Psoriasis Đánh giá ban đầu

Clinical Presentation

General 

Psoriasis generally begins as red, scaling papules that coalesce to form round-to-oval plaques. The rashes are often pruritic and may be painful. 

Plaque Psoriasis 

Plaque psoriasis, also known as psoriasis vulgaris, is the most common form of psoriasis approximately affecting 80-90% of patients. 

It presents as scaling, erythematous, well-demarcated, and silvery plaques with various sizes ranging from 1 cm to several centimeters. The plaques are irregular, round to oval in shape, and tend to be symmetrically distributed. It typically affects areas such as the elbows, knees, scalp, trunk, intergluteal cleft, buttocks, soles, and palms. Occasionally, the genitalia may also be affected. Painful fissuring within plaques can occur when lesions are present over joint lines, palms, and soles.  

Guttate Psoriasis 

Guttate psoriasis is common in persons <30 years old and affects <2% of patients with psoriasis. It usually occurs after an upper respiratory infection with group A beta-hemolytic streptococci. It presents as teardrop-shaped, salmon-pink papules usually within a fine scale measuring 1 to 10 mm. It is usually found on the trunk and proximal extremities and may be the first manifestation of psoriasis in a healthy individual or an acute exacerbation of a long-standing plaque. 

Pustular Psoriasis

The generalized type of pustular psoriasis is also called von Zumbusch psoriasis. It is characterized by sterile pustules on an erythematous base that cover large portions of the trunk and extremities. The pustules may coalesce and form large pools of pus in severe cases. The skin’s protective functions are lost, and the patient is susceptible to infection and loss of fluids and nutrients. It is also considered an uncommon, severe form of psoriasis associated with systemic symptoms (eg fever, malaise) and can be life-threatening. 

The localized type of pustular psoriasis presents as pustules that are localized to the palms and soles of the feet, although they may also localize on top of the plaque. It is not life-threatening, but it may be debilitating because of difficulty in using the hands or feet. 

Erythrodermic Psoriasis

Erythrodermic psoriasis is a severe, generalized erythema affecting up to 100% of the body surface area (BSA) with various degrees of scaling. The skin’s protective functions are lost, and the patient is susceptible to infection, uncontrollable body temperature, and loss of fluids and nutrients. It is often associated with systemic symptoms (eg fever and malaise) and can be life-threatening. 

Inverse Psoriasis 

In inverse psoriasis, the lesions consist of erythematous plaques with minimal scales and are located in the skin folds (eg axillary, genital, perineal, intergluteal, inframammary areas). 

History

Psoriasis has a bimodal age of onset at 16 to 22 years and 57 to 60 years old. Obtaining information on the patient’s history of the environmental or pharmacological impact on lesions is essential. Infections particularly streptococcal can precipitate or exacerbate the disease, and drugs (eg Lithium, antimalarials, alcohol, nonsteroidal anti-inflammatory drugs [NSAIDs], beta-blockers) may aggravate the disease. 

Past medical (eg heart failure, demyelinating disease, inflammatory bowel disease, malignancy) and surgical history are likewise important. The family, social, and symptomatology history should be reviewed. 

Physical Examination

Diagnosis can usually be made from the clinical appearance of the skin lesions. It is important to inspect all areas of the body especially the extensor surfaces, trunk, perineum, scalp, nails, and joints.