Psoriatic lesions are red, inflamed, silvery-white scaly, and circumscribed papules and plaques; often affecting elbows, knees, extensor limbs, and scalp, and, less commonly, nails, ear, and umbilical region.
Psoriasis is a multifactorial disease with a genetic basis. Exacerbations of disease may be related to infection, alcohol, medications, stress, and intercurrent illness.
Diagnosis is usually clinical.
Mild or limited psoriasis is treated with topical corticosteroids and/or vitamin D analogs.
Moderate to severe and/or extensive psoriasis may require phototherapy, and systemic agents such as methotrexate, cyclosporine, acitretin, or biologic agents.
Psoriasis is a chronic inflammatory skin disease characterized by erythematous, circumscribed scaly papules and plaques. It can cause itching, irritation, burning, and stinging. Although approximately 30% of people with cutaneous psoriasis also have psoriatic arthritis, this topic only discusses cutaneous psoriasis.
History and exam
Key diagnostic factors
- skin lesions
Other diagnostic factors
- family history
- joint swelling or pain
- local trauma
- greater body mass index (BMI)
1st investigations to order
- clinical diagnosis
Investigations to consider
- skin biopsy
Andrea Chiricozzi, MD
University of Pisa
University Hospital of Pisa
AC has served as an advisory board member and consultant and has received fees and speaker's honoraria or has participated in clinical trials for AbbVie, Almirall, Biogen, Fresenius Kabi, Leo Pharma, Lilly, Janssen, Novartis, Sanofi Genzyme, and UCB Pharma; AC is also an author of a reference cited in this topic.
Dr Andrea Chiricozzi would like to gratefully acknowledge Dr April W. Armstrong and Dr Tsu-Yi Chuang, previous contributors to this topic.
TC declares that he has no competing interests. AWA is an investigator and consultant for Abbott, Amgen, and Janssen; AWA is also an author of references cited in this topic.
David Burden, MD, FRCP
Western Infirmary, Glasgow
Consultant Dermatologist Dermatology
DB has been reimbursed as a consultant, researcher, and lecturer for Abbott, Leo, Pfizer, Merck, Janssen-Cilag, and Novartis.
Paradi Mirmirani, MD
Department of Dermatology
Kaiser Permanente Vallejo Medical Center
PM declares that she has no competing interests.
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- Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures
- EuroGuiDerm guideline on the systemic treatment of psoriasis vulgaris – part 2: specific clinical and comorbid situations
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