Our understanding of psoriasis-like disease related to use of TNF inhibitors (TNFi) in children has been limited to retrospective case series that fail to comprehensively capture clinical characteristics and include no mechanistic data. Among the approximately 750 children treated with TNFi annually at Lurie Children’s Hospital, almost 100 develop psoriasis/psoriasis-like disease. We have established a REDCap database to enroll these patients prospectively. At serial visits, detailed clinical information, photographs, and tape strips of lesional and nonlesional skin to evaluate gene and protein expression will be collected. In addition to understanding morphologic patterns, distribution, and disease course with therapy, tape strip analysis using qRT-PCR will quantify relative expression of markers of Th1 (IFNγ, CXCL10) and Th17 (CCL20, IL-22) pathways. Tape strips from skin of age- and sex-matched patients with classical plaque psoriasis and healthy skin will serve as controls. We hypothesize that the clinical patterns of TNF-induced vs. classic psoriasis in children will differ in distribution, morphology, and immunophenotype (Th1 vs. Th17 skewing) and that the magnitude of altered immune expression will correlate with disease severity. These studies will pioneer tape strip analyses of pediatric psoriasis. Our goals are to: i) better understand TNFi psoriasiform disease; ii) develop a tape strip panel to distinguish TNFi-induced psoriasis from classic psoriasis; and iii) establish practical techniques for non-invasive tape strip collection in clinics, thereby facilitating gene and protein analyses in future multisite PeDRA studies of pediatric skin disorders.
|Effective start/end date||5/1/21 → 4/30/22|
- Society for Pediatric Dermatology (Paller AGMT 4/21/21)