Psoriasis history and symptoms: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Psoriasis}} | {{Psoriasis}} | ||
{{CMG}} | {{CMG}}; {{AE}}{{HK}} | ||
==Overview== | ==Overview== | ||
The hallmark of psoriasis is a [[papulosquamous]], [[erythematous]], scaly [[rash]] which can be commonly found on [[Dorsal|extensor surfaces]] of the body. Flexural surfaces may also be involved in cases of inverse psoriasis. Patients with psoriasis usually have a history of recent [[Streptococcal pharyngitis|streptococcal throat infection]], [[viral infection]], [[immunization]], use of [[Antimalarial drug|antimalarial drugs]], or [[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) and high [[fever]] (in cases of erythrodermic and [[Pustular rash|pustular]] psoriasis). Other symptoms include dystrophic nails and long-term [[erythematous]], scaly [[rash]] with recent presentation of [[arthralgia]]/[[arthralgia]] without any visible [[skin]] findings. Other extra cutaneous symptoms include [[Erythema|redness]] and tearing of eyes due to [[conjunctivitis]] or [[blepharitis]]. Avoidance of social interactions is common among patients, especially during the active phase of the disease. | |||
==History== | ==History== | ||
=== Age of onset<ref name="pmid8555031">{{cite journal |vauthors=Swanbeck G, Inerot A, Martinsson T, Wahlström J, Enerbäck C, Enlund F, Yhr M |title=Age at onset and different types of psoriasis |journal=Br. J. Dermatol. |volume=133 |issue=5 |pages=768–73 |year=1995 |pmid=8555031 |doi= |url=}}</ref> | === Age of Onset === | ||
* Psoriasis can first appear at any age, though a bimodal distribution of the age of onset is usually observed. | |||
* The first peak for the development of psoriasis occurs between 20 years and 35 years and the second peak occurs between 40 years and 65 years of age.<ref name="pmid8555031">{{cite journal |vauthors=Swanbeck G, Inerot A, Martinsson T, Wahlström J, Enerbäck C, Enlund F, Yhr M |title=Age at onset and different types of psoriasis |journal=Br. J. Dermatol. |volume=133 |issue=5 |pages=768–73 |year=1995 |pmid=8555031 |doi= |url=}}</ref> | |||
=== Family History<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> | === 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. | |||
* Patients 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 | * A typical psoriasis patient 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<ref name="pmid24790463">{{cite journal |vauthors=Ni C, Chiu MW |title=Psoriasis and comorbidities: links and risks |journal=Clin Cosmet Investig Dermatol |volume=7 |issue= |pages=119–32 |year=2014 |pmid=24790463 |pmc=4000177 |doi=10.2147/CCID.S44843 |url=}}</ref> | === Past Medical History === | ||
* Past medical history of the patient may include [[viral]] or [[bacterial]] infection, [[Diabetes mellitus|diabetes]], [[hypertension]], [[chronic kidney disease]], and/or [[obesity]] due to association of psoriasis with these conditions.<ref name="pmid24790463">{{cite journal |vauthors=Ni C, Chiu MW |title=Psoriasis and comorbidities: links and risks |journal=Clin Cosmet Investig Dermatol |volume=7 |issue= |pages=119–32 |year=2014 |pmid=24790463 |pmc=4000177 |doi=10.2147/CCID.S44843 |url=}}</ref> | |||
=== Social History<ref name="pmid13901632">{{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> | === Social History === | ||
* Social history of the patient may indicate smoking, excessive alcohol consumption, and/or a recent stressful event if associated with an acute exacerbation of psoriasis.<ref name="pmid13901632">{{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> | |||
== Symptoms == | == Symptoms == | ||
=== Common Symptoms<ref name="pmid20107724">{{cite journal |vauthors=Ljosaa TM, Rustoen T, Mörk C, Stubhaug A, Miaskowski C, Paul SM, Wahl AK |title=Skin pain and discomfort in psoriasis: an exploratory study of symptom prevalence and characteristics |journal=Acta Derm. Venereol. |volume=90 |issue=1 |pages=39–45 |year=2010 |pmid=20107724 |doi=10.2340/00015555-0764 |url=}}</ref> | === Common Symptoms === | ||
Common symptoms of psoriasis may include the following:<ref name="pmid20107724">{{cite journal |vauthors=Ljosaa TM, Rustoen T, Mörk C, Stubhaug A, Miaskowski C, Paul SM, Wahl AK |title=Skin pain and discomfort in psoriasis: an exploratory study of symptom prevalence and characteristics |journal=Acta Derm. Venereol. |volume=90 |issue=1 |pages=39–45 |year=2010 |pmid=20107724 |doi=10.2340/00015555-0764 |url=}}</ref> | |||
