How Different Is The Presentation In Children
The disease in children is more pruritic, common in girls, and the lesions are relatively thinner, softer, and less scaly. Plaque type is the most common form of disease, but certain clinical variants are rare in children like erythroderma, arthropathy, and localized and generalized pustular psoriasis. Psoriasis in children is more frequently precipitated by infections and manifests as acute guttate psoriasis. However, Indian studies show that children manifest the established plaque type of disease more often, rather than the guttate variety. Facial involvement in children is a frequent observation in majority of the reports, which varies from 18 to 46%, whereas mucosal involvement has been rare in Indian children.
A study from North India reported that extensors of the legs were the most common initial site affected , followed by the scalp . Classical plaque psoriasis was the most frequent clinical presentation , followed by plantar psoriasis . Nail involvement was observed in 130 cases. Pitting was the most common nail change, followed by ridging and discoloration. Five children had psoriatic arthropathy. Koebnerization was observed in 27.9% of patients.
Another study showed that plaque psoriasis was the most common type , followed by guttate psoriasis , psoriasis pustulosa , and psoriasis erythroderma . Scalp was the most common initial site affected , nail changes were found in 25.5%, but no mucosal involvement was observed.
How Is Psoriasis In Children And Teens Treated
Psoriasis in children and teens with mild or moderate symptoms can often be treated effectively with topical medicines apply directly to the affected skin2. These include:
- Topical corticosteroids, to reduce the inflammation that causes symptoms
- Vitamin D analogues , to reduce the amount of skin cells produced
- Anthralin, to reduce both inflammation and skin cell production
- Tacrolimus, which can be useful for symptoms that affect sensitive areas of the skin
Topical coal tar preparations can help with itching, especially for scalp psoriasis, but children and teens sometimes dislike the smell and mess caused by staining skin and clothing. Salicylic acid preparations can help to soften and remove scale, but should never be used in infants due to side effects that they can cause2.
If the psoriasis has been caused by an active infection, such as strep throat, then healthcare providers will probably prescribe antibiotics. Psoriasis due to other causes will not be improved with antibiotic treatment.
For children and teens with more severe psoriasis may need stronger types of therapies. involves treating the affected area with special ultraviolet light. Systemic treatments taken orally , or injected may be needed to affect the way the immune system causes inflammation3.
What Treatments Are Available For Children
Moisturisers and emollients are vital in the treatment of psoriasis – they will help soothe, smooth and hydrate your childs skin in order to keep it in good condition and help the active treatment creams and ointments work more effectively. There are lots of emollients and moisturisers to choose, from oils to put in the bath, to creams, lotions and ointments to put directly onto the skin. For some children, moisturisers and emollients are all they will require to manage their psoriasis. Other more active creams and ointments include coal tar based applications, vitamin D analogues and topical steroid treatments.
If your childs psoriasis becomes more severe, they may be referred to a dermatologist. Dermatologists are able to offer other stronger forms of treatment such as ultraviolet light therapy, tablets, or injections for very severe psoriasis. Four biologic treatments have been recommended by the National Institute for Health and Care Excellence to treat children with severe psoriasis for whom other treatments have not worked. Adalimumab can be used in children over the age of four, Secukinumab can be used in children over the age of six, Etanercept , in children over the age of eight, and Ustekinumab in children over the age of twelve. The Psoriasis Association can provide more in-depth information on these biologics, if required.
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Can Psoriasis Cause Pain
If you child has psoriasis on parts of their body, especially their feet or hands, bear this in mind, as sometimes it may hurt them. This could be because they have scratched the lesions and made them sore, the medication has caused some irritation, even down to the weather temperatures. Cold weather can make the skin really sore and so anything against the skin may irritate and cause pain. Perhaps slightly bigger shoes for periods when their feet hurt may allow some comfort. In the summer the heat may make their feet sweat, this again can cause some discomfort, so perhaps keeping them as dry as possible with some talcum powder may prove useful.
With their hands, the temperature and weather can play havoc too. Cold weather, dry, sore, even cracked skin, causing tightness will bring discomfort so be aware of this and try to encourage them to wear gloves and keep their hands well moisturised to help prevent cracking and soreness. In the summer, moisturising their hands keeps them in good condition avoiding the drying out and cracking of skin. Never a good idea to scratch patches, as this leads to possible infection, bleeding and pain, so if you can, discourage them from scratching.
Will Psoriasis Affect My Childs Education
There is no reason why your childs education should be affected, but a visit to the school with your child to make sure their teacher knows the essential facts about psoriasis might help. Take leaflets and fact sheets with you to leave behind. Make sure your child feels comfortable talking about psoriasis with you and the school, so they will bring any problems to your attention. Ask the school how they will tackle any bullying issues if your childs psoriasis is quite noticeable and devise avoidance tactics to pre-empt any possible situations occurring.
