Childhood Psoriasis

Question 1

Major genetic determinant

Answer 1

PSOR1 gene seen in 35-50% of patients within the major histocompatibility complex on chromosom3 6

Question 2

Medications known to trigger psoriasis

Answer 2

beta-blockers, lithium, IFN, anti-malarials, and sodium valproate

Question 3

Inverse psoriasis

Answer 3

Involves the flexural surfaces

Question 4

Woronoff ring

Answer 4

Peripheral white ring around the psoriasis plaque as it begins to involute

Question 5

Auspitz sign

Answer 5

removal of micaceous scale causing pinpoint bleeding

Question 6

DDx of Koebner phenomenon

Answer 6

Psoriasis, verrucae, Rhus dermatitis, lichen planus/nitidus, Darier disease, and PRP

Question 7

Facial psoriasis

Answer 7

more common in children than adults and classically perioral. Can see geographic tongue in affected children as well

Question 8

Guttate psoriasis

Answer 8

often the first manifestation of psoriasis in children
May clear spontaneously but 40% develop plaque type
often preceding Group A strep infection

Question 9

Scalp psoriasis

Answer 9

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)

Question 10

Diaper area psoriasis

Answer 10

Scale may not be visible clinically due to the local moisture

Question 11

Nail involvement

Answer 11

thought to reflect small intermittent psoriatic lesions in the nail matrix

Question 12

Severe psoriatic forms in childhood

Answer 12

Pustular psoriasis and erythrodermic

Question 13

Pediatric pustular psoriasis

Answer 13

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

Question 14

Pustular psoriasis associated syndromes

Answer 14

Majeed syndrome: CRMO (chronic recurrent multifocal osteomyelitis) w/ anemia and pustular psoriasis 2/2 mutation in LPIN2
SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis)

Question 15

Comorbidities of pediatric psoriasis

Answer 15

MC: obesity which usually precedes psoriasis by 2 yr

CV disease, Diabetes, joint pain, Crohns

Question 16

Pediatric psoriatic arthritis

Answer 16

Biphasic distribution:
younger children more likely females with dactylitis
Older children with enthesitis and axial joint dz

Question 17

DDx of guttate and plaque psoriasis

Answer 17

PRP, PR, pityriasis lichenoides chronica, psoriasiform dermatitis, lichen planus, drug eruptions, widespread dermatophytosis

Question 18

DDx of facial psoriasis

Answer 18

DLE, seb derm

Question 19

DDx of scalp psoriasis

Answer 19

tinea capitis, seb derm

Question 20

DDx of diaper psoriasis

Answer 20

seb derm, irritant contact, candidal diaper dermatitis

Question 21

DDx of pustular psoriasis

Answer 21

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

Question 22

DDx of erythrodermic psoriasis

Answer 22

extensive PRP, congenital icthyosiform erthyroderma, erythrokeratodermia variabilis

Question 23

Topical treatment options for pediatric psoriasis

Answer 23

Topical steroids, Tar, Salicylic acid, anthralin, Vit D analogues (calcitriol/calcipotriene), tazarotene gel, and Tacro/pimecrolimus

Question 24

Treatment options for scalp psoriasis

Answer 24

oil based steroids can be left on at night and washed out in morning to help with scale removal

Question 25

Tx options for nail psoriasis

Answer 25

Cordran (flurandrenolide-impregnanted) tape to the base of the nail

Question 26

Tx options for pustular psoriasis

Answer 26

Local applications of wet dressings with burow solution

Question 27

UV light treatment for psoriasis

Answer 27

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

Question 28

Specific considerations in guttate psoriasis treatement

Answer 28

Be sure to look for Group A strep infection (tx if positive) and consider tonsillectomy if recurrent strep infections

Question 29

Systemic tx options in chronic plaque psoriasis

Answer 29

Methotrexate, Cyclosporine, TNF inhibitors (etanercept and adalimumab), Acitretin, Stelara