Psoriasis is a chronic immune mediated inflammatory disease. It has different clinical patterns in childhood. It can vary from as simple as a napkin psoriasis to pustular and erythrodermic forms. The review discusses the epidemiology, trigger factors, clinical features of childhood psoriasis including the differential diagnosis of the various patterns.

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Despite decades of studies, vitiligo still evades us its exact pathophysiology and remains a challenge for clinicians. With a devastating cosmetic impact, the implications on the patient are dispiriting. A combination of the different proposed hypotheses may be responsible for its pathophysiologic basis. A variety of hypotheses that included autoimmune, neural, self-destruct and biochemical means to explain the pathophysiologic basis of vitiligo were proposed. But they are increasingly giving way to newer theories that better delineate the basis of the disease and have paved way for different advancements in treatment accordingly. Our newer management modalities have bolstered our weaponry in fighting vitiligo. A review of the newer insights in to the pathophysiology and management of vitiligo is presented.

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Lupus vulgris (LV) is a chronic, progressive, and destructive form of cutaneous tuberculosis. This occurs in moderate- to high-immunity patients against Mycobacterium tuberculosis, which a shows strongly positive Mantoux test. We present a case of LV located on the nose of a 14-year-old girl that led to nasal septal perforation. In this modern era of antibiotics, septal perforation secondary to LV is very rare.

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A significant percentage of patients attending the Dermatology OPD belong to the pediatric age group. Children can present with a wide range of skin diseases. In many of these cases, a diagnosis can be made on clinical examination alone. But, sometimes, the differential diagnoses are many and therefore a skin biopsy and histopathological examination are done to arrive at a diagnosis. Pediatric skin presents unique problems. Therefore, skin biopsy, although a minor surgical procedure, along with preparation and after care, have to be tailor made. It is important for the dermatologist to be familiar with the many additional aspects faced in this situation and for the pathologist to be properly equipped to face the many challenges that pediatric skin throws up.

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Childhood psoriasis although a well known entity, isn't a frequently reported one. Childhood psoriasis has a better prognosis as compared to adult onset psoriasis. Management of psoriasis in children is almost on similar lines as that for adults. But management of generalized disease remains a challenge as systemic therapies are to be used with caution in children. The medicines used most commonly for the management of psoriasis are highly toxic and thus require stringent monitoring. This article will discuss the various treatment modalities used for the management of juvenile psoriasis.

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A 6-year-old male child presented with progressive hypertrophy and discoloration of all 20 nails. Further evaluation revealed milia in bilateral concha and face, which were present since infancy. Other findings included atrophoderma over bilateral sides of lateral canthi of eyes and absent lower central incisors. Past medical and family history had remarkable findings such as natal teeth and similar nail changes in his elder sister. Similar nail changes, milia and focal plantar keratoderma were present in his father and elder sister. The patient's clinical presentation and history were compatible with pachyonychia congenita subtype 2.

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The treatment of juvenile psoriasis is challenging. The article addresses the various aspects of management including the laboratory diagnosis and general principles. The treatment of the different types of psoriasis is outlined.

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Lupus erythematosus (LE) is an autoimmune multisystem disorder with varied clinical manifestations. There are many similarities and differences between pediatric and adult disease in regard to epidemiological, clinical and therapeutic aspects. In general, the disease in children has a more aggressive course and need for prolonged treatment is frequent, which implies a greater incidence of therapy-related adverse effects. This review addresses various aspects of pediatric LE and how they differ from or are similar to adult disease.

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Job syndrome is a heterogeneous group of disorders characterised by recurrent staphylococcal infections, unusual eczema-like skin rashes, severe lung infections that result in pneumatoceles and very high concentrations of serum IgE. We present a 10-year-old boy with itchy pus-filled lesions all over the body since the third day of life. On examination, multiple excoriated papules and plaques with crusts distributed over the extremities, trunk, face, palms, scalp and genitalia were present. Staphylococcus aureus was grown on the pus culture. Serum IgE was significantly elevated. The patient showed remarkable improvement with topical and systemic antibiotics and vitamin C supplements. Early diagnosis of phagocytic disorders can be lifesaving and can lead to a significant reduction in morbidity.

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We report a 7-year-old boy with spontaneous, rapid onset of multiple, tiny, white, superficial keratinous cysts over the neck, trunk, axilla and umblicus with few lesions over the face and similar lesions with same distribution in his 3-year-old younger brother. Their clinical presentations were compatible with the diagnosis of multiple eruptive milia (MEM). As far as we are aware, this is the first case of familial MEM to be reported in siblings of this youngest age group.

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'Childhood Psoriasis - A challenge for all' was the slogan of World Psoriasis Day 2010. This entity was aptly recognized as a problem more than skin deep as children are very sensitive to public opinion and peer pressure. Children with psoriasis also face emotional trauma as a result of bullying, discrimination and self-consciousness due to the easy visibility of disease. Severe forms of the disease like erythroderma, and facial involvement which is more in children may further negatively impact the child's psyche. The few studies conducted so far on Quality of life issues in childhood psoriasis equivocally state that there is negative impact on Quality of Life which moderately correlates with PASI scores and Physicians Global Assessment.

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Morphea, also known as localized scleroderma, is characterized by fibrosis of skin and underlying tissue. Report of morphea lead to microtia is not reported till now and we report an unusual case of localized morphea lead to microtia in a 5 year old male child.

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