Psoriasis In Children: Types, Symptoms And Treatment

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• Types of Psoriasis
• What Causes Psoriasis?
• Diagnosis And Treatment
• Home Remedies for Psoriasis

Psoriasis is a non-contagious and life-altering dermatological condition that causes itching and a lot of discomfort. It is characterized by red, scaly rashes on your hands, knees, scalp or anywhere on the skin. The condition is common in children and can have a significant psychological effect on them. Here, we tell you about the symptoms, causes, and treatment of psoriasis in children.

What Is Psoriasis?

Psoriasis is a skin condition that typically results in the formation of skin cells as red scaly rashes or plaque (patches) on the skin. When a person has psoriasis, the skin forms more cells than usual, making the skin scaly and itchy. The rashes can appear anywhere on the child’s body: knees, hands, lower back, scalp and even the face. The intensity of the outbreaks varies from one person to another. Psoriasis is not infectious in origin, although it may get triggered by bacterial infections like streptococcal throat infection. Most children get certain genes from their parents that make them more susceptible to the disease.

While some kids may be free from these rashes with just a few weeks of treatment, some may take longer. Psoriasis can also be chronic: it may be a long-term problem for a child, or it might come back long after your child is free of the symptoms.

[ Read: Scalp Problems In Children ]

Is Psoriasis Common In Children?

Studies show that around 20,000 children in the US are diagnosed with psoriasis every year. Worldwide, around 0.7% kids are affected by the disease.

Children often develop psoriasis before the age of 10. Around 15 to 20% of people with psoriasis develop it before they turn 15. Most people get their first outbreak of psoriasis between the ages 15 and 35, and the second one between the ages 50 and 60 (1).

The good news is that two-thirds of those affected have just a mild form of the childhood psoriasis, with only 3% or less of the skin affected (2). Also, there are several options for treating psoriasis in kids based on the type of this disease.

Different Types Of Psoriasis

Psoriasis is classified into different types based on which part of the body it affects and how severe it is. The symptoms remain more or less the same, while the treatment options and procedures may vary.

1. Scalp psoriasis

Psoriasis of the scalp causes flaky skin or patches of yellow-white skin on the back of the scalp, behind the ears, and the sides. The patches can also be red and itchy. The rough patches may be big and circular and arrange themselves randomly on the scalp.

Symptoms of scalp psoriasis include:

• Itchy head; your kid seems to scratch more often than before
• Flaking on the scalp, like dandruff
• Hair loss
• Burning sensation on the skin
• Extremely dry scalp
• Silver or white scales on the scalp

Scalp psoriasis can be treated by topical creams, anti-microbial medication for secondary infection and steroid injections if the lesions are severe.

2. Acute guttate psoriasis

Guttate psoriasis results in small, drop-like lesions on the skin. These rashes on the skin are tiny and thinner than the plaques that are common. Less than 2% people get this form of psoriasis, which is more common among children than in adults. One of the common causes of guttate psoriasis is the streptococcal infection.

Symptoms include:

• The rashes usually occur two or three weeks after the child develops strep throat.
• Formation of pink or salmon colored drop-like rashes or lesions on trunk, torso, and back
• Itchy lesions that can spread to other parts of the body.

This kind of psoriasis can also be triggered by skin infections and certain types of beta-blockers (drugs).

3. Flexural psoriasis

Also known as inverse psoriasis, flexural psoriasis is not as visible as the other types, but equally painful. In inverse psoriasis, there is no plaque formation on the skin. Instead, a smooth, shiny rash or lesion forms in the folds of the skin. Flexural psoriasis is uncommon and often occurs along with other common types such as chronic plaque psoriasis.

Symptoms include:

• Dry red patches of skin under the armpits, near genitals and other folds of the skin.
• Severe itching and pain, aggravated by sweating.

[ Read: Autoimmune Diseases In Children ]

4. Chronic plaque psoriasis

Nearly, 80 to 90% of psoriasis patients have plaque psoriasis.

In children too, plaque psoriasis is quite common and results in the formation of raised reddish and scaly skin scaly and plaques. A mild condition can be treated with topical creams and medications but topical treatments may not eliminate the rash completely.

