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New report on Archives Of Dermatology suggest that There is a discrepancy in treatment of children with psoriasis between specialties, children of different ages, and adults.
"There were an estimated 3.8 million visits for psoriasis over the study interval with a median of 123 420 visits per year. Dermatologists saw 63% of patients, pediatricians saw 17%, and internists, 14%. The numbers of visits were equal between sexes but ranged by age group: patients ages 13 to 18 years accounted for 47% of visits, those ages 8 to 12 years for 35%, and those ages 0 to 7 for 18%. Ninety-three percent of patients were white. Topical corticosteroids were the most commonly prescribed medications. Children 0 to 9 years old received equally potent corticosteroids as children 10 to 18 years old. Among all patients, the most prescribed medication was topical betamethasone; among those ages 0 to 9 years, tacrolimus; and among those ages 10 to 18 years, betamethasone. By physician specialty, the most prescribed medications were high-potency steroids for dermatologists and internists, and topical tacrolimus for pediatricians. Topical calcineurin inhibitors were not among the top 20 most prescribed medications by dermatologists, and systemic antipsoriatic agents were not among the top 20 most prescribed medications in any age group.
Treatment: The most common medications prescribed overall were topical corticosteroids, which accounted for 7 of the top 10 most prescribed medications. Betamethasone diproprionate, a high-potency topical corticosteroid, was the most listed medication for all children in the study, followed by fluocinonide (high potency) and fluocinolone acetonide (low to medium potency). The most common noncorticosteroid topical medications included a keratolytic (salicylic acid), vitamin D analog (calcipotriene), and coal tar. Topical calcineurin inhibitors occupied the fifth position of most listed medication by class in the nonsteroidal group, the second position by age in the 0- to 8-year-old group, and the first (tacrolimus), and third (pimecrolimus) position by specialty among pediatricians. Systemic antipsoriatic agents were not observed among the top 20 most listed medications by any physician group.
Conclusions: There is a discrepancy in treatment of children with psoriasis between specialties, children of different ages, and adults. Although these data may be biased toward milder or localized disease, the results suggest that pediatric patients with psoriasis, compared with adults, may be undertreated. The documented impairment of quality of life in children with psoriasis, together with recent data suggesting a potential increased risk of comorbid conditions, creates a compelling argument for adequately addressing all aspects of psoriasis management in children. Although treatment guidelines specific to pediatric psoriasis would be useful, formal evidence on which to base such guidelines is not yet available. The current state-of-the-art care for pediatric psoriasis is based primarily on experience and expert consensus. Some differences in approach to management between dermatologists and nondermatologists seem due in part to the "art" of dermatology (choice of vehicle, potency, combination, and rotational therapy) and thus may not be reasonably anticipated to change, even with standardized treatment guidelines. As such, education of our dermatology and nondermatology colleagues about unique clinical and treatment aspects of pediatric psoriasis, rather than guidelines alone, may decrease the treatment gap by creating more comfortable, safe, and effective use of topical and systemic regimens for children with psoriasis.
Source: archderm
"There were an estimated 3.8 million visits for psoriasis over the study interval with a median of 123 420 visits per year. Dermatologists saw 63% of patients, pediatricians saw 17%, and internists, 14%. The numbers of visits were equal between sexes but ranged by age group: patients ages 13 to 18 years accounted for 47% of visits, those ages 8 to 12 years for 35%, and those ages 0 to 7 for 18%. Ninety-three percent of patients were white. Topical corticosteroids were the most commonly prescribed medications. Children 0 to 9 years old received equally potent corticosteroids as children 10 to 18 years old. Among all patients, the most prescribed medication was topical betamethasone; among those ages 0 to 9 years, tacrolimus; and among those ages 10 to 18 years, betamethasone. By physician specialty, the most prescribed medications were high-potency steroids for dermatologists and internists, and topical tacrolimus for pediatricians. Topical calcineurin inhibitors were not among the top 20 most prescribed medications by dermatologists, and systemic antipsoriatic agents were not among the top 20 most prescribed medications in any age group.
Treatment: The most common medications prescribed overall were topical corticosteroids, which accounted for 7 of the top 10 most prescribed medications. Betamethasone diproprionate, a high-potency topical corticosteroid, was the most listed medication for all children in the study, followed by fluocinonide (high potency) and fluocinolone acetonide (low to medium potency). The most common noncorticosteroid topical medications included a keratolytic (salicylic acid), vitamin D analog (calcipotriene), and coal tar. Topical calcineurin inhibitors occupied the fifth position of most listed medication by class in the nonsteroidal group, the second position by age in the 0- to 8-year-old group, and the first (tacrolimus), and third (pimecrolimus) position by specialty among pediatricians. Systemic antipsoriatic agents were not observed among the top 20 most listed medications by any physician group.
Conclusions: There is a discrepancy in treatment of children with psoriasis between specialties, children of different ages, and adults. Although these data may be biased toward milder or localized disease, the results suggest that pediatric patients with psoriasis, compared with adults, may be undertreated. The documented impairment of quality of life in children with psoriasis, together with recent data suggesting a potential increased risk of comorbid conditions, creates a compelling argument for adequately addressing all aspects of psoriasis management in children. Although treatment guidelines specific to pediatric psoriasis would be useful, formal evidence on which to base such guidelines is not yet available. The current state-of-the-art care for pediatric psoriasis is based primarily on experience and expert consensus. Some differences in approach to management between dermatologists and nondermatologists seem due in part to the "art" of dermatology (choice of vehicle, potency, combination, and rotational therapy) and thus may not be reasonably anticipated to change, even with standardized treatment guidelines. As such, education of our dermatology and nondermatology colleagues about unique clinical and treatment aspects of pediatric psoriasis, rather than guidelines alone, may decrease the treatment gap by creating more comfortable, safe, and effective use of topical and systemic regimens for children with psoriasis.
Source: archderm