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Home , Pityriasis alba, Seborrhoeic dermatitis

PEER REVIEWED FEATURE Common problems in children other than atopic GAYLE FISCHER OAM, MB BS, FACD, MD

In addition to , numerous other he earliest dermatoses seen in other than atopic endogenous and exogenous dermatoses are seen dermatitis are nappy , and in prepubertal children including nappy rash, neonatal . In preschool-aged children, florid insect , neonatal acne and allergic rashes. Many bite reactions may be a problem. Skin conditions that Tare often confused with atopic dermatitis are childhood-onset of these childhood dermatoses will clear over time with environmental modification or no intervention, psoriasis and the keratinisation disorders, vulgaris but some may require treatment. and . The most common allergic skin conditions in children, other than insect bite reactions, are virally induced urticaria and contact allergy to plants.

Early dermatoses Nappy rash Nappy rash is the term used to describe any rash occurring in the area under the nappy. It has become less common, probably due to the use of highly absorbent disposable nappies. KEY POINTS A simple irritant dermatitis is the most common cause of nappy rash, but there are many other causes, including Candida • Most cases of nappy rash are due to irritation and maceration, but Candida albicans , seborrhoeic albicans infection (Figure 1), seborrhoeic dermatitis and pso- dermatitis and psoriasis are other common causes. riasis (Figure 2). There are also some very rare causes, such as • Not all babies with seborrhoeic dermatitis recover; and Langerhans cell histiocytosis, and thus any one-third will develop psoriasis and another third, atopic infants with a severe, nonresponsive rash, particularly with dermatitis. lesions in areas other than under the nappy, should be referred • The early signs of psoriasis in children include , to a dermatologist.­ Nappy rash can be mild or it can become nappy rash, and post- and infra-auricular scaling and so inflammatory that ulceration occurs. Rarely, it may become fissuring. papular or nodular and result in lesions that can appear alarm-

• Childhood-onset psoriasis, ichthyosis vulgaris and ing. This condition is called pseudoverrucous and keratosis pilaris are often confused with atopic dermatitis. nodules (PPN).1 • Urticaria is the only childhood that is effectively treated with . • Hypersensitivity to insect bites and plant are common in children and preventative MedicineToday 2021; 22(3): 33-43 measures are often the best treatment. Professor Fischer is Professor of at Sydney Medical School – © LEUGCHOPAN/STOCK.ADOBE.COM© MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY Northern, The University of Sydney, Royal North Shore Hospital, Sydney, NSW.

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Figure 1. Nappy rash caused by Candida albicans infection. Figure 2. Nappy rash caused by psoriasis. Figure 3. Generalised seborrhoeic dermatitis.

