Fast Five Quiz: Psoriasis

William James, MD


November 08, 2021

Erythrodermic psoriasis presents as generalized erythema, pain, itching, and fine scaling; various pustular forms also exist. It typically encompasses nearly the entire body surface area. It may be accompanied by fever, chills, hypothermia, and dehydration secondary to the large body surface area involvement. Patients with severe pustular or erythrodermic psoriasis may require hospital admission for metabolic stabilization and pain management. Older patients with erythrodermic psoriasis may experience cardiac instability and hypotension due to massive vascular shunting in the skin.

Plaque psoriasis is the most common type and is characterized by raised, inflamed lesions covered with a silvery white scale. This is most common on the extensor surfaces of the knees, elbows, scalp, and back. The scale may be scraped away to reveal pinpoint bleeding areas, called the Auspitz sign, which is used to clinically confirm the diagnosis.

Guttate psoriasis presents as small salmon-pink papules, 1-10 mm in diameter, predominately on the trunk; the lesions may be scaly. It frequently appears suddenly, 2-3 weeks after an upper respiratory infection with group A beta-hemolytic streptococci.

Inverse psoriasis occurs on the flexural surfaces, armpit, and groin; under the breast; and in the skin folds. It is characterized by smooth, inflamed lesions without scaling, owing to the moist nature of the areas where this type of psoriasis is located.

Pustular psoriasis presents as sterile pustules on the palms and soles or diffusely over the body. Pustular psoriasis may cycle through erythema and pustules, then scaling. The diffuse variant is termed the von Zumbusch variant, which is accompanied by fever and feeling very unwell in addition to the widespread pustules. Acrodermatitis continua of Hallopeau is considered a form of pustular psoriasis that affects the hands and feet. It may prove resistant to topical and other therapies.

Read more on physical examination findings in psoriasis.


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