Psoriasis In Children Research Articles

Case report: Intralesional secukinumab injection for pediatric nail psoriasis: does it have to be a positive outcome?

Recent studies have shown that local injection of secukinumab can achieve positive therapeutic effects when applied in the treatment of nail psoriasis. At present, there have been no other studies on the use of biological agents in the treatment of pediatric nail psoriasis. Three children were included in the study to evaluate the efficacy and safety of periungual injection and long-term injection of secukinumab in the treatment of nail psoriasis in children. It was found that local injection did not achieve a remarkable therapeutic effect. The nail lesions were improved continuously by subcutaneous injection once a month.

Exploring the Psychological Impact of Childhood-Onset Psoriasis: A Systematic Review.

Childhood-onset psoriasis (COP) is often associated with various psychological challenges. While numerous studies have delved into the connection between adult-onset psoriasis and its potential to heighten a patient's susceptibility to various psychological challenges, less has been written about the influence of childhood psoriasis on psychological disorders, particularly anxiety and depression, eating disorders, and substance abuse. In this study, we delve into studies that shed light on these associated risks. A systematic literature review was conducted using PubMed, focusing on the psychological impacts of childhood-onset psoriasis. From an initial pool of 313 articles, we utilized Covidence for screening and selection, adhering to strict exclusion criteria such as psoriasis in adulthood and incorrect study designs. This process refined our focus to 12 relevant articles, which were critically analyzed to understand the psychological comorbidities associated with childhood-onset psoriasis. Our review reveals a significant link between childhood-onset psoriasis and increased instances of depression and anxiety. Notably, children with psoriasis demonstrate higher frequencies of suicidal thoughts and behaviors, as well as a marked propensity for substance abuse and addiction. The study also uncovers a strong connection between psoriasis in children and the development of eating disorders like anorexia nervosa and bulimia nervosa. COP significantly affects the psychological wellbeing of children, with heightened risks for depression, anxiety, suicidality, substance abuse, and eating disorders. These findings underscore the need for comprehensive management strategies that encompass not only the physical symptoms but also the mental health and psychological support for children with psoriasis. Early intervention and regular screenings are crucial in mitigating these risks and improving the quality of life for pediatric patients with psoriasis.

Psoriasis in pediatric dermatological clinical practice: diagnosis and management

The relevance of this topic is confirmed by the widespread psoriasis prevalence. Psoriasis in children has severe forms growth and diagnostic difficulties. It is crucially important to examine histologically the skin especially in pediatric dermatological clinical practice. According to our observations Pityriasis Rubra Pilaris has become one of the most frequent dermatoses with which differential diagnosis of psoriasis has to be carried out. A clinical dermatosis observation in a 13-year-old girl is described. The disease was similar to the manifestations of Pityriasis Rubra Pilaris. The results of the affected skin biopsy study did not exclude this diagnosis. The clinical and morphological manifestations of the dermatosis could be effected by steroid therapy. Subsequent dynamic observation and histological examination allowed us to diagnose psoriasis. Current data is collected and presented. The choice of external therapy in pediatric practice is a controversial topic. Clinical results of the Activated Zinc Pyrithion external forms use in the psoriasis treatment are presented.

O04 Vulval Psoriasis in Children: A Clinical Audit and Review of Literature

Abstract Objective Vulval psoriasis is frequently under-recognised, under-­diagnosed and under-treated in children due to its nonspecific presentation. This retrospective chart review is aimed to describe the symptoms, signs, and management of vulval psoriasis in children in a private vulval disease referral practice. Materials and methods A retrospective, single-centre cohort study of children was undertaken at a large, combined dermatology and gynaecology practice from January 2016 to January 2023. Clinical photographs and treatment data were systematically collected and recorded in an online patient database. Treatment regimens were individualised and titrated to clinical response. Results This seven-year retrospective cohort study included a total of 100 children with vulval psoriasis. The most common presentation was nonspecific erythema (85%) that is well-demarcated in one-third of children and appears as a raised plaque in one-fifth of children. In 78% of the patients, evidence of psoriasis was found on other parts of the skin. Initial induction treatment with potent topical corticosteroid followed by maintenance treatment with less potent topical steroids and topical tar creams. 5% of children required systemic treatment. Conclusions and Relevance Vulval psoriasis often presents as a nonspecific chronic erythematous vulvitis without vaginitis. It is a chronic relapsing skin condition that requires long-term management. Systematic treatment is required in a small proportion of children.

