Addressing Treatment Hesitancy in Pediatric Psoriasis

Eileen Cheever, PA, a dermatology physician assistant at Clearview Dermatology in Massachusetts, spoke with Dermatology Times at the Elevate Summer Meeting in San Diego. Cheever, a founding advisory board member and medical director for Elevate, discussed her approach to family hesitancy toward systemic treatments in pediatric plaque psoriasis, the impact of visible skin disease on children, and treatment gaps affecting older patients with inflammatory skin disease.

Addressing Family Hesitancy Toward Systemic Treatment

Cheever said families managing pediatric plaque psoriasis may be hesitant to consider systemic options such as injectable or oral medications. Rather than dismissing those concerns, she encouraged clinicians to understand where they come from and provide education about the potential benefits of treatment.

“Meet them where they’re at,” Cheever said.

Inflammation associated with plaque psoriasis in children, as in adults, can extend beyond the skin, Cheever explained. She noted that clinicians should remain aware of factors such as metabolic issues, obesity, and joint symptoms when evaluating pediatric patients. These considerations can help frame conversations with families who may initially be reluctant to consider systemic treatment.

Cheever said some families continue to view topical creams as the primary treatment for atopic or psoriatic conditions and may not realize other therapeutic options are available. For some, a dermatology visit may be their first introduction to systemic treatment.

She emphasized acknowledging families’ concerns while helping them understand benefits they may not have previously considered.

Visible Skin Disease and Pediatric Quality of Life

Cheever also highlighted the broader impact of visible skin disease on children. Conditions such as atopic dermatitis and severe acne can cause pediatric patients to withdraw from activities or become increasingly self-conscious about their appearance.²

Facial acne may affect confidence, while children with eczema on their arms may wear long sleeves even during warm weather to conceal their skin, she explained. Effective treatment can therefore have effects that extend beyond improvement in clinical signs.²

Now their skin’s improving, and now they’re in T-shirts, or they were in sweatpants, and now they’re in shorts, — Cheever

Seeing those changes can be particularly meaningful because pediatric patients can be a challenging population to reach, according to Cheever.²

“It can be really rewarding when you feel like you’ve connected,” she said.

Moving Beyond Age-Based Treatment Assumptions

Cheever said similar opportunities to improve quality of life exist at the opposite end of the age spectrum. She highlighted older adults with conditions such as atopic dermatitis and psoriasis who may be overlooked for treatments because of assumptions related to their age.

She cautioned against allowing age alone to prevent patients from being considered for therapies capable of producing meaningful improvement.

“You’re not too old to get onto some of these treatments and some of these therapies,” Cheever said.

Instead, Cheever encouraged clinicians to walk older patients through the treatment options that are appropriate for their individual circumstances. She said some patients have previously felt dismissed because of their age or a perceived inability to treat them.^2,3

Helping those patients engage in treatment and experience improvements in their disease and quality of life can be particularly fulfilling, Cheever said.

References

1. American Academy of Dermatology. Pediatric psoriasis guideline. Accessed August 12, 2026. https://www.aad.org/member/clinical-quality/guidelines/psoriasis/pediatric-psoriasis
2. Perlmutter JW, Levy R, Sood S, Joseph M. Impact of pediatric psoriasis on child and caregiver health-related quality of life: a systematic review and meta-analysis. Pediatr Dermatol. Published online April 10, 2026. doi:10.1111/pde.70140. https://pubmed.ncbi.nlm.nih.gov/41960930/
3. van Winden MEC, van der Schoot LS, van de L'Isle Arias M, et al. Effectiveness and safety of systemic therapy for psoriasis in older adults: a systematic review. JAMA Dermatol. 2020;156(11):1229-1239. doi:10.1001/jamadermatol.2020.2311.