How to treat psoriasis in older Kids?

Hi,

Welcome to icliniq.com.

I can understand your concern.

I am sorry to hear about your son’s struggles. Psoriasis can be incredibly challenging, especially in a high-impact sport like wrestling, where friction, sweat, and the intensity of physical contact can exacerbate symptoms. Given that his condition is severely impacting both his physical health and mental well-being, here is a comprehensive approach to help:

1. Medical management:

• Topical treatments: Calcipotriene (a vitamin D analog) is effective for many people, but the burning sensation with sweating is a common issue. You could ask his doctor about adjusting the concentration or adding a steroid cream or topical corticosteroid to reduce inflammation and discomfort, especially during practice or matches. Sometimes coal tar preparations can also help, though they can be messy.
• Systemic treatments: Since his psoriasis is severe (as indicated by thick patches, scalp involvement, and pain), oral medications like Methotrexate or Cyclosporine might be considered for more aggressive control. Biologic drugs e.g., TNF inhibitors (tumor necrosis factor) (IL-17, or IL-23 inhibitors) are another option, though they typically require specialist consultation.
• Scalp care: Shampoos containing coal tar or salicylic acid can help reduce flaking and soothe the scalp. You might also try applying topical steroids directly to the scalp, but be careful with irritation.

2. Addressing the impact on physical activity:

• Friction management: During wrestling, the friction from the mat and physical contact is aggravating his condition. Consider using soft, breathable bandages or pads to cover the worst areas of skin before matches to reduce direct friction and prevent bleeding.
• Compression garments: Tight-fitting shirts or rash guards made of moisture-wicking fabric may reduce friction and sweat contact with the skin during matches and practices.
• Pain management: If his knees and elbows are painful, he may benefit from topical analgesics (like menthol or capsaicin creams) or oral NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen to help with pain and inflammation during practice.

3. Nutrition and psychological support:

• Low vitamin D: His vitamin D levels are low (15 ng/mL), which can worsen psoriasis and immune function. Supplementing with vitamin D (under the guidance of a doctor) can help, and foods like salmon, fortified milk, and egg yolks should also be added to his diet.
• Support for eating: It is concerning that he has lost weight and is avoiding the cafeteria due to embarrassment. Encourage him to eat small, nutritious meals at home or even with supportive friends. Psychological support from a therapist or school counselor to address the embarrassment and potential social isolation could be invaluable.

4. Mental health:

• Emotional toll: Psoriasis can deeply affect self-esteem, especially when it is visible and painful. His feelings of embarrassment are understandable, but support and communication from his family, coach, and teammates are important to help him through this. It might help to talk to the coach about creating an environment where he feels less self-conscious.
• Team communication: Let the coach and teammates know what he is going through. A supportive environment, with understanding from those around him, can help him feel more accepted.
• Psychological support: Consider professional counseling or talking to a support group for people with chronic skin conditions. Many young people with psoriasis find that connecting with others facing the same struggles can alleviate feelings of isolation and embarrassment.

5. Plan moving forward:

• Balance between treatment and sport: It is important that he feels he can participate in wrestling without the condition hindering his ability to compete or practice. Working closely with his doctor and coach to find a balanced approach, where his skin is treated, but his physical health and mental well-being are prioritized will help him feel more confident.
• Consider time off if needed: If his condition is too severe and causing him physical pain, taking some time off from wrestling for a period of focused treatment might be an option. This could be a temporary solution to allow his psoriasis to calm down and give him space to manage his mental health.

Next steps:

1. See a dermatologist who specializes in psoriasis to optimize his treatment plan.
2. Reassess treatment options, especially given the pain, bleeding, and limited response to calcipotriene. Systemic treatment may be necessary.
3. Ensure proper follow-up for his vitamin D levels and work with a nutritionist to support his diet.
4. Provide emotional support to help him manage his self-esteem and social challenges.

His condition is treatable, but it may take time to find the right combination of treatments. If wrestling is his passion, finding ways to support his participation while addressing his psoriasis will help him feel more in control. Encourage him to keep communication open with you and his coach so that everyone is on the same page and he does not feel alone in this.

I hope this information will help you.

Thanks.