Baby psoriasis is a skin condition that causes dry patches to form on the skin, eventually turning into scaly, dry patches. Seeing such red scaly patches on your baby’s skin might make you anxious. In most cases, parents consider this an allergic reaction or a rash but only understand the actual disease when the symptoms persist and start to spread.
Psoriasis is considered to be a disease of the immune system. The skin disease might make your baby fussy and irritable as they cannot communicate to you about their discomfort. It is advised to consult your baby’s pediatrician at the earliest in such cases to avoid any complications.
Read on to know more about psoriasis, its causes, signs, treatment, and prevention techniques.
Can Babies Get Psoriasis?
Yes, babies can have psoriasis. The condition is rare but can affect even newborns. Psoriasis is the accumulation of dead skin at several points on the body, resulting in red /pink lesions on the skin that can become flaky and itchy. Layers of human skin form and shed once in a month but those suffering from psoriasis have an accelerated skin growth where a new layer of skin forms every three to four days (1). This aggregation of skin at various points of hyper growth causes inflammation, which leads to irritation, soreness, and redness.
There are several types of psoriasis, and the ones that affect adults can also occur in little ones. Of them, plaque and guttate are two types of psoriasis that are most common in babies.
- Plaque psoriasis is also known as psoriasis vulgaris; 85-90% cases of psoriasis cases are those of plaque psoriasis (2). This condition can cause large, irregularly shaped scaly patches or small scaly lesions that have a white or silvery crest with each patch surrounded by a red, inflamed area. The white crest falls in flakes when scraped, and the baby will do that a lot since they are itchy. Scratching the scales too often causes bleeding from the cracks left behind by a fallen skin flake. Plaque psoriasis flakes happen on the lower back, scalp, elbows and knees.
- Guttate psoriasis affects babies and young adults more than grownups (3). The condition causes small drop-shaped or dot-like lesions scattered in huge numbers across the torso, limbs, scalp, ears and on the face. Guttate psoriasis commonly occurs after a bout of streptococcal throat infection. However, it can occur independently as well.
Napkin psoriasis is a type of plaque or guttate psoriasis that appears only around the diaper area. It is often mistaken as a diaper rash (4).
What Are The Symptoms Of Psoriasis?
Psoriasis affects the entire body or any part of it. If the baby suffers from the condition, then he will show the following symptoms:
- Red, scaly patches or rashes: Psoriasis rashes have multiple layers of dead skin, which are white, yellow or silver in color at the center. The middle patch of the dead skin is surrounded by red or bright pink colored skin, which is often inflamed. There is no definite shape of these lesions. They are irregularly shaped in the case of plaque psoriasis while they are droplet-shaped in guttate psoriasis.
- Chronic itchiness: The baby will rub the affected area often and may cry or whimper while doing so. Older infants may directly scratch the rash using their fingernails. Every time the skin is rubbed, it sheds white flakes, revealing some pinkish skin at the spot of detachment. The skin at the lesions will appear cracked, dry, and will be sensitive to heat.
- Swelling and burning sensation: The region around the sore is swollen due to which the baby may have a burning sensation.
- Bleeding from rashes: The rash bleeds after the flakes of dead skin fall from the body due to rubbing or scratching.
- Scales on fingernails: Nail psoriasis rarely happens alone, and usually accompanies plaque psoriasis (5). Fingernails thicken due to abnormal growth and display scales that are white or yellowish in color. They will even have pits or bend abnormally. In severe cases of psoriasis, the nail may shed from the root after it outgrows the fingertip.
- Limb stiffness: If the lesion is large and on the elbow or knee, then the baby may have trouble moving the limbs as if they are stiff.
Psoriasis has its tell-tale signs, but some conditions could be visually similar to it.
Conditions Visually Similar To Psoriasis
Following are some skin diseases that may appear identical to psoriasis but occur due to entirely different reasons:
- Eczema: Eczema, also known as dermatitis, is an allergic inflammation of the skin that results in red sores or rashes on various parts of the body. The condition may subside when an allergen is removed from the environment, which does not happen in psoriasis since it is not an allergic reaction. A form of eczema only observed in babies is cradle cap (infantile seborrheic dermatitis), which makes the skin on the scalp crusty (6). The scaly skin here is only limited to the scalp with the rashes less defined than those observed in psoriasis.
