What to know about psoriasis in children
However, even though there is currently no cure for psoriasis, many treatments are available to help children with this condition live comfortable, social, and active lives.
In the United States, about one-third of people with psoriasis experience symptoms before the age of 20 years. It is possible for psoriasis to develop at any age, though.
Most children with the condition respond well to treatment, and many have few or only mild flares.
In this article, we look at how psoriasis develops in children and how doctors treat the condition.
Psoriasis in children
Psoriasis can develop in children.
Psoriasis is an inflammatory condition that affects the skin.
When a person has psoriasis, they will develop patches of red, scaly skin on different parts of the body.
These patches will often become worse, or flare, and then go into remission.
Several different types of psoriasis can develop in children.
The most common type of psoriasis in both adults and children is plaque psoriasis, in which well-defined patches or plaques with a silvery-white surface develop on the skin. Often, the first area where these patches appear in children is the scalp.
Another type of psoriasis that often develops in children is guttate psoriasis, which leads to small, raindrop-like patches forming in large groups. When guttate psoriasis occurs in children and young teenagers, it is often the result of a secondary infection in the throat, such as strep throat.
Other upper respiratory infections are also common triggers for psoriasis. In some cases, the symptoms of guttate psoriasis might resolve within a few months and not return.
Children will often develop inverse or flexural psoriasis. This term refers to the large, red patches of psoriasis that form around folds in the skin, such as those at the joints.
A person should look out for several symptoms to identify psoriasis. Psoriasis may affect the skin of children and adults differently.
Some of the symptoms that help distinguish psoriasis from other conditions in children include:
- nail pitting or discoloration
- itching, pain, or general discomfort
- severe scales on the scalp
- dermatitis around the area of a diaper
- plaques similar to those of adult psoriasis on the arms, legs, and trunk
If a rash or lesion does not respond to over-the-counter (OTC) treatments, its cause may be an underlying inflammatory condition. Psoriasis might strongly resemble eczema or seborrheic dermatitis, so close observation is necessary.
The most significant difference between adult and child psoriasis is simply the age of onset. Otherwise, a child with psoriasis will experience many of the same symptoms and triggers as an adult.
Other potential differences in children include a more significant psychological impact, due to the stage of their social development when onset occurs, and a tendency for patches to form around the scalp, buttocks, and face.
Discuss with a doctor whether a child needs treatment for their psoriasis.
Treatment for psoriasis focuses on reducing the severity of a flare and helping with the emotional stress of having psoriasis.
However, before a child undergoes any of the possible treatments, their parents or caregivers should discuss the risks and benefits that treatment carries with a doctor or dermatologist and ask whether it is medically essential.
If clothing covers a child's lesions or they do not experience discomfort as a result of the symptoms, treatment may not be necessary.
Visible lesions may cause a child to withdraw socially, and the itching can cause distraction at school. If the symptoms are affecting a child's quality of life, a course of treatment may be necessary.
Treatment options include the following:
- topical therapy
- oral medications
People use topical therapy to treat most cases of psoriasis. This type of treatment involves medicated creams and lotions, such as vitamin-D creams, keratolytic moisturizers and lotions that help a person remove scales, and topical corticosteroids.
Topical therapies may resolve mild to moderate skin symptoms without the need for any further treatment.
Phototherapy involves the use of concentrated ultraviolet (UV) light on the skin, and doctors usually only recommend it for children over 10 years of age. People with mild plaque or guttate psoriasis tend to respond best to phototherapy.
The treatment takes place two to three times a week in a hospital or at a dermatology clinic.
If the plaques or lesions do not respond to other treatments, doctors might sometimes prescribe oral medications to help treat psoriasis in children. These are systemic drugs that directly treat specific parts of the immune system, addressing the root cause of psoriasis.
Typically, people use these for moderate to severe presentations and only take them for short periods. Doctors rarely prescribe them for psoriasis of the scalp.
Aloe vera can help a person soothe psoriasis.
There are also some natural remedies available for children with psoriasis.
Parents or caregivers seeking alternatives to medicated creams can try a range of natural treatments. Many alternative treatments derive from natural sources and are available as creams and oils.
While some adults report that natural treatments have improved their psoriasis skin symptoms, there is no evidence supporting the use of these treatments in children.
Before applying topical treatments, a person should carry out a patch test on the child to check for an allergy. They should also monitor the child for adverse reactions or a worsening rash.
Some potential alternative treatments include:
- aloe vera
- soaking in Dead Sea or Epsom salt baths
- oat baths
- apple cider vinegar
- tea tree oil
Additionally, some parents and caregivers may wish to seek psychological therapy or counseling on behalf of a child with psoriasis. If a child has the condition, it can lead to them feeling isolated and developing self-image and confidence issues early on in life.
Although this type of therapy does not directly address the skin symptoms of psoriasis, it can play a useful role in helping a child manage any feelings of embarrassment and anxiety.
Additional steps for managing psoriasis in children involve maintaining overall health. A 2017 survey that the University of California-San Francisco carried out suggested that people with psoriasis who follow gluten free, low carb, and high protein diets experience milder symptoms.
The researchers behind the survey also advise that a vegan, paleo, or Mediterranean diet could help reduce symptoms.
While they do not recommend any single diet over the others for people with psoriasis, they do suggest that the common thread between these diets is that they can aid weight loss.
Maintaining a healthy body weight may help reduce the number of flares that a child experiences, as well as their severity.
Researchers have been unable to determine the exact cause of psoriasis.
However, most agree that it has a strong genetic pattern. A person may pass it on to their children in the genes.
Beyond this, researchers have concluded that the incorrect function of the immune system leads to the overproduction of skin cells, which results in the characteristic plaques and lesions of psoriasis forming.
Some known triggers that may cause psoriasis for the first time or cause or worsen a flare include:
- infection in the throat or upper respiratory tract
Psoriasis is not infectious, and one child cannot transfer it to another. Therefore, there is no need to prevent contact between children who do and do not have the condition.
Instead, parents and caregivers should encourage the child to socialize with others, as this can help them build a support network and reduce feelings of isolation.
When to see a doctor
It is very important for children to see their doctor if an unexplained rash develops and does not respond to OTC treatments.
A parent should also consider their family history. If they or someone else in the family has psoriasis, a new rash on a child is more likely to result from this condition.
Children with psoriasis are likely to have the condition for the rest of their life.
Psoriasis that is mild to moderate is unlikely to lead to major medical complications, but children with more severe psoriasis may develop psoriatic arthritis.
It is important to take a child's emotional well-being into account while treating psoriasis. People caring for a child with the condition should be aware of the emotional and physical effects that it may have on them.
Does psoriasis ever develop during childhood but resolve once a person is older?
That is not a typical outcome. Some people learn to manage their psoriasis very successfully and are careful not to trigger a flare-up, which can make it seem as though they have overcome psoriasis.
However, it is not possible to ‘grow out’ of psoriasis, and almost everyone has recurring flare-ups throughout their entire life. Psoriasis is a life-long disease without a known cure.
Eczema, on the other hand, tends to disappear as a child enters adulthood.Debra Sullivan, PhD, MSN, RN, CNE, COI Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.