Skill Checkup: A 49-Year-Old Woman With Treated Psoriasis Is Experiencing Darker and Larger Lesions

Alan Irvine, MD, DSc


September 11, 2023

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

A 49-year-old nonsmoking woman in the United States has an 8-year history of mild inverse psoriasis that mostly affects her groin, and sometimes underarms and under her breasts. The lesions are smooth and light red. She is an avid runner, which creates a lot of friction on her skin. For 7 years and 10 months, she had been keeping the symptoms of inverse psoriasis at bay by avoiding wearing synthetic fibers; removing wet, sweaty clothing as soon as possible; and keeping the intertriginous areas clean and dry with the help of powder. However, these areas have recently become darker red, harder to keep dry, and have increased in size, covering 2% of her body surface area (BSA).

As a result, she was given triamcinolone 0.1% to apply to the affected areas twice a day for 8 weeks. At her next visit, 8 weeks after starting treatment, the redness had receded somewhat to its original lighter red, but the amount of surface area affected had not changed. In addition, she also now has slightly raised reddish scales on both knees with hints of a whitish, silvery hue in places. They are not tender on palpation. Together with the previously existing inverse psoriasis, the total BSA affected by lesions is now 4%. These new unsightly lesions are hard for her to hide while wearing shorts to run and bike during the summer months in Georgia, and she doesn't want people to stare or think she is contagious. Both the patient's father and her sister have a history of psoriasis.


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