Table 3.

Proactive Management Options That Can Be Proposed After Flare-Ups are Under Control, or Used Together with Active Flare-Up Treatments

Education	Explain the pathophysiology and course of psoriasis Choose treatments (pharmaceutical forms) together with the adolescent No restrictions to diet, vaccinations or sports are needed
Avoid factors that aggravate/trigger flare-ups	Avoid injury: onychophagia, scratching, poorly fitting shoes, etc. Keep vaccinations up-to-date (adapt the schedule in case of vaccine-related flare-ups) Tonsillectomy, antibiotic prophylaxis if psoriasis flares are linked to infections Psychological support Management of obesity Mediterranean-style diet
Topical therapy	Emollients Reduce topical corticosteroid use very gradually Weekend therapy (topical corticosteroids: calcipotriol or tacrolimus) Early treatment of flare-ups (topical corticosteroids: calcipotriol)
Systemic therapy	Subcutaneous treatments: local anesthesia Acitretin: mucous, semi-mucous and dermal hydration Methotrexate: folic acid Effective minimum dose (acitretin, cyclosporine, and methotrexate) Dosing intervals (adalimumab and ustekinumab) Weekend therapy (cyclosporine) Intermittent treatment (cyclosporine and etanercept)

Note: Reproduced with permission from Lavaud J, Mahé E. Proactive treatment in childhood psoriasis. Ann Dermatol Venereol. 2020;147(1):29–35.⁴⁸