治疗轻度小儿银屑病的首选药物。而光疗和全身治疗用于中度至重度银屑病儿童。根据提出的处理算法,生物制剂是全身治疗的第一线。
结论:靶向全身疗法正在改变中重度小儿银屑病的治疗,而外用皮质类固醇仍然是轻度疾病的首选。需要以儿童为中心的研究来进一步改善小儿银屑病的治疗。
BACKGROUND: Psoriasis affects children with a considerable burden in early life. Treating pediatric psoriasis is challenging also because of the lack of updated specific
guidelines. With the recent approval of several biologics for pediatric psoriasis and the ongoing COVID-19 pandemic, the management of young psoriatic patients is facing major changes. A revision of treatment recommendations is therefore needed.
METHODS: In September 2021, a board of six Italian dermatologists convened to update treatment recommendations. The board issued evidence- and
consensus-based statements covering relevant areas of pediatric psoriasis, namely: assessment of psoriasis severity, management of children with psoriasis, and treatment of pediatric psoriasis. To reach
consensus, the statements were submitted to a panel of 24 experts in a Delphi process performed entirely via videoconference. A treatment algorithm was produced.
RESULTS: There was full
consensus that psoriasis severity is determined by the extension/severity of skin lesions, site of lesions, and impact on patient quality of life. Agreement was reached on the need for a multidisciplinary approach to pediatric psoriasis and the importance of patient/parents education. The relevance of vaccinations, including COVID-19 vaccination, for psoriatic children was acknowledged by all participants. Management issues that initially failed to reach consensus included the screening for psoriasis comorbidities and early treatment with biologics to prevent them and the use of telemedicine to facilitate patient follow-up. There was full
consensus that topical corticosteroids are the first choice for the treatment of mild pediatric psoriasis, while phototherapy and systemic therapy are used in children with moderate-severe psoriasis. According to the proposed treatment algorithm, biologics are the first line of systemic therapy.
CONCLUSIONS: Targeted systemic therapies are changing the treatment of moderate-severe pediatric psoriasis, while topical corticosteroids continue to be the first choice for mild disease. Children-centered research is needed to further improve the treatment of pediatric psoriasis.