Differentiating psoriasis from other diseases: Difference between revisions

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==Differentiating Psoriasis from other Diseases==
==Differentiating Psoriasis from other Diseases==
*Psoriasis must be differentiated from other diseases causing [[Papulosquamous disorder|papulosquamous]] or [[Erythematous rash|erythematosquamous rash]] especially when the psoriatic lesions are localized in particular sites as [[Palms of the hands|palms]], [[soles]], [[scalp]], body folds, [[penis]] and [[Nail (anatomy)|nails]].
*Psoriasis must be differentiated from other diseases causing [[Papulosquamous disorder|papulosquamous]] or [[Erythematous rash|erythematosquamous rash]] especially when the psoriatic [[lesions]] are localized in particular sites as [[Palms of the hands|palms]], [[soles]], [[scalp]], body folds, [[penis]] and [[Nail (anatomy)|nails]].
*The differential diagnosis of psoriasis includes:
*The differential diagnosis of psoriasis includes:
**[[Cutaneous T cell lymphoma]]/[[mycosis fungoides]]
**[[Cutaneous T cell lymphoma]]/[[mycosis fungoides]]
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* Pink or salmon in colour, which may be scaly, termed as "herald patch"
* Pink or salmon in colour, which may be scaly, termed as "herald patch"
* Oval in shape  
* Oval in shape  
* Long axis oriented along the clevage lines
* Long axis oriented along the cleavage lines
* Distributed on the [[trunk]] and [[proximal extremities]]
* Distributed on the [[trunk]] and [[proximal extremities]]
* Squamous marginal collarette and a “fir-tree” or “Christmas tree” distribution on the posterior trunk
* Squamous marginal collarette and a “fir-tree” or “Christmas tree” distribution on the posterior trunk
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|[[Pityriasis lichenoides chronica]]
|[[Pityriasis lichenoides chronica]]
|
|
* Recurrent lesions are usually less evenly scattered than psoriasis
* Recurrent [[lesions]] are usually less evenly scattered than psoriasis
* Brownish red or orange-brown color
* Brownish red or orange-brown color
* Lesions are capped by a single detachable opaque mica-like scale
* [[Lesions]] are capped by a single detachable opaque mica-like scale
* Often leave [[Hypopigmented area|hypopigmented]] [[Macule|macules]]
* Often leave [[Hypopigmented area|hypopigmented]] [[Macule|macules]]
|
|
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|[[Nummular dermatitis]]<ref name="pmid23517392">{{cite journal |vauthors=Jiamton S, Tangjaturonrusamee C, Kulthanan K |title=Clinical features and aggravating factors in nummular eczema in Thais |journal=Asian Pac. J. Allergy Immunol. |volume=31 |issue=1 |pages=36–42 |year=2013 |pmid=23517392 |doi= |url=}}</ref>
|[[Nummular dermatitis]]<ref name="pmid23517392">{{cite journal |vauthors=Jiamton S, Tangjaturonrusamee C, Kulthanan K |title=Clinical features and aggravating factors in nummular eczema in Thais |journal=Asian Pac. J. Allergy Immunol. |volume=31 |issue=1 |pages=36–42 |year=2013 |pmid=23517392 |doi= |url=}}</ref>
|
|
* Multiple coinshaped [[Eczematous Scaling|eczematous]] lesions  
* Multiple coin-shaped [[Eczematous Scaling|eczematous]] [[lesions]]
* Commonly affecting the [[extremities]] (lower>upper) and [[trunk]]
* Commonly affecting the [[extremities]] (lower>upper) and [[trunk]]
* May ooze [[fluid]] and become dry and crusty
* May ooze [[fluid]] and become dry and crusty
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|
|
* Associated with:<ref name="pmid12466124">{{cite journal |vauthors=Schmid S, Kuechler PC, Britschgi M, Steiner UC, Yawalkar N, Limat A, Baltensperger K, Braathen L, Pichler WJ |title=Acute generalized exanthematous pustulosis: role of cytotoxic T cells in pustule formation |journal=Am. J. Pathol. |volume=161 |issue=6 |pages=2079–86 |year=2002 |pmid=12466124 |pmc=1850901 |doi=10.1016/S0002-9440(10)64486-0 |url=}}</ref>
* Associated with:<ref name="pmid12466124">{{cite journal |vauthors=Schmid S, Kuechler PC, Britschgi M, Steiner UC, Yawalkar N, Limat A, Baltensperger K, Braathen L, Pichler WJ |title=Acute generalized exanthematous pustulosis: role of cytotoxic T cells in pustule formation |journal=Am. J. Pathol. |volume=161 |issue=6 |pages=2079–86 |year=2002 |pmid=12466124 |pmc=1850901 |doi=10.1016/S0002-9440(10)64486-0 |url=}}</ref>
** Antibiotics([[Penicillin|penicillins]], [[sulfonamides]], [[tetracyclines]])
** Antibiotics ([[Penicillin|penicillins]], [[sulfonamides]], [[tetracyclines]])
** [[Carbamazepine]]
** [[Carbamazepine]]
** [[Calcium channel blocker|Calcium channel blockers]]([[Diltiazem]])
** [[Calcium channel blocker|Calcium channel blockers]]([[Diltiazem]])
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* May present with elongated, finger-like patches symmetrically distributed on the flanks, also known as digitate dermatosis
* May present with elongated, finger-like patches symmetrically distributed on the flanks, also known as digitate dermatosis
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|
* Lesions may be asymptomatic  
* [[Lesions]] may be [[asymptomatic]]
* May be mildly [[Itch|pruritic]]  
* May be mildly [[Itch|pruritic]]  
* May fade or disappear after sun exposure during the summer season, but typically recur during the winter
* May fade or disappear after sun exposure during the summer season, but typically recur during the winter

