Differentiating psoriasis from other diseases: Difference between revisions

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* '''Premycotic phase:''' A scaly, red [[rash]] in areas of the [[body]] that usually are not exposed to the sun. This rash does not cause symptoms and may last for months or years.
* '''Premycotic phase:''' A scaly, red [[rash]] in areas of the [[body]] that usually are not exposed to the sun. This rash does not cause symptoms and may last for months or years.
* '''Patch phase:''' Thin, reddened, [[eczema]]-like rash.
* '''Patch phase:''' Thin, [[erythematous]], [[eczema]]-like rash.
* '''[[Plaque]] phase:''' Small raised [[Bumps on skin|bumps]] ([[Papule|papules]]) or hardened [[lesions]] on the skin, which may be reddened.
* '''[[Plaque]] phase:''' Small raised [[Bumps on skin|bumps]] ([[Papule|papules]]) or hardened [[lesions]] on the skin, which may be [[erythematous]].
* '''[[Tumor]] phase:''' Tumors form on the [[skin]]. These tumors may develop [[Ulcer|ulcers]]<nowiki/> and the skin may get infected.
* '''[[Tumor]] phase:''' Tumors form on the [[skin]]. These tumors may develop [[Ulcer|ulcers]]<nowiki/> and the skin may get infected.
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* [[Insomnia]]  
* [[Insomnia]]  
* Red ([[erythematous]]) patches scattered over the [[skin]] of the [[trunk]] and the [[extremities]]  
* Red ([[erythematous]]) patches scattered over the [[skin]] of the [[trunk]] and the [[extremities]]  
* Tumor-like lobulated outgrowths form on the skin in the latter part of the disease
* Tumor-like lobulated outgrowths form on the skin in the latter phase of the disease
* [[Weight loss]]
* [[Weight loss]]
* [[Lymphadenopathy]]
* [[Lymphadenopathy]]
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* Pink or salmon in colour, which may be scaly, termed as "herald patch"
* Pink or salmon in colour, which may be scaly, termed as "herald patch"
* Oval in shape  
* Oval shape  
* Long axis oriented along the cleavage lines
* Long axis oriented along the cleavage lines
* Distributed on the [[trunk]] and [[proximal extremities]]
* Distributed on the [[trunk]] and [[proximal extremities]]
* Squamous marginal collarette and a “fir-tree” or “Christmas tree” distribution on the posterior trunk
* Squamous marginal collarette and a “fir-tree” or “Christmas tree” distribution on posterior trunk
* Develops after [[viral infection]]
* Secondary to [[viral infection]]<nowiki/>s
* Resolves spontaneously after 6-8 weeks
* Resolves spontaneously after 6-8 weeks
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* [[Malaise]]
* [[Malaise]]
* [[Myalgias]]
* [[Myalgias]]
* Skin burning
* [[Paraesthesia]]
* [[Pruritis]]
* [[Pruritis|Pruritus]]
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* Infection by any of the following:<ref name="pmid9109005">{{cite journal |vauthors=Smith KJ, Nelson A, Skelton H, Yeager J, Wagner KF |title=Pityriasis lichenoides et varioliformis acuta in HIV-1+ patients: a marker of early stage disease. The Military Medical Consortium for the Advancement of Retroviral Research (MMCARR) |journal=Int. J. Dermatol. |volume=36 |issue=2 |pages=104–9 |year=1997 |pmid=9109005 |doi= |url=}}</ref>
* Infection by any of the following:<ref name="pmid9109005">{{cite journal |vauthors=Smith KJ, Nelson A, Skelton H, Yeager J, Wagner KF |title=Pityriasis lichenoides et varioliformis acuta in HIV-1+ patients: a marker of early stage disease. The Military Medical Consortium for the Advancement of Retroviral Research (MMCARR) |journal=Int. J. Dermatol. |volume=36 |issue=2 |pages=104–9 |year=1997 |pmid=9109005 |doi= |url=}}</ref>
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* [[Lesions]] commonly relapse after occasional remission or may persist for long periods
* [[Lesions]] commonly relapse after occasional remission or may persist for long periods
