Psoriasis is a chronic autoimmune condition that causes symptoms to appear on the skin. These symptoms are caused by inflammation in the body, which makes the body produce too many skin cells. People can develop psoriasis at any age, although most people experience their first flare-up between the ages of 15 and 35 years.
Psoriasis that affects children and teens is called pediatric psoriasis. The number of children and teens diagnosed with psoriasis has doubled in the past 50 years or so. Around 1 in 3 people are diagnosed before the age of 20 years, and 1 in 4 people are diagnosed before the age of 2 years. The average age for developing pediatric psoriasis is around 8-11 years.
Psoriasis can also affect younger children, infants can develop psoriasis, but it is not a common condition. Psoriasis affects girls and boys at roughly equal rates. Like adults, children and teens with psoriasis are not contagious and do not need to be kept apart from other children during a flare-up or when symptoms are visible.
What types of psoriasis most commonly affect children and teens?
Psoriasis can affect children and teens in different ways. Infants can be diagnosed with infantile psoriasis, which can go away completely after a relatively short time. Some children and teens who develop psoriasis may also have the condition go away after a few months. However, in others the condition will never go away completely, and they will continue to have cycles of flare-ups and times without symptoms (remission). Other children and teens have psoriasis with skin symptoms as well as psoriatic arthritis, a condition in which inflammation causes symptoms in and around the joints.
The symptoms of psoriasis in children and teens can be similar to other skin conditions, which can sometimes make it difficult to get the right diagnosis. Children and teens can develop the same types of psoriasis that adults can, such as:
- Plaque psoriasis
- Scalp and facial psoriasis
- Guttate psoriasis
- Inverse psoriasis
- Nail psoriasis
- Pustular and erythrodermic psoriasis (very rare)
Children under the age of three can sometimes develop a special type of psoriasis called diaper psoriasis. Pustular and erythrodermic psoriasis are quite rare among children and teens, but they can occur.
What are the symptoms of psoriasis in children and teens?
Plaque psoriasis causes areas of red, inflamed, and thickened skin which are often covered with a layer of silvery scales. These plaques commonly occur on the arms, legs, and torso. As with adults, Plaque psoriasis is the most common clinical subtype of psoriasis, affecting about 75% of children and teens with psoriasis symptoms.
Psoriasis plaques can also occur on the scalp and face in children and teens. The scalp is often the first place and is sometimes the only place, that plaques appear in children. The plaques can be particularly thick and scaly, and very itchy.
Guttate psoriasis is a condition that tends to affect children, teens, and young adults more often than older adults. It causes many small, reddish, teardrop-shaped plaques with scales that can appear anywhere on the body, often after an infection like streptococcus. Around 15%-30% of children with the condition have guttate psoriasis. In some children, guttate psoriasis will clear up completely and they never have another flare-up.
Inverse psoriasis is also called flexural psoriasis. It is also more common among children, especially younger children, than among adults. This causes smooth, shiny, pink or red patches on this skin that are usually not scaly. These patches tend to occur most often in skin folds, such as the armpit, groin, and around the face.
Around 40% of children with psoriasis have symptoms on their nails, such as pitting or changes in the color or texture of the nail. These symptoms are more common among older children. Children with nail symptoms may or may not have plaques on other parts of the body.
Diaper psoriasis occurs most often in infants and children aged 2 years or younger. The symptoms are bright red, distinct plaques that are usually not very scaly. This type of psoriasis usually goes away when the child is toilet trained.
What are common causes of psoriasis in children?
The tendency to develop psoriasis tends to run in families. A child with one parent who has psoriasis has about a 10% chance of developing it too. If both parents have psoriasis, the chance increases to about 50%.
Researchers are still working to understand what exactly causes psoriasis in children and teens, and the extent to which the contributing causes are genetic. Having certain types of infections seems to be a common cause. Around 30%-50% of children and teens develop psoriasis a few weeks after having an infection such as:
- strep throat
- upper respiratory tract infection
- ear infection
Other children and teens develop psoriasis after taking certain types of medications, or after a skin injury such as a scrape, cut, burn or bite.
How is psoriasis in children and teens treated?
Psoriasis in children and teens with mild or moderate symptoms can often be treated effectively with topical medicines apply directly to the affected skin. These include:
- Topical corticosteroids, to reduce the inflammation that causes symptoms
- Vitamin D analogues (such as calcipotriene), to reduce the amount of skin cells produced
- Anthralin, to reduce both inflammation and skin cell production
- Tacrolimus, which can be useful for symptoms that affect sensitive areas of the skin
If the psoriasis has been caused by an active infection, such as strep throat, then healthcare providers will probably prescribe antibiotics. Psoriasis due to other causes will not be improved with antibiotic treatment.
For children and teens with more severe psoriasis may need stronger types of therapies. Phototherapy involves treating the affected area with special ultraviolet light. Systemic treatments taken orally (such as methotrexate) or injected (such as biologic therapies) may be needed to affect the way the immune system causes inflammation.
Children and teens with psoriasis will usually be referred to a specialist dermatologist for treatment. Counselling can also be helpful in helping children and teens to deal with the social and emotional impact of living with psoriasis. School age children may be particularly vulnerable to bullying and the effects that their condition can have on their self-esteem, confidence, and willingness to engage with their peers.