PSORIASIS
Diagnosis & Management
Maria Lourdes B. Galima
WHAT IS PSORIASIS?
– Inflammatory and
hyperplastic disease of
skin
– Characterized by
erythema and elevated
scaly plaques
– Chronic, relapsing
condition
– Course of disease often
unpredictable
2
WHAT IS PSORIASIS?
• A noncontagious common skin
condition that causes rapid
skin cell reproduction
resulting in red, dry patches of
thickened skin.
• Commonly affects the skin of
the elbows, knees, and scalp.
EPIDEMIOLOGY
• Prevalence equal in males and females
• Estimated incidence: ~ 60 per 100,000
per year3
4
WHO CAN GET PSORIASIS?
• Psoriasis is seen worldwide,
in all races, and both sexes,
in approximately 125
million people.
• Ranked among the top 20
dermatologic cases seen
every year at the University
of the Philippines-Philippine
General Hospital
Dermatology Clinic, with 10
new Psoriasis cases seen
each day
WHO CAN GET PSORIASIS?
• Others have very severe psoriasis where
virtually their entire body is fully covered
with thick, red, scaly skin.
• Psoriasis is considered a non-curable, longterm (chronic) skin condition.
• It has a variable course, periodically
improving and worsening.
COMMON SITES
AFFECTED BY PSORIASIS
• Can affect any part
of the body –
typically scalp,
elbow, knees and
sacrum1
• Extent of disease
varies
7
WHAT CAUSES PSORIASIS?
• Cause of psoriasis
remains unknown.
• Combination of risk
factors, including genetic
predisposition and
environmental factors.
GENETIC INFLUENCE
9
• Evidence suggests strong genetic association
– Studies of monozygotic twins show concordance
for psoriasis (e.g. 64% in a Danish Study)
– Multiple susceptibility loci have been identified
• Disease expression
– likely result of genetic and environmental factors
WHAT CAUSES PSORIASIS?
• Common to be found in
members of the same
family.
• The immune system is
thought to play a major
role.
COMMON TRIGGER FACTORS
FOR PSORIASIS
•
•
•
•
•
•
•
Infections (e.g. streptococcal, viral)
Skin trauma (Koebner phenomenon)
Psychological stress
Drugs (e.g. lithium, beta blockers)
Sunburn
Metabolic factors (e.g. calcium deficiency)
Hormonal factors (e.g. pregnancy)
11
PSORIASIS IS A T-CELL MEDIATED,
AUTOIMMUNE DISEASE
• Current hypothesis:
– Unknown skin antigens stimulate
immune response
• Antigen-specific memory T-cells are
primary mediators
– Leads to impaired differentiation and
hyperproliferation of keratinocytes
12
WHAT DOES PSORIASIS LOOK LIKE?
• Typically looks like red or
pink areas of thickened,
raised, and dry skin.
• Affects areas over the
elbows, knees, and scalp.
• Any body area may be
involved.
• More common in areas of
trauma, repeated rubbing,
use, or abrasions.
WHAT DOES PSORIASIS LOOK LIKE?
• It may be small flattened
bumps, large thick
plaques of raised skin,
red patches, and mildly
dry pink skin to big
flakes of dry skin that
flake off.
• Covered by white, silvery
scales
CHARACTERISTIC LESION OF
PSORIASIS
• Sharply demarcated erythematous plaque
with micaceous silvery white scale
• Histopathology
– Thickening of the epidermis
– Tortuous and dilated blood vessels
– Inflammatory infiltrate primarily of
lymphocytes
TYPES OF PSORIASIS
•
•
•
•
Chronic plaque
Guttate
Flexural
Erythrodermic
16
• Pustular
– Localized and
generalized
• Local forms
– Palmoplantar
– Scalp
– Nail (psoriatic
onychodystrophy)
PSORIASIS VULGARIS
• Psoriasis vulgaris is
the medical name for
the most common
form of psoriasis
("vulgaris" means
common).
• About 80% of people
with psoriasis have
this type.
PSORIASIS VULGARIS
• Also called plaque psoriasis because
of the characteristic plaques on the
skin:
– well-defined patches of red raised
skin that can appear on any area of
skin, although the knees, elbows,
scalp, trunk, and nails are the most
common locations.
PSORIASIS VULGARIS
• The flaky silvery white buildup on top
of the plaques is called scale;
- it is composed of dead skin cells.
