Fast Five Quiz: Can You Recognize Different Types of Psoriasis?

Dirk M. Elston, MD


August 11, 2020

Figure 3. Guttate psoriasis rash on back.

Although guttate psoriasis is uncommon in the United States (< 2% of the psoriasis population), its prevalence varies internationally (from 1.6% to 44%), depending on the distribution of streptococcus epidemics. Guttate psoriasis often presents 2-3 weeks after upper respiratory infection with group A beta-hemolytic streptococcus. In rare instances, guttate psoriasis can also be precipitated by other bacterial, fungal, or viral infections and some drug therapies. The clinical course of guttate psoriasis can be self-limited to a few weeks or months, or it may evolve into chronic plaque psoriasis. Treatment includes skin emollients, topical corticosteroids, antimicrobial therapy against streptococcal bacteria, phototherapy, and vitamin D analogues. Read more about guttate psoriasis here.

Nail psoriasis is present in 10%-55% of all individuals with psoriasis. Several recent studies have reported nail psoriasis as a risk factor for and a strong predictor of psoriatic arthritis. An oil-drop, salmon-patch discoloration of the nail bed is the best diagnostic sign of nail psoriasis. Other signs include pitting and Beau lines of the proximal nail matrix, leukonychia of the midmatrix, and subungual hyperkeratosis of hyponychium. The pathogenesis of nail psoriasis is unknown, but it tends to run in families and is thought to be due a combination of factors (genetic, immune, and environmental). Read more about nail psoriasis here.

Individuals with acute generalized pustular psoriasis often have fever with accompanying toxicity, which can be fatal if not quickly treated during the acute phase. Although the onset can be idiopathic, known triggers include withdrawal of steroids (systemic or topical); strong irritating topical agents (eg, tar, anthralin); cutaneous infections; and exposure to certain oral and topical medications, and sunlight or phototherapy. Read more about pustular psoriasis here.

Treatment of inverse psoriasis includes topical and systemic therapies. Read more about inverse psoriasis here.


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