Clinical efficacy and safety of secukinumab in the treatment of generalized pustular psoriasis in the pediatric population: a systematic review of the literature.

Generalized pustular psoriasis (GPP) is a severe type of psoriasis. The current treatment primarily relies on corticosteroids and immunosuppressants. In recent years, biologics have been increasingly utilized in the treatment of this disease, and have demonstrated good clinical efficacy. However, children and adolescents are primarily treated with immunosuppressants, which have limited clinical application due to the serious side effects they may cause. At the same time, the effectiveness of current treatments is unsatisfactory. Secukinumab has been widely reported to be effective and safe in treating this disease. However, there are still insufficient data on its use in treating GPP in children. To conduct a systematic review of the existing literature on the use of secukinumab for treating generalized pustular psoriasis in children and adolescents, and to evaluate its clinical effectiveness and safety. We conducted a systematic review of all the literature reporting on the treatment of GPP in children and adolescents with secukinumab. A total of 7 papers (46 patients) were included in this study. After 12 weeks of treatment, all 46 participants were able to achieve a GPPASI score of 90 or higher, with approximately 96% of patients achieving complete clearing of the lesions (GPPASI 100 or JDA0). Adverse events were reported in 8 patients, the rate of adverse reactions was approximately 17%. The treatment of GPP in children and adolescents with secukinumab has a rapid onset of action and a high safety profile. However, the results of the literature may be influenced by publication bias.

Pediatric psoriasis: Understanding pathological conditions and advances in treatment.

Psoriasis is a long-lasting skin disease that primarily affects the skin, nails, and joints and is characterized by inflammation. Genetic factors contribute to its development and environmental triggers can worsen symptoms. Pathologically, psoriasis is characterized by uncontrolled keratinocyte proliferation and abnormal differentiation, and histological features include acanthosis with inflammatory cell infiltration and neovascularization. Psoriasis often starts in childhood, with about one-third of cases beginning during this time. Its prevalence steadily increases from the ages of 1 to 18 years in a linear fashion. Young people with psoriasis often require treatment throughout their childhood and adolescence, and into adulthood. However, prolonged treatment may increase the risk of complications and adverse events, so it is important to adopt an effective treatment approach that minimizes this risk. In addition, psoriasis is often associated with various comorbidities that may place a great burden on the physical and mental health of the children beyond those due to psoriasis itself. To ensure good long-term health outcomes, individuals with psoriasis should undergo regular screening. Treatment should be provided not only for skin lesions, but also for any comorbidities; however, currently there is not enough evidence on the treatment of pediatric psoriasis and no globally agreed-on guidelines exist for treating psoriasis in children. This article describes the etiology, clinical symptoms, and disease burden of pediatric psoriasis, the pathological conditions and diagnosis of plaque psoriasis, psoriatic arthritis, and generalized pustular psoriasis, and the available treatments for these conditions in Japan.

Tapinarof Cream 1% Once Daily for the Treatment of Plaque Psoriasis: Case Photography of Clinical Outcomes from Three Phase3 Trials.

Tapinarof cream 1% (VTAMA®; Dermavant Sciences, Inc.) is a non-steroidal, topical, aryl hydrocarbon receptor agonist approved by the US Food and Drug Administration (FDA) to treat plaque psoriasis in adults and under investigation for the treatment of psoriasis in children down to 2years of age, and for atopic dermatitis in adults and children down to 2years of age. The PSOARING phase3 clinical trial program evaluated tapinarof cream 1% once daily (QD) in adults with mild to severe plaque psoriasis for up to 52weeks (NCT03956355, NCT03983980, NCT04053387). Here we present case photography documenting outcomes in the PSOARING trials. Cases illustrate various outcomes across different body areas, including responses meeting the formal FDA-mandated regulatory endpoint of a Physician Global Assessment (PGA) score of 0 (clear) or 1 (almost clear) and a decrease of at least 2points from baseline at week12, meaningful clinical improvement not meeting this formal endpoint, patient-reported outcomes, and pre-specified adverse events of special interest (AESIs). Tapinarof cream 1% QD demonstrated rapid and highly statistically significant efficacy, with improvements in disease activity and quality of life. In addition, a high rate (40.9%; n = 312/763) of complete disease clearance (PGA = 0) was achieved, and improvements exceeding National Psoriasis Foundation treatment goals were demonstrated. After first achieving complete disease clearance (PGA = 0), patients treated with tapinarof experienced an approximately 4-month remittive effect off therapy. Incidence and severity of folliculitis and contact dermatitis AESIs were generally mild or moderate, localized to the site of application, and associated with low discontinuation rates. Medical images are of importance in trials of dermatologic therapies to inform clinical decision-making and enhance patient assessment. Tapinarof cream 1% QD is efficacious and well tolerated in patients with mild to severe plaque psoriasis, with clinically relevant improvements seen early in the course of treatment.Clinicaltrials.gov numbers: NCT03956355, NCT03983980, NCT04053387.