Symptoms include:

• Dry red patches on the skin, with white/silvery scales.
• Typically affects the knees, elbows and lower back, and sometimes the scalp.
• Itchy and burning sensation in the affected area.
• Skin can crack due to dryness and bleed.

5. Pustular psoriasis

Unlike the other forms, pustular psoriasis is a distinct inflammatory skin condition triggered by a unique immune activation pattern. The rare skin infection results in the formation of pustules or blister-like pimples on red, inflamed skin. The condition usually affects individuals who have a history of psoriasis, and not children.

Symptoms include:

• Pus-filled blisters or bumps on the reddish skin.
• Red blisters usually appear on the soles of the feet or palms and fingertips.
• Sometimes spreads and covers large areas of the body (generalized pustular psoriasis).
• Severe itching on the rash.
• Fever, fatigue, and chills, although rare.

6. Nail psoriasis

Nail psoriasis, also known as psoriatic nail dystrophy, affects the nails. The condition rarely develops in isolation and often follows an existing psoriatic condition such as chronic plaque psoriasis or psoriatic arthritis. Psoriasis occurs within the nail complex and can affect one or more nails of the hands. The severity of nail psoriasis is not necessarily related to the severity of plaque or other forms of psoriasis that the child has.

Symptoms include:

• Hastened nail growth, thickened nails.
• The nail may turn a pale yellow, green or brown.
• The kid’s nail may get separated from the nail bed.
• White chalky debris might accumulate under the nail.

7. Erythrodermic psoriasis

Erythroderma is a severe skin condition which can sometimes be fatal. One-third of erythroderma cases are due to psoriasis, while the condition tends to be triggered by infections, low calcium levels, medications containing lithium and anti-malarial elements, and exposure to strong coal tar preparations.

Symptoms include:

• Red patches all over the skin
• Increased heart rate
• Severe pain and itching
• Exfoliation of skin in large sheets, not just flakes
• Skin looks like it is burnt

[ Read: Ringworm In Children ]

Complications of this condition include dehydration, hypothermia, heart failure, malnutrition and protein loss, edema and even death. Treating and managing erythrodermic psoriasis is not easy and may require hospitalization, intensive treatment and bed rest.

Erythrodermic psoriasis is usually the result of a worsened psoriatic condition. In rare cases, it can be an indicator of psoriasis.

8. Photosensitive psoriasis

This is a rare form of psoriasis, caused by exposure to sunlight. In most cases, people with photosensitive psoriasis have polymorphous light eruption or PLE, which causes rashes on the skin exposed to sunlight. Psoriasis occurs as a secondary symptom. You can prevent this condition by keeping your child away from sunlight or protecting the skin from sun rays.

This form of psoriasis can be treated using topical creams or ultraviolet (UV) light.

Psoriasis could be mild or severe, but why does the tender skin of a child get infected with such a messy condition?

What Is Psoriatic Arthritis?

Psoriatic arthritis affects people who have or had psoriasis. It is a rare form of arthritis that results in inflammation of the joints and also the skin. Girls are more likely to be affected by this type of arthritis, with the knees being affected more than the other joints.

Very rarely do psoriasis and arthritis occur simultaneously. In most cases, the child has a psoriasis outbreak first, followed by arthritis a few weeks or months later.

What Causes Psoriasis In Children?

Research is still underway to figure out what exactly causes psoriasis. What we do know is that the condition results in an excessive generation of skin cells, leading to the formation of raised or inflamed skin with itchy patches and rashes. What is also known is how the disease works and how we can control it.

Psoriasis is an autoimmune disease triggered by a malfunctioning immune system. When a child has psoriasis, the white blood cells in the body, which usually fight bacteria and viruses, attack the healthy skin cells. In an attempt to cure a non-existent wound or infection, the immune system gets more blood to the skin, creating more skin cells than needed.

In a normal scenario, the skin cells are produced deep inside the dermis and move up when the dead cells on the top fall off. But when a person has psoriasis, excessive skin cells get accumulated on the skin, forming a patch or plaque on the surface of the skin.

[ Read: Causes Of Hives In Children ]

1. Psoriasis is hereditary. A child can get psoriasis even if one parent or a close relative has it. A family history of psoriasis increases the chances of your child getting it. A child is 15% more likely to develop psoriasis if at least one parent has the condition and 75% more likely to get it if both the parents have it (3).

