Transmission And Course Of The Disease: Parents Questions
Several questions are frequently asked during consultations: Is it contagious?, Is he going to have this all his life?, If I have another child, is he likely to have psoriasis?, is it my fault?, Is it in the head? should I take my child to a child psychiatrist?, etc.
- The first question poses no problems because in no case is psoriasis contagious. Do not hesitate to explain it to the teacher or sports teacher. In case it is not totally accepted, do not hesitate to ask for a certificate of non-contagiousness for the nursery, school or swimming pool.
- The future of psoriasis in the long term is a more difficult question to address because the evolution is poorly understood and a lot of data are contradictory. It seems that the psoriasis of the small child is not predictive of the occurrence of psoriasis in adolescence, which does not exclude the very late onset of psoriasis.
- In familial forms of psoriasis there is a risk of having children with psoriasis, this risk would be about one in four. However, the child may develop psoriasis either in childhood or in adulthood.
Box : Useful Resources
- Psoriasis Epidemiology Screening Toolbit.ly/33sU9y9
- Lund and Browder Chartbit.ly/33BJ3a3
- Childrens Dermatology Life Quality Index bit.ly/3rwXrbw
- Psoriasis Area and Severity Indexbit.ly/3tJIqG7
- Primary Care Dermatology Societywww.pcds.org.uk
Dr George Moncrieff
GP, Oxfordshire past Chair of the Dermatology Council for England past Committee member of the Primary Care Dermatology Society
Note: At the time of publication , some of the drugs discussed in this article did not have UK marketing authorisation for the indications discussed. Prescribers should refer to the individual summaries of product characteristics for further information and recommendations regarding the use of pharmacological therapies. For off-licence use of medicines, the prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the General Medical Councils Good practice in prescribing and managing medicines and devices for further information.
Will Psoriasis Cause My Child To Be Emotional
Many children if young will accept their skin problems as a matter of course, whilst others, depending on their age of onset may take their conditions differently and feel embarrassed, upset, angry, stressed or even depressed. They may feel anxious about recurring flare-ups once theyve experienced good periods of remission, and become pre-occupied and distracted from normal daily activities. As they grow up, possibly pre-occupied with their body, body image and peer pressure, their psoriasis may become more of an issue for them. Love, support, encouragement and trust in their medical team too will help overcome such stressful periods in their lives. Parents should always be understanding and aware of such issues especially if their child has psoriasis and/or psoriatic arthritis.
One of the best things a parent can do for their child from an early age, or when they first get psoriasis is educate their children about the condition, answer any questions or worries they have as they arise, reassure them on a regular basis, take an interest in how they feel, monitor their psoriasis in a discreet way so not to make a big issue of it. Reassure them that there is much research going on to find a cure and easier, more effective treatments to use with better, longer outcomes of remission. It is not a contagious condition and that their friends, boyfriends and girlfriends will not catch it. Encourage them to talk openly about their condition and not to hide it.
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Management Of Pediatric Nail Psoriasis
From the University General Hospital of Patras, Greece. Drs. Plachouri and Georgiou are from the Department of Dermatology, and Dr. Mulita is from the Department of General Surgery.
The authors report no conflict of interest.
The eFigure is available in the Appendix online at www.mdedge.com/dermatology.
Correspondence: Kearse-Maria Plachouri, MD, PhD, University General Hospital of Patras, Rio 265 04, Greece .
Nail psoriasis is a condition that can affect children and adolescents. It often is refractory to treatment. Data on its management in the pediatric population are limited. This article aims to summarize existing informationsmall case series and case reportson the successful therapeutic approaches for nail psoriasis in children. As more agents are approved for on-label use in plaque psoriasis in pediatric patients, gradually more real-life data on their efficacy for nail psoriasis in children are expected to come to light.
- No clinical trials assessing the management of pediatric nail psoriasis currently are present in the literature. Limited information on the treatment of pediatric nail psoriasis exists, mostly in the form of small case series and case reports.
- As more agents are approved for on-label use in plaque psoriasis in pediatric patients, gradually more real-life data on their efficacy for nail psoriasis in children are expected to come to light.
Less Common Types Of Psoriasis In Children
Kids aren’t likely to get these types of psoriasis:
- Pustular psoriasis. This shows up as blisters on red or swollen skin on the hands and feet. If a child does get it, it’s typically either milder than an adult would have or a kind called annular pustular psoriasis that causes a red ring around the blisters.
- Inverse psoriasis. This happens in the folds of the body: under the knee, in the armpit, or around the groin. It looks very red, smooth, and shiny.
- Erythrodermic psoriasis. This is a severe form that can be life-threatening. It causes redness over most of the body. It’s very itchy and painful and can make skin come off in sheets.
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Psoriasis And Your Childs Emotions
This condition can have a big effect on your child’s mood and how they see themselves. To support your child and help them feel better:
Focus on facts. Don’t focus too much on the disease. Your child should never feel bad or different for having psoriasis. Try to keep discussions about their psoriasis matter-of-fact, not overly emotional.
