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How Psoriasis Affects the Youngest Patients

Pediatric cases appear to be increasing worldwide for a variety of reasons. By Don RaufMedically Reviewed by Ross Radusky, MDReviewed: September 11, 2019Medically ReviewedAn estimated 20,000 U.S. children under age 10 are diagnosed with psoriasis each year.ShutterstockPsoriasis, an autoimmune skin disease, doesn't just affect adults. People usually see their first psoriasis symptoms between ages 15 and 30. About one-third of patients are younger than 20, according to the National Psoriasis Foundation (NPF). While it's less common, younger children can get psoriasis as well. The NPF estimates that about 20,000 youngsters under age 10 are diagnosed with the condition each year. The numbers may be even higher, according to Kelly Cordoro, MD, a professor of dermatology and pediatrics and the division chief of pediatric dermatology at the University of California in San Francisco. That’s because some patients with mild disease may not seek care or may be misdiagnosed. There may also be racial and other disparities in prevalence and access to care. “We have seen a rise in recorded cases of pediatric psoriasis over the last few decades, which may result from increases in trigger factors such as stress, infection, and obesity, as well as increased awareness and recognition of the condition by physicians and the public,” says Dr. Cordoro.

What to Look Out for in Youngsters

While psoriasis can cause serious skin eruptions and itching, the Psoriasis and Psoriatic Arthritis Alliance (PAPAA) emphasizes that many children diagnosed with the disease can go through their lives without the condition ever bothering them or flaring up, and they may have only small patches of psoriasis plaques. The NPF warns that the red scaly patches of psoriasis are often misdiagnosed in young people. The symptoms can be easily confused with other skin diseases such as eczema, ringworm, and viral rashes. This is why it is important to get any skin abnormalities checked out by a dermatologist. Parents should look out for pitting and discoloration of the nails and severe scalp scaling. Infants often develop psoriasis in the diaper area, while older children and teens may show signs on the scalp, elbows, and knees.

Risk Factors Include Infections and Genetics

Common predisposing factors that can trigger the disease in children include bacterial infections such as strep throat (streptococcal pharyngitis). Flare-ups may also occur after an earache, tonsillitis, or respiratory infection. In some cases, patches of psoriasis appear on areas of skin that have been injured — a condition called Koebner phenomenon. Genetics can raise your odds of developing psoriasis. If one parent has psoriasis, the child has a 10 percent chance of contracting it. If both parents have the condition, the odds rise to 50 percent. “We are also beginning to learn that overweight and obesity may trigger onset of psoriasis in susceptible children,” says Cordoro. Although children can get any type of psoriasis, plaque psoriasis and guttate (characterized by teardrop-shaped spots) are most common.

Pediatric Treatments for Psoriasis

Many of the same medicines used to treat adults may be used in children, including topical therapy, phototherapy, and conventional systemic medications such as methotrexate, cyclosporine, and acitretin, as well as the newer biologic drugs, according to Cordoro. The treatment approach with children varies depending on several factors including age, type and severity of psoriasis, whether it's the initial episode or a recurrence, body sites affected, health history, current and prior treatments, patient and family preference, and cost of and access to medicines. “Often children with mild or moderate psoriasis are treated conservatively with creams and phototherapy,” says Cordoro, “but children with more severe disease also may receive other types of therapy — systemics and biologics — which have been shown to be safe and effective.” Matthew Lewis, MD, MPH, a dermatologist with Stanford Health Care and a clinical assistant professor of dermatology at Stanford University in California, stresses that therapy early on may help prevent other health issues later in life. “We know psoriasis is a systemic inflammatory disease,” he says. “That inflammation over time may damage blood vessels and other organs, possibly raising the risk of heart attack, stroke, and diabetes. So controlling that inflammation is really important.”

Dealing With the Stigma

Because unsightly patches of psoriasis can appear on the face, scalp, arms, and legs, children may feel self-conscious. Other youngsters may tease, bully, or exclude them. “Development of self-esteem and confidence is greatly dependent on peer interactions in early childhood, and social development is particularly impaired in children with psoriasis, which affects emotional development and school performance, among other issues,” says Cordoro. “Psoriasis can be horrible for children,” says Dr. Lewis. “That’s why I think seeing a dermatologist early on is so valuable so kids can get treated.”

Living a Positive Life With Psoriasis

Cordoro, who has treated hundreds of children with psoriasis, wants parents and kids to know that they can live productive and happy lives despite having the condition. “There are many very positive and uplifting stories of children diagnosed with the condition who cope extremely well with it,” she says. “They ‘own it’ and are empowered by it. It does not impact their quality of life at all.” Cordoro says that much of the stigma associated with psoriasis “is often due to lack of understanding of what the condition is, and fear in the minds of some that they may contract the psoriasis from the patient [although it is not contagious].”

One Young Patient Changed a Doctor s Life

Cordoro credits one child in particular for igniting her passion to care for young people with psoriasis. The 5-year-old boy had such severe psoriasis all over his body that he could not walk, and he was carried into her office by his parents. He could not play outside or go to school because of the scales, itch, and pain. The family was told he would have to wait until he turned 18 to be treated because there were no treatments approved for pediatric psoriasis patients. Cordoro started him on a systemic therapy, and eight weeks later he walked in to her clinic and gave her a huge hug, as his parents cried in disbelief. “That day, I realized the vulnerability of children, the fear and misunderstanding physicians have about safe and effective treatment for this condition in pediatric patients, and the enormous impact not only on physical health but the mental and emotional well-being of children with severe psoriasis and their caregivers,” she says. “Psoriasis may be mild and more of a nuisance than anything, but it may also be severe and life-altering for the child and family,” Cordoro adds. “My goal is to treat each and every child as an individual and tailor treatment to the specific needs of the child while taking into account the beliefs and preferences of the family.” NEWSLETTERS

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