The social experiences of young people with visible differences

From psoriasis-association.org.uk

The Centre for Appearance Research have published their findings after speaking to young people with visible differences about their social media experiences. We're sharing the results as Psoriasis can be classed as a visible difference. 

Researchers spoke to people aged between 13-17 years (9 girls, 3 boys) who expressed how using social media makes them feel.

“I was constantly comparing myself to other people’s lives, which made me quite unhappy”

“You've got people commenting horrifying things to people just because there's that screen and there’s the anonymity”

Young people talked about how spending time on social media can be harmful to their mental health.

They felt that beauty standards and social comparisons could negatively impact their self esteem and daily life. They felt that online interactions could be harsher due to anonymity, leading to unwelcome comments and questions about their visible differences.

“If people are negative, you can just block them.”

I’ve got a private account that I just let a few people follow and that’s where I usually put my day-to-day stuff”

Young people talked about ways they protected themselves online, such as being mindful of their audience when sharing content, and using strategies to cope with negative reactions.

“I think it just feels good that people are supporting me and what I go through”

"A lot of people I’ve found similar to me that I probably wouldn't have found if I didn't use social media”

“I feel like this [an image of a midsize model with vitiligo] shows I don't have to be perfect. I don't have to be perfectly slim. I don't have to be ashamed of my birthmark.”

Young people found social media valuable for connecting with others who have visible differences, sharing their experiences, and forming supportive relationships.

They felt that increased representation on social media could help reduce stigma and positively impact their self-esteem and how they felt about their appearance. Supportive reactions to posts about visible difference boosted their confidence and sense of belonging.

Many young people wanted to use social media to support and uplift others.

They believed that increasing representation of people with visible differences doing everyday tasks could challenge narrow beauty ideals, prompting people to question their own beliefs and ultimately encouraging societal change.

“If they [people who react negatively to visible differences] see more stuff on social media with visible differences, and they get more used to it, they'll stop commenting on it so much and they'll stop commenting badly on visible differences”

“[My goal is] to help other people that are also going through alopecia to know that they're beautiful and then just to make a stand as well."

Young people used social media intentionally, choosing content and setting limits to maintain a healthy balance.

They found it helped them remember happy memories, express emotions, and show gratitude. They felt the impact of social media depended on how people chose to use it, including who they follow and how much time they spend online.

So what?

• This study provided valuable information about what it is like to use social media for young people with visible differences.
• Centre for Appearance Research will be combining these results with results from two other studies - one with adults with visible differences, and one with influencers with visible differences.
• This will give us a better understanding of what it’s like to use social media for people of different ages and roles who have visible differences.
• The findings will be used to create resources to help increase awareness of the risks of social media and tips to use it in a positive way.
• These resources will emphasise the importance of peer support and involving young people with visible differences in decision making, helping their voices be heard.

https://www.psoriasis-association.org.uk/news/the-social-media-experiences-of-young-people-with-visible-differences

Childhood Psoriasis: Emotional Toll on Families During Adolescence

From hmpgloballearningnetwork.com

Psoriasis diagnosed in childhood profoundly affects not only children but also their parents, especially as they transition into adolescence, a pivotal phase for identity and self-esteem development. A recent interpretative phenomenological analysis published in the British Journal of Health Psychology sheds light on the multifaceted challenges faced by families navigating this chronic condition.

Researchers conducted in-depth interviews with 8 parent-child pairs, identifying 3 key themes: transition and transaction, stigma and social impact, and the treatment journey. During childhood, uncertainties about treatment options were central concerns. However, as children approached adolescence, their struggles shifted toward issues of identity, body image, and self-management of the condition.

The social visibility of psoriasis emerged as a recurring source of distress. Both children and parents reported significant emotional challenges due to stigmatization, which heightened during adolescence. Parents expressed feelings of helplessness while witnessing their child’s increased responsibility for managing the disease and coping with peer scrutiny.

These findings underscore the systemic impact of psoriasis on families, highlighting a pressing need for interventions that address not only medical treatment but also emotional and social well-being. Researchers recommend mindfulness-based cognitive-behavioural therapy tailored to children and parents to reduce stress and enhance resilience.

“This study suggests that childhood psoriasis can have a significant impact on children, particularly as they begin to transition to adolescence. Findings also highlight the burden of psoriasis for parents,” researchers concluded. “As such, psychological interventions (such as adapted forms of mindfulness-based cognitive-behavioural-therapy) are needed to target and reduce stress. Such interventions are likely to require a systemic focus and support validation of the real impact and fear of stigmatization.”

 

Reference

Day M, Heapy C, Norman P, et al. Impact of childhood psoriasis on children and parents during transition to adolescence: an interpretative phenomenological analysis. Br J Health Psychol. 2025;30(1):e12763. doi:10.1111/bjhp.12763

https://www.hmpgloballearningnetwork.com/site/thederm/news/childhood-psoriasis-emotional-toll-families-during-adolescence 

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/

Obese kids may have higher odds of eczema and psoriasis

From upi.com 

Obese kids are more likely to develop immune-based skin problems like eczema or psoriasis, a new study says.

