When GPP does occur in children, it usually appears during the first year of life.Khan et al. reported that in GPP patients ten or younger, less than 12% of cases are preceded by ordinary psoriasis. This differs greatly from GPP cases in adults, where 85% of GPP is preceded by typical psoriatic lesions.According to the article by the University of São Paulo, mentioned above, "The onset of childhood GPP is generally abrupt and accompanied by toxic features." The original acute episode usually lasts a few days, but "repeated waves of inflammation and pustulation may follow." It is important that the disease is managed immediately in order to prevent life-threatening complications, such as infection or [sepsis]. Other complications include "metabolical, hemo-dynamic, and thermoregulatory disturbances" which occur as a result of "alterations of the epidermal barrier. "See Case Report 3

Circinate and annular
This type of psoriasis appears as round lesions. It begins as discrete areas that become raised and swollen. Pustules appear at the edges of the round lesions, creating rings. The pustules then dry out and leave a trail of scale as the lesion grows.See Case Report 4

Treatments
Treatments vary widely, and many different drugs have been documented as being successful. Some medications are successful in some patients, while unsuccessful in others. Below is a list of some medications used to treat GPP:
Etanercept
PUVA
Hydroxyurea
Dapsone
Systemic corticosteroids
Cyclosporin A
Adalimumab
Etretinate
Isotretinoin
Acitretin

Prognosis
GPP is a rare and severe type of psoriasis. It in rare cases it is said to be fatal and in some cases has driven patients to intensive burn units.
With respect to trauma patients, roughly 10% have some sort of facial fracture, the majority of which come from motor vehicle collisions. When the person is unrestrained in a car, the risk of fracture rises 50% and when an unhelmeted motorcyclist the risk rises 4-fold. History
Management of mandible fractures has been mentioned as early as 1700 B.C. in the Edwin Smith Papyrus and later by Hippocrates in 460 B.C., "Displaced but incomplete fractures of the mandible where continuity of the bone is preserved should be reduced by pressing the lingual surface with the fingers...". Open reduction was described as early as 1869. Since the late 19th century, modern techniques including MMF (see above) have been described with titanium based rigid internal fixation becoming commonplace since the 1970s and biodegradable plates and screws being available since the 1980s. References


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