Differentiating psoriasis from other diseases: Difference between revisions

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=== Differential diagnosis of psoriasis ===
=== Differential diagnosis of psoriasis ===
*Psoriasis must be differentiated from other diseases that cause [[Papulosquamous disorder|papulosquamous]] or [[Erythematous rash|erythematosquamous rash]], especially when the psoriatic [[lesions]] are localized in such sites as the [[Palms of the hands|palms]], [[soles]], [[scalp]], body folds, [[penis]], and [[Nail (anatomy)|nails]].
*Psoriasis must be differentiated from other diseases that cause [[Papulosquamous disorder|papulosquamous]] or [[Erythematous rash|erythematosquamous rash]], especially when the psoriatic [[lesions]] are localized in such sites as the [[Palms of the hands|palms]], [[soles]], [[scalp]], body folds, [[penis]], and [[Nail (anatomy)|nails]]. The differential diagnosis of psoriasis includes:
*Psoriasis must be differentiated from the following diseases:
**[[Cutaneous T cell lymphoma]]/[[mycosis fungoides]]
**[[Pityriasis rosea]]
**[[Pityriasis rubra pilaris]]
**[[Pityriasis lichenoides chronica]]
**[[Nummular dermatitis]]
**[[Secondary syphilis]]
**[[Bowen’s disease]]
**[[Exanthematous pustulosis]]
**[[Lichen planus|Hypertrophic lichen planus]]
**Sneddon–Wilkinson disease
**[[Parapsoriasis|Small plaque parapsoriasis]]
**[[Intertrigo]]
**[[Langerhans cell histiocytosis]]
**[[Dyshidrotic dermatitis]]
**[[Tinea manuum]]/pedum/[[Tinea Capitis|capitis]]
**[[Seborrheic dermatitis]]
{| class="wikitable"
{| class="wikitable"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
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! align="center" style="background:#4479BA; color: #FFFFFF;" + |Images
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Images
|-
|-
|[[Cutaneous T cell lymphoma]]/[[Mycosis fungoides]]<ref name="urlMycosis Fungoides and the Sézary Syndrome Treatment (PDQ®)—Patient Version - National Cancer Institute">{{cite web |url=https://www.cancer.gov/types/lymphoma/patient/mycosis-fungoides-treatment-pdq |title=Mycosis Fungoides and the Sézary Syndrome Treatment (PDQ®)—Patient Version - National Cancer Institute |format= |work= |accessdate=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cutaneous T cell lymphoma]]/[[Mycosis fungoides]]<ref name="urlMycosis Fungoides and the Sézary Syndrome Treatment (PDQ®)—Patient Version - National Cancer Institute">{{cite web |url=https://www.cancer.gov/types/lymphoma/patient/mycosis-fungoides-treatment-pdq |title=Mycosis Fungoides and the Sézary Syndrome Treatment (PDQ®)—Patient Version - National Cancer Institute |format= |work= |accessdate=}}</ref>
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* '''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.
* '''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.
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* [[Sezary syndrome]]
* [[Sezary syndrome]]
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[[Image:Mycosis_fungoides.JPG|200px]]
[[Image:Mycosis_fungoides.JPG|200px|courtesy of wikipedia.org]]
|-
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|[[Pityriasis rosea]]<ref name="pmid27512182">{{cite journal |vauthors=Mahajan K, Relhan V, Relhan AK, Garg VK |title=Pityriasis Rosea: An Update on Etiopathogenesis and Management of Difficult Aspects |journal=Indian J Dermatol |volume=61 |issue=4 |pages=375–84 |year=2016 |pmid=27512182 |pmc=4966395 |doi=10.4103/0019-5154.185699 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pityriasis rosea]]<ref name="pmid27512182">{{cite journal |vauthors=Mahajan K, Relhan V, Relhan AK, Garg VK |title=Pityriasis Rosea: An Update on Etiopathogenesis and Management of Difficult Aspects |journal=Indian J Dermatol |volume=61 |issue=4 |pages=375–84 |year=2016 |pmid=27512182 |pmc=4966395 |doi=10.4103/0019-5154.185699 |url=}}</ref>
