Is psoriasis a problem in children ?
-In 27% of cases, psoriasis presents before the age of 16. In 16% of this the skin condition presents before 1 and in a quarter of cases, before the age of 2.
-It represents 4.1% of skin conditions seen by dermatologists in this population group
-Like in adults, the more North you go, the higher the prevalence. Indeed in Germany the incidence is higher in the Northern half of the country when compared with the South.
Which areas are most often affected ?
-The scalp is involved 58% of the time
-The face is involved in 47% of cases
What else should one think about ? (Differential diagnosis)
-In scalp involvement, tinea capitis. eczema and seborrheic dermatitis should be considered
-In other areas the differential diagnosis includes: eczema, lymphoma, eczema, other causes of intertrigo, hand dermatitis, B-cell lymphoma
What types of psoriasis do children have ?
–plaque type in most cases = 90%
-guttate type = 10%
-Inverse, pustular and erythrodermic types each account for less than 5% of cases
How often are nails involved ?
-Nail involvement occurs in 20% of cases
What autoimmune diseases are present in children with Psoriasis ?
–Alopecia areata occurs in 15% of patients with psoriasis (Other autoimmune skin conditions are less frequent but can occur concurrently)
Systemic associations in Children with Psoriasis
–Metabolic syndrome is also present in young patients and should be looked for. As a reminder features of metabolic syndrome include obesity, insulin resistance and a disturbed lip profile
Particularities of psoriasis in children
-Clinical presentation tends to be severe
-A family history is often present
-Anxiety and depression need to be looked for
Who manages Psoriasis in children ?
-63% of patients are managed by dermatologists
-17% are managed by pediatricians
-14% are managed by internal medicine doctors
What are the treatments used in children with psoriasis ?
–topical corticosteroids are still the mostly used method of treatment
-phototherapy: NBUVB but modalities are often avoided (PUVA defintately is a No…no)
-Systemic treatments include retinoids (other options include fumaric acid and/or etanercept are furhter options…ustekinumab appears to be a viable treatment aletrnative). MTX is avoided
-biologics are sometimes used in severe forms: etanercept is the safest, so is infliximab. Studies have shown a safe profile for adalimumab but in practice it is hardly used (according to some studies)
Itin P. Psoriasis in Children and Teenagers. Swiss Psoriasis Day 2015 – Bern, Switzerland