2. Infections like strep throat and tonsils caused by bacteria can also trigger a defective immune reaction and cause childhood psoriasis. Children often tend to develop psoriasis after they have been affected by the streptococcal bacteria.

3. Obesity can flare up existing psoriasis in a child. The infection can form in the folds of the skin and thrive too.

4. Stress can also affect the functioning of the immune system in the body, making it attack healthy skin cells.

5. Medications like beta blockers used for blood pressure, lithium and medicines used to prevent malaria can also trigger psoriasis.

6. Sometimes, skin irritation caused due to sunburn, rashes, and food or other allergies can flare up and affect the skin, making the psoriasis outbreak worse.

7. Cold and dry weather conditions can make the condition worse. For quicker healing, let the child get a moderate amount of sunlight every day.

Diagnosing Psoriasis

The symptoms of psoriasis are visible. Typically, the dermatologist would examine the skin inflammation, scalp or nails to determine the condition. In case the doctor is unable to identify the exact condition, he may take a skin sample and send it for lab tests and possibly a biopsy.

There is no permanent  cure for psoriasis, as doctors are still trying to find out what exactly causes this condition. The treatment options, however, are many.

Treatment For Psoriasis In Children

The most common options considered for treating psoriasis in children as well as adults are as follows.

1. Topical ointments and medicines

Treatment of mild psoriasis can be done through topical creams, lotions, sprays applied directly to the affected area. Depending on the severity of the condition, you may have to use moisturizers, psoriasis shampoos for scalp related infection, and prescription corticosteroids that contain vitamin D extracts, salicylic acid and coal tar.

The only drawback of this form of treatment is it can be messy.

2. Phototherapy or light therapy

This treatment involves the use of natural or artificial ultraviolet (UV) rays to treat the rashes/ patches on the skin. In the case of mild psoriasis, the doctor may recommend exposure of the affected area to the rays for a specific duration every day.

But in the case of unfavorable weather or severe symptoms, the doctor may use treatment options such as laser therapy, which involves controlled use of the UV light on the skin. Some light treatments combine the use of topical ointments and UV light to treat the symptoms.

[ Read: Folliculitis In Children ]

3. Injections or oral medications

The doctor may recommend oral medications or steroid injections when the infection does not respond to other treatments or the condition is severe. These medications can be given in the form of tablets, injections or through IV. Doctors recommend a limited dosage of medicines to prevent any side effects in kids.

As there is no permanent cure for this condition, parents must take additional care when the child is treated for psoriasis. More than the physical discomfort, it is the psychological trauma and embarrassment of having the plaque on the skin that affects the child most.

Support At Home:

Identify the condition early on and take timely action. As the parent, you can make life a lot easier for the child. Here is how:

• Follow the doctor’s advice to the ‘T’ and ensure that the treatment goes on as it should.

• Ensure that the child is getting healthy meals every day. Include a lot of fruits and vegetables in the food. That can help fight the diseases that trigger or flare up psoriasis.

• Help the child maintain a healthy weight, to prevent obesity that can flare up the condition.

• Dry skin can worsen his problem. So keep his skin moisturized and healthy at all times.

Most important of all, give your child emotional support. Children are very sensitive and can develop emotional problems like social anxiety or even depression. So encourage them to talk about how they feel and let them know that it is okay. If need be, talk to a therapist to help them get through the condition.

In addition to psychological support, you can try out some home-made remedies that would complement the medication.

Home Remedies For Psoriasis In Children

Natural ingredients can aid the medical treatment of psoriasis in children. However, some ingredients may have a reaction to the medication that your child is on. So, talk to your doctor before you try any of these remedies. Here are the herbal remedies you can make at home, to prevent the outbreak or flare up of psoriasis.

1. Aloe vera

Aloe vera has compounds that can help keep the skin healthy and prevent reddening. You can apply aloe vera extract directly on the affected area or look for natural topical creams that have at least 0.5% aloe in them. Avoid taking aloe vera orally or in the form of tablets, as it may not be effective or safe.

2. Apple cider vinegar

In the past, people used apple cider vinegar as a disinfectant. When applied directly on the skin, apple cider vinegar (ACV) can provide some relief from itching and redness caused due to psoriasis. Always have a bottle of this at home.

• Dip a small round of cotton in ACV and dab it on the affected areas.

