Do Children Get Psoriasis, And Does It Go Away?

Yes, children can get psoriasis. Although psoriasis is less common in children, and may appear differently than in adults, children can get psoriasis. Among adults with psoriasis, 30% to 45% had the onset of their dis-ease before age 20.

Psoriasis is slightly more common in boys than in girls, and almost 70% of children who get psoriasis have family members with psoriasis. For reasons that are unclear, psoriasis often first appears in the fall.

Although children and young adults may get any type of psoriasis, one type found almost exclusively in children or younger patients and young adults is guttate psoriasis (see color plate C). Guttate is Latin for rain-drop and describes the small, 0.25- to 0.5-inch (0.64-to 1.3- cm) psoriasis spots that are scattered over the body like raindrops.

Unlike other types of psoriasis, guttate psoriasis is often associated with an infection and resolves when the infection goes away. An infection causes an overactive immune reaction, where T cells become activated in the skin in different spots in addition to the infection.

In children, the most common infections are pharyngitis (infection of the throat), dermatitis (skin infection), and ear infections. A pediatrician or pediatric dermatologist, after recognizing the infection, will look for the infectious source and begin treatment with antibiotics. If antibiotics treat the infection properly, the skin lesions can resolve in weeks or months. If the infection returns, or a new infection develops, the guttate psoriasis may return and can be treated the same way.

Fortunately, guttate psoriasis is not always associated with the chronic plaque-type form usually seen in adults. A childhood episode has not been proven to increase or decrease the lifetime risk of acquiring common adult forms of psoriasis. However, a study conclusively proving or disproving a relationship has not yet been done.

In addition to guttate psoriasis seen after strep infection, children can get all forms of psoriasis. In children, psoriasis is often confused with diaper rash, eczema, a yeast infection, or cradle-cap (seborrheic dermatitis). Over time, the diagnosis can usually be made by the skin’s appearance, and in most cases a skin biopsy is not needed.

In children, psoriasis affects the scalp about half the time. Children who get psoriasis are more likely than adults to have psoriasis on the face and on the nails.

Treatment options for children are the same as those for adults, but greater care must be taken to minimize side effects. Particularly when using topical medications, the degree of systemic absorption can be higher in children. In general, children should avoid using super-potent topical steroids, especially over long periods of time.

Treatment considerations are sometimes different than in adults because the side effects of some medications in a growing child may be different than in older people. Challenges particular to children and teens with psoriasis often revolve around appearance issues and consistent use of treatment.

Resources such as the National Psoriasis Foundation have dedicated message boards and online chat rooms for children, teens, and their parents to interact with other people with psoriasis.