Psoriasis physical examination: Difference between revisions
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*Patient with psoriasis may look distressed and [[anxious]]. | *Patient with psoriasis may look distressed and [[anxious]]. | ||
===Vital signs=== | ===Vital signs=== | ||
*[[Fever|High-grade fever]] with generalized pustular psoriasis | *[[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> | ||
*[[Tachycardia]] with regular pulse | *[[Tachycardia]] with regular pulse<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> | ||
*[[Tachypnea]] | *[[Tachypnea]] | ||
*Kussmal respirations may be present in patients with comorbid [[diabetes]] and [[DKA]] | *Kussmal respirations may be present in patients with comorbid [[diabetes]] and [[DKA]] | ||
*High-output [[Congestive heart failure|cardiac failure]] in [[erythroderma]] | *High-output [[Congestive heart failure|cardiac failure]] in [[erythroderma]]<ref name="pmid14245176">{{cite journal |vauthors=FOX RH, SHUSTER S, WILLIAMS R, MARKS J, GOLDSMITH R, CONDON RE |title=CARDIOVASCULAR, METABOLIC, AND THERMOREGULATORY DISTURBANCES IN PATIENTS WITH ERYTHRODERMIC SKIN DISEASES |journal=Br Med J |volume=1 |issue=5435 |pages=619–22 |year=1965 |pmid=14245176 |pmc=2165960 |doi= |url= |issn=}}</ref> | ||
===Skin=== | ===Skin=== | ||
* A [[diagnosis]] of psoriasis is usually based on | * A [[diagnosis]] of psoriasis is usually based on the [[skin]] appearance | ||
** Sometimes a skin [[biopsy]], or scraping, may be needed to rule out other disorders and to confirm psoriasis | |||
** Skin from a biopsy may show [[Clubbing|clubbed]] [[rete pegs]] | |||
* | * [[Papulosquamous disorder|Papulosquamous]] [[disease]] with variable morphology, distribution, severity, and course | ||
* | * Scaling [[Papule|papules]] and [[Plaque|plaques]] | ||
*[[Koebner phenomenon]]: Appearance of new psoriatic lesions at the site of skin injury | *[[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]] | *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 | *Auspitz’s sign: Small [[bleeding]] points seen upon disruption of a psoriatic scale | ||
<gallery> | <gallery> | ||
[[Image:Psoriasis (uv light, steroids, keratolytics).jpg|thumb|400px|left]] | [[Image:Psoriasis (uv light, steroids, keratolytics).jpg|thumb|400px|left]] | ||
Revision as of 20:25, 31 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] Kiran Singh, M.D. [3]
Overview
Common physical examination findings of psoraisis include erythematous, scaling papules and plaques on the skin.
Physical Examination
Appearance of the Patient
- Patient with psoriasis may look distressed and anxious.
Vital signs
- High-grade fever with generalized pustular psoriasis[1]
- Tachycardia with regular pulse[1]
- Tachypnea
- Kussmal respirations may be present in patients with comorbid diabetes and DKA
- High-output cardiac failure in erythroderma[2]
Skin
- Papulosquamous disease with variable morphology, distribution, severity, and course
- Scaling 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
Extremities
Trunk
Face
Nail Psoriasis
Inverse Psoriasis
HEENT
- Scalp psoriasis may cause raised, reddish, often scaly patches.
- Ophthalmoscopic exam in psoriasis may show uveitis, more frequently in patients with arthropathy or pustular psoriasis.[3]
- 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 sensorineuronal hearing loss.
Neck
Lungs
- Psoriasis has been known to be associated with COPD.[4]
- Expanded/barrel shaped chest because of COPD.
- Bilateral decreased breath sounds.
- Bilateral wheezes.
- Egophony absent.
- Reduced tactile fremitus.
Heart
- The risk of arterial and venous vascular diseases (eg, myocardial infarction, thrombophlebitis, pulmonary embolization) is higher in sever psoriasis involving multiple areas of the body.[5]
- There may be a chance of getting high output cardiac failure to erytheroderma.[5]
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.
- ↑ FOX RH, SHUSTER S, WILLIAMS R, MARKS J, GOLDSMITH R, CONDON RE (1965). "CARDIOVASCULAR, METABOLIC, AND THERMOREGULATORY DISTURBANCES IN PATIENTS WITH ERYTHRODERMIC SKIN DISEASES". Br Med J. 1 (5435): 619–22. PMC 2165960. PMID 14245176.
- ↑ 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.
- ↑ 5.0 5.1 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.