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Treating Psoriasis in Children

What parents need to know about therapy options, side effects, and fostering overall health in children.

Treating Psoriasis in Children

Most people experience their first psoriasis symptoms sometime between their late teenage years and their early thirties, but psoriasis can begin at any age. A significant number of patients experience their first symptoms during childhood.

A diagnosis of pediatric psoriasis comes with a number of concerns for parents. There’s the struggle of watching a child cope with symptoms that can be itchy, painful, and frustrating. There are the concerns about the long-term impacts the disease can have on a child’s physical and mental health. There are decisions that need to be made about what therapies to use and concerns about the potential side effects of those therapies.

The first step
The first step to treating any condition is to work with a healthcare provider that understands the condition and has experience treating it. With pediatric psoriasis, this means working with a pediatric dermatologist, a healthcare provider that specializes in treating skin conditions in children.

In some cases, this may also mean working with a pediatric rheumatologist. Rheumatologists specialize in the treatment of autoimmune conditions and musculoskeletal diseases. Psoriatic arthritis, a type of arthritis that affects people with psoriasis, can occur in children. Psoriasis and psoriatic arthritis are considered “immune-mediated inflammatory diseases” meaning they are caused by abnormal immune system activity that promotes inflammation throughout the body.

There is no cure for psoriasis, but there are therapies that can help control symptoms and reduce disease activity. Minimizing side effects is another goal of treatment—and another reason why it is important to work with a healthcare provider.

Psoriasis therapies for children
Topical therapies are usually the first therapies that will be prescribed for psoriasis, including pediatric psoriasis. Topical therapies are medications that are applied directly to the skin, and include creams, ointments, and lotions, as well as shampoos and conditioners that are used to treat scalp psoriasis. Some topical treatments can be purchased over the counter, others are available by prescription, and all must be used under the guidance of a pediatrician to avoid side effects from overuse or incorrect use.

Phototherapy utilizes exposure to ultraviolet light (UV light), which can help regulate immune system activity in the skin. It is also referred to as light therapy or ultraviolet light treatment. This can be accomplished with artificial light sources in a healthcare provider’s office or exposure to sunlight for short periods of time. Because exposure to UV light can damage the skin, it's important that this treatment is used under the careful guidance of a healthcare provider. Sunburn can make psoriasis symptoms worse and also increase a person’s risk of developing skin cancer.

Systemic treatments are another treatment option, but are typically only used to treat severe psoriasis when other therapies have not controlled symptoms. Systemic treatments work directly on the immune system to suppress the abnormal immune activity that causes psoriasis symptoms. These medications are taken as pills or administered with injections. There are two broad categories of systemic therapies—biologic and nonbiologic, which may be used in combination with one another and in combination with other types of therapies.

Because of the risk of side effects, systemic therapies are uses as sparingly as possible. The lowest effective dose should be used, and pediatric patients may transition off systemic therapies once symptoms are under control.

Overall health
It’s important to remember that psoriasis is only one aspect of a child’s health. While a diagnosis of a chronic disorder can seem all-encompassing at times, parents shouldn’t neglect the other things that are important to a child’s overall health and development. This includes keeping regular appointments with a pediatrician, keeping up to date on vaccinations, and encouraging healthy eating habits and physical activity. It also means looking after a child’s mental and emotional health—skin disorders like psoriasis can have a negative impact on self-esteem, mood, and social development.

Psoriasis is a life-long condition and people with psoriasis are at a higher risk for other health conditions during childhood and later in life, including diabetes, heart disease, and obesity. It's never too early to start establishing healthy habits that can have benefits later in life.

Medically reviewed in July 2020.

Sources:
National Psoriasis Foundation. "About Psoriasis."
Roxanne Pinson, Bahman Sotoodian, and Loretta Fiorillo. "Psoriasis in Children." Psoriasis (Auckland, N.Z.), 2016. Vol. 6.
Sandipan Dhar, Raghubir Banerjee, et al. "Psoriasis in Children: An Insight." Indian Journal of Dermatology, 2011. Vol. 56, No. 3.
Nanette B. Silverberg. "Pediatric Psoriasis: An Update." Therapeutics and Clinical Risk Management, 2009. Vol. 5.
Medical News Today. "What to know about psoriasis in children."
I. M. G. J. Bronckers, A. S. Paller, et al. "Psoriasis in Children and Adolescents: Diagnosis, Management and Comorbidities." Pediatric Drugs, 2015. Vol. 17.
KidsHealth.org. "Psoriasis."
Children's Hospital of Philadelphia. "Psoriatic Arthritis in Children."
American College of Rheumatology. "What is a Rheumatologist?"
Nilmarie Ayala-Fontanez, David C Soler, and Thomas S. McCormick. "Current knowledge on psoriasis and autoimmune diseases." Psoriasis: Targets and Therapy, 2016. Vol. 6.
Jayakar Thomas and Kumar Parimalam. "Treating pediatric plaque psoriasis: challenges and solutions." Pediatric Health, Medicine and Therapeutics, 2016. vol. 7.
UVAHealth. "Phototherapy."
UpToDate. "Patient education: Psoriasis (Beyond the Basics)."
The Psoriasis and Psoriatic Arthritis Alliance. "Psoriasis and the sun."
Skin Cancer Foundation. "Sunburn & Your Skin."
Alan Menter, Kelly M. Cordoro, et al. "Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients." Journal of the American Academy of Dermatology, 2020. Vol. 82, No. 1.
DermNet NZ. "Paediatric psoriasis."
Maddalena Napolitano, Matteo Megna, et al. "Systemic Treatment of Pediatric Psoriasis: A Review." Dermatology and Therapy, 2016. Vol. 6, No. 2.
National Psoriasis Foundation. "Rebound effect: When stopping treatments starts a psoriasis flare."
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