Psoriasis in children

Your questions answered

These are common questions that you may like to consider, when thinking about your child's psoriasis. 

Why does my child have psoriasis?

The heredity factor seems to play a part. About one third of people with psoriasis are able to identify a relative, living or dead, with psoriasis. It is estimated that if 1 parent has psoriasis that there is a 15% chance that a child will develop the condition. If both parents have psoriasis this increases to about 75%. Interestingly, if a child develops psoriasis and neither parent is affected there is a 20% chance that a brother or sister will also get psoriasis. This is because the condition is known to skip generations but somewhere there will be a familial link to a relative via either or both parents.

What triggers psoriasis in children?

Symptoms only develop if they are triggered by certain events, most frequently in children and teenagers, often after a throat infection due to streptococcal bacteria. This type of psoriasis is known as guttate psoriasis or raindrop psoriasis so named because it manifests itself over the body in the form of scaly droplet-like shaped patches. Numerous small red scaly patches quickly develop over a wide area of skin, although the palms and the soles are usually not affected. Some people will go on in later life to develop chronic plaque psoriasis.

What does psoriasis in babies look like?

Babies can develop psoriasis in the nappy area of an infant to cause a bright red, weeping rash or more typical psoriasis plaques. A child who has napkin psoriasis as a baby does not seem to have a higher risk of developing other forms of psoriasis in later life.

My child has a rash and I suspect it’s psoriasis what should I do?

Any rashes on a child should be checked out by a doctor to rule out other conditions. If your child develops a rash make sure when you visit your doctor to tell them (if you are aware) that there is a family history of psoriasis and/or psoriatic arthritis in your family as this is an important fact that may be overlooked at initial diagnosis as psoriasis can also be mistaken for eczema.

Who should I see about my child’s psoriasis?

Once you have noticed that something is wrong with your child and has not cleared up within a short period of time you should make an appointment with your doctor (GP) to discuss this. The doctor will then make a diagnosis and discuss a treatment plan with you and explain what your child has. If the doctor feels it necessary, he may suggest referring your child on to secondary care to see a specialist in skin problems, this will be a dermatologist. However, if this is not the case, your GP may feel happy that your child’s problem can be controlled and managed in their care, prescribing topical creams to help clear the condition up.  

Should you after a reasonable length of time feel you would like to consult a specialist about your child’s problem as it does not seem to be responding to treatment, then you can request a referral to secondary care.

What is secondary care?

Secondary care is usually when your GP refers you to a hospital, or specialist centre to be seen by a consultant dermatologist, who is a doctor trained and specialising in skin conditions, and will be better placed to give advice on treatments that your child requires. More potent medications/treatments are only available at secondary care level. Your child will have a thorough assessment of their condition and confirmation of existing diagnosis made or further tests advised if thought needed. In many cases you will be referred back to your GP with a treatment plan.

What questions should I ask my doctor or healthcare provider?

Always get your concerns answered about any treatments that your child is about to be given. Ask about any side-effects – both short and long-term. If you feel that you will not be able to comply with a treatment regime because it is too complicated, time consuming or feel it is unacceptable for your child, as it may be too distressing for them tell your doctor or healthcare provider.  

A programme that suits you and your child is essential to ensure good compliance and results. Remember you know your child and you know what is achievable at home, lifestyle also plays a vital part in compliance with medication. If it is too sticky or has to be applied very early on a cold winters morning  it is not going to do anyone any good, but cause more stress for all, so a good treatment plan is important. Ask your doctor or healthcare provider for alternative formulations which are cosmetically more acceptable, or maybe see if you can use treatments once a day.

How do I tell difference between psoriasis and eczema?

Psoriasis which is rare in young children will show itself in most cases as raised red patches, covered by overlaying silver scales which may be flaky when touched.
In eczema the colouring may appear different, more pink than angry red, and its texture will be rougher to the touch. They are hard to the untrained eye to diagnose and so a correct diagnosis is necessary from a doctor.If you cannot see a doctor quickly, then speak to your pharmacist who may be able to examine your child and advise you on what would be safe to use to comfort your child’s skin without doing any harm or cause any more discomfort.

Can my child have both psoriasis and eczema?

Yes, it is possible to have both psoriasis and eczema particularly when they appear on the face and the term sebo-psoriasis may be used. You should always get the correct diagnosis from a dermatologist if this is the case so that the best course of treatments can be prescribed for your child.

Can my child’s psoriasis be controlled?

Yes, once correctly diagnosed you and your health team will devise an appropriate healthcare plan for your child.

What are the treatments for psoriasis in children?

Generally those used in children are the same as for adult psoriasis, although there may be dosage differences and some products might not have a licence for use in children.
Go to treatment section for full list.

In general, doctors try to control psoriasis in children with topical treatments because they are the safest. Occasionally they may use UV light or systemic treatments. The therapeutic needs of each individual, child or adult, are different. Your doctor is in the best position to decide what is the best treatment for you or your child. He will always come to that decision by weighing up the relative risks and benefits involved in each possible treatment. Once you and your child have agreed a treatment plan with your doctor it is important to follow it through even though it can be hard work and frustrating. Medicines can only be effective if they are used according to instructions.