- This scale comes loose and sheds
constantly from the plaques.
19
PSORIATIC PLAQUE
SEVERITY OF DISEASE
• Three Cardinal Signs of Psoriatic Lesions
– Plaque elevation
– Erythema
– Scale
• Body Surface Area
CHRONIC PLAQUE PSORIASIS
• Most Common Variant
• Plaques may be as large
as 20 cm
• Symmetrical disease
• Sites of Predilection
– Elbows
– Knees
– Presacrum
– Scalp
– Hands and Feet
CHRONIC PLAQUE PSORIASIS
23
CHRONIC PLAQUE PSORIASIS
CHRONIC PLAQUE PSORIASIS
• May be widespread – up to 90% BSA
• Genitalia involved in up to 30% of patients
• Most patients have nail changes
– Nail pitting
– “Oil Spots”
– Involvement of the entire nail bed
• Onychodystrophy
• Loss of nail plate
WIDESPREAD CHRONIC PLAQUE
PSORIASIS
26
WIDESPREAD CHRONIC
PSORIASIS
27
CHRONIC PSORIASIS
SYMPTOMS OF CHRONIC PLAQUE
PSORIASIS
•
•
•
•
Pruritus
Pain
Excessive heat loss
Patient Complaints
–
–
–
–
Unsightliness of the lesions
Low self-esteem
Feelings of being socially outcast
Excessive scale
CHRONIC PLAQUE PSORIASIS
30
CHRONIC PLAQUE PSORIASIS
31
CHRONIC PLAQUE PSORIASIS
32
GUTTATE PSORIASIS
• Guttate psoriasis is a type
of psoriasis that looks like
small, salmon-pink drops
on the skin.
• The word guttate is
derived from the Latin
word gutta, meaning
drop.
• Usually there is a fine scale
on the droplike lesion that
is much finer than the
scales in plaque psoriasis.
GUTTATE PSORIASIS
– Numerous and small
lesions – ~ 1 cm diameter
– Pink with less scale than
plaque psoriasis
– Commonly found on trunk
and proximal limbs
– Typically seen in
individuals < 30 years
– Often preceded by an upper
respiratory tract
streptococcal infection
34
GUTTATE PSORIASIS
• The trigger to the disease is often a
preceding streptococcal (bacterial)
infection.
• The eruption of the lesions on the skin
usually happens about two to three weeks
after the person has strep throat.
• Characterized by numerous 0.5 to 1.5 cm
papules and plaques
• Most common form in children
GUTTATE PSORIASIS
INVERSE/FLEXURAL PSORIASIS
– Lesions in skin folds
– Particularly groin,
gluteal cleft, axillae and
submammary regions
– Often minimal or
absent scaling
– May cause diagnostic
difficulty when genital
or perianal region is
affected in isolation
37
INVERSE/FLEXURAL PSORIASIS
• Inverse/Flexural
psoriasis consists of
bright red, smooth (not
scaly) patches found in
the folds of the skin.
• The most common areas
are under the breasts, in
the armpits, near the
genitals, under the
buttocks, or in abdominal
folds.
INVERSE/FLEXURAL PSORIASIS
• These irritated and inflamed areas are
aggravated by the sweat and skin rubbing
together in the folds.
• Yeast overgrowth, common in skin folds,
may trigger the skin lesions of psoriasis.
INVERSE/FLEXURAL PSORIASIS
40
LIFE–THREATENING FORMS OF
PSORIASIS
• Generalized Pustular Psoriasis
• Erythrodermic Psoriasis
41
PUSTULAR PSORIASIS
• Pustular psoriasis is an
uncommon form of
psoriasis.
• People with pustular
psoriasis have clearly
defined, raised bumps on
the skin that are filled
with pus (pustules).
• The skin under and
around these bumps is
reddish.
GENERALIZED PUSTULAR PSORIASIS
• Unusual manifestation of psoriasis
• Can have a gradual or an acute onset
• Characterized by waves of pustules on
erythematous skin often after short episodes of
fever of 39˚ to 40˚C
• Weight loss
• Muscle Weakness
• Hypocalcemia
• Leukocytosis
• Elevated ESR
GENERALIZED PUSTULAR PSORIASIS
• Cause is obscure
• Triggering Factors
– Infection
– Pregnancy
– Lithium
– Hypocalcemia secondary to hypoalbuminemia
– Irritant contact dermatitis
– Withdrawal of glucocorticosteroids, primarily
systemic
GENERALIZED PUSTULAR PSORIASIS
PUSTULAR PSORIASIS
• Pustular psoriasis may cause large portions
of the skin to redden.
