An Integrative Approach To Treating Psoriasis In Children And Adolescents
Psoriasis in both adults and children is a complicated disease, the more so with the severity of outbreaks. An integrative approach to treating psoriasis in children may draw on conventional treatments to provide relief but convey benefits as well from modifications to the child’s diet and environment. A good place to start with psoriasis is with a healthy diet, paying close attention to potential triggers. Close attention to environmental factors that trigger outbreaks is also advised. Conventional medical treatments in the form of topicals and light therapy, in conjunction with changes in diet, targeted nutritional supplements, and to the extent possible, a reduction of stress are all ways to help the young person and their caregivers manage this disease.
Because implementing a healthy diet to help promote natural healing of psoriatic symptoms in children is often a special challenge for parents, Deirdre Earls, MBA, RD, LD, herself a sufferer of chronic psoriasis, offers 5 diet tips for children with psoriasis.
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Steroid Creams Or Ointments
Topical steroids are other commonly used treatments. They work by reducing inflammation. They are easy to use and may be a good treatment for difficult areas such as the scalp and face. However, one problem with steroids is that in some cases, once you stop using the cream or ointment, the psoriasis may come back worse than it was in the first place. Only milder steroid creams or ointments should be used on your face or for psoriasis affecting flexures. See the separate leaflet called Topical Steroids for more information on how to use them.
Psoriasis In Childrenan Overview Of Current Treatment Options
+Psoriasis
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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What Are Causes And Risk Factors Of Scalp Psoriasis
It is generally accepted that scalp psoriasis, like all psoriasis, is related to genetic defects that affect certain parts of the immune system. There are undoubtedly environmental risk factors that trigger its initial development in genetically predisposed individuals. The notion that “emotional stress” plays a causal role or at least exacerbates psoriasis has been difficult to prove. There is no question, however, that psoriasis of the scalp can be an extremely stressful experience.
Clinical Trials For Psoriasis
Before a new treatment can be registered in Australia it must undergo extensive testing. Clinical trials are used to determine the safety and effectiveness of new treatments for psoriasis. The regulations governing clinical trials in Australia make the process as safe as possible for clinical trial participants. People with psoriasis may consider volunteering to participate in a clinical trial. Participation provides volunteers with access to cutting edge treatments that are not otherwise available. General information about being part of a clinical trial can be found here. Internationally, ClinicalTrials.gov provides patients, their family members, and the public with easy and free access to information on clinical studies for a wide range of diseases and conditions. If you are interested in participating in a clinical trial, talk to your doctor.
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What Does Cradle Cap Look And Feel Like
Cradle cap usually appears as a yellow or brown scaly layer on a babyââ¬â¢s scalp, that may look oily or waxy. The skin usually looks normal underneath the scales. However, the appearance of cradle cap can vary. It can also present as:
- Mild, patchy scales
- Red skin surrounded by pink patches this is more common in skin fold areas
- Swollen areas of skin – more common in skin folds
Cradle cap is not the result of bacteria, an allergy or an infection and should not feel hot to the touch, itch, smell or weep fluids. If the rash feels warm, smells bad or weeps fluids, infection may have occurred, and medical help should be sought.
Good to know: Whether or not cradle cap itches can vary depending on who is affected, which body part is affected, and how severe the problem is. Although babies are often not bothered by it, affected adults can experience considerable itching or even burning, especially when the rash affects the ear. However, although cradle cap is not always itchy, other skin conditions affecting babies do itch. These include diaper rash and atopic dermatitis, as well as ringworm. If you are concerned that your baby may have a skin condition, you can do a free symptom assessment using the Ada app at any time.
Cradle cap in toddlers, older children, teenagers and adults
- Contact dermatitis including diaper rash
- Ringworm
Types Of Psoriasis In Children
There are five types of psoriasis, but some are much more common in children than others. The symptoms can show up differently in children, too. For example, they’re more likely to have psoriasis on their face or around joints.
The two types children are most likely to get are:
- Plaque psoriasis. Most kids who have psoriasis have this type. It causes red, dry patches called plaques. It can also cause silvery scales. The plaques or scales usually show up on knees, elbows, lower back, and the scalp. They’re itchy, red, and sometimes painful. They can also bleed. Plaque psoriasis patches are smaller, thinner, and less scaly in children than in adults.
- Guttate psoriasis. This kind is also called “drop-like” psoriasis. It causes small red dots to form on the trunk, back, arms, and legs. It’s most likely to be triggered by a strep infection. Many children who get this type of psoriasis also develop plaque psoriasis.
