Differential diagnosis common conditions that may present like unstable psoriasis include eczema and tinea incognito. Diagnosis and classification of psoriasis sciencedirect. The differential diagnosis of psoriasis palmoplantarpsoriasis is rather common and may occur with or without psoriatic lesions on other parts of the skin. Differential diagnosis in pediatric dermatology pdf author ernesto bonifazi isbn 8847028582 file size 6. They appear as pusfilled blisters on top of the tender, red patch on your skin.
Your doctor can suspect or diagnose psoriasis by examining your scalp, skin, and nails. Sep 10, 2012 inverse psoriasis is a rare form of psoriasis that affects between 3% and 7% of psoriasis patients. Its appearance and distribution in the flexural skin folds makes it a difficult disease to diagnose, and because it is thought of as a variant of psoriasis, there are very few studies that deal with it exclusively. Your healthcare provider may call this process a differential diagnosis. Enteropathic arthritis arthritis of inflammatory bowel disease should also be considered, and spotted bone disease has been reported in a patient with psoriatic arthritis. Psoriasis differential diagnoses medscape reference. This agewise categorization of atopic dermatitis combined with thorough clinical examination of the patient, facilitates a variable differential diagnosis. Dermatologists diagnose psoriasis based on its appearance and your symptoms. Michels, md, mph, family medicine residency at madigan army medical center, tacoma, washington. A simple physical exam will help your dermatologist determine the severity of your psoriasis.
Doctor answers on symptoms, diagnosis, treatment, and more. He combined three dermatoses into one group, having some common features. We aimed to evaluate the histopathological differences between psoriasis and. Psoriasis is a chronic inflammatory skin disease, with a strong genetic basis. It is important to exclude a number of other skin conditions before any prognosis of atopic dermatitis can be made by a doctor.
Koh examination of skin scrapings, woods lamp examination, and bacterial cultures are useful to rule out infections. Differential diagnosis psoriatic arthritis psoriasis causes. Psoriasis is an immunemediated, genetic disease manifesting in the skin or joints or both. With a good biopsy, histopathology is usually pathognomonic and helps to delineate nail psoriasis. The differential diagnoses of contact dermatitis are psoriasis and seborrheic eczema, which can typically involve the diaper area. Nummular eczema, tinea corporis, cutaneous tcell lymphoma, atopic dermatitis, contact dermatitis and yeast infections in skin folds can all be confused with psoriasis. About forty years has passed since brocq united under the name parapsoriasis a group of diseases belonging to. Pdf differential diagnosis of psoriasis researchgate. Dermoscopy in differential diagnosis of palmar psoriasis. Occasion may arise when nothing is more difficult in dermatology than a differentiation between parapsoriasis and allied conditions which are similar both clinically and histologically.
Differential diagnosis of psoriasis should be done with all bacterialviral diseases, tumors, precancerous lesions, mycosis fungoides, subacute lupus erythematosus, allergic and atopic dermatitis, lichen. Psoriasis differential diagnosis clinical dermatology. Also, a lot of people tend to visit a primary care physician before seeing a dermatologist, which may even be required by some insurance companies. Psoriasis is a complex, chronic, multifactorial, inflammatory disease that involves hyperproliferation of the keratinocytes in the epidermis, with an increase in the epidermal cell turnover rate see the image below. Apr 09, 2020 the differential diagnosis also includes rheumatoid arthritis of the hands and spine. Visiting a dermatologist may help confirm a diagnosis. Plaque psoriasis see the image below is rarely life threatening, but it often is intractable to treatment. Clinical features of chronic psoriasis are generally sufficient to make the diagnosis. It occurs worldwide, but its prevalence varies considerably between different. In most cases, diagnosis of psoriasis is fairly straightforward. If an adult or child presents with an acquired predominantly scaly eruption, the most likely explanation is psoriasis, which is estimated to affect 14% of the population. Shingles differential diagnosis what you need to know. Describe the clinical features and management of chronic forms of psoriasis. A definitive diagnosis can be made based on history, physical examination, and, if the diagnosis.
Psoriasis is a chronic inflammatory skin disease characterized by erythematous, circumscribed scaly papules and plaques. Less common variants of psoriasis include inverse psoriasis, pustular psoriasis, guttate psoriasis, erythrodermic psoriasis, and annular psoriasis figures 3. Uptodate, electronic clinical resource tool for physicians and patients that provides information on adult primary care and internal medicine, allergy and immunology, cardiovascular medicine, emergency. The differential diagnosis of psoriasis vulgaris hilaris publishing. As for atopic eczema, lesions rarely appear in the diapered area for most infants with this diagnosis. Psoriasis is a common chronic skin disorder estimated to affect about 2% of the western population. Parapsoriasis dermatologic disorders merck manuals. In general the diagnosis psoriasis can be made on clinical grounds. This part of the emedtv library describes the process of diagnosing this condition and gives a brief description of some of the different types of psoriasis. Rarely, your doctor may take a small sample of skin biopsy. What other conditions have symptoms that are similar to psoriasis symptoms. Psoriasis provides many challenges including high prevalence, chronicity, disfiguration, disability, and associated comorbidity. Long list including diverticulitis, crohns disease. Psoriasis patches can range from a few spots of dandrufflike scaling to major eruptions that cover large areas.
