Childhood Psoriasis Flashcards
Major genetic determinant
PSOR1 gene seen in 35-50% of patients within the major histocompatibility complex on chromosom3 6
Medications known to trigger psoriasis
beta-blockers, lithium, IFN, anti-malarials, and sodium valproate
Inverse psoriasis
Involves the flexural surfaces
Woronoff ring
Peripheral white ring around the psoriasis plaque as it begins to involute
Auspitz sign
removal of micaceous scale causing pinpoint bleeding
DDx of Koebner phenomenon
Psoriasis, verrucae, Rhus dermatitis, lichen planus/nitidus, Darier disease, and PRP
Facial psoriasis
more common in children than adults and classically perioral. Can see geographic tongue in affected children as well
Guttate psoriasis
often the first manifestation of psoriasis in children
May clear spontaneously but 40% develop plaque type
often preceding Group A strep infection
Scalp psoriasis
Can extend past hairline unlike lesions of seborrheic dermatitis.
Variant form called pityriasis amiantacea (asbestos like) with large plates of scale that are firmly adherent to hair (progresses to classic psoriasis in 2-15% of kids)
Diaper area psoriasis
Scale may not be visible clinically due to the local moisture
Nail involvement
thought to reflect small intermittent psoriatic lesions in the nail matrix
Severe psoriatic forms in childhood
Pustular psoriasis and erythrodermic
Pediatric pustular psoriasis
Erythematous halos develop and rapidly become studded with pinpoint pustules which progresses in explosive manner to generalized exfoliative dermatitis. Systemic sx present.
On histology, see Spongiform pustules of Kogoj without surrounding spongiosis or inflammation
Pustular psoriasis associated syndromes
Majeed syndrome: CRMO (chronic recurrent multifocal osteomyelitis) w/ anemia and pustular psoriasis 2/2 mutation in LPIN2 SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis)
Comorbidities of pediatric psoriasis
MC: obesity which usually precedes psoriasis by 2 yr
CV disease, Diabetes, joint pain, Crohns
Pediatric psoriatic arthritis
Biphasic distribution:
younger children more likely females with dactylitis
Older children with enthesitis and axial joint dz
DDx of guttate and plaque psoriasis
PRP, PR, pityriasis lichenoides chronica, psoriasiform dermatitis, lichen planus, drug eruptions, widespread dermatophytosis
DDx of facial psoriasis
DLE, seb derm
DDx of scalp psoriasis
tinea capitis, seb derm
DDx of diaper psoriasis
seb derm, irritant contact, candidal diaper dermatitis
DDx of pustular psoriasis
Staph pustulosis, candidal pustulosis, herpes simplex, Acute generalized exanthematous pustulosis (viral/drug), extensive eosinophilic folliculitis, IL-1 receptor antagonist deficiency, Palmoplantar psoriasis, candidiasis, and infantile acropustulosis
DDx of erythrodermic psoriasis
extensive PRP, congenital icthyosiform erthyroderma, erythrokeratodermia variabilis
Topical treatment options for pediatric psoriasis
Topical steroids, Tar, Salicylic acid, anthralin, Vit D analogues (calcitriol/calcipotriene), tazarotene gel, and Tacro/pimecrolimus
Treatment options for scalp psoriasis
oil based steroids can be left on at night and washed out in morning to help with scale removal
Tx options for nail psoriasis
Cordran (flurandrenolide-impregnanted) tape to the base of the nail
Tx options for pustular psoriasis
Local applications of wet dressings with burow solution
UV light treatment for psoriasis
Typically use narrow band UVB (~311nm) for a minimum of 3 treatments per week to be effective.
Can also use Excimer laser (~308nm) for more localized treatment
Specific considerations in guttate psoriasis treatement
Be sure to look for Group A strep infection (tx if positive) and consider tonsillectomy if recurrent strep infections
Systemic tx options in chronic plaque psoriasis
Methotrexate, Cyclosporine, TNF inhibitors (etanercept and adalimumab), Acitretin, Stelara