Generally, a simple irritant rash does cream used in conjunc- Seborrhoeic dermatitis not involve the flexures, whereas endo­ tion with a topical such as Seborrhoeic dermatitis is the term used genous dermatoses and do. nystatin or an imidazole ( to describe a clinical presentation that may Irritant nappy rash results from loss of or ). There are several com- occur in three common infantile derma- barrier function of the due to bined products, such as clotrimazole plus toses: idiopathic seborrhoeic dermatitis, maceration from urine and irritation from hydrocortisone, which are convenient atopic dermatitis and psoriasis. The erup- faecal . Sometimes topical prod- and not much more expensive. The treat- tion is seen most often before 2 months ucts, including soap and over-the-counter ment should be used three times daily of age. Initially, the , , neck, axillae treatments, aggravate the rash. In many until the rash has resolved. Generally, and nappy areas are involved, but the rash cases of nappy rash, the affected area is hydrocortisone 1% is the only cortico­ may generalise (Figure 3). The lesions are colonised with C. albicans. steroid that should be used in the nappy well defined and have a greasy scale. area. ­Characteristically, babies with seborrhoeic Management Inadequate response to treatment may dermatitis are well and not itchy. Generally, management for all forms of be due to: The rash in classic, idiopathic sebor- nappy rash is the same, even when the • noncompliance with treatment rhoeic dermatitis is self-limiting, clearing rash is very severe. Treatment involves • irritancy or allergy from topical spontaneously in a few weeks or sooner environmental modification and spe- therapy if treated. However, both atopic dermatitis cific medical management. Highly • bacterial or viral infection and infantile psoriasis may also present absorbent disposable nappies are pref- • psoriasis in this way, and in these cases, the rash erable to cloth nappies. If cloth nappies • an underlying rare condition. recurs. In about one-third of cases, seb- are used, parents should be advised to Pustules, erosions, vesicles, ulcers or orrhoeic dermatitis will remit completely change them every two hours and avoid areas of weeping may indicate a bacterial and the babies will have no further prob- using plastic overpants and nappy liners. or viral infection, particularly in infants lems with their skin; in the other two- As with any sort of dermatitis, a soap in whom there has been an inadequate thirds, psoriasis or atopic dermatitis will substitute should be used instead of response to therapy. A bacterial, and pos- develop. Infection with either C. albicans soap and a dispersible bath oil used in sibly a viral, swab should be taken and or Staphylococcus aureus is common; it every bath. At each nappy change, a damp treatment started according to culture and should be suspected if crusting, weeping cloth and bland emollient should be used sensitivity results. C. albicans will grow or pustulation are present and actively instead of commercial wipes, and further from a bacterial swab. treated. emollient applied. Zinc and castor oil In the very rare instance of a herpetic Very rarely, Langerhans cell histiocy- preparations are popular as a nappy rash infection, no specific treatment is needed, tosis (an increase in Langerhans cells in treatment, but any greasy emollient is as the lesions will heal spontaneously the skin) may simulate seborrhoeic der- effective. within two weeks. If the infection is severe matitis. The cause for this is unknown. In many cases, environmental modi­ with ulceration or urinary retention, the In small children it may cause death as fication alone is inadequate and the may need to be admitted to hospital the infiltrate may also involve internal ­medical treatment of choice is 1% for intravenous aciclovir. organs. The condition is differentiated

