Psoriasis physical examination: Difference between revisions
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__NOTOC__{{Psoriasis}} | __NOTOC__{{Psoriasis}} | ||
{{CMG}}; {{AE}} {{HK}} {{KS}} | {{CMG}}; {{AE}} {{HK}}, {{KS}} | ||
==Overview== | ==Overview== | ||
Common physical examination findings of psoriasis include [[erythematous]], scaling [[papules]] and [[plaques]]. | Common physical examination findings of psoriasis include [[erythematous]], scaling [[papules]], and [[plaques]]. | ||
==Physical Examination== | ==Physical Examination== | ||
===Appearance of the | ===Appearance of the patient=== | ||
*Patient may | *Patient may appear distressed and [[anxious]] | ||
===Vital signs=== | ===Vital signs=== | ||
*[[Fever|High-grade fever]] with generalized pustular psoriasis<ref name="pmid12677433">{{cite journal |vauthors=Iizuka H, Takahashi H, Ishida-Yamamoto A |title=Pathophysiology of generalized pustular psoriasis |journal=Arch. Dermatol. Res. |volume=295 Suppl 1 |issue= |pages=S55–9 |year=2003 |pmid=12677433 |doi=10.1007/s00403-002-0372-5 |url= |issn=}}</ref> | *[[Fever|High-grade fever]] with generalized pustular psoriasis<ref name="pmid12677433">{{cite journal |vauthors=Iizuka H, Takahashi H, Ishida-Yamamoto A |title=Pathophysiology of generalized pustular psoriasis |journal=Arch. Dermatol. Res. |volume=295 Suppl 1 |issue= |pages=S55–9 |year=2003 |pmid=12677433 |doi=10.1007/s00403-002-0372-5 |url= |issn=}}</ref> | ||
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*Kussmaul respirations may be present in patients with comorbid [[diabetes]] and [[DKA]] | *Kussmaul respirations may be present in patients with comorbid [[diabetes]] and [[DKA]] | ||
===Skin=== | ===Skin=== | ||
* A [[diagnosis]] of psoriasis is usually based on the [[skin]] | * A [[diagnosis]] of psoriasis is usually based on the appearance of the [[skin]] | ||
** | ** A skin [[biopsy]], or scraping, may be necessary to rule out other disorders and confirm a diagnosis of psoriasis | ||
** Skin from a biopsy may show [[Clubbing|clubbed]] [[rete pegs]] | ** Skin from a biopsy may show [[Clubbing|clubbed]] [[rete pegs]] | ||
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*Auspitz’s sign: Small [[bleeding]] points seen upon disruption of a psoriatic scale | *Auspitz’s sign: Small [[bleeding]] points seen upon disruption of a psoriatic scale | ||
<gallery> | <gallery> | ||
Image:Psoriahair.jpg|200px|left|frame|'''Scalp psoriasis''', courtesy of regionalderm.net | |||
Image:Extremity_psoriasis.jpg|200px|left|frame|'''Extremity psoriasis(guttate variety)''', courtesy of regionalderm.net | |||
Image:Trunkpsor.jpg|200px|left|frame|'''Trunk psoriasis''', courtesy of regionalderm.net | |||
Image:Psoriasis_face.jpg|500px|left|frame|'''Face psoriasis''', courtesy of https://aloeworldnorfolk.wordpress.com/tag/psoriasis/ | |||
Image:Nail_psoriasis01.jpg|200px|left|frame|'''Nails showing pitting, crumbling and brittleness''', courtesy of http://www.atlasdermatologico.com.br/ | |||
Image:PsoriasisAxilla.jpg|200px|left|frame|'''Inverse psoriasis''', courtesy of regionalderm.net | |||
</gallery> | </gallery> | ||
===HEENT=== | ===HEENT=== | ||
*Scalp psoriasis may | *Scalp psoriasis may manifest as raised, reddish, often scaly patches | ||
*Ophthalmoscopic exam in psoriasis may show [[uveitis]], | *Ophthalmoscopic exam in psoriasis may show [[uveitis]], most commonly in patients with [[arthropathy]] or pustular psoriasis<ref name="pmid23197207">{{cite journal |vauthors=Fraga NA, Oliveira Mde F, Follador I, Rocha Bde O, Rêgo VR |title=Psoriasis and uveitis: a literature review |journal=An Bras Dermatol |volume=87 |issue=6 |pages=877–83 |year=2012 |pmid=23197207 |pmc=3699904 |doi= |url= |issn=}}</ref> | ||
