Follicular psoriasis causing erythroderma in a child: A rare presentation

Abstract

Erythroderma in children is an uncommon, yet striking entity with an incidence of 0.11%. Psoriatic erythroderma accounts for 1.4% of psoriasis cases in children. Follicular psoriasis is an underdiagnosed variant of psoriasis, with only about 15 cases reported till date, characterized by scaly follicular papules on the trunk and extremities. Although two thirds of these reported occurred in adults, cases have been described in children under the age of 10 years. Follicular lesions may present without psoriasis vulgaris elsewhere. We report here a 13-year-old boy who presented with severe erythrodermic psoriasis that started as dark, rough, horny, discrete, follicular papules over knees and elbows, associated with nail and joint involvement. Such a presentation of follicular psoriasis causing erythroderma is uncommonly seen in children and has not yet been reported in literature.

Follicular psoriasis: an under‐recognized condition

“…[1][2][3] It seems to be associated with diabetes mellitus and plaque-type psoriasis, especially of the scalp (the same as patient 1 and 3 in our series), and its occurrence seems higher among darkskinned patients. [2][3][4] Notably none of the previously reported cases had concurrent palmo-pustular psoriasis, as is the case in our patient 4. Furthermore, a very recent case report described a 13-year-old boy with severe erythroderma due to follicular psoriasis associated with nail and joint involvement.…”

“…Sir Follicular psoriasis is an under-diagnosed variant among the other well documented forms of psoriasis since only 17 cases have been reported to date. [1][2][3][4] Hence, we report the clinical and histological findings of follicular psoriasis in five patients.…”

“…Furthermore, a very recent case report described a 13-year-old boy with severe erythroderma due to follicular psoriasis associated with nail and joint involvement. 4 In summary, follicular psoriasis is an under-recognized condition that might develop alone or in association with other variants of psoriasis. Based on our observations, it could be hypothesized that follicular psoriasis might be regarded in some patients as an initial phase of the disorder and might eventually develop into classic psoriasis later on.…”

“…The extent of cutaneous carcinogenesis is thus fundamental to current clinical practice guidelines in the dermatological care of OTR. 3,4 Clinical practice guidelines originated as systematically developed instruments with the goal to support decisions on appropriate health care for specific clinical circumstances. 5 Physicians frequently deviate from guidelines in their practice of medicine.…”

Erythrodermic psoriasis: pathophysiology and current treatment perspectives

“…Other rare types of EP include congenital EP and EP secondary to an environmental trigger ( Table 1 ). 19 – 21 Documented environmental triggers include sunburn, skin trauma, emotional stress, alcoholism, systemic illness, drug exposure, chemical exposure (such as to computed tomography contrast material or topical tar), and rapid withdrawal from medications known as the rebound phenomenon. 11 , 13 , 14 Common antipsoriatic medications that may lead to the rebound phenomenon include topical and oral steroids, efalizumab, and methotrexate.…”