Talk about feelings. Teach young children to name their feelings, especially when a symptom develops. Make a “happy” and “sad” feelings word list. Some symptoms may not bother them as much as they may bother you. This can help you understand how their disease affects their mood.
Let them decide. Give your child some power over the condition. For example, let an older child have a say in treatment. They might want a cream instead of a greasy ointment. Or they could choose a phototherapy session time.
Let go. Give your child support and understanding. Recognize that as your child gets older, they may turn to friends for support instead of you. This is OK. It’s important for your child to stay connected to their peers.
Spread the word. Educate your child about the condition at an early age. Give them books or links to websites about psoriasis and talk about it afterward. Encourage them to ask questions during doctor’s appointments. Help them practice how to handle uncomfortable questions or comments from other kids. Your child will feel more confident with answers at the ready, and may come to enjoy the chance to educate their classmates.
Reassure Your Child About The Road Ahead
One of the hardest things about psoriasis is how unpredictable it is, and that it is a lifelong, chronic disease. Flares may happen for no reason. Treatments that worked well in the past may stop working. And children’s perspectives change, too. A kid who seemed completely fine with symptoms in the past could become painfully self-conscious once middle school starts.
Life with a long-term skin disease has ups and downs. So reassure your child — and yourself — that while there may be some tough days, they’ll get better. It’s not an easy lesson, but you’re helping them build a sense of resilience, and they’ll benefit from that for the rest of their life.
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Prevention Of Psoriasis In Children
You cannot prevent psoriasis as it is an autoimmune disease, but you can minimize the flare-ups by eliminating the triggers. Identify what is causing the symptoms and try to eliminate them from your childs life. Stress is an important triggering factor. Stress of exams or tensions at home or other kids promote psoriasis.
A volunteer with The National Psoriasis Foundation, US, and a psoriasis patient expert Alisha M. Bridges recommends these tips to, minimize and manage psoriasis flare-ups:
- Staying on top of the treatment regimen and communicating with the doctor.
- Trying to get a head-start on flare-ups by paying attention to the childs body, and recognizing any new spots, or areas that feel itchier.
- Moisturizing the skin, especially in winter.
- Changing shower and bath water to cooler temperatures.
Eating healthy, exercising, and getting adequate sleep can also help your childs body cope with the symptoms of psoriasis. Also, keeping your childs skin clean and moisturized might reduce irritation and itching.
Talk With Others Who Understand
MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 90,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.
Do you have a child with psoriasis? Share your experience in the comments below, or start a conversation by posting on your MyPsoriasisTeam Activities page.
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When Its Time To See A Doctor
Early detection and diagnosis of psoriasis are crucial for children. As soon as you notice symptoms that could be caused by psoriasis, make an appointment with your childs doctor.
Early intervention, treatment, and general support can also help reduce the stigma and self-esteem issues that may arise because of this skin condition.
Research And Statistics: Who Has Psoriasis
According to the National Psoriasis Foundation, about 7.5 million people in the United States have psoriasis. Most are white, but the skin disease also affects Black, Latino, and Asian Americans as well as Native Americans and Pacific Islanders.
The disease occurs about equally among men and women. According to the National Institutes of Health , it is more common in adults, and you are at a greater risk if someone in your family has it. A study published in September 2016 in the journal PLoS One concluded that interactions between particular genes as well as genetic and environmental factors play an important role in the diseases development.
People with psoriasis generally see their first symptoms between ages 15 and 30, although developing the disease between 50 and 60 years of age is also common.
The biggest factor for determining prognosis is the amount of disease someone has, says Michael P. Heffernan, MD, a dermatologist at the San Luis Dermatology and Laser Clinic in San Luis Obispo, California.
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The National Psoriasis Foundation And The American Academy Of Dermatology Releases First
Dermatologists say psoriasis may affect a childâs quality of life as much as diabetes, epilepsy and atopic dermatitis
ROSEMONT, Ill. â One-third of psoriasis cases begin in the pediatric years, and onset is most common during adolescence for the chronic, multisystem, inflammatory skin disease that causes the skin to develop new skin cells too rapidly. Thatâs why the National Psoriasis Foundation and the American Academy of Dermatology are releasing guidelines to help ensure that pediatric psoriasis patients receive the best possible treatment and care.
The joint NPF/AAD âGuidelines of Care for the Management and Treatment of Psoriasis in Pediatric Patients,â published today in the Journal of the American Academy of Dermatology, outline best practices for treatment of the disease in this vulnerable population. Developed by board-certified dermatologists, the guidelines are based on the most up-to-date scientific evidence for managing the disease.
Because psoriasis can increase a personâs risk of developing certain diseases, like diabetes, the new guidelines address some of those comorbidities in young people:
That emotional stress can also manifest psychosocially in children with visible skin disease. Dr. Menter points out that kids with psoriasis are susceptible to bullying, name-calling, and shaming at school and in other social settings.