*[[Sensorineural hearing loss]] associated with [[psoriatic arthritis]] | *[[Sensorineural hearing loss]] associated with [[psoriatic arthritis]] | ||
*[[Rinne test]] may be negative (abnormal) | *[[Rinne test]] may be negative (abnormal) | ||
*[[Weber test]] may show a quieter sound in the ear with the [[sensorineural hearing loss]] | *[[Weber test]] may show a quieter sound in the ear with the [[sensorineural hearing loss]] | ||
===Neck=== | ===Neck=== | ||
*[[Lymphadenopathy|Cervical lymphadenopathy]] | *[[Lymphadenopathy|Cervical lymphadenopathy]] | ||
===Lungs=== | ===Lungs=== | ||
*Psoriasis has been known to be associated with [[COPD]]<ref name="pmid18637897">{{cite journal |vauthors=Dreiher J, Weitzman D, Shapiro J, Davidovici B, Cohen AD |title=Psoriasis and chronic obstructive pulmonary disease: a case-control study |journal=Br. J. Dermatol. |volume=159 |issue=4 |pages=956–60 |year=2008 |pmid=18637897 |doi=10.1111/j.1365-2133.2008.08749.x |url=}}</ref> | *Psoriasis has been known to be associated with [[COPD]]<ref name="pmid18637897">{{cite journal |vauthors=Dreiher J, Weitzman D, Shapiro J, Davidovici B, Cohen AD |title=Psoriasis and chronic obstructive pulmonary disease: a case-control study |journal=Br. J. Dermatol. |volume=159 |issue=4 |pages=956–60 |year=2008 |pmid=18637897 |doi=10.1111/j.1365-2133.2008.08749.x |url=}}</ref> | ||
*Expanded/barrel shaped chest | *Expanded/barrel shaped chest secondary to [[COPD]] | ||
*Bilateral decreased breath sounds | *Bilateral decreased breath sounds | ||
*Bilateral wheezes | *Bilateral wheezes | ||
*Reduced [[tactile fremitus]] | *Reduced [[tactile fremitus]] | ||
===Heart=== | ===Heart=== | ||
*The risk of arterial and venous vascular diseases (e.g. [[myocardial infarction]], [[thrombophlebitis]], [[Pulmonary embolism|pulmonary embolization]]) is higher in severe psoriasis involving multiple areas of the body.<ref name="pmid17433490">{{cite journal |vauthors=Kremers HM, McEvoy MT, Dann FJ, Gabriel SE |title=Heart disease in psoriasis |journal=J. Am. Acad. Dermatol. |volume=57 |issue=2 |pages=347–54 |year=2007 |pmid=17433490 |doi=10.1016/j.jaad.2007.02.007 |url=}}</ref> | *The risk of arterial and venous vascular diseases (e.g. [[myocardial infarction]], [[thrombophlebitis]], [[Pulmonary embolism|pulmonary embolization]]) is higher in severe psoriasis involving multiple areas of the body.<ref name="pmid17433490">{{cite journal |vauthors=Kremers HM, McEvoy MT, Dann FJ, Gabriel SE |title=Heart disease in psoriasis |journal=J. Am. Acad. Dermatol. |volume=57 |issue=2 |pages=347–54 |year=2007 |pmid=17433490 |doi=10.1016/j.jaad.2007.02.007 |url=}}</ref> | ||
*There may be a chance of | *There may be a chance of [[high output cardiac failure]] due to [[erythroderma]].<ref name="pmid17433490">{{cite journal |vauthors=Kremers HM, McEvoy MT, Dann FJ, Gabriel SE |title=Heart disease in psoriasis |journal=J. Am. Acad. Dermatol. |volume=57 |issue=2 |pages=347–54 |year=2007 |pmid=17433490 |doi=10.1016/j.jaad.2007.02.007 |url=}}</ref> | ||
=== Abdomen === | === Abdomen === | ||
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==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Dermatology]] | [[Category:Dermatology]] | ||
Latest revision as of 23:52, 29 July 2020
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Psoriasis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Psoriasis physical examination On the Web |
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American Roentgen Ray Society Images of Psoriasis physical examination |
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Risk calculators and risk factors for Psoriasis physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2], Kiran Singh, M.D. [3]
Overview
Common physical examination findings of psoriasis include erythematous, scaling papules, and plaques.
