Shaken Baby Syndrome

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Amniotic fluid problems

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Choosing a pre-school

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Mastitis

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Colic

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Antenatal Classes

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Strap-in-the-Future

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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Psoriasis

Psoriasis is a chronic, genetic skin condition, in which the immune system causes skin cells to produce too quickly. In general, normal skin cells mature and fall off the body in 28-30 days. In the case of psoriasis, the skin matures within 3-4 days and moves to the surface. This results in a pile up of skin cells (thickening) with silvery scales and the development of lesions. The skin also becomes very red due to increased blood flow. Psoriasis is commonly found on the elbows, knees, scalp and trunk. It may give the nails a rough, pitted appearance, and less commonly, results in a form of arthritis. Psoriasis can be a persistent problem, that is itchy and painful. Psoriasis is derived from the Greek word 'psora', which means to itch.It tends to run in families and may be triggered or exacerbated by stress, infections such as a sore throat, or skin injuries. Psoriasis affects men and women almost equally, of all races and socioeconomic groups. Most people have their first outbreak between the ages of 15 and 35, but the disease can appear at any age. In children, psoriasis does not usually begin before the age of 4 or 5. Psoriasis is not contagious; it cannot be spread from one person to another, nor can it be transmitted from one part of the body to another (Kidsgrowth.com, 2003;National Psoriasis Foundation, 2011; Netdoctor, 2010; Peters, M., 2009).

Causes:

The exact cause of psoriasis is unknown, but there seems to be a genetic component. It is agreed that the immune system is mistakenly triggered, causing the skin cells to produce 10 times quicker than normal. If a person is genetically predisposed to developing psoriasis, they must then be exposed to specific factors, that will then trigger the disease. If 1 parent has psoriasis, their child has 10% chance of developing the disease. If both parents have psoriasis, this number increases up to 50 % (National Psoriasis Foundation, 2011).

Triggers:

Young people have reported psoriasis starting or flaring-up after an infection, such as earache, strep throat, bronchitis, tonsillitis or a respiratory infection. Certain medications, as well as physical and emotional stressors can trigger the immune system to produce the rash. Occasionally, areas of skin that have been injured or traumatized, become the site of psoriasis. This is known as the "Koebner phenomenon" (Kidsgrowth.com, 2003; National Psoriasis Foundation, 2011).

Types:

There are 4 main types of psoriasis, each with its own characteristic appearance. Each subtype is divided on the basis of severity, duration, location on the body and the appearance of lesions;

Plaque psoriasis- Is the most common form of psoriasis. The skin develops areas called plaques, that consists of red, thickened skin, with a cream-coloured, scaly appearance. Plaque psoriasis is generally found on the elbows, knees, lower back, scalp, behind the ears and at the hairline. The nails become discolored and pitted. In severe cases, the nails thicken and lift away from the nail bed. Itching occurs intermittently and the plaques may last for weeks or months. The condition may be recurrent.

Guttate Psoriasis- Is most commonly found in children and adolescents, following a bacterial throat infection. The skin presents with coin-shaped (1cm), pink, scaly patches, primarily on the back and chest. Symptoms, including intermittent itching, usually disappear after 4-6 months and do not recur. However, more than 50% of those affected, go on to develop another type of psoriasis.

Pustular psoriasis- Involves the acute development of small, pus-filled blisters, on the palms of the hands and the soles of the feet. The skin becomes red, inflamed and severely tender, possibly with some scaly, thickened areas.

Inverse psoriasis- Commonly occurs in the elderly, with large, moist, red areas, developing in the skin folds. The rash primarily appears on the skin under the breasts, the groin and sometimes the armpits. Inverse psoriasis generally responds to treatment but may recur (Dr. Stoppard, M., 2005; Netdoctor, 2010).

Treatment:

Although there are numerous similarities between childhood and adult psoriasis, there are several differences in treatment. Many psoriasis treatments that are used for adults, are contra-indicated in children due to long term or delayed side effects. Your doctor will devise a treatment plan for your child on the basis of the type and the severity of their condition, the area of skin affected, your child's age and their past medical history. Psoriasis symptoms are generally controlled with a combination of medically recognized treatments and home remedies. Always contact your physician before starting any new treatment regime with your child (National Psoriasis Foundation, 2011).

