From the Guidelines
Psoriasis in children is primarily caused by a combination of genetic predisposition, immune system dysfunction, and environmental triggers, including infections, stress, and cutaneous trauma, as noted in the joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients 1.
Key Factors
- Genetic predisposition is a significant factor, with many children having family members with the condition
- Immune system dysfunction leads to an overactive immune response, accelerating skin cell production and causing characteristic thick, red, scaly patches
- Environmental triggers such as infections (particularly streptococcal throat infections), skin injuries, stress, and certain medications can initiate or worsen psoriasis flares
- Hormonal changes during puberty may also influence disease activity
Comorbidities and Quality of Life
- Psoriasis in children can be associated with comorbidities such as psoriatic arthritis, cardiovascular disease, metabolic syndrome, obesity, dyslipidemia, hypertension, insulin resistance, mental health issues, and inflammatory bowel disease, as discussed in the guidelines 1
- The impact of psoriasis on a child's quality of life (QOL) should be considered when determining disease severity, with tools such as the Children's Dermatology Life Quality Index (CDLQI) available to assess QOL 1
Management and Treatment
- Various treatments can help manage symptoms, including topical corticosteroids, vitamin D analogs, moisturizers, and in more severe cases, phototherapy or systemic medications
- Early diagnosis and treatment are crucial to minimize physical discomfort and potential psychological impacts on the child
- A comprehensive approach to managing psoriasis in children should include addressing potential comorbidities and assessing the impact of the disease on QOL, as emphasized in the guidelines 1
From the Research
Causes of Psoriasis in Children
The exact cause of psoriasis in children is not fully understood, but research suggests that it is a complex interplay between genetic and environmental factors.
- Genetic predisposition: Studies have shown that psoriasis can be inherited, and certain genetic mutations can increase the risk of developing the condition 2.
- Immune system dysfunction: Psoriasis is characterized by an abnormal immune response, which leads to inflammation and skin cell proliferation 3, 4.
- Environmental triggers: Environmental factors, such as stress, infections, and exposure to certain chemicals, can trigger psoriasis in susceptible individuals 4.
Genetic Factors
Genetic studies have identified several genetic variants that are associated with an increased risk of developing psoriasis.
- Genome-wide association studies have identified multiple genetic loci that are linked to psoriasis susceptibility 2.
- Genetic analyses have also shown that psoriasis can be stratified by phenotype, outcome, and response to treatment 2.
Immune-Mediated Inflammation
Psoriasis is characterized by an immune-mediated inflammatory response, which involves the activation of various immune cells and the release of pro-inflammatory cytokines.
- The inflammatory cascade in psoriasis involves the activation of immune cells, such as T cells and dendritic cells, and the release of cytokines, such as tumor necrosis factor-alpha (TNF-α) and interleukin-17 (IL-17) 3, 4.
- The inflammatory response in psoriasis can lead to the development of skin lesions and other systemic complications, such as psoriatic arthritis and cardiovascular disease 5, 6.