FIGURE 70.2 Classic plaque-type psoriasis tends to occur on extensor surfaces FIGURE 70.3 Small drop-like papules and plaques typical of guttate psoriasis FIGURE 70.4 Palmar psoriasis FIGURE 70.5 Inverse psoriasis The classic diaper area or napkin psoriasis pattern is visible here A small proportion of patients develop arthritis between and 12 years of age; some develop it before the onset of the skin eruption The distal interphalangeal joints of the hands and feet are involved most often, usually asymmetrically In the emergency department, patients with limited disease can be successfully managed with a course of topical corticosteroid until they can be referred back to their primary physician or dermatologist Facial or genital areas may be treated with a lower potency topical steroid such as hydrocortisone 2.5%, a vitamin D derivative topical (calcipotriene or calcitriol), or a topical calcineurin inhibitor such as pimecrolimus or tacrolimus Body affected areas may be treated with a mid-potency topical steroid such as triamcinolone 0.1% For the scalp, treatment with a steroid solution or oil-based compound is recommended, using a fluocinolone solution or oil, for example For a guttate psoriasis presentation, it would be reasonable to screen for streptococcal pharyngitis and treat accordingly if positive ... interphalangeal joints of the hands and feet are involved most often, usually asymmetrically In the emergency department, patients with limited disease can be successfully managed with a course of