Psoriasis In Childrenan Overview Of Current Treatment Options
For as many as 30% to 45% of adults suffering with psoriasis, their first experience with the disease began before 16 years of age. Although very rare in neonatal infants, psoriasis has been seen in children as young as one year old, albeit to a much lesser extent than in older children. Psoriasis is evenly distributed between the sexes in adults, and the same holds true for children.
Plaque psoriasis is the most common type of psoriasis in children, and in the exceptionally young quite a few first manifest psoriasis as a psoriatic diaper rash. Afflicting the diapering area, this manifestation differs in appearance than the contact dermatitis typical of diaper rash. Margins of the lesions are more clearly defined, folds of skin are frequently involved, and pruritus may or may not accompany the bright, reddish lesions. Conventional topical treatments for contact diaper rash typically have little effect on psoriatic diaper rash. From the onset of this condition in the infant, within a couple of weeks classical plaque lesions may develop in other areas of the body, such as face, trunk, or limbs.
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Other Symptoms Of Childhood Psoriasis
But in addition to this common form in which psoriasis manifests in children, we can find others that are also characteristic, especially of pediatric age :
- Diaper psoriasis: mainly affects the infant and occurs precisely in the diaper area, particularly in the groin folds, with bright red lesions, usually without peeling. It is a very difficult way to distinguish it from other diaper rashes.
- Inverse psoriasis: It affects the folds of the skin such as the armpits, groin, genital area, and navel. The lesions are deep red and often without scales.
- Guttate psoriasis: It is characterized by small plaques of 1-2 cm in diameter, generally very numerous, distributed mainly on the trunk . It usually appears after bacterial infection of the respiratory tract, such as otitis, pharyngitis, or tonsillitis, due to an abnormal reaction of the immune system, which attacks certain skin molecules, mistaking them for molecules produced by bacteria. The patches can last from a few weeks to a couple of months. Thereafter, there is usually a complete remission, but in some cases, guttate psoriasis progresses to the form of plaque.
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Systemic Treatments For Psoriasis
Systemic treatments that have shown significant effect in adults have been used in children, but are typically reserved for severe cases. The three common systemic treatments approved for adults by the FDAacitretin , methotrexate , and cyclosporine are not approved for use in children. The data collected showing relative safety on long-term use of these compounds for psoriasis in children has accumulated through the use of these treatments for other ailments. Systemic treatments are only used for individuals with moderate to severe psoriasis and psoriatic arthritis who are not responsive to other treatments.
Acitretin is a retinoid analog that acts on retinoid receptors in the nuclei of keratinocytes to correct abnormal cell differentiation. It is used in children and adolescents for intermittent rescue therapy, and is not recommended for females of child-bearing age because of potential effects on bone. Methotrexate is widely prescribed for severe psoriasis, but carries significant risks for long-term side effects in children and adults. Cyclosporine is an FDA-approved immunosuppressant, indicated for severe psoriasis in non-immunosuppressed adults and for the prevention of transplant rejection in young children. Cyclosporine, however, carries significant risk of serious side effects when used in children, including skin cancer.
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How To Tell Baby Psoriasis From Other Conditions
The only accurate way to tell if it is baby psoriasis or another skin condition is through careful observation.
A dermatologist or pediatrician can usually recognize the differences, so it is important for caregivers to seek medical attention for any rashes that do not clear up with time or treatment.
If a rash develops on a babys skin and remains for several days despite the use of over-the-counter creams and treatments, caregivers should seek consultation with a doctor so they can examine the rash.
There are for treating baby psoriasis. Doctors tend to rely on the results of case studies, guidelines for adult psoriasis, and expert opinion to treat the skin symptoms of psoriasis in babies.
However, some treatment options include:
- applying moisturizing creams and emollients to the skin
- keeping the affected areas clean and dry
- using specialized moisturizers for psoriatic skin symptoms
- trying phototherapy, which involves administering controlled doses of ultraviolet light to the affected areas
- avoiding exposure to extreme cold and heat
- taking oral medication
However, it is unlikely that a dermatologist or pediatrician will recommend a treatment more intensive than an emollient or moisturizer for a baby with mild psoriasis.
If symptoms are more severe than this, however, the doctor may suggest stronger treatment options.
How Is Childhood Psoriasis Treated
If the disease is mild, local therapy is generally preferred, particularly with cortisone-based ointments. Other possibilities, although not studied directly in children but derived from its use in adults, are ointments based on calcipotriol , tazarotene, vegetable tar, or non-steroidal anti-inflammatory drugs. In the scaly forms and only in older children, keratolytic creams can be applied, with salicylic acid, urea, mixtures of alpha and beta hydroxy acids, capable of detaching the scales and favoring their elimination.
For the most severe forms, that is, those that affect sensitive parts such as hands and face, or an extension greater than 10% of the body, the treatment of choice is that of biological drugs that block TNF-alpha, an immunological factor known to its involvement in psoriasis, as well as in other inflammatory diseases such as rheumatoid arthritis. These are drugs that are usually given by subcutaneous injection once a week or every two weeks. Meanwhile, other biological drugs are being studied that could be used as therapy in the future.
For all forms, a constant treatment with moisturizers and emollients is always indicated.
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