Psoriasis in Children

Tips and Treatments to Help Your Child Feel Better

In This Article

Table of Contents

Psoriasis, a condition characterized by red, itchy, raised and, oftentimes, painful lesions on the surface of the skin, affects around 45,000 children in the United States under the age of 18, according to a 2016 review in the journal Psoriasis.

Psoriasis most commonly manifests as skin lesions on a child's face, buttocks, elbows, knees, or scalp. While previously thought to be a dermatological condition like eczema, it is actually a chronic autoimmune disorder that causes the body's immune system to attack its own cells.

The autoimmune assault causes severe inflammation, resulting in the hyperproduction of skin cells. In people without psoriasis, new skin cells generate every 28 to 30 days. In people with psoriasis, the generation occurs every three to four days.

Diagnosing psoriasis in kids can be tough since it can mimic other common skin conditions, so it is vital to get your child’s symptoms checked. Not only is psoriasis extremely uncomfortable for kids, but the stigma and embarrassment associated with the disease can hurt their emotional health, as well.

Symptoms

The challenge of diagnosing psoriasis in kids is that it can look like other conditions common in childhood like diaper rash, dermatitis, alopecia areata, and pityriasis rosea. However, if your child’s nails begin to pit and discolor, or they develop thick patches of red and flaky skin, this could very well be a sign that your child has psoriasis.

Although there are several types of psoriasis, the most common in both children and adults are plaque psoriasis and guttate psoriasis. Both are characterized by lesions on the surface of the skin albeit with slightly different appearances.

  • Plaque psoriasis causes the formation of thick red patches, called plaques, often covered with silvery-white scales. The plaques are often very itchy and may crack or bleed when scratched.
  • Guttate psoriasis is characterized by smaller dot-shaped lesions. This type of psoriasis has been linked to strep throat infections in childhood and often presents right after an acute bout.

If your child begins to show any of these symptoms, it is important to reach out to your pediatrician even if the signs are subtle. As an autoimmune disorder, psoriasis is linked to serious chronic conditions that could have a life-long impact on your child’s health.

If left untreated, psoriasis may increase the risk of cardiovascular disease, cancer, and diabetes as well as promoting depression, anxiety, and low self-esteem.

Causes

The cause of psoriasis is poorly understood, but it’s believed to have a genetic component. In fact, according to the National Psoriasis Foundation, while around 10 percent of the population will have one or more of the genes linked to psoriasis, only 2 percent to 3 percent will actually develop the disease.

Moreover, having one parent with psoriasis increases your risk of getting the disease, while having two increases your risk even more.

In order for symptoms to manifest, it is believed that the inherited gene must be triggered by external factors, such an infection, stress, environmental toxin, or allergy. Even a change of weather can dry the skin and lead to a psoriasis flare.

Psoriasis in children is closely linked to common childhood infections, most predominately group A streptococcal and viral infections. Once symptoms develop, any number of triggers can cause a flare. Among them:

  • Skin injury, even minor scratches or sunburn, may induce psoriasis at the site of the injury. This can make participating in sports or playing with friends fraught with risks.
  • Stress is a common trigger for psoriasis. Problems with school, friends, or home life may manifest with symptoms even if the stress is unseen. Living with psoriasis can in and of itself cause stress.
  • Allergies to mold, dust, pollen, pet dander, food, detergent, and other common allergens can trigger psoriasis flares.
  • Cold dry weather can trigger psoriasis in some kids. By contrast, hot, sunny weather tends to improve symptoms.
  • Obesity places a child at an increased risk of psoriasis but can also trigger a flare with a sudden weight gain.

Diagnosis

There aren't any special tools or tests that a dermatologist will use to diagnose psoriasis. Rather, the doctor will perform a physical exam to assess whether the symptoms are consistent with psoriasis and review the child's medical history. Among the question the doctor may ask:

  • Has your child ever had strep throat?
  • Does anyone in your family have psoriasis or a skin condition?
  • Is there a history of autoimmune disease, like lupus or rheumatoid arthritis, in your family?
  • Are there any medications your child is taking?
  • Have there been any recent illnesses or infections?