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* Pink or salmon in color, which may be scaly; referred to as "herald patch"
* Pink or salmon in color, which may be scaly; referred to as "herald patch"
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** [[HHV-8]]
** [[HHV-8]]
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[[Image:Pityriasisrosea.png|200px]]
[[Image:Pityriasisrosea.png|200px|courtesy of https://commons.wikimedia.org]]
|-
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|[[Pityriasis lichenoides chronica]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pityriasis lichenoides chronica]]
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* Recurrent [[lesions]] are usually less evenly scattered than in cases of psoriasis
* Recurrent [[lesions]] are usually less evenly scattered than in cases of psoriasis
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** [[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]] (HIV)
** [[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]] (HIV)
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[[Image:PLEVA2.jpg|200px|courtesy http://www.regionalderm.com]]
[[Image:PLEVA2.jpg|200px|courtesy of http://www.regionalderm.com]]
|-
|-
|[[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>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[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>
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* Multiple coin-shaped [[Eczematous Scaling|eczematous]] [[lesions]]  
* Multiple coin-shaped [[Eczematous Scaling|eczematous]] [[lesions]]  
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** [[Atopy]]
** [[Atopy]]
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[[Image:Nummular_dermatitis_eczematous.jpg|200px]]
[[Image:Nummular dermatitis dry.jpg|200px|courtesy of your-doctor.net dermatology atlas]]
|-
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|[[Secondary syphilis]]<ref name="urlSTD Facts - Syphilis">{{cite web |url=https://www.cdc.gov/std/syphilis/stdfact-syphilis.htm |title=STD Facts - Syphilis |format= |work= |accessdate=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Secondary syphilis]]<ref name="urlSTD Facts - Syphilis">{{cite web |url=https://www.cdc.gov/std/syphilis/stdfact-syphilis.htm |title=STD Facts - Syphilis |format= |work= |accessdate=}}</ref>
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* Round, coppery, red colored [[lesions]] on palms and soles
* Round, coppery, red colored [[lesions]] on palms and soles
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** Positive [[Venereal disease research laboratory (VDRL) test|VDRL]] test
** Positive [[Venereal disease research laboratory (VDRL) test|VDRL]] test
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[[Image:Secondary_Syphilis.jpg|200px]]
[[Image:Secondary_Syphilis.jpg|200px|courtesy of wikipedia.org]]
|-
|-
|[[Bowen’s disease]]<ref name="pmid28523295">{{cite journal |vauthors=Neagu TP, Ţigliş M, Botezatu D, Enache V, Cobilinschi CO, Vâlcea-Precup MS, GrinŢescu IM |title=Clinical, histological and therapeutic features of Bowen's disease |journal=Rom J Morphol Embryol |volume=58 |issue=1 |pages=33–40 |year=2017 |pmid=28523295 |doi= |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Bowen’s disease]]<ref name="pmid28523295">{{cite journal |vauthors=Neagu TP, Ţigliş M, Botezatu D, Enache V, Cobilinschi CO, Vâlcea-Precup MS, GrinŢescu IM |title=Clinical, histological and therapeutic features of Bowen's disease |journal=Rom J Morphol Embryol |volume=58 |issue=1 |pages=33–40 |year=2017 |pmid=28523295 |doi= |url=}}</ref>
