Red scaly rashes
Psoriasis affects 1–2% of the
population. One third develops the disease before age 20. It is an immune
mediated disorder of T cells. There is a strong genetic component in childhood
psoriasis, however, environmental factors such as infection (streptococcal and
HIV), stress, smoking (pustular psoriasis) and drugs (beta blockers, calcium
channel blockers, thiazides, lithium, interferon and antimalarials) also play a
role.
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Red,
well-demarcated plaques with overlying silvery scale.
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Classically
affects elbows, knees, and scalp.
•
However,
facial (40%) and napkin (25%) psoriasis is a common presentation in children.
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The
clinical appearance may be site-modified in the scalp (concretions), genital
area (glazed), palms and sole (pustules).
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Variant
presentations include guttate (small plaque), annular (ring-like), pustular and
erythrodermic (>90% skin affected).
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Common
nail signs include pitting, onycholysis (separation of the nail plate from the
nail bed) and subungual hyperkeratosis (distal thickening).
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Psoriatic
arthropathy may develop.
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Soap
avoidance.
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Moisturize
immediately after bath/shower.
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Provide
emotional support (very important).
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Remove
any precipitating triggers.
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Topical
steroids
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Topical
tar and salicylic acid creams
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Topical
calcipotriol (vitamin D derivative)
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Those
patients that do not respond to topical therapy and general measures may be
referred to a dermatologist for consideration of phototherapy and systemic
agents (acitretin, cyclosporin, methotrexate and biologics).
May be life-long or spontaneously
remit.
In children irritant contact
dermatitis due to urine, faeces and friction in the napkin area is common. It
spares the folds, favours convexities and there may be s Candida infection. Frequent nappy changes, drying after bathing and
use of a barrier cream may help to prevent this. Hydrocortisone cream in
combination with an antifungal cream are the treatment of choice.
Allergic contact dermatitis
(delayed type IV hypersensitivity) less common; often occurs in older children.
Strong reactions often cause an acute blis-tering and weeping eczema. Common
allergens include nickel (earrings), colophony (sticking plasters), topical
medicaments (topical neomycin and preservatives), some henna tattoos, plants
(e.g. poison ivy) and rubber. Treatment is allergen withdrawal and topical
steroids.
Self-limiting condition common
between ages 1 and 6yrs. Cause Probably s reaction to viral infections. Presentation
·Distinctive initial truncal
(usually) oval, red, scaly ‘herald patch’ (2–5cm diameter).
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Several
days later generalized smaller scaly, yellowish-pink patches develop over trunk
and proximal limbs.
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Characteristic
‘Christmas tree’ distribution common. Patches follow lines parallel to ribs.
·Pruritus, malaise, lymphadenopathy
may occur.
Reassurance. Antipruritics may be
required.
Resolves after 4–6wks usually, but
may persist for several months.
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