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Psoriasis: Getting under the skin
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Psoriasis: Getting under the skin

Early recognition and management of psoriasis among children is crucial to curb the detrimental effects the condition can have not only on the body but also on the mind
psoriasis
Photo by Anantha Subramanyam K

Spotty, dry and itchy rashes on your child’s body? It would not be wise to ignore this as a minor issue as experts have pointed out that this could be the early symptoms of psoriasis, an immune-mediated, inflammatory skin disease that could result in psoriatic arthritis and other comorbid conditions.

According to experts, the onset of psoriasis is quite common during early childhood. Up to 40 per cent of adults affected with this condition start showing symptoms before the age of 16. Psoriasis is often mistaken as diaper rash in infants as they get raised patches of skin that are often red and covered with whitish silvery scales. Some of the experts opine that parents could pass on this condition to their children.

Psoriasis is a disease that causes itchy, dry patches on the skin and currently there is no cure for it,” says Dr Ramadas, senior dermatologist, Kamineni Hospitals, Hyderabad. He says that psoriasis can occur in people with no family history of the disease. “Having a family member with the disease increases your risk. If one of the parents has psoriasis, the child has about a 10 per cent chance of getting it. If both parents have psoriasis, the child’s risk is at 50 per cent. About one-third of people diagnosed with psoriasis have a relative with psoriasis,” he adds.


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Psychosocial impact on children

Dr Ramdas says that psoriasis is associated with a variety of psychosocial symptoms, including feelings of guilt, shame, embarrassment or helplessness. Poor self-esteem and low self-worth, sometimes lead to social isolation and sexual dysfunction, due to self-consciousness or painful lesions.

Paediatric psoriasis can have a profound long-term impact on the psychological health of affected children. Additionally, paediatric psoriasis has been associated with certain comorbidities, such as obesity, hypertension, hyperlipidemia, diabetes mellitus and rheumatoid arthritis, making early diagnosis and management essential, states a review paper, ‘Psoriasis in Children and Adolescents: Diagnosis, Management and Comorbidities,’ published in 2015.

Dr Ramdas points out the variations of this condition among children. They are pustular psoriasis, erythrodermic psoriasis, plaque psoriasis, guttate psoriasis, scalp psoriasis, nail psoriasis, inverse psoriasis and genital psoriasis. He says that erythrodermic psoriasis is one of the most severe types of psoriasis. If complications develop, it can be life-threatening. The condition most often affects people who already have unstable plaque psoriasis.

A study from North India published in 2004, reports that extensors of the legs are the most common initial site affected, followed by the scalp. Classical plaque psoriasis meaning (presents with large oval-circular plaques over the scalp, trunk and extensor body surface) is the most frequent clinical presentation, followed by plantar psoriasis (psoriasis on the soles of the feet). The peak age of onset in boys is between six to ten, whereas the majority of girls show an onset of psoriasis between 10 and 14.

Psoriasis symptoms

“The common symptom observed is dry cracked skin with bleeding. The affected portion could also be very itchy and in some intense cases, prolonged itching could lead to bleeding.  The affected individual would also have soreness or burning sensation in and around the affected area. Red marks also start to appear in skin folds. Scratching the rash can pull the scales off the skin and cause bleeding. As the rash progresses, bumpy red and silvery-scaled patches can develop on the skin,” says Dr Ramdas.

Parental advice

Dr Vijaya Gowri Bandaru, visiting consultant, dermatology, Sakra World Hospital, Bengaluru, says, “In most cases, paediatric psoriasis is inherited from parents or very close family members. Parents need to be careful in winter, and they need to stay cautious of dry patches, psoriatic patches or dry skin problems. Sometimes, even the scalp and the nails are involved in the formation of psoriasis,” she says.

Bandaru points out that there is mild, moderate and severe psoriasis. “Children with psoriasis are treated topically and strong and aggressive medications or treatment are always avoided. If more than 40 per cent of body involvement is observed and the body doesn’t respond with creams, we begin oral treatments for children. Early detection and diagnosis of psoriasis always help, as the treatment can be initiated at an earlier stage and the person will be relieved of the symptoms and the patches faster.”

A review paper, ‘Children and Adolescents with Psoriasis’, published in 2012, states that the main trigger factors for psoriasis among children are infections, mechanical trauma and stress factors, and to a much lesser extent, medical and recreational drugs. Apart from the classical predilection sites, the diaper area, scalp and face are mainly involved.

Psoriasis treatment

Dr Ramadas says that the treatment focuses on easing symptoms when they occur and helping prevent or reduce the severity through topical treatments, light therapy, FDA-approved biological treatments and lifestyle changes.

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