How long will the treatments take to work?

You must be aware that psoriasis treatments can take time to work effectively, and it may take some time to find the treatments that work best for your child in collaboration with your healthcare professionals. Good compliance is essential to ensure good treatment results for your child.

Will my child always have psoriasis?

Probably yes, but with correct management you and your child can ensure that it is controlled. Also you should be aware that psoriasis can go into remission (disappear) for periods of time for no apparent reason. Every person is an individual with their own bodily cycles. You will learn what triggers flare-ups and what treatment work best for your child.

Remember: your child may only have a few tiny patches at a time, and not overall coverage, or large patches to treat, and there will be periods where they may have none at all – psoriasis waxes and wanes.

There will be times your child may go for long periods trouble free and there will be times if they get stressed, for example around exam times in school, their psoriasis may flare-up, but as you learn together about this condition, and live with it, it will become easier f to cope and deal with, and become part of normal life.

Can I predict a flare?

Although psoriasis is unpredictable, there might be triggers that you notice that cause it to flare. It may even be as your child gets older, their psoriasis becomes milder. There is no way of predicting what it is going to do next, or pre-empting the next flare-up, so worrying about it will not change things, your child may pick up on your concerns and anxiety thus causing them distress which could then cause a flare-up. So a laid-back, relaxed approached where possible will help.

Your healthcare professionals are there to support you too, as well as prescribing treatments, so talk to them about any concerns you have, this could be the difficulties you have with applying the treatments to your child, they might be able to alter things or give you tips on how best to approach the current problem.

Does psoriasis itch?

Although some people will claim that psoriasis does not itch, most people who have it, will say it does and this can be very distracting and uncomfortable for any person with psoriasis, especially a child. Moisturisers can help soothe such irritation but always ask your doctor or pharmacist first to see if such products are suitable for your child.

Can diet affect my psoriasis?

There is no clear link between what you eat and severity of the psoriasis symptoms. A healthy diet is important for well-being and can reduce your child's risk of many long term illnesses. If you are worried about your child's diet then talk to your doctor.

What can I do to help?

Psoriasis can affect both you as parents emotionally as well as physically, and this is especially true of children. It may influence their social life, performance in school, leisure activities, confidence and self-esteem.
As a parent you may feel guilty or unable to cope, and feel frustrated at times that your child does not understand how important it is to carry out or comply with their treatments so great patience is needed .

So you can help your child to cope with psoriasis by explaining that:

• It is not catching
• it is a common skin problem and they are not alone
• you love them just as much with psoriasis as you did before
• it is not anyone’s fault
• it is not due to lack of cleanliness  
• it is important to persevere with treatments because they can control the disease

Make their treatments as normal as possible so that it will be  part of their daily structure; this will prepare them for dealing with things more easily and naturally as they get older

Can psoriasis cause pain?

If you child has psoriasis on parts of their body, especially their feet or hands, bear this in mind, as sometimes it may hurt them. This could be because they have scratched the lesions and made them sore, the medication has caused some irritation, even down to the weather temperatures. Cold weather can make the skin really sore and so anything against the skin may irritate and cause pain. Perhaps slightly bigger shoes for periods when their feet hurt may allow some comfort.  In the summer the heat may make their feet sweat, this again can cause some discomfort, so perhaps keeping them as dry as possible with some talcum powder may prove useful.

With their hands, the temperature and weather can play havoc too. Cold weather, dry, sore, even cracked skin, causing tightness will bring discomfort so be aware of this and try to encourage them to wear gloves and keep their hands well moisturised to help prevent cracking and soreness. In the summer, moisturising their hands keeps them in good condition avoiding the drying out and cracking of skin. Never a good idea to scratch patches, as this leads to possible infection, bleeding and pain, so if you can, discourage them from scratching.

What is the best clothing to wear?

Loose fitting cotton clothing is probably the most comfortable, especially during the summer months. If wearing synthetic clothing such as football tops, these could be worn over cotton clothing so as to avoid any possible irritations.It is best sometimes to be guided by your child and how their skin feels during a flare-up.

Some topical treatments can be messy, and some can cause staining, and so this needs consideration when wearing good clothing, and indeed sitting on household furnishings. Always read product/patient instruction leaflets before use. Set aside some old clothes, night bedding, etc if you are to be using messy treatments.

Will psoriasis cause my child to be emotional?

Many children if young will accept their skin problems as a matter of course, whilst others, depending on their age of onset may take their conditions differently and feel embarrassed, upset, angry, stressed or even depressed. They may feel anxious about recurring flare-ups once they’ve experienced good periods of remission, and become pre-occupied and distracted from normal daily activities. As they grow up, possibly pre-occupied with their body, body image and peer pressure, their psoriasis may become more of an issue for them. Love, support, encouragement and trust in their medical team too will help overcome such stressful periods in their lives. Parents should always be understanding and aware of such issues especially if their child has psoriasis and/or psoriatic arthritis.