34 MedicineToday ❙ MARCH 2021, VOLUME 22, NUMBER 3 Downloaded for personal use only. No other uses permitted without permission. © MedicineToday 2021. https://medicinetoday.com.au/mt/march-2021 from ­seborrhoeic dermatitis by the pres- Management DIFFERENTIATING CHILDHOOD ence of purpura and erosions as well as Neonatal acne is self-limiting and usually PSORIASIS FROM ECZEMA treatment resistance. remits by 12 months of age, but it may persist to 24 months. If treatment is A diagnosis of classic paediatric Management needed, topical therapy usually used for psoriasis requires any of the following: Management of seborrhoeic dermatitis is mild teenage acne is appropriate. This • palmoplantar essentially the same as that for atopic includes topical tretinoin 0.025% cream • guttate disease 2 ­dermatitis. Scalp scaling responds to once daily and erythromycin 2% gel once • pustular psoriasis treatment with liquor picis carbonis (LPC, daily. Rarely, neonatal acne may be nod- • pits or solution) 2% and ulocystic and can be treated with oral • napkin psoriasis 2% in a moisturising base, and the nappy to prevent permanent scar- • well-demarcated psoriatic plaques area is treated with a combination of 1% ring. In this case referral to a paediatric on elbows, knees or lower back hydrocortisone and an anticandidal dermatologist is required.3 For prepu­ cream, such as nystatin or an imidazole. bertal children with acne, topical therapy A diagnosis of atopic eczema can be made in children with itchy skin and It is a good idea to follow up the infant to is also often adequate. Oral antibiotic three or more of the following: ensure that this is not the first presentation therapy is usually not required, but in • visible flexural dermatitis in the skin of a chronic dermatosis such as atopic severe cases, oral erythromycin may be creases (such as the bends of the dermatitis or infantile psoriasis. used (tetracycline is contraindicated in elbows or behind the knees) this age group because it may stain teeth). OR visible dermatitis on the cheeks Childhood acne and/or extensor areas in children Acne is usually thought of as a condition Other childhood rashes aged ≤18 months seen in teenagers, but it may also occur in Psoriasis • history of flexural dermatitis babies and prepubertal children. Because Although psoriasis is less common in OR visible dermatitis on the cheeks acne is an -dependent condition children than in adults, up to 30% of cases and/or extensor areas in children aged 18 months occurring in genetically predisposed have their onset in childhood and in about ≤ patients, it may be seen in children at times 5% the onset is before the age of 2 years. • history of dry skin in the last 12 months when there is a high enough androgen The average age of diagnosis in childhood • history of asthma or allergic rhinitis level to permit expression of the tendency. cases is about 8 years. Neonatal acne is the term used to describe There are surprisingly few meaningful OR history of atopic disease in a first-degree relative of a child aged acne occurring in the first two years of studies on the incidence, prognosis and <4 years life. The acne is often predominantly nature of childhood psoriasis. We know • onset of in comedonal and its onset is soon after birth. little about how likely it is to remit com- children aged <2 years (do not use It is more common in boys, varies in sever- pared with the disease in adults, and this this criterion if the child is aged ity and often needs no treatment, but it is largely because there is no definitive <4 years) can be severe enough to cause scarring. definition for childhood psoriasis. In Adapted from Forward E. Clin Exp Dermatol 2021; 4 Parents should be warned that neonatal many studies, the diagnosis is usually 4: 65-73. acne may, and often does, recur at . clinical and, therefore, open to interpre- Children with early onset acne usually go tation. A recent publication has sought to (Figure 4a); however, these are usually on to suffer from teenage acne. clarify how to differentiate childhood smaller, thinner and less scaly. Acute Acne is also seen in prepubertal chil- psoriasis from eczema (Box).4 guttate psoriasis with eruption of small dren after the age of 8 years, when the The earliest sign that a child is destined lesions after a streptococcal throat infec- secreted at adrenarche stimulate to suffer from psoriasis is often cradle cap tion is a frequent presentation. Common sebaceous glands in predisposed individ- or persistent nappy rash that typically presenting sites include the scalp, retro- uals. It is not usually necessary to investi- involves the flexures and has a well-­ auricular folds, face, flexures and genital gate for androgen excess unless there are defined edge. The term ‘napkin psoriasis’ areas. Scalp scaling and a persistent ret- other concerning signs such as excess facial refers to a psoriatic nappy rash associated roauricular rash or infra-auricular fis- hair. Acne presenting for the first time with cradle cap, plaques on the trunk and suring are common and often subtle after 12 months of age and before the age and often a facial rash, particularly signs. Acral psoriasis with nail dystrophy of 8 years raises the possibility of androgen on the cheeks. (Figure 4b) and and scaling of excess. Such patients should be referred to In children, psoriasis may present the fingertips may occur, and may involve a dermatologist or an endocrinologist. with the typical plaques seen in adults only one or a few digits. However, the

