In this article, we will discuss the Clinical Features of Psoriasis. So, let’s get started.
• It is characterized by well-circumscribed, sharply demarcated erythematous papules and/or plagues.
• These are covered by silvery or grayish white scales.
• Woronoff’s ring – a white blanching ring around the lesion.
• After grattage of scales, candle grease sign can be observed → Berkley’s membrane (thin peel like membrane) comes off → A surface, which is wet with multiple pinpoint bleeding is revealed (Auspitz’s sign)
• Elbows, knees, scalp and lumbosacral area mainly affected.
• Nail involvement is common.
• Psoriasis may be present as any one of the following clinical variants:
– Chronic plaque psoriasis:
• Common manifestation
• Fairly, symmetrically distributed erythematous squamous plagues
• Size: Coin to a palm or larger size
– Guttate psoriasis:
• Lesions are distributed as droplets over the body (mostly trunk)
• Palms and soles are spared
• Preceded by streptococcal infection
– Flexural psoriasis:
• Poorly demarcated lesion with fine, moist scales (always with central fissure)
– Erythrodermic psoriasis:
• Generalized scaling and erythema
• Systemic dysregulation (dehydration, thermal regulation, renal & cardiac failure)
– Pustular psoriasis
– Psoriasis of the scalp : (Psoriasis vulgaris)
– Palmo plantar psoriasis
– Psoriatic arthritis :
• Inflammatory arthritis
• RA factor is negative
• Human leukocyte antigens (HLA) may be a marker
• HLA-B38 = Peripheral arthropathy
• HLA-DR4 = Severe erosive arthritis
• HLA-B27 = Spondylotic involvement
Five Forms of Psoriatic Arthritis
• Asymmetric oligo-articular arthritis (70% of cases)
– Joints involved – DIP, PIP, MCP mostly
– Tenosynovitis – Hip/Knee occasionally
• Symmetric rheumatoid like arthritis (15% of cases)
• Classical psoriatic arthritis (5% of cases)
– DIP mostly involved
• Arthritis multilans (5% of cases)
– Osteolysis with severe destruction/deformation of bones
– Even dissolution of the phalanges
• Ankylosing spondylitis with or without peripheral joint involvement (5% of cases)