Clinically, coin sized to large palm sized, well defined erythemato-squamous (red, scaly) plaques distributed bilaterally on the body are seen in psoriasis vulgaris. It is typically found on the extensor aspect of the body, the elbows, knees, scalp and lower back, although it can occur on any area of the skin. Though itching is a major symptom in most patients, for many, itching is not a prominent feature.
Loosely adherent silvery white scales of psoriasis vulgaris reveals bleeding spots when scraped off, the Auspitz sign. Psoriasis vulgaris is typically precipitated in areas of skin trauma, known as Koebner or isomorphic response.
If palm sized large lesions are more, it is called psoriasis geographica.
If coin sized predominate, we call it nummular (nummular=coin like) psoriasis.
Clinical Course of Psoriasis Vulgaris
Plaque psoriasis is usually stable and remains unchanged for longer periods than the guttate variety and is called the chronic plaque psoriasis as compared to the acute nature of the guttate psoriasis.
At times chronic plaque psoriasis may show sudden fluctuations in disease activity. It becomes more reddish, new guttate type lesions develop or become pustular or erythrodermic in type. Local treatments are not tolerated and the lesions worsen. The clinical picture is that of a combined plaque and acute guttate psoriasis.This is called progressive, unstable or restless psoriasis.
The Triggers for Plaque Psoriasis
The worsening of the scaly rashes of plaque psoriasis are usually precipitated by the sudden withdrawal of systemic corticosteroids, or local treatment with coal tar, dithranol or potent topical corticosteroids, or by hypocalcemia caused by prolonged steroid therapy, emotional upsets or foci of infection anywhere on the body.
Differential Diagnosis of Psoriasis Vulgaris
Small scaling plaques of psoriasis vulgaris has to be differentiated from seborrheic dermatitis, especially on the scalp, chest and between shoulder blades; psoriasiform drug eruptions especially caused by beta blockers, gold and methyldopa and psoriasiform secondary syphilis. Thick, chronic ring worm and mycosis fungoides, the cutaneous T cell lymphoma have to be ruled out in large plaque psoriasis.
How to Manage Psoriasis?
A number of factors will determine how to manage a patient suffering from common plaque psoriasis.
- Age of the patient: Certain medications are not suitable for young children and old age
- The stage of psoriasis: eruptive, progressive, stationary or regressive
- Its location on the body
- Its severity
- Life style of the patient
- Response to previous therapies.Any associated diseases like diabetes, HIV infection etc.
Thus management of psoriasis has to be tailored for each individual patient.
Management of psoriasis mainly involves the following areas of therapy
- Topical treatment: Creams, ointments, solutions, baths, oils.
- Phototherapyor a combination of phototherapy and medications
- Systemic treatment:A whole range of systemic medications are available for the treatment of psoriasis vulgaris, the latest addition being the biological agents.
- Life Style Management: Most dermatologists now consider psoriasis a life style disease like diabetes or hypertension. Life style management thus is an important part of management of psoriasis vulgaris.
Next: New Year Resolutions for Psoriasis Patients:Tips on Life Style Management in Psoriasis
Reference
Psoriasis, in Rook’s Textbook of Dermatology, 7th Edition, 2004
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