Treatment of Eczema and Psoriasis in Adolescents

Initial Assessment and Topical Therapy

The American Academy of Dermatology recommends beginning with moderately potent (class III) topical corticosteroids for both eczema and psoriasis, as they effectively reduce inflammation while minimizing side effects 1
Topical calcipotriene (vitamin D analogue) can be used alone or in combination with corticosteroids for better efficacy in treating psoriatic lesions 1

The American Academy of Dermatology recommends narrowband UVB (NB-UVB) phototherapy as a second-line treatment for both eczema and psoriasis if topical treatments provide inadequate response 2
Phototherapy can be administered 2-3 times weekly for patients old enough to cooperate with therapy, with baseline monitoring including skin cancer screening and eye examination before starting treatment 2
Regular skin examinations should be conducted during phototherapy to monitor for adverse effects 2

The American Academy of Dermatology recommends considering biologic therapy for moderate to severe psoriasis unresponsive to topical therapy and phototherapy 3, 4
Adalimumab is recommended for adolescents with moderate to severe psoriasis at a dose of 0.8 mg/kg (maximum 40 mg) at weeks 0 and 1, then every other week 3, 5
Etanercept is an alternative option for patients 6 years and older at a dose of 0.8 mg/kg (maximum 50 mg) once weekly 3, 5
Ustekinumab is recommended for adolescents 12 years and older with moderate to severe plaque psoriasis, administered at weeks 0, 4, 16, and then every 12 weeks with weight-based dosing 3, 5

The British Medical Journal advises avoiding acitretin in female adolescents approaching childbearing potential due to its teratogenic effects that can persist for up to 3 years 5, 6
Methotrexate should be used with extreme caution and only with reliable contraception due to its teratogenic potential 6
Counsel regarding contraception if considering any systemic therapy, as most are contraindicated in pregnancy 6, 7

Regular clinical reviews are essential when using topical corticosteroids to monitor for adverse effects, according to Praxis Medical Insights 1
For patients on biologics, monitor for injection site reactions and increased risk of infection 3, 5
If using methotrexate, perform baseline and periodic monitoring of full blood count, liver function tests, and serum creatinine 6, 7

For moderate disease or inadequate response to topicals, add NB-UVB phototherapy 2-3 times weekly, as recommended by the Journal of the American Academy of Dermatology 2
Consider combination with topical treatments 2
For severe disease or inadequate response to above, consider biologic therapy with adalimumab, etanercept, or ustekinumab based on age and weight, as recommended by the Journal of the American Academy of Dermatology 3, 5

The American Academy of Dermatology recommends biologic therapy for moderate-to-severe plaque psoriasis when patients have failed other treatments, including topical agents, phototherapy, or conventional systemic therapies 8
The patient meets the criteria for systemic therapy consideration with a PGA score of 3.0 and 20% body surface area involvement, as supported by the Journal of the American Academy of Dermatology 8, 9
The patient has demonstrated failure of multiple previous treatments, including topical steroids and methotrexate, as documented in the Journal of the American Academy of Dermatology 8, 9
The patient has also failed Taltz (ixekizumab, an IL-17 inhibitor), as reported in Arthritis care & research 10

The Joint American Academy of Dermatology-National Psoriasis Foundation (AAD-NPF) guidelines support the use of biologic therapy, such as Skyrizi (risankizumab), for moderate-to-severe plaque psoriasis when patients have failed other treatments 8
The British Association of Dermatologists and AAD-NPF guidelines also support the use of biologics in patients with moderate-to-severe psoriasis who have failed conventional therapies 8, 11, 12

For patients who have failed an IL-17 inhibitor, guidelines suggest switching to a TNF inhibitor or an IL-12/23 inhibitor, such as Skyrizi (risankizumab), as reported in Arthritis care & research 10