Childhood Psoriasis: What Parents Need to Know

From everydayhealth.com

Psoriasis — an autoimmune skin disease that causes itchy, scaly rashes on the body — doesn’t just affect adults. One-third of psoriasis cases begin during childhood, usually during adolescence.

Overview

What Is Psoriasis?

Psoriasis is an autoimmune condition that causes the body’s immune system to mistakenly attack healthy skin cells. “It’s as though the body is trying to fight off a fungal infection, even though there’s no fungus there,” says Steven Feldman, MD, PhD, a professor of dermatology at Wake Forest University in Winston-Salem, North Carolina.

This leads to an overproduction of skin cells and a build-up of scaly, patchy rashes known as plaques, Dr. Feldman says.

Every year, about 20,000 children under 10 are diagnosed with psoriasis. That makes it rare among children, affecting about 1 percent. Childhood psoriasis has a higher frequency in girls. The earlier a child develops psoriasis, the more likely it is to be severe.

“It can be very extensive,” says Feldman. “Fortunately, we’ve got treatments for controlling the disease.”

Symptoms of Childhood Psoriasis

In both children and adults, the hallmark symptoms of psoriasis are patchy, scaly rashes, says Adnan Mir, MD, PhD, a paediatric dermatologist, dermatopathologist, and an assistant professor of dermatology at the Albert Einstein College of Medicine in Bronx, New York.

“When you think of psoriasis, you think of these scaly plaques on the elbows and knees,” says Dr. Mir. “But it can happen anywhere, including on the scalp and on the face. It can even involve the nails.”

Other signs and symptoms of psoriasis include:

• Rash that varies in colour, spanning shades of purple with grey scales on darker skin tones to pink or red with silvery-white scales on white skin
• Rashes that also range in size from spots of dandruff-like scaling to patches of affected skin or major eruptions over many parts of the body
• Small scaling spots, which are most often seen in children
• Dry, cracked skin due to rashes that may bleed
• Itching, burning, or soreness in the affected areas
• Cyclic rashes that flare up for a few weeks or months, subside, then recur again

An early sign of psoriasis is typically small bumps that grow with scales forming on top. If your child scratches the rash, the scales may tear from the skin, which can lead to bleeding. Lesions — or larger areas of damaged skin — can form as the rash continues to spread across the body.

Research suggests that psoriasis tends to happen most often on the extremities (limbs, hands, or feet) in children. Pruritus (itchy skin) is the most common symptom among children. In infants, it’ll often appear in the first year as diaper psoriasis, a lingering rash on a baby’s diaper area, Mir notes.

Types of Childhood Psoriasis

There are several distinct types of psoriasis that can affect children, each with their own signs and symptoms.

Plaque Psoriasis

As in adults, plaque psoriasis is the most common type of psoriasis in children, affecting about 34 to 73 percent of children. Those with plaque psoriasis have dry, itchy, raised, patchy rashes covered with scales, most commonly on the scalp, elbows, lower back, or knees. The affected skin might heal with changes in colour, especially in darker skin tones. This is known as post-inflammatory hyperpigmentation.

Nail Psoriasis

Psoriasis can also affect the fingernails and toenails. This often leads to pitting, discoloured fingernails, or abnormal nail growth. Psoriatic nails can loosen and separate from the nail bed. In severe cases, nail psoriasis can lead to weak and crumbling nails.

Guttate Psoriasis

Guttate psoriasis causes 2 percent of all cases of psoriasis and most often affects children and teens rather than adults. It’s often triggered by a bacterial infection, usually the bacteria that causes strep throat. It’s marked by small, drop-shaped patches on the arms, legs, and torso.

Most people who have guttate psoriasis will make a complete recovery, but about one-third of people will go on to develop chronic psoriasis.

Inverse Psoriasis

People with inverse psoriasis develop rashes in areas where the skin rubs against itself, such as the armpits, belly button, below your breasts, and in your groin area. The rash may be discoloured (brown, red, or purple), and the affected parts of your body may feel damp.

A key difference between inverse psoriasis and other types is that inverse psoriasis doesn’t involve thick, scaly plaques or flaky skin.

Pustular Psoriasis

People who develop this rare type of psoriasis have clearly defined pus-filled blisters on top of their psoriasis plaques. The pustules can join together, creating other fluid-filled blisters that can burst.

Erythrodermic Psoriasis

Erythrodermic psoriasis is serious and life-threatening and requires immediate medical attention. Most people who develop it already have another form of psoriasis.

When someone develops this condition, the skin on most of the body looks burnt, and patients have chills, fever, muscle weakness, a quick pulse, and severe itching. Before developing erythrodermic psoriasis, patients will often notice their psoriasis is worsening or not responding to treatment at all.

Causes of Childhood Psoriasis

Psoriasis isn’t contagious. Your child can’t catch psoriasis from another person or spread it to someone else, Mir says.

Scientists don’t yet know the exact cause of psoriasis, but they believe genetics and the immune system are significant factors.

