Psoriasis occurs in several forms during childhood: plaque-type, guttate, palmoplantar, inverse, pustular, and erythrodermic The most classic form is plaque-type psoriasis which is associated with thick, beefy red plaques with overlying silvery scales ( Fig 70.2 ) often in a symmetrical distribution on the extensor surfaces of the extremities, although other anatomic sites may be affected When a scale is removed, there may be pinpoint areas of bleeding (Auspitz sign) Guttate psoriasis is one of the most common forms encountered in childhood, manifesting as guttate (drop-like) erythematous scaly papules scattered over the body ( Fig 70.3 ) The characteristic silvery scale is only minimally expressed, and the lesions may appear quite red This form is classically (but not always) preceded by or coincides with a streptococcal infection Palmoplantar psoriasis manifests as thickened plaques concentrated on the palms and soles of the feet ( Fig 70.4 ) The plaques may become fissured and painful These areas may become so thickened that patients complain of pain with moving the fingers or walking Inverse psoriasis refers to the usually pink, salmon-colored, sometimes macerated plaques that arise in the axillae, inguinal areas, or on the genitalia and buttocks ( Fig 70.5 ) The gluteal crease is usually involved Erythrodermic psoriasis is less common and more severe Onset may be abrupt or gradual, with a diffuse erythema and severe desquamation In the growing child, there may be associated failure to thrive