Dermatology Physiotherapy Psoriasis Systemic Conditions

Clinical Features of Psoriasis

In this article we will discuss the Clinical Features of Psoriasis

In this article, we will discuss the Clinical Features of Psoriasis. So, let’s get started.

Clinical Features

• 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)

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