For Parents: What is Psoriasis?

Each year, roughly 20,000 children under 10 years of age are diagnosed with psoriasis (sore-Eye-ah-sis) [1] with approximately 1% of children and teens being diagnosed during adolescence [2] (ages 10-19). Psoriasis can affect children of all ages (including infants), genders, race, and ethnicities. You and your family are not alone.

Understanding what psoriasis is, including the types and locations, and possible triggers, will help you and your child in their journey with psoriasis. Psoriasis is a chronic, immune-mediated disease characterized by an overactive immune system that produces inflammation in the body. Chronic means the disease is lifelong and recurring. It will require ongoing medical attention. Normally, it takes 21-28 days for cells on the surface of the skin to grow and shed. In psoriasis, it only takes 3 to 4 days! The inflammation speeds up skin cell growth, and instead of shedding, the skin cells pile up on the surface of the skin, creating plaques.

Psoriasis is not contagious. No one can catch it from your child. It is not you or your child’s fault.

Types of Psoriasis:

There are 5 types of psoriasis: plaque, guttate, inverse (or intertriginous), pustular, and erythrodermic. Depending on the type of psoriasis your child has, it could look different. Plaque and guttate psoriasis are the most common types of psoriasis among children. It is possible to have more than one type of psoriasis at a time. For example, plaque psoriasis could occur with guttate psoriasis, which is characterized by small, round spots.

Plaque, Guttate, Inverse, Pustular, and Erythrodermic psoriasis

Symptoms and Sites

The inflamed plaques, or patches on the skin, are due to the increased growth of the skin. This increased growth results in itchy, painful, dry, cracked scale on the skin. Plaques may look red, pink, violet, or brown depending on how dark the skin is normally. Pustular psoriasis appears as pustules (white, pus-filled, painful bumps) that may be surrounded by inflamed, red or discolored skin, depending on skin type. Plaques can be a few small patches or can affect large areas. The amount of skin affected by psoriasis could change over time, such as during a flare of the disease there could be more plaques. When treatment is working well there will be fewer plaques.

Unique Considerations for Children and Teens

Plaques may look different in children than in adults. Psoriasis scales may be thinner, smaller, softer, and may develop on the face and flexural areas (crease of the elbows, backs of the knees). Children often get psoriasis on the scalp, which may be the first sign of a child’s psoriasis. [4] Psoriasis may also develop on the chest, back, genital area, hands and feet, with changes even occurring on the nails. Psoriasis can occur in more than one area at a time.

Unique to young children is psoriatic diaper rash. This appears as slightly raised plaques in the diaper area. Psoriatic diaper rash can be difficult to treat and does not typically respond to diaper rash cream. [4] If your child develops a diaper rash that appears to have plaques or does not go away, talk with their health care provider about treatment options.

Psoriasis in the genital area may cause embarrassment for older children and teens. It may help to talk to your child or teen about what psoriasis in the genital area may look or feel like. Your teen may not feel comfortable talking to a health care provider about genital psoriasis. You can offer to attend your child’s appointment to provide support or send a note to the provider if you will not be at the appointment.

Causes of Psoriasis in Children and Teens

It is not known what truly causes psoriasis however the immune system, genetics, and environmental factors are all known to play a role in the development of the disease. While the genetics of psoriasis are complex, it is possible for psoriasis to develop even in the absence of a family history of the disease.

A trigger is something that either starts a flare of your child’s psoriasis or causes the disease to worsen. A flare could be either new psoriasis plaques or location, or the return of prior plaques, itch, irritation, or burning. A flare of disease may last for different amounts of time and may vary in severity.

Triggers

Common triggers of psoriasis

Emotional Stress

Stress is one of the most common triggers for psoriasis. Emotional stress can cause a flare of disease. This can also happen in reverse—a flare of psoriasis can cause stress especially if psoriasis is visible to others which can also make the psoriasis worse. Talk with your child if a flare occurs to see if emotional stress or anxiety may be the result of bullying or other factors such as an upcoming test or issues with friends.

Illness and Infections

For some youth, the onset of psoriasis, particularly guttate psoriasis, follows a streptococcal [strehp-tuh-KAH-kuhl] infection, also known as strep throat. One-third to one-half of youth with psoriasis may experience a flare 2 to 6 weeks after strep throat, an earache, bronchitis, tonsillitis, or a respiratory infection. Since it is possible to have strep throat without symptoms, speak with your child’s health care provider about testing for strep throat if guttate psoriasis (small, round spots) develop.

Injury to the Skin

New plaques can occur on previously healthy skin that has been injured. This is known as the Koebner [KEB-ner] phenomenon. This can happen with a bug bite, sunburn, scratch, or even a needle puncture. Encourage your child not to scratch or pick at psoriasis plaques. Not everyone who has psoriasis will develop plaques at the site of an injury.

Certain Medications

Some medications can trigger psoriasis. If you think a medication is causing your child’s psoriasis to flare, do not stop the medication since some medications need to be tapered down. Instead, contact your child’s health care provider to explain what is occurring and if another medication is an option. Flares due to medication usually occur 2 to 3 weeks after starting a medication.

Weather

It is possible a change in the weather may cause psoriasis to flare. As weather turns cold, more time is spent inside where the air is drier with less humidity causing the skin to become dry and cracked. This is one reason why it is important to keep the skin hydrated with moisturizers.

