Psoriasis…clinical varieties

-Bibin T. Varghese

Introduction

        Bibin T Varghese, internee, Nethra Homoeopathy Medical College, Coimbatore wirtes here on different clinical varieties and differential diagnosis.

        Psoriasis may be one of the oldest recorded skin conditions. It was probably first described around 35 AD. Psoriasis occurs equally in males and females and the incidence occurs between 15 and 35 years of age. About 75% develop psoriasis before age 40. However, it is possible to develop psoriasis at any age. About 1 in 10 people develop psoriasis during childhood, and psoriasis can begin in infancy.

Symptoms

        The affected skin may be red and scaly or have pustules, depending on the type of psoriasis the individual has. Psoriasis is usually found on the arms, legs, trunk, nails, or scalp, but psoriasis may be found on any part of the skin, even nails. The most commonly affected areas are the knees and elbows. Pain, inflammation, itching, cracked skin, skin blisters also varies from individual to individual. About 10% of case gets arthritis caused by psoriatic arthritis.

Clinical varieties

Plaque psoriasis:

Plaque psoriasis is the most common type of psoriasis. About 80% of people who develop psoriasis have plaque psoriasis, which appears as patches of raised, reddish skin covered by silvery-white scale. These patches, or plaques, frequently form on the elbows, knees, lower back, and scalp. However, the plaques can occur anywhere on the body.

Guttate psoriasis:

Small, drop-like lesions appear on the trunk, limbs, and scalp. Guttate psoriasis is most often triggered by bacterial infections (for example, Streptococcus)

Pustular psoriasis:

Blisters of noninfectious pus appear on the skin. Attacks of pautular psoriasis may be triggered by medications, infections, emotional stress, or exposure to certain chemicals. Pustular psoriasis may affect either small or large areas of the body.

Inverse psoriasis:

Large, dry, smooth, vividly red plaques occur in the folds of the skin near the genitals, under the breasts, or in the armpits. Inverse psoriasisis related to increased sensitivity to friction and sweating and may be painful or itchy.

Erythrodermic psoriasis:

Widespread reddening and scaling of the skin is often accompanied by itching or pain. Erythrodermic psoriasis may be precipitated by severe sunburn, use of oral steroids (such as cortisone), or a drug-related rash.

Differential diagnosis

        A microscopic examination of tissue taken from the affected skin patch is required to make a definite diagnosis of psoriasis and to distinguish it from other skin disorders. Usually in psoriasis, the examination will show proliferation of dry skin cells but without any signs of inflammation or infection. Changes in the nails typical of psoriasis are often strong indicators of psoriasis.

        A number of conditions produce symptoms that resemble those of psoriasis. Examples include the following:

• Dermatitis and eczema can be differentiated by its erythema,oedema, papulation,vesiculation,exudation,crusting and scaling lichenification is common in chronic cases
  
• Lichen planus looks like purple or reddish-purple bumps on the skin. The bumps have flat tops. They are uneven in shape. If you look at the bumps closely, you might see white scales or flakes on them. Lichen planus can appear on any area of the skin. The most common areas are the inner wrists, the forearms and the ankles.
  
• A fungal skin infection characterized by ring-shaped, red, scaly or blistery patches. Fungi thrive in warm moist areas and cause tinea infections such as jock itch (tinea cruris) in the groin area and athlete’s foot (tinea pedis) between the toes. Other locations of tinea include the body (tinea corporis), the face (tinea faciei), and scalp (tinea capitis). Tinea versicolor is a fungal infection characterized by a rash consisting of white or brown patches on the trunk.
  
• Seborrheic psoriasis is hard to distinguish from seborrheic dermatitis (dandruff is one form of this condition). Seborrheic dermatitis patches are usually greasy, yellowish, and crusty. Nail involvement may also help to differentiate psoriasis.

Bibin T. Varghese Nethra Homoeopathy Medical College & Hospital 54, Mettupalayam Road G.N.mills (PO) Coimbatore - 641029