One of the best things a parent can do for their child from an early age, or when they first get psoriasis is educate their children about the condition, answer any questions or worries they have as they arise, reassure them on a regular basis, take an interest in how they feel, monitor their psoriasis in a discreet way so not to make a big issue of it. Reassure them that there is much research going on to find a cure and easier, more effective treatments to use with better, longer outcomes of remission. It is not a contagious condition and that their friends, boyfriends and girlfriends will not catch it. Encourage them to talk openly about their condition and not to hide it.

Counselling can be helpful when people feel particularly low or in a crisis. Ask your doctor what services are available on the NHS. All are confidential and some may offer their services without charge.

Will psoriasis affect my child’s education?

There is no reason why your child’s education should be affected, but a visit to the school with your child to make sure their teacher knows the essential facts about psoriasis might help. Take leaflets and fact sheets with you to leave behind. Make sure your child feels comfortable talking about psoriasis with you and the school, so they will bring any problems to your attention. Ask the school how they will tackle any bullying issues if your child’s psoriasis is quite noticeable and devise avoidance tactics to pre-empt any possible situations occurring.

The school should realise that there will be periods when your child may not want to participate in P.E sessions during flare-ups and this should be explained to the school so that they can avoid any stressful situations for your child.

Swimming can be a particularly difficult for a child with psoriasis, as the chlorine in the water can make psoriasis patches worse than they actually are and more pronounced, so your child may become upset over this or embarrassed..

As your child gets older consider encouraging him or her with the following advice:

• Don’t stop doing the things you enjoy, like sport.
• Be positive
• Reach out to people and life - don’t withdraw and try to hide
• Aim to keep learning new skills and broaden your horizons
• Try not to take rejections personally. If others discriminate against you, it is through their lack of knowledge and fear
• Camouflage cream can help to conceal  the redness of psoriasis so it is less noticeable. Many creams are available on prescription. Go to skin camouflage page
• Learn more about your condition.
• Don’t forget to pack sun cream and a hat in their bags for warmer days
• Don’t forget to pack a tube of favourite moisturiser for hands to stop drying and cracking and itching of skin
• Don’t forget a good lip balm to protect your lips too from the sun
• Don’t forget common sense

What can I do to help an older child?

It is important that your child understands their condition, and that they treat it as normal for them, so as they grow they accept the situation in a natural way. Involve them in their treatment regimes, try to make it fun by devising games, or a reward system. Listen to them and what they say about the treatments they are using. If they say it stings, it’s too sticky, its uncomfortable, it makes them itch more these are all things you can discuss together with your doctor when you next meet, as these factors may be alleviated or other products tried. It is important that they have your support and encouragement and that they can discuss issues with you as they grow.

If your child is older approaching their teen years encourage them to explore and experiment with camouflage cosmetic creams that will help disguise bad patches that they may want to hide on a  daily basis or for a special occasion.

Relationships can be difficult, some finding it difficult to enter into relationships because they feel self-conscious. Encourage them to have more inner confidence and work on their self-esteem empowering them to feel more confident about themselves. Encourage them to talk to their friends and others educating them about this condition, that it is not catching, it can be genetic and that it is an over production of skin cells.

Will the sun help my child's psoriasis?

Those who have psoriasis find that the sun helps to improve their skin’s appearance. For some the change is dramatic, with red scaly patches almost disappearing altogether during summer months in a warm climate. Go to psoriasis and the sun.

Sunlight can help psoriasis, but sunburn must be avoided at all times. Not only is it a risk factor for skin cancer, it may precipitate the Keobner Phenonomon which is where psoriasis can form on a injury site such as sun burnt skin.

Good skin protection when dealing with the sun goes for everyone with or without the condition. Many people who have psoriasis find that sunlight during the summer helps their skin clear up so as a parent if you notice this with your child, proper, regular, viligant skin protection is paramount, whilst letting them get the benefits of the good weather and the natural vitamin D (found in sunlight) we all need to keep us healthy.

Especially taking care to promote this regime whilst they are at school, is essential, when schools in the summer months are preparing for their sports days, and children spend more time outside generally. Again some research by yourself to find a good high factor, skin sensitive sun creams, and discussing this with your doctor or healthcare team will make things easier and give you the reassurance your child is protected whilst having fun. As your child gets older teach them how to apply their own suncreams and why this is so important for them to do so.

In summary

• Remember that psoriasis is common and affects as many as 1 in 50 people
• Try to encourage your child to feel positive and concentrate on their good points instead of their skin
• Try to reduce their levels of stress and anxiety
• Try to work out what trigger factors can bring their symptoms on and avoid these
• Encourage your child to talk to someone close, or write down their feelings to let them out and don’t bottle things up
• Encourage you child to take control and visualise their skin getting clearer

Useful links:

• HMRC Child benefits OR Direct Gov website
• Anti-bullying Alliance - charity
• Education rights - Direct Gov website
• Equality and Human Rights Commission

You may wish to read the following sections on this to learn about the various aspects of psoriasis in more detail:

• About psoriasis
• Nail psoriasis
• About psoriatic arthritis
• Scalp psoriasis