Psoriasis in children and adolescents is associated with high disease burden and an increased prevalence of comorbidities including type 2 diabetes and psychiatric disorders. Thus, early diagnosis and therapeutic intervention are essential. This study was conducted to assess prevalence and biological treatment of psoriasis in children and adolescents based on real-world data. 
This was a non-interventional retrospective analysis of anonymized insurance claims data using an age- and gender-stratified database subset, which contains 4.34 million subjects. Continuously insured individuals in the year 2017 were identified by ICD-10 codes (L40.x: psoriasis; L40.0: psoriasis vulgaris, PV). Prescription of biological medication (last observed prescription) was determined based on ATC codes. Numbers of individuals were extrapolated on the GKV population as follows: number of individuals in the database/number in the database in total*total number of individuals in the GKV population.
In 2017, 756 minor subjects prevalent with psoriasis (PV: 410) were identified in the database. Based on extrapolation, the prevalence of psoriasis was 19 (PV: 11) per 100,000 insured subjects and 123 (67 with PV) per 100,000 insured minors. Of these, 2.12% received biological medication. 110 children and adolescents were treated with Etanercept (0.79%), 92 with Ustekinumab (0.66%) and 92 with Adalimumab (0.66%).
Prior analyses of German claims data in the years 2005 and 2009 on approximately 1.4 million subjects have identified a higher prevalence (0.45-0.71%) of juvenile psoriasis than the present study (0.12%). This might be a result of differences in study time points and population. Here, we show that a higher proportion of minors were treated with biologics as compared to an earlier study (0.31%), which may indicate a change in clinical practice over the past years. In line with this, the new German treatment guidelines emphasize the important role of biological treatment in the management of psoriasis in children and adolescents.

Prevalence and biological treatment of psoriasis in children and adolescents in Germany