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Caring for Pediatric Patients With PP


Lauren Miller, MPAS, and Tj Chao, MPAS, offer considerations for treating pediatric patients with plaque psoriasis (PP).


Lauren Miller, MPAS, PA-C: Let’s talk about pediatric patients. In my previous practice, there were some days when it felt as if it were a pediatric clinic. I love children. I saw a lot of pediatric psoriasis. I want to talk about how we address a pediatric patient with plaque psoriasis. I look at pediatric patients the same as I do adults. If my goal is to get an adult clear or to improve their quality of life, I want to treat pediatric patients the same way.

The things I look at for adults are severity, BSA [body surface area], location, what comorbidities they have, maybe see if they’ve tried any therapies in the past. I’m going to approach [pediatric patients] the same way. But earlier, you had a good point. I’m going to let you share about being a younger patient, the difficulties within their age, and why it’s important for us to be somewhat aggressive with treatment.

TJ Chao, MPAS, PA-C: I have 2 teenagers and an 8-year-old. The world is completely different from when you and I were children. There are a lot of pressures, and there’s social media. I don’t think it’s as fun or easy as it was when we were growing up because of social media and other factors. The trauma that could be inflicted on patients is a lot greater now than it was in the past. My approach is that if Mom and Dad want to treat with a systemic agent [then I do.] By the way, we have great systemic agents to treat the disease, as well as good topical medications. We can get pediatric patients as clear as adults. Honestly, the children deserve the freedom. They deserve to have a normal childhood. They don’t have to go through the things that children with psoriasis went through 30 or 40 years ago, especially considering the environment that we have in our society.

Lauren Miller, MPAS, PA-C: Depending on how severe the disease is. When I say severe, it’s different for everybody. A patient can have 1 plaque, but depending on where it is, to that patient it [can be] severe.

TJ Chao, MPAS, PA-C: Exactly.

Lauren Miller, MPAS, PA-C: A patient may be covered, and it doesn’t bother them. But I go back to the fact that this is a chronic disease, and 20% or 30% of these patients are going to develop psoriatic arthritis. If we’re making this diagnosis when they’re pediatric patients, what’s the risk? What’s the likelihood that they could develop psoriatic arthritis over the years? I take that into account as well. We also have some good nonsteroidal options approved for pediatric patients.

TJ Chao, MPAS, PA-C: That’s right.

Transcript edited for clarity.

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