Lee, RE, Gaspari, AA, Lotze, MT et al, Interleukin 2 and psoriasis. Van Hoof, J, Leunissen, K, Van der Staak, W. Cyclosporin and psoriasis letter. Lack of efficacy of topical cyclosporin A in atopic dermatitis and allergic contact dermatitis. (CyA; Sandimmun) for longterm treatment of chronic severe plaque psoriasis. The safety and efficacy of cyclosporine therapy have been extensively studied in severe adult and childhood atopic dermatitis and in adult. Figure 2. Case 4. A 2-year-old boy with highly inflammatory plaque psoriasis. Which agents are first-line for treatment of psoriasis in children? J Am Acad Dermatol 2009 Feb;60(2):21824.
Erythrodermic, pustular, and inverse psoriasis may also occur in adolescents, but less frequently. Moreover, it remains controversial whether the loss of efficacy with time must be attributed to tachyphylaxis or if it reflects the loss of compliance and adherence that usually characterizes adolescent patients treated with topical regimens. Erythrodermic psoriasis is a chronic condition that is difficult to treat. Cyclosporine and infliximab have a rapid onset of action and are recommended first line therapies; etanercept and methotrexate are considered second line agents, although in the case of etanercept, published data are very limited 1. A chest X-ray was normal and two PPD tests one week apart were negative. After the 6th infusion, infliximab lost efficacy and his psoriasis flared with large plaques on the trunk. Systemic agents are used to treat more severe cases. 6 In a review of 1262 cases of psoriasis, initial disease onset occurring before the age of 2 years was found in 14-27. Plaque-type psoriasis is the most prevalent variant that affects children. 5 Combination therapy can help reduce side-effects caused by topical steroids without reducing the efficacy of the treatment.9 Side-effects of topical steroids include skin atrophy, striae, telangiectasia, acneiform eruptions, and in rare cases, suppression of the hypothalamic-pituitaryadrenal axis may occur after prolonged widespread application or overuse, especially of potent preparations.
Psoriasis treatments can be divided into three main types: topical treatments, light therapy and systemic medications. To minimize side effects and to increase effectiveness, topical corticosteroids are generally used on active outbreaks until they’re under control. The two therapies together are more effective than either alone because coal tar makes skin more receptive to UVB light. This more aggressive treatment consistently improves skin and is often used for more-severe cases of psoriasis. Letter: Long-term management of erythrodermic psoriasis with anti-TNF agents. BACKGROUND: The efficacy of biologic therapy in treating plaque-type psoriasis is well documented. Traditional systemic therapy for erythrodermic and generalized pustular psoriasis includes cyclosporine, acitretin, and methotrexate. In addition, anakinra was used to treat two cases of generalized pustular psoriasis.16.
Management Of Psoriasis In Adolescence
All patients had extensive plaque psoriasis with erythroderma, in two cases affecting 65 90 of the body surface area. Efficacy and safety of infliximab monotherapy for plaque type psoriasis: a randomized trial. Cyclosporine in psoriasis: A multicenter dose-finding study in severe plaque psoriasis. Mueller W, Herrmann B. Cyclosporin A for psoriasis Letter. Lancet 1979;1:555. 2. This biological agent has shown good efficacy against plaque-type psoriasis and emerging effectiveness in a variety of inflammatory skin diseases such as atopic dermatitis2. Herein, we report 2 cases of erythrodermic psoriasis that successfully improved following ustekinumab treatment. He was previously treated with cyclosporine A, methotrexate, and narrow band ultraviolet B phototherapy.