• The skin changes that occur before, during,
or after an episode of pustular psoriasis can
be similar to those of regular psoriasis.
PUSTULAR PSORIASIS
ERYTHRODERMIC PSORIASIS
• This is the least common
type of psoriasis and can
be quite serious.
• A very large area of the
body, if not most of the
body, is bright red and
inflamed.
• The body can appear to
be covered in a peeling
red rash. The rash
usually itches or burns.
ERYTHRODERMIC PSORIASIS
• Classic lesion is lost
• Entire skin surface becomes markedly
erythematous with desquamative
scaling.
• Often only clues to underlying psoriasis
are the nail changes and usually facial
sparing
ERYTHRODERMIC PSORIASIS
• Triggering Factors
– Systemic Infection
– Withdrawal of high potency topical or oral
steroids
– Withdrawal of Methotrexate
– Phototoxicity
– Irritant contact dermatitis
ERYTHRODERMIC PSORIASIS
ERYTHRODERMIC PSORIASIS
PSORIASIS OF THE SCALP
• The scalp may have fine, dry,
scaly skin or have heavily
crusted plaque areas.
• The plaque can flake off or
peel off in crusted clumps.
• Sometimes psoriasis of the
scalp is confused with
seborrheic dermatitis.
• A key difference is that in
seborrheic dermatitis, the
scales are greasy looking,
not dry.
SCALP PSORIASIS
– Varies from minor
scaling with erythema
to thick
hyperkeratotic
plaques
– May extend beyond
hairline1,2
– Patient scratching
may produce
asymmetric plaques
54
PSORIATIC ARTHRITIS
• Psoriatic arthritis is a
specific condition in which
a person has both
psoriasis and arthritis.
PSORIATIC ARTHRITIS
• Rarely, a person can
have psoriatic arthritis
without having skin
psoriasis.
• Arthritis can precede
the psoriasis by
months or years, or
present after years of
psoriasis.
CAN PSORIASIS AFFECT
ONLY NAILS?
• More commonly, the nail
symptoms accompany the
skin and arthritis
symptoms.
• Nails affected by psoriasis
can have small pinpoint
pits or large yellowish
separations of the nail
plate called "oil spots."
CAN PSORIASIS AFFECT
ONLY NAILS?
• Nail psoriasis is
typically very difficult
to treat, but it can
respond to
medications taken
internally to treat
psoriasis or psoriatic
arthritis.
PSORIASIS OF THE NAIL
• potent topical steroids
applied at the nail-base
cuticle,
• injection of steroids at the
nail-base cuticle, and
• oral or systemic
medications
PSORIASIS OF THE NAIL
NAIL PSORIASIS
NAIL PSORIASIS
NAIL PSORIASIS
NAIL PSORIASIS
PALMOPLANTAR PSORIASIS
– Can be hyperkeratotic
or pustular
– May mimic dermatitis –
look for psoriatic
manifestations
elsewhere to aid
diagnosis
– Possibly aggravated by
trauma
IS PSORIASIS CURABLE?
• Psoriasis is not currently
curable.
• However, it can go into
remission and show no
signs of disease.
IS PSORIASIS CONTAGIOUS?
• You cannot catch it from
anyone, and you cannot
pass it to anyone else via
skin-to-skin contact.
• You can directly touch
someone with psoriasis
every day and never
develop the skin
condition.
FACTORS THAT MAY TRIGGER
PSORIASIS.
• Injury to the skin:
- Injury to the skin has been associated with plaque
psoriasis.
- For example, a skin infection, skin inflammation, or
even excessive scratching can trigger psoriasis.
• Sunlight:
- Most people generally consider sunlight to be
beneficial for their psoriasis. However, a small minority
find that strong sunlight aggravates their symptoms.
-A bad sunburn may worsen psoriasis.
FACTORS THAT MAY TRIGGER
PSORIASIS
• Streptococcal infections:
- Some evidence suggests that streptococcal infections
may cause a type of plaque psoriasis.
- These bacterial infections have been shown to cause
guttate psoriasis, a type of psoriasis that looks like
small red drops on the skin.
• HIV:
- Psoriasis typically worsens after an individual has
been infected with HIV. However, psoriasis often
becomes less active in advanced HIV infection.
