Pediatric Psoriasis is on the rise. The incidence has more than doubled between 1970 and 2000! However, there are many treatment options for children– from topical steroidal and non-sterioidal creams to shots and some pills (for adults).

Ada West Pediatric Dermatologist, Dr. Swanson answers…

What is Psoriasis?

So psoriasis is an inflammatory condition of the skin that causes a rash on the skin that typically consists of pink or red scaly patches. It’s kind of misunderstood.

Can kids get psoriasis?

There’s a rumor out there that kids don’t get psoriasis. I can tell you they definitely do.

Is it common for kids to have psoriasis?

And the incidence of it is increasing. When I started in practice almost 13 years ago, I would see one new pediatric patient a month with psoriasis and nowadays I see one every day and it’s been that way for the past five or six years. Other people nationwide have noticed this increase as well. It’s actually been correlated with a worldwide increase incidence of pediatric psoriasis. We don’t know why, but the incidence is increasing and kids can get psoriasis.

Is there anything that makes kids more susceptible to it?

Family history plays a role. One third of kids with psoriasis will have family history of psoriasis. So it’s not every kid that has family history, but family history certainly does set the stage for a child to have psoriasis.

How can we treat pediatric psoriasis?

We have so many treatment options for psoriasis. In fact, when I tell a patient and their family that they have psoriasis, I immediately say This is a great time to have psoriasis. We have so many tools in our toolbox and so many ways to help. We have tons of topical creams, some that contain a steroid, some that don’t. In fact, we got two new topical non-steroidal medications for the treatment of psoriasis just last summer. So we have a lot of topical options to treat psoriasis. We also have a lot of medicines that work on the inside to take away the psoriasis on the outside. Those medicines are most commonly available in a shot formulation. We do have a couple of pills that are approved in the adult patient population.

What if we don’t treat it?

The biggest downside to not treating it is you have to live with it on your skin.And psoriasis can be itchy or some people don’t like the way it looks. Psoriasis can make you self-conscious if it occurs on your scalp. It can cause scaling that might look like dandruff or flakes and it can occur in the underwear area and in that place it can be uncomfortable for people and it can occur in areas that are visible to other people. Your elbows, your knees, your hands.

And so the biggest consequence to not treating it on your skin is you have to look at it and you have to feel it all the time. Plus, I would say the treatment options are so good, there’s no reason not to treat it. One of the other big reasons why we encourage treatment of psoriasis is that the inflammation that’s present in the skin that causes the rash on the skin is also present inside our bodies and can increase the risk for certain things over decades.

For a patient who has psoriasis over time, people with psoriasis have increased rates of high blood pressure, high cholesterol, diabetes, heart disease. And so treating it is really important. We think we can decrease that risk if we treat it effectively in kids.

What triggers psoriasis?

One of the most common triggers for psoriasis is strep throat, particularly for a type of psoriasis called guttate psoriasis. Guttate means teardrops. These little teardrops of psoriasis that occur all over the skin kind of all of a sudden.  The most common trigger for that type of psoriasis is strep throat. Even if your child is asymptomatic, I always recommend having that strep test done.  If strep is the trigger and you don’t treat the strep, it’s almost impossible to treat the psoriasis.

One other trigger that we see in the pediatric patient population is that psoriasis demonstrates something called the Koebner phenomenon.  The Koebner phenomenon is where when your skin is traumatized, psoriasis likes to pop up there. So kids are always falling down and skinning their knee. Sometimes they’ll fall down skin their knee and when it heals, low and behold, there’s a psoriasis patch there. And so that’s another trigger we can see in the children.

Is it curable?  Will kids outgrow psoriasis?

So psoriasis is something where kids and adults with it don’t tend to completely outgrow it. You don’t tend to ever be permanently cured of psoriasis, but that doesn’t mean it’s always a problem. Psoriasis can go into periods of remission where people are clear for years and years. So just because I can’t promise people that they could outgrow it doesn’t mean it’s always an issue. And again, with the treatments we have available, nobody needs to suffer with this anymore. We can really help in the pediatric patient population.

Is it misdiagnosed as something else?

It is constantly misdiagnosed as something else. That’s one of the biggest things that I deal with. In fact, I would say every pediatric patient I diagnose with psoriasis has been told that they have something else, most commonly eczema, but sometimes things like fungus or a rash called Pityriasis rosea. So yes, it is constantly misdiagnosed and so I try to um, help with that.

What age do kids get psoriasis?

Psoriasis can present really at any age we even see babies with it. And the most common location for it in babies is the diaper area. So sometimes it’s mistaken as a bad diaper rash and low and behold it’s psoriasis. But psoriasis literally can pop up at any age.

What is the best thing to do for pediatric psoriasis?

So best thing you can do if your child has psoriasis is come to somebody like me and get some treatment for their psoriasis. Because again, the treatments are so good, there’s no reason to not treat it and to just live with it cause we can really help with that. So I would say that’s the most important thing to do.

What common home remedies are there?

We see a lot of people try a lot of home remedies for things and they might be trying it to treat psoriasis or they might be trying it to treat eczema or acne. A lot of these things have a high potential to cause irritation. It’s what we call contact dermatitis. So you might try something and mean well in trying that thing, but there might be something in it that your skin does not agree with. And then you get a second rash on top of the first rash. So in my opinion, best to come to somebody like me and ask what would be the best thing to use.

Psoriasis and the sun

Probably the most common do-it-yourself treatment for psoriasis is going out in the sun. So sunlight and light therapy does tend to help psoriasis. Uh, we use it in the office. Uh, and a lot of people will decide, well, they’ll kind of see that the sunlight helps their psoriasis and the so they start going outside with that purpose in mind. The important thing with that is that sunlight does help psoriasis, but sunlight can also cause skin cancer over time. And so it’s all about getting the appropriate amount of exposure enough to treat the psoriasis without causing sunburns or increasing your risk for skin cancer along the way.

How important is early intervention?

Early intervention I think is quite important. The milder the psoriasis is the more options we have available to us, we can really jump on it and get it better. Um, so I think early intervention is important, but it’s better late than never. So don’t be, uh, embarrassed or ashamed if you haven’t come in to treat your child’s psoriasis and they’ve had it for a couple years. There’s still so many ways I can help and it’s no biggie better late than never.

Early Intervention and Acne

I would definitely say that the earlier you come in for acne is very, very important because acne is capable of causing scars. As much as psoriasis is important to treat, it doesn’t cause scarring and acne can. So the earlier you treat it, the easier it is for us to make it better and prevent any long-term consequences of it.