Challenges in diagnosis and treatment of pediatric psoriasis and atopic dermatitis

Psoriasis and atopic dermatitis are prevalent skin conditions affecting many children, each driven by distinct immunological pathways. Psoriasis is characterized by the activation of the Th17/IL-17/IL-23 axis, leading to rapid skin cell proliferation and the formation of thick, scaly plaques. In contrast, atopic dermatitis is primarily driven by the Th2/IL-4/IL-13 pathway, resulting in intense itching and disruption of the skin's protective barrier. The overlapping symptoms and atypical presentations of these conditions in children often complicate diagnosis and treatment. This article explores the underlying mechanisms, clinical manifestations, diagnostic approaches, and treatment options for pediatric psoriasis and atopic dermatitis. Emphasizing the need for individualized treatment plans and continuous monitoring, we highlight the complexities of managing these conditions in children. While a clinical diagnosis remains the most common approach, the more definitive method-biopsy-comes with significant risks. These include psychological trauma, bleeding, infection, and scarring, all of which can be particularly distressing for young patients. We identify a critical gap in current pediatric dermatology practices. Addressing this gap could lead to more accurate diagnoses, improved disease management, enhanced patient education, and better psychosocial outcomes for children suffering from psoriasis and atopic dermatitis.