- Fungal infection: Fungal infections, like those caused by ringworms (tinea), are often confused to be psoriasis (7). Fungal lesions usually form a defined pattern, since they are due to a pathogen, unlike psoriasis lesions that have less predictable patterns.
- Skin hives: Sometimes what you see is just some skin hives, which is an indicator of an allergic reaction. Unlike psoriasis, skin hives are tiny bumps that appear in clusters. They can form on any part of the body and are usually accompanied by other symptoms of the allergy.
If you have the slightest doubt about your baby developing psoriasis, then visit a doctor to get the little one checked. The sooner the condition is diagnosed, the faster it can be resolved.
How Is Psoriasis Diagnosed?
A medical professional can diagnose psoriasis by observing the lesions. He will look for the presence of psoriasis sores at particular sites on the body to differentiate it from other skin problems. In an unusual instance, the doctor may perform a painless biopsy by gently scraping the flakes of the lesion and sending it for laboratory testing to determine the presence of psoriasis. While the symptoms of infantile psoriasis are usually evident, the causes tend to be elusive.
What Causes Psoriasis In Infants?
The exact reasons for psoriasis are not known (8). However, modern research has accumulated a list of probable reasons that may lead to psoriasis:
1. Genetic anomalies in the immune system: Genetic mutations are considered the leading cause of psoriasis (9). Babies whose parents have a family history of psoriasis may have a greater risk of developing the condition.
Psoriasis is an autoimmune disease, wherein the T-lymphocytes, also referred to as killer T cells, attack healthy skin cells as they mistake them to be foreign bodies. The spot where they attack the skin cells thickens, like in a wound, and forms plaque, which is externally visible as a psoriasis lesion.
A constriction of blood vessels is also noticed around lesions along with a substantial inflow of other types of lymphocytes. The body behaves like it is healing a dermatological infection or fighting a skin pathogen, piling layers of skin atop each other and overwhelming the spot with lymphocytes. It is the accumulated skin and lymphocytes that form the white/yellowish/silvery scales on the lesion.
2. Risk factors that trigger the psoriasis genes: Psoriasis may occur when the defective genes are activated due to another external factor (10). These are not direct causes of the problem but the conditions or events that trigger the genetic mutations (in the affected individual), and may lead to psoriasis:
- Infections caused by streptococcus bacteria: The bacteria affects the throat and sinonasal passages. The body’s immune system detects the presence of the pathogen and responds to it but during this process activates the erroneous genetic code, which mobilizes killer T cells to attack healthy skin cells.
- Certain medications: Medicines like that for malaria can make the immune system go haywire by triggering the defective genes, eventually causing psoriasis.
- Skin injuries: Injuries to the skin, such as bruises, cuts, burns, and severe sunburns may influence the immune system to lead to a psoriasis condition.
- Stress: When a baby develops psoriasis randomly, then stress could be the reason behind it. A baby can get stressed due to numerous reasons such as noisy environment, uncomfortable crib, extreme weather or pollution. An infant’s underdeveloped immune system reacts to these external factors in a manner that consequently may cause psoriasis.
These triggers are conditional as the baby may still develop psoriasis if he carries the defective genes that lead to the condition.
Psoriasis is not contagious, therefore, you need not have to worry about the disease getting spread to the other children in the family.
How Is Psoriasis Treated?
The treatment involves a series of procedures that aim at achieving two objectives viz. reducing the rampant growth of the skin at psoriasis lesions and curing the condition. Treatment for psoriasis has three applied components that are administered simultaneously (11):
- Topical treatment
- Injected and oral medications
1. Topical treatment:
It involves the use of medicated baby cream and lotion, which provide relief from lesion scaling, irritation, inflammation and flaking. Following are some of the common drugs and their functions:
- Corticosteroids – Reduces inflammation
- Retinoids – Normalizes defective gene activity, reduces inflammation
- Vitamin D – Prevents scaling
- Anthralin – Removes scales, smoothens the skin
- Calcineurin inhibitors – Disrupts the activity of killer T cells
- Coal tar – Relieves inflammation, reduces skin irritation
- Salicylic acid – Spurs shedding of dead skin, makes skin smoother
Artificial light of ultraviolet (UV) frequency is used to zap the T-cells at the lesion site to subdue inflammation and proliferation of dead skin. Medical professionals can employ a broad spectrum of artificial UV light and even use laser beams depending on the extent of psoriasis. Phototherapy or light therapy treatment may have side effects such as redness, itching and slight burning sensation. For this reason, the treatment is always accompanied by the use of topical medicinal moisturizers that alleviate discomfort.
