Psoriasis is a disease that causes itchy, dry patches on your skin. Up to 40% of people with psoriasis have symptoms before they’re 16 years old, and 10% get it before they’re 10.
Psoriasis is a lifelong condition with no cure, but you can treat the symptoms with medication. Children can have mild, moderate, or severe psoriasis, but most pediatric cases are mild and get better with treatment.
Psoriasis isn’t contagious. While it’s not known exactly what causes psoriasis, scientists confirm that it’s likely due to an overactive immune system and genetics. Often, an autoimmune response to something like a bacterial infection such as strep throat can trigger psoriasis for the first time in children. Some kids get certain genes from their parents that make them more likely to get it.
Other things that may trigger or worsen psoriasis in children include:
- High body mass index (BMI)
- Emotional stress
- Second-hand smoke exposure
- Changes in weather, especially cold weather
- Cuts, scratches, sunburn, or rashes on the skin
- Infections
- Certain medications
Types of Psoriasis in Children
There are many types of psoriasis, but some are much more common in children than others. The symptoms can show up differently in children, too. For example, they’re more likely to have psoriasis on their face or around joints.
The types that children are most likely to get are:
Plaque psoriasis
Most kids who have psoriasis have this type. It causes red, dry patches called plaques. It can also cause silvery scales. The plaques or scales usually show up on the knees, elbows, lower back, and scalp. They’re itchy, red, and sometimes painful. They can also bleed. Plaque psoriasis patches are smaller, thinner, and less scaly in children than in adults.
Guttate psoriasis
A sudden eruption of “drop-like” spots on the trunk, back, arms, and legs that appear about one to two weeks after a sore throat or strep infection is a classic sign of guttate psoriasis in children. Many children who get this type of psoriasis also get plaque psoriasis.
Psoriatic diaper rash
Children under 2 years of age can get psoriatic diaper rash. It happens on the skin that’s covered up by the diaper. It may show up like plaque psoriasis, or it may cause a bright red, weeping rash. You can tell the difference between psoriatic diaper rash and regular diaper rash because psoriatic diaper rash doesn’t get better with regular diaper rash treatment.
Less Common Types of Psoriasis in Children
Kids aren’t likely to get these types of psoriasis:
Pustular psoriasis. This shows up as blisters on red or swollen skin on the hands and feet. If a child does get it, it’s typically either milder than an adult would have or a kind called annular pustular psoriasis that causes a red ring with blisters.
Inverse psoriasis. This happens in the folds of the body: behind the knee, in the armpit, or around the groin. It looks very red, smooth, and shiny.
Erythrodermic psoriasis. This is a severe form that can be life-threatening. It causes redness over most of the body. It’s very itchy and painful and can make skin come off in sheets.
What Are the Symptoms of Childhood Psoriasis?
The first sign of psoriasis is a rash. The rash can appear anywhere, including places you may not expect, such as your scalp, behind the ears, in the groin, and the palms of your hands and bottoms of your feet. Sometimes, fingernails and toenails may be affected, too.
The rashes appear differently on different skin tones. On black or brown skin, the rashes may appear purple with gray scales. On white skin, the rashes appear pink or red with silver scales. These rashes may appear in small spots on the body or all over. Some children may find their rashes itchy, while others do not.
What’s the Difference Between Psoriasis and Eczema?
To the average person, the signs of psoriasis and eczema seem similar — an itchy rash. But doctors can usually tell the difference immediately. Eczema affects far more people than psoriasis does: 9.6 million children and 16.5 million adults in the U.S.
Psoriasis vs. Eczema
| Psoriasis | Eczema | |
|---|---|---|
| Appearance | Psoriasis may have thick, raised plaques with defined borders, covering large areas. | Eczema has thinner, smaller patches of affected skin with less defined borders. |
| Itch factor | Psoriasis isn’t as itchy as eczema, especially in children. It can sometimes feel like it burns or stings. | Eczema is extremely itchy. |
| Prevalence | About 1% of all children are diagnosed with psoriasis. | Between 10% and 20% of all children have eczema. |
| Demographics | About 3.6% of people with psoriasis are White, followed by 1.9% who are Black and 1.6% who are Hispanic. | Nearly 19.3% of children with eczema are Black compared to 16.1% who are White. |
| Triggers | Psoriasis may be triggered by infections, stress, medications, and weather changes. | Eczema triggers include allergens, irritants, stress, and weather changes. |
How Is Childhood Psoriasis Diagnosed?
A doctor usually can tell whether it’s psoriasis by looking carefully at your child’s skin, nails, or scalp. To be sure, they might also remove a small sample of skin and send it to a lab for a closer look. They’ll also ask about your family history and habits to see how many risk factors your child has.
What Are the Treatments for Psoriasis in Children?
Your child’s psoriasis treatment plan is dependent on a few factors:
Disease severity. How much of their body is covered or if their quality of life is affected will determine if the doctor will choose to start your child on topical or systemic treatments.
Affected areas. Even if the affected area is small, it may still be considered severe psoriasis depending on the area. These include your face, genitals, and hands and feet. In these situations, your child’s doctor may choose to treat the psoriasis more aggressively.
How they respond to treatment. Doctors aim to reduce your child’s psoriasis to less than 1% of their body surface area. If that is not achieved within three to six months of treatment, they may opt to increase dosages or switch to something new.
Treatment options for children with psoriasis
Pediatric psoriasis treatments may include topicals, light therapy, as well as systemic and biologic medications. Some treatments approved for treating adults with psoriasis have not yet been approved for children. Your child’s doctor may prescribe these medications “off-label.”
