Patient Case: Psoriasis
A 35-year-old man presents to the dermatology clinic with a six-month history of red, scaly patches on his elbows, knees, and lower back. He reports that the lesions started as small, itchy red spots but gradually expanded into larger plaques with thick white scaling. He denies fever or systemic symptoms but mentions that cold weather and stress seem to worsen his condition.
He has no known allergies and no history of similar skin issues in the family. However, he was recently diagnosed with mild joint pain in his fingers and knees. On examination, there are well-demarcated, erythematous plaques with silvery-white scales on the extensor surfaces of the elbows, knees, and sacral region. When a scale is gently removed, pinpoint bleeding is observed (Auspitz sign). His nails show mild pitting, but there is no significant joint swelling or deformity.
A diagnosis of chronic plaque psoriasis is made. The patient is started on topical corticosteroids and vitamin D analogs and advised to moisturize regularly. Given his mild joint symptoms, a rheumatology referral is recommended to evaluate for psoriatic arthritis.
- What is the most likely diagnosis for this patient’s condition?
a) Eczema
b) Psoriasis
c) Tinea corporis
d) Seborrheic dermatitis - Which of the following clinical features is most characteristic of psoriasis?
a) Hyperpigmented patches with central clearing
b) Lichenified plaques with intense pruritus
c) Well-demarcated erythematous plaques with silvery-white scales
d) Yellow, greasy scales on the scalp and face - Which sign is commonly associated with psoriasis?
a) Darier’s sign
b) Nikolsky’s sign
c) Auspitz sign
d) Koebner phenomenon - What is the first-line treatment for mild to moderate plaque psoriasis?
a) Oral corticosteroids
b) Topical corticosteroids and vitamin D analogs
c) Systemic antibiotics
d) Antifungal creams
