Psoriasis physical examination: Difference between revisions
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[[Image:PsoriasisAxilla.jpg|200px|align right|inverse psoriasis|courtesy regionalderm.net]] | [[Image:PsoriasisAxilla.jpg|200px|align right|inverse psoriasis|courtesy regionalderm.net]] | ||
===HEENT=== | ===HEENT=== | ||
*Scalp psoriasis may | *Scalp psoriasis may show raised, reddish, often scaly patches | ||
*Ophthalmoscopic exam in psoriasis may show [[uveitis]], more frequently in patients with [[arthropathy]] or pustular psoriasis | *Ophthalmoscopic exam in psoriasis may show [[uveitis]], more frequently 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 sensorineuronal hearing loss | *[[Weber test]] may show a quieter sound in the ear with the sensorineuronal hearing loss | ||
===Neck=== | ===Neck=== | ||
*[[Lymphadenopathy|Cervical lymphadenopathy]] | *[[Lymphadenopathy|Cervical lymphadenopathy]] | ||
===Lungs=== | ===Lungs=== | ||
*Psoriasis has been known to be associated with [[COPD]] | *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 because of [[COPD]] | *Expanded/barrel shaped chest because of [[COPD]] | ||
*Bilateral decreased breath sounds | *Bilateral decreased breath sounds | ||
*Bilateral wheezes | *Bilateral wheezes | ||
*[[Egophony]] absent | *[[Egophony]] absent | ||
*Reduced [[tactile fremitus]] | *Reduced [[tactile fremitus]] | ||
===Heart=== | ===Heart=== | ||
*The risk of arterial and venous vascular diseases ( | *The risk of arterial and venous vascular diseases (e.g. [[myocardial infarction]], [[thrombophlebitis]], [[Pulmonary embolism|pulmonary embolization]]) is higher in sever 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 getting [[high output cardiac failure]] to erytheroderma | *There may be a chance of getting [[high output cardiac failure]] to erytheroderma<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 === | ||
*No abdominal distention | *No abdominal distention | ||
*No abdominal tenderness | *No abdominal tenderness | ||
*No [[Hepatomegaly]]/[[splenomegaly]]/[[hepatosplenomegaly]] | *No [[Hepatomegaly]]/[[splenomegaly]]/[[hepatosplenomegaly]] | ||
==References== | ==References== | ||
Revision as of 20:33, 31 July 2017
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Psoriasis Microchapters |
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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 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 show 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 (e.g. 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.