Why We Must Look Beyond the Skin in Children with Psoriasis

Psoriasis is a chronic inflammatory disorder that in its juvenile form can affect approximately 0.7% of children.^[1] It is commonly characterized by scaly plaques that can be itchy and painful. For children, starting out their life with a life-long disease that has no cure can be extremely distressing.

Psoriasis in children and adolescents can have a negative impact on their normal development. These young patients may have problems in their interpersonal relationships, can be victims of bullying, may suffer from missed days at school, and can have reduced opportunities to participate in sports and play with their friends.^_[1] Studies have shown that psoriasis, along with atopic dermatitis, can have a greater impact on quality of life in children than any other chronic skin condition. In fact, the impact of psoriasis on quality of life in children is greater than that of other chronic diseases such as asthma, epilepsy, and diabetes.^_[2]

Mental Health

Psoriasis can lead to itchy, painful, and visible lesions that can greatly impact the daily lives of children and adolescents. The visibility of the lesions can cause young patients with psoriasis to feel embarrassed about their appearance and to experience rejection and social isolation. This can cause issues with self-esteem and can lead to depression, anxiety, and suicidal ideation.^[3] In addition, one study found that children and adolescents living with psoriasis were much more likely to receive medications for psychiatric disorders than children without psoriasis.^[3]

Mental illness and the use of psychiatric medications at such a young age in these patients is alarming, considering this is a chronic, life-long disease that will likely affect these patients for the rest of their lives. It is important for children and adolescents with psoriasis to be followed by a mental health professional in order to ensure their well-being.

Interpersonal Relationships

As psoriasis affects body image and self-confidence, children and adolescents with psoriasis may suffer from more social isolation than the average healthy person. Making friends and socializing with strangers can often be a challenge for children and adolescents with psoriasis.^[4] Having visible skin lesions can also interfere with intimate and romantic relationships in adolescents.^[4] In addition, relationships with family members can also be affected, as arguments between individuals and their parents can be common. For example, parents may insist that they should take their medications or stop picking at their skin, which can create tension at home.^[4]

Social isolation

Young patients with psoriasis often describe feeling “disgusting” and say they often just want to go somewhere and hide so that they don’t have to be seen.^[5] The thought of looking different than their friends and classmates can be extremely hard for children and adolescents with psoriasis. For this reason, psoriasis can often leave young patients feeling lonely and forgotten.^[5]

One study showed that patients with psoriasis that were diagnosed at an earlier age were more likely to feel stigmatized and rejected by others when compared to those who develop psoriasis later in life.^[6] The authors in this study stressed how important it is for physicians to closely monitor children and adolescents who develop symptoms of psoriasis in a time period that is critical for identity formation and comparison between peers.

Bullying

Bullying towards young patients with psoriasis can sometimes be part of their daily lives. For those individuals who experience bullying, the degree of loneliness can be even more severe.^[5] Most children and adolescents report that most of their bullying occurs at school.^[4] Unfortunately, in some instances, bullying can come from strangers on the street or from their own family members. One patient told a story of how her dad called her “flaky” and asked her to stop “flaking” in his car.^[4]

Quality of Sleep

Psoriasis can be extremely itchy and uncomfortable at times. For this reason, quality of sleep is often affected in young patients with psoriasis. Many patients find that their skin symptoms are so uncomfortable that they are unable to find a comfortable position while lying in bed.^[4] Sometimes even choosing the right temperature at bedtime can be difficult, as some patients say they feel pain if the temperature is cold in bed but then feel itchy if the temperature is warmer.^[4] 

Not getting a good night’s sleep can negatively impact anyone’s health, especially young patients who are still developing. Sleep is necessary for the recovery of our body on a daily basis, including tissue repair and muscle growth. In addition, lack of sleep has been associated with a higher risk of developing other serious medical conditions (including obesity, diabetes, and heart disease) and a shortened lifespan.^{[7, 8]} Therefore, the lack of healthy sleeping patterns may greatly affect quality of life.

Missing School and Other Activities

Young patients with skin conditions such as psoriasis may be more likely to miss days of school than their healthy peers.[9] Reasons for missed days of school can be related to doctor’s visits and treatment or may result from fear to be seen and embarrassment.[4] This is very concerning as missing school can have a tremendous negative impact on their education and their future. In addition, discomfort from psoriasis symptoms and embarrassment can cause young individuals to avoid outdoor activities such as swimming and sports.[10] Avoiding these types of activities may further contribute to social isolation and can lead to a more sedentary lifestyle.

Other Conditions Associated with Psoriasis

Aside from its direct impact on quality of life, psoriasis may be associated with the development of other serious medical conditions such as obesity, high blood pressure, high cholesterol, diabetes, and rheumatoid arthritis.^[11] Development of these medical conditions can each affect the quality of life in their own ways, which would further increase the already tremendous burden of young patients living with psoriasis.

Considering how psoriasis can negatively impact the life of a young patient, it is essential that children and adolescents find an effective psoriasis treatment early on. Adequate control of psoriasis symptoms, as well as encouragement by parents and education, may improve quality of life in these patients.