ABSTRACT
BACKGROUND: Psoriasis is one of the most common inflammatory skin disorders. There are only limited data on systemic treatment in children. OBJECTIVE: To assess the safety and clinical efficacy of the treatment of six paediatric patients with fumaric acid esters (FAE, Fumaderm) for psoriasis. METHODS: Six patients aged 6-17 years were treated with FAE. Patients underwent regular assessment. Treatment efficacy was evaluated using the Psoriasis Area and Severity Index (PASI) and body surface area (BSA). RESULTS: The mean duration of treatment was 17.8 months. PASI and BSA were determined after 12 weeks. All patients showed improvement in their skin condition, two achieving PASI75, one PASI90 and three PASI100 response. Proteinuria was encountered in one patient and two patients suffered from gastrointestinal discomfort. Treatment was discontinued due to remission in two patients. CONCLUSION: Treatment with FAE in paediatric patients is a valuable alternative option when systemic treatment is needed.
Subject(s)
Dermatologic Agents/administration & dosage , Fumarates/administration & dosage , Psoriasis/diagnosis , Psoriasis/drug therapy , Academic Medical Centers , Administration, Oral , Adolescent , Child , Dermatologic Agents/adverse effects , Dimethyl Fumarate , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Follow-Up Studies , Fumarates/adverse effects , Germany , Humans , Male , Maximum Tolerated Dose , Retrospective Studies , Sampling Studies , Severity of Illness Index , Time Factors , Treatment OutcomeSubject(s)
Delivery of Health Care/statistics & numerical data , Dermatology/statistics & numerical data , Health Care Surveys , Patient Satisfaction/statistics & numerical data , Self-Help Groups/statistics & numerical data , Skin Diseases/epidemiology , Skin Diseases/rehabilitation , Germany/epidemiology , Humans , PrevalenceABSTRACT
Psoriasis of childhood shows an annual prevalence of 0.71 % and accordingly has to be regarded as a frequent chronic inflammatory skin disorder of this age. The impact on the quality of life as well as development of the afflicted children and their parents is evident. On the other side, therapy is demanding with regard to the specific juvenile metabolism, physical development and skin penetration of topical drugs. Long-term treatment at an early age has to be critically judged regarding the chronicity of the disease. Topical corticosteroids, alternatively dithranol may be used first-line, followed by vitamin D derivatives. A combination with UV-light, preferably UV-B, has to be decided on an individual basis. Systemic treatment may be initiated in recalcitrant disease with methotrexate and cyclosporine where long-term experience is available from juvenile rheumatology and transplantation medicine. Alternatively fumaric acid esters or retinoids are available. Rehabilitation procedures will help the children and their parents to cope with the disease and its treatment. The different treatment options are presented here as a German expert consensus, as clinical studies are hardly available and only a few therapeutics are licensed for this age. In any case the therapy has to be individually planned and decided together with the patients and their parents to gain maximal safety, comfort and success.
Subject(s)
Adrenal Cortex Hormones/administration & dosage , Anthralin/administration & dosage , Anti-Inflammatory Agents/administration & dosage , Dermatologic Agents/administration & dosage , Psoriasis/drug therapy , Administration, Oral , Administration, Topical , Adolescent , Adrenal Cortex Hormones/adverse effects , Adrenal Cortex Hormones/pharmacokinetics , Anthralin/adverse effects , Anthralin/pharmacokinetics , Anti-Inflammatory Agents/adverse effects , Anti-Inflammatory Agents/pharmacokinetics , Child , Cross-Sectional Studies , Dermatologic Agents/adverse effects , Dermatologic Agents/pharmacokinetics , Germany , Humans , Psoriasis/diagnosis , Psoriasis/epidemiology , Skin Absorption/drug effects , Skin Care/methods , Urea/administration & dosage , Urea/adverse effects , Urea/pharmacokineticsABSTRACT
In addition to topical monotherapy for mild and systemic monotherapy for moderate to severe psoriasis, combination therapy plays an important role in daily practice. Although clinical trials almost exclusively evaluate monotherapy regimens, in real life psoriasis patients are usually treated with combination therapies. All combinations are used, topical/topical, topical/UV-light, topical/systemic or UV-light/systemic. Often not only two but more drugs/therapies are combined. Not every combination provides additive or synergistic effects. Some combinations are not possible and may be regarded as contraindications. Data on a benefit-risk-assessment are much more sparse in medical literature as compared to monotherapies. We summarize current knowledge about the use of combination therapies in psoriasis on the basis of published literature in the form of a table to show which combinations are possible, useful or which can not be recommended. This provides a quick overview of available options.
