Research Day


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Introduction: Although pediatric psoriasis is a common skin disorder, guttate psoriasis is a lesser common subtype. The subacute rash typically appears after an acute streptococcal or viral upper respiratory tract infection. As these are common acute illnesses in the pediatric population, the general pediatrician may not link such illness to the rash, leading to a delay in diagnosis and treatment. We present a case of guttate psoriasis secondary to streptococcal infection to bring awareness to this unique diagnosis.

Case Description: A 10-year-old vaccinated male presented to the outpatient clinic with concern for pruritic rash for 3 days. It was located over the chest and abdomen with a focal lesion over the umbilicus. Erythematous papules with excoriations and honey colored discharge were observed, consistent with impetigo. He was prescribed oral clindamycin and topical mupirocin for 7 days. Two months following resolution, the patient again presented with impetigo and dry, erythematous, pruritic plaques. He was treated with clindamycin and mupirocin and referred to dermatology where he was diagnosed with guttate psoriasis in addition to impetigo. Topical triamcinolone acetonide 0.1% was added to treat for guttate psoriasis. Within days, there was resolution of the rash. Intriguingly, he was previously treated for acute streptococcal pharyngitis weeks prior to onset of the initial rash.

Discussion: Our patient presented with classical history and physical exam for guttate psoriasis. Despite this, our diagnosis was delayed given the presence of a confounding impetigo rash and lack of reference back to his preceding acute streptococcal infection.

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