Psoriasiform acral dermatitis: A peculiar clinical presentation of psoriasis in children

Recently an unusual chronic dermatosis, considered a new clinical entity an d closely resembling psoriasis, has been described in the literature under the term psoriasiform acral dermatitis (PAD), It is characterized by cutane ous involvement of the digits without nail dystrophy. We describe three you ng patients, ages 6 to 8 years, in whom this condition was associated with psoriasis, Two children were affected by psoriasis vulgaris, while the thir d had a palmoplantar psoriasis, All laboratory investigations performed wer e within normal limits, Skin biopsy specimens taken from the fingers of two patients revealed the pathologic features of subacute spongiotic dermatiti s, Histologic examination of a biopsy specimen taken from an erythematous s quamous patch confirmed the clinical diagnosis of psoriasis in two patients . The dermatitis showed a fluctuating course in all three patients, with on ly a moderate to strong improvement with therapy with calcipotriol ointment (50 mu g/g). During follow-up, two patients experienced marked spontaneous , persistent improvement, while the disease slightly worsened in the third. The children had features similar to those described in PAD, but were also suffering from psoriasis, Whether PAD is a distinctive entity or just a cl inical manifestation of psoriasis in children is still an open question, We strongly believe this latter hypothesis, although further studies are need ed to confirm it.