P06 Atopic dermatitis and psoriasis in children, and SARS-CoV-2 infection: different impact of the infection on these dermatoses, and of these dermatoses on the infection?

Abstract The SARS-CoV-2 pandemic has raised many questions regarding chronic inflammatory dermatoses and their treatments. Atopic dermatitis (AD) and psoriasis are chronic inflammatory dermatoses with different immunological profiles. Their susceptibility to infections also differs. We were interested in the link between SARS-CoV-2 infection and these two dermatoses in children: different impact of the infection on AD and psoriasis (disease flare-ups), and of these two dermatoses on the severity of this infection (severity). This was a single-centre study of children with AD or psoriasis or those who developed these dermatoses within 1 month of infection, and who developed a SARS-CoV-2 infection. Thirty-two children with AD and 66 with psoriasis were included. Age, sex, frequency of overweight and frequency of systemic treatments (systemic or biotherapy) were not different in the two groups. The frequency of symptomatic forms and the duration of symptoms were not statistically different between the two groups. In 15.6% of AD and 12.7% of psoriasis (P = 0.69), a worsening of symptoms was noted in the month following the onset of the infection. De novo psoriasis was diagnosed in three cases, but no AD. There was no difference in the impact of SARS-CoV-2 infection on the evolution of these two dermatoses, with the possible exception of the appearance of post-infection psoriasis, which was not observed with AD. Similarly, these two diseases did not seem to have a different impact on the severity of SARS-CoV-2 infection. These results should be confirmed with larger cohorts such as Secure-AD and Chi-PsoCov.

Content of CD4<sup>+</sup>T cell subpopulations in predicting the efficacy of biological therapy for psoriasis in children

Psoriasis is a chronic inflammatory skin disease characterized by increased proliferation of epidermal cells, impaired keratinization and an inflammatory reaction in dermis caused by activation of T lymphocytes and synthesis of pro-inflammatory cytokines. The pathophysiology of psoriasis is also associated with a decrease in anti-inflammatory functions of immunosuppressive cells. Recently, there are more cases of development of resistance to ongoing therapy with biologics in children, requiring cancellation of drug or its replacement. The aim of the study was to evaluate the content of T helper subpopulations in prognosis of effectiveness of biologics in children with psoriasis. Immunophenotyping of T helper populations was performed in 110 children with psoriasis vulgaris before appointment of biologics, at 16 and 52 weeks. Age of children ranged from 6 to 18 years. Severity of psoriasis and effectiveness of therapy were assessed by index PASI, which varied 0-68. Content of Tregs, Thact and Th17 was determined by flow cytometry. In group with a sufficient effect of biologics, a decrease in PASI was obtained, both at week 16 of therapy (p = 0.000) and by year of treatment, p = 0.017. In children with psoriasis, regardless of duration and effectiveness of biologics, percentage of Thact was increased relative to normal values. In group 1 before prescription of biologics was increased percentage of Thact (p = 0.005) and Th17 (p = 0.001). Analysis of dynamics of content of small populations of T helper during 1 year of use of biologics in children with different efficacy of therapy showed that significant changes were found in content of Th17 and Treg, as well as their Th17/Treg. ROC analysis showed that when Th17 deviation was above 53%, Thact above 181% and Th17/Treg above 2.6 before biologics were prescribed, insufficient efficacy of therapy could be expected in 75% of cases by year. By the end of induction course, with a Th17 deviation above 102% and a Th17/Treg above 2.6, probability of ineffective treatment was already 82%. The study shows the informative value of assessment of Thact before appointment of biologics, dynamics of Th17 by the end of induction course and Treg after 16 weeks of therapy in prognosis of effectiveness of biologics in children with psoriasis.

