Is Psoriasis Hereditary? What to Know About the Genetic Risk for Your Kids

Parents with psoriasis may wonder whether their children will inherit the condition, too. A rash, patch of dry skin, or nail pitting on their little one may add another layer of concern for parents who have the inflammatory condition.

Psoriasis can be hereditary — having one or both parents with psoriasis increases a child’s chance of developing it, but at the same time, many children with a family history never do. That’s because genetics are only part of the picture. Children can inherit a susceptibility to psoriasis, but factors such as strep infections, stress, or skin injuries can also play a role in whether — and when — symptoms appear.

Here’s what parents with psoriasis should know about their child’s risk, the symptoms to watch for, and what they can — and can’t — do to prevent it.

“I always tell patients and families that one-third of children with psoriasis will have a family history of psoriasis. So, family history is certainly meaningful, but [it’s] not everything,” says Lisa Swanson, MD, an adult and pediatric dermatologist in private practice in Boise, Idaho.

Typically, other factors are involved, too, according to Jody A. Levine, MD, an adult and pediatric dermatologist in New York City.

“We think of genetics as creating a predisposition, while environmental and immune triggers often play a role in determining whether the condition actually appears,” Dr. Levine says.

While genes may increase the risk of psoriasis in children, environmental factors may cause the disease’s onset.

“Psoriasis is an immune-mediated inflammatory condition, so anything that activates or disrupts the immune system can potentially trigger a flare in someone who is predisposed,” Levine says.

Strep Throat and Other Infections

Swanson says that she often recommends a strep test when she sees patients with guttate psoriasis in case the infection is asymptomatic.

Cuts, Scrapes, and Other Skin Injuries

Something as simple as a skinned knee may cause plaques to pop up in that same location in people with psoriasis — or people who are predisposed to it, Swanson says. “This phenomenon can even be a helpful way for me to differentiate psoriasis and eczema in a pediatric patient. If I see evidence of koebnerization, then I know it's psoriasis,” she says.

Physical and Emotional Stress

“A serious injury, a hospitalization, a bereavement — any of these kinds of major stressors can sometimes lead to an initial presentation of psoriasis,” Dr. Adigun says.

• Thin, pink or red, well-defined patches that may have some scaling
• Small, drop-like spots that appear suddenly, especially after a strep infection, which may suggest guttate psoriasis
• Scaly patches on the scalp or face, which are common sites for psoriasis in children
• A persistent rash in the diaper area or skin folds that isn’t responsive to standard diaper rash treatment
• Nail changes, such as pitting, thickening or separation of the nail from the nail bed
  
  

Some clues can help dermatologists distinguish psoriasis from other conditions. “There are certain locations that psoriasis in kids likes to present — the belly button, the underwear area, the scalp, and the face,” Adigun says, noting that she “always” checks fingernails for nail pitting.

In babies, cradle cap shouldn’t extend beyond six months, so if symptoms linger, dermatologists may consider psoriasis. Diaper rash tends to spare skin folds — if skin irritation is present there, that’s another hint, Adigun says. “Psoriasis characteristically involves all the folds and creases … but it’s classic that [diaper rash] spares the folds,” Adigun says.

With so much overlap in symptoms between conditions, seek a professional evaluation instead of trying to self-diagnose at home, Levine says. “Even as a pediatric dermatologist, I will sometimes need continuous evaluation over time to distinguish psoriasis from eczema in very young children, so a rash that keeps coming back or isn't responding to treatment deserves a closer look,” she says.

There’s currently no proven way to prevent psoriasis from developing in children who are genetically predisposed to it, Levine says. “What parents can do is protect the skin and reduce triggers that may contribute to flares,” she says.

She says measures can look like:

• Protect the skin barrier. Keep skin moisturized with gentle, fragrance-free products, especially during cold, dry weather.
• Prevent skin injury when possible. Try to avoid sunburn and skin trauma, as injuries can trigger psoriasis in affected areas.
• Treat infections appropriately. Because strep throat is an important trigger for guttate psoriasis, make sure infections are evaluated and treated. Be aware, though, that “treating an infection does not guarantee that psoriasis can be prevented,” Levine says.
• Manage stress levels and support healthy habits. Nurture a healthy lifestyle in your child, helping to manage stress, provide a balanced diet, encourage regular activity, and limit their exposure to cigarette smoke.

If psoriasis appears, try not to ruminate on what triggered it. “The most important thing would be to get accurately diagnosed by a pediatric dermatologist as early as possible and get started on appropriate treatment,” she says.

“We have so many great options — topicals, pills, shots — to help our patients thrive with this condition.”