It is exceedingly rare for babies to have psoriasis particularly if there is no history in the family. Rashes in the nappy area may be psoriasis or may be a straightforward nappy rash. Psoriasis in the nappy area will look red and shiny with little scaling, and it will be very clearly demarcated i.e. it will be clear where the psoriasis stops and regular skin begins. Immunisations, All the usual immunisation procedures may be safely given but it is worth remembering that a patch of psoriasis may come up at any site where the skin has been injured e.g. following immunisation with BCG.
The most common form of psoriasis in children is plaque psoriasis affecting the elbows, knees and lower back. The scalp can also be involved in children, along with the face and flexures (for example, the groin, armpit and behind the knees). There are several forms of psoriasis; guttate (a history of streptococcal infections) is the one that most commonly occurs in children and teens. It is sometimes preceded by an upper respiratory infection. Guttate psoriasis is noncontagious and characterized by small drop-like lesions, usually scattered over the trunk, limbs, and scalp.
Although these common respiratory infections may trigger psoriasis, they are not the cause. The exact cause of psoriasis is unknown, but research has found that heredity plays a role. For example, if one parent has psoriasis, however, around 30% of people with psoriasis have a family history of the condition, and certain genes have been identified as being linked to psoriasis. A trigger is still required for psoriasis to develop, regardless of a family link. If one parent has the disease, there is about a 10 percent chance of a child contracting it. If both parents have psoriasis, the chance increases to 50 percent. No one can predict who will get psoriasis. Scientists now believe that at least 10 percent of the general population inherits one or more of the genes that create a predisposition to psoriasis. However, only 2 to 3 percent of the population develops the disease.
Triggers include injury to the skin (a simple scratch or insect bite) Koebner [keb-ner] phenomenon., the streptococcal sore throat, stress and emotional upset and puberty. we know that Psoriasis is an autoimmune disorders or a T-helper (Th1) / (Th17) immune dysfunction. T-cell activation, TNFα, and dendritic cells are pathogenic factors stimulated in response to a triggering factor, such as a physical injury, inflammation, bacteria (A self-peptide cross-reacting with streptococcal M protein bacteria-derived superantigens is one of the candidates as streptococcal infections precede 90% of psoriasis type I cases).
Monotherapy may be effective for limited, focal or mild disease. In cases where multiple medications are necessary, the number of agents that must be applied can be reduced by compounding compatible agents. Research the surrounding community and keep a list of compounding pharmacies to provide to your patients. Ointment formulations tend to have greater efficacy than creams but some patients, particularly adolescents, find them objectionable. In an effort to increase compliance, prescribe whichever vehicle the patient finds preferable. Thick, greasy ointments can be used at nighttime and more cosmetically acceptable creams, lotions and solutions reserved for daytime use.
Topical steroids are the most common treatment choice for children, because they are available in a range of potencies. A child's skin is very sensitive, so milder topical medications are ordinarily preferred. Moisturisers and emollients are vital in the treatment of psoriasis – they will help soothe, smooth and hydrate your child’s skin in order to keep it in good condition and help the active treatment creams and ointments work more effectively. There are lots of emollients and moisturisers to choose, from oils to put in the bath, to creams, lotions and ointments to put directly onto the skin. For some children, moisturisers and emollients are all they will require to manage their psoriasis. Other more active creams and ointments include coal tar based applications, vitamin D analogues, topical steroid treatments and dithranol. Ultra violet light can be used in severe cases. However, children with severe, life-threatening, or disabling psoriasis may be treated with ultraviolet light therapy or systemic treatments such as methotrexate, acitretin, and cyclosporine. One study showed that etanercept was effective for treating psoriasis in children. Tazarotene is a third-generation topical retinoid US FDA-approved for once daily treatment of psoriasis in adults aged 18 and older and acne vulgaris in patients aged 12 and above. Topical Calcineurin Inhibitors Tacrolimus and pimecrolimus are nonsteroidal immunomodulating macrolactams that work by blocking the enzyme calcineurin, ultimately inhibiting the downstream production of IL-2 and subsequent T-cell activation and proliferation. Both topical agents are currently FDA approved for second line intermittent treatment of atopic dermatitis in patients aged 2 years and older (pimecrolimus and tacrolimus 0.03%) and aged 15 and older (tacrolimus 0.1%).
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