Children under 2 can get psoriatic diaper rash. It happens on the skin that’s covered up by the diaper. It may show up like plaque psoriasis, or it may cause a bright red, weeping rash. You can tell the difference between psoriatic diaper rash and regular diaper rash because psoriatic diaper rash doesn’t get better with regular diaper rash treatment.
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Natural History Of The Disease And Triggers
The goal of control versus cure is a more practical outcome of treatment. Many randomized controlled clinical trials involving children under the age of 12 years have reported on two topical treatments: calcipotriol and corticosteroids. Avoidance of triggers like trauma , including physical, surgical, or inflammatory trauma, should be borne in mind in this age group. A strong association between pharyngitis by group A beta-hemolytic streptococci and the clinical activity of psoriasis is now well established and should be properly investigated where relevant.
Living A Positive Life With Psoriasis
Cordoro, who has treated hundreds of children with psoriasis, wants parents and kids to know that they can live productive and happy lives despite having the condition.
There are many very positive and uplifting stories of children diagnosed with the condition who cope extremely well with it, she says. They own it and are empowered by it. It does not impact their quality of life at all.
Cordoro says that much of the stigma associated with psoriasis is often due to lack of understanding of what the condition is, and fear in the minds of some that they may contract the psoriasis from the patient .
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Oral Or Injected Medications
For moderate to severe cases of psoriasis in children, your childs doctor may prescribe pills, injections, or intravenous medications.
Some of these medications can cause serious side effects, so its important to understand what you may face before the treatments begin. Because of possible serious side effects, this type of treatment may be reserved until your child is older or used only for short periods of time.
Injected medications that the FDA has approved for use in children as young as 4 years old include:
- ustekinumab
Other Treatments For Psoriasis
If you have severe psoriasis then you may need hospital-based treatment. Light therapy is one type of treatment that can be used. This may involve treatment with ultraviolet B light. Another type of phototherapy is called PUVA – psoralen and ultraviolet light in the A band. This involves taking tablets which enhance the effects of UV light on the skin. You then attend hospital for regular sessions under a special light which emits ultraviolet A .
Sometimes people with severe psoriasis are given intense courses of treatment, using the creams or ointments described above, but in higher strengths and with special dressings.
If psoriasis is severe and is not helped by the treatments listed above then a powerful medicine which can suppress inflammation is sometimes used. For example, methotrexate, ciclosporin, acitretin, etanercept, infliximab, efalizumab, secukinumab, ustekinumab and adalimumab. There is some risk of serious side-effects with these medicines, so they are only used on the advice of a specialist.
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What Are The Common Treatments For Chronic Plaque Psoriasis
There is no once-and-for-all cure for psoriasis. Treatment aims to clear the rash as much as possible. However, as psoriasis tends to flare up from time to time, you may need courses of treatment on and off throughout your life. There are various treatments options. There is no ‘best buy’ that suits everybody. The treatment advised by your doctor may depend on the severity, site and type of psoriasis. Also, one treatment may work well in one person but not in another. It is not unusual to try a different treatment if the first one does not work so well.
Many of the treatments are creams or ointments. As a rule, you have to apply creams or ointments correctly for best results. It usually takes several weeks of treatment to clear plaques of psoriasis.
The following is a brief overview of the more commonly used treatments for chronic plaque psoriasis. Unless psoriasis is very severe, treatment is usually with creams or ointments. If these treatments are not successful, you will usually be referred to a skin specialist for advice about other treatments such as medicines and light treatments.
Note: treatments of the less common forms of psoriasis are similar but are not dealt with here. Your doctor will advise.
Treating Pediatric Plaque Psoriasis: Challenges And Solutions
Presentation of disease is different from that in adults
The incidence of guttate psoriasis is more frequent than in adults, needing an appropriate antibiotic therapy in children.
Psoriatic plaques of children show lesser amount of scaling than that seen in adults, and hence it is preferable to avoid keratolytics alone or in combination unless indicated.
There can be an overlap of napkin psoriasis with diaper dermatitis or the former can be mistaken for the latter . This needs astute clinical examination, relevant investigation, and appropriate selection of drug.
Peculiarities with reference to physical status
Increased BSA in relation to weight in children leads to increased absorption of topical medication applied. This has to be borne in mind while using topical agents, especially steroids. It is advisable to adhere to fingertip units while prescribing TCS.
