Psoriasis in children: Epidemiology, clinical manifestations, and diagnosis
- Amy S Paller, MD
Amy S Paller, MD
- Walter J. Hamlin Professor and Chair of Dermatology
- Professor of Pediatrics
- Director, Northwestern University Skin Disease Research Center
- Northwestern University Feinberg School of Medicine
- Emily Broun Lund, MD
Emily Broun Lund, MD
- University of Chicago
- Section Editors
- Kristina Callis Duffin, MD
Kristina Callis Duffin, MD
- Section Editor — Psoriasis
- Associate Professor, Department of Dermatology
- University of Utah
- Moise L Levy, MD
Moise L Levy, MD
- Section Editor — Pediatric Dermatology
- Professor of Pediatrics and Medicine (Dermatology)
- Dell Medical School, University of Texas, Austin
- Clinical Professor of Dermatology and Pediatrics
- Baylor College of Medicine
Psoriasis is a systemic, immune-mediated disease that is most often characterized by well-demarcated, erythematous plaques with adherent, micaceous scale. The onset of psoriasis can occur during childhood or adulthood.
Chronic plaque psoriasis is the most common clinical form of psoriasis in children; guttate, pustular, and erythrodermic psoriasis are additional presentations. Certain distributions of plaque psoriasis are more common in children than adults, including involvement of the face, scalp, and intertriginous skin. Psoriatic diaper rash (also known as "napkin psoriasis") can be the initial manifestation of psoriasis in infants and young children.
The epidemiology, clinical features, comorbidities, and diagnosis of psoriasis in children will be reviewed here. Detailed discussions of specific clinical variants of psoriasis, psoriatic arthritis in children, and the management of psoriasis in children are provided separately.
●(See "Guttate psoriasis".)
- Farber EM, Nall ML. The natural history of psoriasis in 5,600 patients. Dermatologica 1974; 148:1.
- Michalek IM, Loring B, John SM. A systematic review of worldwide epidemiology of psoriasis. J Eur Acad Dermatol Venereol 2017; 31:205.
- Augustin M, Glaeske G, Radtke MA, et al. Epidemiology and comorbidity of psoriasis in children. Br J Dermatol 2010; 162:633.
- Tollefson MM, Crowson CS, McEvoy MT, Maradit Kremers H. Incidence of psoriasis in children: a population-based study. J Am Acad Dermatol 2010; 62:979.
- Paller AS, Mercy K, Kwasny MJ, et al. Association of pediatric psoriasis severity with excess and central adiposity: an international cross-sectional study. JAMA Dermatol 2013; 149:166.
- Nair RP, Duffin KC, Helms C, et al. Genome-wide scan reveals association of psoriasis with IL-23 and NF-kappaB pathways. Nat Genet 2009; 41:199.
- Jordan CT, Cao L, Roberson ED, et al. PSORS2 is due to mutations in CARD14. Am J Hum Genet 2012; 90:784.
- Eytan O, Qiaoli L, Nousbeck J, et al. Increased epidermal expression and absence of mutations in CARD14 in a series of patients with sporadic pityriasis rubra pilaris. Br J Dermatol 2014; 170:1196.
- Shah KN. Diagnosis and treatment of pediatric psoriasis: current and future. Am J Clin Dermatol 2013; 14:195.
- Nyfors A, Lemholt K. Psoriasis in children. A short review and a survey of 245 cases. Br J Dermatol 1975; 92:437.
- Pouessel G, Ythier H, Carpentier O, et al. Childhood pustular psoriasis associated with Panton-Valentine leukocidin-producing Staphylococcus aureus. Pediatr Dermatol 2007; 24:401.
- Ito T, Furukawa F. Psoriasis guttate acuta triggered by varicella zoster virus infection. Eur J Dermatol 2000; 10:226.
- Ergin S, Karaduman A, Demirkaya E, et al. Plaque psoriasis induced after Kawasaki disease. Turk J Pediatr 2009; 51:375.
- Nestle FO, Kaplan DH, Barker J. Psoriasis. N Engl J Med 2009; 361:496.
- Guttman-Yassky E, Nograles KE, Krueger JG. Contrasting pathogenesis of atopic dermatitis and psoriasis--part II: immune cell subsets and therapeutic concepts. J Allergy Clin Immunol 2011; 127:1420.
- Cai YH, Lu ZY, Shi RF, et al. Enhanced proliferation and activation of peripheral blood mononuclear cells in patients with psoriasis vulgaris mediated by streptococcal antigen with bacterial DNA. J Invest Dermatol 2009; 129:2653.
