Do we know the prevalence of psoriasis among children?
We don’t actually know that number, partially because there are many kids who are not diagnosed or who are misdiagnosed. Very commonly, they may be told that they have fungal infections or eczema until they reach a specialist who identifies it as psoriasis. However, it is common to have the onset of psoriasis appear before the age of 20. It can happen from our youngest babies all the way to our oldest adults, and onset may occur at any time.
Can children who have psoriasis get psoriatic arthritis?
Psoriatic arthritis can occur in up to 30 percent of individuals with psoriasis. The number may be a little lower in children, but we actually don’t have a solid number in kids, and the onset of the psoriatic arthritis can occur at any time. So you can get arthritis before you actually have psoriasis on your skin, or you can have had psoriasis for many years and then start developing joint pain and stiffness and be diagnosed with psoriatic arthritis.
Are there specific activities that children with psoriasis should avoid?
That really depends on your child. I don’t like limiting anything for children because I feel strongly that they should live their life just like normal, whether they have psoriasis or not. What’s important is to pay attention to whether certain activities really flare the skin and to think about ways to prevent that. Not letting the skin dry out is really important. There are some activities that lead to more dryness, and therefore, more flaring, but to participate in those activities, you might just have to increase your moisturizer use. These are all really important things to help your kid work through and figure out what’s important to them and to try to not let the psoriasis control their life. Find a doctor who will work with you to try to really solve these issues.
What are the risks and benefits of methotrexate in children?
Methotrexate is one of the systemic medications that we’ve had the longest experience with. So prior to the approval of Enbrel (etanercept) in pediatric patients, methotrexate has been our go-to medication because we have vast experience with it in children of all ages and in a wide variety of diseases. Methotrexate may not be as effective as some of the newer biologic agents, but a child taking methotrexate could have complete clearance, whereas another one may not respond at all. With methotrexate, fewer kids are going to have complete clearance, but if you’re seeing clearance, it could be a great medication for you. It is an oral medication without many side effects, considering the doses we use for psoriasis. We do have to follow up with lab work, but kids who have stayed on it for a long time and have had a good response can tolerate it quite well.
Is it safe to use narrowband UVB treatment in children as young as 2?
Certainly, it could be safe to use. The problem with younger kids and narrowband UVB is oftentimes that they simply can’t follow the directions that are needed during the treatment. For example, to use narrowband safely, you have to stand fairly still, you have to keep goggles on, etc. From the side effect standpoint, though, we think that it would be a safe treatment.
Do you have recommendations for college students treating away from home?
A lot of that depends on your child. Some kids, by the time they’re off to college, are very mature and have already been doing a lot of their treatment plans by themselves. The other thing is, you need to find the treating physician on campus or the treating physician who’s going to be there for them because they may not able to get to their regular doctor. Many doctors will form a good relationship when there are two — the person managing at home and the person managing when they’re away. But there are a number of treatment options that are excellent for kids and teenagers, even if they’re away.
Lara Wine Lee, M.D., Ph.D., is a pediatric dermatologist at the Medical University of South Carolina in Charleston. Portions of this interview were edited for clarity and brevity.
Editor’s note: Since this story was published in the Winter 2017 issue of Psoriasis Advance magazine, the U.S. Food and Drug Administration approved Stelara (ustekinumab) for patients 12 and older with moderate to severe psoriasis.
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