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* [[Erythematous]], small, scaly plaque, which enlarges erratically over time
* [[Erythematous]], small, scaly plaque, which enlarges erratically over time
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** [[Sjögren's syndrome|Sjögren’s syndrome]]
** [[Sjögren's syndrome|Sjögren’s syndrome]]
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[[Image:Bowen.jpg|200px]]
[[Image:Bowen.jpg|200px|courtesy of wikipedia.org]]
|-
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|[[Exanthematous pustulosis]]<ref name="pmid26354880">{{cite journal |vauthors=Szatkowski J, Schwartz RA |title=Acute generalized exanthematous pustulosis (AGEP): A review and update |journal=J. Am. Acad. Dermatol. |volume=73 |issue=5 |pages=843–8 |year=2015 |pmid=26354880 |doi=10.1016/j.jaad.2015.07.017 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Exanthematous pustulosis]]<ref name="pmid26354880">{{cite journal |vauthors=Szatkowski J, Schwartz RA |title=Acute generalized exanthematous pustulosis (AGEP): A review and update |journal=J. Am. Acad. Dermatol. |volume=73 |issue=5 |pages=843–8 |year=2015 |pmid=26354880 |doi=10.1016/j.jaad.2015.07.017 |url=}}</ref>
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* Numerous small, primarily non-follicular, sterile [[pustules]], arising within large areas of [[Edema|edematous]] [[erythema]]
* Numerous small, primarily non-follicular, sterile [[pustules]], arising within large areas of [[Edema|edematous]] [[erythema]]
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** [[Hydroxychloroquine]]
** [[Hydroxychloroquine]]
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[[Image:Acute_generalized_exanthematous_pustulosis.jpg|200px]]
[[Image:Acute_generalized_exanthematous_pustulosis.jpg|200px|commons.wikimedia.org]]
|-
|-
|[[Lichen planus|Hypertrophic lichen planus]]<ref name="pmid27222766">{{cite journal |vauthors=Ankad BS, Beergouder SL |title=Hypertrophic lichen planus versus prurigo nodularis: a dermoscopic perspective |journal=Dermatol Pract Concept |volume=6 |issue=2 |pages=9–15 |year=2016 |pmid=27222766 |pmc=4866621 |doi=10.5826/dpc.0602a03 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lichen planus|Hypertrophic lichen planus]]<ref name="pmid27222766">{{cite journal |vauthors=Ankad BS, Beergouder SL |title=Hypertrophic lichen planus versus prurigo nodularis: a dermoscopic perspective |journal=Dermatol Pract Concept |volume=6 |issue=2 |pages=9–15 |year=2016 |pmid=27222766 |pmc=4866621 |doi=10.5826/dpc.0602a03 |url=}}</ref>
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* Classically involves shin and ankles and is characterized by [[Hyperkeratosis|hyperkeratotic]] [[Plaque|plaques]] and [[Nodule (medicine)|nodules]] covered by a scale
* Classically involves shin and ankles and is characterized by [[Hyperkeratosis|hyperkeratotic]] [[Plaque|plaques]] and [[Nodule (medicine)|nodules]] covered by a scale
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* Associated with [[Hepatitis C virus]] infection<ref name="pmid19770446">{{cite journal |vauthors=Shengyuan L, Songpo Y, Wen W, Wenjing T, Haitao Z, Binyou W |title=Hepatitis C virus and lichen planus: a reciprocal association determined by a meta-analysis |journal=Arch Dermatol |volume=145 |issue=9 |pages=1040–7 |year=2009 |pmid=19770446 |doi=10.1001/archdermatol.2009.200 |url=}}</ref>