- Fan X, Xiao FL, Yang S, et al. Childhood psoriasis: a study of 277 patients from China. J Eur Acad Dermatol Venereol 2007; 21:762.
- Mallbris L, Larsson P, Bergqvist S, et al. Psoriasis phenotype at disease onset: clinical characterization of 400 adult cases. J Invest Dermatol 2005; 124:499.
- Morris A, Rogers M, Fischer G, Williams K. Childhood psoriasis: a clinical review of 1262 cases. Pediatr Dermatol 2001; 18:188.
- Mercy K, Kwasny M, Cordoro KM, et al. Clinical manifestations of pediatric psoriasis: results of a multicenter study in the United States. Pediatr Dermatol 2013; 30:424.
- Bellet JS, Chamlin SL, Yan AC, Paller AS. Intertriginous pustular psoriasis. J Am Acad Dermatol 2009; 60:679.
- Minkis K, Aksentijevich I, Goldbach-Mansky R, et al. Interleukin 1 receptor antagonist deficiency presenting as infantile pustulosis mimicking infantile pustular psoriasis. Arch Dermatol 2012; 148:747.
- Marrakchi S, Guigue P, Renshaw BR, et al. Interleukin-36-receptor antagonist deficiency and generalized pustular psoriasis. N Engl J Med 2011; 365:620.
- Posso-De Los Rios CJ, Pope E. New insights into pustular dermatoses in pediatric patients. J Am Acad Dermatol 2014; 70:767.
- Sugiura K, Takemoto A, Yamaguchi M, et al. The majority of generalized pustular psoriasis without psoriasis vulgaris is caused by deficiency of interleukin-36 receptor antagonist. J Invest Dermatol 2013; 133:2514.
- Farooq M, Nakai H, Fujimoto A, et al. Mutation analysis of the IL36RN gene in 14 Japanese patients with generalized pustular psoriasis. Hum Mutat 2013; 34:176.
- Nanda A, Kaur S, Kaur I, Kumar B. Childhood psoriasis: an epidemiologic survey of 112 patients. Pediatr Dermatol 1990; 7:19.
- Farber EM. Facial psoriasis. Cutis 1992; 50:25.
- Benoit S, Hamm H. Childhood psoriasis. Clin Dermatol 2007; 25:555.
- Koebnick C, Black MH, Smith N, et al. The association of psoriasis and elevated blood lipids in overweight and obese children. J Pediatr 2011; 159:577.
- Zisman D, Gladman DD, Stoll ML, et al. The Juvenile Psoriatic Arthritis Cohort in the CARRA Registry: Clinical Characteristics, Classification, and Outcomes. J Rheumatol 2017; 44:342.
- Stoll ML, Zurakowski D, Nigrovic LE, et al. Patients with juvenile psoriatic arthritis comprise two distinct populations. Arthritis Rheum 2006; 54:3564.
- Tollefson MM, Finnie DM, Schoch JJ, Eton DT. Impact of childhood psoriasis on parents of affected children. J Am Acad Dermatol 2017; 76:286.
- Varni JW, Globe DR, Gandra SR, et al. Health-related quality of life of pediatric patients with moderate to severe plaque psoriasis: comparisons to four common chronic diseases. Eur J Pediatr 2012; 171:485.
- Kimball AB, Wu EQ, Guérin A, et al. Risks of developing psychiatric disorders in pediatric patients with psoriasis. J Am Acad Dermatol 2012; 67:651.
- Bilgic A, Bilgic Ö, Akış HK, et al. Psychiatric symptoms and health-related quality of life in children and adolescents with psoriasis. Pediatr Dermatol 2010; 27:614.
- Niccoli L, Nannini C, Cassarà E, et al. Frequency of iridocyclitis in patients with early psoriatic arthritis: a prospective, follow up study. Int J Rheum Dis 2012; 15:414.
- Rosenbaum JT. Uveitis in spondyloarthritis including psoriatic arthritis, ankylosing spondylitis, and inflammatory bowel disease. Clin Rheumatol 2015; 34:999.
- Osier E, Wang AS, Tollefson MM, et al. Pediatric Psoriasis Comorbidity Screening Guidelines. JAMA Dermatol 2017; 153:698.
- RISK FACTORS
- CLINICAL PRESENTATION
- Chronic plaque psoriasis
- Guttate psoriasis
- Pustular and erythrodermic psoriasis
- Special sites
- Obesity and cardiovascular risk
- Psoriatic arthritis
- Psychosocial effects
- Clinical assessment
- Skin biopsy
- DIFFERENTIAL DIAGNOSIS
- ADDITIONAL EVALUATION
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS