Psoriasis affects about 3% of the population. For 33% of these patients, psoriasis first presents itself in the first 20 years of life, and it is estimated that 10% of these patients develop psoriasis before the age of 10.
We still don’t know what causes psoriasis, but evidence does suggest that there is a genetic link. In fact, 72% of children with psoriasis have at least one immediate relative with the condition. There also seem to be several other factors that can worsen psoriasis in children and these include respiratory infection, emotional stress, and injury to the skin. These triggers tend to be greater patients with pediatric onset rather than adult onset. Strep infections are also common causes of guttate psoriasis in children which may clear up within 3-4 months, although a significant number of cases result in chronic plaque psoriasis.
While psoriasis in adults often appears as deep red plaques with silver scales, it can present differently in children, making a diagnosis of psoriasis more difficult. Dermatologists will look at the skin and what happens when a scale is removed, as well as changes to the nails to confirm a pediatric psoriasis diagnoses.
Where it shows up on the body can also differ in children than adults. It is more common to appear on the face and joints (ie elbows, knees) in children, and there is a prevalence of lesions in the diaper area during infancy.
Like with adults, Plaque psoriasis is the most common type of psoriasis in children, however the lesions are smaller, thinner and tend to be less scaly. The plaques can also affect the scalp and cause temporary hair loss and psoriatic alopecia. Psoriatic diaper rash is also common in very young children and differs from conventional diaper rash by its appearance (bright red, glazed rash that is followed by widespread psoriasis-like lesions) and poor response to traditional treatments or diaper rash. The other types of psoriasis such as pustular and erythrodemic are rare in children.
Treating children with psoriasis involves educating both the patient and the parents about the disease and the importance of adhering to the treatment plan. Given that there is no cure, the goal for treatment is to control the disease and reach long periods between flare ups. The majority of pediatric psoriasis patients have a mild form of the disease and can be successfully treated with topical agents. Systemic treatments (oral mediations) are usually reserved for the more severe cases that are resistant to other treatment. Biologics are not often used to treat children with psoriasis, however we are working towards that, and currently there is one biologic approved in Canada to treat adolescents with psoriasis.
Having a chronic visible disease like psoriasis can also have a significant impact on a child’s psychosocial development, which is often caused by negative reactions of their peers.
If you suspect that your child has pediatric psoriasis, visit a dermatologist for proper diagnosis and to discuss the best treatment plan.