From healthcentral.com
From plaques scratched so hard they bleed to eye, mouth, and nail issues, here’s what dermatologists say to keep a lookout for
There is so much information to process when your child is diagnosed with psoriasis (PsO), from treatment plans to new skincare routines. Plus, you are learning how to deal with the discomfort your child is likely experiencing from itchy, scaly plaques as this autoimmune condition spurs skin cell production into overdrive. And not only do you need to address the symptoms they have now, but there are potential complications that can come along with PsO, too. Deep breath: We went to the experts to explain the top psoriasis complications to watch for—and what you can do about them.
Skin Infection
“If your child scratches at their psoriasis, they can break the skin barrier, causing bleeding and creating an entry point for bacteria,” explains Jody Levine, M.D., a paediatrician and dermatologist who is the director of dermatology at Plastic Surgery & Dermatology of NYC in New York City. If you notice signs of infection like redness, warmth, swelling, pus, and fever, see a doctor, who may prescribe antibiotics, notes Dr. Levine. Meanwhile, keep skin clean by washing with a hypoallergenic soap and moisturize twice daily, advises Dawn Davis, M.D., a dermatologist and paediatrician at the Mayo Clinic in Rochester, MN.
Psoriatic Arthritis
“A common consequence of psoriasis is psoriatic arthritis, where inflammation in the joint space erodes the joints and can cause arthritis,” says Dr. Davis; about a third of children with PsO will eventually develop psoriatic arthritis. Keep an eye out for symptoms like joint pain, swelling, and stiffness–especially in the morning, says Anna Chacon, M.D., a dermatologist in Miami, FL. “Early detection and treatment are crucial to prevent joint damage, chronic pain, and potential disability,” Dr. Chacon says. “It is important to schedule regular screenings for joint symptoms and get an early referral to a rheumatologist if psoriatic arthritis is suspected.”
Nail Changes
You may notice that your child’s nails become pitted, discoloured, and thick due to psoriasis, resembling the look of a thimble, explains Dr. Chacon. This is known as nail psoriasis—which can also be a sign of psoriatic arthritis, per the National Psoriasis Foundation (NPF). “By managing psoriasis, these conditions can also be treated,” says Dr. Levine. She advises keeping your child’s nails trimmed and clean as nails may break easily, even crumbling. According to the NPF, a dermatologist can prescribe corticosteroids to be applied directly to the nails and cuticles; oral medications and phototherapy can also help to improve severe cases.
Fungal Infections
Another form of psoriasis called inverse psoriasis is marked by smooth, red or purple lesions that show up in skin folds like under the armpits or around the groin, causing pain, irritation, and secondary infections due to the moist environment; according to the NPF, some 21% to 30% of people with PsO can develop inverse psoriasis. “This can be particularly uncomfortable and make your child prone to fungal or bacterial infections,” Dr. Chacon says. It is important to try to keep the areas of the skin dry to avoid further discomfort and infection as your child continues their PsO treatment.
Vision Issues
The effects of psoriasis don’t just show up on your child’s skin, they can also impact their eyes. “They can develop uveitis, or inflammation in the eye,” says Dr. Davis; some 7% of those with psoriatic arthritis develop uveitis per the NPF. “This can cause pain, soreness, or difficulty with vision.” If your child complains about any of these symptoms, it’s important to get them to an ophthalmologist. They may also experience light sensitivity, blurred vision, dryness, and floaters, says Dr. Chacon. “If left untreated, uveitis can lead to complications such as glaucoma, cataracts, or even vision loss,” she says.
Oral Issues
Psoriasis can spread to the mouth, causing red, white, or grey plaques which lead to discomfort and difficulty eating, Dr. Levine says. One study found that severity of psoriasis increased the odds of tongue lesions. “If your child notices sores, pain, or changes in taste, you should seek advice from a dermatologist or dentist,” she advises. The gums can also become inflamed, causing swelling, redness, and bleeding. This can be a sign of gingivitis, or mild gum disease, says Dr. Chacon. She recommends regular brushing and flossing as well as non-alcoholic mouthwash to keep your child’s mouth clean.
Obesity Concerns
“Patients with psoriasis often have difficulty with obesity, though some patients with normal body weight or who are underweight will also have difficulty with psoriasis,” says Dr. Davis. Still, one meta-analysis of psoriasis research has found a link between greater body mass index (BMI) and the severity of psoriasis. Obesity is also linked to other metabolic disorders like diabetes and hypertension. These comorbidities can be cause for concern about increased risk of future cardiovascular diseases. “It is important to regularly monitor blood pressure, cholesterol levels, and other cardiovascular risk factors,” Dr. Chacon advises. “Early intervention can help manage these risks.”
Severe Forms of Psoriasis
A few types of psoriasis can develop and indicate more serious complications, says Dr. Chacon. Erythrodermic psoriasis causes intense redness over a large portion of the body as well as itching, pain, and a hot or cold feeling. “This is a medical emergency that can lead to severe complications like infection, dehydration, and heart failure. Immediate medical attention is required,” she says. Pustular psoriasis causes white pustules surrounded by red skin, fever, chills, severe itching, and fatigue. “This can be localized to one area or generalized,” says Dr. Chacon. “Generalized pustular psoriasis can be life-threatening and requires urgent treatment.”
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