Childhood psoriasis

Abstract

In about one third of patients, psoriasis starts in the first or second decade of life. In the beginning, involvement is often atypical or mild, and a confident diagnosis may be difficult to establish. Plaque psoriasis is the most frequent type, also in children, but lesions are often smaller, thinner, and less scaly than in adults. Treatment can be a challenge because many therapeutic options have drawbacks or are not approved in childhood. Because psoriasis is a life-long disease, affected children and their parents need special support and guidance. We herein focus on the peculiarities of clinical presentations and of the management of psoriatic children and adolescents.

Management of Psoriasis in Children: a Narrative Review

“…Therapeutic agents including beta-blockers, lithium, antimalaria, NSAID, withdrawal oral or topical potent steroids play an important role in development or rebound of psoriasis. In addition, psychological and psychosomatic factors like stress and lake of social support are effective in the disease prognosis (7). Clinical features of disease in children are different from adults.…”

“…Predisposing factors include trauma, infections such as staphylococci, streptococci, HIV and candida species, medications, stresses, cigarette smoking and alcohol. Each type of trauma such as physical, chemical, thermal, surgical and/or inflammatory injuries are thought to play a role in the progression of disease (7). Streptococcal pharyngitis or perineal streptococcal dermatitis often predisposes the development of Guttate psoriasis.…”

“…Long-term steroid therapy can lead to steria and atrophic telangiectasia, and even in rare cases, suppression of Adreno-hypophyseal-hypothalamic axis occurs. Although the use of topical steroids beneath dressing may be effective, increasing penetration of agent may increase the adverse effects (7,14). Halobetasol cream 0.05% and clobetasol propionate emulsion 0.05% seem to be efficacious treatments in childhood plaque psoriasis for two weeks.…”

“…If no sibling, one sibling or both siblings affected, the corresponding risks are 0.24%, 0.51% and 0.83%, respectively (6). The onset of disease in girls is earlier than boys (7,8). Psoriasis is a chronic cell mediated inflammatory disease characterized by keratinocyte hyperproliferation, vascular endothelial proliferation and inflammatory cell infiltration of dermis and epidermis, with many of pathogenic mechanisms not fully cleared yet (1)(2)(3)(4).…”

“…In a number of children with hand and palmar pustular psoriasis, psoralen combined with UVA (PUVA) may be indicated. In such cases, using psoralen bath is preferred to oral route (7). Although the safety of long-term use of phototherapy and chemotherapy has not been cleared in childhood psoriasis, it plays an important role in the treatment of older children with psoriasis resistant to conventional treatment, and patients with moderate to severe psoriasis with 15-20% of body surface involvement by plaque psoriasis, and in patients with palmar and plantar debilitating involvement (3).…”