FACTORS THAT MAY TRIGGER
PSORIASIS
• Drugs: A number of medications have been shown
to aggravate psoriasis. Some examples are as
follows:
– Lithium: Drug that may be used to treat depression
– Beta-blockers: Drugs that may be used to treat high
blood pressure
– Antimalarials: Drugs used to treat malaria
– NSAIDs: Drugs, such as ibuprofen (Motrin and Advil)
or naproxen (Aleve), used to reduce inflammation
FACTORS THAT MAY TRIGGER
PSORIASIS
• Emotional stress:
- Many people see an increase in their psoriasis when
emotional stress is increased.
• Smoking:
- Cigarette smokers have an increased risk of chronic
plaque psoriasis.
• Alcohol:
- Alcohol is considered a risk factor for psoriasis,
particularly in young to middle-aged males.
FACTORS THAT MAY TRIGGER
PSORIASIS
• Hormone changes:
- The severity of psoriasis may fluctuate with
hormonal changes.
- Disease frequency peaks during puberty and
menopause.
- A pregnant woman's symptoms are more likely to
improve than worsen, if any changes occur at all.
- In contrast, symptoms are more likely to flare in
the postpartum period, if any changes occur at all.
DIAGNOSING PSORIASIS
• Other dermatological disorders
can resemble psoriasis
• Diagnosed clinically according to
appearance, distribution, history of lesions
and family history
• Important to consider non-cutaneous
complications
73
DIFFERENTIAL DIAGNOSIS
• Localised patches/plaques
– Tinea
– Eczema
– Superficial basal cell
carcinoma and Bowen’s
disease
– Seborrhoeic dermatitis
– Cutaneous T-cell lymphoma
(mycosis fungoides)
• Guttate
– Pityriasis rosea
– Drug eruption
– Secondary syphilis
• Flexural
–
–
–
–
Tinea
Eczema
Candidiasis
Seborrhoeic dermatitis
• Erythrodermic
–
–
–
–
–
Eczema
Cutaneous T-cell lymphoma
Pityriasis rubra pilaris
Lichen planus
Drug
• Palmoplantar
– Tinea
CAN I PASS PSORIASIS ON TO MY
CHILDREN?
• Yes, it is possible.
• Psoriasis may be inherited
from parents to their children
or other ancestors.
• It does tend to run in some
families, and a family history
is helpful in making the
diagnosis.
MEDICAL TREATMENT – TOPICAL
AGENTS
• Medications applied directly
to the skin are the first
course of treatment options.
• The main topical treatments
are corticosteroids
(cortisone like creams, gels,
liquids, sprays, or
ointments), vitamin D-3
derivatives, coal tar,
anthralin, or retinoids.
MEDICAL TREATMENT – TOPICAL
AGENTS
• Because each drug has specific adverse effects or
loses potency over time, it is common to rotate
them.
• Sometimes topical preparations are combined
together.
- For example, keratolytics (substances used to
break down scales or excess skin cells) are often
added to these preparations.
MEDICAL TREATMENT – TOPICAL
AGENTS
• Some preparations should never be mixed
together because they interfere with each
other.
- For example, salicylic acid inactivates
calcipotriene cream or ointment (a form of
vitamin D-3).
• On the other hand, drugs such as anthralin
(tree bark extract) may require the addition
of salicylic acid to work effectively.
MEDICAL TREATMENT – PHOTOTHERAPY
(LIGHT THERAPY)
• The ultraviolet (UV) light from
the sun slows the production of
skin cells and reduces
inflammation.
• If psoriasis is widespread, as
defined by more patches than can
easily be counted, then artificial
light therapy may be used.
• Resistance to topical treatment is
another indication for light
therapy.
MEDICAL TREATMENT – PHOTOTHERAPY
(LIGHT THERAPY)
• Proper facilities are
required for the two main
forms of light therapy.
• Medical light sources use
particular wavelengths of
light.
• Sunlamps and tanning
booths are usually not
acceptable as substitutes
for medical light sources.
ULTRAVIOLET B (UV-B)
• Usually combined with one or more topical
treatments and is extremely effective for treating
moderate to severe plaque psoriasis.
• UV-B is light with wavelengths of 290-320
nanometers (nm), shorter than the range of visible
light (visible light ranges from 400-700 nm).
