Psoriasis is a chronic skin disorder in which reddish plaques covered by thick scales appear and recur in outbreaks throughout life. It is a relatively common condition, affecting 1 – 2% of the population and can appear at any age, from childhood to adulthood. However, one third of patients develop the condition before the age of 20.
Although there is no cure for psoriasis, specialists in pediatric dermatology do have numerous treatment options currently available for children as well, which vary according to the intensity and location of the lesions.
Causes of psoriasis
It is not yet known what causes psoriasis, but it is known that genetics and immunology play an important role in its development. In patients with psoriasis, the immune system is abnormally activated, resulting in an acceleration of the skin cell growth cycle. Instead of shedding, the more superficial cells accumulate, forming thick scales over areas of reddened skin.
There is a clear familial factor. If one parent has psoriasis, there is a 25% chance that each child will have psoriasis. Some factors can trigger psoriasis or intensify it in children, such as skin damage and infections. Up to half of children with psoriasis will have a flare-up of the disease 2 to 6 weeks after illnesses such as respiratory or digestive infections. However, psoriasis is not a contagious disease.
Symptoms of psoriasis in children
Psoriasis usually presents as dry, red, scaly patches of skin that may be very itchy. Sometimes it may also cause burning and appear and disappear unpredictably.
There are numerous forms of presentation of the disease, but the most common in children is plaque psoriasis. It may be limited to a few plaques or affect large areas of the skin. It can appear on any area but most often affects the backs of the elbows and knees and the scalp. Gouty psoriasis – where the rash takes the form of lesions in small droplets – is another common form in children. The face and genital region are frequently affected in young children. Psoriasis can also affect the nails (mostly as small depressions or dimples in the nail plate), and the joints (psoriatic arthritis).
How to diagnose psoriasis
There are no specific blood tests to diagnose psoriasis. Diagnosis is clinical and is made on the basis of skin lesions. In case of doubt, a skin biopsy may be performed to confirm the diagnosis and rule out other causes.
Emotional considerations in children with psoriasis
For many children, the main problem with psoriasis is its visibility and the effect it may have on their self-esteem. Children with psoriasis are at increased risk of depression and anxiety. Psoriasis does not leave scars on the skin but can cause emotional scarring.
Treatment of psoriasis in children
Treatment of psoriasis in children depends on the severity, extent and type of psoriasis. Most of them reduce skin inflammation, while others reduce scaling and itching. Treatments range from creams, shampoos and ointments to phototherapy with ultraviolet light and systemic medication in severe cases. There is no one medication that works for all patients and it may take some time to achieve the ideal therapeutic regimen for each child.
In this sense there is:
- Topical treatment. Topical medications are applied directly to the psoriasis plaques. They contain cortisone derivatives or other non-corticosteroid anti-inflammatory products such as vitamin D3, tar, salicylic acid and retinoids. They can be applied alone, although they are often presented in combination products. Moisturizing creams are also used to maintain good skin hydration and reduce itching, dryness and scaling.
- Phototherapy with ultraviolet light. When topical drugs are not effective, or the involvement is very extensive, some children may be treated with ultraviolet light. Phototherapy uses ultraviolet light to reduce skin inflammation. Natural light contains ultraviolet light and may be recommended by the pediatric dermatologist. Although natural light can be helpful, too much exposure, and sunburn, can lead to a flare-up of psoriasis at the affected site and increase the risk of premature aging and skin cancer. Phototherapy is performed 2-3 times per week in the hospital office.
- Oral and biological treatments. More severe forms of psoriasis will require oral medication, or by infusion or injection into the body (“biologic” medications). These treatments have risks and benefits that should be assessed by the dermatologist.
Important considerations in pediatric psoriasis
Children with psoriasis are at an elevated risk of developing obesity, diabetes, high cholesterol and cardiovascular disease in adulthood. That is why they should eat a healthy diet, maintain their ideal weight and exercise regularly.