BAL HARBOUR, FLA. — Diaper-area psoriasis, also known as napkin psoriasis, is a fairly common finding in children, Amy Paller, M.D., said at the annual Masters of Pediatrics conference sponsored by the University of Miami.
Although inclusion of this “rash” in the realm of psoriasis has been controversial, Dr. Paller said she “truly believes” it should be considered a psoriatic condition.
About 13% of children present with napkin psoriasis with dissemination; about 4% present with localized disease. The frequency of this condition in infants reflects the Koebner phenomenon—a response to the constant trauma to the skin that is a consequence of exposure to stool and urine.
It can be difficult to distinguish napkin psoriasis from seborrheic dermatitis, but there are certain characteristics that can help, said Dr. Paller, professor and chair of dermatology at Northwestern University, Chicago.
Plaques associated with napkin psoriasis are sharply defined, brightly erythematous, and larger than those in seborrheic dermatitis. They also tend to have drier scale, which in the diaper area often can be seen only when the skin is scratched.
This is caused by the constant moisture in the area, which also can obscure diagnosis in some cases, Dr. Paller noted.
For treatment, she uses a short course (about 3 weeks) of nonhalogenated topical steroid or topical calcineurin inhibitor and a lot of protective paste.