• Perla Lansang, James N Bergman, Loretta Fiorillo, Marissa Joseph, Irene Lara-Corrales, Danielle Marcoux, Catherine McCuaig, Elena Pope, Vimal H Prajapati, Sue Z J Li, and Ian Landells.
• Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; Section of Dermatology, Division of Pediatric Medicine, The Hospital for Sick Children, and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada. Electronic address: perlalansang@gmail.com.
• J. Am. Acad. Dermatol. 2020 Jan 1; 82 (1): 213-221.

BackgroundPsoriasis is a chronic inflammatory disease with clinical manifestations of the skin that affect adults and children. In adults, biologics have revolutionized the treatment of moderate to severe plaque psoriasis where clear or almost clear is a tangible goal. Research on biologics has recently been extended to children. The introduction of these new therapeutic options has outpaced the limited guidelines in this population.ObjectiveTo provide a review of current data on biologics, with a proposal for a clinically relevant treatment algorithm on the management of moderate to severe plaque psoriasis in the pediatric population.MethodsA Canadian panel with expertise in psoriasis, pediatric dermatology, and experience with consensus recommendation processes was selected to review the current landscape of pediatric psoriasis and clinical data on biologics plus identify special considerations for baseline workup and monitoring. Recommendations were reviewed and edited by each expert in an iterative process.ConclusionA treatment algorithm for moderate to severe plaque psoriasis in pediatric patients is presented, incorporating approved biologics. Guidance on baseline screening and ongoing monitoring is also provided. Ultimately, treatment choice depends on the patient and his or her caregiver, with consideration of comorbidities, impact on quality of life, and relevant safety aspects.Copyright © 2019 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

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