• Genetics Family history is a major factor when it comes to psoriasis. Thirty-five to 90 percent of cases are linked to family history. In about 30 percent of cases, a first-degree relative of the person with psoriasis (such as a parent or sibling) has the condition, too. Researchers have found more than 1,300 genes that are linked to an increased risk of psoriasis. That said, not all children with a family history will develop psoriasis, and some children with no family history can still develop it, Feldman notes.
• Infections Certain infections, especially strep throat, are a common trigger for psoriasis. This is especially relevant in cases of childhood psoriasis, Mir notes. In children, about one-third to half of all young people with psoriasis may experience a flare two to six weeks after an ear infection, strep throat, bronchitis, tonsillitis, or a respiratory infection.

Children who are susceptible to psoriasis may not develop symptoms for months or years until an environmental factor triggers the condition. Common psoriasis triggers include:

• Cold, dry weather
• Smoking or being exposed to second-hand smoke
• Injuries to the skin, ranging from bug bites and sunburn to cuts and scrapes
• Infections
• Certain medications, such as high blood pressure drugs, lithium, and antimalarial drugs

Diagnosis of Childhood Psoriasis

A dermatologist, especially a paediatric dermatologist who specializes in treating psoriasis, can provide an accurate diagnosis.

A dermatologist will examine your child’s skin and ask you or your child questions about their personal health history and family history. In some instances, your child may need a skin biopsy to rule out other health conditions with similar symptoms.

During the physical assessment, your child’s dermatologist may ask questions such as:

• Does your child’s parents, siblings, or extended family have a history of skin conditions?
• Is this the first time you’ve noticed an outbreak on your child’s skin?
• When did you or your child first notice symptoms like a rash, itchy skin or spots?
• Have you tried any home remedies to treat your child’s skin?
• What types of soaps and shampoos do you use on your child?

Treatment of Childhood Psoriasis

“Psoriasis should be managed closely with a dermatologist,” says Mir. “They can advise on the safety of different treatments, whether they should consider a phototherapy, or whether the psoriasis is severe enough for systemic therapy.”

The treatment options your child’s dermatologist recommends for them will depend on your child’s age, psoriasis severity, where the rash occurs on the body, and their overall health. Here are some possible treatments for childhood psoriasis.

Topical Treatments

These can include steroid creams, moisturizers for dry skin, and medicated lotions or shampoos, among other formulations. The most common topical treatments for psoriasis are:

• Anthralin: a tar cream that slows the growth of skin cells.
• Calcineurin inhibitors: a type of topical treatment that calms rashes and lessens the build-up of scales
• Coal tar: a treatment that can reduce itching, scaling, and inflammation
• Corticosteroids: the most commonly prescribed treatments for mild to moderate psoriasis
• Retinoids: a gel- or cream-based treatment option
• Salicylic acid: a treatment option to reduce scales associated with scalp psoriasis
• Vitamin D analogues: synthetic forms of vitamin D that slow the growth of skin cells

Light Therapy

Light therapy is often the first treatment option doctors turn to for moderate to severe psoriasis, either on its own or together with medications. With light therapy, patients are exposed to controlled amounts of natural or artificial light in repeated sessions.

Oral or Injectable Medications

Your doctor may prescribe your child an oral or injectable medication if they have moderate to severe psoriasis or if other treatments aren’t effective. These may include:

• Biologics: injectable drugs that affect the immune system and interrupt the cycle of psoriasis in the body
• Cyclosporine: an oral immunosuppressant for severe psoriasis that’s usually well tolerated among children
• Methotrexate: an oral medication that slows the growth of skin cells and calms inflammation
• Retinoids: oral medications that can slow the growth of skin cells.
• Steroids: injectable treatments for small but persistent patches of psoriasis

Lifestyle Management Strategies

Along with medication treatment, daily self-care and lifestyle management strategies can help your child keep their psoriasis symptoms at bay. Key lifestyle strategies include:

• Ensure your child gets physical activity every day and is at a healthy weight.
• Feed your child a healthy, well-balanced diet.
• Have your child take their medications as directed.
• Take gentle, lukewarm baths every day. Avoid using hot water, which can worsen symptoms.
• Use moisturizer regularly, especially after bathing to help lock moisture into your skin.
• Avoid harsh soaps, which can irritate your child’s skin, and use mild soaps instead.
• Remind your child to avoid scratching and trim their nails short so it won’t hurt their skin if they do scratch.
• Learn your child’s triggers and help them avoid those triggers.
• Consider having your child join a support group if one is available. It can help to connect with peers who are going through similar challenges.

The Takeaway

• If you suspect your child has psoriasis, see a dermatologist for an accurate diagnosis and a tailored treatment plan.
• There’s no cure for psoriasis, but treatment options such as topical creams and ointments, oral medications, or light therapy can help manage symptoms.
• Parents can help manage their child’s condition by understanding their triggers and helping them stick to their treatment.

https://www.everydayhealth.com/skin-conditions/childhood-psoriasis/