Skip to Main Content

Patient Story

A 5-year-old boy presents to his pediatrician with a new onset rash 2 weeks after being treated for strep pharyngitis. He had been treated with a10-day course of amoxicillin after a positive rapid strep test in the office. The mother states that her son is otherwise feeling well with a good appetite and no change in his activities. The pediatrician notes small plaques on the child’s face, arms and trunk and sees the resemblance to drops of water (Figure 136-1). The vital signs are normal as is the rest of the physical examination. A diagnosis of guttate psoriasis is made without any laboratory tests or biopsies. The child is started on 0.1 percent triamcinolone ointment to be applied twice daily. A referral to dermatology is also made.

FIGURE 136-1

This 5-year-old boy developed guttate psoriasis 2 weeks after a strep throat. A. Note the drop-like pink plaques on the face and neck. B. Drop-like plaques on the arms and trunk. (Used with permission from Richard P. Usatine, MD.)

Graphic Jump Location

Psoriasis is a chronic inflammatory papulosquamous and immune-mediated skin disorder. It is also associated with joint and cardiovascular comorbidities. Psoriasis can present in many different patterns, from the scalp to the feet, and cause psychiatric distress and physical disabilities. It is crucial to be able to identify psoriasis in all its myriad presentations so that patients receive the best possible treatments to improve their quality of life and avoid comorbidities.


  • Psoriasis affects approximately 2 percent of the world population.1

  • The prevalence of psoriasis was 2.5 percent in white patients and was 1.3 percent in African American patients in one population study in the US.2

  • Sex—No gender preference.

  • Age—Psoriasis can begin at any age. In one population study of the age of onset of psoriasis two peaks was revealed, one occurring at the age of 16 years (female) or 22 years (males) and a second peak at the age of 60 years (female) or 57 years (males).3

  • The prevalence rates for pediatric psoriasis increased in a linear way from 0.2 percent at the age of one year to 1.2 percent at the age of 18 years in a German study.4

  • Psoriasis begins before the age of 20 in about 1/3 of patients.5

  • Psoriatic arthritis affects about 20 percent of all psoriasis patients.5

Etiology and Pathophysiology

  • Immune-mediated skin disease, where the T cell plays a pivotal role in the pathogenesis of the disease.

  • Langerhans cell (antigen-presenting cells in the skin) migrate from the skin to regional lymph nodes, where they activate T cells that migrate to the skin and release cytokines.

  • Cytokines are responsible for epidermal and vascular hyperproliferation and proinflammatory effects.

Risk ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPediatrics Full Site: One-Year Subscription

Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPediatrics

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.