• Psoriasis landscape is shifting, based in large part on the identification of comorbidities in children and adults and the concern that under treating children may facilitate the “psoriatic march” from severe untreated inflammation in childhood and its associations to cardiovascular morbidity and mortality in adults.
• Physicians should consider each person’s unique presentation, comorbidities, effect on quality of life (QoL), and health now and in the future when making treatment decisions, despite the lack of FDA approval for most systemic therapies.
• Comorbidities include obesity, hypertension and psychosocial disorders. This chronic skin condition may affect emotional and school functioning.
• Pediatric psoriasis can have distinct presentations that may evolve over time and vary from those classically seen in adults. Most cases are mild or moderate and respond to topical therapy. Children with more severe disease are candidates for phototherapy or systemic therapy.
• Current state-of-the-art care for pediatric psoriasis is based primarily on experience and expert consensus. Given the potential need for life-long treatment, shared decision-making with the family is critical.
• In most children with psoriasis, management involves topical therapy and trigger avoidance, but in many cases, therapy must be escalated in accordance with the disease’s effect on the patient.

Practice sutra: Most importantly, there is no “one size fits all algorithm”; treatment must be tailored to each individual presentation.