Physical Examination
Appearance of the patient
- Patient may appear distressed and anxious
Vital signs
- High-grade fever with generalized pustular psoriasis[1]
- Tachycardia with regular pulse[1]
- Tachypnea
- Kussmaul respirations may be present in patients with comorbid diabetes and DKA
Skin
- Papulosquamous disease with variable morphology, distribution, severity, and course
- Scaly papules and plaques
- Koebner phenomenon: Appearance of new psoriatic lesions at the site of skin injury
- Woronoff’s ring: Ring of peripheral blanching skin around a psoriatic plaque
- Auspitz’s sign: Small bleeding points seen upon disruption of a psoriatic scale
-
Scalp psoriasis, courtesy of regionalderm.net -
Extremity psoriasis(guttate variety), courtesy of regionalderm.net -
Trunk psoriasis, courtesy of regionalderm.net -
Face psoriasis, courtesy of https://aloeworldnorfolk.wordpress.com/tag/psoriasis/ -
Nails showing pitting, crumbling and brittleness, courtesy of http://www.atlasdermatologico.com.br/ -
Inverse psoriasis, courtesy of regionalderm.net
HEENT
- Scalp psoriasis may manifest as raised, reddish, often scaly patches
- Ophthalmoscopic exam in psoriasis may show uveitis, most commonly in patients with arthropathy or pustular psoriasis[2]
- Sensorineural hearing loss associated with psoriatic arthritis
- Rinne test may be negative (abnormal)
- Weber test may show a quieter sound in the ear with the sensorineural hearing loss
Neck
Lungs
- Psoriasis has been known to be associated with COPD[3]
- Expanded/barrel shaped chest secondary to COPD
- Bilateral decreased breath sounds
- Bilateral wheezes
- Reduced tactile fremitus
Heart
- The risk of arterial and venous vascular diseases (e.g. myocardial infarction, thrombophlebitis, pulmonary embolization) is higher in severe psoriasis involving multiple areas of the body.[4]
- There may be a chance of high output cardiac failure due to erythroderma.[4]
Abdomen
- No abdominal distention
- No abdominal tenderness
- No hepatomegaly/splenomegaly/hepatosplenomegaly
References
- ↑ 1.0 1.1 Iizuka H, Takahashi H, Ishida-Yamamoto A (2003). "Pathophysiology of generalized pustular psoriasis". Arch. Dermatol. Res. 295 Suppl 1: S55–9. doi:10.1007/s00403-002-0372-5. PMID 12677433.
- ↑ Fraga NA, Oliveira Mde F, Follador I, Rocha Bde O, Rêgo VR (2012). "Psoriasis and uveitis: a literature review". An Bras Dermatol. 87 (6): 877–83. PMC 3699904. PMID 23197207.
- ↑ Dreiher J, Weitzman D, Shapiro J, Davidovici B, Cohen AD (2008). "Psoriasis and chronic obstructive pulmonary disease: a case-control study". Br. J. Dermatol. 159 (4): 956–60. doi:10.1111/j.1365-2133.2008.08749.x. PMID 18637897.
- ↑ 4.0 4.1 Kremers HM, McEvoy MT, Dann FJ, Gabriel SE (2007). "Heart disease in psoriasis". J. Am. Acad. Dermatol. 57 (2): 347–54. doi:10.1016/j.jaad.2007.02.007. PMID 17433490.