The good news is that psoriasis,
in general, will not affect your child's health, growth
or development. With the proper treatment, especially
for the majority of children with mild disease, this
condition can be well controlled and will have little
impact on their emotional and physical health. In children
with more severe, extensive and chronic or persistent
forms of psoriasis, it is important to realize that
there are many new treatments being investigated, and
that the future for effective control of psoriasis has
never been brighter.
What Does Psoriasis Look
Like in Children?
Psoriasis can begin at or shortly
after birth but in most children it usually does not
occur until school age. A family history of the disorder
is quite common. When present in babies or infants,
it commonly starts in the diaper area (napkin psoriasis)
and can spread elsewhere on the body. In children, psoriasis
can develop as small, flat or raised, red, discrete
areas that develop a thick, silvery scale. These small
areas can join to form raised, thick, scaling plaques
with a sharp border separating involved and uninvolved
skin. Common sites involved include the scalp, ears,
elbows, knees, buttock crease, genitals and nails. The
most common form of psoriasis in children is chronic
plaque-type psoriasis, with raised, thick, scaling areas.
Psoriatic arthritis is quite rare in children.
In up to one-third of cases in
children, the initial development of psoriasis can involve
multiple, small, teardrop-shaped, scaling, raised lesions,
known as guttate psoriasis. Children might experience
an outbreak of guttate psoriasis following a cold (upper
respiratory infection), most commonly a bacterial infection
of the throat (streptococci pharyngitis or "strep
throat"). Occasionally, a bacterial infection (streptococci)
of the rectum can lead to a flare of guttate psoriasis.
Also, if the child is prone to tonsillitis, psoriasis
could recur with future cases of tonsillitis. Guttate
psoriasis most commonly affects the back, abdomen, arms
and legs. While a child might have a fever with a bacterial
infection, it is unusual for children to have a fever
with psoriasis.
In children, as in adults, psoriasis
can develop at the site of an injury (Koebner's phenomenon).
Psoriasis can occur in a straight line along a scratch
or appear after abrasions, cuts or insect bites. This
information can be a helpful clue in diagnosing psoriasis.
Scalp involvement is very common
in children. Thick, scaling, raised lesions can involve
either localized areas of the scalp, such as behind
the ears and/or along the hairline, or the entire scalp.
This can result in the shedding of white scales from
the scalp, commonly mistaken for dandruff.
The genitals are also frequently
affected in children, particularly babies and infants.
The penis, groin, buttock crease and labia are common
sites of involvement. The fingernails and toenails might
also be involved. The nails may become pitted or rough,
and the distal part of the nail can become quite thick
and crumbly. Lifting of the nail from the surrounding
skin can also occur (onycholysis). Occasionally in children,
all 20 nails may be involved.
Other forms of psoriasis seen
in adults, such as erythrodermic and pustular psoriasis,
are less common in childhood.
With treatment, psoriasis
can be controlled effectively in children.
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