Pediatric Psoriasis: Clinical Aspects and Comorbidities: A Study of 50 Patients in Morocco

Aims: The objective of our study was to describe the epidemiological and clinical characteristics of pediatric psoriasis, as well as metabolic comorbidities and cardiovascular diseases.
 Study Design: Retrospective descriptive study.
 Place and Duration of Study: Dermatology department of the CHU of Rabat Morocco over a two- and half-year period.
 Methodology: We conducted a retrospective descriptive study collecting the cases of psoriasis in children followed in the pediatric dermatology consultation of Ibn Sina University Hospital of Rabat Morocco over a two- and half-year period.
 Results: We collected 50 patients. A female predominance was notedwith a sex ratio of 0.58. Concerning the antecedents; Parental consanguinity was identified in 8 % of cases, family history of psoriasis in only 6% and the atopy in 16%. The triggering factors were an infection in 12% of cases and psychological trauma in 6 % of cases. Concerning the metabolic comorbidity, one case of diabetes (2%), one case of obesity (2%) and three cases of overweight (6%) were noted. however, no cases of dyslipidaemia were reported.Psoriasis vulgaris was the most frequent clinical presentation (48 %), followed by guttate psoriasis (34%), inverted psoriasis (10%), napkin psoriasis (4 %) and blaskoline psoriasis (2 %). Palmoplantar involvement was observed in 10 % of cases, nail involvement in 22% and scalp involvement in 40 %. Oral mucosal involvement was noted in only one patient.

Psoriasis in children Study of 463 patients

o illustrate the epidemiological and clinical features of psoriasis in children.

Psoriasis in children and adolescents

Psoriasis is nowadays regarded as amultifactorial, inflammatory, immune-mediated systemic condition with predominant involvement of the skin. It starts in about one third of cases in childhood and adolescence and is often accompanied by marked impairment of the quality of life of sufferers and their parents. Aside from genetic disposition, trigger factors such as streptococcal infections are notably involved in manifestation and in exacerbations. The harmful role of comorbidities even in the young, particularly of obesity, has been well documented. Treatment options have considerably improved following the approval of five biologic agents in childhood but are still insufficiently used. The present article gives ashort overview of current knowledge and the recommendations of the updated German guideline. Besides frequent types, unusual presentations such as pustular psoriasis, psoriasis dermatitis, and paradoxical psoriasis induced by tumor necrosis factor alpha (TNF-α) inhibitors are addressed.

Early predictors of efficacy of biological therapy for psoriasis in children

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Psoriasis in children and adolescents : Short update and guideline-based treatment

Psoriasis is nowadays regarded as amultifactorial, inflammatory, immune-mediated systemic condition with predominant involvement of the skin. It starts in about one third of cases in childhood and adolescence and is often accompanied by marked impairment of the quality of life of sufferers and their parents. Aside from genetic disposition, trigger factors such as streptococcal infections are notably involved in manifestation and in exacerbations. The harmful role of comorbidities even in the young, particularly of obesity, has been well documented. Treatment options have considerably improved following the approval of five biologic agents in childhood but are still insufficiently used. The present article gives ashort overview of current knowledge and the recommendations of the updated German guideline. Besides frequent types, unusual presentations such as pustular psoriasis, psoriasis dermatitis, and paradoxical psoriasis induced by tumor necrosis factor alpha (TNF-α) inhibitors are addressed.

Genetically engineered biologics to treat psoriasis. Experience with ustekinumab in an adolescent with severe psoriasis

Modern pathogenetic therapy of psoriasis is the use of suppressive methods aimed to suppress immune reactions in the dermis, synovia, enthesis and eliminate the imbalance between anti-inflammatory and pro-inflammatory cytokines, chemokines. Today, genetically engineered biological drugs are one of the most promising pharmacotherapy achievements for the management of psoriasis, psoriatic arthritis in the group of immunosuppressive agents. Knowing the pathogenetic mechanisms that underlie the development of these diseases allows us today to highly selectively target the top key links of the immunopathogenetic cascade using genetically engineered biologicals, while barely affecting the protective factors of the patient’s immune system unlike the standard backbone (what is referred to as traditional) anti-inflammatory therapy. The treatment of psoriasis in children and adolescents practically involves the same drugs and methods as in adults. However, most of them are used in paediatric practice for conditions for which they are not clearly indicated, and studies on their efficacy and safety are still missing. Currently, it is possible to treat children and adolescents with genetically engineered biological drugs. Ustekinumab, etanercept, adalimumab, secukinumab, and ixekizumab are approved for use in moderate to severe psoriasis in the Russian Federation. In paediatric practice, the genetically engineered biological drug ustekinumab is one of the most effective, safe and convenient for the delivery of therapy (short induction cycle, rare infusions of the drug during maintenance therapy). The article describes the case study of the effective treatment of a 17-year-old patient with severe, continuously recurrent psoriasis. The targeted therapy, including the use of genetically engineered biological drugs, is increasingly being used to treat childhood psoriasis. Moreover, there are now more and more supporters among dermatologists who believe that genetically engineered biological drugs can be prescribed as the first-line drugs for the treatment of moderate to severe psoriasis in children and adolescents.

