Australian consensus: treatment goals for moderate to severe psoriasis in the era of targeted therapies: considerations for paediatric patients

Peter Foley, Patrick D. Mahar, Saxon D. Smith, Monisha Gupta, Nicholas Manuelpillai, David Orchard, Li Chuen Wong, John C. Su, Amelia James, Gayle Fischer, Gillian Marshman, Morton Rawlin, Murray Turner, Emma King, Robyn Kennedy, Christopher Baker

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    Abstract

    Background: Treatment goals have been established in Australia to facilitate the management of adults with moderate to severe psoriasis. The Australasian College of Dermatologists sought to determine if and how these adult treatment goals could be modified to accommodate the needs of paediatric and adolescent patients. 

    Methods: A modified Delphi approach was used. Comprehensive literature review and guideline evaluation resulted in the development of statements and other questions to establish current clinical practices. Two rounds of anonymous voting were undertaken, with a collaborative meeting held in between to discuss areas of discordance. Overall, consensus was defined as achievement of ≥75% agreement in the range 7–9 on a 9-point scale (1 strongly disagree; 9 strongly agree). 

    Results: Consensus was achieved on 23/29 statements in round 1 and 17/18 statements in round 2. There was a high level of concordance with treatment criteria in the adult setting. The limitations of applying assessment tools developed for use in adult patients to the paediatric setting were highlighted. Treatment targets in the paediatric setting should include objective metrics for disease severity and psychological impact on the patients and their family, and be based on validated, age-appropriate tools. 

    Conclusion: While the assessment, classification and management of moderate to severe psoriasis in paediatric patients aligns with metrics established for adults, it is vital that nuances in the transition from childhood to adolescence be taken into account. Future research should focus on psoriasis severity assessment scales specific to the paediatric setting.

    Original languageEnglish
    Pages (from-to)e134-e144
    Number of pages11
    JournalAustralasian Journal of Dermatology
    Volume65
    Issue number6
    DOIs
    Publication statusPublished - Sept 2024

    Bibliographical note

    Publisher Copyright:
    © 2024 The Authors. Australasian Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Australasian College of Dermatologists.

    Open Access - Access Right Statement


    Keywords

    • adolescent
    • Australia
    • child
    • consensus
    • paediatric
    • patient acuity
    • psoriasis
    • quality of life
    • treatment goals

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