Pediatric Psoriasis

The diagnosis of psoriasis in children is based on clinical features. Biopsy confirmation is rarely necessary and should be avoided unless important to the diagnosis, such as in pustular psoriasis. Psoriasis occurs in almost 1% of children, but the diagnosis is often missed. The highly visible lesions in more severely affected children can significantly affect a child’s quality of life, and pediatric psoriasis is clearly established to be linked to obesity, as has been described in adults. For adults with psoriasis, 31%-45% have the onset of the disease during the first two decades of life. Scalp psoriasis is usually characterized by discrete patches of erythema with overlying scale, but many authors consider pityriasis amiantacea to be a form of psoriasis or a precursor to it. Approximately 5% of pediatric patients show an eczema/psoriasis overlap. These patients may either have typical plaques of psoriasis and features of eczema or may show scaling erythematous patches with features intermediate between eczema and psoriasis.