1.1. Paediatric psoriasis
The psychological suffering brought about by psoriasis in a child, and hence the severity of the psoriasis, is much more difficult to assess than in the adult. It is also difficult to distinguish from the anguish experienced by the parents. The questioning, explanations and negotiations must therefore be done not only with the child but with the parents too. Children are much better at tolerating systemic treatments than adults, but the cumulative toxic effects of treatment are most feared in children, of course, because the future is not something to be signed away.
- The first line of treatment is moisturizing of the skin.
- The second line of treatment is vitamin D derivatives.
- The third line of treatment is UVB phototherapy, to cope with a crisis situation.
- The fourth line of treatment is retinoids. In general, these are remarkably effective and very well tolerated at a dose that must never exceed 1/2 mg/kg/j (photos 93 and 94). Two side effects are more frequent in children: these are cephalalgia and irritability. These two side effects are the consequence of mild cerebral oedema. These must prompt a reduction in dosage and, if they fail to disappear, the treatment must be stopped.
Photo 93. Before systemic retinoids (photo: C. Beylot).
hoto 94. After systemic retinoids (photo: C. Beylot).
Retinoid treatment in infants must be monitored in collaboration with the paediatrician and the GP in order to make sure that there is no negative repercussion on the growth curve. It should be recalled that extensive psoriasis, like any other chronic inflammatory disease, might curb child’s growth.
Treatment with retinoids poses a very difficult problem in young girls during puberty. In medico-legal terms, as soon as the period has occurred for the first time, contraception is necessary. This is not always immediately workable in a reasonable fashion, but the question must always be raised, the dialogue engaged and the contraception arranged as soon as it can be taken on. As a matter of fact, retinoids are rarely prescribed to young girls embarking on adolescence.
- Methotrexate and cyclosporine, in those exceptional cases indicated, are certainly better tolerated in children than in adults.
- Anti-TNF began to be used in children suffering from arthritis and etanercept began to be used in children suffering from severe psoriasis.
[|Anthralin works very well and
rapid in children, as the psoriasis in children often is very superficial. The
discoloration of the skin may be disturbing, but the effect is excellent.|auteur195]
1.2. The fertile woman
Two teratogenic drugs, retinoids and methotrexate, require strict precautions when used in fertile women.
Current retinoids require contraception throughout the duration of the treatment and for two years following discontinuation of treatment. This means that, in practice, they are of no use in the fertile woman. We await impatiently the advent of other retinoids that will only require contraception for the duration of the treatment and the month following discontinuation of treatment. In the event of pregnancy occurring in the weeks following the withdrawal of acitretine, the teratogenic risk is minimal. Before discussing pregnancy termination, retinoid levels in the blood must be determined. This analysis can be done with the aid of the Roche Laboratories. Most often, the analysis will be negative and the pregnancy can be allowed to continue with no worries.
Methotrexate requires contraception during treatment and for the three months following its discontinuation. Methotrexate is not mutagenic but is powerfully teratogenic. It is wise to recommend contraception in the woman as well as the man, due to the disruption in spermatogenesis caused by methotrexate.
Biological treatments need contraception because we do not have today data proving their safety during pregnancy.
[|I would mention in this paragraph the fact that the biologic agents are certainly of more value than methotrexate, ciclosporin, and retinoids, ie the traditional agents, in family planning situations. |auteur215]
1.3. The pregnant woman
One of the rules with pregnant women is to use as few drugs as possible.
In topical terms, moisturizing of the skin is always important; topical corticotherapy may be used, but only stintingly, particularly given the significant risk of promoting the appearance of stretch marks.
UVB phototherapy may be done in pregnant women without any problem.
In the severe forms, the only systemic treatment authorized is cyclosporine after agreement of the gynaecologist or obstetrician.
1.4. The elderly
In the elderly, topical treatment is only worth prescribing if applied by a nurse.
Phototherapy and PUVA therapy may be widely used without any misgivings about the several-year period between genotoxic aggression and the appearance of skin cancer. However, elderly people with ample solar keratosis or a history of skin cancer will not derive reasonable benefit from phototherapy. Retinoids may only be used at a weak dose to avoid weakening the skin too much. The risk of senile pruritus or prurigo triggered by retinoids is more significant in the elderly.
The medicine of medicines for major psoriasis in elderly individuals is methotrexate. It is important always to start off at 5 mg a week, and extreme caution must be exercised when increasing dosage. It is rare to have to exceed 10 or 15 mg a week in elderly subjects.
Cyclosporine is not indicated in the elderly, as side-effects appear quite more quickly with advancing age.
Age is not a contraindication by itself to the use of biological treatments.
- 2019/08/12 Focus on...Latin American Clinical Practice Guidelines on the Systemic Treatment of Psoriasis
- 2019/06/03 Focus on...News from our SPIN Columbian members
- 2019/05/21 Focus on...SPIN2019 is now available on your screen!
- 2019/04/18 Focus on...SPIN Congress 2019 in Paris coming soon
- 2019/04/17 Focus on...Do not miss Spin Congress 2019 highlights
News from the web office
- 2017/06/05PIN becomes SPIN - Skin Inflammation & Psoriasis International Network
- 2016/10/29PSO 2016 Congress - Webcasts Available!
- 2016/05/26PIN Survey on Phototherapy
- 2016/02/20PIN Study on Therapeutic Patient Education
- 2016/02/19World Directory of Psoriasis Medical Resources - February 2016 Update
- 2019/04/18 Focus on...SPIN Congress 2019 in Paris coming soon
- 2018/07/16SPIN Symposium at the Spring continental meeting - Tehran, 25-27 April 2018
- 2018/02/222nd National Meeting of the Egyptian Society for Psoriasis
- 2018/02/211st Psoriasis Symposium - Sarajevo 2017
- 2017/06/2815th São Paulo Meeting of Psoriasis and Vitiligo
News from medical groups
- 2018/04/183rd Turkish National Psoriasis Symposium
- 2017/06/21Brazilian Center for Psoriasis Studies joins SPIN!
- 2017/06/21Costa Rica Psoriasis Group - Meet them!
- 2017/02/02Works of the 1st Senegalese Psoriasis Day published!
- 2016/07/29Swiss S1 Guidelines for Systemic treatment of psoriasis vulgaris
News from patients associations
- 2017/02/08France Psoriasis - 2016 World Psoriasis Day
- 2016/05/26Senegal Patients Association joins PIN!
- 2015/08/04Epidermia Greece: a new partner association of PIN
- 2015/08/01Canadian Association of Psoriasis Patients joins PIN!
- 2015/04/09AEPSO Argentina launches digital map to find people with psoriasis in the country
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This study aimed to evaluate the effects of cinnamamides on atopic dermatitis (AD) and the mechanisms underlying these effects. To this end, the actions of two cinnamamides, (E)-3-(4-hydroxyphenyl)-N-phenylethyl acrylamide (NCT) and N-trans-coumaroyltyramine (NCPA), were determined on AD by orally administering them to mice. Oral administration of the cinnamamides ameliorated the increase in epidermal and dermal thickness as well as mast cell infiltration. Cinnamamides suppressed serum (...)see on pubmed
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