psoriasis

Psoriasis is a common, chronic skin disorder. It begins in childhood or adolescence for perhaps one third of all affected persons. About half of all children with psoriasis have a family history of the disease. Girls are more frequently affected in childhood. The cause is not known; various theories of inheritance have been advanced, but no clear pattern is understood at this time.

The rash of psoriasis consists of reddish papules that coalesce to form raised plaques with sharply defined, irregular borders. A characteristic thick, silvery or yellow-white scale develops in untreated psoriasis. Scraping of this scale may result in pinpoint bleeding. This is known as the Auspitz sign. New rash patches often break out at sites of trauma to the skin. This is a valuable sign for diagnosis, called the Koebner phenomenon.

The scalp, knees, elbows, umbilicus, buttocks creases, and genitals are the most common areas of rash. When the rash occurs on the scalp, it may be confused with seborrheic dermatitis, atopic dermatitis (eczema), or tinea capitis (see scaly scalp). Nail involvement is common and valuable for making the diagnosis.

While psoriasis is rare in newborns, it can be a great mimic and resist diagnosis at first. When the first outbreak is in the diaper area, it can mimic seborrheic dermatitis, eczematous diaper dermatitis, perianal streptococcal disease, or yeast infection.

Guttate psoriasis is a variant that occurs predominantly in children. It is marked by a dramatic eruption of many small, oval or round lesions that morphologically are identical to the larger plaques of psoriasis over the trunk, face, and upper limbs. This eruption often occurs after a streptococcal infection. Guttate psoriasis also may follow perianal streptococcal infection, viral infections, sunburn, and withdrawal of systemic steroid drugs.

Treatment of psoriasis can be challenging and should be overseen by a dermatologist. Various preparations are used, including coal tar and salicylic acid. Steroids are used, but with caution. Avoidance of trauma to the skin is important because of the Koebner phenomenon mentioned above.

The outlook is best for children with limited disease. Psoriasis is characterized by a waxing and waning course. If it is present during adolescence, it is a lifelong disease. A type of arthritis related to the psoriasis may develop in later years as a complication.

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