Psoriasis in children

Overview

Psoriasis is a skin condition where the body makes new skin cells too quickly, causing thick, red, flaky patches on the skin. In children, these patches often have silvery scales and can appear anywhere on the body.

Psoriasis is not very common in children, but it does happen. About one in three people with psoriasis first notice symptoms before age 20. In children, it often starts between ages 9 and 12.

Psoriasis affects children of all ages, including babies and teenagers. Both boys and girls get it equally. It can affect any skin type or race.

Symptoms

Common symptoms

• Red patches on the skin with silvery white scales
• Itching, burning, or soreness on the patches
• Dry, cracked skin that may bleed
• Thickened or pitted nails

Symptoms in children

• Patches may be smaller, thinner, and less scaly than in adults
• Often appears on the face, scalp, elbows, knees, and around the diaper area in babies
• Skin folds (like armpits or groin) may be involved

Symptoms in older adults

• Psoriasis in older adults may look similar, but patches are more likely to appear on the elbows, knees, and scalp. The condition is less common in older adults than in younger people.

Causes

Main causes

• Psoriasis is caused by a problem with the immune system. The body mistakenly attacks healthy skin cells, which makes new skin cells grow too quickly.
• Genes play a big role — many children with psoriasis have a family member who also has it.

Risk factors

• Having a close relative (parent, sibling) with psoriasis
• Stress or emotional upset
• Infections, especially strep throat (can trigger a type called guttate psoriasis)
• Cold weather or dry air
• Skin injuries like cuts, scrapes, sunburn, or even a bad scratch (this is called the Koebner phenomenon)

When to see a doctor

See a doctor urgently if:

• If your child has joint pain, swelling, or stiffness, especially in the morning
• If the skin patches are very painful, oozing, or show signs of infection (redness, warmth, fever)
• If your child seems very itchy and can't sleep or concentrate

Book a routine appointment if:

• If your child has patches of thick, scaly skin that don't go away after a few weeks
• If you are worried about any rash that looks like psoriasis — even if it's mild, it's good to get it checked
• If you notice pitting or thickening of the fingernails or toenails

Diagnosis

A doctor — usually a GP or a skin specialist (dermatologist) — can diagnose psoriasis by looking at the skin. They will ask about your child's symptoms and family history.

Tests that may be done

• A skin biopsy: taking a very small piece of skin to look at under a microscope. This is not always needed, but it can confirm the diagnosis if there is doubt.
• Blood tests: sometimes done to rule out other conditions if arthritis is suspected.

What to expect at your appointment

The doctor will examine your child's skin, scalp, and nails. They may gently scrape a scale to see if it flakes off easily. The exam is painless and quick. If a biopsy is done, your child may feel a tiny pinch from the numbing medicine, but it heals fast.

Treatment

Treatment for childhood psoriasis focuses on controlling symptoms, reducing flare-ups, and helping your child feel comfortable. Most children start with moisturisers and medicated creams. If these aren't enough, other options such as light therapy or medications that work on the immune system may be considered.

Self-care at home

• Keep your child's skin well moisturised with fragrance-free creams or ointments
• Use gentle, soap-free cleansers and warm (not hot) water for baths
• Avoid scrubbing or picking at the scales
• Help your child manage stress through relaxation, play, and talking about feelings
• Dress your child in soft, breathable fabrics like cotton

Medical treatments

A doctor may prescribe creams or ointments containing mild steroids or vitamin D-like substances to apply to the patches. For more stubborn cases, light therapy (using a special type of ultraviolet light) can be given in a clinic. If psoriasis is severe or affecting joints, a doctor might recommend oral or injected treatments that calm the immune system. Always follow the doctor's advice on how to use any treatment.

When is surgery considered?

Surgery is not used to treat psoriasis itself. In very rare cases, if a joint is badly damaged by psoriatic arthritis, a joint replacement might be considered. This is extremely uncommon in children.

Living with this condition

Living with psoriasis means having a daily skincare routine. Help your child apply moisturiser and any prescribed creams as directed. Teach them that psoriasis is not their fault and it's okay to talk about it. Keep an eye on triggers like stress or infections, and try to avoid them.

Lifestyle tips

• Moisturise skin every day, especially after bathing
• Avoid harsh soaps, bubble baths, and scented products
• Try to keep your child's nails short to reduce scratching damage
• Encourage your child to wear comfortable clothes that don't rub against patches
• Manage stress with hobbies, exercise, and open communication

Diet and exercise

A balanced diet with plenty of fruits, vegetables, and whole grains may help reduce inflammation. Some parents find that certain foods (like dairy or gluten) seem to trigger flare-ups — you can try keeping a food diary. Regular exercise is good for overall health and can help with stress, but avoid excessive sweating or skin friction from tight gear.

Mental health and emotional wellbeing

Psoriasis can affect how a child feels about their appearance. They may feel embarrassed, sad, or anxious. It is important to listen to their feelings and reassure them that they are not alone. If your child seems very distressed, ask your doctor about talking to a child counsellor or therapist.

Prevention

There is no known way to prevent psoriasis from developing. But once your child has it, you can help reduce the number and severity of flare-ups by identifying and avoiding triggers, keeping skin healthy, and following the treatment plan.

Vaccines

Children with psoriasis can have routine vaccinations, including the flu shot and others. If your child is taking strong medications that affect the immune system, some live vaccines may not be safe. Always tell your doctor about your child's psoriasis and treatment before any vaccination.

Screening programmes

There is no routine screening test for psoriasis. If your child has a family history of psoriasis, you can watch for early signs and see a doctor if you notice anything unusual.

Complications

If left untreated

• Psoriatic arthritis: joint inflammation that causes pain, swelling, and stiffness, especially in the fingers, toes, and back
• Skin infections: because the skin barrier is broken, bacteria can enter and cause infection
• Emotional effects: low self-esteem, anxiety, or depression due to visible skin changes
• In rare cases, severe psoriasis can become widespread and cause problems with temperature regulation and fluid balance

Long-term outlook

With proper care, most children with psoriasis live normal, active lives. Many children find that their psoriasis improves as they get older, or goes away for long periods. There are many safe and effective treatments available today, so talk to your doctor about the best plan for your child.

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