* A long-term history of erythematous scaly area, which may involve multiple areas of the body | * A long-term history of [[erythematous]], scaly area, which may involve multiple areas of the body | ||
* Recent [[Streptococcal pharyngitis|streptococcal throat infection]], [[viral]] infection, [[immunization]], use of [[antimalarial drug]], or [[Physical trauma|trauma]] | |||
* 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) | ||
* 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 [[Erythema|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:<ref name="urlPsoriasis: epidemiology, natural history, and differential diagnosis | PTT">{{cite web |url=https://www.dovepress.com/psoriasis-epidemiology-natural-history-and-differential-diagnosis-peer-reviewed-article-PTT |title=Psoriasis: epidemiology, natural history, and differential diagnosis | PTT |format= |work= |accessdate=}}</ref><ref name="pmid20713823">{{cite journal |vauthors=Kurd SK, Troxel AB, Crits-Christoph P, Gelfand JM |title=The risk of depression, anxiety, and suicidality in patients with psoriasis: a population-based cohort study |journal=Arch Dermatol |volume=146 |issue=8 |pages=891–5 |year=2010 |pmid=20713823 |pmc=2928071 |doi=10.1001/archdermatol.2010.186 |url=}}</ref> | |||
* [[Enthesitis]] | |||
=== Less Common Symptoms<ref name="urlPsoriasis: epidemiology, natural history, and differential diagnosis | PTT">{{cite web |url=https://www.dovepress.com/psoriasis-epidemiology-natural-history-and-differential-diagnosis-peer-reviewed-article-PTT |title=Psoriasis: epidemiology, natural history, and differential diagnosis | PTT |format= |work= |accessdate=}}</ref><ref name="pmid20713823">{{cite journal |vauthors=Kurd SK, Troxel AB, Crits-Christoph P, Gelfand JM |title=The risk of depression, anxiety, and suicidality in patients with psoriasis: a population-based cohort study |journal=Arch Dermatol |volume=146 |issue=8 |pages=891–5 |year=2010 |pmid=20713823 |pmc=2928071 |doi=10.1001/archdermatol.2010.186 |url=}}</ref> | * [[Depression]], leading to: | ||
* Enthesitis | ** [[Insomnia]] | ||
* Depression leading to: | ** [[Decreased appetite]] | ||
** Insomnia | |||
** Decreased appetite | |||
** Guilt | ** Guilt | ||
** Loss of energy | ** [[Fatigue|Loss of energy]] | ||
** Decreased concentration | ** [[Inattention|Decreased concentration]] | ||
* Dactylitis | * [[Dactylitis]] | ||
* Geographic tongue | * [[Geographic tongue]] | ||
** The dorsal surface may have sharply demarcated gyrate red patches with a white to yellow border that may evolve, giving the appearance of a map | |||
==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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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 the body. Flexural surfaces may also be involved in cases of inverse psoriasis. Patients with psoriasis usually have a history of recent streptococcal throat infection, viral infection, immunization, use of antimalarial drugs, or 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) and high fever (in cases of erythrodermic and pustular psoriasis). Other symptoms include dystrophic nails and long-term erythematous, scaly rash with recent presentation of arthralgia/arthralgia without any visible skin findings. Other extra cutaneous symptoms include redness and tearing of eyes due to conjunctivitis or blepharitis. Avoidance of social interactions is common among patients, especially during the active phase of the disease.
History
Age of Onset
- Psoriasis can first appear at any age, though a bimodal distribution of the age of onset is usually observed.
- The first peak for the development of psoriasis occurs between 20 years and 35 years and the second peak occurs between 40 years and 65 years of age.[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.
- Patients 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 psoriasis patient 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 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 appearance 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.