Dermatology (Skin conditions)

Psoriasis (Treatment of Children and Young People)

This information has been produced to help explain the treatments prescribed for psoriasis and also to answer any questions you may have. If you require more information please ask the dermatology nursing staff or your dermatologist.

What is Psoriasis?

Psoriasis is a common skin condition. We constantly produce new skin but with psoriasis the skin cells are made more quickly (up to ten times more quickly) and immature skin cells are pushed up to the surface. The turnover of new skin cells is usually 28 days but with psoriasis it may only be two or three days. The build up of the skin appears as red patches on the surface of the skin covered by a silvery or white scale.

There are many types of psoriasis but the most common in children and teenagers are:

  • Guttate psoriasis - many small red patches over the body which look like ‘rain-drops’. This often can occur after a bacterial throat infection.
  • Scalp psoriasis - a build up of skin on the scalp. The dryness or scale may be thick, white and stick to the scalp.
  • Plaque psoriasis - appears as large scaly patches known as plaques most commonly on the knees and elbows.

The physical effects of psoriasis may cause discomfort and itchiness. It can make people feel embarrassed about the appearance of their skin and may effect their self-confidence.

Why me?

Approximately two percent of the population in the UK have psoriasis. The cause of psoriasis is unknown but we do know that the tendency to develop psoriasis runs in some families.

Psoriasis is NOT contagious and therefore cannot be caught from someone else with psoriasis.

If you do have the tendency to develop psoriasis certain things can trigger it:

  • Infection such as a sore throat.
  • Damage to the skin such as a burn or scratch.
  • Stress.
  • Hormonal changes such as those that occur at puberty

Psoriasis is a chronic condition, which means for some children/teenagers it may reoccur throughout their life so it is important to understand the condition, and the treatments, which are used.

What are the treatments?

The aim of treatment is to try to:

  • Control the condition.
  • Relieve the symptoms of the condition e.g. itch, dryness or scale.
  • Minimise the impact of the condition on your lifestyle.
  • Promote independence with treatment.

What are the types of treatment?

Emollients

These are moisturisers and there are many different types e.g. Epaderm, aqueous, E45. Emollient improve the condition of the skin by moisturising, lubricating and soothing plus removing the scale. They may also reduce itchiness of the skin. They should be applied frequently and in a downward motion in the direction of hair growth. Emollients also include soap substitutes and bath oils, which also help to relieve dryness.

Tar Treatment

These products relieve itch, loosen skin flakes, reduce the redness of the psoriasis and slow the production of new skin cells. These treatments have been used for many years and they are effective. However some people find them messy and smelly. There are many different preparations e.g. Alphosyl, Exorex, coal tar, tar pomade. The side-effect most commonly seen when using tar is irritation and dryness of the skin. Do use an emollient in between treatment times. You should also be careful in the sun as tar can make your skin more sensitive to sunlight.

Vitamin D preparations

These products help to slow the production of new skin cells and help skin cells to fully mature. An example is Dovonex. This is an effective and easy, clean ointment or cream to apply. Some people do experience skin irritation. It is important not to exceed the recommended dose.

Dithranol

This is a synthetic chemical, which also slows production of new skin cells. It can be used in two ways.

  • Short contact dithranol - this is applied directly to the psoriasis lesions and is left on for 15 minutes before it is carefully washed off.
  • Ingram’s regime - the dithranol is in a thicker base ointment and is applied just to the areas of psoriasis, then powder stops the ointment from spreading and bandages hold it in place. It can be left on for 6-24 hours.

The advantage of dithranol is that it is safe long-term and effective. The disadvantages of dithranol are that it is messy and stains the skin temporarily. Avoid contact with surfaces and clothing as it will stain. It can irritate and burn the skin. Short contact dithranol can be taught for home use or used as outpatient or inpatient treatment. Ingram’s regime is used as either an outpatient or inpatient treatment.

Light Treatment

It has been found that sunlight helps some cases of psoriasis. A type of light treatment maybe used as a treatment in our department for some people. The use of light treatment will only be considered if the child is old enough to be able to understand about the treatment and happy to stand in the machine. It is important that commercial sun beds are avoided as the dose is not measured and the risk of damage to the skin is increased.

Topical steroids

Topical steroid cream or ointments may be used in the short term for particular sites of the body such as under arms, breasts, and the genital area. They are used to reduce inflammation and itch. Although they are easy to use it is important they are used as directed, and for a limited amount of time due to the potential side effects of long term usage. Topical steroids are also used to reduce redness and soreness from other treatments e.g. burn from dithranol.

Systemic or oral medications

These treatments are rarely given to children/teenagers and only if they have severe psoriasis that has not responded to conventional treatments. These medicines are strong and may affect the whole body so it is important to have regular blood tests and to be under close supervision by your dermatologist. Examples of these medicines are methotrexate, acitretin.

Scalp treatments

The scalp is often affected by psoriasis and it is difficult to hide, but the right treatments can control it. If there is thick scale on the scalp start by using salicylic acid, a thick white preparation, which is applied to the scalp, left overnight and then washed off the following morning. The hair while wet is combed through gently to remove the scale. This is not a treatment for the psoriasis but instead enables us to remove the thick
scale so the psoriasis beneath can be treated. Therefore it should only be used for a short period. Cocois or tar pomade are examples of tar preparations applied to psoriasis on the
scalp and can be washed out the next day.

Dithranol pomade is also used to treat scalp psoriasis, but must not be used in fair hair due to staining. It can irritate and burn the skin so a low strength is used initially and then increased each week if tolerated. Shampoos containing tar may also be useful. Topical steroid scalp application such as Betnovate scalp application may be used to calm the scalp if it is very itchy or sore, but only for a short time until treatment with
other products can resume.

Inpatient care

Sometimes patients do not respond to treatment at home or cannot travel daily for outpatient treatment. These children and young people can be admitted to the children’s ward and receive skin treatment in the dermatology department. The following tips may be helpful:

Clothing

  • Light coloured or patterned clothing can be useful to disguise dry scale on shoulders.
  • Cotton clothing may be more comfortable as well as loose fitting clothes. Labels may need to be removed if they irritate.
  • Old clothes can be worn when undergoing treatments due to risk of staining or mess.

Skin trauma/damage

It is important to know that psoriasis may arise on damaged skin so avoid trauma or damage to the skin.

Hints

  • Try and combine treatment with enjoyable activities e.g. music, TV.
  • Try to keep cool especially at night to help reduce itchiness.
  • Sometimes an anti-histamine can help you to sleep at night. Ask your dermatologist or GP about this.
  • Cover-up creams e.g. concealer, can be used for special occasions.
  • All medications must be kept out of the reach of small children.

More information

If you have any queries please contact Dermatology Outpatients on 0191 282 4485.

For more support, you can contact the Psoriasis Association at:

The Psoriasis Association
Milton House
7 Milton Street
Northampton
NN2 7JG
Telephone 01604 711 129
Fax 01604 792 894
Website: www.psoriasis-association.org.uk


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