Although the disease has many characteristic and even pathognomonic features, no established diagnostic criteria exist for cutaneous psoriasis. Differential diagnoses plaque psoriasis confirmed patient has psoriasis involving 80% of his total body surface area 1. Histological differential diagnosis between psoriasis. In most cases, nail psoriasis is diagnosed on clinical grounds.
Differential diagnosis of psoriasis should be done with all bacterialviral diseases, tumors, precancerous lesions, mycosis fungoides, subacute. Since psoriasis can also be genetically inherited, the doctor may also check your familys medical history. Oct 03, 2019 psoriasis is a complex, chronic, multifactorial, inflammatory disease that involves hyperproliferation of the keratinocytes in the epidermis, with an increase in the epidermal cell turnover rate see the image below. Dermoscopy in differential diagnosis of palmar psoriasis and chronic hand eczema.
Oct 23, 2016 here are some reasons why a misdiagnosis occurs with psoriasis. We aimed to evaluate the histopathological differences between psoriasis. Psoriasis has a large spectrum of clinical features and evolution. The national psoriasis foundation works to find a cure for psoriasis and psoriatic arthritis and to eliminate their devastating effects through research, advocacy and education. The clinical diagnosis of psoriasis p is relatively easy, especially when the lesions consist of ery thematous salmon pink, silvery white scaly.
Department of experimental and clinical medicine, institute of dermatology, university of udine, udine, italy. Environmental, genetic, and immunologic factors appear to play a role. Cutaneous tcell lymphoma lymphomatoid papulosis nummular dermatitis parapsoriasis pityriasis lichenoides. Psoriasis symptoms, diagnosis and treatment bmj best. The clinical diagnosis of psoriasis is relatively easy, especially when the lesions consist of erythematous, silvery white scaly, sharply demarcated, indurated plaques, distributed symmetrically on the extensor.
The differential diagnosis of guttate psoriasis includes the following. The disease however can be confused with many other entities. These clinical features reflect the histopathological findings observed in active lesions, characterized by parakeratosis, acanthosis of. What is included in the differential diagnoses of guttate. Most types of psoriasis go through cycles, flaring for a few weeks or months, then subsiding for a time or even going into complete remission. Outline clinical presentations of psoriasis and their differential diagnosis. The process of diagnosing psoriasis involves ruling out other conditions that often have similar symptoms. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and wellbeing around the world. Home novemberdecember 1996 volume 1 issue 4 diagnosis and differential diagnosis of psoriasis. Characteristic features are sharply delineated erythematosquamous plaques with adherent scales and fissures. Less common variants of psoriasis include inverse psoriasis, pustular psoriasis, guttate psoriasis, erythrodermic psoriasis. The first one is nummular eczema which is a dermatosis showing rounded, circular coinshaped, desquamative erythematous lesions, covered with vesicles, crusts and scales that are almost always very itchy. Pancreas allograft needle biopsy main differential diagnoses. Parapsoriasis blue morbus brocq is a clinically heterogeneous disease with an unexplained pathogenesis.
View enhanced pdf access article on wiley online library html view download pdf. The differential diagnosis of psoriasis and seborrheic dermatitis can be difficult when both conditions are localized to the scalp without the involvement of other skin sites. Psoriasis is a complex, chronic, multifactorial, inflammatory disease that involves hyperproliferation of the keratinocytes in the epidermis, with. Histopathological differential diagnosis of psoriasis and. Erythrodermic psoriasis when more than 90% of the body is involved by psoriasis, it is defined as erythrodermic psoriasis.
The differential diagnosis is vast and includes many other immunemediated, inflammatory disorders. Dermnet does not provide medical advice, diagnosis or treatment. Psoriasis frequency ranges from 1 to 3 % in white population, and arthritis occurs in 1040 % of psoriasis patients, representing a relevant health issue. Psoriatic arthritis psa is an inflammatory arthropathy, associated with psoriasis, in which ocular, intestinal, metabolic, and cardiovascularrelated manifestations can variably coexist. Differential diagnosis of parapsoriasis jama dermatology. Introduction psoriasis is a chronic inflammatory disease that affects primarily the skin and joints. Jul 26, 2016 the differential diagnosis of psoriasis and seborrheic dermatitis can be difficult when both conditions are localized to the scalp without the involvement of other skin sites. Itching may be absent but tends to be mild to moderate.