• The major drawbacks of this therapy are the time
commitment required for treatments and the
accessibility of UV-B equipment.
PUVA
• Is the therapy that combines a psoralen drug (taken
by mouth) with ultraviolet A (UV-A) light therapy
(UV-A is light with wavelengths of 320-400 nm).
• Psoralen drugs make the skin more sensitive to
light and the sun.
• More than 85% of patients report relief of disease
symptoms with 20-30 treatments.
• Therapy is usually given two to three times per
week on an outpatient basis, with maintenance
treatments every two to four weeks until remission.
ADVERSE EFFECTS OF PUVA THERAPY
• Adverse effects of PUVA therapy include
nausea, itching, and burning.
• Long-term complications include increased
risks of sensitivity to the sun, sunburn, skin
cancer, and cataracts.
• Protective glasses must be worn during and
after treatment to prevent cataracts.
• PUVA therapy is not used for children
younger than 12 years of age.
TREATMENT: LASER THERAPY
• This lets doctors aim
the treatment at
affected areas
without exposing
healthy skin.
TREATMENT: LASER THERAPY
85
• Laser therapy may have fewer side effects
and a smaller risk of skin cancer compared
to traditional phototherapy.
• It also appears to deliver results with fewer
treatments.
NATURAL REMEDIES FOR
PSORIASIS
• Natural alternatives include
aloe, tea tree oil, and oatmeal
baths to soothe itchy skin.
• Although alcohol has been
linked to psoriasis, experts are
skeptical about special diets
that claim to treat psoriasis.
• There's no convincing
evidence that they work
86
CLIMATOTHERAPY
• For decades, people
have claimed that
visiting the Dead Sea in
Israel is a powerful
treatment for psoriasis.
• The sun and water,
which is 10 times
saltier than the ocean,
are believed to be a
healing combination.
CLIMATOTHERAPY
88
• It may sound like a myth, but scientific
evidence suggests this form of
climatotherapy works.
• In studies, 80% to 90% of patients
improved after visiting the Dead Sea.
• Almost half saw their rash disappear for the
next several months.
STRESS REDUCTION
• Relaxation techniques
may help control flareups.
• Anything that helps
you relax, whether it's
yoga, deep breathing,
or a long walk, may
help ease your
symptoms.
SOCIAL SUPPORT
• Isolation can lead to stress
and depression, which tend
to make symptoms worse.
• Experts recommend staying
connected to the people you
trust.
SYSTEMIC AGENTS (DRUGS TAKEN
WITHIN THE BODY)
• These drugs are often
started for psoriasis after
both topical treatment
and phototherapy have
failed.
• These agents are potent
drugs given by mouth or
injection and block
inflammation which can
slow the growth of skin
cells in psoriasis.
• Examples include methotrexate
(Rheumatrex, Trexall), adalimumab
(Humira), and infliximab (Remicade).
• Systemic agents may also be considered for
psoriatic arthritis.
• People whose disease is disabling because of
physical, psychological, social, or economic
reasons may also be considered for systemic
treatment.
WHAT IS THE LONG-TERM PROGNOSIS
IN PATIENTS WITH PSORIASIS?
• Overall, the prognosis for most
patients with psoriasis is good.
• Many newer medications have
led to excellent results."
• There have been a few studies
showing a possible association of
psoriasis and other medical
conditions, including obesity and
heart disease.
LOCALIZED PATCHES/PLAQUES
94
– Tinea corporis1
•
Affects body
•
Lacks symmetrical
lesions
•
Presence of peripheral
scale and central
clearing
Tinea coporis
Psoriasis
LOCALIZED PATCHES/PLAQUES
95
– Discoid eczema1
•
Individualised patches
more pruritic than
psoriasis
•
Lack silvery scale
•
Less vivid colour than
psoriasis
Discoid eczema
Psoriasis
LOCALISED PATCHES/PLAQUES
96
– Superficial basal cell
carcinoma/Bowen’s
disease1,2
• Asymmetrical lesions,
either single or few in
number
• Perform biopsy if
lesions resistant to
topical psoriasis
treatment, or to
confirm diagnosis
Bowen’s disease
Psoriasis
LOCALISED PATCHES/PLAQUES
– Seborrhoeic dermatitis
• Characterized by yellowish
scaling and erythema1
– Localized to many of the same
areas as psoriasis
• Diffuse scaling differs from
sharply defined psoriasis
plaques2
• Affects furrows of face
(facial psoriasis is generally
restricted to hairline)1
Dermatitis
Psoriasis
97
LOCALIZED PATCHES/PLAQUES
98
– Cutaneous T-cell lymphoma
(mycosis fungoides)
• Red, discoid lesions1
• Asymmetrical and less scaly
than psoriasis1
• Lesions may present with fine
atrophy and be resistant to
antipsoriatic therapy2
• Biopsy to confirm diagnosis
Mycosis fungoides
Psoriasis
1. Fry L. An atlas of psoriasis. Spain: Taylor & Francis, 2004. 2. Menter A
et al. Fast facts: psoriasis. 2nd ed. Oxford: Health Press, 2004.