Linear Psoriasis: A Rare and Often Underdiagnosed form of Psoriasis in Children

Blaschko-linear psoriasis (PBL) is a rare form of psoriasis that presents as longitudinal lines on the skin, along Blaschko lines. This form of psoriasis is often observed in children and can be difficult to distinguish from other acquired Blaschko linear dermatoses such as inflammatory linear verrucous epidermal nevus (ILVEN) and lichen striatus. The prevalence of PBL is unknown, but it is generally observed in children and is more common in boys than in girls. The clinical and histological similarity of PBL to ILVEN presents a diagnostic challenge. In this case report, we present the case of a 7-year-old child with PBL and discuss the diagnostic and therapeutic aspects of this rare form of psoriasis. We were able to confirm the diagnosis of PBL after treatment with white petroleum jelly and salicylic acid petroleum jelly 5% resulted in a significant improvement of the lesions. Topical treatments, phototherapy, and systemic medications can be used in the case of PBL. It is important to select the most appropriate treatment based on the severity of the lesions, the location, and the patient's tolerance, and to keep in mind that PBL can have long-term effects on the quality of life of patients and their families.

Secukinumab for the Treatment of Psoriasis in Pediatrics: Patient Selection and Acceptability.

Psoriasis (PsO) is a chronic, systemic, immune-mediated inflammatory skin disease affecting 1% to 5% population worldwide. In one-third of patients, the first symptoms of PsO manifest in childhood, with a mean age of nine years. Psoriasis in children under 16 years of age constitutes 4% of dermatological problems in this age group. Chronic inflammation of the skin observed in PsO is associated with a development of potentially serious comorbidities, including psoriatic arthritis, hypertension, metabolic syndrome, cardiovascular diseases, inflammatory bowel disease, depression and anxiety. It is reported that among children with psoriasis between 5 and 16 years of age health-related quality of life is reduced by 30.5%. Early diagnosis and effective treatment are crucial in pediatric psoriatic patients to avoid future complications and stigmatization. Treatment for psoriasis consists of a range of topical medications, phototherapy and non-biologic and biologic systemic therapies. Approved biologics for PsO in pediatric patients include etanercept, adalimumab, ustekinumab, ixekizumab and secukinumab. Secukinumab, a recombinant, fully human monoclonal antibody targeting IL-17A, was approved by the EMA (2020) and FDA (2021) in pediatric patients above 6 years of age for the treatment of moderate to severe plaque psoriasis who are candidates for systemic therapy. This review discusses the selection and acceptability of secukinumab in children with psoriasis.

301 Tapinarof cream 1% once daily for the treatment of extensive atopic dermatitis in adolescents and children: 4-week maximal use trial

Abstract There is a need for efficacious non-steroidal topical therapies for atopic dermatitis (AD) without restrictions relating to duration, the extent of use and application sites. Tapinarof (VTAMA®; Dermavant Sciences, Inc., USA) is a first-in-class, non-steroidal, topical, aryl hydrocarbon receptor agonist approved by the Food and Drug Administration for the treatment of plaque psoriasis in adults and under investigation for the treatment of psoriasis in children down to 2 years of age and for AD in adults and children down to 2 years of age. Tapinarof cream 1% once daily (QD) demonstrated significant efficacy vs. vehicle at 12 weeks and was well tolerated in adults and adolescents and with moderate to severe AD in a previously reported phase 2b trial (NCT02564055). To assess the safety, tolerability, pharmacokinetics (PK) and efficacy of tapinarof cream 1% QD in adolescents and children with extensive AD. In this open-label, maximal use, phase 2 trial (NCT05186805), adolescents and children, aged 2–17 years, with a clinical diagnosis of AD, a validated Investigator Global Assessment in Atopic Dermatitis™ (vIGA-AD™) score ≥3, and percent body surface area (%BSA) involvement of ≥ 25% for adolescents (12–17 years) or ≥35% for children (2–11 years) were assigned tapinarof cream 1% QD for 27 days. Primary endpoints include adverse events, mean investigator-assessed local tolerability scores (overall and sensitive areas) and PK parameters. Secondary endpoints include a change in vIGA-AD™, Eczema Area Severity Index (EASI), %BSA affected, and Peak Pruritus-Numeric Rating Scale scores at each trial visit. Eligible patients completing this trial have the option to enrol in an open-label, long-term extension trial (NCT05142774) to receive up to an additional 48 weeks of tapinarof cream 1% QD treatment. Overall, 36 patients aged 2–17 years were enrolled at nine sites in the US and Canada. Of these patients, equal proportions (33.3% [12/36]) were young children (2–6 years), children (7–11 years) and adolescents (12–17 years); 66.7% (24/36) were male and mean age (standard deviation [SD]) was 8.9 (4.9) years. At baseline, 77.8% (28/36) had a vIGA-AD™ score of 3 (moderate) and 8/36 (22.2%) had a score of 4 (severe). At baseline, the mean (SD) %BSA affected was 52.4% (19.1%), 42.0% (10.0%) and 33.9% (8.6%) for young children, children and adolescents, respectively. The overall mean (SD) EASI score was 23.8 (9.2). This trial will assess the safety, tolerability, PK and efficacy of tapinarof cream 1% QD in 36 adolescents and children down to 2 years of age with extensive, moderate-to-severe AD.

