Psoriasis in babies and children: how to treat it?

It can occur that an infant presents with lesions of psoriasis during the first few months of their life. This skin disease is characterised by the appearance of red patches and inflammatory reactions on the area of skin located beneath the nappy. It is often referred to as "nappy psoriasis". This typically appears during the first two years of the infant's life. It initially affects the fold areas before spreading to all areas covered by the nappy. It takes on the typical appearance of nappy rash, but is clearly defined. It is minimally scaly and predominates on convexities with a glossy appearance.

One of the recurring forms of psoriasis that can affect children is the plaque psoriasis. Affecting the face, it can give the child a particular semiological appearance known as "red clown". Sometimes, it affects both cheeks at the same time. Plaque psoriasis is characterised by the presence of defined and symmetrical inflammatory patches on the skin.

In children, psoriasis can be pustular or palmoplantar. They may suffer from dry pulpitis with cracks and pain in most cases. For instance, at school, they may struggle with writing. The child may also suffer from other forms of psoriasis such as the guttate psoriasis. The skin rash can spread to different areas of the body like the scalp. Often, it is characterised by the presence of pink macules that predominate on the trunk and the root of the limbs. In 50% of cases, guttate psoriasis only lasts a few months and will disappear without treatment.

In treating psoriasis in babies or children, the primary goal is not to cure the disease, but to encourage the child to accept it. It is essential to provide them with a normal life so they can engage in everyday activities (such as swimming, writing, etc.) while avoiding ridicule.

The treatment of psoriasis in children is straightforward when the doctor, parents, and child work together harmoniously. Through consultations, parents can understand psoriasis and choose the appropriate treatment to achieve the goals set out beforehand.

• Theacitretin, a treatment designed for severe forms of psoriasis. It works by limiting the speed of cell renewal in the epidermis and thinning the plaques.

• Theuse of dermocorticoids which are prescribed to provide relief to the patient.

• The phototherapy, a treatment is available to children from the age of 8.

• The methotrexate, a medication used to treat psoriasis as well as potential joint pain, and psoriatic arthritis.

• The cyclosporine, an emergency treatment used on a child suffering from psoriasis who needs to be relieved quickly.

• AUGUSTIN M. & al. Epidemiology and comorbidity of psoriasis in children. British Journal of Dermatology (2009).

• Dr MAHÉ. Le psoriasis de l'enfant. Association France Psoriasis (2013).