* [[Pruritis]]
* [[Pruritis|Pruritus]]
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* Associated with:
* Associated with:
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* [[Sore throat]]
* [[Sore throat]]
* [[Hair loss|Patchy hair loss]]
* [[Hair loss|Patchy hair loss]]
* [[Headaches]]
* [[Headaches|Headache]]
* [[Weight loss]]
* [[Weight loss]]
* [[Myalgia]]  
* [[Myalgia]]  
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* [[Erythematous]], small, scaly plaque, which enlarges over time in an erratic manner
* [[Erythematous]], small, scaly plaque, which enlarges over time in an erratic manner
* Scale is usually yellow or white and it is easily detachable without producing any [[bleeding]]  
* Scale is usually yellow or white and it is easily detachable without any [[bleeding]]  
* Well defined margins
* Well defined margins
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* [[Pruritis]]
* [[Pruritis|Pruritus]]
* [[Pain]]
* [[Pain]]
* Bleeding [[lesions]]
* Bleeding [[lesions]]
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* [[Lesions]] may transform into [[Hyperkeratosis|hyperkeratotic]] thickened elevated purplish or reddish [[Plaque|plaques]] and [[nodules]]
* [[Lesions]] may transform into [[Hyperkeratosis|hyperkeratotic]] thickened elevated purplish or reddish [[Plaque|plaques]] and [[nodules]]
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* Chronic [[pruritis]]
* Chronic [[pruritis|pruritus]]
* Scaling
* Scaling
* May be [[asymptomatic]]
* May be [[asymptomatic]]
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* [[Flaccid]] [[pustules]] that are often generalized and have a tendency to involve the flexural areas
* [[Flaccid]] [[pustules]] that are often generalized and have a tendency to involve the flexural areas
* Have an annular configuration
* Annular configuration
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* [[Pruritis]]
* [[Pruritis|Pruritus]]
* May[[ be asymptomatic]]
* May be asymptomatic
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* Associated with:
* Associated with:
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|[[Parapsoriasis|Small plaque parapsoriasis]]<ref name="pmid7026622">{{cite journal |vauthors=Lambert WC, Everett MA |title=The nosology of parapsoriasis |journal=J. Am. Acad. Dermatol. |volume=5 |issue=4 |pages=373–95 |year=1981 |pmid=7026622 |doi= |url=}}</ref>
|[[Parapsoriasis|Small plaque parapsoriasis]]<ref name="pmid7026622">{{cite journal |vauthors=Lambert WC, Everett MA |title=The nosology of parapsoriasis |journal=J. Am. Acad. Dermatol. |volume=5 |issue=4 |pages=373–95 |year=1981 |pmid=7026622 |doi= |url=}}</ref>
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* [[Erythematous]] [[plaques]] which are covered with fine scale
* [[Erythematous]] [[plaques]] with fine scaly surface
* May present with elongated, finger-like patches symmetrically distributed on the flanks, also known as digitate dermatosis
* May present with elongated, finger-like patches
* Symmetrical distribution on the flanks
* Known as digitate dermatosis
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* [[Lesions]] may be [[asymptomatic]]  
* [[Lesions]] may be [[asymptomatic]]  
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* May be sore
* May be sore
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* [[Pruritis]]
* [[Pruritis|Pruritus]]
* Musty odor
* Musty odor
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|[[Langerhans cell histiocytosis]]<ref name="pmid18577030">{{cite journal |vauthors=Satter EK, High WA |title=Langerhans cell histiocytosis: a review of the current recommendations of the Histiocyte Society |journal=Pediatr Dermatol |volume=25 |issue=3 |pages=291–5 |year=2008 |pmid=18577030 |doi=10.1111/j.1525-1470.2008.00669.x |url=}}</ref>