The school should realise that there will be periods when your child may not want to participate in P.E sessions during flare-ups and this should be explained to the school so that they can avoid any stressful situations for your child.
Swimming can be a particularly difficult for a child with psoriasis, as the chlorine in the water can make psoriasis patches worse than they actually are and more pronounced, so your child may become upset over this or embarrassed..
As your child gets older consider encouraging him or her with the following advice:
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Generalised Pustular Psoriasis Or Von Zumbusch Psoriasis
This causes pustules that develop very quickly on a wide area of skin. The pus consists of white blood cells and is not a sign of infection.
The pustules may reappear every few days or weeks in cycles. During the start of these cycles, von Zumbusch psoriasis can cause fever, chills, weight loss and fatigue.
Can My Child Plays Sports With Psoriasis
Its a healthy lifestyle must! Staying active with sports is highly encouraged for the overall wellbeing of a child with psoriasis, says Dr. Kang. The latest research bears this out: In a study in the journal Medicine, investigators found that physical activity is related to a reduction in the prevalence of psoriasis. The study also demonstrated that regular bouts of physical activity can improve psoriatic skin lesions due to the benefits of sunlight during outdoor exercises. Loose-fitting, breathable clothing may provide the most comfort during exercise, especially in hot weather.
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One Young Patient Changed A Doctors Life
Cordoro credits one child in particular for igniting her passion to care for young people with psoriasis.
The 5-year-old boy had such severe psoriasis all over his body that he could not walk, and he was carried into her office by his parents. He could not play outside or go to school because of the scales, itch, and pain.
The family was told he would have to wait until he turned 18 to be treated because there were no treatments approved for pediatric psoriasis patients.
Cordoro started him on a systemic therapy, and eight weeks later he walked in to her clinic and gave her a huge hug, as his parents cried in disbelief.
That day, I realized the vulnerability of children, the fear and misunderstanding physicians have about safe and effective treatment for this condition in pediatric patients, and the enormous impact not only on physical health but the mental and emotional well-being of children with severe psoriasis and their caregivers, she says.
Psoriasis may be mild and more of a nuisance than anything, but it may also be severe and life-altering for the child and family, Cordoro adds. My goal is to treat each and every child as an individual and tailor treatment to the specific needs of the child while taking into account the beliefs and preferences of the family.
An American Academy Of Dermatology Reading Room Selection
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Guttate psoriasis: If your child develops this type of psoriasis, you’ll likely see small, scaly, teardrop-shaped spots scattered on the skin. It’s possible.
Children get psoriasis. This disease can begin when the child is a newborn, teenager, or any age in between. Children develop all the types of psoriasis that adults do.
Differences between psoriasis in children and adults
One type of psoriasis is more common in children. Called guttate psoriasis, it often appears when the child has an infection, especially strep throat. It’s also possible for a child to get guttate psoriasis without having an infection.
If your child has an infection, successfully treating the infection may cause the psoriasis to clear within a few months and never return. While the guttate psoriasis may clear, some children who’ve had it later develop plaque psoriasis.
When a child gets any type of psoriasis, it can also look a lot like diaper rash, cradle cap, or a yeast infection. Children are often treated for these very common conditions first. If the skin doesn’t clear after treatment, your child should see a dermatologist.
Seeing a dermatologist can help you get an accurate diagnosis for a disease that affects the skin.
Fortunately, many of the treatments for psoriasis and eczema are the same. In time, a dermatologist can tell you whether your child has eczema or psoriasis.
Treating a child requires special considerations
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Key Points To Remember
- Psoriasis is an autoimmune disorder where the body attacks healthy skin cells.
- Psoriasis is not contagious.
- The most common symptom of psoriasis is dry red patches of skin that can form anywhere on the body.
- This is a chronic condition that can be managed with treatment.
- In about 40 percent of cases, psoriasis is inherited.
You And Your Child Are Not Alone
IMPORTANT SAFETY INFORMATION
ENBREL is a medicine that affects your immune system. ENBREL can lower the ability ofyour immune system to fight infections. Serious infections have happened in patients takingENBREL. These infections include tuberculosis and infections caused by viruses, fungi,or bacteria that have spread throughout the body. Some patients have died from theseinfections. Your healthcare provider should test you for TB before you take ENBREL and monitor youclosely for TB before, during, and after ENBREL treatment, even if you have tested negativefor TB.
There have been some cases of unusual cancers, some resulting in death, reported in children and teenage patientswho started using tumor necrosis factor blockers before 18 years of age. Also, forchildren, teenagers, and adults taking TNF blockers, including ENBREL, the chances ofgetting lymphoma or other cancers may increase. Patients with RA may be morelikely to get lymphoma.
