Initial management of psoriasis in children

* Refer to UpToDate topics on the management of psoriatic juvenile idiopathic arthritis.
¶ Topical therapy is often inadequate for children with moderate to severe disease; however, we typically attempt topical therapy prior to initiating phototherapy or systemic therapy to identify those children who can be sufficiently managed with topical therapy.
Δ All listed treatments are reasonable first-line choices. Selection among these agents is dependent upon factors such as patient age, disease severity, comorbidities, tolerance of risks and side effects, and prior treatment history. Refer to UpToDate topics on the management of plaque psoriasis in children for additional information on treatment selection. Alternative systemic therapies include acitretin, cyclosporine, fumaric acid esters, and apremilast. Fumaric acid esters are not available in the United States.
◊ Phototherapy and systemic therapy are generally avoided in children under the age of four due to safety concerns. However, use of these interventions may be necessary in rare, refractory cases.
§ Refer to UpToDate table on topical corticosteroids.
¥ Topical calcineurin inhibitors are preferred over topical corticosteroids for long-term therapy.
‡ Often, patients find medications in shampoos, foams, solutions, gels, sprays, or oils preferable for application to the scalp. The vehicle options should be discussed with the child or caregiver to identify the most acceptable regimen.