A condition summary of Psoriasis, including presenting signs and symptoms, clinical background, pathophysiology, investigations and diagnosis and management.
PSORIASIS
Psoriasis = chronic inflammatory papulosquamous disorder of the skin that has a relapsing-remitting course, often
associated with systemic disease such as psoriatic arthritis.
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Presentation
There are many forms of psoriasis but some general specific signs of psoriasis are:
§ Plaques ® raised, scaly, well demarcated
§ Auspitz sign ® small points of bleeding when plaques are scraped off
§ Koebner phenomenon ® development of psoriatic lesions to areas of skin affected by trauma
§ Residual pigmentation
Chronic plaque psoriasis (80-90%)
§ Raised, scaly, well-demarcated plaques (1-10 cm diameter)
o Caucasians: erythematous and pink/red with silver-white scale
o Hispanics: salmon coloured with silver-white scale
o POC: violet with grey scale
§ Symmetrical distribution
§ Affects scalp, extensor surfaces, trunk, gluteal cleft and knees
§ Lesions are itchy and may become fissured and painful over joint lines, on palms or soles
Nail Psoriasis (90%)
§ Subungual hyperkeratosis
§ Nail pitting
§ Oil drop discolouration (yellow/pink patches)
§ Leukonychia (white discolouration)
§ Onycholysis (detachment of nail from nail bed)
§ Splinter haemorrhages.
Inverse/Flexural Psoriasis
§ Affects intertriginous areas (points where skin touches) e.g. axilla, groin, genitals, inframammary folds, gluteal cleft
§ Smooth, well-defined patches
§ Colonised by Candida yeasts
Guttate Psoriasis
§ Sudden eruption of small circular plaques (raindrops)
§ Follows 2 weeks after streptococcal sore throat or flare of disease in pre-existing psoriasis.
Erythrodermic Psoriasis (1-2.5%)
§ Widespread erythema and psoriasis
§ Affects large portion of BSA (75-90%)
§ Triggers: recent illness, medications (steroids), stress.
Generalised Pustular Psoriasis
§ Rapidly developing, widespread erythema
§ Pustules ® may coalesce, forming lakes of pus
§ Systemic symptoms ® fever, malaise, arthralgia.
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