Thin skin of children also leads to increased absorption of topical medications. Judicious use of topical steroids by selecting the correct potency will help avoid complications due to inadvertent use of TCS in children.
Since the immature liver of children cannot metabolize certain systemic drugs, it is better to keep systemic therapy as the last resort. Systemic agents should be considered only in severe cases not responding to conventional therapy and should be instituted under strict supervision.
Peculiarities with reference to mental status
Evidences about usage of any particular drug in pediatric age group
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Get The Most Out Of Treatment
To make sure your child’s treatment has the best chance to succeed:
Find the right doctor. Look for one who regularly treats children with psoriasis. This is usually a dermatologist. Make sure you can talk with them easily. If they donât ask for your input on what you see happening with your child, find a new doctor.
Stick to a plan. Talk to your child about how important it is to stick to the treatment schedule. You may need to apply medication a couple of times a day. Remind your child that it can take time for the treatment to work. They should take an active role in their treatment as early as possible. Even first-graders can put on moisturizers, and older kids can take full control.
Pick the right therapy. Think about your child’s age and schedule. Work with the doctor to find a therapy that works best for them.
Talk straight. Choose your words carefully when talking with your child about covering up. Some kids get used to wearing long sleeves year-round. But you donât want your child to feel like theyâre always hiding.
Build connections. Look for groups or message boards online, or ask your child’s doctor about face-to-face support groups. You can also check out summer camps for kids with skin conditions. They’re all great ways to get support, learn practical tips, and build confidence. And that goes for you, too. A chat with other parents who have kids with psoriasis can give you new insights and strategies.
Topical Treatments For Moderate To Severe Scalp Psoriasis
If your symptoms are more severe and the plaques on your scalp are thick, you will probably need prescription treatment. Your GP can recommend a topical treatment containing corticosteroids, vitamin D analogues, or dithranol. Prescription products containing these ingredients include dermovate scalp application, locoid scalp lotion, dithrocream and dovobet gel.
You should use these treatment exactly as directed by your doctor. Make sure that you apply the medicated product directly to the scalp, and not to the hair.
In addition to these medicated treatments, you might also try using emollients on your scalp, as these can help to soften thick plaques. An emollient is a rich moisturiser which can prevent itching and inflammation, and create a protective barrier on the skin, sealing in moisture. One to consider using is grahams natural psoriasis cream, which is made from manuka honey and calendula. Formulated with natural ingredients, this moisturising treatment offers effective relief will helping to normalise the skins structure.
If you are going to use an emollient on your scalp, you should try the following method:
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Prevalence Of Scalp Disorders And Hair Loss In Children
Cutis
Sarifakioglu E, Yilmaz AE, Gorpelioglu C, Orun E
Hair loss in children can have psychologic effects that interfere with a childs growth and development. In our case series, we evaluated 1003 children aged 0 months to 17 years who presented to the pediatric and dermatology outpatient clinics at Fatih University, Ankara, Turkey, from December 2009 through October 2010. The patients were routinely examined for scalp disorders and hair loss. We documented 69 patients with scalp disorders and hair loss, most commonly seborrheic dermatitis , transient neonatal hair loss , alopecia areata , temporal triangular alopecia , and pityriasis amiantacea . The clinical presentation of scalp disorders and hair loss in children varies widely and may be attributed to congenital or acquired causes. Hair loss in children can be associated with serious illness. Therefore, hair examination by a pediatrician or dermatologist is an important part of the physical examination.
What To Look Out For In Youngsters
While psoriasis can cause serious skin eruptions and itching, the Psoriasis and Psoriatic Arthritis Alliance emphasizes that many children diagnosed with the disease can go through their lives without the condition ever bothering them or flaring up, and they may have only small patches of psoriasis plaques.
The NPF warns that the red scaly patches of psoriasis are often misdiagnosed in young people. The symptoms can be easily confused with other skin diseases such as eczema, ringworm, and viral rashes. This is why it is important to get any skin abnormalities checked out by a dermatologist.
Parents should look out for pitting and discoloration of the nails and severe scalp scaling. Infants often develop psoriasis in the diaper area, while older children and teens may show signs on the scalp, elbows, and knees.
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More Your Doctor Can Do
If shampoos, creams, foams, gels, or sprays arent enough to control your scalp psoriasis, your doctor may suggest other options. Ultraviolet B phototherapy — light aimed directly at lesions, usually in a doctors office — works for some people.
There are also medications called biologics. Some you take as a shot, others you receive through a vein . They suppress the immune system. Speak with your doctor about your options.