Psoriasis in Children

To the untrained eye, psoriasis might look like a severe case of nappy rash, especially if your little one is not toilet trained. Psoriasis appears in the diaper area for infants, but it can also appear on the face, chest, stomach and the scalp, and can be easily confused with severe dandruff. This article will help you understand what the condition is, its causes, etc.

What Is Psoriasis?

Psoriasis in babies is an uncommon skin condition that can affect at an early age, but in most cases, it doesn’t develop until teenage or later. It can be identified by red patches, which are raised and covered with silver scales. It arises due to the rapid growth of skin cells, which build up and shed quicker than usual. Psoriasis appears on the knees and elbows but may spread to other areas, such as the armpits, near the bottom and the back of the knees.

Paediatric psoriasis is a rare, inflammatory skin condition, which affects children in two forms. They are:

• Plaque Psoriasis – This is the most common type of psoriasis in children. It appears on the knees, scalp, elbows and the lower back as scratches covered with flaky, whitish-silver scales.
• Guttate Psoriasis – This type is more prevalent among children than adults. It isn’t as thick or scaly as plaque psoriasis, but it appears on the skin as small, dot-like lacerations on the legs and arms.

There are mild, moderate and severe cases of psoriasis. The mild ones only have a few rashes; the moderate cases cover 3% to 10% of the body, and the most severe cases cover 10% of the body or more, with some cases covering the whole body.

Let’s take a look at some more forms of psoriasis that fall under these two categories.

Types of Psoriasis in Children

Here are the different types of psoriasis that can affect kids.

• Scalp Psoriasis – Scalp psoriasis causes patches of whitish-yellow skin or flaky skin on the scalp, sides, and the back of the ears. They can be itchy and red as well. The big, circular and rough patches can be found arranged randomly on the scalp.
• Acute Guttate Psoriasis – These are small, spot-like marks on the skin. These are tinier and thinner than the common plaques. It is less prevalent in adults and more common in children. Less than 2% of people suffer from this type of psoriasis.
• Flexural Psoriasis – Otherwise known as inverse psoriasis, it is not as noticeable as the other types, but it is still as painful as the others. It is a shiny, smooth rash on the folds of skin rather than plaque formation. It is rare and comes along with other types of psoriasis, such as chronic plaque psoriasis.
• Chronic Plaque Psoriasis – Around 90% of psoriasis cases are plaque psoriasis. Even amongst children, it is quite common.
• Nail Psoriasis – It also called psoriatic nail dystrophy, and it affects the nails. It rarely occurs alone and usually follows existing psoriatic conditions like psoriatic arthritis or plaque psoriasis. It occurs within the nail and can infect other nails on the hands.
• Photosensitive Psoriasis – It is a rare type of psoriasis caused due to exposure to sunlight or due to a polymorphous light eruption. It can be prevented by keeping your child away from sunlight.

Causes of Psoriasis in Kids

Here are some causes of psoriasis in kids:

• A child could be suffering from psoriasis due to heredity reasons as genes play a vital role.
• One in three people, affected with psoriasis have a relative, dead or alive with psoriasis.
• Even if one parent suffers from psoriasis, there is a 15% probability that the child will have the condition, too.
• Because it skips generations, if parents don’t have psoriasis, the children and the siblings have a 20% chance of acquiring the condition.

Signs and Symptoms of Psoriasis

The symptoms and signs of psoriasis vary according to the type of psoriasis you have. Symptoms of psoriasis in children include:

• Plaques of red skin, covered with silver-coloured, loose scales.
• Pain and itchiness leading to cracks and bleeding of the skin.
• In extreme cases, plaques expand and merge into each other, spreading over large areas.
• Fingernails and toenails are discoloured. They crumble and detach from the bed of the nail.
• Scaly, dandruff-like plaque on the scalp.
• Bleeding when the skin is scratched.
• Psoriatic arthritis accompanies swelling of joints, causing pain.
• 30% of the people who are affected by psoriasis also suffer from psoriatic arthritis.

If you are wondering what childhood psoriasis looks like, keep an eye out for the signs given below.

What Does Childhood Psoriasis Look Like?

• Symptoms of psoriasis in children include discolouration and pitting of nails.
• Severe scaling of the skin.
• Diaper dermatitis or plaques identical to adult psoriasis in the groin area.

Psoriasis is uncommon in infants, but not unheard of. Close observation to identify the disease is required.

Is Psoriasis Common in Children?

Psoriasis in children can lead to significant psychological harm as they grow up. Studies state that more than 20,000 children are diagnosed with psoriasis in the United States every year. Around 0.7% of kids are affected by this disease, globally. About 1 in 10 children develop psoriasis by the age of ten. It is vital to treat childhood psoriasis immediately as skin conditions can be possibly painful and uncomfortable. They may also make your child feel anxious, worried or sad. Psoriasis has the potential to damage the heart over time.

