This 4-year-old boy was found to have a rash around his gastrostomy tube (G tube) and on the right dorsal hand (Fig. 1). The rash around the G-tube site appeared 3 months earlier and was treated with topical antifungal creams and triamcinolone cream 0.1% daily for 1 month without any improvement. Topical sucralfate suspension was applied around the G-tube site 4 times per day for 1 week. The rash persisted and enlarged to become a 4 Â 5 cm sharply demarcated erythematous plaque with silvery scale. A new rash on the dorsum of the right hand appeared. This lesion was a similar 1.5 Â 2 cm sharply demarcated erythematous plaque with silvery scale near an intravenous site. Both lesions were pruritic. The erythematous plaque with silvery scale surrounding the G-tube site and on the right dorsal hand are clinically consistent with plaque psoriasis, which may be occurring in areas of injury or chronic irritation caused by the Koebner phenomenon (1).In a case study of 18 patients with peristomal psoriasis, 2 had no psoriasis after 4 weeks of betamethasone lotion, 2 had mild psoriasis and declined further treatment and 2 developed systemic psoriasis. Six patients required intermittent application (every 2-4 weeks) of topical corticosteroid for maintenance therapy (2).

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