Skill Checkup: A 32-Year-Old Woman With Several Thick, Scaly, Well-Defined, Erythematous Plaques

David T. Robles, MD, PhD, FAAD


April 20, 2022

The Skill Checkup series provides a quick, case-style interactive quiz, highlighting key guideline- and evidence-based information to inform clinical practice.

A 32-year-old woman presents with several thick, scaly, well-defined, erythematous plaques characteristic of psoriasis. Prominent plaques cover the extensor surfaces of her knees, and there is a patch on her scalp. Her lesions cover about 8% of her body surface area (BSA). She initially applied moisturizing lotion or witch hazel when the lesions became irritating, and then 2 years ago, her primary care provider prescribed a calcineurin inhibitor, which she rotates with topical corticosteroids. The patient finds that topical treatment is no longer adequate. She would like to deal with these lesions more effectively and asks how quickly these skin eruptions can be cleared.

She uses an inhaler to control mild asthma. She is 5 feet 6 inches and 175 lb (body mass index, 28.2). Although she has made efforts to stop, she smokes about half a pack of cigarettes a day.


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