(LifeWire) - If you notice scaly red patches on your child's skin, they may be due to the chronic skin condition called psoriasis. About one-third of all people with psoriasis develop it before age 20.
What Causes Childhood Psoriasis?
Psoriasis at all ages seems to occur due to a combination of genetic and environmental factors. Your child is much more likely to develop psoriasis if other members of the family have the condition. Generally, a trigger in your child's environment (such as a strep infection or injury) prompts the immune system to swing into overdrive. So new skin cells that usually take nearly a month to develop begin forming much more quickly. In psoriasis, skin cells mature within days, resulting in a pile up of excess skin cells and symptoms characteristic of psoriasis.
What Are Its Symptoms?
Psoriasis begins as red bumps on the skin, which merge into patches called plaques. The top of each plaque is often silver-gray, thick and scaly.
Psoriasis frequently shows up in areas of skin that have been injured or sunburned, especially the knees and elbows. Other commonly affected areas include the scalp, around the navel, between the buttocks and around the genitalia. Fingernails and toenails can also be affected, becoming ridged, pitted and discolored - and sometimes detaching.
Children with stiff, painful joints may have psoriatic arthritis.
Are There Different Types of Childhood Psoriasis?
Children, like adults, may develop any of the several types of psoriasis:
- Plaque psoriasis. The classic (and most common) type of psoriasis, characterized by swollen, scaly, reddened patches of skin.
- Guttate psoriasis. Marked by teardrop-shaped, light pink or salmon-colored lesions, often occurring during or after an infection (especially strep throat), an injury or sunburn. This form is particularly common in childhood. It may occur only once or may recur with future infections. It can also develop over time into other forms of psoriasis.
- Pustular psoriasis. Blisters filled with white fluid appear on the skin, sometimes only on the palms of the hands and the soles of the feet.
- Inverse psoriasis. Smooth, swollen, reddened areas are located in folds of skin, especially areas that tend to stay moist or rub together.
- Erythrodermic psoriasis. A potentially severe form of psoriasis in which large areas of skin become very red and swollen and may peel off. Children with erythrodermic psoriasis have a high risk of fever, dehydration and infection during the condition's flare-ups.
- Psoriatic arthritis. Swollen, painful, stiff, reddened joints, especially in the fingers and toes. Over time, joints may actually become deformed due to chronic inflammation. Fingernails and toenails may be ridged and pitted.
How Is The Condition Diagnosed?
Psoriasis is usually diagnosed when a doctor recognizes its characteristic appearance. If there is any confusion as to the diagnosis, a small sample, or biopsy, of a skin lesion may be examined in a laboratory to verify that the symptoms are those of psoriasis.
How Is It Treated?
Unfortunately, there is no cure for psoriasis. However, a number of effective treatments can help improve your child's symptoms, including:
- Topical treatments. Applied directly to affected area, topicals include steroid creams; Dovonex ointment (with calcipotriene, a vitamin D preparation); Tazorac (tazarotene), a retinoid compound related to vitamin A; Psoriatec (anthralin); and preparations that contain coal tar. Psoriasis of the scalp can be treated with special coal tar-containing shampoos; Baker Cummins P&S Shampoo (a phenol and saline preparation); or steroid creams, foams, gels or ointments. Shampoos containing salicylic acid are also commonly recommended to help control he scaling common in scalp psoriasis. Getting rid of scales helps treat dandruff and helps other medicines penetrate better.
- Phototherapy. Exposes affected areas of skin to special ultraviolet B (UVB) light over 3 to 5 weekly sessions.
- Systemic treatments. These travel through the bloodstream, affecting cells throughout the body. For example, anyone who develops psoriasis in response to an active strep infection will need to take antibiotics.
On the other hand, only children with particularly severe cases will need more potent medications that slow new skin cell growth - Soriatane (acitretin) or Accutane (isotretinoin) - or that suppress the immune system to reduce damage to skin and joints, such as Trexall (methotrexate), Neoral or Sandimmune (cyclosporine) or Enbrel (etanercept).
What Other Kinds of Support Might My Child Need?
As with anyone who has a chronic condition, children with psoriasis need extra support and understanding, especially if the psoriasis crops up in a visible or cosmetically difficult location.
Children with psoriasis may need help understanding their condition, accepting the treatment(s) or coping with the frustrations of feeling different from their peers. During flares, they may feel embarrassed by unwanted questioning or stares from peers or strangers.
In seeking to help your child, you should consult with health professionals as needed. In addition, the following points are important:
- Children with psoriasis should understand - and be able to explain to others when necessary - that psoriasis is neither contagious nor life-threatening.
- They may need help in striking a healthy balance between choosing clothes that conceal affected areas and developing a healthy self-image that includes acceptance of their own appearance.
- Stress management can help children with psoriasis feel better emotionally. Practices that may help include yoga, meditation, guided imagery, exercise, deep breathing and relaxation techniques.
- Support groups for children with chronic conditions can help prevent them from feeling alone.
- Children who are deeply distressed or sad about their condition for a prolonged period of time should be evaluated for depression.
Habif T.P."Psoriasis and Other Papulsquamous Diseases." Clinical Dermatology. Fourth ed. St.Louis: Mosby, 2004. 209-39.
Morelli J.G. "Diseases of the Epidermis." Nelson Textbook of Pediatrics. 18th ed. Robert M. Kliegman et al. Philadelphia: Saunders, 2007. 2702-03.
"Youth: Overview." Psoriasis.org. National Psoriasis Foundation. 10 June 2008. <http://www.psoriasis.org/about/youth/>
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