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Management Management of psoriasis in children may vary depending on the site, nature and severity at different stages. It is important that treatment is individualised. Almost all of the topical therapies used for adult psoriasis may be used in children. Generally, topical coal tar preparations are safer in the long term and usually more effective than topical for treating psoriasis in children. There are drawbacks, however, and irritancy, cost and poor patient acceptance because of their odour may limit their use. Tars are usually started at a strength of 4% LPC on the body and limbs. This may be increased up to 10% LPC with the addition of salicylic acid to reduce scale, but this is not often required. Weak tars, usually no more than 2% LPC, may be used on the face and flexures. Tar treatment needs to be carefully monitored but when tolerated and used persistently is very rewarding. Topical corticosteroids may be used in Figures 4a to d. Typical presentations of psoriasis in children include plaques (a, top left), similar to conjunction with tars, particularly where adults, and psoriatic nail dystrophy (b, top right), often confused with . Unusual presentations include psoriatic rash on the hands and soles of the feet (c, above left) and the rash is itchy. of the feet (d, above right). Calcipotriol combined with betameth- asone dipropionate has good patient acceptance because of its lack of odour most common nail change is pitting, and may be linked genetically in some and can be more effective than topical is a useful diagnostic clue. Unusual pres- patients. When this occurs, typically monotherapy. It is usually entations include persistent rashes on the there are eczematous lesions in the cubi- well tolerated. It is too potent to use on palms and soles (Figure 4c), intertrigo of tal and popliteal fossae, but also psoriatic the face and flexures in children but is the hands and feet (Figure 4d), follicular plaques on the dorsal surface of the useful on the trunk and limbs. eruptions, persistent elbows, knees and other typical areas Topical may also be and . such as the scalp. Parents will often relate useful for psoriasis affecting the eyelids Rarely, acute pustular psoriasis may that the dermatitis component clears but in general is too weak to be effective. occur in children, with sudden onset of easily and promptly with topical corti- Narrow band UVB phototherapy, oral widespread erythema studded with sheets costeroid, while other lesions are resistant retinoids, methotrexate and of pustules and associated fever and to treatment. Concur­rent psoriasis is one A may be used in very severe cases of ­systemic toxicity. Children with this of the most common reasons for ‘non­ childhood psoriasis, but this situation ­condition should be admitted to hospital responsiveness’ in treating atopic rarely arises and if it does, the patient and monitored for systemic infection and dermatitis. needs to be referred to a paediatric evidence of dehydration. Mild topical In children a common precipitant of dermatologist. corticosteroids, wet dressings and oral psoriasis is streptococcal throat infec- When an attack of psoriasis has been antibiotics are used for treatment. Recov- tions. Stress and trauma may also play a precipitated by a streptococcal infection, ery may take several weeks. part, as they do in adults. the infection should be treated with oral In some children, psoriasis and atopic Psoriasis is an unpredictable, recur- antibiotics. Eradication of streptococci dermatitis occur together. This is not rent or chronic condition. It is seldom will not always improve the psoriasis. In surprising, considering how common severe in children, and psoriatic arthritis some patients, psoriasis is exacerbated each is, and recent evidence suggests they is very uncommon. by chronic or recurrent streptococcal

