Psoriasis
Introduction
Psoriasis (suh-rai-uh-suhs) is a skin condition that causes small patches of red, thickened and flaky skin. While the rash may be noticeable, it is not generally itchy or painful. Psoriasis is a common condition, and there are many treatments available. However, it is a chronic condtion, meaning there is no cure and it tends to persist for life.
Psoriasis can affect any part of the skin and some children may have only mild disease with only some dandruff in the scalp whilst others may have the rash cover most of their skin. Psoriasis may also affect joints, known as psoriatic arthritis and nails.
.png)
Psoriasis plaques with red round scaly rash on arms of a baby
Who gets it?
Approximately 3 in 100 Australians have psoriasis. Psoriasis can affect anyone, but it is most common among people with fair (Caucasian) skin. Psoriasis commonly begins in adolescence and early adulthood (~15-25 years old), but can also begin in childhood. Girls and boys are affected equally.
What causes it?
The exact cause of psoriasis is unclear, but it is thought to be aggravated by an overactive immune system. Many (but not all) children with psoriasis also have a family member with the condition. Some other factors that are known to play a role as triggers in this condition include:
Infection: Sometimes psoriasis develops after a child has had an infection, such as a sore throat. This is due to the body’s immune system responding to the infection, not the infection spreading.
Stress: Many children's conditions worsen when they become stressed, although this is not a cause for psorasis.
Skin trauma or irritation: Psoriasis may sometimes be made worse due to scratches or cuts to the skin. Gentle sunlight may help psoriasis, but sunburn will make it worse.
What does it look and feel like?
Looks like…
Psoriasis causes plaques, which are small patches of red, thickened skin that are often covered with silvery-white flakes.
Most commonly, they are somewhere between the size of a 5c and a 50c coin, but can be smaller or larger than this.
Some children have just a couple of patches while others may have many. Your child may have plaques anywhere, but they are most common on the scalp, elbows, knees, belly button and ears. In babies psoriasis can affect the nappy area and look like nappy rash.
Nail psoriasis can look like little pits on the nail, stain the nail yellow, deform the nail and cause brittle and flaking of the nail, with skin build up under the nail.
Feels like…
Psoriasisis is not usually itchy.
For a small number of children it can be uncomfortable and painful, but this is uncommon.
Occasionally, people with psoriasis also feel pain and stiffness in their joints, but this is less common among children and young people.
What tests might be needed?
Most of the time, your child's GP or dermatologist will not need to perform tests. Occasionally, a biopsy may be performed, where a small portion of plaque is removed for further tests to confirm that your child’s skin changes are caused by psoriasis.
What treatments are available?
What can I do?
It is important to avoid any triggers of psoriasis and these triggers may be different for different children.
Maintaining a healthy lifestyle with regular physical activity, adequate sleep and a general balanced diet is always great for children and young people, and may also help with psoriasis symptoms.
There are no specific diets or foods that are known to improve or worsen psoriasis.
Some children find that gentle sunlight for ~30 minutes per day may help to improve psoriasis, but sunburn should be avoided.
Medical therapies
All medical therapies for psoriasis should be prescribed by a doctor, usually a dermatologist. As there is no cure for this condition, treatment focuses on easing symptoms as they occur.
Creams: Prescription and non-prescription creams are used to treat psoriasis for most children, and in most cases will need to be used daily. These include thick moisturisers, steroid creams, and tar creams. Your child’s doctor will tell you about the options that are best for your child's condition.
Phototherapy: Phototherapy is a specialised light treatment used for some children that have not improved with cream treatments.
Tablets: In some cases, tablets can be used to help to treat psoriasis that is not improving with creams. These are immune suppressing medications and reserved for psoriasis that is moderate to severe and is affecting quality of life in children.
Biologic medicines: These are injections that specifically target psoriasis-causing immune cells in the body and therefore have little effect on the rest of the immune system. They are the most effective treatments for psoriasis but due to Medicare restrictions and cost are reserved for children with severe psoriasis that have failed to respond to other treatment options.
What happens after treatment?
Psoriasis is a chronic condition, which means that it will likely never go away completely. It is also a condition that cycles through periods of waxing and waning. These cycles are unpredictable in their timing and duration. However, symptoms can be improved significantly with the many treatments that are available. While psoriasis may be bothersome, it is not dangerous or harmful.
As your child grows up, their condition will change and treatment options will also change based on this. Newer therapies are becoming available all the time and these are making significant differences in the lives of children suffering from this condition.
What support is available?
Your GP and dermatologist will work together to look after your child and improve their psoriasis.
Psoriasis Australia is a patient support group that provides information about psoriasis and treatments for patients and their families, and can be found here: http://www.psoriasisaustralia.org.au
Authors/Reviewers:
Author: Dr Imogen Kate Thompson
Paediatric Reviewer: Dr Mayuri Sivagnanam
Editor in Chief: Dr Tevi Wain
