Clinical Manifestations of Pediatric Psoriasis: Results of a Multicenter Study in the United States

Abstract

Background/Objectives The clinical features of pediatric psoriasis warrant further attention. A national study was completed to determine the prevalence of scalp and nail involvement, and history of guttate psoriasis at onset, according to age, sex, and disease severity. Materials and Methods 181 children, ages 5 to 17 years, with plaque psoriasis were enrolled in a multi-center, cross-sectional study. Subjects/guardians were asked about a history of scalp and nail involvement and whether the initial presentation was guttate. Peak psoriasis severity was assessed and defined historically as mild psoriasis (MP) or severe psoriasis (SP) according to Physician Global Assessment and Body Surface Area measures. Results 79.0% (n=143) of subjects reported a history of scalp involvement and 39.2% (n=71) described a history of nail involvement. Boys were less likely than girls to report a history of scalp involvement (OR= 0.40 (0.19-0.84)), but were more likely to have had nail involvement (OR=3.01 (1.62-5.60)). Scalp and nail involvement was not related to psoriasis severity. In contrast, SP subjects (35.9%) more often reported a history of guttate lesions than did MP subjects (21.8%) (p=0.017). Antecedent streptococcal infection was more common in children with guttate vs. plaque psoriasis at onset (p=0.02), but did not correlate with severity. Conclusions Gender-related differences in scalp and nail involvement suggest koebnerization. Preceding streptococcal infection predicts guttate morphology but not severity, and initial guttate morphology is associated with eventual greater severity of disease More aggressive monitoring and management should be considered for guttate psoriasis, given its later association with more severe disease.

Clinico-epidemiological study of childhood psoriasis

“…13, 23 Mercy et al suggested that the risk of severe disease is higher if psoriasis started as guttate psoriasis which persisted. 24 In our study, 18.8% children had Guttate psoriasis. One Danish study found guttate psoriasis as the most common variant.…”

Childhood psoriasis

“…Jako przyczynę wymienia się: stres, infekcje, zwiększony wskaźnik otyłości oraz uwarunkowania genetyczne [6]. Łuszczyca dziecięca występuje częściej u dziewcząt niż u chłopców [7,8], a wczesny początek choroby może prognozować jej ciężki przebieg. Pomimo charakterystycznego obrazu klinicznego zdarza się, że powoduje trudności diagnostyczne i jest mylona z innymi chorobami skóry [1].…”

“…Typowe zmiany chorobowe stanowią widocznie odgraniczone, złuszczające się, rumieniowe tarczki, które pojawiają się okresowo i ustępują w okresie remisji, zajmując w zależności od stopnia nasilenia prawie całą powierzchnię ciała lub jedynie drobne fragmenty skóry [1,2,7,8]. Zmiany u dzieci są zazwyczaj mniejsze, delikatniejsze, dobrze odgraniczone od otoczenia, nie ma charakterystycznej łuski [10].…”

“…The typical lesion presentation includes visibly demarcated, scaling red patches that appear periodically and subside during remissions; depending on disease severity, these lesions may affect nearly the whole body surface area or just small portions of the skin [1,2,7,8]. In children, the lesions are typically smaller and milder, well-defined, without the typical plaque [10].…”

“…Stress, infections, increased obesity rate, and genetic factors have been named as the causes [6]. Childhood psoriasis is more common in girls than in boys [7,8], and an early onset might be predictable of a more severe course of the disease. Despite the distinctive clinical characteristics, it may pose a diagnostic challenge and might be incorrectly diagnosed as other skin pathologies [1].…”