Psoriasis history and symptoms: Difference between revisions
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==Overview== | ==Overview== | ||
The hallmark of psoriasis is | The hallmark of psoriasis is a [[papulosquamous]], [[erythematous]], scaly [[rash]] which can be commonly found on [[Dorsal|extensor surfaces]] of multiple body parts (although flexural surfaces may also be involved in inverse psoriasis). Patients with psoriasis usually give history of recent [[Streptococcal pharyngitis|streptococcal throat infection]], [[viral infection]], [[immunization]], use of [[Antimalarial drug|antimalarial drugs]], and [[Physical trauma|trauma]]. The most common symptoms of psoriasis include [[pain]], which has been described by patients as unpleasant, superficial, sensitive, itchy, hot or burning (especially in erythrodermic psoriasis and in some cases of traumatized [[plaques]] or in the [[joints]] affected by [[psoriatic arthritis]]). Patients also present with [[pruritus]](especially in eruptive, guttate psoriasis), high [[fever]] in erythrodermic and [[Pustular rash|pustular]] psoriasis. Other symptoms include dystrophic nails, long-term [[erythematous]] scaly [[rash]] with recent presentation of [[arthralgia]]/[[arthralgia]] without any visible [[skin]] findings, [[Erythema|redness]] and tearing of eyes due to [[conjunctivitis]] or [[blepharitis]] and avoidance of situations requiring social interaction. | ||
==History== | ==History== | ||
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=== Family History === | === Family History === | ||
* Patients with early disease onset often have a positive family history of psoriasis, frequent association with histocompatibility antigen (HLA)- Cw6, and more severe disease. Those with onset after the age of 40 usually have a negative family history and a normal frequency of the HLA- Cw6 allele.<ref name="pmid1390163">{{cite journal |vauthors=Naldi L, Parazzini F, Brevi A, Peserico A, Veller Fornasa C, Grosso G, Rossi E, Marinaro P, Polenghi MM, Finzi A |title=Family history, smoking habits, alcohol consumption and risk of psoriasis |journal=Br. J. Dermatol. |volume=127 |issue=3 |pages=212–7 |year=1992 |pmid=1390163 |doi= |url=}}</ref> | * Patients with early disease onset often have a positive family history of psoriasis, frequent association with [[histocompatibility]] [[antigen]] (HLA)- Cw6, and more severe disease. Those with onset after the age of 40 usually have a negative family history and a normal frequency of the HLA- Cw6 allele.<ref name="pmid1390163">{{cite journal |vauthors=Naldi L, Parazzini F, Brevi A, Peserico A, Veller Fornasa C, Grosso G, Rossi E, Marinaro P, Polenghi MM, Finzi A |title=Family history, smoking habits, alcohol consumption and risk of psoriasis |journal=Br. J. Dermatol. |volume=127 |issue=3 |pages=212–7 |year=1992 |pmid=1390163 |doi= |url=}}</ref> | ||
=== Initial Presentation === | === Initial Presentation === | ||
* A typical patient of psoriasis will present with a history of a long-term erythematous scaly area with ocular and joint involvement depending upon the clinical subtype and chronicity of the disease. There may be multiple relapses and remissions. | * A typical patient of psoriasis will present with a history of a long-term [[erythematous]] scaly area with [[ocular]] and [[joint]] involvement depending upon the clinical subtype and chronicity of the disease. There may be multiple relapses and remissions. | ||
=== Past Medical History === | === Past Medical History === | ||
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* Recent [[Streptococcal pharyngitis|streptococcal throat infection]], [[viral]] infection, [[immunization]], use of [[antimalarial drug]], or [[Physical trauma|trauma]]. | * Recent [[Streptococcal pharyngitis|streptococcal throat infection]], [[viral]] infection, [[immunization]], use of [[antimalarial drug]], or [[Physical trauma|trauma]]. | ||
* Pain, which has been described by patients as unpleasant, superficial, sensitive, itchy, hot or burning (especially in erythrodermic psoriasis and in some cases of traumatized plaques or in the joints affected by psoriatic arthritis). | * [[Pain]], which has been described by patients as unpleasant, superficial, sensitive, itchy, hot or burning (especially in erythrodermic psoriasis and in some cases of traumatized plaques or in the joints affected by psoriatic arthritis). | ||
* [[Pruritus]] (especially in eruptive, guttate psoriasis). | * [[Pruritus]] (especially in eruptive, guttate psoriasis). | ||
* High [[fever]] in erythrodermic and pustular psoriasis. | * High [[fever]] in erythrodermic and pustular psoriasis. | ||
* Dystrophic nails. | * Dystrophic nails. | ||
* Long-term rash with recent presentation of arthralgia. | * Long-term rash with recent presentation of [[arthralgia]]. | ||
* Arthralgia without any visible skin findings. | * Arthralgia without any visible [[skin]] findings. | ||
* Ocular symptoms include redness and tearing due to [[conjunctivitis]] or [[blepharitis]]. | * [[Ocular]] symptoms include [[Erythema|redness]] and tearing due to [[conjunctivitis]] or [[blepharitis]]. | ||
* Avoidance of situations requiring social interaction. | * Avoidance of situations requiring social interaction. | ||
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* [[Depression]] leading to: | * [[Depression]] leading to: | ||
** [[Insomnia]] | ** [[Insomnia]] | ||
** Decreased appetite | ** [[Decreased appetite]] | ||
** Guilt | ** Guilt | ||
** Loss of energy | ** [[Fatigue|Loss of energy]] | ||
** Decreased concentration | ** [[Inattention|Decreased concentration]] | ||
* [[Dactylitis]] | * [[Dactylitis]] | ||
* [[Geographic tongue]] ( The dorsal surface may have sharply demarcated gyrate red patches with a white to yellow border that may evolve giving the appearence of a map) | * [[Geographic tongue]] (The dorsal surface may have sharply demarcated gyrate red patches with a white to yellow border that may evolve giving the appearence of a map). | ||
==References== | ==References== | ||
Revision as of 21:50, 24 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
The hallmark of psoriasis is a papulosquamous, erythematous, scaly rash which can be commonly found on extensor surfaces of multiple body parts (although flexural surfaces may also be involved in inverse psoriasis). Patients with psoriasis usually give history of recent streptococcal throat infection, viral infection, immunization, use of antimalarial drugs, and trauma. The most common symptoms of psoriasis include pain, which has been described by patients as unpleasant, superficial, sensitive, itchy, hot or burning (especially in erythrodermic psoriasis and in some cases of traumatized plaques or in the joints affected by psoriatic arthritis). Patients also present with pruritus(especially in eruptive, guttate psoriasis), high fever in erythrodermic and pustular psoriasis. Other symptoms include dystrophic nails, long-term erythematous scaly rash with recent presentation of arthralgia/arthralgia without any visible skin findings, redness and tearing of eyes due to conjunctivitis or blepharitis and avoidance of situations requiring social interaction.
