12-Year-Old with Scaly, Itchy Scalp




© Springer International Publishing AG 2017
Jashin J. Wu (ed.)Clinical Cases in PsoriasisClinical Cases in Dermatology10.1007/978-3-319-52779-6_1


1. 12-Year-Old with Scaly, Itchy Scalp



Daniel J. No1, Mina Amin2 and Jashin J. Wu 


(1)
Loma Linda University School of Medicine, Loma Linda, CA, USA

(2)
University of California, Riverside School of Medicine, Riverside, CA, USA

(3)
Wu Medical Associates, Inc., Los Angeles, CA, USA

 



 

Jashin J. Wu



Keywords
Pediatric psoriasisChildhoodBiologicsAdolescentTopical corticosteroidsCalcipotrieneTacrolimus


A 12-year-old male presents with a 2-month history of a pruritic and scaly scalp. The patient was referred to dermatology by his pediatrician after failed empiric treatment with griseofulvin for presumptive tinea capitis. Since the initial examination performed by his pediatrician, the patient also developed erythematous, pruritic, scaly papules and plaques on bilateral arms, legs, and postauricular folds. His pediatrician prescribed low- to mid-potency topical corticosteroids, and he experienced mild improvement. Upon further questioning, the patient admitted to frequent self-scratching with subsequent development of lesions in the areas of irritation. He denied joint stiffness or pain. He denied a family history of psoriasis. With the exception of obesity and impaired fasting glucose, the patient was otherwise healthy and denied recent illness, sore throat, or sick contacts.

On physical examination, the scalp showed multiple areas of erythematous papules with overlying silvery scale coalescing to plaques on the right parietal-temporal scalp. The lesion spanned approximately 5 inches. No alopecia was appreciated. Bilateral posterior auricular folds had approximately 1-inch area of erythema with a thick white scale. The back and bilateral lower extremities had multiple areas of indurated pink plaques with loose micaceous scale. The left inguinal crease had a well-defined bright red erythematous patch without an overlying scale. Nail pitting was evident on the right second digit nail plate. There was no evidence of dactylitis or joint inflammation. Approximately 4% of the body surface area was affected.

Based on the clinical case description, what is the most likely diagnosis?


  1. 1.


    Tinea capitis

     

  2. 2.


    Atopic dermatitis

     

  3. 3.


    Plaque psoriasis

     

  4. 4.


    Seborrheic dermatitis

     

  5. 5.


    Contact dermatitis

     


Diagnosis


Plaque psoriasis


Discussion


Pediatric psoriasis accounts for about one-third of all cases of psoriasis (Tollefson et al. 2010). The clinical presentation and course vary, but the most frequently observed variant is plaque-type psoriasis, followed by guttate psoriasis. Erythrodermic psoriasis and pustular psoriasis are rare but life-threatening forms of psoriasis that have been observed in the pediatric population. Interestingly, the distribution of lesions tends to differ in comparison to psoriasis in adulthood. Most children present with lesions localized to the scalp, face, extensor regions, postauricular area, and intertriginous areas. Additionally, there appears to be a stronger genetic component to pediatric psoriasis in comparison to adult-onset psoriasis (Raychaudhuri and Gross 2000).

The increased prevalence of childhood obesity is of particular concern because studies reveal that children affected by psoriasis tend to have excess adiposity. In fact, data suggests a stronger correlation between obesity and psoriasis with the pediatric population in comparison to adults affected by psoriasis (Paller et al. 2013). The increased body mass indices, waist circumference percentiles, and waist to height ratios place these children at an increased risk of developing conditions such as hypertension, metabolic syndrome, hyperlipidemia, and diabetes mellitus. This underscores the importance of early diagnosis and intervention with a particular focus on healthy lifestyle modification.

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Aug 20, 2017 | Posted by in Dermatology | Comments Off on 12-Year-Old with Scaly, Itchy Scalp

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