It can lead to unhealthy changes in blood fats, blood pressure, and insulin levels. When all these occur together, it is known as metabolic syndrome. This has been linked to diabetes and heart problems. Children with psoriasis have been observed to have a higher risk of obesity leading to heart problems.

Is Psoriasis Painful?

Psoriasis is often painful and itchy. Among the various types of psoriasis, erythrodermic psoriasis is the least common type of psoriasis. It is extremely painful and itchy. It is a severe form of psoriasis that causes redness over almost, the whole body. It is life-threatening as it can make the skin come off in sheets.

Can Psoriasis Be Cured?

Although Psoriasis cannot be cured, it can be managed through various treatments.

Conditions That Increase the Risk of Psoriasis in Children

While the exact causes of psoriasis are unknown, the various triggers that may aggravate psoriasis are as follows:

• Infection
• Skin Irritation
• Stress
• Obesity
• Cold Weather

Managing triggers help reduce the severity of psoriasis.

Is Psoriasis Contagious?

Psoriasis is an inflammation and is not contagious. Due to lack of awareness, people fear that the infection can spread just by touch, which is not the case. The reason for this misconception is that they think the disease is caused due to some type of virus, fungus or bacteria. However, it arises due to inflammation and problems caused due to a poor immune system.

How Can You Tell Whether It Is Psoriasis or Eczema?

Psoriasis is itchy, and one is likely to experience a strong stinging and burning sensation. Some people have described it as being bitten by fire ants. Many people can confuse eczema with psoriasis. Eczema is accompanied by an intense itch. People have been known to scratch so much that their skin bleeds. Eczema causes inflamed, red skin which can be crusty or scaly. You may see leathery rough patches, which are dark sometimes. It may also cause swelling in certain people. It is similar to psoriasis in many ways, and you may also have red patches, but they are scaly and silvery and rise up high. Under close examination, you will find the skin to be more inflamed and thicker than eczema.

Also, these skin conditions tend to affect different areas of the body. Psoriasis shows up on the knees, elbows, face, scalp, lower back, palms of the hands, soles of the feet, fingernails, toenails, mouth, lips, ears and skin folds. Eczema commonly appears on body parts that bend, such as behind the knees or the inner elbow. It can also be found on the neck, ankles, and wrists. Babies uncommonly get it on their scalp, cheeks, chin, chest, back, legs and arms.

Here are the possible triggers for eczema and psoriasis:

• Eczema commonly occurs due to things that irritate the skin like, detergents, soaps, disinfectants and juices from meats or produce. Things that your child is allergic to also trigger eczema, like dust, pets, pollen, mould, dandruff, and certain foods. Infections, stress, heat, sweating, humidity and changes in hormones also set off eczema. Eczema commonly occurs in babies and young children. In most cases, the condition improves as the child grows up. It is very rare for adults to be affected by it. It is usually set off as a side effect of other conditions like stress, hormone changes or thyroid disease. Eczema is accompanied with sensitive skin or dry skin. You probably have members in your family who have it or has hay fever or asthma.
• Psoriasis is set off due to infection, stress or due to an injury to the skin. The injuries could be because of sunburn, scratches, and vaccination. Certain types of medications like antimalarials, lithium, commonly used for treating bipolar disorder can cause flare-ups. It usually shows up between 15 and 35 years of age. Although it is rarely found in babies, you can get it during other ages, too. It is linked to other major health conditions. If you have it, you have high chances of having heart disease, depression or diabetes.

Let’s take a look at how psoriasis can be diagnosed.

Diagnosing Psoriasis in Children

The diagnosis of psoriasis in children is made through a physical examination. Doctors inspect the skin and make the diagnosis based on the observation of the affected areas.

• The plaques are commonly distributed symmetrically.
• They particularly infect areas like the scalp, knees, elbows, and skin folds, such as behind the ears, groin, and armpits.
• They are red, circumscribed and scaly.
• There is a history of psoriasis in the family.

In severe cases, a skin biopsy might be necessary to not confuse psoriasis with other similar looking skin conditions.

Assessing the severity of psoriasis aids in choosing the most appropriate method of treatment. Its severity can be assessed in the following ways:

• Calculating the area of body surface involved.
• Estimating a psoriasis area and severity index (PASI score).
• Assessing the quality of life with the help of a questionnaire.

A good dermatologist can help individuals deal with severe psoriasis. Adolescents and children with psoriasis require the help of a paediatric dermatologist. Additionally, counsellors are also recommended as psoriasis can cause significant social and psychological damage to the child.

