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psoriasis

Pediatric Psoriasis

Teaser: 

Yvonne Deng,1 Joseph M. Lam, MD, FRCPC,2

1 Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
2Department of Pediatrics, Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada.

CLINICAL TOOLS

Abstract: Psoriasis is a chronic inflammatory skin disease that affects up to 1.4% of children (aged <18 years) with a strong genetic predisposition and is mediated by dysregulation in the crosstalk between the innate and adaptive immune responses. It can have significant impact on quality of life for many patients. There are various subtypes of psoriasis with plaque psoriasis being the most common presentation in both adults and children. Pediatric psoriasis is primarily a clinical diagnosis. With the advent of biologics, the treatment landscape for pediatric psoriasis has shifted and encompasses diverse modalities of therapeutics, including topical and systemic treatments, as well as phototherapy.
Key Words: pediatric psoriasis, psoriasis, chronic, inflammatory, skin disease.

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Pre-test CME Quiz Post-test CME Quiz
Psoriasis affects the pediatric population and is associated with negative effects on quality of life and psychological impairments.
Lesions of pediatric plaque psoriasis may be thinner, smaller, more macerated than those classically in adult and present more commonly on the scalp, face, intertriginous areas, and extremities (flexural surfaces for younger children and extensor surfaces for older children).
Psoriasis is not an isolated condition and is correlated with higher rates of myocardial infarction, diabetes mellitus, hypertension, obesity, arthritis and liver disease.
In mild to moderate cases of psoriasis, topical therapies with a short course of corticosteroids and/or vitamin D analogue are first-line. In moderate to severe cases, narrowband UVB phototherapy, systemic agents, such as methotrexate, and biologics should be considered.
Pediatric patient should be assessed for risk factors for associated comorbidities.
A history of preceding streptococcal or viral infection can be suggestive of guttate psoriasis, which is more common in children than adults.
Approach to treatment should be guided by the extent and severity of disease, which can be quantified by BSA, the PASI score and quality of life index surveys.
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Related Terms: Dermatology, pediatric, psoriasis, chronic, inflammatory, skin disease
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Frequently Asked Questions about Psoriasis

Frequently Asked Questions about Psoriasis

WHAT IS PSORIASIS?

Psoriasis is a common but chronic skin condition that causes inflammation and scaling (red elevated patches and flaking silvery scales). The patches can be itchy or sore, causing discomfort and pain. Psoriasis causes skin cells to rise to the surface and shed at a very rapid rate. On average, people with psoriasis shed their skin cells every 3 to 4 days, while people without the condition have a turnover rate of about every 30 days.1,2,3,4

Related Terms: Dermatology, acne, psoriasis, dermatology

Psoriasis in Older Adults

Psoriasis in Older Adults

Teaser: 

Carrie Lynde, MD, Dermatology PGY-1, University of Toronto, Toronto, ON.
John Kraft, MD, Dermatology PGY-4, University of Toronto, Toronto, ON.
Charles Lynde, MD, FRCPC, Assistant Professor, Division of Dermatology, University of Toronto; Dermatology consultant for Metropolitan Homes for the Aged, Toronto; Markham Stouffville Hospital; Scarborough Grace Hospital, Toronto, ON.

Psoriasis is a chronic relapsing skin disease. Age of onset is bimodal with a peak in second to third decades and the sixth decade. Individuals affected by psoriasis usually complain of lower self-esteem. Choice of therapy depends on many factors, including areas affected, extent of disease, patient’s lifestyle, other health problems, and medications. Many effective therapies exist, including topicals, phototherapy, systemics, and biologicals.
Key words: psoriasis, comorbidities, topical steroids, phototherapy, biologics.

Related Terms: Dermatology, biologic agents, comorbidities, phototherapy, psoriasis, topical steroids

Skin Manifestations of Internal Disease

Skin Manifestations of Internal Disease

Teaser: 


D’Arcy Little, MD, CCFP, Lecturer, Department of Family and Community Medicine, University of Toronto, Toronto, ON.

The skin can be a window to certain internal diseases. Notable internal diseases with a prominent skin component include systemic lupus erythematosus, dermatomyositis, scleroderma, psoriasis, and sarcoidosis. This article will review some of the common skin manifestations of these diseases.

Key words: skin disease, internal disease, systemic lupus erythematosus, dermatomyositis, scleroderma, psoriasis, sarcoidosis.

Related Terms: Dermatology, dermatomyositis, internal disease, psoriasis, sarcoidosis, scleroderma, skin disease, systemic lupus erythematosus

Psoriasis in Older Adults: Issues and Treatment

Psoriasis in Older Adults: Issues and Treatment

Teaser: 

Scott RA Walsh, MD, PhD, Division of Dermatology, Sunnybrook and Women’s College Health Sciences Centre, University of Toronto Medical School, Toronto, ON.

Madhuri Reddy, MD, MSc, FRCPC, Divisions of Dermatology and Geriatric Medicine, Department of Medicine, Sunnybrook and Women’s College Health Sciences Centre, University of Toronto Medical School, Toronto, ON.

Psoriasis is a chronic, recurring T-cell- mediated skin disease that causes significant morbidity. The disease is often life-long and thus prevalence is highest in older adults. Severe clinical variants are also more frequent. Complicating psoriasis presentation and treatment in older adults are issues related to polypharmacy, including a higher frequency of drug-induced or drug-exacerbated disease and potential drug interactions. Treatment should be tailored to the individual with his/her respective limitations and reflect disease severity. This review examines suitable treatment protocols, including patient education and topical and systemic medications in older populations coping with psoriasis.

Key words: psoriasis, older adults, complications, treatment, immunologic disease

Related Terms: Dermatology, complications, immunologic disease, older adults, psoriasis, treatment