An Overview of Psoriasis in Children 

Tips and Treatments to Help Your Child Feel Better

Psoriasis affects around 45,000 children in the United States under the age of 18, according to a review in the journal Psoriasis. Red, itchy, raised and, oftentimes, painful lesions on the surface of the skin are most commonly found on a child's face, buttocks, elbows, knees, or scalp. While these skin changes are classic signs of psoriasis, they can be overlooked because they mimic those of other childhood skin issues, such as diaper rash.

Diagnosing psoriasis in kids can be tough, 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 not only diaper rash, but dermatitis, alopecia areata, and pityriasis rosea. However, if your child develops thick patches of red and flaky skin, or their nails begin to pit and discolor, this could very well be a sign that your child has psoriasis.

lthough 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. Although serious complications of psoriasis are not a given, the condition (if untreated) is linked to some chronic conditions that could have a life-long impact on your child’s health, such as cardiovascular disease, diabetes, depression, and more. This is especially the case in severe cases.

Causes

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.

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

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; sudden weight gain can also trigger a flare.

Diagnosis

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

Among the questions the doctor may ask:

• 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?
• Is your child taking any medications?
• Have there been any recent illnesses or infections?
• Has your child ever had strep throat?

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 their symptoms (including the date when symptoms first appeared or got worse), medications, and previous treatments and hospitalizations. Doing this prep work can help ensure that you don't forget to share anything that may be relevant to the diagnosis.

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 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, remove them and make certain that friends and teachers are advised about the importance of this 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: These 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, this 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 and UV lamps not specially designed for psoriasis treatment.
• Oral or injectable medications: These kinds of treatments are considered controversial in children since they suppress the immune system, which may not yet be fully developed. However, they may be considered in severe cases.

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, then, to be sensitive to your child’s feelings and to take steps to help your them feel more confident and empowered. Here are some tips that may help:

• Be an advocate: Educate your child, as well as friends, teachers, and 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 they are different for having psoriasis. The more you stress about the condition, the more your child will. When discussing psoriasis, stick to the facts.
• Allow your child to participate in health decisions: Giving children a say in treatment and 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 feelings no matter how painful they may be. This opens the door to honest discussion, encouraging rather than shutting down conversation.

A Word From Verywell

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 and physical concerns. By doing so now, your child will be better able to develop a positive self-image as they move toward adulthood. 

Reference: Verywellhealth.com: By Christina Donnelly