Psoriasis in children: a guide to its diagnosis and management.

Psoriasis often presents in childhood. The diagnosis may be challenging if the disease is mild or the presentation is atypical. All of the forms recognised in adults are encountered in childhood (plaque, guttate, erythrodermic and pustular). Guttate and flexural forms are particularly common in children. Successful management requires education of the child and parents regarding the course of the disease and treatment options. Environmental triggers should be sought out and eliminated where possible. Most patients respond to topical treatment with emollients, coal tar, anthralin (dithranol) or calcipotriol. Treatment is tailored according to patient age, extent and distibution of psoriasis. For those who fail to respond, daycare or inpatient care is appropriate. Phototherapy with UVB may be combined with topical agents. Systemic therapy is required in a minority, usually those with resistant or erythrodermic disease, pustular psoriasis and arthropathic psoriasis. Retinoids are probably the systemic agent of choice. There are few data regarding the use of methotrexate or cyclosporin in childhood psoriais.