Pediatric Psoriasis
Pediatric Psoriasis
Psoriasis is a chronic, immune-mediated inflammatory disease affecting approximately 2% of children worldwide. Pediatric psoriasis presents unique challenges in diagnosis and management, with significant impact on quality of life.
Key Points:
- One-third of cases begin in childhood
- Peak onset: 8-11 years of age
- Strong genetic component (HLA-Cw6)
- Significant psychosocial impact
- Associated with multiple comorbidities
- Requires long-term management strategy
Immunological Mechanisms
- Key Pathways:
- IL-23/Th17 axis activation
- TNF-α signaling
- IL-22 production
- Innate immune activation
- Keratinocyte hyperproliferation
- Cellular Components:
- T-cells (Th1, Th17, Th22)
- Dendritic cells
- Neutrophils
- Keratinocytes
Genetic Factors
- Major Susceptibility Genes:
- PSORS1-9
- HLA-Cw6
- IL12B
- IL23R
- ERAP1
Environmental Triggers
- Common Triggers:
- Streptococcal infection
- Physical trauma (Koebner)
- Stress
- Medications
- Climate changes
- Obesity
Classic Presentation
- Primary Lesions:
- Well-demarcated plaques
- Silvery scale
- Erythematous base
- Variable thickness
- Often symmetrical
- Common Locations:
- Scalp (most common)
- Extensor surfaces
- Periumbilical region
- Diaper area
- Nails
- Face (more common in children)
Age-Specific Features
- Infants (0-2 years):
- Diaper psoriasis
- Facial involvement
- Napkin distribution
- Children (2-12 years):
- Guttate psoriasis common
- Scalp involvement
- Post-streptococcal triggers
- Adolescents:
- Plaque psoriasis predominant
- Inverse patterns
- Nail involvement
Clinical Variants
1. Plaque Psoriasis
- Classic presentation
- Well-defined plaques
- Silvery scale
- Symmetrical distribution
2. Guttate Psoriasis
- Small drop-like lesions
- Post-streptococcal trigger
- Acute onset
- Better prognosis
3. Inverse Psoriasis
- Flexural areas
- Minimal scaling
- Bright red plaques
- May be mistaken for fungal infection
4. Pustular Psoriasis
- Sterile pustules
- Generalized or localized
- Can be severe
- May require hospitalization
5. Erythrodermic Psoriasis
- Rare in children
- Total body involvement
- Medical emergency
- Requires hospitalization
6. Nail Psoriasis
- Pitting
- Onycholysis
- Oil spots
- Subungual hyperkeratosis
Diagnostic Approach
Clinical Assessment
- History Taking:
- Age of onset
- Family history
- Triggering factors
- Previous treatments
- Impact on quality of life
- Physical Examination:
- Complete skin examination
- Nail assessment
- Joint examination
- Growth parameters
Severity Assessment
- PASI Score (modified for children)
- BSA involvement
- PGA (Physician Global Assessment)
- CDLQI (Children's Dermatology Life Quality Index)
Laboratory Studies
- Baseline Tests:
- Complete blood count
- Comprehensive metabolic panel
- Lipid profile
- Throat culture if indicated
- Additional Testing (as needed):
- HLA-Cw6 typing
- Skin biopsy (rarely needed)
- Screening for comorbidities
Treatment Strategy
Topical Therapy
- First-Line Agents:
- Corticosteroids (various potencies)
- Vitamin D analogs
- Calcineurin inhibitors
- Combination products
- Other Topicals:
- Salicylic acid
- Coal tar
- Emollients
Phototherapy
- Options:
- Narrowband UVB
- Targeted phototherapy
- Natural sunlight
Systemic Therapy
- Traditional Systemics:
- Methotrexate
- Cyclosporine
- Acitretin
- Biologics:
- Etanercept
- Adalimumab
- Ustekinumab
- Secukinumab
- Ixekizumab
Associated Conditions
- Metabolic Comorbidities:
- Obesity
- Diabetes
- Hypertension
- Dyslipidemia
- Inflammatory Conditions:
- Psoriatic arthritis
- Inflammatory bowel disease
- Uveitis
- Psychological Impact:
- Depression
- Anxiety
- Poor self-esteem
- Social isolation
Pediatric-Specific Issues
- Growth and Development:
- Monitor growth parameters
- Impact on physical activities
- School performance
- Treatment Challenges:
- Limited approved medications
- Long-term safety concerns
- Compliance issues
- Impact on vaccination schedule
- Quality of Life Impact:
- Body image concerns
- Peer relationships
- Family dynamics
- Educational challenges
Follow-up Care
- Regular Monitoring:
- Disease activity
- Treatment response
- Adverse effects
- Comorbidity screening
- Growth parameters
- Quality of life assessment
- Laboratory Monitoring:
- Based on treatment
- Metabolic screening
- Infection screening
- Prevention Strategies:
- Trigger avoidance
- Lifestyle modifications
- Stress management
- Sun protection
Disclaimer
The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.
