Psoriasis in childhood. Psoriasis in children. Although this has been shown as a disabling disease in adults, in children it is a condition that is not only painful but incomprehensible and unexplainable to children between the ages of 0 to 5 years old.
Psoriasis is a chronic skin disease that affects between 2 to 3% of the population and manifests by red scaly spots, usually distributed symmetrically on elbows, knees and scalp in adults. In children it appears as confluent, bright red and well defined lesions, located mainly in the diaper area during the first two years of life and on the scalp and back during childhood. Although this has been shown as a disabling disease in adults, in children it is a condition that is not only painful but incomprehensible and unexplainable to children between the ages of 0 to 5 years. In fact, the word “infant” comes from the Latin infans which means "mute" and so, by extension, it acquires the meaning of "child who cannot speak".
Today we know that there are several factors that trigger the disease, for example: mechanical traumas such as rubbing, oropharynx infections, emotional factors, climate, certain medications, stress, fatigue, emotional trauma or hormonal changes. To control psoriasis manifestations, we can work on everything that causes physical damage and, especially, psychological harm. At the physical level the steps to take start “at the dinner table”, taking into account everything the child eats during the day. This information is of utmost importance.
• Eat meals rich in Omega 3, folic acid and selenium, which are found in many foods such as fish, grapes, peaches and garlic, whole grain cereals, legumes and spinach;
• Avoid or reduce the consumption of meat, fatty foods, foods with preservatives and additives; these are common ingredients in packaged snacks so it would be better to replace them with good homemade desserts such as a sponge cake. Not only will this satisfy the child’s hunger and taste buds, it will also keep them healthy;
• It is also a good idea to remember that soft drinks are rich in preservatives and additives; therefore, it’s a good idea to eliminate, reduce or replace them with lots of water that will allow the body to be more hydrated.
Just as the doctor gives the child the tools to eat healthy meals, to follow therapy properly and to practice some appropriate sport, you should make sure that your child follows an adequate lifestyle for physical and psychological benefits.
In terms of psychological aspects, psoriasis is a really difficult disease for children since they have to deal with environments such as school where people look at them all the time. They feel as if they are being watched, and so anxiety and stress increases. This triggers psoriasis and provides the conditions for making it worse.
Watch for these warning signs. They will tell you that your child has too much stress. Try to make their environment calmer.
• Excessive perspiration or flushing while interacting with other children or during school activities; this is commonly associated with insecurity or rage;
• Crying attacks and tantrums without good reason
• Transitional disorders in language development generated or aggravated by psychological reasons. (e.g. delayed speech, stuttering, defective pronunciation, the tendency to stay with “baby talk”)
• Gastrointestinal disorders
• All problems are physically manifested and appear to be related to stressful factors like nervous coughs and night bruxism, the habit of unconsciously grinding the teeth.
WHAT TO DO?
A good tactic is to spend a specific time of the day playing relaxation games so that your child can free extra energy. After facing difficult or stressful situations relaxation games help children to calm down, restore energy, focus their attention on tasks and release muscular tension, helping them to adapt better to changes.
The "Montessori Method" (Maria Montessori, founder of modern pedagogy and education) can be helpful since it focuses on respecting the child's spontaneity.
Here are some tips that will help you and your child to relax while spending time together:
LET’S RELAX ... PLAYING!
• Watering plants and caring for animals makes the child feel more secure and happy, since it awakens their instincts of the soul;
•Ask them for help in doing housework from an early age, assigning age-appropriate tasks. For example, a two-year-old is quite capable of carrying bread or plastic dishes to the table and 3 or 4-year-olds can help washing dishes, etc....
• This will allow the child to feel useful and thereby increase their self-esteem;
• A game that is simple and fun, which calms the child and stimulates his/her imagination: first invite the child to lie or sit down, then the adult begins to list a series of foods the child likes such as bananas, chocolate, apples, warm bread, cake ... ask the child to describe shape, color, taste and smell.
• Finally, another alternative that could appeal to both boys and girls consists of asking them to make a series of gestures associated with stories you are telling them: swimming, jumping, rolling over, cooking, etc.
