Psoriasis is a chronic inflammatory skin disease characterized by exaggerated proliferation of skin cells in response to activation of the system in focal skin areas.The result is a rash with red, scaly patches that are itchy.
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The risk of this condition exists in both adults and children. Although this happens very rarely, Pediatric psoriasis corresponds to approximately 1 in 3 cases in the world. The complication in these cases is that, when psoriasis occurs in childhood, it is usually less pronounced.
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In an interview, Dr. Carolina Cortés Correa, dermatologist, professor of dermatology at the Universidad Nacional de Colombia and Universidad de los Andes, and academic coordinator of the dermatology service at the Hospital Universitario La Samaritana.WebMD talks about everything you need to know about the disease and how it affects Colombia and the region.
How prevalent is Pediatric Psoriasis in Latin America and Colombia?
In general, psoriasis may occur in 3% of the population. There are not many specific data for children and adolescents, but there is a study published by the University of Javeriana in Colombia, led by Dr. Daniel Fernandez and Dr. Laura Chari, where they show a study of the prevalence of psoriasis in Colombia in general. , and show that patients between the ages of one and 16 make up less than 1% of the population.
These figures, in particular, are taken from the database of the National Ministry of Health, and are the data that was studied till 2017.
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If I take as a basis all skin diseases that occur in children, there are studies in Latin America that report that psoriasis may correspond to 4% of all diseases that this population has from birth to Can affect till the age of 17 years.
What age groups can psoriasis affect and why the special focus on pediatrics?
Psoriasis can occur from childhood to adolescence, At first it is often that it begins as a red plaque in the diaper areas that is not adequately controlled with diaper rash creams.
It can also occur in preschool age or when children are already in school, linked to an infectious trigger. For example, certain bacterial infections, mainly of the throat, can be triggers for a particular type of psoriasis called “visceral”; However, I can get psoriasis at any time during childhood or adolescence.
Is there any effective treatment for it? Is its treatment possible?
Early diagnosis (from childhood) of patients with psoriasis is important, as it allows us to treat faster, as well as improve the prognosis of the disease.
So far, there is no cure for psoriasis, that is, it is chronic like hypertension or diabetes, but its early diagnosis will help us to conduct timely treatment, identify concomitant diseases such as arthritis, which can lead to psoriasis in the first place. may be associated with. , and thus avoid future complications.
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Although there is no cure for the disease yet, there are a number of treatments, either topical or oral or injected, that help control the manifestations of psoriasis, ranging from the mildest to the most severe.
What are the early warning signs and when should parents take their child for counseling?
Psoriasis typically appears as red, scaly plaques that are very sticky to the skin, and it can have many of the same diagnoses, such as allergies or certain fungi. So, as a parent, the biggest warning sign for me to suspect possible psoriasis in my son is that he receives treatment for allergies and it doesn’t go away easily, or they treat him thinking he has it. Let’s say it’s a fungus and it doesn’t improve.
At that point, the primary care physician should be alerted to a dermatological pathology that is not being treated most appropriately, and should then refer to a dermatologist, as psoriasis is managed dermatologically and is Treatment should be guided by this characteristic.
Besides physical symptoms, how can psoriasis affect a child’s life?
In addition to the fact that psoriasis will affect the physical condition of the patient, since it will present one or several plaques throughout the body. As we have already mentioned, childhood and adolescence are the periods where we all begin to form our self. . perception; That is, it is the stage where we all generate our self-esteem and our personality traits.
So, if a child has a disease that affects the visible parts of his skin, he is a child who will be shy, who will be bullied at school, who will have difficulty making friends and who will. Their self-esteem declines in adulthood, which can lead to a nervous, insecure adult who is not able to establish adequate relationships.
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It is already known that more than 30% of patients with psoriasis in childhood have problems of depression and/or anxiety, and that is why it is important to treat them in time, to avoid this type of association with psychological pathology. It is very important to do.
There is still a lot of stigma around psoriasis. What are the main myths you hear in counseling about this disease and what is the truth to debunk them?
The first and biggest myth of psoriasis that we must bust is that it is contagious, as this is the belief that many patients are rejected at work or school; However, the pathophysiology of the disease does not result from any bacteria or infection at any point in time, therefore, it may not be infectious.
We must remember that psoriasis occurs because the body’s defense cells, which are lymphocytes, attack the skin and produce these red plaques because the skin does not replace itself in the time it takes (36 and 37 days among). But seven days in six or 37 days. This is very important to know so that we do not stigmatize people with psoriasis.
Is Psoriasis Commonly Underdiagnosed? If yes, why and how do we solve it to counter it?
Psoriasis is not something that happens every day. This rarity means that general practitioners do not know much about the disease; However, in recent years we have had campaigns where we are teaching doctors to recognize the pathology of psoriasis.
If I have psoriasis, my child may be at higher risk of developing it than in the hypothetical case that none of his or her family members had the disease. Therefore, if the predisposition is in our family and red plaques start appearing in our children, we should be alert and consult doctors.
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Underdiagnosis is actually due to the lack of knowledge about this disease at the community level, and that is why it is so important to have an awareness campaign around it, so that we can promote the consultation of this diagnosis throughout Colombia.
Can psoriasis be prevented?
Psoriasis is a multifactorial disease, this means that we must have a genetic part (that our genes must be coded for this tendency), but I may be the first person in my family to be diagnosed with psoriasis. About four out of 10 patients have a family history.
However, these genes that I have to activate psoriasis are usually associated with a very significant stress episode or infectious event. For example, just now when we had COVID-19, many patients developed psoriasis after being infected with the virus.
Physical stress, such as being hospitalized or being very ill for any reason, is also taken into account. These triggers can trigger psoriasis, just like cigarette smoking.
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Since it is a disease that has a genetic basis, but is activated by certain environmental factors, its treatment is very complex and is not something that can be avoided. If I have that genetic trait, any of these triggers can activate it, there’s nothing I can do to stop it happening to me, it’s not possible.
Is there any advice that can be given to a parent who does not want their child to suffer from this disorder?
My advice is that if someone has a history of psoriasis in the family and your child starts showing symptoms, seek advice immediately and find out if this is the disease or not. There are many diseases that can look very similar, and only the trained eye of an expert will be able to tell them apart.
What types of treatments are there and what does your choice depend on?
The treatment of psoriasis is defined on the basis of how widespread it is. If less than 10% of a patient’s body surface is involved, in general, we will decide on treatments that we call topical, which are specific creams to treat the disease.
If the prevalence of psoriasis is more than 10%, we consider it moderate or severe, and it will be treated with pills or injections, not just creams.
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In children, a treatment called phototherapy is very useful, which involves entering a chamber containing bulbs that emit light with wavelengths similar to the sun’s radiation, and has been applied very safely in this population. goes. However, this option is not the most accessible as it is not available in all cities, apart from the fact that it is not easy for children to undergo this therapy twice or thrice a week. In these cases we can use oral treatments (tablets) or subcutaneous with some special injections for this pathology.
10 or 12 years ago there were few treatment options for psoriasis, but research on the disease has come a long way and we now have a wide variety of drugs with excellent responses, so you shouldn’t put off getting a consultation.