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in children with atopy. Usually, symptoms are minimal. alba must be differentiated from pityriasis versicolor, a fungal skin condition that, in children, typically occurs on the face (Figure 6). should also be considered as a but is not scaly and has a very sharp border, with obvious depigmenta- tion rather than . Figure 6. Pityriasis versicolor, which can Figure 5. Hypopigmented patches of Management occur on the face in children and should be . differentiated from pityriasis alba. It is often not necessary to treat pityriasis alba, as it is more a cosmetic than symp- infections, particularly of the , nose tomatic problem. Avoidance of skin irri- whole skin may be dry, particularly early and throat. In these patients there may be tants such as soap and and use in life. All forms of ichthyosis are more a role for prophylactic antibiotics and of a soap substitute as well as an emollient troublesome in dry, cool weather. The some benefit from tonsillectomy. twice daily are often all that is needed. recessive ichth­yosis skin dryness is of a Response to psoriasis treatment is Hydrocortisone ointment 1% twice degree that will not be confused with ­typically slow, much more so than to daily will settle irritation and scaling but eczema and patients’ very abnormal skin atopic dermatitis treatment. This is will not restore pigmentation. This is usually obvious from birth, when most because psoriasis is a hyperproliferative requires graduated sun exposure to the present as ‘collodion babies’ with an rather than an inflammatory condition. pale areas while using a sunscreen daily appearance of being encased in plastic The normal turnover time of the epider- to avoid excess tanning of the skin that is wrap as neonates. mis is about six weeks, and this is usually not affected. As this is quite difficult to the minimum time needed to obtain a do, it is often better to ignore the condi- Management good response from any treatment aimed tion, which improves with age. Treatment of ichthyosis consists of avoid- at treating the rash. Unless patients are ance of products that dry the skin, such warned of this, many will give up long Ichthyosis as soap, shampoo and bubble bath. A before their treatment has had a chance Ichthyosis is a genetically determined skin dispersible bath oil and moisturiser need to become effective (see the Patient and condition. It presents at or soon after birth to be used daily and can make the skin Carer Handout). Once the rash has and persists throughout life. Affected appear relatively normal. Generally, cleared, preventative treatment with tar patients have chronically dry, scaly skin. greasier preparations are more useful, ointments can be effective at maintaining Ichthyosis is often confused with atopic particularly in winter. Excess scale may remission, and topical corticosteroids dermatitis, but it lacks the and inflam- be removed with a preparation contain- should be restarted at the first sign of any matory component (unless there is con- ing a such as 10%, sali- new lesions. comitant atopic dermatitis). There are cylic acid 2 to 6%, lactic acid 10% or Treatment of psoriasis can be complex, many forms, dominantly inherited ich- propylene glycol 10 to 20%. Urea cream and if a patient’s response is particularly thyosis vulgaris, X-linked and a number containing sodium pyrrolidone carbox- slow, referral to a dermatologist is of recessively inherited forms. Most are ylate is particularly useful. However, recommended. quite rare; ichthyosis vulgaris is the most may cause stinging and may common. In patients with ichthyosis vul- be poorly tolerated by children. Topical Pityriasis alba garis, the skin surface is dry and scaly. corticosteroids are not required in the Pityriasis alba is a common mild form of This may be obvious only on the lower treatment of ichthyosis unless there is dermatitis in which postinflammatory legs. Additionally, these children have also atopic dermatitis. hypopigmentation is marked. Patients ‘hyperlinear’ palms and soles; in other present with poorly defined hypo­ words, the normal lines seen on these Keratosis pilaris pigmented scaly patches on the face surfaces are accentuated. In the more Present in about 50% of the population, (Figure 5). It is most obvious in summer, severe X-linked ichthyosis, seen only in keratosis pilaris is a very common, dom- when the skin is tanned, and in dark- boys, the lower legs may exhibit a ‘crazy- inantly inherited condition. It comprises skinned children, and it is more common paving’ appearance (Figure 7) and the very small keratotic papules found

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Figure 8. Keratosis pilaris, which occurs Figure 7. ‘Crazy paving’ appearance of predominantly on the lateral thighs and Figure 9. Lesions of papular urticaria ichthyosis vulgaris. upper outer arms. occurring on exposed skin surfaces.

