Johns Hopkins pediatric dermatologist Bernard Cohen discusses key issues for parents to think about when their child shows symptoms and signs of psoriasis.
Psoriasis affects only old people — right?
Most people think of psoriasis as a condition that affects the old folks, but one third to a half of all people with psoriasis will have their first outbreak before the age of 21. Though not as common in children, it can appear at any age.
How does psoriasis appear in children?
The distribution of skin rash and the structure of the skin lesions in children are very different from what we see in adults, as they can present as thinner oyster-like scales that tend to show up on knees and elbows, the lower back and scalp. They can be painful and itchy, though psoriasis does not have the intensity of itching you often see in eczema.
Where else can these scales show up?
Generally in any area where the skin is traumatized, including the genital area. Psoriasis in children under two can be mistaken for a diaper rash, but you will know for sure when it does not get better with diaper rash treatment. It is important to diagnose pediatric psoriasis early.
How is pediatric psoriasis diagnosed?
Most of the time the skin lesions are diagnostic. If it does not look like your classic eczema, pediatricians will ask about the family’s history of skin rashes. If it is a persistent rash and the child has a family history, the index of suspicion for psoriasis needs to be high.
And how is it treated in children?
We treat with moisturizers, topical corticosteroids and other topical medications. If the rash is severe, we also use ultraviolet light, which suppresses psoriasis. That explains why the incidence of the condition is greater in the fall and winter months. For itchiness, we may prescribe an antihistamine. However, it is not just a simple matter of treating the psoriasis.
Why is that?
In the last decade, more and more dermatologists have considered psoriasis a chronic inflammatory disease with systemic implications because of conditions associated with it, including obesity and hypertension. You want to make sure patients are doing well systemically, that their blood pressure is normal. If you treat the child’s obesity, that will help reduce the risk of psoriasis. We also looks for signs and symptoms of psoriatic arthritis, which is more common than previously thought. Therefore, I always ask patients if they have morning stiffness and pain in their joints.
How do children respond to treatment?
Children tend to respond quite well to ultraviolent light, topical and systemic agents. A number of biologic agents have been approved for use in adults, and there is now one for children. Again, it is important to treat early because psoriasis may present a psychosocial quality of life issue for children as well. It is a visible rash that can get in the way of socialization. Also, psoriasis is not something that goes away on its own and often gets worse over time.
For more information, contact the National Psoriasis Foundation.