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Psoriasis in children: natural outcome often positive

Topical treatment of the symptoms is usually sufficient. Treatments with severe adverse effects should be avoided as far as possible.

Psoriasis in children is a benign skin disease which generally clears up naturally. The lesions usually take the form of patches, particularly at the elbows, knees, the lumbo-sacral area, the navel, the scalp and the face. Psoriasis appears on average at the age of 7. In around 30% of cases, it clears up naturally, but around 30% of children still have lesions after the age of 15.

There is no known treatment guaranteed to cure psoriasis permanently. In most cases, it is best to use emollient-type skin creams to relieve itching and moisturize the skin, and to avoid emollients containing substances that can cause irritation. Mild topical corticosteroids are useful during flare-ups. However they should only be used on children for a short period because of their adverse effects.

Phototherapy is sometimes suggested in cases of widespread and resistant psoriasis, with the long-term risk of skin cancer.

Immunosuppressants expose patients to severe adverse effects. Methotrexate is the least poorly evaluated drug for the treatment of psoriasis. Etanercept, despite some effectiveness in the short term, carries the risk of infectious, sometimes fatal adverse effects and there are worrying uncertainties as to its long-term effects.

It is better to keep to topical treatments as far as possible, managed closely and with patience.

©Prescrire December 2009

"Childhood psoriasis: often favourable outcome" Prescrire Int 2009; 18 (104): 275 (pdf, subscribers only).

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