ENBREL can cause serious side effects including: New infections or worsening of infectionsyou already have hepatitis B can become active if you already have had it nervous systemproblems, such as multiple sclerosis, seizures, or inflammation of the nerves of the eyes blood problems new or worsening heart failure new or worsening psoriasis allergic reactions autoimmune reactions, including a lupus-like syndrome and autoimmunehepatitis.
Common side effects include: Injection site reactions and upper respiratory infections .
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What Are The Possible Complications Of Psoriatic Arthritis In A Child
Children with psoriatic arthritis are at risk of having an eye condition called uveitis. This is an inflammation of the eyes middle layer.
With early diagnosis and treatment, children can go into remission. This means that symptoms go away. But when treatment is delayed, remission is less likely. Then the condition may lead to long-term disability.
What Are Common Causes Of Psoriasis In Children
The tendency to develop psoriasis tends to run in families. A child with one parent who has psoriasis has about a 10% chance of developing it too. If both parents have psoriasis, the chance increases to about 50%3.
Researchers are still working to understand what exactly causes psoriasis in children and teens, and the extent to which the contributing causes are genetic. Having certain types of infections seems to be a common cause. Around 30%-50% of children and teens develop psoriasis a few weeks after having an infection such as2:
- strep throat
Other children and teens develop psoriasis after taking certain types of medications, or after a skin injury such as a scrape, cut, burn or bite.
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Is Psoriasis Common In Children
Psoriasis in children can lead to significant psychological harm as they grow up. Studies state that more than 20,000 children are diagnosed with psoriasis in the United States every year. Around 0.7% of kids are affected by this disease, globally. About 1 in 10 children develop psoriasis by the age of ten. It is vital to treat childhood psoriasis immediately as skin conditions can be possibly painful and uncomfortable. They may also make your child feel anxious, worried or sad. Psoriasis has the potential to damage the heart over time.
It can lead to unhealthy changes in blood fats, blood pressure, and insulin levels. When all these occur together, it is known as metabolic syndrome. This has been linked to diabetes and heart problems. Children with psoriasis have been observed to have a higher risk of obesity leading to heart problems.
Can My Childs Diet Make A Difference With Psoriasis
While there is no one special diet that can cure your childs psoriasis, food choices still matter when it comes to optimizing your childs health. Many studies have shown a higher prevalence of metabolic syndrome such as obesity, hypertension, and insulin-resistance/diabetes in patients with psoriasis compared to those without, says Dr. Kang. From that standpoint, a healthy diet should be encouraged to avoid developing these potentially associated conditions. Helping your child choose foods that are full of nutrients and fiber like fruits and vegetables and limiting high-calorie snack foods will help him achieve a healthy weight and reduce his risk of some of the diseases associated with psoriasis.
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Pediatric Plaque Psoriasis Revealed
You might notice them on your child’s knees, elbows, or scalp: raised, red patches with silvery scales. Your child might try to hide the plaques from his or her friends by wearing long pants and long sleeves. Ask your child’s doctor if ENBREL can help your child get clearer skin for moderate to severe plaque psoriasis.
- Plaque psoriasis is a chronic disease
- The exact cause isn’t known, but studies suggest genetics may play a role for some patients
- It’s not contagious
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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What Types Of Psoriasis Most Commonly Affect Children And Teens
Psoriasis can affect children and teens in different ways. Infants can be diagnosed with infantile psoriasis, which can go away completely after a relatively short time. Some children and teens who develop psoriasis may also have the condition go away after a few months. However, in others the condition will never go away completely, and they will continue to have cycles of flare-ups and times without symptoms 2. Other children and teens have psoriasis with skin symptoms as well as psoriatic arthritis, a condition in which inflammation causes symptoms in and around the joints3.
The symptoms of psoriasis in children and teens can be similar to other skin conditions, which can sometimes make it difficult to get the right diagnosis3. Children and teens can develop the same types of psoriasis that adults can, such as:
Children under the age of three can sometimes develop a special type of psoriasis called diaper psoriasis. Pustular and erythrodermic psoriasis are quite rare among children and teens, but they can occur4.
Mind Your Emotional Needs Too
If you feel upset about your childs psoriasis diagnosis, they may pick up on those feelings. For your sake and theirs, its important to address your own emotional needs.
Children sense our feelings through our tone of voice and our body language, so we need to be really mindful of that and make sure that we engage in self-care, said Sileo.
Try to take time for self-care, including stress-relieving activities that you enjoy.
If you feel frequently stressed, anxious, angry, or sad, let your doctor know. They may refer you to a mental health professional for counseling or other treatment.
Also be mindful of how you and your partner approach the topic with your child.
We also need to be good co-pilots. If youre in a relationship, whether youre divorced or together, this is your child, and you need to work together collaboratively as a parental unit, suggested Sileo.
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