Juvenile Psoriasis

Zusammenfassung

Die Psoriasis ist eine der häufigsten chronisch-entzündlichen Erkrankungen des Menschen. 30 % aller Psoriasisfälle manifestieren sich bereits vor dem 20. Lebensjahr. Virale und bakterielle, allen voran Streptokokkeninfekte scheinen bei Kindern und Jugendlichen eine größere Rolle zu spielen wie auch eine Manifestation im Gesicht und Inguinalbereich sowie am Kopf häufiger als bei Erwachsenen ist. Angesichts des Nebenwirkungsspektrums, der fehlenden Zulassung der meisten Therapeutika sowie fehlender klinischer Studien zu deren Anwendung im Kindesalter müssen sowohl die lokale als auch systemische Therapie kritisch eingesetzt werden. Topische Glukokortikosteroide und Dithranol sind VitaminD-Derivaten zu bevorzugen. Auch eine Therapie mit ultraviolettem Licht ist angesichts der chronischen Lichtschädigung und Induktion von Hauttumoren sehr kritisch zu sehen. Nur bei Versagen der topischen Therapie und schwerem, rezidivfreudigem Krankheitsbild ist eine systemische Therapie indiziert. Zu Methotrexat besteht in der Kinderrheumatologie die größte Erfahrung, gefolgt von Ciclosporin. Orale Retinoide sind angesichts ihres Nebenwirkungsspektrums problematisch. Insgesamt muss die Therapie der kindlichen Psoriasis kritisch und in enger Rücksprache mit den Eltern erfolgen, andererseits aber sind die sozialen und emotionalen Folgen der Erkrankung für das Kind mit einzubeziehen.

Summary

Psoriasis is one of the most common chronic inflammatory human skin diseases. 30 % of cases become manifest before the age of twenty. Viral and bacterial infections seem to play a common role in juvenile psoriasis. A manifestation on the face and groins as well the scalp is more prominent in childhood. Regarding side effects, lacking licencing as well as lacking clinical studies for the juvenile age both topical and systemic treatment have to be administered very cautiously. Whereas corticosteroids and dithranol are the mainstay of topical therapy, ultraviolet light has to be avoided in most cases with regard to its chronic side effects and induction of skin tumors. Only when topical therapy is unsuccessful, systemic therapy may be initiated. Most extensive clinical expertise is available from juvenile rheumatology for methotrexate as well as for ciclosporin in childhood use. Altogether, therapy of juvenile psoriasis should be initiated very cautiously and in close cooperation with parents. However, the impact of social and emotional consequences for the development of children and adolescents have to be taken into account in the decision of therapeutic alternatives.

Schlüsselwörter

Psoriasis - chronisch-entzündliche Erkrankung - topische Therapie - systemische Therapie

