Children with chronic skin conditions such as eczema and psoriasis often face challenges related to treatment plans and quality of life. Successful management involves educating children about their conditions and encouraging active participation in their skin care.
Many children with eczema and psoriasis require topical medications, and there are developmentally appropriate strategies to use when applying them. Infants and toddlers can play with a special, designated toy while a parent applies medication. Using pretend play can also be helpful. Some parents pretend that moisturizers and other topical medicines are ‘magical’ and putting it on makes them healthy and strong. Preschool and early elementary students are often motivated by sticker charts to help follow their skin care. With adolescents and teens, we should focus on empowerment and personal responsibility. This age group benefits from having medications visible (not in a drawer), and anchoring regimens around showering—preferably in the evening, rather than during hectic mornings. Cell phone alarms may help your child remember to take their medication.
Parents should ask their child’s dermatologist how to use the medications. If a topical medication hurts, parents should stop using it and contact their provider. One general tip is that ointments tend to not sting and can sometimes be more effective than lotions, gels and creams for children with open areas on their skin. Most topical medications require small amounts and should not be applied too thickly.
Children and parents should also be aware that if topical medications are not effective, other options are available. Light therapy such as narrow-band UVB phototherapy and immunosuppressive medications by mouth, such as methotrexate or cyclosporine, can be helpful. There is now FDA approval for several biologic injection treatments for psoriasis (etanercept and ustekinumab) and eczema (dupilumab) in pediatric patients. These options can be further discussed with your child’s dermatologist.
Providers and parents can help children manage questions from their peers about their eczema and psoriasis. Practice with your child a response that includes that their condition is not contagious, that they are seeing a doctor and end with a closing remark like, “Thank you for asking.” Some children feel better talking openly about their skin condition and may even want to give a class presentation. Talk to your child’s dermatologist for resources.
Jillian Rork, MD, practices pediatric dermatology at the Children’s Hospital at Dartmouth-Hitchcock (CHaD) in Manchester, and serves as an assistant professor of Dermatology, Department of Surgery, Geisel School of Medicine. Her areas of focus include pediatric eczema, psoriasis, hemangiomas, Down syndrome and genetic skin diseases.