PSORIASIS is a chronic inflammatory skin disorder of unknown etiology and and inconstant course. It is said to occur in 1% to 2% of the white population, but is rare in Negroes.1 The disease is relatively uncommon in the pediatric age range, particularly in children under 3 years of age.2 The diffuse erythrodermic form is extremely rare in young children.3,4The purpose of this report is to present a case of erythrodermic psoriasis in a Negro child whose disease began about 18 months of life. Perlman states that psoriasis is uncommon in Negroes.2 Our case is of further interest because it illustrates problems in differential diagnosis, particularly for the pediatrician. We also wish to report our experience with the use of methotrexate as a therapeutic agent in this intractable disease.A Negro boy was admitted to Freedmen's Hospital at the age of 23 months with a history of an erythematous dermatitis which began on the left side of his face at age 18 months. Over a period of 10 to 12 weeks, the pruritic dermatitis gradually spread to involve the entire body sur¬ face, except for the palms and soles. Two months prior to admission, his skin began to peel and he was treated at another hospital for "eczema" with temporary improvement. One month prior to admission, he was seen by one of us (R.B.S.) and hospitalized for diagnostic studies. The his¬ tory revealed the occurrence of psoriasis in sev¬ eral members of the family, including a paternal grandaunt, a paternal aunt, and the maternal grandmother. There was also a strong family history of allergies, involving the patient's father (bronchial asthma) and one male sibling (in¬ fantile eczema).The child was born prematurely at 36 weeks' gestation and weighed 2220 gm (4 lb 15 oz).Developmental milestones were not unusual ex¬ cept that he was slow in talking.At the time of admission, he was irritable and exhibited a generalized erythematous pruritic exfoliative dermatitis (Figure, top). His scalp was covered by thick greasy scales. A few pinhead-sized pustular lesions were found over the abdomen and lower extremities. His temper¬ ature was 99 F (37.2 C) ; radial pulse, 120 beats per minute; respirations, 22 breaths per minute; weight, 9,299 gm (20 lb, 8 oz) ; height, 83.8 cm (33 inches) ; and head circumference, 47 cm. His face and eyelids appeared edematous and the lower eyelids also exhibited ectropion. Gen¬ eralized lymphadenopathy was present in the form of nontender discrete nodes. The findings of examination of the heart, lungs, abdomen, and nervous system were essentially normal. The nails and joints were normal at the time of entry to the hospital.Laboratory Findings.-On admission, his hemo¬ globin level was 11 gm/100 cc; and white blood cell count was 11,400, with a normal differential assortment. The urinalysis revealed normal values on microscopic and chemical examination. Normal values were obtained for serum sodium, chloride, potassium, calcium, phosphorus, serum glutamic oxalopyruvic, transaminase, serum glutamic pyruvic transaminase, serum protein electrop...