Revision as of 19:51, 31 July 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

Psoriasis must be differentiated from other diseases that cause erythematous, scaly rash such as cutaneous T cell lymphoma/mycosis fungoides, pityriasis rosea, pityriasis rubra pilaris, pityriasis lichenoides chronica, nummular dermatitis, secondary syphilis, Bowen’s disease, exanthematous pustulosis, hypertrophic lichen planus, Sneddon–Wilkinson disease, small plaque parapsoriasis, intertrigo, Langerhans cell histiocytosis, dyshidrotic dermatitis, tinea manuum/pedum/capitis and seborrheic dermatitis.

Differentiating Psoriasis from other Diseases

Disease Rash Characteristics Signs and Symptoms Associated Conditions Images
Cutaneous T cell lymphoma/Mycosis fungoides[1]
  • Premycotic phase: A scaly, red rash in areas of the body that usually are not exposed to the sun. This rash does not cause symptoms and may last for months or years.
  • Patch phase: Thin, reddened, eczema -like rash.
  • Plaque phase: Small raised bumps (papules) or hardened lesions on the skin, which may be reddened.
  • Tumor phase: Tumors form on the skin. These tumors may develop ulcersand the skin may get infected.

Pityriasis rosea[2]
  • Pink or salmon in colour, which may be scaly, termed as "herald patch"
  • Oval in shape
  • Long axis oriented along the cleavage lines
  • Distributed on the trunk and proximal extremities
  • Squamous marginal collarette and a “fir-tree” or “Christmas tree” distribution on the posterior trunk
  • Develops after viral infection
  • Resolves spontaneously after 6-8 weeks

Pityriasis lichenoides chronica
  • Recurrent lesions are usually less evenly scattered than psoriasis
  • Brownish red or orange-brown color
  • Lesions are capped by a single detachable opaque mica-like scale
  • Often leave hypopigmented macules

courtesy http://www.regionalderm.com

Nummular dermatitis[5]
  • Lesions commonly relapse after occasional remission or may persist for long periods
  • Pruritis

Secondary syphilis[6]
  • Round coppery red color lesions on palms and soles
  • Papules with collarette of scales

Bowen’s disease[7]
  • Erythematous little scaly plaque, which enlarges over time in an erratic manner
  • Scale is usually yellow or white and it is easily detachable without producing any bleeding
  • Well defined margins

Exanthematous pustulosis[9]

Hypertrophic lichen planus[11]
  • Chronic pruritis
  • Scaling
  • May be asymptomatic

Sneddon–Wilkinson disease[13]
  • Flaccid pustules that are often generalized and have a tendency to involve the flexural areas
  • Have an annular configuration