* Associated with [[Hepatitis C virus]] infection<ref name="pmid19770446">{{cite journal |vauthors=Shengyuan L, Songpo Y, Wen W, Wenjing T, Haitao Z, Binyou W |title=Hepatitis C virus and lichen planus: a reciprocal association determined by a meta-analysis |journal=Arch Dermatol |volume=145 |issue=9 |pages=1040–7 |year=2009 |pmid=19770446 |doi=10.1001/archdermatol.2009.200 |url=}}</ref>
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[[Image:Lichen_planus2.JPG|200px]]
[[Image:Lichen_planus2.JPG|200px|courtesy of wikipedia.org]]
|-
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|Sneddon–Wilkinson disease<ref name="pmid9564592">{{cite journal |vauthors=Lutz ME, Daoud MS, McEvoy MT, Gibson LE |title=Subcorneal pustular dermatosis: a clinical study of ten patients |journal=Cutis |volume=61 |issue=4 |pages=203–8 |year=1998 |pmid=9564592 |doi= |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Sneddon–Wilkinson disease<ref name="pmid9564592">{{cite journal |vauthors=Lutz ME, Daoud MS, McEvoy MT, Gibson LE |title=Subcorneal pustular dermatosis: a clinical study of ten patients |journal=Cutis |volume=61 |issue=4 |pages=203–8 |year=1998 |pmid=9564592 |doi= |url=}}</ref>
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* [[Flaccid]] [[pustules]] that are often generalized and have a tendency to involve the flexural areas
* [[Flaccid]] [[pustules]] that are often generalized and have a tendency to involve the flexural areas
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** [[Adalimumab]]<ref name="pmid23489057">{{cite journal |vauthors=Sauder MB, Glassman SJ |title=Palmoplantar subcorneal pustular dermatosis following adalimumab therapy for rheumatoid arthritis |journal=Int. J. Dermatol. |volume=52 |issue=5 |pages=624–8 |year=2013 |pmid=23489057 |doi=10.1111/j.1365-4632.2012.05707.x |url=}}</ref>
** [[Adalimumab]]<ref name="pmid23489057">{{cite journal |vauthors=Sauder MB, Glassman SJ |title=Palmoplantar subcorneal pustular dermatosis following adalimumab therapy for rheumatoid arthritis |journal=Int. J. Dermatol. |volume=52 |issue=5 |pages=624–8 |year=2013 |pmid=23489057 |doi=10.1111/j.1365-4632.2012.05707.x |url=}}</ref>
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[[Image:Snedden.jpg|200px]]
[[Image:Sneddon wilkinson disease 03.jpeg|200px|courtesy http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=427]]
|-
|-
|[[Parapsoriasis|Small plaque parapsoriasis]]<ref name="pmid7026622">{{cite journal |vauthors=Lambert WC, Everett MA |title=The nosology of parapsoriasis |journal=J. Am. Acad. Dermatol. |volume=5 |issue=4 |pages=373–95 |year=1981 |pmid=7026622 |doi= |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Parapsoriasis|Small plaque parapsoriasis]]<ref name="pmid7026622">{{cite journal |vauthors=Lambert WC, Everett MA |title=The nosology of parapsoriasis |journal=J. Am. Acad. Dermatol. |volume=5 |issue=4 |pages=373–95 |year=1981 |pmid=7026622 |doi= |url=}}</ref>
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* [[Erythematous]] [[plaques]] with fine scaly surface
* [[Erythematous]] [[plaques]] with fine scaly surface
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[[Image:Small_plaque_parapsoriasis.jpg|200px|courtesy http://www.regionalderm.com]]
[[Image:Small_plaque_parapsoriasis.jpg|200px|courtesy http://www.regionalderm.com]]
|-
|-
|[[Intertrigo]]<ref name="pmid16156342">{{cite journal |vauthors=Janniger CK, Schwartz RA, Szepietowski JC, Reich A |title=Intertrigo and common secondary skin infections |journal=Am Fam Physician |volume=72 |issue=5 |pages=833–8 |year=2005 |pmid=16156342 |doi= |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Intertrigo]]<ref name="pmid16156342">{{cite journal |vauthors=Janniger CK, Schwartz RA, Szepietowski JC, Reich A |title=Intertrigo and common secondary skin infections |journal=Am Fam Physician |volume=72 |issue=5 |pages=833–8 |year=2005 |pmid=16156342 |doi= |url=}}</ref>
