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Psoriasis Guttate
Help me!!! My child has guttate psoriasis?
I got told that my 8 year old child that she has guttate psoriasis. The doctor gave her some cream to help the brake outs, but I just want to know is there more I can do to help. Thanks to anyone that can help.
I am sorry to say there are no cures. There are some excellent managements but some of these are quite messy and many of the older and most potent ones must be used with care,especially in one so young.
Most GPs reach for Calcipotriol (Dovonex® ) first, fortunately it is licenced for ages 6 and above. It is clean and easy to apply and has few risks or side effects,provided it is not used to excess. Unfortunately it has a significant fail rate and also it tends to become less effective with ongoing use.
At this point many GPs,rather unwisely, move on to Dovobet,or other steroid cream. These have significant risks,especially in young children,they can produce systemic absorption of steroids,skin thinning and marking and the skin becomes 'addicted' to them,so that when attempts are made to stop them the condition rebounds often more severely than the original attack! Why are they used,because they do produce remission while in use and they get the patient out of the door of the surgery!
Very mild steroid creams,no more potent than 1% hydrocortisone, can be used in sensitive areas,(face or genitals,) without these risks however.
The problems with the next steps are twofold,firstly the medications are old and few young doctors have any more than a dim awareness of their use,secondly they need care and experience in their use,which is becoming less and less common.
I refer to dithranol,which is applied to non-acute areas (subacute and chronic psoriasis). It must be used initially for very short periods of time and in initially very low strength. Both contact time and strength are gradually increased until the desired improvement occurs. I started with 0.1% applied for 30 minutes,then washed off.The process is long and laborious but ultimately rewarding.
The use of tar is very similar,but it is used on the more acute areas.It is also messy and smelly,so I usually applied it overnight.It is also difficult to shower off,especially when mixed with say diprobase as an emollient,which was my practise.However this is helped by using olive oil,(which surprisingly is also NHS prescribable,) then the child needs to use normal shower gels to remove the oil and the smell.Here again the strength must be increased very gradually or the skin may be damaged. Again this is a time consuming process to which the mother AND the GP must be committed.Sadly this is all too rare these days.
There is of course no evidence that either dietary change or alternative managements are of any benefit,though as for many conditions that are difficult to treat the expected,extravagant claims are made.
