Psoriasis Signs and Symptoms

• Psoriasis is a systemic, chronic, inflammatory disorder that can be transmitted genetically and provoked by environmental factors
  
  • Found in approximately 2% of the population
    • Prevalence ranged from 0.5-11% in adults and 0-1.4% in children
  • Primarily affects the skin and joints
  • Associated with other inflammatory disorders and autoimmune diseases (eg psoriatic arthritis, inflammatory bowel disease, coronary artery disease)
  • Characterized by recurrent exacerbations and remissions

General

• Begins as red scaling papules that coalesce to form round-to-oval plaques
• Rashes are often pruritic and may be painful

Plaque Psoriasis

• Also known as psoriasis vulgaris
• Most common form of psoriasis approximately affecting 80-90% of patients
• Scaling, erythematous, well-demarcated and silvery plaques with various sizes ranging from 1 cm to several centimeters
• Plaques are irregular, round to oval in shape and tend to be symmetrically distributed
• Typically affected areas: Elbows, knees, scalp, trunk, intergluteal cleft, buttocks, soles and palms
  • Occasionally, genitalia may also be affected 
• Painful fissuring within plaques can occur when lesions are present over joint lines, palms and soles

Guttate Psoriasis

• Common in persons <30 years old and affects <2% of patients with psoriasis
• Usually occurs after an upper respiratory infection with group A beta-hemolytic streptococci
• Teardrop-shaped, salmon-pink papules usually within a fine scale measuring 1-10 mm
• Usually found on the trunk and proximal extremities
• May be the first manifestation of psoriasis in a healthy individual or an acute exacerbation of long-standing plaque

Pustular Psoriasis

• Generalized
  
  • Also called von Zumbusch psoriasis
  • Characterized by sterile pustules on an erythematous base that cover large portions of the trunk and extremities
  • Pustules may coalesce and form large pools of pus in severe cases
  • Skin’s protective functions are lost and patient is susceptible to infection, loss of fluids and nutrients
  • Uncommon, severe form of psoriasis associated with systemic symptoms (eg fever, malaise); can be life-threatening 

• Localized
  
  • Pustules are localized to the palms and soles of the feet; may also localize on top of plaque
  • Not life-threatening but debilitating because of difficulty in using hands or feet

Erythrodermic Psoriasis

• Severe, generalized erythema affecting up to 100% of the body surface area (BSA) with various degrees of scaling
• Skin’s protective functions are lost and patient is susceptible to infection, uncontrollable body temperature, loss of fluids and nutrients
• Often associated with systemic symptoms (eg fever and malaise); can be life-threatening

Inverse Psoriasis

• Lesions consist of erythematous plaques with minimal scales
• Located in the skin folds (eg axillary, genital, perineal, intergluteal, inframammary areas)

• A complex immune-mediated inflammatory disease involving T lymphocytes, dendritic cells and cytokines (eg interleukin [IL]-23, IL-17, and tumor necrosis factor [TNF]) causing hyperproliferation and abnormal differentiation of the epidermis, infiltration of inflammatory cells, and vascular dilatation in genetically susceptible patients