Psoriasis: what it is
La Psoriasis it is an inflammatory disease chronic of the skin. It is often mistakenly thought that it can only manifest itself in adulthood and instead it can occur even in childhood and adolescence, sometimes with specific manifestations.
We talk about it with May El Hachem, head of the dermatology operating unit of the Bambino Gesù Pediatric Hospital of the city, and with Vito Di Lernia, medical director of the dermatology unit of the Santa Maria Nuova hospital in Reggio Emilia, specializing in pediatric dermatology. Both are among the authors of the recommendations on the treatment of severe psoriasis in children, published in 2022 in the European Journal of Pediatrics.
In this article
- Psoriasis, how it manifests itself
- How frequent is it
- What are the causes
- How to cure
- Beware of weight and fat
- Who to contact
How it manifests itself
"It depends on the type of psoriasis," says El Hachem. "The most common form, in both adults and children, is the vulgar (plaque) psoriasis, which usually manifests itself with rounded patches, with sharp edges, of a reddish color, typically covered with whitish scales, generally located on the elbows and knees and in the lumbo-sacral region. Sometimes, they associate with the patches peeling at the scalp level e thickening of the nails, which take on a yellowish color and a dotted appearance ".
Three other forms are instead characteristic especially of the pediatric age:
- "Diaper" psoriasis: mainly affects the infant and occurs precisely in the diaper area, in particular in the folds of the groin, with intense and shiny red lesions, generally without desquamation. It is a very difficult form to distinguish from other diaper rashes.
- inverse psoriasis. It affects skin folds such as the armpits, groin, genital area and navel. The lesions are intensely red and often without scales.
- Guttate psoriasis. It is characterized by small patches of 1-2 cm in diameter, usually very numerous, distributed mainly on the trunk (but can appear all over the body). "It usually appears after a bacterial infection of the respiratory tract, such as otitis, pharyngitis or tonsillitis, due to an abnormal reaction of the immune system, which attacks certain molecules in the skin, mistaking them for molecules produced by bacteria," explains Di Lernia. The patches can last anywhere from a few weeks to a couple of months. After that, usually there is complete remission, but in some cases guttate psoriasis evolves into the plaque form.
"From a physical point of view, there are often no particular discomforts: however, there may be a slight itch and fatigue" underlines Di Lernia. "But above all, if the patches are visible there can be a marked impact on quality of life, precisely because the exposure of the patches, for example on the face, hands, forearms, can create considerable discomfort. "In fact, some studies suggest that affected children are more at risk than unaffected peers to develop disorders such as anxiety and depression.13 PHOTOS
Psoriasis in children: photos to recognize itgo to the gallery
Psoriasis is an inflammatory skin disease. The most common form, both in adults and children, is vulgar (plaque) psoriasis, which in ...
How frequent is it
"In Del Paese, 3% of adults suffer from it, and a third of them began to suffer from it as children," explains Di Lernia. On the other hand, it is more difficult to clearly determine how many children are affected: "We can estimate about XNUMX 0,5% of the pediatric population, with a frequency that increases with increasing age, from 1 to 18 years ".Read also: Children's dermatitis: a guide to the most common ones in early childhood
What are the causes
"There is one underlying psoriasis genetic predisposition, so much so that often those who suffer from it have other cases in the family (a parent or a grandparent), but to favor the appearance of the lesions also contribute various triggers, such as mechanical trauma (for example rubbing), infections, drugs, emotional, climatic factors, etc. "explains El Hachem. For this reason, experts define it as polygenic disease (the genes involved are different) and multifactorial.
"Psoriasis - adds the dermatologist - is basically a disease chronic with relapsing evolution, that is, it alternates moments of remission with moments of recovery. However, when it strikes in childhood, it is very likely that the lesions will never return for life. "However, it is not predictable which children will go into remission and which will keep the disease even in adulthood.
How to cure
If the disease is mild, a local type of therapy is generally preferred, in particular with cortisone-based ointments. "By the way, they don't have to scare," Di lernia warns. "If the steroids are used with the correct doses and second times there should be no side effects". Other possibilities, although not studied directly in children but derived from use in adults, are ointments based on calcipotriol (a derivative of vitamin D), tazarotene, vegetable tar, non-steroidal anti-inflammatory drugs.
And again, adds El Hachem: "In scaly forms and only in the older child can they be applied keratolytic creams, with salicylic acid, urea, mixtures of alpha and beta hydroxy acids, able to detach the scales and favor their elimination. "
for more severe forms - that is, those affecting sensitive parts such as hands and face, or an extension greater than 10% of the body - the document drawn up by Di Lernia, El Hachem and colleagues, indicates the treatment of choice with biological drugs that block TNF-alpha, an immune factor known for its involvement in psoriasis, as well as other inflammatory diseases such as rheumatoid arthritis. In particular, this is adalimumab ed etanercept, which are administered by subcutaneous injection once a week or every two weeks. "These therapies can also be administered in the long term and give significant results in a good percentage of small patients. In the meantime, they are being studied. other biological drugs which in the future may be used for therapy.
For all forms, the constant treatment with moisturizing and emollient creams. On their own they are not decisive, but they are important in combination with other treatments.
Healing with the Sun
"In the most extensive forms, theheliotherapy (ie exposure to the sun), which however must be adopted with the appropriate precautions, since excessive exposure to ultraviolet rays is harmful in children, ”says El Hachem.
“In order not to subject the child to a cumulative dose of rays, treatment with ultraviolet lamps is not recommended in young patients. In very localized forms, the looks like eccimeri, a device that produces a light with a wavelength of 308ŋm, very effective and free of side effects ".
Beware of weight and fat
"A certain association between childhood psoriasis and conditions such as overweight and obesity or increased cholesterol and lipids in the blood "explains Di Lernia." For this reason, the treatment of children with this disease should not neglect - where necessary - a certain attention to the diet, which should be varied and balanced, and to the lifestyle, with a adequate physical exercise ".
Who to contact
"Thanks to the studies of recent years, the treatment of childhood psoriasis is changing" explains Di Lernia. "For this it is good to contact a Specialized center, as are generally the hospital dermatological departments, which often have referral clinics for children and their conditions ".Read also: Children in the emergency room, when to take them
Questions and answers
What is psoriasis?
Psoriasis is a chronic inflammatory skin disease that can appear at any age.
How does psoriasis manifest itself?
It manifests itself with rounded patches, with sharp edges, of a reddish color, typically covered by whitish scales, generally located on the elbows and knees and in the lumbo-sacral region.
- first year