Finding out that a child has psoriasis can be difficult news for parents or caregivers, who may worry about the effects that this chronic, inflammatory disease can have on the skin. The flares of psoriasis can cause itchy, painful plaques and lesions to develop.
However, even though there is currently no cure for psoriasis, many treatments are available to help children with this condition live comfortable, social, and active lives.
Most children with the condition respond well to treatment, and many have few or only mild flares.
In this article, we look at how psoriasis develops in children and how doctors treat the condition.
Psoriasis in children
Psoriasis is an inflammatory condition that affects the skin.
When a person has psoriasis, they will develop patches of red, scaly skin on different parts of the body.
These patches will often become worse, or flare, and then go into remission.
Several different types of psoriasis can develop in children.
The most common type of psoriasis in both adults and children is plaque psoriasis, in which well-defined patches or plaques with a silvery-white surface develop on the skin. Often, the first area where these patches appear in children is the scalp.
Another type of psoriasis that often develops in children is guttate psoriasis, which leads to small, raindrop-like patches forming in large groups. When guttate psoriasis occurs in children and young teenagers, it is often the result of a secondary infection in the throat, such as strep throat.
Other upper respiratory infections are also common triggers for psoriasis. In some cases, the symptoms of guttate psoriasis might resolve within a few months and not return.
Children will often develop inverse or flexural psoriasis. This term refers to the large, red patches of psoriasis that form around folds in the skin, such as those at the joints.
Symptoms
A person should look out for several symptoms to identify psoriasis. Psoriasis may affect the skin of children and adults differently.
Some of the symptoms that help distinguish psoriasis from other conditions in children include:
- nail pitting or discoloration
- itching, pain, or general discomfort
- severe scales on the scalp
- dermatitis around the area of a diaper
- plaques similar to those of adult psoriasis on the arms, legs, and trunk
If a rash or lesion does not respond to over-the-counter (OTC) treatments, its cause may be an underlying inflammatory condition. Psoriasis might strongly resemble eczema or seborrheic dermatitis, so close observation is necessary.
Differences
The most significant difference between adult and child psoriasis is simply the age of onset. Otherwise, a child with psoriasis will experience many of the same symptoms and triggers as an adult.
Other potential differences in children include a more significant psychological impact, due to the stage of their social development when onset occurs, and a tendency for patches to form around the scalp, buttocks, and face.
Treatments
Treatment for psoriasis focuses on reducing the severity of a flare and helping with the emotional stress of having psoriasis.
However, before a child undergoes any of the possible treatments, their parents or caregivers should discuss the risks and benefits that treatment carries with a doctor or dermatologist and ask whether it is medically essential.
If clothing covers a child’s lesions or they do not experience discomfort as a result of the symptoms, treatment may not be necessary.
Visible lesions may cause a child to withdraw socially, and the itching can cause distraction at school. If the symptoms are affecting a child’s quality of life, a course of treatment may be necessary.
Treatment options include the following:
- topical therapy
- phototherapy
- oral medications
People use topical therapy to treat most cases of psoriasis. This type of treatment involves medicated creams and lotions, such as vitamin-D creams, keratolytic moisturizers and lotions that help a person remove scales, and topical corticosteroids.
Topical therapies may resolve mild to moderate skin symptoms without the need for any further treatment.
Phototherapy involves the use of concentrated ultraviolet (UV) light on the skin, and doctors usually only recommend it for children over 10 years of age. People with mild plaque or guttate psoriasis tend to respond best to phototherapy.
The treatment takes place two to three times a week in a hospital or at a dermatology clinic.
If the plaques or lesions do not respond to other treatments, doctors might sometimes prescribe oral medications to help treat psoriasis in children. These are systemic drugs that directly treat specific parts of the immune system, addressing the root cause of psoriasis.
Typically, people use these for moderate to severe presentations and only take them for short periods. Doctors rarely prescribe them for psoriasis of the scalp.