The blisters dry within a day or two but may reappear every few days or weeks. The clinical diagnosis of psoriasis is relatively easy, especially when the lesions consist of erythematous, silvery white scaly, sharply demarcated, indurated plaques, distributed symmetrically on the extensor surfaces of limbs, the lower back and the scalp. Psoriatic arthritis psa is an inflammatory arthritis associated with psoriasis. Pdf the clinical diagnosis of psoriasis is relatively easy, especially when the lesions consist of erythematous, silvery white scaly, sharply. The differential diagnosis of psoriasis continuous dermatological education the differential diagnosis of psoriasis p.
A diverse team of clinicians with a range of expertise is often needed to treat the disease. Psoriatic arthritis psa is an inflammatory arthropathy, associated with psoriasis. Differential diagnosis in pediatric dermatology pdf. Intertrigo secondary to skin friction can also be very similar in appearance to inverse psoriasis.
This book is devoted exclusively to differential diagnosis. In most cases, your primary care doctor or dermatologist will be able to diagnose psoriasis by examining your skin. The differential diagnosis of mf includes a garden variety of benign reactive skin disorders, such as psoriasis, eczema, parapsoriasis, drug reactions, contact dermatitis, and photodermatitis. The principal differential diagnosis includes some papulosquamous or erythematosquamous disorders, such as pityriasis lichenoides chronica, sec.
These distinctions can be quite challenging and often settled only by the results of tcr gene rearrangement studies. The disease creates a significant stigma for patients and is a major economic burden. The differential diagnosis of generalized pustular psoriasis includes pustular drug eruption, dermatitis with secondary infection, immunoglobulin a pemphigus, and pustular tinea corporis. Differential diagnosis of psoriasis the journal of rheumatology. Differential diagnosis of psoriasis the journal of. Use of images for any purpose including but not limited to research, commercial, personal, or noncommercial use is prohibited without prior written consent. To make a psoriasis diagnosis, the doctor usually starts by examining the affected area of skin.
Your doctor usually can diagnose psoriasis by taking your medical history and examining your skin, scalp and nails. In cases of inverse psoriasis, the differential diagnosis often includes fungal and bacterial infections. The lesions typically appear one or two weeks after a severe streptococcal infection of the upper respiratory tract. Psoriasis, which manifests most often as plaque psoriasis, is a chronic, relapsing, inflammatory skin disorder with a strong genetic basis. Learn more about how your doctor may identify your psoriasis and its type. In the differential diagnosis of psoriasis vulgaris, five dermatological diseases are generally considered. Diagnosis while psoriasis commonly affects knees and elbows, it can show up anywhere, including your scalp and nails. The diagnosis of psoriasis can be made by clinical observation without laboratory tests in most cases. Understanding the role of immune function in psoriasis. Differential diagnosis of psoriasis 57 also be involved. The differentiation from eczema and other erythematosquamous eruptions is of importance. Although the differential diagnosis of psoriasis is broad, its identification can be made by means of careful anamnesis and physical examination in the vast majority of cases. Psoriasis is a complex, chronic, multifactorial, inflammatory disease that involves hyperproliferation of the keratinocytes in the epidermis, with an increase in the epidermal cell turnover. Differential diagnosis of psoriasis should be done with all bacterialviral diseases, tumors, precancerous lesions, mycosis fungoides, subacute lupus erythematosus, allergic and atopic dermatitis, lichen planus, tinea pedis.
May 01, 20 psoriasis is a chronic inflammatory skin condition that is often associated with systemic manifestations. Aug 23, 2018 the diagnosis of psoriasis is usually made upon physical examination, following a discussion about the family and medical history of the patient. Psoriasis is a chronic, immunemediated, inflammatory disease which affects primarily the skin and joints. It can cause itching, irritation, burning, and stinging in half the cases. These variants to 6 can be differentiated from the common plaque type by morphology. Psoriasis is a chronic inflammatory multi organ disease with well characterized pathology occurring in the skin and often the joints. Although the disease has many characteristic and even pathognomonic features, no established diagnostic criteria exist for cutaneous psoriasis and there is no unified classification for the clinical spectrum of the disease. Further tests may be required as psoriasis resembles other skin diseases, such as eczema. You should have already read the overview page about psoriasis. Uptodate, electronic clinical resource tool for physicians and patients that provides information on adult primary care and internal medicine, allergy and immunology, cardiovascular medicine, emergency medicine, endocrinology and diabetes, family medicine, gastroenterology and hepatology, hematology, infectious diseases, nephrology and.