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Dermatology
Figure 5: 10-year-old Boy with Plaque Psoriasis and Figure 6: Same Patient as in Figure 5 After Five Months of
Involvement of All Fingernails Subcutaneous Etanercept Treatment
The patient had an extremely strong family history of psoriasis and psoriatic arthritis in Excellent clinical response – complete remission of skin lesions (not shown) and
first-degree relatives. nail dystrophy.
arthritis. Figures 5 and 6 show a 10-year-old boy with plaque psoriasis anti-p40 antibody targeting the subunit shared between the interleukin
and involvement of all fingernails. The subject had an extremely strong (IL)-23 and IL-12 receptor, which is already showing impressive efficacy
family history of psoriasis and psoriatic arthritis in first-degree relatives. in adult psoriasis.
He was treated with etanercept subcutaneously for five months, with
excellent clinical response that resulted in complete remission of skin Concluding Remarks
lesions and nail dystrophy. Side effects of etanercept include injection The increasing awareness of psoriasis as a systemic disease with the risk
reactions that are usually transient. Adverse events noted during the of significant co-morbidities associated with high disease activity will
study were three cases of infections in roughly 200 patients who likely lead to more active treatment in children with severe disease.
received etanercept during the study. After withdrawing the drug at Also, widespread psoriasis may have a major psychosocial impact,
week 36, 42% of patients had lost the response by week 48. leading to stigmatisation and a profound impairment of quality of life.
Undoubtedly, the approval of etanercept for childhood psoriasis will be Safety issues obviously remain vital in the paediatric population, and
followed by other biologic drugs, and there are already case reports post-marketing surveillance of both long-term efficacy and side effects
documenting efficacy using the monoclonal anti-TNF antibodies of novel drugs will be critical. Even though there is as yet no cure for
infliximab and adalimumab.
28
The deepening understanding of psoriasis psoriasis, the rapid development of new and effective treatments
pathogenesis will lead to the development of new drugs, such as the for psoriasis is highly encouraging. ■
1. Hensler T, Christophers E, Psoriasis of early and late onset: 2006;176(11):7104–11. 1988;5(4):266–72.
characterization of two types of psoriasis vulgaris, J Acad 10. Martin BA, Chalmers RJ, Telfer NR, How great is the risk of 19. Brecher AR, Orlow SJ, Oral retinoid therapy for dermatologic
Dermatol, 1985;13(3):450–56. futher psoriasis following a single episode of acute guttate conditions in children and adolescents, J Am Acad Dermatol,
2. Burden AD, Management of psoriasis in childhood, Clin Exp psoriasis?, Arch Dermatol, 1996;132(6)717–18. 2003;49(2):171–82.
Dermatol, 1999;24:341–5. 11. Zappel K, Sterry W, Blume-Peytavi U, Therapy options for 20. Ruzicka T, Sommerburg C, Braun-Falco O, et al., Efficiency of
3. Owen CM, Chalmers RJG, O’Sullivan T, et al., psoriasis in childhood and adolescence, J Dtsch Dermatol Ges, acitretin in combination with UV-B in the treatment of severe
Antistreptococcal interventions for guttate and chronic 2004;2:329–42. psoriasis, Arch Dermatol, 1990;126(4):482–6.
plaque psoriasis. In: The Cochrane Library, Oxford: Update 12. Zvulunov A, Anisfeld A, Metzker A, Efficacy of short-contact 21. Perrett CM, Ilchyshyn A, Berth-Jones J, Cyclosporin in
Software, 2001;3. therapy with dithranol in childhood psoriasis, Int J Dermatol, childhood psoriasis, J Dermatolog Treat, 2003;14(2):113–18.
4. Leung DYM, Hauk P, Strickland I, et al., The role of 1994;33:808–10. 22. Sugie N, Fujii N, Danno K, Cyclosporin-A suppresses p53-
superantigens in human diseases: therapeutic implications for 13. Oranje AP, Marcoux D, Svensson A et al., Topical calcipotriol dependent repair DNA synthesis and apoptosis following
the treatment of skin diseases, Br J Dermatol, in childhood psoriasis, J Am Acad Dermatol, 1997;36(2 Pt 1): ultraviolet-B irradiation, Photodermatol Photoimmunol
1998;139:17–29. 203–8. Photomed, 2002;18(4):163–8.
5. Rosenberg EW, Noah PW, Zanolli MD, et al., Use of Rifampin 14. Darley CR, Cunliffe WJ, Green CM, et al., Safety and efficacy 23. Kumar B, Dahr S, Handa S et al., Methotrexate in childhood
with penicillin and erythromycin in treatment of psoriasis, J of calcipotriol ointment (Dovonex) in treating children with psoriasis, Pediatr Dermatol, 1994;11(3):271–3.
Am Acad Dermatol, 1986;14:761–4. psoriasis vulgaris, Br J Dermatol, 1996;135(3):390–93. 24. Dogra S, Handa S, Kanwar AJ, Methotrexate in severe
6. Skinner RB, Rosenberg EW, Noah PW, Antimicrobial 15. Pasic A, Ceovic R, Lipozencic J, et al., Phototherapy in childhood psoriasis, Pediatr Dermatol, 2004;21(3):283–4.
treatment of psoriasis, Dermatol Clin, 1995;13:909–13. pediatric patients, Pediatr Dermatol, 2003;20(1):71–7. 25. Smith CH,Ormerod AD, British guidelines on the use of
7. Nyfors A, Rasmussen PA, Lemholt K, et al., Improvement of 16. Wohlrab J, Calcineurin inhibitors for topical therapy in biological therapies for psoriasis: a note of clarification on
recalcitrant psoriasis vulgaris after tonsillectomy, J Laryngol psoriasis, Hautarzt, 2006;57(8):685–9. the role of etanercept, Arch Dermatol, 2007;143(12):1595–6.
Otol, 1976;90:789–94. 17. Ortonne JP, van de Kerkhof PC, Prinz JC, et al., 0.3% 26. Nast A, Kopp I, Augustin M, et al., German evidence-based
8. Kataura A, Tsubota H, Clinical analyses of focus tonsil and Tacrolimus gel and 0.5% Tacrolimus cream show efficacy in guidelines for the treatment of Psoriasis vulgaris (short
related disease in Japan, Acta Otolaryngol Suppl, 1996;523: mild to moderate plaque psoriasis: Results of a randomized, version), Arch Dermatol Res, 2007;299(3):111–38.
161–4. open-label, observer-blinded study, Acta Derm Venereol, 27. www.emea.europa.eu/humandocs/Humans/EPAR/enbrel/
9. Diluvio L, Vollmer S, Besegen P et al., Identical TCR beta- 2006;86(1):29–33. enbrel.htm
chain rearrangements in streptococcal angina and skin 18. Rosinska D, Wolska H, Jablonska S, et al., Etretinate in 28. Menter MA, Cush JM, Successful treatment of pediatric
lesions of patients with psoriasis vulgaris, J Immunol, severe psoriasis in children, Pediatr Dermatol, psoriasis with infliximab, Pediatr Dermatol, 2004;21(1):87–8.
10 EUROPEAN PAEDIATRICS
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