Managing Childhood and Teenage Psoriasis

How to navigate the unique challenges of dealing with psoriasis at a young age

Child and teen psoriasis

Although we commonly think of psoriasis as something that affects adults, it is quite common for it to start in childhood and continue into the adult years. Children face unique challenges in dealing with psoriasis, including different risks from treatment and navigating the social aspects of having psoriasis while growing up. The good news is that through the combination of monitoring, treatments, and social education, psoriasis and psoriatic arthritis in can be controlled and children can enjoy as normal a childhood as possible.

The onset of psoriasis can occur at any age, but it most commonly begins between the ages of 15 and 25. Younger children can certainly develop it as well although it is rare in babies. Some aspects of childhood psoriasis are similar those found in adults, and can vary from a minor annoyance to severe, usually affecting the scalp, elbows, knees, and lower back with pink plaques covered in a thick scale. Some children will also develop psoriatic arthritis, with morning stiffness and swollen joints in the hands or back. It is important to see a pediatric rheumatologist if arthritis is present because if not treated, it can potentially lead to permanent disability in these joints.

Teenagers and young adults are particularly prone to guttate psoriasis, where the spots are very small and numerous on the chest, back, and arms. This form often occurs after an infection, especially strep throat. Sometimes this type of psoriasis will improve once the strep throat is treated with antibiotics, and if not it tends to respond very well to ultraviolet light treatments.

For more severely affected children, there can be a strong negative impact on their social development if the psoriasis is not kept under control. It is hard to be so different from your peers in the pre-teen and teen years. Often their friends and schoolmates may not know much about psoriasis, and might worry it is contagious.

Uninformed teachers or lifeguards may even try to keep the affected child away from others or out of the pool. It is important to educate those in your child’s life about psoriasis so they will understand that it is not contagious and should not limit activities. Consulting with a dermatologist to try to get the best possible control of the skin disease is important and a school counselor or psychologist may also help work through challenging social issues.

Although most dermatologists treat children, if the psoriasis is severe it may be helpful to seek out a pediatric dermatologist or a dermatologist who specializes in treating psoriasis. Many children can be treated with topical steroids and other creams but treatment options for more severe childhood psoriasis include:

  • Ultraviolet light therapy: this form of treatment often used in children because it tends to be very safe and effective.

    • Considerations: It requires visiting the dermatologist’s office 1-3 times per week for a short treatment. Children must be old enough to routinely wear protective eye goggles during treatment. If used over a long-term (10 years or more), it may increase the risk of skin cancer.

  • Methotrexate: a prescription drug that has been used for many years to treat children with juvenile rheumatoid arthritis and psoriasis.

    • Considerations: it can damage the liver and suppress the bone marrow, so it requires routine monitoring of blood tests. It can help the pain of psoriatic arthritis as well.

  • Biologics: these are newer medications that can help both the skin and the joints. They include etanercept (Enbrel) and adalimumab (Humira) and have been used with children as young as 2-4 years old for other types of arthritis. These medications may be able to stop the destruction of joints over the long-term in psoriatic arthritis.

    • Considerations: these can suppress the immune system and make the child more sensitive to certain infections, especially tuberculosis.

The goal of treating childhood psoriasis should be to help the child to live as normal a life as possible. Children with psoriasis can and should get all of their normal vaccines, however ask your doctor about vaccines if your child takes a medication that can suppress the immune system.

They should also be able to play, swim, and learn with other children. Educating children and teachers about psoriasis can go a long way to helping ease fears and social barriers. Some websites such as the National Psoriasis Foundation and the Psoriasis Association have specific information about psoriasis for parents and teens. Lastly, a good relationship with a dermatologist experienced in treating psoriasis in children can be especially helpful to keep the skin (and joint) disease under control as the child grows and matures. 

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