Psoriasis is a disease that causes itchy, dry patches on your skin. Up to 40% of people with psoriasis have symptoms before they're 16 years old, and 10% get it before they're 10.
Children can have mild, moderate, or severe psoriasis. It's a lifelong condition with no cure, but you can treat the symptoms with medication. Most pediatric cases of psoriasis are mild and get better with treatment.
Psoriasis isn't contagious. Often, a bacterial infection like strep throat triggers psoriasis for the first time in children. Other kids get certain genes from their parents that make them more likely to get it.
Things that raise a child's risk of getting the disease also include:
- Being obese
- Certain medications, like lithium, beta-blockers, or malaria drugs
- Cold weather
- Cuts, scratches, sunburn, or rashes on the skin
- High levels of stress
Types of Psoriasis in Children
There are five types of psoriasis, but some are much more common in children than others. The symptoms can show up differently in children, too. For example, they're more likely to have psoriasis on their face or around joints.
The two types children are most likely to get are:
- Plaque psoriasis. Most kids who have psoriasis have this type. It causes red, dry patches called plaques. It can also cause silvery scales. The plaques or scales usually show up on the knees, elbows, lower back, and scalp. They're itchy, red, and sometimes painful. They can also bleed. Plaque psoriasis patches are smaller, thinner, and less scaly in children than in adults.
- Guttate psoriasis. This kind is also called "drop-like" psoriasis. It causes small red dots to form on the trunk, back, arms, and legs. It's most likely to be triggered by a strep infection. Many children who get this type of psoriasis also get plaque psoriasis.
Children under 2 can get psoriatic diaper rash. It happens on the skin that's covered up by the diaper. It may show up like plaque psoriasis, or it may cause a bright red, weeping rash. You can tell the difference between psoriatic diaper rash and regular diaper rash because psoriatic diaper rash doesn't get better with regular diaper rash treatment.
Less Common Types of Psoriasis in Children
Kids aren't likely to get these types of psoriasis:
- Pustular psoriasis. This shows up as blisters on red or swollen skin on the hands and feet. If a child does get it, it's typically either milder than an adult would have or a kind called annular pustular psoriasis that causes a red ring with blisters.
- Inverse psoriasis. This happens in the folds of the body: behind the knee, in the armpit, or around the groin. It looks very red, smooth, and shiny.
- Erythrodermic psoriasis. This is a severe form that can be life-threatening. It causes redness over most of the body. It's very itchy and painful and can make skin come off in sheets.
Diagnosis
A doctor usually can tell whether it's psoriasis by looking carefully at your child's skin, nails, or scalp. To be sure, they might also remove a small sample of skin and send it to a lab for a closer look. They’ll also ask about your family history and habits to see how many risk factors your child has.
Treatment
Your child's doctor is likely to recommend an antihistamine (a kind of drug used to treat allergies) to help with itching. Keeping skin moisturized is important, too. They may suggest petroleum jelly to lock in moisture. Salicylic acidand urea cream may also be an option for thick plaques, but you shouldn't use it on children under 6 years old.
Other options may include:
- Topical treatments. Most children have mild psoriasis you can treat with a cream, lotion, or ointment that's spread onto the skin. These include:
- Anthralin
- Calcipotriene (a form of vitamin D)
- Coal tar
- Corticosteroids
- Light therapy. Your child's doctor might choose this option if plaques are on most of your child's body. Types include artificial light (UV light) and laser therapy. But these treatments are known as “second line,” meaning your doctor will likely try a topical treatment before light therapy.
- Systemic medications. Your child's doctor will probably recommend medicine to take by mouth or by shot only if the psoriasis is severe. Many of the ones doctors use for adults are not as safe in children and have serious side effects. Your child's doctor may prescribe etanercept (Enbrel), ixekizumab (Taltz), or ustekinumab (Stelara).
Get the Most Out of Treatment
To make sure your child's treatment has the best chance to succeed:
Find the right doctor. Look for one who regularly treats children with psoriasis. This is usually a dermatologist. Make sure you can talk with them easily. If they don’t ask for your input on what you see happening with your child, find a new doctor.
Stick to a plan. Talk to your child about how important it is to stick to the treatment schedule. You may need to apply medication a couple of times a day. Remind your child that it can take time for the treatment to work. They should take an active role in their treatment as early as possible. Even first-graders can put on moisturizers, and older kids can take full control.
Pick the right therapy. Think about your child's age and schedule. Work with the doctor to find a therapy that works best for them.
Talk straight. Choose your words carefully when talking with your child about covering up. Some kids get used to wearing long sleeves year-round. But you don’t want your child to feel like they’re always hiding.
Build connections. Look for groups or message boards online, or ask your child's doctor about face-to-face support groups. You can also check out summer camps for kids with skin conditions. They're all great ways to get support, learn practical tips, and build confidence. And that goes for you, too. A chat with other parents who have kids with psoriasis can give you new insights and strategies.
Go to school. Make connections with people at your child's school at the start of each year. It's a good way to head off problems. Try to get confirmation from the staff about these issues:
- Which staff member your child can turn to for help.
- Staff will watch for problems in the classroom or conflict with other students, like teasing or bullying.
- The gym teacher won't be surprised if your kid doesn't want to wear shorts or can't take part in some activities.
Psoriasis and Your Child’s Emotions
This condition can have a big effect on your child's mood and how they see themselves. To support your child and help them feel better:
Focus on facts. Don't focus too much on the disease. Your child should never feel bad or different for having psoriasis. Try to keep discussions about their psoriasis matter-of-fact, not overly emotional.
Talk about feelings. Teach young children to name their feelings, especially when a symptom develops. Make a "happy" and "sad" feelings word list. Some symptoms may not bother them as much as they may bother you. This can help you understand how their disease affects their mood.
Let them decide. Give your child some power over the condition. For example, let an older child have a say in treatment. They might want a cream instead of a greasy ointment. Or they could choose a phototherapy session time.
Let go. Give your child support and understanding. Recognize that as your child gets older, they may turn to friends for support instead of you. This is OK. It's important for your child to stay connected to their peers.
Spread the word. Educate your child about the condition at an early age. Give them books or links to websites about psoriasis (preferably written by or about kids who have it) and talk about it afterward. Encourage them to ask questions during doctor's appointments. Help them practice how to handle uncomfortable questions or comments from other kids. Your child will feel more confident with answers at the ready, and may come to enjoy the chance to educate their classmates.
Be positive. Psoriasis is unpredictable. Flares can pop up anytime. Medications stop working without warning. Your kid might be OK with psoriasis in elementary school then flip out when middle school starts. Reassure your child they’re going to get better.
Consider therapy. It can be a big help to any kid with psoriasis, even right after the diagnosis. Therapists can offer kids with long-term diseases practical ways to deal with daily life and issues with friends and classmates. Kids with psoriasis have a higher chance of getting low self-esteem and depression. Schedule an appointment with a therapist, such as a child psychologist or social worker, if you see that your child:
- Is cranky and angry
- Spends less time with friends
- Has changes in sleeping or eating habits
- Has problems in school