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* Red and fleshy looking [[lesion]] in [[skin]] folds
* Red and fleshy looking [[lesion]] in [[skin]] folds
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** [[Obesity]]
** [[Obesity]]
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[[Image:Axillary_intertrigo.png|200px]]
[[Image:Axillary_intertrigo.png|200px|courtesy of cdc.gov]]
|-
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|[[Langerhans cell histiocytosis]]<ref name="pmid18577030">{{cite journal |vauthors=Satter EK, High WA |title=Langerhans cell histiocytosis: a review of the current recommendations of the Histiocyte Society |journal=Pediatr Dermatol |volume=25 |issue=3 |pages=291–5 |year=2008 |pmid=18577030 |doi=10.1111/j.1525-1470.2008.00669.x |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Langerhans cell histiocytosis]]<ref name="pmid18577030">{{cite journal |vauthors=Satter EK, High WA |title=Langerhans cell histiocytosis: a review of the current recommendations of the Histiocyte Society |journal=Pediatr Dermatol |volume=25 |issue=3 |pages=291–5 |year=2008 |pmid=18577030 |doi=10.1111/j.1525-1470.2008.00669.x |url=}}</ref>
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* Scaling and crusting of [[scalp]]
* Scaling and crusting of [[scalp]]
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** [[Pancytopenia]]
** [[Pancytopenia]]
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[[Image:Langerhan_cell_histiocytosis.jpg|200px|courtesy http://www.regionalderm.com ]]
[[Image:Langerhan_cell_histiocytosis.jpg|200px|courtesy http://www.regionalderm.com]]
|-
|-
|[[Tinea manuum]]/pedum/capitis<ref name="pmid15050029">{{cite journal |vauthors=Al Hasan M, Fitzgerald SM, Saoudian M, Krishnaswamy G |title=Dermatology for the practicing allergist: Tinea pedis and its complications |journal=Clin Mol Allergy |volume=2 |issue=1 |pages=5 |year=2004 |pmid=15050029 |pmc=419368 |doi=10.1186/1476-7961-2-5 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tinea manuum]]/pedum/capitis<ref name="pmid15050029">{{cite journal |vauthors=Al Hasan M, Fitzgerald SM, Saoudian M, Krishnaswamy G |title=Dermatology for the practicing allergist: Tinea pedis and its complications |journal=Clin Mol Allergy |volume=2 |issue=1 |pages=5 |year=2004 |pmid=15050029 |pmc=419368 |doi=10.1186/1476-7961-2-5 |url=}}</ref>
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* Scaling, flaking, and sometimes blistering of the affected areas
* Scaling, flaking, and sometimes blistering of the affected areas
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** May lead to [[asthma]] exacerbation
** May lead to [[asthma]] exacerbation
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[[Image:Tinea_pedis.jpg|200px]]
[[Image:Tinea_pedis.jpg|200px|courtesy regionalderm.com]]
|-
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|[[Seborrheic dermatitis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Seborrheic dermatitis]]
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* [[Papulosquamous]], scaly, flaky, [[itchy]], and red [[rash]] found particularly at [[sebaceous gland]]-rich areas of the body
* [[Papulosquamous]], scaly, flaky, [[itchy]], and red [[rash]] found particularly at [[sebaceous gland]]-rich areas of the body
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** [[Biotin]] deficiency
** [[Biotin]] deficiency
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[[Image:Seborrhoeic_dermatitisnew.jpg|200px]]
[[Image:Seborrhoeic_dermatitisnew.jpg|200px|courtesy of wikipedia.com]]
|}
|}