predominantly on the upper outer arms irritation or dryness. two to four years. In children of any age, and lateral thighs (Figure 8). It is often If facial redness is a problem, keratosis grass ticks can also produce very persistent also found on the cheeks in young chil- pilaris can be treated with vascular laser, itchy papular rashes. dren. Rarely, it generalises and is then although the results are variable. This termed follicular ichthyosis. Sometimes treatment is uncomfortable and expensive, Management the lesions appear pustular but are usually requiring a general anaesthetic in most The best approach in regard to papular sterile. children. It may be best, therefore, to wait urticaria is prevention with insect repel- Keratosis pilaris is asymptomatic. Some until patients are old enough to make the lent, protective clothing and insect con- parents see it as a cosmetic problem and ­decision for treatment themselves. Unless trol, using insecticide, screens and a few are truly distressed by it. Occasion- very highly motivated, most patients tire treatment of pets. These strategies must ally, it may appear erythematous, which of topical treatment eventually and accept be maintained throughout spring and can be a cosmetic problem, particularly the condition. summer. If infection occurs, it can usu- if it is on the face. Sometimes it is confused ally be treated with topical antibiotic with dermatitis and inappropriately Common allergic rashes ointment and itch can be relieved with treated with corticosteroids. Papular urticaria topical corticosteroid. It is best to use a The prognosis of this condition is good. The term papular urticaria is used to potent corticosteroid and to cover the The facial papules disappear around describe hypersensitivity to insect bites, lesions with a dressing to ­prevent exco- puberty, and although the lesions else- usually from mosquitoes and fleas. It is riation. In areas where grass ticks occur, where may be most prominent in the a misleading term, as it bears no relation avoidance of playing outside is the best second decade, they become less obvious to ordinary urticaria and the condition prevention. with advancing age. is not helped by antihistamines. Seen in young children aged between Urticaria Management 2 and 6 years, papular urticaria usually Urticaria () is most often a benign, Keratosis pilaris is a normal variant. It is occurs in spring and summer. The lesions self-limiting, condition in children difficult to treat effectively and is best most often occur on exposed surfaces (Figure 10). The most common precipi- ignored. If treatment is desired, kerato­ (Figure 9), although fleabites usually occur tant is a preceding or current viral illness lytics such as urea, salicylic acid or glycolic under clothes. Individual lesions are but foods and can be less acid can be used overnight in combination intensely itchy papules, and crusts. often involved. Intestinal giardiasis may with an abrasive therapy (e.g. an abrasive Scratching leads to excoriation, infection cause urticaria and, occasionally, urti- sponge or facial scrub) in the shower in and ulceration that may result in scarring caria may be a complication of the morning. Care should be taken when and hypopigmentation. The prognosis of and fungal infections. Extensive systemic using these topical preparations in chil- this condition is good, with most children investigations are rarely indicated for dren as they may sting or cause redness, becoming hyposensitive to the bites after children with this condition.

40 MedicineToday ❙ MARCH 2021, VOLUME 22, NUMBER 3 Downloaded for personal use only. No other uses permitted without permission. © MedicineToday 2021. https://medicinetoday.com.au/mt/march-2021 culprit of plant dermatitis, this has now been declared a noxious weed, and many of these trees have been removed. They are still found in some gardens, however, and have a potent allergen that cross- reacts with the allergens in the ubiquitous plant genus grevillea. Grevillea is currently the most common plant allergen for children. Grevillea Robyn Gordon, an attractive hardy plant with red flowers, used to be quite ubiquitous but has been removed from public places because of the problem of allergy. Other grevillea varieties such Figure 10. Urticaria, which is often as Superb, Ned Kelly and the silky oak Figure 11. Plant contact dermatitis. precipitated by a viral illness, foods or medications. tree are close relatives, and the allergens of these all cross-react with each other. Allergic contact dermatitis presents with confused with atopic dermatitis, including Management an intensely itchy and often blistering rash. psoriasis, ichthyosis vulgaris and keratosis The best approach to urticaria manage- It may cause significant oedema on the face pilaris. Psoriasis is the most important of ment is simply to treat children ­empirically and around the genital area. It often has a these, and many patients with ‘treatment with an oral nonsedating streaky, asymmetrical pattern, reflecting resistant atopic dermatitis’ presenting to such as cetirizine or loratadine for two where the plant brushed against the skin paediatric dermatologists turn out to have weeks or until the rash has resolved, and (Figure 11). Often contact has been very psoriasis. Pityriasis alba is a very common then gradually withdraw it. If the rash brief and is not remembered by the child. and harmless childhood facial depigment- recurs, the antihistamine can be restarted ing dermatosis that is most often confused and an attempt made to withdraw it every Management with pityriasis versicolor and vitiligo, both two weeks. If urticaria persists for more If untreated, lesions of plant dermatitis tend of which are much less common. Acne than six weeks, it is worth excluding giar- to keep appearing for several days and may may occur in babies, most often boys, and diasis, and an elimination diet may be take weeks to resolve. They respond well is not a cause for concern. The most com- considered. In children, this is best done and rapidly to a short course of oral pred- mon allergic rashes in children include with the help of a dietitian with an interest nisone, starting with 0.5 mg/kg/day until florid reactions to insect bites, contact in food allergy. settled then reducing the dosage over two dermatitis from plants and urticarial reac- Antihistamines have been linked to weeks. An attempt should be made to iden- tions to viral illnesses. MT sudden infant death syndrome in children tify the cause. This can be confirmed by References under 2 years of age and should only be applying a tiny bit of the plant to the skin, 1. Dixit S, Scurry JP, Fischer G. A vesicular variant used in children younger than 12 months which will rapidly reproduce the rash. Take of pseudoverrucous papules and nodules in the if the rash is very distressing; in this case care when doing this as there is a risk of a genital area of an incontinent 4-year-old. Aust J only a nonsedating preparation should be severe reaction. Do not occlude the plant, Dermatol 2013; 54: e92-e94. used. and leave it on the skin for only five 2. Fischer G. Common skin problems in children. minutes. Managing atopic dermatitis. Med Today 2021; Plant dermatitis 22(1-2): 25-36. Acute contact dermatitis from touching Conclusion 3. Barnes CJ, Eichenfield LF, Lee J, Cunningham allergenic substances is not common in Not all childhood skin conditions are BB. A practical approach for the use of oral children as they have much less contact with atopic dermatitis, even though this is by isotretinoin for infantile acne. Pediatr Dermatol 2005; 22: 166-169. potential allergens than adults. However, far the most common problem. Nappy 4. Forward E, Lee G, Fischer G. Shades of grey: children are more prone than adults to have rash is rarely atopic and is more likely to what is paediatric psoriasiform dermatitis and what contact with plant allergens, which may indicate simple irritation, seborrhoeic does it have in common with childhood psoriasis? occur while they are playing outside. dermatitis, C. albicans infection or psori- Clin Exp Dermatol 2021; 4: 65-73. Although the rhus tree (Toxicodendrom asis. Several endogenous dermatoses that succedaneum) was once a well-known can present in childhood are often COMPETING INTERESTS: None.