Topical treatments. Most children have mild psoriasis that you can treat with creams, lotions, ointments, foams, bath solutions, shampoos, and more. These help moisturize and soothe the skin, remove scales, and ease itching. While some need to be prescribed, others are available over the counter. These may be used alone or in combination with other treatments.
Light therapy. Your child’s doctor might choose light therapy (or phototherapy) if plaques are on most of your child’s body. The types include artificial light (ultraviolet [UV] light) and laser therapy. But these treatments are known as “second-line,” meaning your doctor will likely try a topical treatment before light therapy.
Systemic and biologic medications. Your child’s doctor will probably recommend medicine to take by mouth or shot if your child’s psoriasis is severe or has not responded to topical treatments or light therapy. These medicines target specific parts in the immune system related to psoriasis. Approved treatments for children with psoriasis include:
Your child’s doctor will discuss with you the potential benefits and side effects of any treatment they are considering. Together, you can weigh your options and choose the best treatment plan for your child.
Keeping skin moisturized is important, too. Your child’s doctor may suggest petroleum jelly to lock in moisture. Salicylic acid and urea cream may also be an option for thick plaques, but you shouldn’t use it on children under 6 years of age. If itching is a problem, they may recommend an antihistamine (a type of drug to treat allergies) as well.
Get the Most Out of Treatment
To make sure your child’s treatment has the best chance to succeed:
Find the right doctor. Look for one who regularly treats children with psoriasis. This is usually a dermatologist. Make sure you can talk with them easily. If they don’t ask for your input on what you see happening with your child, find a new doctor.
Stick to a plan. Talk to your child about how important it is to stick to the treatment schedule. You may need to apply medication a couple of times a day. Remind your child that it can take time for the treatment to work. They should take an active role in their treatment as early as possible. Even first-graders can put on moisturizers, and older kids can take full control.
Pick the right therapy. Think about your child’s age and schedule. Work with the doctor to find a therapy that works best for them.
Talk straight. Choose your words carefully when talking with your child about covering up. Some kids get used to wearing long sleeves year-round. But you don’t want your child to feel like they’re always hiding.
Build connections. Look for groups or message boards online, or ask your child’s doctor about face-to-face support groups. You can also check out summer camps for kids with skin conditions. They’re all great ways to get support, learn practical tips, and build confidence. And that goes for you, too. A chat with other parents who have kids with psoriasis can give you new insights and strategies.
Go to school. Make connections with people at your child’s school at the start of each year. It’s a good way to head off problems. Try to get confirmation from the staff about these things:
- There should be a staff member your child can turn to for help.
- Staff will watch for problems in the classroom or conflict with other students, such as teasing or bullying.
- The gym teacher won’t be surprised if your kid doesn’t want to wear shorts or can’t take part in some activities.
Psoriasis and Your Child’s Emotions
This condition can have a big effect on your child’s mood and how they see themselves. To support your child and help them feel better:
Focus on facts. Don’t focus too much on the disease. Your child should never feel bad or different for having psoriasis. Try to keep discussions about their psoriasis matter-of-fact, not overly emotional.
Talk about feelings. Teach young children to name their feelings, especially when a symptom develops. Make a “happy” and “sad” feelings word list. Some symptoms may not bother them as much as they may bother you. This can help you understand how their disease affects their mood.
Let them decide. Give your child some power over the condition. For example, let an older child have a say in treatment. They might want a cream instead of a greasy ointment. Or they could choose a phototherapy session time.
Let go. Give your child support and understanding. Recognize that as your child gets older, they may turn to friends for support instead of you. This is OK. It’s important for your child to stay connected to their peers.
Spread the word. Educate your child about the condition at an early age. Give them books or links to websites about psoriasis (preferably written by or about kids who have it), and talk about it afterward. Encourage them to ask questions during doctor’s appointments. Help them practice how to handle uncomfortable questions or comments from other kids. Your child will feel more confident with answers at the ready and may come to enjoy the chance to educate their classmates.
Be positive. Psoriasis is unpredictable. Flares can pop up anytime. Medications can stop working without warning. Your kid might be OK with psoriasis in elementary school, then flip out when middle school starts. Reassure your child that they’re going to get better.
Consider therapy. It can be a big help to any kid with psoriasis, even right after the diagnosis. Therapists can offer kids with long-term diseases practical ways to deal with daily life and issues with friends and classmates. Kids with psoriasis have a higher chance of getting low self-esteem and depression. Schedule an appointment with a therapist, such as a child psychologist or social worker, if you see that your child:
- Is cranky and angry
- Spends less time with friends
- Has changes in sleeping or eating habits
- Has problems in school
Psoriasis in Children FAQs
Can babies have psoriasis?
Newborn psoriasis, or infantile psoriasis, is not common. Only about 2% of psoriasis cases occur in the first 2 years of life. One type of psoriasis that affects babies is psoriatic diaper rash, which cannot be treated by typical diaper rash creams.
What triggers psoriasis in children?
An infection such as strep throat is the most common trigger for childhood psoriasis. Other triggers include emotional stress, obesity, second-hand smoke, and weather changes.
How do you treat psoriasis in children?
Depending on the disease severity, areas affected by psoriasis, and your child’s age, your doctor may recommend treating them with topicals, light therapy, systemic and biologic medicines, or some combination of these.
Can a child grow out of psoriasis?
Psoriasis is a chronic, or lifelong, disease. But with proper care, the disease can remain in remission for a long period.
Can sunlight help children with psoriasis?
Yes, sunlight can help relieve psoriasis symptoms in children by slowing the growth of skin plaques and reducing inflammation. But be careful not to get too much sun exposure. Sunburn can actually trigger a psoriasis flare.
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