Case history
Case history #1
A middle-aged man with a known history of psoriasis presents with white scaly papules and plaques on his elbows, extensor arms, knees, and shins. In the past 6 months, these lesions have become much worse and have started to appear on his waist and hip. Scaly and flaky eruptions are also present on his scalp, ears, and eyebrows. He describes the lesions as being itchy and irritating. He is a heavy smoker and has been unsuccessful in a previous attempt at smoking cessation.[Figure caption and citation for the preceding image starts]: Plaque psoriasis on legsFrom the collection of Professor Tsu-Yi Chuang, MD, MPH, FAAD; used with permission [Citation ends].
[Figure caption and citation for the preceding image starts]: Plaque psoriasis on backFrom the collection of Professor Tsu-Yi Chuang, MD, MPH, FAAD; used with permission [Citation ends].
[Figure caption and citation for the preceding image starts]: Plaque psoriasis on scalpFrom the collection of Professor Tsu-Yi Chuang, MD, MPH, FAAD; used with permission [Citation ends].
Case history #2
A young woman without a known history of psoriasis or skin disorder had a sudden onset of wide-spreading, white-scaly, oval- to round-shaped erythematous papules, which have been present for 2 weeks. Lesions are primarily on her trunk but also appear scattered on her arms and legs. She recalls a recent episode of sore throat and upper respiratory tract infection. A short course of antibiotics seemed to help, but did not clear the lesions.
Other presentations
Inverse psoriasis may present in the genital skin, the gluteal cleft and skin folds of the axillae, and under breasts. Palmar plantar psoriasis presents on palms and soles of feet. Pustular psoriasis presents as sudden-onset disease with generalized pustulosis. However, the pustules carry no bacteria and patients are not febrile. Psoriatic arthritis is often insidious, with stiffness and inflammation around finger and toe joints only. The associated cutaneous lesions may be very minor, which makes it difficult to establish the diagnosis of psoriasis.[Figure caption and citation for the preceding image starts]: Pustular psoriasisFrom the collection of Professor Tsu-Yi Chuang, MD, MPH, FAAD; used with permission [Citation ends].
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