Psoriasis and other papulosquamous diseases in infants and children

Abstract

Listen

Translate article

Many excellent textbooks on pediatric dermatology are available,2–8 and pediatric diseases are well covered even in many treatises of general dermatology. It would therefore seem useless endeavoring to repeat in a restricted space the matter which is put forth through thousands of printed pages. Accordingly, we will not reproduce here another picture of a “Typical case of PRP of the knee in a child aged . . . ” but we will survey critical items regarding diagnosis and choice of treatment of papulosquamous diseases in this peculiar age subset. This is not an article for beginners, and full knowledge of clinical dermatology is a prerequisite to study it with profit. However, it can also serve as a tool for training of residents in dermatology and clever medical students. Indeed, highlevel clinical practice leans on the same principles as chess mastery: under the guidance of a sound chess strategy, one must thoroughly analyze thousands of critical positions, grasp their deepest significance, and be ready to recollect each of them at the right time in order to exploit the acquired knowledge. Too often, this is called experience, but the choice of such a term sounds inappropriate, as “experience” bears the zest of quackery and of slapdash, parrot-fashion practice. Indeed, the right term is exercise, which must be either theoretical, so that you can diagnose diseases you have never seen before, because you have learned to recognize them, or practical, through engagement in clinical practice and merciless self-quizzing about difficult cases. Continuous meditation on roadmap articles (just like this one!) and book chapters is the bridge spanning the gap between the conceptual and the applied poles of knowledge. We hope such a dynamic approach will provide readers of Clinics in Dermatology with an openminded, flexible outlook on pediatric papulosquamous diseases, which is a sine qua non to broach the following items. In the past, the dermopediatric patient had been regarded as a “small adult with skin complaint,”5 and this concept was rightly blamed; however, the old misconception has been substituted by the commonplace notion that sick children are just something apart, quite unlike adults or elderly suffering from the very same disease. This puts pressure on clinical researchers who struggle to document the originality of skin pediatric diseases. The somewhat amusing result is that you can read chapters in renowned textbooks of pediatric dermatology describing the very adult pattern of a given illness, which then conclude with short notes on peculiar aspects of the child, or with clauses such as “The disease of children is the same as in adults,” “References about children are scarce,” and so on. Particularly in the case of papulosquamous diseases, such efforts are overtly artificial, because in general such diseases contribute to extending the category of “adult skin diseases in the pediatric patient” introduced by Howard and Tsuchiya.9 This article has been written by two clinical, general dermatologists who take care of pediatric patients among others in their daily office practice. The authors advocate that clinical dermatology is a very united corpus of compact doctrine, and that one cannot be a fine diagnostician and therapist of pediatric skin diseases if he or she has a sectorial and limited outlook on the discipline. The dermatologist who takes cares of children must also be a pediatric dermatologist, not solely a dermatologic pediatrician!