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Diagnosing different forms of psoriasis

Psoriasis can take on a variety of forms, which include plaque, guttate, pustular, inverse and erthyrodermic. Some of these types may evolve from plaque psoriasis.

Plaque psoriasis is the most common form and it occurs in about 90% of patients.It usually begins with red scaly patches.The symptoms can range from mild to severe, covering very small or extensive areas of the body.Psoriasis is severe when 10%or more of the body surface is affected by psoriasis.

If I Had - Scaly Plaques on Elbows and Knees - Dr. Richard Langley MD, FRCPC, Dalhousie University, October 6, 2008
(video)
Guttate psoriasis is typically of abrupt onset, appearing in a few weeks, being often quite extensive. It is marked by lesions that are small and “drop-like”, which often appear on the trunk (i.e. lower back), arms, legs or scalp.  It makes up about 10% of psoriasis cases and is the second most common form. It often develops following an upper respiratory infection, namely strep throat, which acts as the trigger. Guttate psoriasis can resolve on its own without treatment, and the individual will never develop psoriasis again, or it can become recurrent throughout life. Sometimes, it can become severe and require treatment.

Pustular psoriasis is characterized by pus-filled pustules. It can be limited to certain areas of the body (localized) or widespread (generalized). If localized, the pustules are usually confined to the palms and soles of the feet. Scales gradually form as pustular lesions dry out.

Inverse psoriasis occurs in skin folds (also called “flexures”) where there tends to be pressure, friction and/or moisture or perspiration, such as between buttocks, the genitals, under breasts and armpits. These lesions are smooth and red as opposed to raised and scaling.

Erythrodermic psoriasis is a rare but serious form of disease marked primarily by widespread redness and inflammation that resembles sunburn. It can result from severe sunburn, using certain medications (i.e. oral corticosteroids, lithium) or even suddenly stopping psoriasis treatment. It can also stem from poorly controlled psoriasis. It can be life-threatening and
usually requires hospitalization, since the skin loses its ability to perform vital functions, such as controlling body temperature and protecting against infectious organisms (i.e. bacteria).

Psoriatic arthritis
This form of psoriasis, often seen as a disease in its own right, may be severe and involves inflammation, stiffness and pain within joints (arthritis) in addition to skin plaques. Psoriatic arthritis may affect up to one third of patients with psoriasis. The skin plaques and joint pain do not coincide, so a flare-up may consist of joint pain in the absence of visible lesions or vice-versa. Typically, the arthritic component develops about a decade after the skin plaques.

For more information
CDA-reviewed patient information is available at www.medbroadcast.com.Accurate medical information can also be found on the American Academy of Dermatology website at PsoriasisNet, the US National Psoriasis Foundation website www.psoriasis.org and the New Zealand Dermatological Society website dermnetnz.org.

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