Psoriasis is one of the most common skin problems and affects 1 to 3% of people. It appears as inflamed areas of overgrown skin, topped with white scale. Up to 37% of people first get it as a child. Most get it during their teenage years. Psoriasis is a chronic problem that comes and goes for no clear reason. Although many patients report that another family member has psoriasis, many patients do not have anyone in the family with it. Psoriasis is not contagious. Most people with psoriasis have a very mild skin condition. Often people only have with a few scaly skin spots in the scalp or on the elbows and knees.
Factors That Make Psoriasis Worse
- Sore throats caused by streptococcal infections may result in dozens of small skin spots of psoriasis, called "guttate psoriasis." A throat culture is needed for a sore throat or exposure to streptococcal bacteria. If the culture is positive for Streptococcus species, prompt antibiotic treatment is advised.
- Damage to the skin from abrasions, scratches, or picking off the scale will bring out more psoriasis. This is called the Koebner phenomenon. That may explain why we see most lesions of psoriasis at areas of trauma, such as the scalp, the elbows, knees, and buttocks.
Have your child put extra moisturizer on the skin. This will help your child avoid picking the skin.
- Certain prescription medicines may make psoriasis worse. This includes cortisone shots or pills, beta-blockers, or lithium. Try to avoid having your child take these.
Treatments for Psoriasis
There is no cure for psoriasis, but there are many treatments that work well to control the problem. The treatments often require 4 to 6 weeks to show improvement or clearing.
Steroid Creams and Ointments
For certain types of psoriasis, steroid creams or ointments are the most common treatment. Over-the-counter (OTC) cortisones do not work well. Your doctor may prescribe a medium or high strength steroid to treat it.
Vitamin D3 Cream and Ointment
For many patients, twice-daily use of a vitamin D3 cream or ointment (Dovonex®) helps clear psoriasis. It can irritate the skin in some children. A few complain of stinging when applied. The cost is expensive.
Coal-tar ointments have been used to treat psoriasis for 150 years. They work well but are smelly and stain the skin, clothing, and bathtub. Your doctor can suggest a product and a treatment routine. They are often used at bedtime and washed off in the morning. Using the same sleep wear each night is advised.
Retinoid Creams and Ointments
Tazorac® ointment may be applied to the skin once daily for the treatment of psoriasis. It works best when a few thick areas of psoriasis are present. It can be quite irritating. It helps to use cream or lotion daily to reduce the drying and irritating effects of the drug.
Sunlight and Ultraviolet Light Treatments
Sunlight has been known to improve psoriasis since the times of the ancient Greeks. Using mineral oil on the skin just before being exposed to sunlight allows the light to evenly penetrate the skin. The scale of psoriasis normally reflects light rather than absorbing it. Light treatments work slowly. Sunbathing three times a week or using artificial UVB sunlamps three times a week requires 25 to 30 treatments for clearing the skin. Although sunlight is often very helpful for patients with psoriasis, sunburn can result in many new lesions at the sites of the burn. Also, too much sunlight can cause premature aging of skin, eye damage, and, later in life, skin cancers. For safety, ultraviolet light must be used in a medical setting.
Methotrexate is a strong anticancer drug that is used for children with the most severe forms of psoriasis. It is taken once weekly. Periodic blood tests will need to be taken.
This material is partially duplicated from Weston WL, Lane AT, Morelli JG: Cc/or Textbook of Pediatric Dermatology ed 3, St Louis, Mosby.
UW Dermatology Department
1 S. Park St 7th Floor
Madison, WI 53715
Clinic: 608 287-2450
American Family Children’s Hospital
Pediatric Dermatology Specialty Clinic
1675 Highland Ave.
Madison, WI 53792
Clinic: 608 263-6420
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Last Updated: 01/22/2013
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