It affects 1-2% of children. Although it is possible to observe long periods of remission, during which the lesions disappear completely, this condition can have profound psychological and social effects on children and adolescents, regardless of the severity of the symptoms
When a parent notices red, scaly patches on their child’s skin, the first reaction is often concern. One wonders whether it is an allergy, an infection, a fungus or simple dermatitis. Sometimes, behind these signs, there can be psoriasis, a skin disease that not only affects adults but can also appear in children, sometimes already in the first months of life.
Psoriasis in newborns, as well as psoriasis in children in general, is a fairly frequent condition. It is not contagious but is a chronic disease, that is, destined to accompany the child for a more or less long period of life. This does not mean that we cannot live well: today, in fact, we have many effective therapies that allow us to reduce the symptoms of this condition, control it and improve the quality of life of those affected.
What is psoriasis
Psoriasis is a chronic inflammatory skin disease, meaning it tends to recur over time. It affects approximately 1-2% of children and is characterized by the appearance of well-demarcated red patches, covered with white or silver scales. These lesions can appear in different areas of the body and take on different appearances, localizing themselves above all in areas where the skin suffers small and constant traumas.
At the base there is a mechanism of excessive “acceleration” of normal cell turnover. Normally, skin cells renew themselves every three to four weeks. In psoriasis, however, this process occurs in a few days: the cells accumulate, the skin thickens and the typical silvery-white scales appear.
In children, psoriasis can present itself in particular forms, sometimes more difficult to recognize than in adults. Furthermore, children’s skin is more delicate, and this makes the disease more impactful on daily life.
Symptoms of psoriasis in children
The onset of psoriasis is generally slow and progressive, but there are cases in which the lesions appear very quickly. The symptoms of psoriasis are not always the same: they depend on the type of condition, the age of the child and the location of the lesions. Some signs, however, are very common:
- Well-defined red patches, often with clear edges, which are covered with whitish or silvery scales that come off easily when scratched. The plaques can be small, but they can also take on large dimensions, up to 20 cm. They are generally located on the elbows, knees, head, ears, hands, armpits, groin, intergluteal region.
- Itching, which can disturb sleep and play. In pediatric age it is a very frequent symptom.
- Pain or discomfort, especially if the lesions are in areas subject to rubbing, such as elbows, knees, armpits.
- Changes in the nails, with spots, fragility or thickening.
In younger children, the lesions may resemble those of atopic dermatitis, but psoriasis often has sharper edges and tends not to improve with common treatments for sensitive skin.
There are rare cases in which psoriasis can also be associated with other more important symptoms, such as arthritis, fever or fatigue.
Another aspect to consider is the “wave” progression: psoriasis can appear and last weeks or months, regress even without treatment and then reappear later. This unpredictable pattern is often a source of frustration for parents, who feel helpless in the face of an illness that seems to come and go for no reason.
Causes of psoriasis in children
Psoriasis is a multifactorial disease: it means that it does not have a single cause but derives from multiple interacting elements. That is to say:
- Genetic predisposition. Psoriasis tends to run in families. If one of the parents suffers from it, the risk for the child is higher.
- Immune system. Psoriasis is considered an “immune-mediated” disease. Some of the body’s defense cells activate abnormally, as if there were an infection to fight, stimulating the skin to produce excess cells.
- Triggering factors. In children they are often respiratory tract infections (especially streptococcal), small skin traumas (rubs, scratches or small wounds), emotional stress, climatic changes or certain medications.
It is important to remember that psoriasis is not linked to poor hygiene habits, it is not caused by diet and it is not contagious.
Diagnosis of psoriasis
The diagnosis is clinical, that is, it is based on the observation of the lesions by the pediatrician or dermatologist. In most cases, invasive tests are not necessary. Sometimes a specialist visit can be useful to distinguish psoriasis from other dermatitis, such as atopic dermatitis or seborrheic dermatitis, given that they can be very similar in both form and progression.
When the lesions are very atypical, a small skin biopsy may be necessary, but this is rare in children. In some cases, if a streptococcal infection is suspected as the trigger, a throat swab may be required.