Keywords

Psoriasis - chronic inflammatory disease - topical therapy - systemic therapy

• Literatur

• 1 Alexis AF, Strober BE. Off-Label Dermatologic Uses of Anti-TNF-a Therapies. J Cutan Med Surg 2005; 9: 296-302.
• 2 Beattie PE, Lewis-Jones MS. A comparative study of impairment of quality of life in children with skin disease and children with other chronic childhood diseases. Br J Dermatol 2006; 155: 145-151.
• 3 Benoit S, Hamm H. Childhood psoriasis. Clin Dermatol 2007; 25: 555-562.
• 4 Brecher AR, Orlow SJ. Oral retinoid therapy for dermatologic conditions in children and adolescents. J Am Acad Dermatol 2003; 49: 171-182.
• 5 Farber EM, Nall L. Childhood psoriasis. Cutis 1999; 64: 309-314.
• 6 Fond L, Michel JL, Gentil-Perret A. et al. [Psoriasis in childhood]. Arch Pediatr 1999; 6: 669-674.
• 7 Gelfand JM, Weinstein R, Porter SB. et al. Prevalence and treatment of psoriasis in the United Kingdom: a population-based study. Arch Dermatol 2005; 141: 1537-1541.
• 8 Guilhou JJ, Moles JP. New hypotheses in the genetics of psoriasis and other “complex” diseases. Dermatology 2008; 216: 87-92.
• 9 Häfner R, Michels H. Psoriatic arthritis in children. Curr Opin Rheumatol 1996; 8: 467-472.
• 10 Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005; 352: 1685-1695.
• 11 Harries MJ, Chalmers RJ, Griffiths CE. Fumaric acid esters for severe psoriasis: a retrospective review of 58 cases. Br J Dermatol 2005; 153: 549-551.
• 12 Hazard E, Cherry SB, Lalla D. et al. Clinical and economic burden of psoriasis. Manag Care Interface 2006; 19: 20-26.
• 13 Henseler T. The genetics of psoriasis. J Am Acad Dermatol 1997; 37: 1-11.
• 14 Horneff G, Forster J, Seyberth HW, Michels H. für die Arbeitsgemeinschaft Kinder- und Jugendrheumatologie.. Empfehlungen der Arbeitsgemeinschaft Kinder- und Jugendrheumatologie zur Therapie mit Etanercept (P75 TNF-a-Rezeptor-Immunglobulinfusionsprotein). Z Rheumatol 2000; 59: 365-369.
• 15 Huemer C, Malleson PN, Cabral DA. et al. Patterns of joint involvement at onset differentiate oligoarticular juvenile psoriatic arthritis from pauciarticular juvenile rheumatoid arthritis. J Rheumatol 2000; 29: 1531-1535.
• 16 Jacobsson LT, Turesson C, Gulfe A. et al. Treatment with tumor necrosis factor blockers is associated with a lower incidence of first cardiovascular events in patients with rheumatoid arthritis. J Rheumatol 2005; 32: 1213-1218.
• 17 Kalla G, Goyal AM. Juvenile generalized pustular psoriasis. Pediatr Dermatol 1996; 13: 45-46.
• 18 Krueger G, Koo J, Lebwohl M. et al. The impact of psoriasis on quality of life: results of a 1998 National Psoriasis Foundation patient-membership survey. Arch Dermatol 2001; 137: 280-284.
• 19 Lebwohl M, Ellis C, Gottlieb A. et al. Cyclosporine consensus conference: with emphasis on the treatment of psoriasis. J Am Acad Dermatol 1998; 39: 464-475.
• 20 Lebwohl M, Colón LE. The evolving role of topical treatments in adjunctive therapy for moderate to severe plaque psoriasis. Cutis 2007; 80: S29-S40.
• 21 Lowes MA, Bowcock AM, Krueger JG. Pathogenesis and therapy of psoriasis. Nature 2007; 445: 866-873.
• 22 Ludwig RJ, Boehncke WH. Psoriasis and risk of myocardial infarction. JAMA 2007; 297: 362.
• 23 Lukas A, Wolf G, Fölster-Holst R. Besonderheiten der topischen und systemischen Dermatotherapie im Kindesalter. JDDG 2006; 8: 658-678.
• 24 Mallbris L, Ritchlin CT, Stahle M. Metabolic disorders in patients with psoriasis and psoriatic arthritis. Curr Rheumatol Rep 2006; 8: 355-363.
• 25 Marcoux D, Prost Y. Pediatric psoriasis revisited. J Cutan Med Surg 2002; 6 Suppl 22-28.
• 26 Minden K, Niewerth M. Zink A und Kinderrheumatologen der AG Kinder- und Jugendrheumatologie. Kerndokumentation rheumakranker Kinder und Jugendlicher. Med Welt 2004; 55: 73-77.
• 27 Moll JM, Wright V. Psoriatic arthritis. Semin Arthritis Rheum 1973; 3: 55-78.
