Pediatric emergency medicine trisk 1353 1353
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (100.84 KB, 1 trang )
important ones. Linear lesions can also be seen with allergic contact
dermatitis and inoculation sites for warts or molluscum.
The distribution of skin lesions may also provide useful diagnostic clues.
Plaque-type psoriasis favors the extensor surfaces of the extremities like the
elbows and knees, as well as the scalp, ears, and intertriginous areas. While
seborrheic dermatitis also tends to involve intertriginous areas, it has a
predilection for the perinasal areas, eyebrows, and external auditory canals.
PR usually manifests predominantly on the torso, and skin lesions are
characteristically distributed along skin tension lines (the lines of Langer)
producing the so-called “fir tree” or “pine tree” pattern on the back.
Concomitant involvement of the diaper area, acral areas, and the face would
raise the possibility of seborrheic dermatitis, acquired zinc deficiency, or
acrodermatitis enteropathica.
Examination of the mucous membranes and skin appendages can provide
corroborating evidence for a particular diagnosis. Geographic tongue may be
a normal variant but is often a feature of psoriasis. Oral erosions or lacy
white patterns in the mouth suggest lichen planus. Genital involvement is
also a typical feature of psoriasis, lichen planus, lichen nitidus, and syphilis.
Nail pitting is frequently seen in psoriasis, but nails are generally normal in
PRP.
The degree of pruritus is a helpful differentiating symptom for
papulosquamous disorders. Many of the papulosquamous disorders are not
particularly pruritic. When intense, itching suggests lichen planus or
lichenoid drug eruptions ( Table 70.1 ).
Psoriasis
Psoriasis is a relatively common, chronic papulosquamous disease that
makes up approximately 4% of all skin disorders encountered in children.
There is a predisposition for involvement of the scalp, perineum (particularly
in infants), and the extensor surfaces of the body, particularly the elbows and
knees. Psoriatic arthritis occurs in a minority of patients, but arthritis is more
common among pediatric patients. One-third of adults with psoriasis
experiences onset of disease in childhood or adolescence. Among children
with psoriasis, the majority develop the condition during adolescence
although the condition arises in 12% before the age of 10 years.