If your child suffers from psoriasis, they should be able to lead a life as normal as possible. Occasionally, they may need to abstain from physical activities if their lesions are severe.

Cotton clothing is preferable, especially during the summer months.

From a psychosocial point of view, the attitude of family and friends is important in helping children who have psoriasis, cope with their condition. The rash may be unsightly and they may be prone to teasing or embarrassing questions at school. Tender loving care is therefore required and you could possibly contact your child's teacher to explain her condition to her school mates.

Medically, treatment usually begins with the use of a topical steroid cream. Hydrocortisone not only helps to soothe the itching and redness, it also helps to thin out the thick scaly part of the rash.

Bath your child daily in warm water to soak off the scales. A coal tar preparation can be added to the bath, to help control the psoriasis. This preparation does have a strong smell and may stain clothing and bedlinen.

As an alternative, your doctor or dermatologist may prescribe a topical preparation containing the vitamin D derivative calcipotriol. It has no smell, does not stain the skin or clothing, can be applied twice daily and is usually effective within 4 weeks. This treatment may NOT be used on the face or in the creases of the skin.

Ensure that your child's skin is sufficiently moisturized, in order to lubricate and soften scaly patches of skin and to relieve itching. A moisturizing or emollient cream, such as aqueous should be applied 1-3 times daily.

Provide your child with a small pot of moisturizer that will fit in their handbag or school bag, that can be used to relieve itchy, bothersome skin, when they are away from home.

If the scalp is covered in thick scales; a coal tar shampoo, combined with salicylic acid, should be used to soften and remove them.

NB: If your child's skin becomes irritated by these products, discontinue them immediately. Coal tar also makes the skin more sensitive to ultraviolet light. Therefore avoid exposing the skin to sunlight immediately after use.

Encourage your child not to scratch or rub their skin. Oatmeal bath oils, help to soften scaly plaques and reduce itching. Similarly, aloe vera creams and gels, help to alleviate dryness and itching in psoriasis.

In some cases, regular, short doses of sunshine may improve psoriasis but caution must be taken against sunburn, as this can make the condition worse.

Ultraviolet B rays may be administered at the doctor or at home, using a phototherapy device.

If stress is exacerbating the psoriasis, deep breathing and muscle relaxing exercises may be helpful.

Generally, doctors do not prescribe systemic medications for children and teenagers with psoriasis. However, if their condition is severe, they might, in order to speed up the healing process and make the young person more comfortable (Dr. Stoppard, M., 2005; kidsgrowth.com, 2003; National Psoriasis Foundation, 2011; Peters, M., 2009; The Psoriasis Association.org).

Prognosis:

If psoriasis starts in childhood, there is a good chance that it will disappear completely or improve with increasing age. However, the course of the condition may be unpredictable. There is no way of knowing when the rash will start, how long it will last for, or if it will go away for good and when. Although there is no cure for psoriasis, treatment helps to control symptoms and allows many suffers to lead a normal life (Dr. Stoppard, M., 2005; kidsgrowth.com, 2003).

The prognosis for people with Plaque, Guttate and Inverse psoriasis is good. While the more severe types of psoriasis (Pustular, Erythrodermic and Psoriatic Arthritis) may cause disability (Psoriasis-Aid.com).

Complications:

Approximately 1 in 10 people with any type of psoriasis, develop a form of arthritis that primarily affects the fingers or knee joints. Psoriatic arthritis can have a childhood onset, making it difficult for children to move around, due to painful, swollen joints. In the case of exfoliative or pustular psoriasis, a massive loss of cells from the surface of the skin, may result in a loss of protein, high fever and infection. If left untreated, this condition may be life threatening. In addition to some of the physical complications associated with psoriasis, the skin condition may have a psychological impact on a child's self-esteem and self-confidence (Dr. Stoppard, M., 2005; Yahoo! Inc., 2011).

Consult your doctor immediately if:

  • Your child's psoriasis is not responding to treatment.
  • Large sections of skin have become red and inflamed, and your child has a fever and is feeling generally unwell.
  • Your child develops joint pain (Peters, M., 2009).