Vicky Price thought it was a food allergy when her 3-year-old daughter broke out with red, hot patches all over her body. But then, flaky scales started to appear on the little girl's scalp.
"The rashes started so suddenly, out of the blue," says Price. "As a mom, I was naturally worried. But she had no other symptoms. I took her to the doctor who said she had psoriasis. I had never heard of that before."
About 1 in 10 people with psoriasis develop it before age 10.
Psoriasis in Kids
"Psoriasis, in most cases, is a long-term [non-contagious] condition that waxes and wanes over a lifetime," says Kelly M. Cordoro, MD, assistant chief of pediatric dermatology at the University of California, San Francisco.
It's an autoimmune disorder that targets the skin, scalp, and nails. That means something in your child's immune system is telling skin cells to grow too fast. As a result, the cells build up and cause thick, red scales, or lesions. Kids usually get them on the face, buttocks, and scalp.
There are many types of psoriasis. The most common type in childhood is called guttate, or raindrop, psoriasis. Small, red, scaly dots form over wide areas of skin. It's often triggered in children and teens by the onset of a throat infection such as strep throat. Your child's genes may play a role in whether she develops psoriasis.
It's important to treat childhood psoriasis right away. Skin symptoms can be uncomfortable and possibly painful. They also may cause your child to feel sad, anxious, or worried.
And psoriasis can damage the heart over time. Studies show it can make someone more likely to have unhealthy changes in blood pressure, blood fats (lipids), and insulin levels. When they occur together, it's called "metabolic syndrome." This has been linked to heart problems and diabetes. Children with psoriasis are also more at risk for obesity, which also can lead to heart problems.
"Psoriasis is a full-body disorder," says Joan E. Tamburro, DO, director of the pediatric dermatology section at the Cleveland Clinic. "You should make sure that your child is eating well, sleeping well, exercising, and doing everything he or she can to be at their ultimate health."
Treating Psoriasis in Children
There's no cure for psoriasis, but doctors have many ways to manage symptoms and help your child feel better. In general, they treat psoriasis the same way in kids as adults. But how much medicine your child uses or how often she takes it may be a bit different.
The U.S. Food and Drug Administration (FDA) hasn't approved many therapies for children. Cordoro says doctors typically recommend treatments for kids based on their experience and information from other doctors.
Children with psoriasis are always treated first with ointments or creams called topicals that you rub on irritated skin. "We tend to believe they have fewer side effects for a child," Tamburro says.
Other treatments include light therapy (phototherapy) and medications. Have a detailed conversation with your child's doctor about treatment plans, especially about whether any of them might have long-term effects on your child's health.
Here are things you can do to improve your child's care and treatment:
- Schedule your child's appointments with a doctor who regularly treats children with psoriasis, usually a dermatologist. Make sure you can talk with him easily. "If the dermatologist is not seeking input from you regarding your thoughts and perspectives, it may be best to seek a different dermatologist," says Cordoro.
- Talk to your child about how important it is to stick to the treatment schedule. Price says it was hard at first to remember to put her daughter's two prescription creams on her every day. Remind your child it can take time for the treatment to work.
Think about your child's age and pick a therapy that best fits her. "Topical treatments take about 20 minutes a day to apply. This may be more stressful at age 16 than younger ages," says Tamburro, who has had teenage patients on topical treatments say they don't have time for them with school, work, and social activities.
- Choose your words carefully when talking with your child about covering up. Some kids get used to wearing long sleeves year round. However, "there is a fine line of trying to help them as opposed to making them feel like they are constantly hiding something," Tamburro says. She adds that the more treatment focuses on "treating both the skin lesions and the person emotionally, then the healthier they will be."
Psoriasis & Your Child's Emotions
Psoriasis is more than skin deep. It can have a big effect on your child's mood and how he sees himself.
"More and more, studies are showing that kid's quality of life is greatly changed by having psoriasis," says Tamburro. "This is a very difficult disorder for children because they are in situations [like school] where people are looking at them."
To support your child and help her feel better:
- Don't focus too much on the disease. "You never want to make a child feel bad or different for having psoriasis. Kids do best when parents are direct and matter-of-fact about it rather than being overly emotional," Cordoro says.
- 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.
- Give your child some power over the condition. For example, let an older child have a say in treatment. She might want a cream instead of a greasy ointment. Or she could choose a phototherapy session time.
- Give your child support and understanding. Recognize that as your child gets older, he may turn to friends for support instead of you. This is OK. It's important for your child to stay connected to his peers.
- Educate your child about the condition at an early age. Encourage her to talk to friends about it. Cordoro says, "Education is the best way to prevent stigmatization, bullying, and social withdrawal."
"Psoriatic arthritis is probably underdiagnosed in children because kids don't know what the symptoms are and they may be subtle," says Tamburro. "A 6-year-old doesn't know that other 6-year-olds don't wake up with their knees hurting or their elbows sore."
Psoriatic arthritis most often occurs in adults. When it affects kids, it usually develops around age 11 or 12. Boys or girls can get it.