Psoriasistherapie im Kindes- und Jugendalter

Zusammenfassung

Die Behandlung der Psoriasis im Kindes- und Jugendalter stellt den Dermatologen vor besondere Herausforderungen. Therapieentscheidungen sind nicht nur in Bezug auf Schwere und Verlauf der Erkrankung sowie individuelle Beeinträchtigung des Patienten abzuwägen, sondern haben auch für das Kinder- und Jugendalter geltende Zulassungsbeschränkungen zu berücksichtigen. Leitlinien fehlen weitgehend. Neben Vitamin-D₃-Analoga und topischen Glukokortikoiden, die in Deutschland mit Einschränkungen zur Behandlung der Psoriasis im Kindesalter zugelassen sind, stellt der Einsatz von Dithranol (Cignolin) eine wichtige Behandlungsoption dar. Tazaroten hingegen ist nicht zur Therapie im Kindes- und Jugendalter zugelassen. Hinsichtlich einer Therapie mit UV-Licht, z. B. UV-B 311 nm, müssen potenzielle Langzeitfolgen in besonderer Weise berücksichtigt werden. Systemische Therapieoptionen bleiben schweren und ansonsten therapieresistenten Fällen vorbehalten. Systemische Retinoide (Acitretin) sind im Kindesalter lediglich zur Behandlung der erythrodermatischen und pustulösen Psoriasis zugelassen, Anwendungsbeschränkungen gelten aufgrund der begrenzten Erfahrungen für Methotrexat. Ciclosporin und Biologicals sind derzeit nicht zur Behandlung der Psoriasis im Kindes- und Jugendalter zugelassen. Publizierte Studien zum Einsatz von Fumaraten im Kindes- und Jugendalter liegen derzeit nicht vor.

Abstract

Treatment of childhood psoriasis represents a special challenge. Only a limited number of trials have studied the use of antipsoriatics in this age group and guidelines are often missing. Many therapies are not licensed for use with children. Apart from vitamin-D₃-analogues and topical corticosteroids, which are licensed with restrictions for the treatment of childhood psoriasis, dithranol (cignolin) still represents an important therapeutic option. Tazarotene is not certified for the treatment of children. Phototherapy, especially narrowband UV-B, has been proven as effective therapy option for psoriasis in adults. In children, however, long-term adverse effects of UV need to be considered in a special way. Systemic therapy should only be initiated in severe and otherwise treatment-resistant psoriasis. While systemic retinoids are licensed for the treatment of erythrodermic and pustular psoriasis in children, the use of methotrexate is restricted due to limited experience. Ciclosporine and biologicals are yet not certified for psoriasis treatment in childhood and adolescence. No published studies are currently available for the use of fumaric acid with children.

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