Hormones

As your child grows older and starts to enter puberty (usually between the ages of 8 and 14), hormonal changes can trigger a psoriasis flare. This is also when psoriasis may present for the first time. Changes involve levels of estrogen for girls or testosterone for boys. When levels are high they tend to experience fewer psoriasis symptoms. When levels are low such as during menstruation, girls may experience more flares and symptoms. Hormone changes can trigger your child’s psoriasis throughout their lives.

Triggers vary from person to person. What affects one person may not affect another. Sometimes it can be very clear what triggers a flare and other times it is not easy to identify. You and your child can keep track of their flares and possible triggers using a notebook or an app on your phone. You can also download a copy of the NPF weekly Youth Symptom Tracker to help find patterns associated with your child’s psoriasis and/or psoriatic arthritis symptoms.

Diagnosis

If you suspect your child has psoriasis based on changes on the skin or scalp, contact your child’s health care provider or seek a referral to a dermatologist to confirm the diagnosis and begin treatment.

Dermatologist

A dermatologist is a doctor specializing in the diagnosis and care of diseases that affect the skin, scalp, hair, and nails. If you notice changes in your child’s skin, scalp or nails consider a referral for your child to see a dermatologist. It is possible you may also work with a Nurse Practitioner (NP) or Physician Assistant (PA) who specializes in dermatology. You can find a health care provider using the NPF Health Care Provider Directory or contact the Patient Navigation Center.

It may take time to get a correct diagnosis, as psoriasis is sometimes confused with other skin diseases like diaper rash, ringworm, bacterial infection, or eczema (also known as atopic dermatitis), another chronic skin condition. Eczema occurs on creases of the skin, such as inside the elbows and behind the knees, behind and under the neck, on the hands and feet, on the scalp, and in the groin area.

To help make a diagnosis of psoriasis, your child’s health care provider or dermatologist will:

Do a physical exam to look at the appearance of your child’s skin to see the color of the plaques, if they are thick and raised, or fine and drop like.
Check the location of the psoriasis to see if the plaques appear in areas common for psoriasis, such as the face, scalp, knees, elbows, fingernails, and/or toenails.
Ask about symptoms, which include itching of the skin. Itching is a common symptom of psoriasis.
Ask about a family history of the disease to see if other family members have psoriasis and if there’s a genetic connection.

A dermatologist may be able to diagnose psoriasis by looking at your child’s skin and their medical history. However, if additional information is needed to confirm the diagnosis of psoriasis and rule out other potential diseases, a skin biopsy (removal of a small piece of skin to be looked at under a microscope) may need to be done.

You may hear your child’s health care provider describe psoriasis as “mild”, “moderate”, or “severe”, which may determine the choice of treatment. The choice of treatment depends on the type, location, and severity of the psoriasis, and its impact on quality of life.

Next Steps

Why Treat Psoriasis

It is important to treat the disease effectively to reduce the inflammation associated with psoriasis. Inflammation, in addition to being part of the development of psoriasis, also contributes to the potential development of comorbidities (other health conditions associated with psoriasis) such as psoriatic arthritis, heart disease, diabetes, anxiety, and depression. Children living with psoriasis are at a higher risk of developing such comorbidities. Fortunately, there are numerous treatments available today that are effective in treating psoriasis and the related inflammation. Research continues to identify new treatments and pathways towards a cure.

Connecting with Others

If your child is newly diagnosed with psoriasis, you are adapting to changes, both physical and emotional, that impact your child and your family’s way of life. You are not alone. There are thousands of parents who are or have made the adjustment to living with this lifelong disease. If you need to talk with another parent who has experience living with psoriasis and is a trained volunteer, contact the One to One Peer Support program. We are here to help you and your child live their best life possible with psoriasis.

Your Best Action is to Treat Psoriasis

More treatments are available now for psoriasis than ever before.

Learn what your options are

Additional Resources

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Patient Navigation Center

Contact the PNC to receive the free booklet “Psoriatic Disease and Children: A Guide for Parents” for more information about psoriasis and psoriatic arthritis or if you need help finding a dermatologist for your child.

Connect with the PNC

Become a Psoriasis Insider

Become a Psoriasis Insider to get special resources and perks delivered directly to your inbox throughout the year. Receive new educational resources, perks, and a first look at NPF events in the year ahead.

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Our Spot Media Playlist

Need more information about types of psoriasis? Listen to “What’s Your Type of Psoriasis?” with dermatologist Dr. G. Michael Lewitt as he discusses the five types of psoriasis, including symptoms, locations, and treatment options.

Watch and listen

References

Therapeutic challenges in managing pediatric psoriasis. International Journal of Women's Dermatology. Volume 7, Issue 3, June 2021, Pages 314-318 https://www.sciencedirect.com/science/article/pii/S2352647520301489?via%3Dihub
Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients. J Am Acad Dermatol. Jan. 2020;82(1):161-201.
“Psoriatic Disease and Children” A Guide for Parents. National Psoriasis Foundation. December 2022.
Bronckers IM, Paller AS, van Geel MJ, van de Kerkhof PC, Seyger MM. Psoriasis in Children and Adolescents: Diagnosis, Management and Comorbidities. Paediatr Drugs. 2015;17(5):373-384. doi:10.1007/s40272-015-0137-1
“Are triggers causing your psoriasis flare-ups?” American Academy of Dermatology https://www.aad.org/public/diseases/psoriasis/triggers/flares