Psoriasis in Children

Psoriasis is a chronic inflammatory skin condition that causes red or pink patches of skin with scaling. It is not an infection and cannot be spread from one person to another.

In children, psoriasis may look different from adult psoriasis and often follows a relapsing course, with periods of flare and improvement.

Psoriasis often runs in families. Many children with psoriasis have a family history of psoriasis or other inflammatory conditions, although this is not always the case.

A family history can help support the diagnosis and guide discussion about how the condition may behave over time.

Symptoms can vary between children and may include:

·       Red or pink patches of skin with scale

·       Dry, thickened, or cracked skin

·       Itching, irritation, or discomfort

·       Scalp involvement, which may be mistaken for dandruff

·       Nail changes, such as pitting, thickening, or lifting from the nail bed

·       Joint pain, stiffness, or swelling, which may suggest associated inflammatory arthritis (psoriatic arthritis)

Severity can range from mild, localised patches to more widespread skin involvement. Joint symptoms are less common but important to recognise early, as they may require specialist assessment and treatment.

Management is individualised and considers the child’s age, severity of psoriasis, affected body sites, and impact on daily life.

Treatment may include:

• Prescription topical treatments to reduce inflammation and scaling

• Regular moisturising to support the skin barrier

• Identifying and managing triggers where possible

Treatment plans are reviewed and adjusted over time as symptoms change.

Topical corticosteroids play an important role in controlling inflammation in psoriasis when used appropriately.

Specialist guidance focuses on:

• Choosing the appropriate strength for the child’s age and body site

• Using treatment for the correct duration

• Adjusting therapy as the skin improves

Where appropriate, steroid-sparing treatments may also be introduced to support longer-term management and maintenance.

In addition to topical corticosteroids, other prescription treatments are commonly used in childhood psoriasis.

These may include vitamin D–based treatments, which help slow excessive skin cell turnover and reduce scaling. Vitamin D preparations are often used:

• In combination with topical corticosteroids

• As part of maintenance therapy

• On areas such as the scalp or thicker plaques

For thick or scaly psoriasis, especially on the scalp, additional preparations may be used to help soften scale and improve penetration of active treatments. These may include:

• Medicated scalp solutions, foams, or gels

• Treatments designed to lift or reduce scale before anti-inflammatory therapy is applied

The choice of preparation depends on the child’s age, the location of psoriasis, the thickness of scale, and how well treatments can be applied and tolerated.

Using the right combination of treatments and formulations is particularly important for scalp psoriasis, where thick scale can make treatment more challenging.

For children with moderate to severe psoriasis that does not respond adequately to topical treatments alone, additional therapies may be considered under specialist care.

These may include biologic therapies, which target specific inflammatory pathways involved in psoriasis. In Australia, biologic medications for psoriasis are prescribed by dermatologists under specialist supervision and require careful assessment, discussion with families, and ongoing monitoring to ensure safety and effectiveness.

Psoriasis can be associated with other health factors, even in childhood. These may include:

• A family history of inflammatory conditions

·       An association with metabolic health issues over time, such as obesity and insulin resistance, particularly in more severe or longstanding psoriasis.

Assessment includes consideration of the child’s overall health and wellbeing. Management focuses on skin control alongside healthy lifestyle habits appropriate for age.

Psoriasis can affect a child’s confidence, particularly when visible areas such as the face, scalp, or hands are involved. It may also impact social interactions, school experiences, and emotional wellbeing.

Management includes:

• Acknowledging the emotional impact of psoriasis

• Supporting children and families in understanding the condition

• Discussing treatment options aimed at improving both skin symptoms and quality of life

With appropriate care and support, many children manage psoriasis well and maintain good self-esteem.

Medical review may be helpful if psoriasis:

• Is widespread or difficult to control

• Affects the scalp, nails, or sensitive areas

• Causes persistent itch or discomfort

• Is affecting confidence, sleep, school, or quality of life

Early review supports treatment optimisation and reduces the impact of psoriasis on daily life.

At Ready Dermatology, North Shore Health Hub, St Leonards, our dermatologist provides assessment and management of childhood psoriasis in accordance with Australian clinical guidelines. Care is individualised and focuses on safe treatment use, long-term disease control, and supporting children and families as symptoms evolve over time.