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This handout provides Frequently asked some information about psoriasis in children questions about psoriasis

Prepared by Professor Gayle Fischer, Professor of Dermatology at Sydney Medical School – Northern, The University of Sydney, Royal North Shore Hospital, Sydney, NSW.

Q. What is psoriasis? A. Psoriasis is a very common inherited condition where areas of the skin look red and scaly and are often itchy. It is a skin condition, and although in adults it may be associated with arthritis, this is very rare in children.

Q. Can other people catch psoriasis from my child? A. No, psoriasis is not an infectious disease. It cannot be caught, it is not cancer, and it is rarely dangerous. However, children can inherit from their parents the genetic tendency to have psoriasis.

Q. Is there a cure for psoriasis? A. At present there is no cure for psoriasis, and beware anyone who claims to have one. This is because we still don’t have any way to alter our genetics. However, we know a great deal more about this than we did 10 years ago.

Q. Is psoriasis caused by something in my child’s diet? A. We don’t believe that diet has any effect on psoriasis. This is a medical point of view, and natural therapists will disagree. However, eating a healthy diet improves your child’s general health, and this is always good for psoriasis.

Q. What will make psoriasis worse? A. Stress, illness, lack of sleep and injury, especially to your child’s skin, may make psoriasis worse. Infection with a type of bacteria called Streptococcus, which causes tonsillitis, will also often result in the psoriasis getting worse. COPY FOR YOUR PATIENTS OR DOWNLOAD PDF Q. What treatment is available? www.medicinetoday.com.au/ A. Psoriasis in your child can be controlled with a bit of time and effort from you and patient-handouts help from your doctor; however, you have to be committed. There are many ways to Doctors may photocopy these pages for treat the psoriasis. It often takes at least six weeks of treatment to achieve a good result. distribution to patients. Written permission Remember, everyone is different and an individual treatment needs to be prescribed is necessary for all other uses. for your child. Your doctor will recommend the best and safest treatment. MT © MedicineToday 2021

This MedicineToday handout is provided only for general information purposes. The information may not apply to everyone and the handout is not a substitute for

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