Psoriasis — Clinical Case (Wikimedia Commons)

Diagnosis: Psoriasis

Grade 2 psoriasis-like rash consisting of erythematosquamous papules and plaques, occurring 11 months after idelalisib initiation. (a, c) Treatment with topical steroids and 4-week interruption of ide. Clinical photograph sourced from Wikimedia Commons (CC BY 4.0). Attribution: Salma Machan,Carlos Plaza, Yosmar Pérez-González, Maria Rodriguez-Pinilla, Luis Requena, Raul Cordoba.

Clinical Presentation

Well-demarcated erythematous plaques with thick silvery-white scale, classically on extensor surfaces (elbows, knees), scalp, and lumbosacral area. Auspitz sign (pinpoint bleeding on scale removal). Nail changes: pitting, oil-drop discoloration, onycholysis.

Clinical History

Onset bimodal (16-22 and 55-60 years). Triggers: stress, infections (streptococcal pharyngitis for guttate), medications (beta-blockers, lithium), alcohol. Family history in ~40%. Screen for psoriatic arthritis (joint pain/stiffness) and metabolic comorbidities.

Treatment

Mild: topical corticosteroids, vitamin D analogs, calcineurin inhibitors. Moderate: phototherapy (NB-UVB). Severe: biologics (IL-17 inhibitors: secukinumab, ixekizumab; IL-23 inhibitors: guselkumab, risankizumab), methotrexate, apremilast.

Differential Diagnosis

Eczema, Seborrheic dermatitis, Tinea corporis, Pityriasis rosea, Lichen planus, Secondary syphilis, Cutaneous T-cell lymphoma

Key Learnings

Psoriasis is a systemic disease — screen for cardiovascular risk factors, metabolic syndrome, depression, and psoriatic arthritis. PASI and BSA scores guide treatment decisions. Biologic therapies have revolutionized severe psoriasis management.

Tags: psoriasis, autoimmune, plaque, inflammatory, chronic