Systemic Therapy in Pediatric Dermatology

Introduction

The children usually have numerous skin changes. Pediatric dermatology was first recognized as a subspeciality in 2000. Newer technology in pediatric dermatology has evolved in recent times. Severe skin conditions like psoriasis and atopic dermatitis need special care. Systemic therapy includes hormonal therapy, target drug delivery, and immunotherapy. Systemic therapy is beneficial in treating childhood melanoma and other dermatitis conditions.

What Is Systemic Therapy?

Systemic therapy is psychotherapy mostly given to children with psychological difficulties. Systemic therapy is different from other forms of therapy. Systemic therapy contains the chemical compounds that travel through the blood and reach the affected area to perform its action. Systemic therapy is advised for pediatric patients with severe chronic dermal conditions. Children beyond the treatment of typical therapy are primarily involved in systemic therapy. Systemic therapy is typically suggested in children with moderate to extreme conditions of atopic dermatitis. In some cases, topical and systemic therapy is also prescribed in pediatric dermatology.

What Are the Conditions That Require Systemic Therapy?

Systemic therapy is mainly performed in severe eczematous skin conditions. For example, atopic dermatitis, in addition to superinfections, needs systemic treatment. Pediatric dermatologists include allergy, immunology, cancer, superinfections, rheumatology, and plastic surgery. Some of the pediatric conditions involving systemic therapy are mentioned below.

• Acne - Oral antibiotics, hormonal therapy, and drug-like Isotretinoin are systemic therapy.

• Eczemas such as atopic dermatitis and systemic steroids are advised.

• For birthmarks, such as hemangiomas, systemic Propranolol is used.

• Target therapy, cytotoxic chemotherapy, and immunotherapy are involved in the systemic treatment of melanoma.

• Skin connective disorder.

• Contact dermatitis. Antibiotics are administered.

• Alopecia.

• For erythromelalgia, Aspirin is the main drug of choice.

• Moles.

• Psoriasis, systemic drugs like Retinoids, Methotrexate, Cyclosporine, Apremilast, and immunotherapy.

• Blood malformations.

• Warts.

• Pregnancy dermatomes.

• Genetic disorders.

• Skin cancer.

What Causes Skin Infections in Children?

Skin is the natural barrier for any pathogens, but skin infections should be treated when infected. Skin infections can occur due to bacteria, viruses, and fungi. According to the severity of the disease, the appropriate treatment is given. Systemic therapy is advised in children with severe skin infections. Good hygiene is maintained to avoid most skin infections. Some skin conditions in children where systemic therapy is mandatory are given below.

• Molluscum contagiosum.

• Viral warts.

• Impetigo.

• Tinea capitis also known as scalp ringworm.

Molluscum Contagiosum:

Molluscum contagiosum is a common viral condition affecting children. Molluscum contagiosum is a self-limiting skin disorder caused due to human-specific poxvirus. The clinical features of molluscum contagiosum include the papules in dome shape with umbilication. Topical Imiquimod is advised, and cryotherapy is recommended in extreme cases.

Viral Warts:

Warts are the epithelial proliferations that happen due to the human papillomavirus. Viral warts are common cutaneous conditions that are more prevalent among children. Topical salicylic acids, cryotherapy, intralesional Bleomycin, topical immunotherapy, pulsed laser therapy, and photodynamic therapy are used for treating viral warts. The other types of viral warts are given below.

• Common warts appear as smooth papules in flesh color.

• Plantar warts, also known as verrucae. Plantar warts are painful skin lesions.

• Mosaic warts are typically seen as small and discrete warts.

• Plane warts are the flat papules usually seen on the face, extremities, and upper extremities.

Impetigo:

Impetigo is the most common cutaneous disorder affecting children. Staphylococcus aureus and Streptococcus pyogenes are the causative agents for impetigo. Impetigo is a contagious infection often seen in combination with atopic dermatitis in children. Systemic antibiotics in combination with topical antiseptics are administered in impetigo. Cephalosporins like Cephalexin are advised for the treatment of impetigo. Other drugs like Amoxicillin and Clavulanic acid, co-amoxiclav, are highly active against streptococcus aureus.

Tinea Capitis:

Tinea capitis is the scalp ringworm caused due to fungus caused by Microsporum canis. Tinea capitis is predominantly present in children. Symptoms of tinea capitis include patchy alopecia. Griseofulvin is an antifungal drug administered for treating tinea capitis. Other drugs found to be effective in treating tinea capitis include Itraconazole, Fluconazole, and Ketoconazole. The various patterns of tinea capitis are mentioned below.

• Gray type.

• Moth eaten.

• Kerion.

• Black dot.

• Diffuse scale.

• Pustular type.

What Is the Systemic Approach for Melanoma?

Since the introduction of Ipilimumab in 2011, the systemic therapy of melanoma has rapidly evolved. The systemic therapy given for the treatment of childhood melanoma is given below.

• Immune therapy includes immune inhibitors like Pembrolizumab, Ipilimumab, and Nivolumab.

• Target therapy involves BRAF inhibitors such as Vemurafenib, Dabrafenib, and Encorafenib.

• Recurrent childhood melanoma is treated by target therapy with the help of Dabrafenib.

What Are the Indications of Systemic Therapy in Pediatric Dermatology?

Systemic therapy is used to perform therapeutic actions on the entire body. Other systemic therapy types include hormonal therapy, immunotherapy, and target therapy. The indications of systemic therapy in pediatric dermatology are mentioned below.

• Childhood melanoma.

• Infantile atopic dermatitis.

• Eczema.

• Skin infectious conditions.

• Boils and abscesses.

• Cellulitis.

• Impetigo.

• Insect bites.

• Scabies.

• Fungal infections.

• Measles or Rubeola.

• Rubella or German measles.

• Roseola.

• Chickenpox.

• Parasitic skin infections.

• Herpes zoster infections.

• Shingles.

• Pityriasis rosea.

• Warts.

• Molluscum contagiosum.

• Viral exanthematous condition.

Conclusion

Children are mostly subjected to various skin conditions or skin problems. The mild form of skin conditions in children will be spontaneously resolved. But systemic therapy is advised in severe dermal diseases like melanoma, eczema, and other infectious skin conditions. Systemic therapy is highly effective against various dermal conditions in children and prevents the recurrence of particular conditions. Systemic therapy in combination with topical treatment is also effective in children with skin disorders. Proper awareness is mandatory among parents about the detrimental effects of poor health in children. Pediatric care, protective measures, and doctor-guided treatment will avoid the risk of skin disorders.