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Persistence of treatments in children with psoriasis followed into young adulthood: from topical to systemic treatments
Publication year - 2021
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.19771
Subject(s) - psoriasis , discontinuation , medicine , persistence (discontinuity) , systemic therapy , young adult , dermatology , surgery , gerontology , geotechnical engineering , cancer , breast cancer , engineering
Psoriasis is a common skin disease in both children and adults that causes scaly and itchy patches on the skin and may greatly reduce quality of life. It affects at least 100 million individuals worldwide. Most patients can control their psoriasis with topical treatments alone (meaning that the medicine is applied directly to the skin, such as topical corticosteroids). However, sometimes more intensive treatment may be required, such as phototherapy or systemic treatment (tablets or injections). However, especially in young patients, the use of systemic therapies is mostly reserved for only severe cases due to risks and potential side‐effects. This study, from the Netherlands, aimed to find out what the time is from the start of psoriasis until, firstly, discontinuation of topical treatment (and switch to a more intensive treatment), and secondly, switch to systemic treatment. Data from the Child‐CAPTURE registry were used. This Dutch registry collects information about treatment of children with psoriasis, who are followed into young adulthood. Of all 448 children, 62.3% used only topical treatments throughout the study, 14.3% switched from topical treatment to phototherapy, but not to systemic treatment, and 23.4% switched to systemic treatment. The median time from the start of psoriasis until topical discontinuation was 7.3 years, meaning that 50% of all patients switched from topical to a more intensive treatment after 7.3 years. The median time until switch to systemic treatment was 10.8 years. We conclude that these median times until discontinuation of topical therapy and until switch to systemic treatment seem long. In recent years information on the safety and effectiveness of systemic treatments has increased. Therefore the question arises whether more effective systemic treatments should be started earlier on in the treatment of children with psoriasis. The results of this study support this discussion on early intervention in this important subgroup of patients with psoriasis. Linked Article : Bruins et al. Br J Dermatol 2021; 184 :464–472.