Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:19

1236 Psoriasis

PSORIASIS

JEFFREY P. CALLEN, MD

history & physical

History

■Psoriasis is a genetically determined disorder that affects the skin

and nails

➣Plaque type psoriasis

➣Guttate psoriasis – small, drop-like scaly plaques, often in chil-

dren or adolescents and triggered by streptococcal infection

➣Pustular psoriasis – localized v. generalized

➣Erythrodermic

■Environmental triggers

➣Heat and sunlight improve many patients

➣Trauma to the skin leads to development of lesions (Koebner

phenomenon)

■Infections may exacerbate the disease – e.g., Group A beta-hemolytic

streptococcal infection or HIV

■Stress may worsen the condition

■Flares with drugs – e.g. lithium, withdrawal of topical or systemic cor-

ticosteroids, occasionally beta blockers or angiotensin-converting

enzyme inhibitors and possibly antimalarial agents

Signs & Symptoms

■Chronic Plaque Psoriasis

➣Well-demarcated erythematous plaques with micaceous scale

➣Most common on the elbows, knees, scalp, lower back, and nails

➣Inverse Psoriasis – occurs in the folds

■Guttate Psoriasis

➣Small scaly erythematous plaques primarily on the trunk

■Pustular psoriasis

➣Generalized – erythematous skin studded with small pustules

➣Localized – most often the palms or soles, a pustular eruption

■Erythrodermic psoriasis

➣Exfoliative erythroderma

➣Signs of high output cardiac failure, or hypovolemia may accom-

pany the eruption

■Nail Changes

➣Common