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Chapter: Paediatrics: Dermatology

Paediatrics: Red scaly rashes

Psoriasis affects 1–2% of the population. One third develops the disease before age 20.

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.




   Red, well-demarcated plaques with overlying silvery scale.

   Classically affects elbows, knees, and scalp.

   However, facial (40%) and napkin (25%) psoriasis is a common presentation in children.

   The clinical appearance may be site-modified in the scalp (concretions), genital area (glazed), palms and sole (pustules).

   Variant presentations include guttate (small plaque), annular (ring-like), pustular and erythrodermic (>90% skin affected).

   Common nail signs include pitting, onycholysis (separation of the nail plate from the nail bed) and subungual hyperkeratosis (distal thickening).

   Psoriatic arthropathy may develop.




General measures


   Soap avoidance.


   Moisturize immediately after bath/shower.


   Provide emotional support (very important).


   Remove any precipitating triggers.


Specific measures


   Topical steroids


   Topical tar and salicylic acid creams


   Topical calcipotriol (vitamin D derivative)


   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.

Contact dermatitis


Irritant contact dermatitis


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


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.


Seborrhoeic dermatitis


Pityriasis rosea


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).

Several days later generalized smaller scaly, yellowish-pink patches develop over trunk and proximal limbs.


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.


Tinea infections


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