Pediatric emergency medicine trisk 340

FIGURE 70.2 Classic plaque-type psoriasis tends to occur on extensor surfaces.


FIGURE 70.3 Small drop-like papules and plaques typical of guttate psoriasis.


FIGURE 70.4 Palmar psoriasis.


FIGURE 70.5 Inverse psoriasis. The classic diaper area or napkin psoriasis pattern is
visible here.

A small proportion of patients develop arthritis between 9 and 12 years of
age; some develop it before the onset of the skin eruption. The distal
interphalangeal joints of the hands and feet are involved most often, usually
asymmetrically.
In the emergency department, patients with limited disease can be
successfully managed with a course of topical corticosteroid until they can
be referred back to their primary physician or dermatologist. Facial or
genital areas may be treated with a lower potency topical steroid such as
hydrocortisone 2.5%, a vitamin D derivative topical (calcipotriene or
calcitriol), or a topical calcineurin inhibitor such as pimecrolimus or
tacrolimus. Body affected areas may be treated with a mid-potency topical
steroid such as triamcinolone 0.1%. For the scalp, treatment with a steroid
solution or oil-based compound is recommended, using a fluocinolone
solution or oil, for example. For a guttate psoriasis presentation, it would be
reasonable to screen for streptococcal pharyngitis and treat accordingly if
positive.