Papular-Purpuric Glove-and-Sock Syndrome is a rare, infectious disease, of viral etiology, . Carrascosa JM, Just M, Ribera M, Ferrandiz C. Papular acrodermatitis of Sanchez MA, Ceballos Salobreña A. Sindrome de Sjögren en la infancia. papular acrodermatitis of childhood Noun. Translate “papular acrodermatitis of childhood” to Spanish: acrodermatitis papular de la infancia. Acrodermatitis papular de la infancia pdf download ampgt httphyredronyprytra. . Acrodermatite wereldwijd verspreid nettwerk van computers for.
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Psoriasis in childhood and adolescence. Psoriasis is a chronic, immunologically mediated, recurrent and universal inflammatory disorder. Approximately one third of adults refer onset before 16 years of age. The sooner the onset, the worse is the laa. In children, lesions may be physically disfiguring, leading to psychological impairment and evident loss of quality of life.
Systemic therapy used in psoriasis, as well as phototherapy, has limited use in children due to accumulative effects of drugs, low acceptance, and risk of teratogenicity. In this section, we discuss the main clinical aspects of psoriasis in childhood and adolescence, differential diagnosis, therapeutic options, and prognosis.
Psoriasis that starts in childhood has high family incidence. The most common type presented in infants is characterized by well-delimited erythematous plaques involving the genitals, gluteal and peri-umbilical region, which tends to be persistent and resistant to treatment Figure 1. Facial affection is rare.
As time goes by, new erythematous-squamous plaques show up, affecting primarily the trunk and the limbs. Childhood psoriasis variants include peri-ungual affection with different levels of onycodystrophy present Figure 2as well as forms restricted to the scalp.
Guttate psoriasis is rarely observed in children below the age of 5 years. Treatment basically depends on severity, association with articular affections, presence of co-morbidities, patient age, previous therapies and adverse events. To present, there is no authorized systemic treatment for psoriasis in childhood approved by the Food and Drug Administration FDA. In Brazil, acitretin and cyclosporine have indication for pediatric use in severe cases of psoriasis. As to methotrexate, the package insert does not include indication to children with psoriasis, but it refers to its use in the symptomatic control of recalcitrant, severe and disabling psoriasis, especially in cases that do not response well to other approaches.
Hippocrates AC described lesions similar to psoriasis that he classified as “squamous eruptions” and named them lopoi from lepo, desquamation.
Galenus DC created the word psoriasis, from Greek, psorapruritus. However, palpebral affection associated with other psoriasiform lesions, as well as the presence of desquamation and pruritus in the original description of Galenus, suggest the hypothesis that his report referred in fact to seborrheic eczema. In the end of 18th century, psoriasis and Hansen’s disease were classified together and patients were treated based on the same prejudice papu,ar marginalization by the society.
Willian, in the beginning of 19th century, made a careful and precise characterization of psoriasis and described all its different clinical variants. Only inpsoriasis was definitely separated from Hansen’s disease by Avrodermatitis von Hebra. Even though psoriasis is seldom reported in children, the real prevalence in this age range is unknown 2. It may in some exceptional occasions be congenital or nevoid 4.
Even though in the past there was greater prevalence of psoriasis in girls, but current studies indicate that both genders are equally affected, similarly to adults. The risk of developing psoriasis is greater when one of the parents is affected. Despite the advances in the last decade, the cause of psoriasis remains unknown. It is a chronic skin and acroder,atitis inflammatory disease, immunomediated, with polygenic predisposition, characterized by complex modifications of growth and epidermal differentiation and multiple biochemical, immune and vascular abnormalities, in addition to the unexplained correlation with emotional episodes.
In the past, keratonocyte disorder was the etiopathogenic basis of psoriasis; however, currently it is known that it is initially an immune affection mediated by type Th1 response 5,7,8,9, The genetic component involved in the etiology of psoriasis may be evidenced through studies about family incidence, incidence in cases of issues, level of concordance between twins and identify of histocompatibility antigens HLA.
Recent studies have revealed loci of susceptibility named Psors, located on chromosomes 6p, 17q, 4q, and 1q 5,6, There is a possible exacerbation of psoriasis by the use of non-hormonal antiinflammatory drugs, tetracyclines and ACE inhibitors should be considered with care, because despite the high frequency of use of these drugs, there are few reports associating their use with worsening of psoriasis In pathogenesis, there is acceleration of epidermal germinative cycle, increase in proliferation cells and shortening of the time required for cell renovation on the epidermis, both of the lesion and incancia normal skin in patients with psoriasis.
It is believed that hyperproliferation of keratinocytes is due to increase in amount of epidermal growth factor EGFalpha transformation growth TGF-alpha and the participation of proinflammatory cytokines IL-1, IL-6, IFN-gammawhich would operate as mitogenic agents to these cells. To guttate psoriasis, there is induced self-immunity by cross-reaction to streptococcus antigens. Relative frequency of clinical types of psoriasis and the clinical presentations of the disease differ among adults and children.
Lesions are characterized by papules and well-delimited erythematous plaques of varied sizes and silver desquamation, frequently organized in a symmetric fashion. In childhood, psoriasis may present atypical characteristics, that is, single or few erythematous plaques that are slightly desquamative, affecting uncommon regions such as the face – including periorbital, perioral and nasal regions – many times hindering the correct diagnosis Figure 3. What is characteristic in childhood psoriasis is follicular affection with variable pruritus, better detected in limb lesions Figure 4A 14,15, There may also be alternate forms that mimic pityriasis alba Figure 4B.
Psoriasis lesions frequently affect the scalp, followed by extremities and the trunk. There is frequent symmetric distribution of lesions and absence of pruritus Figure 5A. Affection of hands, feet, genitals and flexion areas Figure 5Bincluding the periumbilical area, is also common among children 6, The congenital form, defined as occurrence of any of the clinical variants of psoriasis at birth or during the first days of life, is extremely rare.
