Mercy Katherine, Kwasny Mary, Cordoro Kelly M, Menter Alan, Tom Wynnis L, Korman Neil, Belazarian Leah, Armstrong April W, Levy Moise L, Paller Amy S
Department of Dermatology, Northwestern University, Chicago, Illinois 60611, USA.
Pediatr Dermatol. 2013 Jul-Aug;30(4):424-8. doi: 10.1111/pde.12072. Epub 2013 Jan 30.
The clinical features of pediatric psoriasis warrant further attention. A national study was conducted to determine the prevalence of scalp and nail involvement and a history of guttate psoriasis at onset according to age, sex, and disease severity. One hundred eighty-one children ages 5 to 17 years with plaque psoriasis were enrolled in a multicenter, cross-sectional study. Subjects and guardians were asked about a history of scalp and nail involvement and whether the initial presentation was guttate. Peak psoriasis severity was assessed and defined historically as mild psoriasis (MP) or severe psoriasis (SP) according to the Physician's Global Assessment and body surface area measures. One hundred forty-three (79.0%) subjects reported a history of scalp involvement, and 71 (39.2%) described a history of nail involvement. Boys were less likely than girls to report a history of scalp involvement (odds ratio [OR] = 0.40, 95% confidence interval [CI] = 0.19-0.84) but more likely to have had nail involvement (OR = 3.01, 95% CI = 1.62-5.60). Scalp and nail involvement was not related to psoriasis severity. In contrast, subjects with SP (35.9%) more often reported a history of guttate lesions than did those with MP (21.8%) (p = .02). Antecedent streptococcal infection was more common in children with guttate than those with plaque psoriasis at onset (p = .02) but did not correlate with severity. Sex-related differences in scalp and nail involvement suggest koebnerization. Preceding streptococcal infection predicts guttate morphology but not severity, and initial guttate morphology is associated with eventual greater severity of disease. More aggressive monitoring and management should be considered for guttate psoriasis, given its later association with more severe disease.
儿童银屑病的临床特征值得进一步关注。一项全国性研究旨在根据年龄、性别和疾病严重程度，确定头皮和指甲受累情况以及点滴状银屑病起病史的患病率。181名年龄在5至17岁的斑块状银屑病患儿参与了一项多中心横断面研究。研究人员询问了受试者及其监护人关于头皮和指甲受累情况以及初始表现是否为点滴状。根据医生整体评估和体表面积测量，对银屑病严重程度峰值进行了评估，并将其历史定义为轻度银屑病（MP）或重度银屑病（SP）。143名（79.0%）受试者报告有头皮受累史，71名（39.2%）描述有指甲受累史。男孩报告头皮受累史的可能性低于女孩（优势比[OR]=0.40，95%置信区间[CI]=0.19-0.84），但指甲受累的可能性更高（OR=3.01，95%CI=1.62-5.60）。头皮和指甲受累与银屑病严重程度无关。相比之下，SP组受试者（35.9%）比MP组受试者（21.8%）更常报告有点滴状皮损史（p=0.02）。起病时，点滴状银屑病患儿前驱链球菌感染比斑块状银屑病患儿更常见（p=0.02），但与严重程度无关。头皮和指甲受累的性别差异提示同形反应。前驱链球菌感染可预测点滴状形态，但与严重程度无关，初始点滴状形态与疾病最终更严重程度相关。鉴于点滴状银屑病后期与更严重疾病相关，应考虑对其进行更积极的监测和管理。