Some of the questions are used to assess whether your child fits the profile for psoriasis; others are used to exclude other possible causes, like drug reactions or diseases that cause psoriasis-like lesions.

When you go to your child's appointment, bring a list of your child's symptoms, medications, and previous treatments and hospitalization may be relevant to the diagnosis, Doing so will ensure that you don't forget anything, including the date when symptoms first appeared or got worse.

If the diagnosis is inconclusive, the doctor may perform a skin biopsy to examine a sample of tissue under the microscope. A biopsy is typically performed in the doctor's office with a local anesthetic to numb the skin. The biopsy sample can help differentiate psoriasis from other similar conditions. 

With psoriasis, the cells will appear dense and compacted (acanthotic) unlike those seen with eczema or pityriasis rosea.

Treatment

Currently, there is no cure for psoriasis. Most treatments aim to alleviate symptoms when they occur and reduce the risk of flare-ups.

Be sure to keep track of your child’s psoriasis triggers to avoid flares. If stress at home or school is a common trigger, teach stress management techniques like deep breathing exercises or guided imagery which most children can manage. Sitting down and talking with your child can also go a long way to defusing stress.

If there are chemical triggers, removes them from your shelves and make certain that friends and teachers are advised, as well. During winter months, bundle your child up with a hat, scarves, gloves, and even a ski mask if cold temperatures trigger symptoms.

Along with prevention, your child’s doctor may recommend other treatments. Depending on the severity of symptoms, these may include:

  • Mild topical steroids are often recommended for kids because they won’t hurt sensitive skin. In addition, the doctor may recommend emollient-rich moisturizers to keep the skin soft and prevent dryness and cracking.
  • Light therapy, also known as phototherapy, involves controlled exposure to natural light or a specialized ultraviolet (UV) lamp to alleviate psoriasis symptoms. The treatments should be done under the supervision of a medical professional. Avoid sunbeds or UV lamps not specially designed for psoriasis.
  • Oral or injectable medications may be recommended in especially severe cases. With that being said, these kinds of treatments are considered controversial in children since they suppress the immune system (which may not yet be fully developed).

If unsure about a recommended treatment, do not hesitate to seek a second opinion. Doing so doesn't mean you distrust the doctor. Rather, it provides you the objective insights needed to make a fully informed choice as a parent.

Coping

Psoriasis can have a major effect on your child’s quality of life and mood. The simple fact is that people living with psoriasis are twice as likely to experience depression than those in the general population, according to a 2017 review in the Journal of Psoriasis and Psoriatic Arthritis.

It is vital, therefore, to be sensitive to your child’s feelings and to take steps to help your son or daughter feel more confident and empowered. Here are some tips that may help:

  • Be an advocate. Educate your child as well as friends, teachers, and extended family. Doing so can eliminate stigma, debunk myths, and normalize the condition among those who care.
  • Don't obsess about psoriasis. Never make your child feel that he or she is different for having psoriasis. The more you stress about the condition, the more your child will. When discussing the condition, stick to the facts rather than trying to "pretty things up." 
  • Allow your child to participate in health decisions.  Giving children a say in treatment or lifestyle choices can build confidence by providing them a sense of control and self-determination.
  • Acknowledge your child's feelings. Avoid platitudes like "looks don't matter" or "who cares what other people think?" Doing so can minimize a child's feelings. Instead, acknowledge your child's feeling no matter how painful it may be. This opens the door to honest discussion, encouraging rather than shutting down conversation.

Psoriasis is a challenging life-long disorder, but with the proper treatment and support, your child can learn to manage the disease and live a happy and healthy life. Work your child's medical team to address emotional concerns as well as physical ones.

By doing so now, your child will be better able to develop a positive self-image as he or she moves toward adulthood.

Was this page helpful?

Article Sources