Magan Medical Clinic, Dermatology
We provide quality dermatology care with compassion. Our specialty is medical dermatology, including:
If you have psoriasis or hair questions, Dr. Chiang possesses special expertise. He completed fellowships in both fields at University of California, San Francisco where he saw a wide spectrum of patients (including the most severe), performed clinical trials, and published research.
We take pleasure in serving our community including Covina, West Covina, San Dimas, Rancho Cucamonga, Baldwin Park, Azusa, Glendora, Upland, El Monte, Duarte, Monrovia, Arcadia, La Puente, and Diamond Bar.
Same day appointments often available. No referral is necessary if you have PPO insurance. We accept a wide range of insurance plans (unfortunately, we do not accept Medi-Cal as primary insurance, only as secondary insurance).
For appointments, please call (626) 331-6411. We look forward to serving you!
"What’s New in..."
A monthly column by Dr. Chiang
What's New in Pediatric Psoriasis
Psoriasis is a skin disease of pink raised rashes covered with “silvery scale.” While it is most common in adults (about 2.6% of the population), 1 in 3 patients have their first outbreak before age 20 and 20,000 children are diagnosed with psoriasis each year.
First line treatment is usually topical therapy. However, there are definitely teenagers with such widespread psoriasis that systemic therapies are considered. The most studied systemic biologic for pediatric psoriasis is currently etanercept. Recently, a 5 year clinical extension trial of 182 pediatric patients treated with etanercept has been published. This is in addition to the initial trial lasting 48 weeks. Of course, the medication was efficacious with most achieving at least 75% improvement in their psoriasis.
That being said, most parents are reasonably concerned primarily with the safety data. In the original clinical trial for 48 weeks of 211 patients, there were 4 serious adverse events (3 infections, 1 ovarian cyst that was removed). There were no long term side effects after these were treated. In the 5 year extension trial, there was only one serious side effect reported to be due to the medication, a single case of skin infection (cellulitis). Otherwise, there were no other serious infections or cancers thought to be due to the medication. However, there were 7 other serious adverse events that occurred, but were thought by the study investigators not due to the medication. Some I would agree sound completely unrelated (a patient with a bone birth defects had more bone issues, a patient with a bladder birth defect had intestinal issues after a surgery), some sound unlikely (anxiety), some sound possible without further information (an abortion, infectious mononucleosis, a thyroid cyst). The most common side effect was an upper respiratory infection (ie, cold, flu, etc). The overall conclusion was “etanercept in pediatric patients was generally well tolerated.”
It is always good to have options, and I’m glad that there is a relatively safe option if a patient’s psoriasis is severe enough. That being said, topical steroids are the usual first line therapy for most patients. For pediatric patients with widespread psoriasis, I usually first suggest considering phototherapy (ie, standing in a medical upright light booth using a wavelength called narrow band UVB. high rate of improvement but needs regular visits to maintain the benefit) before biologics such as etanercept.
Charles Chiang, MD, FAAD
- Paller AS, et al. Long-term safety and efficacy of etanercept in children and adolescents with plaque psoriasis. J Am Acad Dermatol 2016
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