Approaches to Disease Management: Psoriasis
Diagnosis and management of diseases affecting children’s life quality are sometimes not comprehensive. An example is psoriasis, an immune-mediated skin condition characterized by the distribution of thick silvery scales triggered by genetic or environmental factors (Burns et al., 2017). Although the causes are unclear, the gene contributing to the condition is known as PSORS1 (Burns et al., 2017). Effective disease management and diagnosis require understanding the condition and alternative treatments.
Psoriasis among children is highly prevalent compared to other age groups. Statistics show that 2% to 3% of the population have the disease, of whom 31 % to 45 % are children (Burns et al., 2017). Furthermore, psoriasis accounts for 4% of all dermatological conditions affecting children (Burns et al., 2017). Guttate psoriasis is the most common type among children. The signs of psoriasis vary in children. However, common symptoms include red patches with silver colorings on the skin, scaling, itching and bleeding dry skin, burning sensation, nails thickening, and stiff joints (Burns et al., 2017). Since the condition is systemic inflammation, it causes multiple complications in children, such as secondary infections around the diaper area, temperature instability, and fluid imbalance (Burns et al., 2017). Thus, the disease makes children’s social functioning difficult.
The disease is an autoimmune complication whereby the skin begins regenerating at a faster than usual rate. The rapid turnover of cells within the body causes the skin to scale and form red patches. Additionally, some individuals may be disease carriers for years before environmental factors trigger the condition (Burns et al., 2017). Common triggers include infections to the skin and throat, weather, skin injury, smoking, stress, alcoholism, certain medications, and family history.
Psoriasis diagnosis is generally clinical. A primary care specialist will examine a child’s skin to identify its symptoms. Psoriasis presents in many forms. Plaque Psoriasis is characterized by symmetric, erythematous, and demarcated plaques with silver-colored scales (Burns et al., 2017). There can be concomitant plaques on the nails and active itchy lesions. Other types of psoriasis include napkin psoriasis, inverse psoriasis, guttate (teardrop) psoriasis, pustular psoriasis, and psoriasis vulgaris (Burns et al., 2017). In diagnosis, the types of psoriasis are differentiated by the plaques’ form, shape, and structure. A biopsy is conducted in cases where the primary care doctor is unsure of a psoriasis diagnosis. The procedure entails examining a sample of the skin under a microscope (Atkins and Leung, 2011). Additionally, swollen joints and legs, which can be symptomatic of arthritis, are ruled out when the dermatologist orders blood tests and X-rays. The distinguishing sign for psoriasis compared to arthritis or other skin conditions is the skin’s plaque formations.
Treatments for psoriasis include emollient creams such as Eucerin and Aquaphor. A child can also use topical steroids three times daily for 2 to 3 weeks to treat the disease (Burns et al., 2017). Besides, treatment such as phototherapy (exposure to sunlight) effectively manages the condition (Sarma, 2017). In advanced stages, physicians prescribe light therapy. Light therapies such as PUVA use the drug psoralen alongside ultraviolet A, narrow-band UVB therapy (Burns et al., 2017). Finally, oral, and injectable treatments, such as Methotrexate and oral retinoids are available. Effective psoriasis treatments are diverse.
Despite psoriasis prevalence and its impact on a child’s quality of life, its diagnosis is never concrete. Psoriasis has a physical effect on a child’s life. With timely and appropriate treatment, the long- term adverse outcome associated with the disease reduces.
References
Atkins, D., & Leung, D. Y. (2011). Principles of treatment of allergic disease. Nelson Textbook of Pediatrics, 768-775.e1.
Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L. (Eds.). (2017). Pediatric primary care (6th ed.). Elsevier.
Sarma, N. (2017). Evidence and suggested therapeutic approach in psoriasis of difficult-to-treat areas: Palmoplantar psoriasis, nail psoriasis, scalp psoriasis, and intertriginous psoriasis. Indian Journal of Dermatology, 62(2), 113.
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