Pediatric Psoriasis Comorbidities

Nicole W. Kittler, MD; Kelly M. Cordoro, MD


Skin Therapy Letter. 2020;25(5):1-6. 

In This Article

Case Presentation

A 10 year-old male presents with a 5 year history of psoriasis that has been increasing in severity over time. His psoriasis has been treated with topical therapies only until recently, when a course of Goeckerman therapy provided temporary improvement but then flared significantly after 1 month. Upon presentation to pediatric dermatology, he has near erythroderma with large bright red scaly plaques and scattered guttate papules and small plaques covering more than 75% of his body surface area (Figures 1A and 1B). There are scattered superficial erosions within the larger plaques. He has missed the last 4 weeks of school due to malaise, intermittent chills, and severity of his psoriasis, which is painful and has reduced his ability to walk and sit comfortably. During the visit, he does not make eye contact and answers questions with shoulder shrugs and one-word answers. He is otherwise healthy, has no known recent infections and takes no medications. A review of systems is positive for malaise, fatigue, skin tenderness, reduced range of motion of the extremities due to erosions at flexural sites, depressed mood and social withdrawal. He has not had pain, swelling or stiffness of his joints and denies ocular symptoms. His family history is positive for psoriasis and vitiligo. He is accompanied by his parents, who are separated. His mother is in tears, and his father is very frustrated throughout the visit. The patient has been having rage attacks at home and has withdrawn from his friends and social activities. How should we approach this child in terms of psoriasis comorbidities?

Figure 1.

A & B Initial presentation of a 10 year-old male with a 5-year history of psoriasis covering more than 75% of body surface area.