Forms and localizations of psoriasis in children
Plaque psoriasis
Also called “vulgaris psoriasis”, it is the most frequent form in pediatric age (35-85%). It presents the characteristic plaques on various locations of the body, specifically:
- Scalp psoriasis. In children it manifests itself with scaly plaques in the hair. It represents the most frequent form of plaque psoriasis. It can be confused with dandruff or seborrheic dermatitis, but the scales of psoriasis are thicker and whitish. It generally does not lead to alopecia (hair loss) but often causes itching.
- Psoriasis of the elbows and knees. These are very common areas in children due to constant rubbing. Plaques can become hard and uncomfortable.
- Facial psoriasis. Less frequent in children, but very impactful, the lesions are clearly visible, often localized to the auricles and can affect the child’s self-esteem.
- Diaper psoriasis. In children it can present itself in the first months of life. It manifests itself as a persistent redness in the area covered by the diaper, which does not improve with normal creams. Multiple episodes may occur with relapses and improvements. It is important to distinguish it from common diaper rash as it requires different treatments.
- Nail psoriasis. Rather frequent in adults but also visible in children. It can cause small dots on the surface of the nails like a “sewing thimble,” thickening, salmon-colored patches, or brittleness. In children it can be a source of discomfort, especially at school or during sporting activities.
- Psoriasis of the feet and hands. Rare in pediatric age, it can cause painful cracks, which limit running and playing.
Guttate psoriasis
It is a typical form in children. It represents the second most frequent form in childhood. It presents with many small red spots scattered on the trunk, arms and legs. The appearance of the lesions is quite rapid, in about a week. It is often associated with a streptococcal infection (occurs in approximately 2% of infections). Although it can be scary, it tends to regress over time or following antibiotic therapy. It can be confused with other exanthematous diseases.
Minimal psoriasis
In some children it presents with very small lesions, localized in a few areas. Even if less obvious, it still needs to be followed and treated.
Psoriasis in children: care and treatment
The treatment of psoriasis depends on the severity, location and extent of the condition. In general, skin manifestations last from weeks to months. Relapses are also unpredictable and are often not caused by any particular event. There is no definitive cure, but there are many treatments that help control the disease:
- Local therapies. Exfoliating keratolytics (to remove scales), moisturizers, cortisone creams and vitamin D derivatives are the most used treatments. Emollients are key to keeping skin soft and reducing itching.
- Phototherapy. Ultraviolet light, administered in a controlled environment, can improve psoriasis. It should not be confused with normal sun exposure, which has variable effects.
- Systemic therapies. In more severe or resistant cases, especially in adolescents, drugs that modulate the immune response are used (such as methotrexate, ciclosporin or biological drugs). These therapies are always managed by specialists and require regular checks. If a concurrent streptococcal infection has become evident, antibiotic therapy is necessary to eradicate both the infection and the psoriasis.
- Daily support. Baths can help relieve itching and remove scales. They should be lukewarm and last a maximum of 10 minutes. Daily hydration, avoid scratching and rubbing, treat infections promptly.
Each therapeutic plan is tailor-made: there is no valid approach for all children, but it must be adapted to the severity, location and impact of the disease on the child’s life.
Psychological impact on children and adolescents
Psoriasis is not limited to the skin. It can have profound psychological and social effects on children and adolescents, regardless of the severity of the disease.
Affected children often report a reduced quality of life due to embarrassment, itching, sleep disturbances, limitations in daily activities, and treatment-related difficulties.
Especially in adolescents, it can become a source of shame or isolation. Boys may feel different, refuse to wear short-sleeved shirts, or avoid sports activities. Furthermore, psoriasis in young people is associated with an increased risk of several metabolic and autoimmune diseases such as hyperlipidemia, obesity, hypertension and diabetes mellitus.
This is why emotional support is essential. Talking to the child, explaining to him that he is not to blame, involving teachers or sports coaches can make the difference. In some cases, psychological support may be useful.
Today there are also associations and support groups that help families to confront each other and feel less alone.
Can childhood psoriasis be cured?
Psoriasis is a chronic disease, so there is no definitive cure. However, in children it is possible to observe long periods of remission, during which the lesions disappear completely. Some children have isolated episodes that never recur.
The important message is that with appropriate treatments, psoriasis can be effectively controlled, allowing the child to lead a normal, unrestricted life.
