What are the ways to effectively manage psoriasis in teens?

Question

Hello doctor,

I am writing about my 16-year-old son who has been dealing with severe psoriasis for the last six months. It started on his scalp but now it is spread to his knees, elbows, back, and under his arms. His dermatologist prescribed Methotrexate (15mg weekly) two months ago, but his recent blood work showed elevated liver enzymes (Alanine aminotransferase 95, Aspartate aminotransferase 88). He has also lost about 12 pounds because he feels sick after taking the medication.

He used to play football but quit due to embarrassment over changing in the locker room. His teachers called, saying he seems depressed and withdrawn in class. We tried phototherapy, but we can not afford the three weekly sessions anymore. He gets bad flare-ups before exams from stress, and nothing seems to help. The creams leave stains on his clothes.

What was the best way forward?

I am concerned about the long-term effects of these medicines on a teenager.

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

To better manage your son’s condition, it is important to first understand the nature of psoriasis.

Psoriasis is a chronic autoimmune skin condition with an unclear cause, though it is linked to an overactive immune system. Triggers can include stress, infections, injuries, and certain medications.

For young people, the emotional impact can worsen the condition, as stress and worry often make flare-ups more severe.

Regarding the liver enzymes, while they are elevated, they are not alarmingly high. However, it is also important to check bilirubin levels.

I recommend considering an online consultation for a more thorough analysis of his condition. A few counseling sessions may also help your son build the emotional strength to cope with this challenge.

Investigations to consider:

Recent LFT (liver function test), KFT (kidney function test), lipid profile, vitamin D, CBC (complete blood count) with ESR (erythrocyte sedimentation rate).
Treatment plan: Please provide a complete list of the medications and creams your son is currently using so I can assess whether any adjustments are necessary.

Preventive measures:

Keep the skin moisturized at all times.
For the scalp, apply oil before each hair wash and wash his hair at least two to three times a week.

I hope this helps answer your query.

Please let me know if I can assist you further.

Thank you.