• Some children may have a burning sensation when the liquid is applied directly. So mix one portion of apple cider vinegar with one part of water and use it on the skin.

Do not apply vinegar if the skin is cracked or bleeding, as it only aggravates it and causes a burning sensation.

[ Read: Common Skin Rashes In Children ]

3. Dead Sea salts

Epsom salts or the Dead Sea salts can also give your child some relief from the discomfort that psoriasis can cause. Add some of these salts to a tub full of warm bath water and let the kid soak in it for around 15 minutes. This will help remove the scales and provide relief from itching.

Make sure you apply a moisturizer or oil to the skin after bath every day.

4. Oats

Oats have a soothing effect on the skin when applied as a paste. There is no research to support the effect of oats for treating psoriasis. But many people with psoriasis say that using oatmeal or oats paste soothes the skin and reduces the burning sensation.

5. Capsaicin or cayenne pepper

Cayenne pepper or capsaicin is used as a painkiller. In ointments, it is added to block the nerve endings that cause pain. Also, research suggests that capsaicin also helps reduce the inflammation and redness of skin (4) caused in psoriasis patients. However, your child may experience a burning sensation when a capsaicin ointment is applied.

Note: Do Not apply cayenne pepper or its extracts directly on the skin. and is only to be used under medical supervision.

6. Turmeric

Turmeric is an antioxidant and also has anti-inflammatory properties. A study by the International Union of Biochemistry and Molecular Biology has indicated that turmeric alters the type-3 cytokine gene expression and is thus effective in reducing the symptoms.

The best way to use turmeric is to take it as food. Add a pinch of turmeric to your curries, risottos or other foods every day.

Keep the consumption to a maximum of three grams.

7. Tea tree oil

Tea tree oil has antiseptic properties. Apply the oil on the affected parts of the skin. However, some people may be allergic to this ingredient, so check it by applying on an unaffected place, before you use it for psoriasis.

In the case of scalp psoriasis, a shampoo with tea tree oil can be helpful.

8. Oils for moisturizing

People with psoriasis have dry skin, especially in places where there is a plaque or rash. Keep the child’s skin healthy by moisturizing it often. Effective moisturizers for kids with psoriasis include:

• Cashew oil can be used on the lesions to alleviate the inflammation and redness caused by psoriasis flare-ups. The oil moisturizes and softens any dead skin caused by the disease.

• Olive oil can also be used to relieve the discomfort of the skin.

• Coconut oil will prevent aggravation of psoriasis breakout and also moisturizes the skin.

• Fish oil is rich in Omega 3 fatty oils which can help fix dry and parched skin and prevent skin bleeding in psoriasis patients. Using creams with fish oil can be a good idea, but only after consulting your doctor. You can also take fish oil capsules, but ask the doctor beforehand.

• Vegetable oil has a number of nutrients. Applying the oil to the patches or lesions on the skin will keep them moisturized and also provide nutrition that helps fight the infection.

• Castor oil, combined with baking soda, can be used to heal the lesions on the skin. Mix one spoon of baking soda to the oil and apply the paste on the affected areas on the skin. Do this for a few weeks, and the symptoms will disappear eventually.

9. Vegetable shortening

Apply some vegetable shortening to the affected area and cover it with a bandage. Keep it like that for two to three hours to let the moisture sink into the dead and dry skin. It mitigates the discomfort and itching sensation.

10. Flax seeds

If you do not eat fish or dairy products, try flax seeds, which are rich in Omega 3 fatty acids. These fatty acids block a compound called arachidonic acid, which is produced in the body and causes inflammation. You can add flax seeds to cereals, oatmeal and also juices and smoothies.

[ Read: Benefits Of Apple Cider Vinegar For Kids ]

11. Baking soda and water

Baking soda can help relieve the itching sensation on the skin. Mix one-and-a-half cups of baking soda with water and apply the mixture on the itchy parts of the skin for quick relief.

The treatments and the medications that we have discussed for psoriasis only alleviate the physical symptoms of the skin condition. Scaly patches may disappear over time with medication, but the emotional and psychological scars can only reduce if you help him. So, always be there for the child emotionally, while continuing the treatment for the physical symptoms.

Does your child have psoriasis? How did you help? Tell us about it here.

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