(July 14, 2009 - Insidermedicine) In this video, Dr. Kelly Cordoro, MD, discusses what she would do if she had a child that developed red, scaly patches. Dr. Cordoro is Assistant Professor of Dermatology in the Division of Dermatology, at the University of California, San Francisco Medical Center.
At the American Academy of Dermatology's annual meeting in San Francisco we spoke with Dr. Kelly Cordoro, Assistant Professor of dermatology in the division of pediatric dermatology at the University of California San Francisco Medical Center.
If I had a child who developed red, scaly patches...
Dr. Cordoro: Red scaly patches can be one of many dermatological conditions. Psoriasis is one of those conditions. Viruses can prompt red scaly patches, Eczema, and other things as well. So if your child develops red scaly patches it may be psoriasis. If your child is otherwise well you can call in to see a dermatologist on a "next available" bases. If your child is sick, has a fever, joint pain, or any other symptoms, they should be seen on a more urgent basis.
What questions will my doctor ask?
Dr. Cordoro: When you take your child to the dermatologist's office there will be a number of questions asked to try to arrive at a final diagnosis or the rash. The types of questions will be; how long has the rash been there? Does the rash hurt or itch? What areas of the body does the rash involve? Where did it start? The other types of questions will be to elicit a family history. Is anyone else in the family suffering from this type of rash? And finally, a general medical history will be taken. Is your child otherwise well? Are there any other associated illnesses? Any medications? And so forth.
These are all items that the doctor specifically the dermatologist will use to make a clear identification of the rash. The examination will involve typically a full body examination from the scalp, behind the ears, down to the toes, and a parent should expect a full body examination of their child and not just the areas that area involved. Psoriasis in particular has many manifestations such as on the nails. In areas such as the gluteal cleft, which is the upper part of the buttock area, and other somewhat discrete areas that should be evaluated to be conclusive in diagnosing the condition.
What are the treatment options for psoriasis?
Dr. Cordoro: If your dermatologist diagnoses psoriasis in your child they will then categorize the psoriasis as mild, moderate, or severe. And that generally involves which area of the body is affected. Mild might be in areas on the elbows and the knees. Moderate may be more wide spread areas. Severe can involve the entire body. But these definitions also may depend on how this is affecting your child. Psoriasis can be associated with other problems such as joint pains and arthritis. So therefore very focal psoriasis might be considered moderate or severe depending on what else is going on. If the psoriasis is diagnosed as mild, moderate or severe, then various treatment options are available. Anything from topical therapies such as creams and ointments that are applied to the skin either once or twice a day, up through photo therapy or sunlight therapy, and on into systemic therapy which means that in very severe cases, and typically in kids very rarely, may be treated with medicines that are taken orally.
Are there any possible complications?
Dr. Cordoro: Fortunately the majority of cases of psoriasis, 80% or so, are very mild and are easily controlled with topical therapies like creams and ointments. Some complications can be arthritis, known as psoriatic arthritis, so the doctor will elicit whether or not that is going on. Other complications can be complications from therapies, so it is very important to see a dermatologist who is comfortable treating psoriasis, particularly in children, to be sure that the right medications are prescribed and appropriately monitored.
Psoriasis tends to follow a fairly mild course in most patients and therefore many don't experience complications. But there are many, and others that I haven't mentioned, so it is important to talk to your doctor about anything else that may be going on.
What outcomes should be expected?
Dr. Cordoro: We know that we cannot cure psoriasis unfortunately but we can control it. A good outcome would be clear up the patches that are obvious. Your child might not be very concerned about the psoriasis. Particularly if it is not in a public location. Therefore an expectation might be to just maintain symptoms. If it is itchy, we can control the itch, if it is painful we can fix that. If it is in more public location, that can be very upsetting. Particularly to a child; therefore we work very hard. A good outcome in that regard would be to control those areas of psoriasis so that the child functions normally and doesn't fell ostracized in society; and that’s a big goal of a dermatologist.
Dr. Cordoro: If I were the parent of a child with psoriasis, I would want to make sure that I am seeing a dermatologist who is very comfortable treating children. Many dermatologists see children and a pediatric dermatologist is not required. In many instances where the psoriasis is worse, a pediatric dermatologist is more comfortable handling that type of situation. I would want to make sure that I understand what the risks and benefits are of the treatments and understand how to use the treatments. And also the rational behind why they are used. And finally I would want to be informed about what to watch for in my child such as arthritis, and signs or symptoms of that. I would keep a close relationship with the dermatologist and to have frequent visits for not only education but also for evaluation of the effects of treatment.