|[[Langerhans cell histiocytosis]]<ref name="pmid18577030">{{cite journal |vauthors=Satter EK, High WA |title=Langerhans cell histiocytosis: a review of the current recommendations of the Histiocyte Society |journal=Pediatr Dermatol |volume=25 |issue=3 |pages=291–5 |year=2008 |pmid=18577030 |doi=10.1111/j.1525-1470.2008.00669.x |url=}}</ref>
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* Scaling and crusting of the [[scalp]]
* Scaling and crusting of [[scalp]]
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* Pathological fractures<ref name="pmid1636041">{{cite journal |vauthors=Stull MA, Kransdorf MJ, Devaney KO |title=Langerhans cell histiocytosis of bone |journal=Radiographics |volume=12 |issue=4 |pages=801–23 |year=1992 |pmid=1636041 |doi=10.1148/radiographics.12.4.1636041 |url=}}</ref>
* Pathological fractures<ref name="pmid1636041">{{cite journal |vauthors=Stull MA, Kransdorf MJ, Devaney KO |title=Langerhans cell histiocytosis of bone |journal=Radiographics |volume=12 |issue=4 |pages=801–23 |year=1992 |pmid=1636041 |doi=10.1148/radiographics.12.4.1636041 |url=}}</ref>
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* Hair loss with a black dot on scalp in case of [[tinea capitis]]
* Hair loss with a black dot on scalp in case of [[tinea capitis]]
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* [[Pruritis]]
* [[Pruritis|Pruritus]]
* [[KOH]] preparation of the [[lesions]] confirms [[fungal infection]]
* [[KOH]] preparation of the [[lesions]] confirms [[fungal infection]]
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* [[Papulosquamous]], scaly, flaky, [[itchy]], and red [[rash]] found particularly at [[sebaceous gland]]-rich areas of the body
* [[Papulosquamous]], scaly, flaky, [[itchy]], and red [[rash]] found particularly at [[sebaceous gland]]-rich areas of the body
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* [[Pruritus]]
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* Associated with:<ref name="pmid16848386">{{cite journal |vauthors=Schwartz RA, Janusz CA, Janniger CK |title=Seborrheic dermatitis: an overview |journal=Am Fam Physician |volume=74 |issue=1 |pages=125–30 |year=2006 |pmid=16848386 |doi= |url=}}</ref>
* Associated with:<ref name="pmid16848386">{{cite journal |vauthors=Schwartz RA, Janusz CA, Janniger CK |title=Seborrheic dermatitis: an overview |journal=Am Fam Physician |volume=74 |issue=1 |pages=125–30 |year=2006 |pmid=16848386 |doi= |url=}}</ref>
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=== Differential diagnosis of psoriatic arthritis ===
=== Differential diagnosis of psoriatic arthritis ===
Psoriatic arthritis must be differentiated from other diseases causing oligo/polyarthritis of the peripheral skeleton or arthritis of the [[axial skeleton]], for example:
Psoriatic arthritis must be differentiated from other diseases causing [[Oligoarthritis|oligo]]/[[polyarthritis]] or [[arthritis]] of the [[axial skeleton]], for example:
* [[Rheumatoid arthritis]]
* [[Rheumatoid arthritis]]
* Seronegative arthropathies:
* Seronegative arthropathies:
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|'''Psoriasis'''
|'''History of Psoriasis'''
|'''Symmetric [[joint]] involvement'''
|'''Symmetric [[joint]] involvement'''
|'''Asymmetric [[joint]] involvement'''
|'''Asymmetric [[joint]] involvement'''
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|'''[[Sacroiliac joint|Sacroiliac joints]]'''
|'''[[Sacroiliac joint|Sacroiliac joints]]'''
|'''[[Spine]]'''
|'''[[Spine]]'''
|'''[[Osteoporosis]]'''
|'''[[Osteopenia]]'''
|'''[[Joint]] Space'''
|'''[[Joint]] Space'''
|'''[[Ankylosis]]'''
|'''[[Ankylosis]]'''
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| -
| -
| -
| -
| -
| +
| +
| +
| +++ (Bilateral)
| +++ (Bilateral)
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| +++
| +++
| -
| -
| +
| +
| +
| -
| -
| -
| -
| -
| ++
| -
| +++
| +++
| ++ (Unilateral)
| ++ (Unilateral)