Analysis of more than 2.1 million Korean children between 2009 and 2020 revealed that children who became overweight had a higher risk of developing eczema.

At the same time, overweight kids who shed pounds and reached a healthy weight had a lower risk of eczema, researchers reported Wednesday in the Journal of Investigative Dermatology.

"Our findings support the importance of promoting weight maintenance among children who are already within the normal weight range because it may help reduce the risk of developing atopic dermatitis [eczema]," said researcher Dr. Seong-Joon Koh, an associate professor of internal medicine with the Seoul National University College of Medicine in South Korea.

"In addition, prevention of excessive weight gain and purposeful weight loss, including adopting healthy diet strategies in children with obesity to prevent atopic dermatitis, particularly before school age, should be promoted," Koh added.

Approximately 1 in 5 U.S. children and teens (20%) are obese, according to the U.S. Centres for Disease Control and Prevention.

Previous studies have looked at the link between childhood obesity and skin diseases, said researcher Dr. Seong Rae Kim, with the Seoul National University College of Medicine in South Korea.

However, those studies haven't tracked children over time to see whether changes in body weight made a difference in kids' risk of skin problems, Kim said.

The results indicate that childhood obesity can contribute to the development of skin diseases caused by problems with the immune system, researchers concluded.

These diseases include alopecia, eczema and psoriasis, and maintaining a healthy weight could potentially lower kids' risk of developing these skin problems, researchers said.

https://www.upi.com/Health_News/2024/08/21/obese-kids-higher-odds-eczema-psoriasis/8991724246494/

9 Psoriasis Complications to Watch for in Kids

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

                                                       GettyImages/AntonioGuillem

“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

                                                          GettyImages/SolStock

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

                                                     GettyImages/eclipse_images

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.”

Social and Emotional Difficulties

                                                                GettyImages/Milko

Beyond helping your child achieve clear, itch-free skin, parents can play a key role in addressing the impact of psoriasis on their mental well-being. “If left untreated, psoriasis can lead to significant emotional and social difficulties, impacting the child’s overall quality of life,” says Dr. Levine. “Parents can help their children cope by creating a supportive and understanding environment and encouraging stress-relief activities.” She also advises families to find groups (like this one at the NPF) or counsellors to provide additional support. Working together with your child’s care team can help them—and you—feel more in control of their psoriasis.

https://www.healthcentral.com/slideshow/psoriasis-complications-to-watch-for-in-kids

Low stress resilience may increase psoriasis risk

From labonline.com.au

Young adults who find it harder to cope with stress are more likely to develop psoriasis later in life, according to a large register-based study from the University of Gothenburg. The study is based on data from more than 1.6 million Swedish men who enlisted for military service between 1968 and 2005.

As part of the enlistment process, all the men underwent psychological assessment in accordance with the same strict template. Based on this assessment, the researchers divided up the data on the men’s stress resilience into three levels. A fifth (20.4%) of those who enlisted were placed in the lowest group and a further fifth (21.5%) were placed in the highest group. More than half were placed in the intermediate group. Data relating to the men was cross-checked with other registers, with the National Patient Register used to obtain the diagnosis codes for psoriasis and the joint disease psoriatic arthritis.

Around 36,000 of the men developed psoriasis or psoriatic arthritis later in life, with low stress resilience found to involve a 31% higher risk of developing psoriasis compared to high stress resilience. More severe cases of psoriasis and psoriatic arthritis were also found to be clearly linked to stress; for in-patient diagnoses, low stress resilience meant a 79% higher risk of psoriasis and a 53% higher risk of psoriatic arthritis compared to high stress resilience.

The study’s results, published in the Journal of the European Academy of Dermatology and Venereology, thus support the hypothesis that sensitivity to stress is a risk factor for psoriasis. As psoriasis is a chronic inflammatory systemic disease, this link to stress could be due to an increased inflammatory response in the body.

“We have shown that lower stress resilience in adolescence is a potential risk factor for psoriasis, at least for men,” said lead author Marta Laskowski, a doctoral student in dermatology at the University of Gothenburg and a resident physician at Sahlgrenska University Hospital. “Our results suggest that those with psoriasis have a hereditary psychological sensitivity. It is therefore important that healthcare professionals also pay attention to the mental wellbeing of patients with psoriasis.”

When estimating the increased risk, the researchers adjusted for other risk factors such as BMI and socioeconomic factors. However, the study could only be adjusted indirectly for smoking, which is a well-known risk factor for psoriasis. One weakness of the study is that stress resilience was only tested on one occasion, at the time of enlistment when the men were 18 years old.

“Stress resilience can vary throughout life; however, we have not had the opportunity to investigate these changes,” Laskowski noted.

https://www.labonline.com.au/content/life-scientist/news/low-stress-resilience-may-increase-psoriasis-risk-716344878 

Treating eczema, psoriasis in children

From mayoclinichealthsystem.org

Itchy, uncomfortable skin is bothersome for adults, but it can be especially difficult for children. It can interrupt sleep for the entire family and be a distraction during the day, or cause pain and embarrassment.

