Psoriasis

About Psoriasis

Psoriasis (suh-rye-uh-sus) is a non-contagious disease that causes skin cells to build up on the surface of the skin, forming itchy red patches (plaques) and thick scales. It can appear anywhere on the body but is most commonly found on the scalp, knees, elbows, and torso.

Psoriasis is a long-lasting (chronic) condition that can get better or worse seemingly at random. It may go away completely before suddenly reappearing.

For many kids, psoriasis is just a minor inconvenience; for others, though, it can be quite serious. Psoriasis can lead kids to feel self-conscious about their appearance. Sometimes that affects their emotions, and some kids may develop low self-esteem and even depression as a result.

Right now, there's no cure for psoriasis, but a number of good options are available to treat the symptoms. Lifestyle changes, such as maintaining a healthy diet and weight, also can help ease the symptoms.

Causes

Doctors aren't sure why people get psoriasis, but they do know how the disease works. White blood cells known as T lymphocytes or T cells are part of the immune system. They travel through the bloodstream fighting off bacteria, viruses, and other things that cause illnesses. When someone has psoriasis, however, T cells attack healthy skin as if they were trying to fight an infection or heal a wound.

Skin cells, which are made deep in the skin, normally take about a month to rise to the surface, where they die and are sloughed off. When psoriasis triggers T cells to attack healthy skin, the immune system responds by sending more blood to the area and making more skin cells and more white blood cells. This forces skin cells to rise to the surface in a few days instead of a month. The dead skin and white blood cells can't be shed quickly enough, and they build up on the surface of the skin as thick, red patches. As the skin cells die, they form silvery scales that eventually flake off.

Psoriasis isn't contagious. Some people inherit the genes that make them susceptible to having it. About 40% of people with psoriasis have a family member who also has the disease.

Risk factors that can increase the chances of psoriasis outbreaks include:

• Infections. Strep throat, colds, and other infectious diseases trigger the body's immune system to respond, making a psoriasis outbreak more likely.
• Obesity. The plaques that are produced by many kinds of psoriasis often develop in folds of skin.
• Certain medicines. Lithium, beta-blockers for high blood pressure, and drugs used to prevent malaria have been shown to increase the risk of psoriasis.
• Stress. High stress levels can have an effect on the body's immune system and can make psoriasis symptoms worse.
• Skin irritations. Cuts, scratches, sunburns, rashes, and other irritations that affect the skin can make a psoriasis outbreak more likely.
• Cold weather. In the winter, kids generally spend more time indoors and get less sun. A moderate amount of direct sunlight can help to improve psoriasis.

Symptoms

People with psoriasis will most likely experience one or more of the following symptoms:

• raised red patches of skin that can have silvery scales on them
• dry, cracked skin that may bleed at times
• itching, soreness, or a burning sensation in the affected area
• thick, pitted fingernails

There are many different types of psoriasis that each have their own symptoms. Some of the more common types of psoriasis include:

• Plaque psoriasis. This is by far the most common type of psoriasis. It causes the skin to be covered with dry red patches (plaques) and silvery scales. Plaques can appear anywhere on the skin but most often occur on the knees, elbows, lower back, and scalp. They can be itchy and painful and may crack and bleed.
• Guttate psoriasis. This most often affects people younger than 30 and often shows up following an illness, especially strep throat. It causes small red spots to appear on the skin, usually on the trunk, arms, and legs. Spots can also appear on the face, scalp, and ears or where someone had plaque psoriasis.
• Pustular psoriasis. This type of psoriasis causes the skin to become red, swollen, and covered with pus-filled bumps. Usually, this occurs on the soles of the feet or the palms and fingertips, but can sometimes cover large areas of the body. This is known as generalized pustular psoriasis, which can sometimes be accompanied by fever, chills, severe itching, and fatigue.
• Inverse psoriasis. This type of psoriasis causes smooth, raw-looking patches of red skin that feel sore. The patches develop in places where skin is touching skin, such as the armpits, buttocks, upper eyelids, groin and genitals, or under a woman's breasts.
• Erythrodermic psoriasis. This type of psoriasis is rare. It can cause the entire body to be covered with a bright red rash that makes the skin look as if it has been burned. This is often accompanied by intense itching and pain, a fast heartbeat, and an inability to maintain a proper body temperature.

Diagnosis

Usually, diagnosis of psoriasis is fairly straightforward. The doctor will physically examine your child's skin, scalp, and nails and ask you and your child some questions. The doctor may ask if anyone in your family has psoriasis and if your child recently had an illness or started a new medication.

On rare occasions, the doctor may remove a skin sample (a biopsy) to examine it more closely. A biopsy can tell the doctor whether it's psoriasis or another condition with similar symptoms.

Treatment

There are lots of ways to treat psoriasis, and different things work for different people. Be sure to talk with a doctor to figure out what treatments work best for your child.

Psoriasis treatments fall into three categories:

1. Topical treatments are creams, lotions, and ointments that are applied directly to the skin. This includes moisturizers, prescription corticosteroids and vitamin D creams, and shampoos made with salicylic acid or coal tar. Topical treatments can effectively treat many types of mild to moderate psoriasis, but can be a little messy.
2. Light therapy (phototherapy) involves using natural or artificial ultraviolet light to treat the psoriasis symptoms. A doctor may recommend brief daily exposure to the sun, but too much sunlight can make psoriasis worse. More aggressive forms of light therapy include using controlled doses of ultraviolet light on the affected skin, laser therapy, and therapies that combine ultraviolet light with medications and topical treatments.
3. Oral or injected medications are used to treat severe psoriasis or psoriasis that resists other treatments. They include pills, shots, and medications given intravenously (through an IV). Some of these treatments can have serious side effects and might be prescribed for short periods of time only.

A doctor might try one therapy and then switch to another, or recommend a combination of therapies. It's not always easy to find a therapy that works, and sometimes what works for a time will stop working. It's important to work closely with the doctor to stay on top of your child's treatment.

Things You Can Do at Home

In addition to following your doctor's advice, you can help your child make healthy lifestyle choices:

• Serve healthy foods. Eating a lot of fruits and vegetables can help fend off diseases that might trigger psoriasis.
• Help your child stay at a healthy weight. This decreases the risk of inverse psoriasis.
• Remind your child to keep skin clean and well moisturized. Bathing daily with bath salts or oils and then applying moisturizer can help ease the symptoms of psoriasis.
• Spend time outdoors. Limited amounts of natural light can help with psoriasis.
• Give your child emotional support. Many kids who are experiencing emotional problems due to their psoriasis can benefit from talking with a therapist or joining a support group of people who understand the challenges psoriasis presents.

Most psoriasis will respond well to treatment, but it's important to stay on top of it. If your child should apply an ointment twice a day, remind him or her to do so; if a little more sun is recommended, join your child for a daily walk. Your efforts, and your child's, will help control psoriasis symptoms.

Reviewed by: Patrice Hyde, MD
Date reviewed: December 2011