History
Age of onset
- Psoriasis can first appear at any age; however, a bimodal distribution of the age of onset is usually seen.
- The first peak for the development of psoriasis occurs between 20 years to 35 years and the second peak is between 40 years to 65 years of life.[1]
Family History
- Patients with early disease onset often have a positive family history of psoriasis, frequent association with histocompatibility antigen (HLA)- Cw6, and more severe disease. Those with onset after the age of 40 usually have a negative family history and a normal frequency of the HLA- Cw6 allele.[2]
Initial Presentation
- A typical patient of psoriasis will present with a history of a long-term erythematous scaly area with ocular and joint involvement depending upon the clinical subtype and chronicity of the disease. There may be multiple relapses and remissions.
Past Medical History
- Past medical history of the patient may include viral or bacterial infection, diabetes, hypertension, chronic kidney disease and/or obesity due to association of psoriasis with these conditions.[3]
Social History
- Social history of the patient may indicate smoking, excessive alcohol consumption and/or a recent stressful event if life associated with an acute exacerbation of psoriasis.[4]
Symptoms
Common Symptoms
Common symptoms of psoriasis may include the following:[5]
- A long-term history of erythematous scaly area, which may involve multiple areas of the body.
- Recent streptococcal throat infection, viral infection, immunization, use of antimalarial drug, or trauma.
- Pain, which has been described by patients as unpleasant, superficial, sensitive, itchy, hot or burning (especially in erythrodermic psoriasis and in some cases of traumatized plaques or in the joints affected by psoriatic arthritis).
- Pruritus (especially in eruptive, guttate psoriasis).
- High fever in erythrodermic and pustular psoriasis.
- Dystrophic nails.
- Long-term rash with recent presentation of arthralgia.
- Arthralgia without any visible skin findings.
- Ocular symptoms include redness and tearing due to conjunctivitis or blepharitis.
- Avoidance of situations requiring social interaction.
Less Common Symptoms
Less common symptoms of psoriasis include the following:[6][7]
- Enthesitis
- Depression leading to:
- Dactylitis
- Geographic tongue (The dorsal surface may have sharply demarcated gyrate red patches with a white to yellow border that may evolve giving the appearence of a map).
References
- ↑ Swanbeck G, Inerot A, Martinsson T, Wahlström J, Enerbäck C, Enlund F, Yhr M (1995). "Age at onset and different types of psoriasis". Br. J. Dermatol. 133 (5): 768–73. PMID 8555031.
- ↑ Naldi L, Parazzini F, Brevi A, Peserico A, Veller Fornasa C, Grosso G, Rossi E, Marinaro P, Polenghi MM, Finzi A (1992). "Family history, smoking habits, alcohol consumption and risk of psoriasis". Br. J. Dermatol. 127 (3): 212–7. PMID 1390163.
- ↑ Ni C, Chiu MW (2014). "Psoriasis and comorbidities: links and risks". Clin Cosmet Investig Dermatol. 7: 119–32. doi:10.2147/CCID.S44843. PMC 4000177. PMID 24790463.
- ↑ Naldi L, Parazzini F, Brevi A, Peserico A, Veller Fornasa C, Grosso G, Rossi E, Marinaro P, Polenghi MM, Finzi A (1992). "Family history, smoking habits, alcohol consumption and risk of psoriasis". Br. J. Dermatol. 127 (3): 212–7. PMID 1390163.
- ↑ Ljosaa TM, Rustoen T, Mörk C, Stubhaug A, Miaskowski C, Paul SM, Wahl AK (2010). "Skin pain and discomfort in psoriasis: an exploratory study of symptom prevalence and characteristics". Acta Derm. Venereol. 90 (1): 39–45. doi:10.2340/00015555-0764. PMID 20107724.
- ↑ "Psoriasis: epidemiology, natural history, and differential diagnosis | PTT".
- ↑ Kurd SK, Troxel AB, Crits-Christoph P, Gelfand JM (2010). "The risk of depression, anxiety, and suicidality in patients with psoriasis: a population-based cohort study". Arch Dermatol. 146 (8): 891–5. doi:10.1001/archdermatol.2010.186. PMC 2928071. PMID 20713823.