Risk of Schizophrenia in Patients with Psoriasis: A Systematic Review and Meta‐Analysis

Background. Several studies have shown that psoriasis patients have a higher prevalence rate of schizophrenia, but none has thoroughly examined this association across different ages and genders. Thus, our systematic review and meta‐analysis aims to combine all available evidence and evaluate the risk of schizophrenia in psoriasis patients. Methods. Two independent investigators extracted published studies from PubMed, Embase, Medline, and Web of Science databases from inception until May 2023 and screened 160 articles for eligibility. We included 8 studies in this meta‐analysis. A random‐effects model was employed to estimate the pooled odds ratio (OR) and 95% confidence interval (CI) for schizophrenia in patients with psoriasis. The study protocol is registered with PROSPERO, number CRD42023428576. Results. A total of eight studies with 889,747,79 participants met the eligibility criteria. The pooled OR of psoriasis in patients with schizophrenia versus subjects without schizophrenia was 1.66 (95% CI: [1.20, 2.29]) with a significant level of heterogeneity (I2 = 97%). Specifically, the OR for psoriasis in children with schizophrenia was 12.90 (95% CI: [1.97, 84.64]), with an I2 combined value of 98% and psoriasis in adults with schizophrenia 2.57 (95% CI: [1.44, 4.58]), with an I2 combined value of 61.3%. The combined OR for all age groups was 5.27 (95% CI: [3.02, 9.19]). Additionally, we found that the OR value for psoriasis in females with schizophrenia was 1.74 (95% CI: [1.74, 2.11]), with an I2 combined value of 59%. For male patients, the OR value was 1.58 (95% CI: [1.25, 2.01]), with an I2 combined value of 77%. Conclusions. Our study shows an increased risk of schizophrenia in people with psoriasis. We demonstrated a significantly increased risk of schizophrenia among children with psoriasis and found that females with psoriasis were more likely to have schizophrenia than men with psoriasis under the same conditions.

Pediatric Psoriasis: A Closer View on Clinical Presentations

Introduction: Psoriasis in children is not uncommon. The study is an attempt to shed light on its clinical presentations among children in Basrah, Iraq. Materials and Methods: A cross-sectional observational clinical study of 416 children with psoriasis was conducted in the department of Dermatology of Basrah teaching hospital and two private clinics, Basrah, Iraq, from November 2018 to December 2021. Detailed history and a complete clinical examination were done. In cases of doubt, skin biopsy was performed. Results: Four hundred and sixteen children with psoriasis were enrolled in this study, their age ranged from 11 months to 12 years, 236 of them were females, and the remaining 180 were males. Psoriasis of the scalp, eyelid, blepharitis, follicular, and guttate were the most common types reported in 61.8%, 11.05%, 10.3%, and 9.8%, respectively. Plaque psoriasis was reported in only 6.2% of the patients. Atypical presentations in shape and site were reported in 122 (29.3%) of the patients. Infections, emotional stress, and environmental factors were the most common precipitating causes. Conclusions: Psoriasis is not uncommon among children; the presentations may be atypical regarding clinical features, site affected, symptoms, family history, and gender, so that it should be considered in any child with chronic recurrent erythematous scaly skin lesions, especially when they are recurrent with poor response to treatment.