Of course, the difficulty level of the stories and gestures will change depending on the age of the child. These games should become a regular daily habit. Increase the level of difficulty at an age when relaxation must be combined with the physical, intellectual and especially emotional growth of your child.
Psoriasis in the pediatric population:
Psoriasis often touches infants, children and adolescents. Approximately 30% of the adult population manifest psoriasis before the age of 16, distributed as follows: 5% in children under 4 years old, 10% between 5 and 9 years old and 15% between 10 and 14 years old; the remaining 20% between 15 and 19 years old.
The risk of a child suffering from psoriasis if one of the parents has the disease is from 14 to 28%, 41 to 65% if both parents suffer from it, 6% if a brother has it and 2 to 4% if no parent or brother suffer from psoriasis.
The immunological theory about the presence of superantigens of group A beta-hemolytic streptococci in the pathogenesis of psoriasis becomes increasingly stronger, especially the guttate psoriasis variant, one of the most frequent in the pediatric age. In studies of this population it has been found that 54% of 245 patients had tonsillitis when they presented the first cutaneous manifestations, and among 100 children, 68% had upper respiratory tract infection associated with the presence of group A beta-hemolytic streptococcus.
It is the most frequent variant according to most authors. Unlike the adult, the plaques are usually smaller and the thinner flakes, can touch the face, trunk, limbs, palms and even genitals, also the folds (retroauricular, axillary, intergluteal, inguinal and navel), and facial involvement is more common in the pediatric age. In children with dark skin, the scale is usually insignificant and hypochromia is more characteristic.
According to other authors this variant is the most frequent, although some clarify that just in infants. Others think, it is the second one most frequent in the pediatric age.
It is always recommended as a diagnostic aid the throat culture, the TASO, and the examination of the genital and perineal regions, where intense erythema of well-defined borders, usually without desquamation, is observed.
The suggested risk of generating plaque psoriasis after an acute episode of guttate psoriasis is 1 to 3. The antibiotic treatment is recommended for group A beta-hemolytic streptococcus in patients with recurrent infections since if they have the genetic potential to develop psoriasis, they will do so, triggered by streptococcus.
It can be present from the third month of life. It starts as an inguinal intertrigo and extends to the convex areas, causing an erythematous plaque (bright red, with well-defined borders) that does not respond to conventional treatment for irritant contact dermatitis.
The frequency of developing vulgar psoriasis in children under 10 years of age is estimated between 5 and 25%.
It is more common in children than in adults.
They are very well defined lesions, of annular configuration and predilection for the lower eyelids, in 4% of patients it is the only clinical manifestation or it can be part of a disseminated clinical form.
Pustular forms of psoriasis are rare in children, with male predominance.
The most frequent form is the pustulosa digita, but generalized acute cases or the annular variant are described.
In general, its course is benign compared to that of adults, but cases of difficult management have been reported.
Psoriasiform acral dermatitis:
It is a chronic dermatosis that affects the tip and the lateral parts of the fingers, with the presence of erythema, scales and fissures that come to produce functional limitation with dystrophic nail changes or without them. It can be considered as another form of the clinical spectrum of psoriasis.
It is considered a rare and serious form. It usually manifests as erythema or universal reddening of the skin. Its diagnosis is made with the help of family history, histopathology and the presence of HLA B17.
Treatment in children and adolescents is a challenge since the options are more limited than in adults. There are no unique parameters and for this reason each patient must have an individualized treatment.
Topical treatment: Moisturizers and emollients, corticoids, calcipotriol, anthralin, coal tar, tazarotene, vaseline with 3 and 5% salicylic acid, tracolimus.
Phototherapy with ultraviolet radiation B alone or combined with topical therapy.
Systemic treatment: Cyclosporine, methotrexate, acitretin.
Biological treatment: Etanercept
Psychosocial treatment: With psychosocial treatment for the management of psoriasis symptoms, direct effects on skin symptoms and indirect effects of the acceptance of the disease can be achieved. For this purpose, the impact of the disease on the social, emotional and psychic part of the patient must be considered, integrated into support groups and guaranteed accompaniment by psychiatry.
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