Psoriasis is not very common in children; but it appears that more than a third of adult psoriasis started in childhood, especially in adolescence.
The diagnosis is simple for the doctor and does not require any examination. All forms of psoriasis exist in children.
However, the frequency of the various forms may differ according to the age of the child; and some forms are specific to the child like the “diapers’ psoriasis”.
A large part of the consultation would be to explain the disease to the child; with suitable words, and especially to the parents.
Aspects of children psoriasis
In children, the plaque psoriasis most often has the same appearance as in adults: red plaque (“erythema”) covered with an adherent crust (“dander”).
The plates are rather small and appear on the body relatively symmetrically. As in adults, there are elective sites where plaques (“bastion areas”) develop: elbows, knees, lower back and scalp.
Unlike eczema, psoriasis plaques do not or hardly itch.
In young children, the appearance may be less characteristic, which may explain why the doctor has difficulty initially concluding between eczema or psoriasis.
All aspects of adult psoriasis exist in children
The most frequently encountered aspects are plaque psoriasis and scalp psoriasis.
On the scalp, an aspect known as “asbestos pseudo-ringworm” (helmet of slightly gray crusts) can reveal psoriasis. Two presentations are more particularly common in children: the psoriasis of the nappies and the psoriasis in drops.
During the first two years of life, one aspect is frequently revealing, it is the psoriasis of the nappy. It develops from the age of three months on the child’s bum (buttocks, vulva, folds of the groin).
It can spread over the entire diaper area. The diagnosis can be difficult at the beginning of the rash taken for a common “diaper rash”. The typical appearance is that of a dry and very limited reddening of the buttocks.
The localization at the bum is also possible in the older child but it is often more located, mainly in the glans and the vulva.
Psoriasis in drops presents itself as a rash of rapid and diffuse appearance, predominant on the trunk; and is only of small plaques of psoriasis (less than 1 cm, or 0.4 inch).
In more than half of the cases, it will disappear without treatment within a few months. It frequently follows a streptococcal infection, especially with angina.
The doctor will almost always take a throat swab even if there is no sign of angina; and may sometimes prescribe an antibiotic course for a prolonged period (1 month).
Other characteristics are described in children, although inconsistently:
- increased frequency of facial involvement;
- high frequency of pulpitis. It is an attack on the pulp of the fingers which can be very troublesome especially in school, for writing;
- less frequent nail involvement and rarity of joint involvement;
- greater frequency of the impact of family stress: returning to school, arrival of a little brother or sister, but also in parents’ separations.
Transmission and course of the disease: parents’ questions
Several questions are frequently asked during consultations: “Is it contagious?”, “Is he going to have this all his life?”, “If I have another child, is he likely to have psoriasis?”, “is it my fault?”, “Is it in the head? should I take my child to a child psychiatrist?”, etc.
- The first question poses no problems because in no case is psoriasis contagious. Do not hesitate to explain it to the teacher or sports teacher. In case it is not totally accepted, do not hesitate to ask for a certificate of non-contagiousness for the nursery, school or swimming pool.
- The future of psoriasis in the long term is a more difficult question to address because the evolution is poorly understood and a lot of data are contradictory. It seems that the psoriasis of the small child (psoriasis of the nappies or psoriasis in drops for example) is not predictive of the occurrence of psoriasis in adolescence, which does not exclude the very late onset of psoriasis.
- In familial forms of psoriasis there is a risk of having children with psoriasis, this risk would be about one in four. However, the child may develop psoriasis either in childhood or in adulthood.
- It is important for parents to understand the disease in order to stop feeling guilty: in no case are the parents “responsible” for the child’s illness, even if the genetic trait is transmitted by themselves in a number of cases. This step is important in understanding the child’s illness because it is the child who will have to learn how to live with this disease throughout his life. The parents’ objective will not be to blame themselves (and therefore to focus on their own anxieties) but to support and help the child to become independent in his care so that he grows better with his illness, to allow the child to acquire the skills that will be useful for him to manage his illness (with different episodes) and his daily life with the illness (school, sports activities, friendly and romantic relationships…) by becoming an adult.
- Psoriasis is by no means a “psychiatric” disease, but a skin disease whose breakouts can be favored by external factors such as stress. Back to school, the arrival of a little brother, possible parental separation are all stresses that can trigger a flare-up of psoriasis. Psoriasis is just the physical expression of what any child normally feels in these situations. But the child with psoriasis is no more “psychiatric” than any other child, the stress is only a little more visible.
Managing psoriasis in children
Childhood psoriasis is most often a mild illness that is more often badly lived by the parents than by the children. This is especially true before going back to school.
The impact of psoriasis in adolescence can be aggravated by problems associated with this age. Rare plaques of psoriasis can be stigmatized, especially in family conflicts.
Unlike adult psoriasis, treatment involves three parties: the doctor, the child and the parents. For the small child, a large part of the consultation will be for the parents.
The aim will be to reassure them and explain the disease and the treatment options to them. It should not be surprising if the treatment is very different from that of an adult.
The goal of the treatment will not be to cure the disease, but to make it acceptable to the child. That is to say, allow him her her a life as normal as possible, to ignore mockery, go to the swimming pool …
Thus, a psoriasis of the face will be gladly treated while the objective in a psoriasis in acute drops may be more modest in front of this transient rash and often well tolerated by the child and his family.
The importance of a close doctor-child-parent relationship in caring for the child is paramount. It allows the family to understand psoriasis, to intervene in the choice of treatment, and to ensure good adherence to the therapeutic project in order to achieve the objectives previously established together (treatment of relapse, simple emollients …) .
What else can I do?
Natural treatments for psoriasis in children is pretty much the same as for adults, so if you wish to know more about them, just click on any of the below links.
Also, you might be interested in learning more about how to explain this skin condition to your child. The book below has some great recommendations …
I have also written two articles that might be of interest to you. They are …
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