It is normally expressed in the forms of plaque psoriasis. Cases of congenital or neonatal erythrodermic psoriasis are rare, severe and demand immediate intervention. Differential diagnosis in these cases include staphylococcal scalded skin syndrome, toxic shock syndrome, candidiasis, congenital ichthyosis, immunodeficiencies, such as Omenn syndrome, metabolic disorders, atopical and seborrheic dermatitis, pityriasis rubra pilaris and generalized mastocytosis 1.
Scalp affection, with presence of white scales, adhered and thickened placed around hair follicles with mild erythema pseudo-tinea amiantacea may lead to temporary hair loss or even psoriatic alopecia.
There may be single plaque lesion or poorly delimited and desquamative lesions, clinically indistinguishable from seborrheic dermatitis 17, The characteristic topography in children is affection of diaper area psoriatic diaper rashwhich occurs in children up to the age of two years. Differently from diaper dermatitis contact dermatitislesions have clearer and brighter erythema, well-delimited margins, and involve inguinal folds, with variable pruritus.
Classically, these signs and symptoms respond poorly to conventional therapeutic approach to diaper dermatitis. After one or two weeks from onset of diaper erythema, some children develop the classical lesions of psoriasis on the face, scalp, trunk and limbs Guttate psoriasis is a clinical variant of psoriasis that affects children in frequencies that range from 6.
Papular lesions of up to 1cm in diameter are symmetrically displaced all over the body surface, predominantly on the trunk and root of limbs.
Guttate psoriasis normally regresses spontaneously within 3 to 4 months. Occasionally, lesions may persist and increase in size, taking the characteristics of plaque psoriasis unfancia Within 10 years, between one and two thirds of patients with diagnosis of guttate psoriasis progress to chronic presentation in plaques.
Linear psoriasis, a rare form of psoriasis, is characterized by erythematous-squamous lesions following the lines of Blaschko. It may start in childhood or adult age and affect essentially the trunk or the limbs with variable extension and progression. It should be differentiated from inflammatory linear verrucous epidermal nevus ILVENwhose onset is infnacia childhood and affects primarily inguinal-crural and genital regions, following the lines of Blaschko.
Pruritus may be intense. Despite the fact that histopathology may evidence psoriasiform dermatitis, the chronicity of the lesion and resistance to any form of therapeutic intervention differentiate it from linear psoriasis 6, Pustular psoriasis in children is rare. It is characterized by multiple sterile pustules, over erythematous basis.
It may be generalized or localized. The generalized form von Zumbusch may be triggered in a patient with psoriasis vulgaris by interrupting incancia corticoid, hypocalcemia, infection or local irritants. In general, there is affection of overall status, high temperature and leukocytosis.
Eruption is sudden and generalized, but commonly it persists for few weeks, reverting the previous presentation or transforming it into erythrodermic psoriasis Figure 6.
The localized form comprises three subforms: Rare complications of this form of psoriasis, described in children, are renal failure, cholestatic jaundice, bone lytic lesions, and sterile multifocal osteomyelitis 1. The annular form that is associated with erythematous-desquamative lesions and peripheral pustules seem to be exclusive to children Figure 7 2.
This acrodermattiis may be followed by fever, aseptic osteomyelitis, and lung impairment. When compared to adults, erythrodermic psoriasis and psoriatic arthritis are less frequent clinical presentations in children. In erythordermic psoriasis, there is marked, universal edema with variable desquamation. There may be natural progression of the disease, or more frequently, after attempted therapies, interruption of systemic corticoid therapy, or in patients with AIDS.
There is clear predominance of erythema over desquamation.
Gianotti–Crosti syndrome – Wikipedia
There may be hyper or hypothermia and in long-term cases, there may be reduction of cardiac output and impairment of liver and renal function. The eminent risk of cardiovascular shock and septic shock transform these patients into extremely severe cases, requiring immediate hospitalization and therapeutic intervention associated with support measures. The incidence peak is between 9 and 12 years and girls are slightly more affected than boys F: There may be ophthalmic affections associated with psoriatic arthritis in some occasions.
The most frequent form of psoriatic arthritis is asymmetrical mono or oligoarthritis, which affects primarily hand and feet joints. Other less frequent forms present symmetrical, axial impairment and are sometimes disabling. Almost all forms of psoriasis may be concomitant with arthritis; in general, the more severe the cutaneous affection, the higher the prevalence of arthritis.
The level of involvement depends on the location of the psoriatic process in the ungual system, intensity and duration of the progression of the disease. The most frequent aspect is cupuliform depressions, also named ungual pits thimble-shaped nailsby affection of proximal ungual fold.
Onycolysis, subungual hyperkeratosis and “oil spots” are other evidenced affections and correspond to affections of ungual bed. Finally, affection of ungual matrix may lead to onycodystrophy and trachyonychia. These patterns tend to be similar in children and adults.
Acral affection with variable levels of onycodystrophy may be the only manifestation in children Figure 8. Ungual involvement increases with age, with duration and extension of disease and the presence of psoriatic arthritis To confirm the diagnosis it is necessary to exclude onycomycosis by mycological exam. Bear in mind that they can coexist given that ungual psoriasis increases the likelihood of contamination by dermatophytes 26, Diagnosis of psoriasis is mainly clinical.
Through methodic curettage of Brocq, we ds find the two typical clinical findings of this dermatosis: Woronoff hale or ring perilesional light zone is highly characteristic of the disease, but it is rarely observed The lesions appear between 10 and 14 days after the trauma. However, the onset of lesions after few days or even years has also been reported.