GUTTATE PSORIASIS
99
– Pityriasis rosea1
•
Difficult to distinguish from
acute guttate psoriasis
•
Presents first as single
large patch, progresses to
a truncal rash of multiple
red scaly plaques
(‘Christmas tree’
distribution)
•
Resolves over 8–12 weeks
< Psoriasis
^ Pityriasis rosea
1. Menter A et al. Fast facts: psoriasis. 2nd ed. Oxford: Health Press,
2004.
GUTTATE PSORIASIS
100
– Secondary syphilis
• Search for characteristic
primary syphilitic lesion,
lymphadenopathy, and
lesions of face, palm and
soles1
• Conduct serology and skin
biopsies to confirm1,2
< Psoriasis
^ Secondary syphilis
1. Menter A et al. Fast facts: psoriasis. 2nd ed. Oxford: Health
Press, 2004. 2. Van de Kerkhof P, ed. Textbook of psoriasis. 2nd
ed. Melbourne: Blackwell Publishing, 2003.
FLEXURAL PSORIASIS
101
– Tinea cruris1
• Affects groin area
• Characterized by central
clearing with advancing edge
• Non-silvery lesion with fine
scale, particularly at
periphery
• Lesion frequently extends
more on left side
< Psoriasis
^ Tinea cruris
1. Menter A et al. Fast facts: psoriasis. 2nd ed. Oxford: Health Press, 2004.
FLEXURAL PSORIASIS
102
– Atopic eczema1,2
• Often associated with
asthma and hay fever
• Lacks classic psoriatic nail
involvement and sharply
demarcated scaly plaques
< Psoriasis
1. Menter A et al. Fast facts: psoriasis. 2nd ed. Oxford: Health Press, 2004.
2. Fischer, G. How to treat: atopic dermatitis. Australian Doctor. 16 April 2010: 29–36.
^ Atopic eczema
FLEXURAL PSORIASIS
– Candidiasis1,2
•
Characteristic peripheral
pustules and scaling differ
to psoriasis
•
Yeast cultures are
diagnostic
– Seborrhoeic dermatitis2
Flexural psoriasis
1. Van de Kerkhof P, ed. Textbook of psoriasis. 2nd ed. Melbourne: Blackwell Publishing, 2003.
2. Menter A et al. Fast facts: psoriasis. 2nd ed. Oxford: Health Press, 2004.
103
PALMOPLANTAR PSORIASIS
104
– Tinea manum1
•
Ringworm of hands
•
Fine powdery scale,
particularly involving palms
and palmar creases
•
Usually asymmetrical
Tinea corporis
1. Menter A et al. Fast facts: psoriasis. 2nd ed. Oxford: Health Press, 2004.
Psoriasis
PALMOPLANTAR PSORIASIS
– Hand and foot eczema
• Hyperkeratotic forms
difficult to distinguish from
psoriasis1,2
• Biopsies can assist
diagnosis1
• Look for history of atopy, a
lack of psoriasis elsewhere
on body, and evidence of
eczema elsewhere on skin1
Eczema
Psoriasis
1. Menter A et al. Fast facts: psoriasis. 2nd ed. Oxford: Health Press, 2004.
2. van de Kerkhof P, ed. Textbook of psoriasis. 2nd ed. Melbourne:
Blackwell Publishing, 2003.
105
PALMOPLANTAR PSORIASIS
– Pompholyx of palms and
soles (dishydrotic
eczema)1
• Presents as clear vesicles
– contrast to white/yellow
pustules in pustular
psoriasis
• Accompanied by intense
pruritus
Eczema
Psoriasis
1. Menter A et al. Fast facts: psoriasis. 2nd ed. Oxford: Health Press, 2004.
106