Psoriasis
Basics
Description
Description
- Chronic, noncontagious, inflammatory skin condition
- Complex immune mediated disease of hyperproliferation
- Presents with well-demarcated, erythematous plaques with silver scaling
- Most commonly affects the elbows, knees, lumbar area, gluteal cleft, and glans penis
- Associated with multiple comorbidities
- Up to 30% of patients develop psoriatic arthritis and 10% have ocular manifestations
- Course is unpredictable; marked variability in severity over time and remissions/relapses may be seen
- Exact cause unclear; triggers may include infectious, stressors, medications, or trauma
- Tends to show improvement in summer months, possibly related to UV exposure
- Prevalence tends to increase with increasing distance from equator
- Associated with metabolic syndrome
- Caucasians and atopics most affected
- Prevalence in adults range from 1–8% and 0–2% in children
- Generally affects males and females equally
- 2 peaks of onset: Between ages 30–39 and 50–69
- Rare cause of mortality, but at least 100 deaths annually in the U.S. related to severe disease and/or treatment adverse effects
- Several clinical presentations:
- Chronic plaque psoriasis (psoriasis vulgaris):
- Most common form (75–80%) with erythematous, raised plaques with well-demarcated borders distributed over the scalp, back, and extensor side of the knees and elbows
- Guttate psoriasis:
- Abrupt appearance of multiple, discrete, salmon-colored, “drop-like” papules with a fine scale in a patient with no prior history of psoriasis
- Most commonly seen on the trunk and proximal extremities
- Often preceded by a streptococcal infection and resolves spontaneously
- Pustular psoriasis:
- Occasionally isolated to the palms and soles, but can present as widespread erythema, scaling, and sheets of superficial pustules with erosions
- Patient may appear toxic and have other systemic symptoms, like malaise, fever, and diarrhea
- Potentially severe and life threatening and treated as an inpatient if generalized
- Erythrodermic psoriasis:
- Generalized erythema and pruritus with a fine scale
- Increased risk for infection, dehydration
- Often treated as inpatients
- Inverse flexural psoriasis:
- A variant that causes lesions in flexural areas and in skin folds that do not exhibit scaling due to moisture in these areas
- Nail psoriasis:
- Pitting over the nail plate or change in nail bed
- Nail changes in up to 50% of patients
- HIV-induced psoriasis:
- May be the first manifestation of AIDS, more frequent and severe in HIV population
- Chronic plaque psoriasis (psoriasis vulgaris):
- Genetics:
- Genetic factors play vital role in determining susceptibility
- Psoriasis-susceptibility (PSORS1) locus within the major histocompatibility complex (MHC) on chromosome 6p21 is considered a major genetic determinant of this disease
- 40% of patients with psoriasis have a family history in a first-degree relative
Etiology
Etiology
- Typical findings of erythema and scaling are the result of increased number of epidermal stem cells and keratinocyte hyperproliferation, shortened cell cycles, inflammatory infiltrates, and vascular changes
- Triggers include:
- Drugs:
- Lithium
- β-Blockers
- Antimalarials
- Steroid withdrawal
- NSAIDs
- Alcohol
- Significant risk factor for mortality in psoriasis patients
- Potassium iodide
- Infections:
- Streptococcal pharyngitis
- HIV
- Staph
- Local trauma:
- Frostbite
- Sunburn
- Recent skin trauma (Koebner phenomenon)
- Stress: Emotional and physical
- Winter:
- Low light exposure
- Dry weather
- Cigarette smoking
- Elevated BMI
- Drugs:
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Citation
Schaider, Jeffrey J., et al., editors. "Psoriasis." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307518/all/Psoriasis.
Psoriasis. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307518/all/Psoriasis. Accessed November 5, 2024.
Psoriasis. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307518/all/Psoriasis
Psoriasis [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 November 05]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307518/all/Psoriasis.
* Article titles in AMA citation format should be in sentence-case
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