Treatment of Psoriasis

Although it cannot be cured, there are various options to manage psoriasis.

1. Topical therapy

Topical therapies are ideal for treating mild and moderate psoriasis for all the children with psoriasis.

• The doctor may recommend ointments like calcipotriol on the affected areas to be applied twice daily.
• Topical corticosteroids are usually used in short courses, between two to three times per week.

• The doctor may recommend combining betamethasone diproprionate and calcipotriol gel/ointment and applying it once daily for four weeks. It can be used once for a while afterwards if required.
• Dithranol can be used for immediate relief, but it is not easy to use as it can stain clothes and irritate the skin.
• Coal tar can be used for children with psoriasis as it does not affect the genitals or the face. It is ideal for scalp psoriasis, although it has an unpleasant odour.

2. Phototherapy

Narrowband UVB phototherapy is commonly used for children with psoriasis, especially for children over the age of 10 years. It is the perfect treatment for guttate psoriasis and plaque psoriasis as they respond best. A treatment course based in a hospital normally requires the patient to attend the treatment three times a week, for up to 12 weeks. Some hospitals offer PUVA and Broadband UVB treatment.

3. Methotrexate

If topical treatments and phototherapy do not show satisfactory improvement, methotrexate tablets can be used. These are prescribed once weekly and have been proven useful. It is more extensively used in the treatment of adults than children. Various case studies have shown remarkable clinical improvement amongst two-year-old children, with remarkable tolerance. To ensure safety, regular blood tests are mandatory.

4. Biological Agents

Biologic agents like intravenous infliximad and subcutaneous etanercept should be used only as a last resort. It can be used to deal with severe psoriasis in children who have not responded well to other therapies. Although they are safe, they have adverse side effects like infections. Only after the consultation of a dermatologist on a case-to-case basis, should a biological agent be used.

Home Remedies to Cure Psoriasis

Even though psoriasis is not curable, there are many treatments to ease and manage the symptoms.

• Dietary Supplements: According to the National Psoriasis Foundation, dietary supplements might help ease the symptoms of psoriasis from within. Vitamin D, aloe vera, Oregon grape, milk thistle and evening primrose oil have been known to help manage symptoms of mild psoriasis. It is vital to keep in mind not to take supplements that interfere with pre-existing conditions you might have.
• Prevention of Dry Skin: Keep the air in your home or office moist with the help of a humidifier. It helps prevent dry skin even before it starts. Moisturisers for sensitive skin are also good to keep your skin supple and prevent it from forming plaques.
• Avoid Fragrances: Most perfumes and soaps contain dyes and other chemicals that might irritate your skin. They make you smell great at the cost of inflaming psoriasis. It is best to avoid such products whenever possible; you can also consider choosing products with labels that say sensitive skin.
• Healthy Diet: Diet plays an important role in managing psoriasis. Eliminating fatty snacks and red meat from your diet might help reduce flare-ups that are triggered by such food products. Cold-water fish, nuts, seed and other sources of omega-3 fatty acids are popularly known for their capability to reduce inflammation. These are helpful to manage psoriasis symptoms. Olive oil is also known to have benefits which soothe the skin when topically applied. Try massaging some olive oil on your scalp when you shower next. It helps loosen irritating plaque.
• Warm Baths: While hot water irritates the skin, a lukewarm bath with Epsom salt, milk, mineral oil or olive oil has been noted to soothe the itch and penetrate plaques and scales. For added benefits, moisturise yourself quickly after you finish your bath.
• Light Therapy: Light therapy involves shining ultraviolet light on your skin under the guidance of a medical practitioner. This form of therapy commonly requires frequent and consistent sessions. It is vital to remember tanning beds cannot be substituted as light therapy. Too much exposure to sunlight worsens psoriasis. Therefore, it is recommended to undergo this procedure with the guidance of your doctor.
• Reduce Stress: Most chronic conditions like psoriasis can be a source of stress. This often turns to a vicious cycle, where stress itself worsens the psoriasis symptoms. Along with reducing stress wherever possible, try implementing practices that reduce stress, like meditation and yoga.

Children with psoriasis may clear up completely within months of diagnosis and treatment, particularly if the guttate plaques form because of an infection. It is advised to keep in mind that some children might progress to have long-term psoriasis. In many cases, the disease is life-long. Early large plaque psoriasis normally tends to be especially persistent and hence challenging to treat. It may lead to the occurrence of complications like psoriatic arthritis. Children dealing with severe psoriasis are generally advised to exercise regularly, follow a healthy lifestyle, and maintain a healthy weight.

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