• 28 Morris A, Rogers M, Fischer G, Williams K. Childhood psoriasis: a clinical review of 1262 cases. Pediatr Dermatol 2001; 18: 188-198.
• 29 Nast A, Kopp IB, Augustin M. et al. Evidence-based (S3) guidelines for the treatment of psoriasis vulgaris. J Dtsch Dermatol Ges 2007; 5 (03) 1-119.
• 30 Niehues T, Horneff G, Michels H. et al. Evidence-based use of methotrexate in children with rheumatic diseases: a consensus statement of the Working Groups Pediatric Rheumatology Germany (AGKJR) and Pediatric Rheumatology Austria. Rheumatol Int 2005; 25: 169-178.
• 31 Niewerth M, Minden K, Listing J. et al. Health-related quality of life in children with juvenile idiopathic arthritis. Ann Rheum Dis 2005; 64 (03) 510.
• 32 Paller AS, Siegfried EC, Langley RG. et al. Etanercept treatment for children and adolescents with plaque psoriasis. N Engl J Med 2008; 358: 241-251.
• 33 Peters MJ, van der Horst-Bruinsma IE, Dijkmans BA, Nurmohamed MT. Cardiovascular risk profile of patients with spondylarthropathies, particularly ankylosing spondylitis and psoriatic arthritis. Semin Arthritis Rheum 2004; 34: 585-592.
• 34 Petty RE, Southwood TR, Manners P. et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 2004; 31: 390-392.
• 35 Prodanovich S, Ma F, Taylor JR, Pezon C. et al. Methotrexate reduces incidence of vascular diseases in veterans with psoriasis or rheumatoid arthritis. J Am Acad Dermatol 2005; 52: 262-267.
• 36 Raychaudhuri SP, Gross J. A comparative study of pediatric onset psoriasis with adult onset psoriasis. Pediatr Dermatol 2000; 17: 174-178.
• 37 Rocha-Pereira P, Santos-Silva A, Rebelo I. et al. Dislipidemia and oxidative stress in mild and in severe psoriasis as a risk for cardiovascular disease. Clin Chim Acta 2001; 303: 33-39.
• 38 Scott LJ, Dunn CJ, Goa KL. Calcipotriol ointment. A review of its use in the management of psoriasis. Am J Clin Dermatol 2001; 2: 95-120.
• 39 Stern RS, Nichols KT. Therapy with orally administered methoxsalen and ultraviolet A radiation during childhood increases the risk of basal cell carcinoma. The PUVA Follow-up Study. J Pediatr 1996; 129: 915-917.
• 40 Sterry W, Strober BE, Menter A. International Psoriasis Council.. Obesity in psoriasis: the metabolic, clinical and therapeutic implications. Report of an interdisciplinary conference and review. Br J Dermatol 2007; 157: 649-655.
• 41 Sticherling M. Mechanisms of psoriasis. Drug Discovery Today: Disease Mechanisms 2005; 2: 275-281.
• 42 Sticherling M, Minden K, Küster RM. et al. Psoriasis und Psoriasis-Arthritis in Kindheit und Adoleszenz. Übersicht und Konsensus Statement der 9. Wörlitzer Experten Round Table Diskussion 2006 für die Gesellschaft für Kinder- und Jugendrheumatologie. Z Rheumatol 2007; 66: 349-354.
• 43 Taylor W, Gladman D, Helliwell P. et al. Classification criteria for psoriatic arthritis: Development of new criteria from a large international study. Arthritis Rheum 2006; 54: 2665-2673.
• 44 Taylor WJ. Epidemiology of psoriatic arthritis. Curr Opin Rheumatol 2002; 14: 98-103.
• 45 Van Zander J, Orlow SJ. Efficacy and safety of oral retinoids in psoriasis. Expert Opin Drug Saf 2005; 4: 129-138.
• 46 Wakkee M, Thio HB, Prens EP. et al. Unfavorable cardiovascular risk profiles in untreated and treated psoriasis patients. Atherosclerosis 2007; 190: 1-9.
• 47 Weinstein GD. Therapy of moderate-to-severe psoriasis with methotrexate. In: Weinstein GD, Gottlieb AB. (ed). Therapy of moderate-to-severe psoriasis. New York: Dekker; 2003: 115-137.
• 48 Wilson JK, Al-Suwaidan SN, Krowchuk D, Feldman SR. Treatment of psoriasis in children: is there a role for antibiotic therapy and tonsillectomy?. Pediatr Dermatol 2003; 20: 11-15.
• 49 Wu-Wong JR, Tian J, Goltzman D. Vitamin D analogs as therapeutic agents: a clinical study update. Curr Opin Investig Drugs 2004; 5: 320-326.
• 50 Zappel K, Sterry W, Blume-Peytavi U. Therapieoptionen für die Psoriasis in Kindheit und Adoleszenz. J Dtsch Dermatol Ges 2004; 2: 329-342.