Pediatric emergency medicine trisk 1354 1354
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Psoriasis occurs in several forms during childhood: plaque-type, guttate,
palmoplantar, inverse, pustular, and erythrodermic. The most classic form is
plaque-type psoriasis which is associated with thick, beefy red plaques with
overlying silvery scales ( Fig. 70.2 ) often in a symmetrical distribution on
the extensor surfaces of the extremities, although other anatomic sites may
be affected. When a scale is removed, there may be pinpoint areas of
bleeding (Auspitz sign). Guttate psoriasis is one of the most common forms
encountered in childhood, manifesting as guttate (drop-like) erythematous
scaly papules scattered over the body ( Fig. 70.3 ). The characteristic silvery
scale is only minimally expressed, and the lesions may appear quite red. This
form is classically (but not always) preceded by or coincides with a
streptococcal infection.
Palmoplantar psoriasis manifests as thickened plaques concentrated on the
palms and soles of the feet ( Fig. 70.4 ). The plaques may become fissured
and painful. These areas may become so thickened that patients complain of
pain with moving the fingers or walking.
Inverse psoriasis refers to the usually pink, salmon-colored, sometimes
macerated plaques that arise in the axillae, inguinal areas, or on the genitalia
and buttocks ( Fig. 70.5 ). The gluteal crease is usually involved.
Erythrodermic psoriasis is less common and more severe. Onset may be
abrupt or gradual, with a diffuse erythema and severe desquamation. In the
growing child, there may be associated failure to thrive.
