Beyond the Rash: Understanding Pediatric Psoriasis (In Collaboration with BioBuddies)
Pediatric psoriasis is a noncontagious disease that is autoimmune and affects the skin; mainly prevalent in kids. What is pediatric psoriasis to begin with? Pediatric Psoriasis is an inflammatory disease found on the skin of less than 1% of kids globally. While it is a comparatively rare disease, it is still chronic and demands treatment. Psoriasis forms as a result of different triggers, including genetic mutations, diets, weight variations, and chemical irritation. As the National Institute of Medicine explains, “Pathology is the result of the interaction between genetics and trigger factors such as infections, stress, diet, obesity, and chemical irritants” (NIH). The development of pediatric psoriasis in children can stem from various stimuli in the child’s environment; However, NIH reasserts that some gene mutations in kids can trigger this disease, including the TNF (tumor necrosis factor)-α inhibitors. It is a disease with a long lasting impact on kids’ lives and if not addressed, can be impactful in a variety of ways. This disease can be identified as an autoimmune disease because psoriasis is the result of white blood cells triggering increased inflammation. Due to the immune system being weakened by this disease, the body sends false signals that increase cell production that can be found on the surface of the skin. These cells form to become much thicker, forming a type of plaque that can be identified in your children in a white-ish silver color. Gaining the fundamental knowledge of pediatric psoriasis is an important first step to caring for the patients with this disease.
How do we tell the early signs of pediatric psoriasis in children? As you know, psoriasis appears scaly, with plaque buildup directly on the skin. Many parents and guardians often misinterpret rashes in babies and young children as irritation. In early onsets of the disease, pediatric psoriasis seems to be more tender, red, and scaly. However, this can also reflect signs of diaper rashes, cradle cap, or eczema. In these scenarios, it is important to be educated on the types of symptoms children might be experiencing and to be able to distinguish between rashes and early onsets of pediatric psoriasis. Firstly, caretakers should be educated on what psoriasis is. It’s not contagious as we addressed earlier, but it's rare and can be the cause of either genetics passed down, or external factors. Identifying patterns in diet, habits, infections (like strep) can also help to formulate a list of possible environmental triggers. Taking your child to the doctor, exploring genetic probabilities, and considering prognosis of the disease can help to take vital steps towards treating your child. Especially as your child grows, they will be faced with many sociocultural challenges, and it is imperative you support children through those roadblocks.
Several social and mental health impacts come with pediatric psoriasis, the most prevalent being risks for anxiety, depression, and social withdrawal. Peer stigmatization and bullying are also often seen in youth who have this disease. According to the International Psoriasis Council (IPC), these conditions “were reported in up to 65% of school-aged children with mild psoriasis.” Nervous tension is also especially seen in young adults and children, as “A significant number of children with psoriasis… were also revealed who had high scores for factor Q4 ‘nervous tension’, … finding it difficult to calm down” as shown by an article titled “Psychological Characteristics of Children with Psoriasis”, published in The Open Dermatology Journal. School performance is naturally another concern in regards to children with these sorts of illnesses. However, while many studies showed very little change in school performance, the IPC noted children with the disease showed “decreased participation in social activities and interpersonal challenges, particularly in adolescents with more visible disease”. While a child’s academics aren’t the most affected, pediatric psoriasis can negatively impact the school experience through bullying, discomfort, emotional stress, and other social challenges which can indirectly affect school performance in some individuals.
However, there are still several steps you can take to ensure your child will still get the best experience in school while having pediatric psoriasis; the first includes asking your dermatologist a few essential questions:
“What type of psoriasis does my child have?”
“What are the top at-home treatments for a child of this age and stage of psoriasis?”
“What are the potential side effects of any medication they should be taking?”
“What are some of the best daily moisturizing and bathing routines to reduce itching?”
“How should we handle severe flare ups?”
“What are some mental health resources my child can use?”
Additionally, ask your child’s dermatologist for a 504 medical plan for school. The plan will ensure that your child will get equal access to education by forcing the school to follow your child’s safety and care rules by law while also giving staff clear instructions on what to do in case of a medical emergency.
Additional steps can be made inside the classroom to maximize your child’s experience in school. After securing the legally binding 504 plan, draft an Individual Health Plan (IHP); have the school’s nurse manage an IHP detailing your student’s clinical needs, typical application schedules, and baseline medical information. Afterwards, coordinate a brief meeting with classroom teachers, administrators, and other staff before the term begins to outline known medical triggers. You can also ask for your child to be seated away from the sun and to be placed in air conditioned spaces during heatwaves, as sweat can trigger intense flares. Other requests can include a flexible uniform policy, modified physical education, requested counseling check ins, and instructing teachers to actively monitor peer dynamics during group work and recess to stop bullying.
Writers:
Surabhi & Aditri (BioBuddies)
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