Does your infant have a diaper rash that won’t respond to conventional treatments or cradle cap? Does your child have dandruff or lesions on their body? Is your little one complaining of itchy, burning skin and suffering from dry, cracked skin? If you’ve answered yes, your child might have psoriasis.
Psoriasis is a chronic inflammatory skin disease that affects less than 1 percent of children. The risk is higher in individuals with a family history of psoriasis.
Psoriasis lesions are well-defined pink plaques with white scale. We don’t know exactly what causes psoriasis, but various genes are responsible for upregulating the immune system. Following a strep infection, children can also get guttate psoriasis, with smaller lesions that are more widespread.
If you suspect your child has psoriasis, take them to their pediatrician. After confirming the diagnosis of psoriasis in your child, it is important to stay in touch with your pediatrician or pediatric dermatologist. They will discuss the chronic nature of the condition and realistic expectations of therapy.
You may feel upset learning that there is no cure for this condition. However, be reassured that most children have mild psoriasis that is readily responsive to therapy.
The response to treatment can vary from maintenance of the disease at a cosmetically acceptable level to complete clearance of the plaque. The severity of the psoriasis, the body site locations and the attitudes and views held by you and your child will help determine the choice of treatment.
A variety of treatment options exist, and will be tailored to fit your child’s needs. Fortunately, most pediatric psoriasis can be controlled with topical therapies.
There are many different types of topical steroids. For example, hydrocortisone cream is a mild topical steroid. Steroids that are more potent can be used for thicker lesions on the arms and legs.
Since the skin is thinner on certain areas of the body, such as the face, armpit and groin, non-steroidal therapies are typically preferred. These topical medications include vitamin D or calcineurin inhibitors, which decrease the inflammation of psoriasis without the side effect of thinning the skin after prolonged use, which can be a possible rare side effect of topical steroids.
Topical retinoids or products with salicylic acid or tar may also be used to help reduce the scale of the lesions.
If topical therapies alone cannot control the disease, then systemic therapies may be used. Phototherapy, which is given two or three times weekly in a light box at your doctor’s office, can be used for older children. Natural light exposure is also an option, especially in Florida.
The most commonly used systemic medications for pediatric psoriasis include acitretin, methotrexate and cyclosporine, with the latter two drugs causing suppression of the immune system. A biologic agent, which is given as an injection once weekly, was recently approved in children older than 8 and works by reducing the inflammatory pathway of psoriasis.
Ultimately, the best treatment is the one that your family and child will be most compliant with, and feel comfortable using. The decision should be made in conjunction with your physician after discussing all possible options and side effects.
Diseases associated with psoriasis
Psoriasis is associated with obesity, high blood pressure, high cholesterol, diabetes and heart problems. Children should be monitored carefully for these conditions and manage them through weight loss and increased exercise, which can also improve their skin disease.
Psoriasis in children is also linked to bullying, and it is important for children to know this disease is not contagious, and for parents to be aware of signs that their children are not acting like themselves. Similarly, psoriasis can be associated with depression and reduced quality of life, especially when undertreated, so it is important to make treatment and office visits a priority for your family.
Parents should keep their children busy in mainstream social and physical activities. The more they withdraw, the more depressed they may become, leading to eating more, obesity and worsening symptoms. This cyclical nature leads to increased drug use and ultimately more psoriasis.
Through your child’s medical journey, it is important to keep a consistent relationship with your physician to help your child have the best outcomes with treatment. There are a number of therapies available and every child with psoriasis should receive individualized therapy based on their presentation to help them look and feel good. If you suspect your child has psoriasis, schedule an appointment with your pediatrician or call the University of Miami Health System at 305-243-6704.
Kate E. Oberlin, M.D., is a third-year dermatology resident and Lawrence A. Schachner, M.D., is director of pediatric dermatology at the University of Miami Health System. For more information, visit UHealthSystem.com/patients/pediatrics.