Department of Dermatology, Affiliated Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
World J Pediatr. 2010 Aug;6(3):260-4. doi: 10.1007/s12519-010-0213-0. Epub 2010 Jun 12.
Childhood psoriasis is common, but it has not been adequately reported in China. This study was undertaken to evaluate the epidemiological and clinical findings in children with psoriasis treated in a 9-year period and to compare the data with those from other studies.
The data were from 137 children (< or =14 years old) with psoriasis registered in two tertiary hospitals in Wuhan, China between January 2000 and December 2008. They were retrospectively studied.
Of the 137 patients, aged between 3 and 14 years, 64 were males (46.7%) and 73 females (53.3%). Eleven patients (8%) had a family history of psoriasis. Infection was the most common precipitating factor (39, 28.5%). Seasonal influence was found in 57 patients (41.6%). Exacerbations in winter and spring were noted in 29 and 16 patients respectively. Plaque psoriasis was the most common type (72 patients, 52.6%), followed by guttate psoriasis (35, 25.5%), psoriasis pustulosa (15, 10.9%), and psoriasis erythroderma (7, 5.1%). The scalp was the most common initial site affected (69, 50.3%). Nail changes were found in 35 patients (25.5%), but no mucosal involvements were observed. Five patients had arthralgia and two showed abnormal X-ray appearance. Most of the affected children had pruritus. The co-morbidities of childhood psoriasis included allergic contact dermatitis (31, 22.6%), eczema (6, 4.3%), vitiligo (5, 3.6%), and alopecia areata (3, 2.2%). Psoriasis was sometimes misdiagnosed as dermatitis seborrheica (11, 8.0%), neurodermatitis (9, 6.6%) and balanitis (7, 5.1%). Some patients were treated with steroids, but there were obvious side-effects after longterm administration. Thiamphenicol was effective in the treatment of refractory psoriasis pustulosa in children.
Our findings differ from those of previous studies, showing a lower rate of family history and a higher incidence of severe psoriasis. Differential diagnosis should be made especially when lesions occur at the scalp, elbow or balanus. Allergic contact dermatitis takes place more frequently in children with psoriasis than in normal children. Systemic corticosteroids should not be routinely used and other safer and more effective treatments are needed for severe cases.
儿童银屑病较为常见，但在中国的报道尚不充分。本研究旨在评估在 9 年期间接受治疗的儿童银屑病的流行病学和临床资料，并与其他研究的数据进行比较。
本研究的数据来自于 2000 年 1 月至 2008 年 12 月期间在中国武汉的两家三级医院登记的 137 例（≤14 岁）儿童银屑病患者。对这些患者进行了回顾性研究。
在 137 例年龄为 3 至 14 岁的患者中，男性 64 例（46.7%），女性 73 例（53.3%）。11 例（8%）有银屑病家族史。感染是最常见的诱发因素（39 例，28.5%）。57 例（41.6%）患者存在季节性影响，29 例和 16 例患者分别在冬季和春季出现病情加重。斑块状银屑病是最常见的类型（72 例，52.6%），其次是点滴状银屑病（35 例，25.5%）、脓疱型银屑病（15 例，10.9%）和红皮病型银屑病（7 例，5.1%）。头皮是最常见的首发受累部位（69 例，50.3%）。35 例（25.5%）患者出现指甲改变，但未见黏膜受累。5 例患者出现关节痛，2 例患者 X 线检查异常。大多数受累儿童有瘙痒。儿童银屑病的合并症包括特应性皮炎（31 例，22.6%）、湿疹（6 例，4.3%）、白癜风（5 例，3.6%）和斑秃（3 例，2.2%）。银屑病有时被误诊为脂溢性皮炎（11 例，8.0%）、神经性皮炎（9 例，6.6%）和龟头炎（7 例，5.1%）。一些患者接受了皮质类固醇治疗，但长期应用后出现明显的副作用。儿童脓疱型银屑病用噻苯哒唑治疗有效。
本研究结果与以往研究不同，银屑病家族史发生率较低，而重症银屑病发生率较高。当病变发生在头皮、肘窝或龟头时，应特别注意鉴别诊断。与正常儿童相比，银屑病患儿更常发生特应性皮炎。不应常规使用全身皮质类固醇，对于重症患者需要使用更安全、更有效的治疗方法。
