title: Treatment patterns with systemic antipsoriatic agents in childhood psoriasis: an Italian database analysis.
abstract: BACKGROUND
  The majority of available systemic therapies have never been systematically investigated in moderate to severe childhood plaque psoriasis. For this reason, treatment preferences for moderate to severe psoriasis in childhood are still unknown. The aim of this study was to investigate the systemic treatment patterns of moderate to severe psoriasis in children and adolescents aged 18 or older in Italy. Additional secondary outcomes were duration of treatment and reasons for discontinuation.
  
  
  METHODS
  In order to define differences in treatment patterns, we performed a chart review of all consecutive patients treated with systemic drugs during an index period of 5 years. Consecutive sampling of all patients with psoriasis aged ≤18 years, who had been treated with at least one systemic drug over a 5-year period, was made.
  
  
  RESULTS
  The records of 58 consecutive patients, 27 males, 31 females. with moderate to severe psoriasis treated with at least one systemic therapy were reviewed. The median age (standard deviation) at the start of the first systemic treatment was 11.7±3.7 years. The most preferred first-line systemic treatment was cyclosporine, which was administered as first systemic treatment in 53.4% of patients, followed by acitretin in 22.4% of patients, etanercept and PUVA respectively in 8.6%, methotrexate in 6.8%. 48.2% of patients received a second systemic treatment due to inefficacy or side effects of the first-line therapy during the index period. Because of the small sample, and voluntary contribution, selection bias may have occurred.
  
  
  CONCLUSIONS
  A considerable variation in the management of the first-line systemic therapy in children with moderate to severe psoriasis was observed. Cyclosporine was most commonly preferred as a first-line treatment. The availability of new therapeutic agents could change the scenario of treatment patterns in childhood psoriasis.
authors.affiliation: Dermatology Unit, Department of Internal Medicine, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy - vito.dilernia@asmn.re.it.
authors.forename: Vito
authors.initials: V
authors.lastname: DI Lernia
authors.affiliation: Dermatology Unit, Department of Specialist, Diagnostic and Experimental Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Iria
authors.initials: I
authors.lastname: Neri
authors.affiliation: Section of Dermatology, Department of Medicine, University of Brescia, Brescia, Italy.
authors.forename: Piergiacomo
authors.initials: P
authors.lastname: Calzavara Pinton
authors.affiliation: Section of Dermatology, Department of Clinical and Experimental Medicine, Parma University Hospital, Parma, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: DI Nuzzo
authors.affiliation: Section of Clinical Dermatology, Allergology and Venereology, Department of Medicine, University of Perugia, Perugia, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Stingeni
authors.affiliation: Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Guarneri
authors.affiliation: Pediatric Dermatology Unit, Department of Medicine, University of Padua, Padua, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Belloni Fortina
authors.affiliation: Section of Dermatology, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Bonamonte
authors.affiliation: Pediatric Dermatology Unit, Department of Pathophysiology and Transplantation, Maggiore Hospital, Polyclinic Hospital of Milan, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cambiaghi
authors.affiliation: Dermatology Unit, Department of Head and Neck Surgery, University of Modena, Modena, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Lasagni
authors.affiliation: Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Panzone
authors.affiliation: Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Corazza
authors.affiliation: Dermatology Unit, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Offidani
authors.affiliation: Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Gisondi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016572:Cyclosporine / Q000627:therapeutic use; D016208:Databases, Factual; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D007558:Italy; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011565:Psoriasis / Q000188:drug therapy* / Q000473:pathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D003879:Dermatologic Agents; D016572:Cyclosporine