Natural UV rays from sunlight are also effective in relieving the intensity of the condition. The doctor may ask you to sit with your baby in the sun for a prescribed duration in the morning.
Too much of UV light can exacerbate psoriasis, so never expose the baby to sunlight beyond the length or time of the day suggested by the doctor. Plaque psoriasis responds well to phototherapy (12).
3. Injected and oral medications:
Oral and injected drugs can be part of the medication when the psoriasis is severe and does not respond to the other forms of treatment. Injected medicines are administered through the intravenous (IV) pathway while oral medicines may be prescribed depending on the age of the baby.
This treatment method has the risk of side effects, and is only administered for a brief period. Following are some of the drugs used in injected and oral medication of psoriasis, and their purpose:
- Methotrexate – Decreases production of skin cells, reduces inflammation
- Retinoids – Decreases production of skin cells
- Cyclosporine – Suppresses the immune system
- Etanercept, infliximab, adalimumab – Referred as biologics, these drugs manipulate the overactive immune system to suppress its functions.
Your baby’s doctor will recommend the appropriate course of treatment after determining the intensity of psoriasis and considering the infant’s age. Infantile psoriasis can be tackled through simple topical ointments. However, if the condition is severe, the doctor may opt other forms of treatment. During such scenario, he will discuss the potential side effects and weigh risks against the long-term benefits.
Psoriasis sores may appear and disappear in a cyclic manner, often receding for months and then relapsing one day (13). Therefore, you need to administer the prescribed medicines to the baby until she completes the cycle of treatment even if she gains relief halfway through the procedure.
Can Psoriasis In Babies Lead To Complications?
Infantile psoriasis can lead to complications if the condition is extremely severe or is left untreated for a very long time. There are several complications of psoriasis in adults, but babies are prone to the following:
- Psoriatic arthritis: It is the painful inflammation of joints, quite similar to arthritis that affects. Interestingly, arthritis is also a non-contagious autoimmune disease just like psoriasis.
- Uveitis: Uveitis is the painful swelling of the middle tissue layer of the eye called the uvea. The inflammation often occurs in combination with psoriatic arthritis, which is itself triggered by psoriasis (14). About 7% of psoriatic arthritis patients develop the uveitis condition (15).
Are There Ways To Prevent Psoriasis?
It is tough to prevent a disease, which occurs due to rigid genetic defects. However, you can mitigate the risks that could trigger these defective genes. Here are the ideal lifestyle practices for your baby to reduce the chances of developing psoriasis:
- Maintain a healthy diet: Feed your baby appropriately, on-demand, and if he can eat solid foods, then make sure that he is getting micronutrients that boost immunity. The lesser the chances of infection, the less likely the immune system goes haywire to cause psoriasis.
- Give daily baths: A bath washes away the dead skin and keeps the skin clear of bacteria, like streptococcus, that may transmit into the baby’s mouth when he puts his hands in his mouth.
- Apply moisturizer: Moisturizers prevent skin from cracking especially during the cold weather. Cracked spots on the skin are vulnerable to psoriasis.
- Let your baby soak in some sunlight: Many mothers avoid taking their babies out in direct sunlight with a fear that it may damage their sensitive skin. But some sunlight is good for your baby since it naturally kills germs on the skin, keeping it healthy. You can take the infant outdoors when the sunlight is least intense like in the morning or around sunset. Keep track of how often the baby is going out so that you do not overexpose him to UV rays.
Psoriasis in babies is an autoimmune disease caused due to genetic anomalies. It appears as an itchy rash on the skin that may be flaky or form dot-like lesions. Certain infections, medications, or injuries may trigger the defective genes resulting in psoriasis. Following a healthy lifestyle with a proper bath and moisturizing routine may reduce your baby’s risk of developing the condition. Various topical and oral medications and phototherapy are available to treat psoriasis, but it is best to consult a doctor for a confirmed diagnosis and suitable treatment.