Pediatric emergency medicine trisk 1355 1355
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FIGURE 70.1 Note the linear purplish plaque consistent with koebnerization of lichen
planus.
Pustular psoriasis is rarely seen in children and may arise suddenly.
Patients may have other forms of psoriasis that then suddenly transition into
pustular psoriasis flares, occasionally triggered by use of or withdrawal of
systemic corticosteroid therapy. Various sizes of sterile and superficial
pustules develop on an erythrodermic background. Avoidance of systemic
steroids may be prudent in patients with psoriasis since withdrawal can
precipitate pustular flares of the disease.
Characteristically small, pitted lesions are seen on the nails in 25% to 50%
of patients in all forms of the condition. Areas resembling tan-brown oil
spots may appear as well within the nails.
Eighty percent of children have scalp involvement, and patients with early
scalp psoriasis may be mistaken for having tinea capitis. In contrast to tinea
capitis, most cases of psoriatic scalp involvement do not show frank hair loss
or hair breakage, and scalp lymphadenopathy in psoriasis is uncommon.
