Psoriasis

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, most patients do not have anyone in the family with it. On the other hand, some family members who have psoriasis do not realize they have 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. The best success requires paying careful attention to the details of the treatment program.

 

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.

 

Anthralin

 

Anthralin is an old but good treatment for stubborn patches of psoriasis. The cream is left on for 5 to 10 minutes, and then washed off with Dove® soap (pH 7.0). This is called "short-contact anthralin therapy"' or SCAT. The soap neutralizes changes in the medicine when exposed to air. Leaving anthralin on too long will result in red and sometimes tender skin.

 

Coal Tars

 

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. Newer narrow-band UVB lights are not widely found but will clear the skin in a shorter period of time.

 

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.

 

Photochemotherapy

 

Long-wave ultraviolet light (UVA) can be used when the person is given a pill (psoralen) that makes him or her very sensitive to long-wave ultraviolet light (PUVA). The pill often makes a child feel sick to his stomach. The child must avoid sunlight for 24 hours after taking the pill. Twice weekly treatments are recommended. There is a risk that this treatment promotes skin cancer. It should rarely be used in children.

 

Methotrexate

 

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

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 06/18/2009

Copyright © 05/01/2009 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. UWH #6477

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