Small plaque parapsoriasis[17]
  • Erythematous plaques which are covered with fine scale.
  • May present with elongated, finger-like patches symmetrically distributed on the flanks, also known as digitate dermatosis
  • Lesions may be asymptomatic
  • May be mildly pruritic
  • May fade or disappear after sun exposure during the summer season, but typically recur during the winter

courtesy http://www.regionalderm.com

Intertrigo[19]
  • Red and fleshy looking lesion in skin folds
  • Itching
  • oozing
  • May be sore

Langerhans cell histiocytosis[20]
  • Scaling and crusting of the scalp

courtesy http://www.regionalderm.com

Tinea manuum/pedum/capitis[24]
  • Scaling, flaking, and sometimes blistering of the affected areas
  • Hair loss with a black dot on scalp in case of tinea capitis

Seborrheic dermatitis

References

  1. ↑ "Mycosis Fungoides and the Sézary Syndrome Treatment (PDQ®)—Patient Version - National Cancer Institute".
  2. ↑ Mahajan K, Relhan V, Relhan AK, Garg VK (2016). "Pityriasis Rosea: An Update on Etiopathogenesis and Management of Difficult Aspects". Indian J Dermatol. 61 (4): 375–84. doi:10.4103/0019-5154.185699. PMC 4966395. PMID 27512182.
  3. ↑ Prantsidis A, Rigopoulos D, Papatheodorou G, Menounos P, Gregoriou S, Alexiou-Mousatou I, Katsambas A (2009). "Detection of human herpesvirus 8 in the skin of patients with pityriasis rosea". Acta Derm. Venereol. 89 (6): 604–6. doi:10.2340/00015555-0703. PMID 19997691.
  4. ↑ Smith KJ, Nelson A, Skelton H, Yeager J, Wagner KF (1997). "Pityriasis lichenoides et varioliformis acuta in HIV-1+ patients: a marker of early stage disease. The Military Medical Consortium for the Advancement of Retroviral Research (MMCARR)". Int. J. Dermatol. 36 (2): 104–9. PMID 9109005.
  5. ↑ Jiamton S, Tangjaturonrusamee C, Kulthanan K (2013). "Clinical features and aggravating factors in nummular eczema in Thais". Asian Pac. J. Allergy Immunol. 31 (1): 36–42. PMID 23517392.
  6. ↑ "STD Facts - Syphilis".
  7. ↑ Neagu TP, Ţigliş M, Botezatu D, Enache V, Cobilinschi CO, Vâlcea-Precup MS, GrinŢescu IM (2017). "Clinical, histological and therapeutic features of Bowen's disease". Rom J Morphol Embryol. 58 (1): 33–40. PMID 28523295.
  8. ↑ Murao K, Yoshioka R, Kubo Y (2014). "Human papillomavirus infection in Bowen disease: negative p53 expression, not p16(INK4a) overexpression, is correlated with human papillomavirus-associated Bowen disease". J. Dermatol. 41 (10): 878–84. doi:10.1111/1346-8138.12613. PMID 25201325.
  9. ↑ Szatkowski J, Schwartz RA (2015). "Acute generalized exanthematous pustulosis (AGEP): A review and update". J. Am. Acad. Dermatol. 73 (5): 843–8. doi:10.1016/j.jaad.2015.07.017. PMID 26354880.
  10. ↑ Schmid S, Kuechler PC, Britschgi M, Steiner UC, Yawalkar N, Limat A, Baltensperger K, Braathen L, Pichler WJ (2002). "Acute generalized exanthematous pustulosis: role of cytotoxic T cells in pustule formation". Am. J. Pathol. 161 (6): 2079–86. doi:10.1016/S0002-9440(10)64486-0. PMC 1850901. PMID 12466124.
  11. ↑ Ankad BS, Beergouder SL (2016). "Hypertrophic lichen planus versus prurigo nodularis: a dermoscopic perspective". Dermatol Pract Concept. 6 (2): 9–15. doi:10.5826/dpc.0602a03. PMC 4866621. PMID 27222766.