Two common causes of itchy skin in children are eczema and psoriasis. These chronic, inflammatory diseases of the skin cause dry, itchy and inflamed skin. These conditions can go through cycles, flaring up and then subsiding. They can cause intermittent flares or be unrelenting. Importantly for family and friends, eczema and psoriasis are not contagious.

If your child has skin issues, here's what you need to know about these common types of skin conditions:

Eczema basics

Eczema, also called atopic dermatitis, is a common, itchy skin condition in childhood. Most cases begin before age 5, but eczema can occur at any age. It is long-lasting and can appear anywhere on the body.

When a child has eczema, the skin becomes dry and cracked. It can be especially itchy and look like small, raised bumps on the skin. Sometimes, the skin can thicken or darken. It can even become painful when the skin gets raw from intense scratching.

At its core, eczema is a barrier problem of the skin. Under normal circumstances, the skin acts as a barrier for things moving in and out of the body. When a person has eczema, the barrier is not working as effectively. This allows environmental contaminants to penetrate the skin and protective moisture to leave.

Many items can trigger eczema. Common culprits are fragrances and dyes in products, like laundry detergents, soaps and lotions. Keeping a journal of potential triggers and the child's skin reaction can be helpful. This doesn't need to be elaborate but having a way of documenting symptoms helps to identify eczema triggers for your child.

People with eczema may have other conditions in the atopic triad, namely asthma and allergic rhinitis also called seasonal allergies. Some children have one or two of these conditions, while their siblings have other ones. Researchers are still trying to understand the link between these conditions, but there is clearly a genetic component.

Treating eczema

The best way to treat eczema is to avoid triggers that cause a flare. When a child develops eczema, I recommend that the entire family switch to fragrance-free, dye-free products. This includes family members who do not have eczema. Children like to hug and snuggle with parents and siblings, so their clothing and bedding should be fragrance and dye-free as well to prevent eczema flares.

Medical treatment of eczema begins by controlling skin inflammation. If we can treat skin inflammation, we can control the itch. In the past, eczema often was treated with antihistamines, partly because of the sleepiness they could induce. These medications are used less now because the itch in atopic dermatitis does not appear to be histamine-based.

Usually, the first line of medical treatment is topical steroids. They are effective and time-tested. When a family makes an appointment, I often recommend treating eczema using a method called "wet wraps" consistently for two weeks. This is cumbersome but very effective, and it remains a tool for use in the future for subsequent flares. Taking photos before and after treatment is reassuring because improvement in the skin may be subtle at first.

There are lifestyle changes that families can do at home to reduce eczema flares, such as:

• Apply cream or ointment on the skin at least twice a day to seal in moisture.
  These products should be specifically formulated for sensitive skin. Generally, lotions are not very effective in atopic dermatitis because they can promote additional water loss.
• Take a short, daily bath or shower using warm, not hot, water.
  The frequency of bathing is not as important as is following the bath or shower with liberal application of a moisturizer.
• Use gentle cleansers free of dyes, alcohols and fragrances.
• Pat the skin dry after bathing and avoid rubbing.
  Apply the moisturizer to the slightly damp skin to help "seal in" the moisture.

Most kids will outgrow the constant need to have topical steroids, but the condition is genetically determined, so they will need to maintain diligence as they get older. Avoiding products with perfumes and dyes will be a lifelong commitment.

Psoriasis basics

While psoriasis is less common than eczema in children, it still can cause itchy or painful skin issues. It's primarily a skin disease with sometimes itchy, scaly and well-defined patches. Most commonly, psoriasis occurs on the knees, elbows, trunk and scalp, but it is often seen on children's faces as well. Another type unique to children is guttate psoriasis, where hundreds of small, scaly, drop-like bumps appear on the body, often following a strep throat infection. Classic psoriasis is a chronic condition with no cure, but guttate psoriasis tends to resolve with time.

Psoriasis rashes vary widely in how they look, ranging from dandruff-like scaling to major eruptions over large portions of the body. Small, scaling spots are more common in children. Dry and cracked skin can bleed and cause intense itching, burning or soreness.

When a person has psoriasis, there is an issue with the internal regulator of skin growth and turnover. Psoriasis causes the regulator to be in hyperdrive or sped up. It causes redness and flakiness of the skin because the body doesn't have enough time to shed old skin cells. This leads to a build-up of dead cells on the surface of the skin.

Psoriasis treatment

The goal of the treatment of psoriasis is to stop the inflammation, generally with topical steroids on the flares located on a person's trunk and limbs. Facial psoriasis is more common in children. In these cases, steroids are not used as often. Instead, a topical calcineurin inhibitor is used to stop the inflammation.

Light therapy may be recommended if your child has moderate to severe psoriasis. This involves exposing the skin to controlled amounts of natural or artificial light.

Talk with your child's health care team if you notice an ongoing, itchy or uncomfortable rash. Treatment can help soothe your child's skin and ease your concerns.

Kevin Boyd, M.D., is a paediatric dermatologist and dermatopathologist in Onalaska, Wisconsin.

https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/treating-eczema-psoriasis-in-children