Ustekinumab in Pediatric Dermatology: An Updated Review

Managing chronic pediatric skin disorders is challenging due to a lack of approved medication and the relative weakness of research studies for this age group. Ustekinumab is a human monoclonal antibody that targets the p40 subunit shared by IL12 and IL23 and thereby modulates the inflammatory reaction triggered by the Th1 and Th17 pathways, respectively. Currently, in dermatology, ustekinumab is the only IL12/IL23 inhibitor approved by regulatory authorities to treat moderate to severe psoriasis in adults, adolescents, and children of age six years and older. Although off-label and not supported by strong evidence, the therapeutic use of ustekinumab has been gradually extended to various other dermatoses. The reported adverse events of this biologic in pediatric patients were generally consistent with those in adults. However, its long-term safety remains to be confirmed. In this review, we discuss the existing evidence on the mechanisms of ustekinumab action, the current regulatory authority-approved indications, off-label use in pediatric cutaneous disorders, and the most reported adverse events related to this drug.