  12. ↑ Shengyuan L, Songpo Y, Wen W, Wenjing T, Haitao Z, Binyou W (2009). "Hepatitis C virus and lichen planus: a reciprocal association determined by a meta-analysis". Arch Dermatol. 145 (9): 1040–7. doi:10.1001/archdermatol.2009.200. PMID 19770446.
  13. ↑ Lutz ME, Daoud MS, McEvoy MT, Gibson LE (1998). "Subcorneal pustular dermatosis: a clinical study of ten patients". Cutis. 61 (4): 203–8. PMID 9564592.
  14. ↑ Kasha EE, Epinette WW (1988). "Subcorneal pustular dermatosis (Sneddon-Wilkinson disease) in association with a monoclonal IgA gammopathy: a report and review of the literature". J. Am. Acad. Dermatol. 19 (5 Pt 1): 854–8. PMID 3056995.
  15. ↑ Delaporte E, Colombel JF, Nguyen-Mailfer C, Piette F, Cortot A, Bergoend H (1992). "Subcorneal pustular dermatosis in a patient with Crohn's disease". Acta Derm. Venereol. 72 (4): 301–2. PMID 1357895.
  16. ↑ Sauder MB, Glassman SJ (2013). "Palmoplantar subcorneal pustular dermatosis following adalimumab therapy for rheumatoid arthritis". Int. J. Dermatol. 52 (5): 624–8. doi:10.1111/j.1365-4632.2012.05707.x. PMID 23489057.
  17. ↑ Lambert WC, Everett MA (1981). "The nosology of parapsoriasis". J. Am. Acad. Dermatol. 5 (4): 373–95. PMID 7026622.
  18. ↑ Väkevä L, Sarna S, Vaalasti A, Pukkala E, Kariniemi AL, Ranki A (2005). "A retrospective study of the probability of the evolution of parapsoriasis en plaques into mycosis fungoides". Acta Derm. Venereol. 85 (4): 318–23. doi:10.1080/00015550510030087. PMID 16191852.
  19. ↑ Janniger CK, Schwartz RA, Szepietowski JC, Reich A (2005). "Intertrigo and common secondary skin infections". Am Fam Physician. 72 (5): 833–8. PMID 16156342.
  20. ↑ Satter EK, High WA (2008). "Langerhans cell histiocytosis: a review of the current recommendations of the Histiocyte Society". Pediatr Dermatol. 25 (3): 291–5. doi:10.1111/j.1525-1470.2008.00669.x. PMID 18577030.
  21. ↑ Stull MA, Kransdorf MJ, Devaney KO (1992). "Langerhans cell histiocytosis of bone". Radiographics. 12 (4): 801–23. doi:10.1148/radiographics.12.4.1636041. PMID 1636041.
  22. ↑ Sholl LM, Hornick JL, Pinkus JL, Pinkus GS, Padera RF (2007). "Immunohistochemical analysis of langerin in langerhans cell histiocytosis and pulmonary inflammatory and infectious diseases". Am. J. Surg. Pathol. 31 (6): 947–52. doi:10.1097/01.pas.0000249443.82971.bb. PMID 17527085.
  23. ↑ Grois N, Pötschger U, Prosch H, Minkov M, Arico M, Braier J, Henter JI, Janka-Schaub G, Ladisch S, Ritter J, Steiner M, Unger E, Gadner H (2006). "Risk factors for diabetes insipidus in langerhans cell histiocytosis". Pediatr Blood Cancer. 46 (2): 228–33. doi:10.1002/pbc.20425. PMID 16047354.
  24. ↑ Al Hasan M, Fitzgerald SM, Saoudian M, Krishnaswamy G (2004). "Dermatology for the practicing allergist: Tinea pedis and its complications". Clin Mol Allergy. 2 (1): 5. doi:10.1186/1476-7961-2-5. PMC 419368. PMID 15050029.
  25. ↑ Schwartz RA, Janusz CA, Janniger CK (2006). "Seborrheic dermatitis: an overview". Am Fam Physician. 74 (1): 125–30. PMID 16848386.
  26. ↑ Misery L, Touboul S, Vinçot C, Dutray S, Rolland-Jacob G, Consoli SG, Farcet Y, Feton-Danou N, Cardinaud F, Callot V, De La Chapelle C, Pomey-Rey D, Consoli SM (2007). "[Stress and seborrheic dermatitis]". Ann Dermatol Venereol (in French). 134 (11): 833–7. PMID 18033062.

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