=== Differential diagnosis of psoriatic arthritis ===
=== Differential diagnosis of psoriatic arthritis ===
Psoriatic arthritis must be differentiated from other diseases causing [[Oligoarthritis|oligo]]/[[polyarthritis]] or [[arthritis]] of the [[axial skeleton]], including:
Psoriatic arthritis must be differentiated from other diseases causing [[Oligoarthritis|oligo]]/[[polyarthritis]] or [[arthritis]] of the [[axial skeleton]], including:
* [[Rheumatoid arthritis]]
* Seronegative arthropathies:
** [[Ankylosing spondylitis]]
** [[Inflammatory bowel disease]] associated arthritis (enteropathic arthritis)
** [[Reactive arthritis]] ([[Reiter's syndrome]])
<small>
<small>
{| class="wikitable"
{| class="wikitable"
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|75%
|75%
|}
|}
<small/>
 


Key:+ : Infrequently present, ++ : Frequently present, +++ : Always present, - : Absent
Key:+ : Infrequently present, ++ : Frequently present, +++ : Always present, - : Absent
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{{Reflist|2}}
{{Reflist|2}}


[[Category:Primary care]]
[[Category:Dermatology]]


{{WH}}
{{WH}}
{{WS}}
{{WS}}

Latest revision as of 02:24, 14 August 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 an 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

Differential diagnosis of psoriasis

Disease Rash Characteristics Signs and Symptoms Associated Conditions Images
Cutaneous T cell lymphoma/Mycosis fungoides[1]

courtesy of wikipedia.org

Pityriasis rosea[2]
  • Pink or salmon in color, which may be scaly; referred to as "herald patch"
  • Oval 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 posterior trunk
  • Secondary to viral infections
  • Resolves spontaneously after 6-8 weeks

courtesy of https://commons.wikimedia.org

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

courtesy of http://www.regionalderm.com

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

courtesy of your-doctor.net dermatology atlas

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

courtesy of wikipedia.org

Bowen’s disease[7]
  • Erythematous, small, scaly plaque, which enlarges erratically over time
  • Scale is usually yellow or white and it is easily detachable without any bleeding
  • Well-defined margins

courtesy of wikipedia.org

Exanthematous pustulosis[9]

commons.wikimedia.org

Hypertrophic lichen planus[11]

courtesy of wikipedia.org

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

courtesy http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=427

Small plaque parapsoriasis[17]
  • Erythematous plaques with fine scaly surface
  • May present with elongated, finger-like patches
  • Symmetrical distribution on the flanks
  • 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]

courtesy of cdc.gov

Langerhans cell histiocytosis[20]
  • Scaling and crusting of 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

courtesy regionalderm.com

Seborrheic dermatitis

courtesy of wikipedia.com

Differential diagnosis of psoriatic arthritis

Psoriatic arthritis must be differentiated from other diseases causing oligo/polyarthritis or arthritis of the axial skeleton, including:

Arthritis Type Clinical Features Body Distribution Key Signs Laboratory Abnormalities
History of Psoriasis Symmetric joint involvement Asymmetric joint involvement Enthesopathy Dactylitis Nail Dystrophy Human immunodeficiency virus association Upper extremity-hands Lower extremity Sacroiliac joints Spine Osteopenia Joint Space Ankylosis Periostitis Soft tissue swelling ESR Rheumatoid factor (RF) HLA-B27
Psoriatic arthritis + + ++ + + + + +++ (DIP/PIP) +++ ++ (Unilateral) ++ - ++ (Widening) ++ +++ (Fluffy) ++ + - 30-75%
Rheumatoid arthritis - ++ + - - - - +++

(MCP/wrist)

+++ + (Unilateral) ++(Cervical) +++ +++ (Narrowing) + + (Linear) +++ +++ +++ 6-8%
Ankylosing spondylitis - +++ - + - - - + + +++ (Bilateral) +++ +++ ++ (Narrowing) +++ +++ (Fluffy) + +++ - 90%
Reactive arthritis (Reiter's syndrome) - +++ - + + - - ++ +++ ++ (Unilateral) + + + (Narrowing) - +++ (Fluffy) ++ ++ - 75%


Key:+ : Infrequently present, ++ : Frequently present, +++ : Always present, - : Absent

References

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  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.
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  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.
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  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.
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  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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