Biological Response Modifiers Have Uses Beyond Psoriasis for Children and Adolescents

Published Online November 26, 2015
Pediatric Dermatology

An extensive medical literature review reveals an expanding role for biologic response modifiers in treating inflammatory dermatologic disorders other than psoriasis in children and adolescents.

The report, published in Pediatric Dermatology, was led by Kara Shah, MD, PhD, director, Division of Dermatology; and Fernanda Bellodi Schmidt, MD, clinical director.

Previous studies indicate that biologics pose fewer safety risks than traditional immune-suppressing agents. However, doctors have limited experience treating children with biologics because most of the conditions studied are relatively rare and the drugs were developed for adults.

This study examined treatment regimens, doses, side effects and responses among children treated with etanercept, infliximab, ustekinumab, omalizumab and rituximab.

Their review found potential off-label uses for biologics including: omalizumab for atopic dermatitis; etanercept and other TNF-a antagonists for pyoderma gangrenosum and hidradenitis suppurativa (HS); and rituximab for autoimmune bullous diseases.

Since the study was published in print in early 2016, adalimumab has been approved for HS treatment in adults. Phase 2 clinical trials are evaluating the use of topical tofacitinib and injectable secukinumab and tralokinumab for alopecia areata in adults. Work continues to develop a biologic response modifier for severe atopic dermatitis.

“The hope is to raise awareness for other dermatologic conditions that also can benefit from treatment with biologics,” Schmidt says. “New and promising therapies are undergoing studies in adults. Further studies will be needed to investigate how children respond to these drugs."

Fig A: Some off-label uses of biologic response modifiers show promise for treating children with dermatologic conditions, including: omalizumab for atopic dermatitis (A); etanercept and other TNF-a antagonists for pyoderma gangrenosum (B); and rituximab for autoimmune bullous diseases (C).
Click image to view caption.


Bellodi-Schmidt F, Shah KN. Beyond Psoriasis: Novel Uses for Biologic Response Modifiers in Pediatric Dermatology. Pediatr Dermatol. 2016 Jan-Feb;33(1):18-27.

A photo of Kara Shah.

Kara Shah, MD, PhD

A photo of Fernanda Bellodi Schmidt.

Fernanda Bellodi Schmidt, MD