PsoriasisDr. Salvador Arias SantiagoHospital Virgen de las Nieves de Granada

Psoriasis

Pediatric psoriasis: systemic therapy and beyond

• Phototherapy in Pediatric Psoriasis (Mega M. Tollefson MD)

• Efficacy

• Safety• Mild erythema, HSV reactivation• Carcinogenesis (nbUVB) no reported (short-term FU)

• Indications• >10% BSA, palmo-plantar, guttate• Severe scalp, visible location, refractory areas• When systemic therapy is consider• Motivated patient and family

Study Modality Age N Duration Outcome

Pavlosky nbUVB 8-16 88 3 months 92% (PASI 75)

In office vs. Home phototherapy

• Parent involvement• Headphones• Spaceship• Rewards

Pediatric psoriasis: systemic therapy and beyond

• Update in systemic therapies and emerging treatments (Amy S. Paller MD)

• Methotrexate 69,2%• Retinoids 14,6%

• Pustular/PP• Cyclosporine 7,7%

• Good response/Low survival• Fumaric acid 4,9%• Biologics 27,2%

• Eta• Ada• Ust Bronckerst et al.

JAMA Derm 2017

Methotrexate• May take many months for

the best effect• Daily folic acid– lower risk of

GI side effects

Pediatric psoriasis: systemic therapy and beyond

• Update in systemic therapies and emerging treatments (Amy S. Paller MD)

Pediatric psoriasis: systemic therapy and beyond

• Update in systemic therapies and emerging treatments (Amy S. Paller MD)

Psoriasis

• Use of oral medications before biologics vs. Biologic should be used first line (Dr. Gordon and Langely, MD)

Biologics first

Yes 67%Biologics first

No 33%

Efficacy and less side effects support this results

Step by step treatments is no longer justified

Psoriasis

• Treatment of genital psoriasis (Alan Menter, MD)

• Clothing should be loose fitting, lubricant• Topical

• Non steroidal (tacrolimus and pimecrolimus)• Vitamin D• Steroidal (oinments preferable)

• Systemic (no quality trials)• Metotrexate• Cyclosporine• Acitretin• Apremilast

• Biologics• Ixekizumab: response rate 73%

Psoriasis

• Comorbidities in psoriasis (Joel M Gelfand, MD)

Psoriasis and Hot topics

• Psoriasis: which drug for which patient? (Mark Lebwohl, MD)

• Strong• Few reactions• Fast• Durable• Safe• Safe in pregnancy• Effective in obese patients• Work for PsA• Cheap

Psoriasis and Hot topics

• Psoriasis: which drug for which patient? (Mark Lebwohl, MD)

Strong Few injections

Fast Durable Safe Safe in pregnancy

Obesity PsA

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Psoriasis

• Psoriasis: Posters

51% patients respond to TNF inh in the first follow-up visitNon responders:

Similar disease burdenHigher BMIMore biologic experiencedPoor quality of life

Thank you