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Kinder- und Jugendmedizin 2009; 9(01): 23-30
DOI: 10.1055/s-0038-1629007
Dermatologie
Schattauer GmbH

Juvenile Psoriasis

Juvenile psoriasis
M. Sticherling
1   Hautklinik, Friedrich-Alexander-Universität Erlangen
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Further Information

Publication History

Eingereicht am: 19 May 2008

angenommen am: 13 July 2008

Publication Date:
25 January 2018 (online)

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Zusammenfassung

Die Psoriasis ist eine der häufigsten chronisch-entzündlichen Erkrankungen des Menschen. 30 % aller Psoriasisfälle manifestieren sich bereits vor dem 20. Lebensjahr. Virale und bakterielle, allen voran Streptokokkeninfekte scheinen bei Kindern und Jugendlichen eine größere Rolle zu spielen wie auch eine Manifestation im Gesicht und Inguinalbereich sowie am Kopf häufiger als bei Erwachsenen ist. Angesichts des Nebenwirkungsspektrums, der fehlenden Zulassung der meisten Therapeutika sowie fehlender klinischer Studien zu deren Anwendung im Kindesalter müssen sowohl die lokale als auch systemische Therapie kritisch eingesetzt werden. Topische Glukokortikosteroide und Dithranol sind VitaminD-Derivaten zu bevorzugen. Auch eine Therapie mit ultraviolettem Licht ist angesichts der chronischen Lichtschädigung und Induktion von Hauttumoren sehr kritisch zu sehen. Nur bei Versagen der topischen Therapie und schwerem, rezidivfreudigem Krankheitsbild ist eine systemische Therapie indiziert. Zu Methotrexat besteht in der Kinderrheumatologie die größte Erfahrung, gefolgt von Ciclosporin. Orale Retinoide sind angesichts ihres Nebenwirkungsspektrums problematisch. Insgesamt muss die Therapie der kindlichen Psoriasis kritisch und in enger Rücksprache mit den Eltern erfolgen, andererseits aber sind die sozialen und emotionalen Folgen der Erkrankung für das Kind mit einzubeziehen.

Summary

Psoriasis is one of the most common chronic inflammatory human skin diseases. 30 % of cases become manifest before the age of twenty. Viral and bacterial infections seem to play a common role in juvenile psoriasis. A manifestation on the face and groins as well the scalp is more prominent in childhood. Regarding side effects, lacking licencing as well as lacking clinical studies for the juvenile age both topical and systemic treatment have to be administered very cautiously. Whereas corticosteroids and dithranol are the mainstay of topical therapy, ultraviolet light has to be avoided in most cases with regard to its chronic side effects and induction of skin tumors. Only when topical therapy is unsuccessful, systemic therapy may be initiated. Most extensive clinical expertise is available from juvenile rheumatology for methotrexate as well as for ciclosporin in childhood use. Altogether, therapy of juvenile psoriasis should be initiated very cautiously and in close cooperation with parents. However, the impact of social and emotional consequences for the development of children and adolescents have to be taken into account in the decision of therapeutic alternatives.

Schlüsselwörter

Psoriasis - chronisch-entzündliche Erkrankung - topische Therapie - systemische Therapie

Keywords

Psoriasis - chronic inflammatory disease - topical therapy - systemic therapy
 

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