Revision as of 13:02, 7 August 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]

Overview

Psoriasis must be differentiated from other diseases that cause erythematous, scaly rash such as cutaneous T cell lymphoma/mycosis fungoides, pityriasis rosea, pityriasis rubra pilaris, pityriasis lichenoides chronica, nummular dermatitis, secondary syphilis, Bowen’s disease, exanthematous pustulosis, hypertrophic lichen planus, Sneddon–Wilkinson disease, small plaque parapsoriasis, intertrigo, Langerhans cell histiocytosis, dyshidrotic dermatitis, tinea manuum/pedum/capitis, and seborrheic dermatitis.

Differentiating psoriasis from other diseases

Differential diagnosis of psoriasis

Disease Rash Characteristics Signs and Symptoms Associated Conditions Images
Cutaneous T cell lymphoma/Mycosis fungoides[1]
  • Premycotic phase: A scaly, red rash in areas of the body that usually are not exposed to the sun. This rash does not cause symptoms and may last for months or years.
  • Patch phase: Thin, erythematous, eczema-like rash.
  • Plaque phase: Small raised bumps (papules) or hardened lesions on the skin, which may be erythematous.
  • Tumor phase: Tumors form on the skin. These tumors may develop ulcers and the skin may get infected.

Pityriasis rosea[2]
  • Pink or salmon in colour, which may be scaly, termed as "herald patch"
  • Oval shape
  • Long axis oriented along the cleavage lines
  • Distributed on the trunk and proximal extremities
  • Squamous marginal collarette and a “fir-tree” or “Christmas tree” distribution on posterior trunk
  • Secondary to viral infections
  • Resolves spontaneously after 6-8 weeks

Pityriasis lichenoides chronica
  • Recurrent lesions are usually less evenly scattered than psoriasis
  • Brownish red or orange-brown color
  • Lesions are capped by a single detachable, opaque, mica-like scale
  • Often leave hypopigmented macules

courtesy http://www.regionalderm.com

Nummular dermatitis[5]
  • Lesions commonly relapse after occasional remission or may persist for long periods
  • Pruritus

Secondary syphilis[6]
  • Round, coppery, red colored lesions on palms and soles
  • Papules with collarette of scales

Bowen’s disease[7]
  • Erythematous, small, scaly plaque, which enlarges over time in an erratic manner
  • Scale is usually yellow or white and it is easily detachable without any bleeding
  • Well defined margins

Exanthematous pustulosis[9]

Hypertrophic lichen planus[11]

Sneddon–Wilkinson disease[13]
  • Flaccid pustules that are often generalized and have a tendency to involve the flexural areas
  • Annular configuration

Small plaque parapsoriasis[17]
  • Erythematous plaques with fine scaly surface
  • May present with elongated, finger-like patches
  • Symmetrical distribution on the flanks
  • Known as digitate dermatosis
  • Lesions may be asymptomatic
  • May be mildly pruritic
  • May fade or disappear after sun exposure during the summer season, but typically recur during the winter

courtesy http://www.regionalderm.com

Intertrigo[19]

Langerhans cell histiocytosis[20]
  • Scaling and crusting of scalp

courtesy http://www.regionalderm.com

Tinea manuum/pedum/capitis[24]
  • Scaling, flaking, and sometimes blistering of the affected areas
  • Hair loss with a black dot on scalp in case of tinea capitis

Seborrheic dermatitis

Differential diagnosis of psoriatic arthritis

Psoriatic arthritis must be differentiated from other diseases causing oligo/polyarthritis or arthritis of the axial skeleton, for example:

Arthritis Type Clinical Features Body Distribution Key Signs Laboratory Abnormalities
History of Psoriasis Symmetric joint involvement Asymmetric joint involvement Enthesopathy Dactylitis Nail Dystrophy Human immunodeficiency virus association Upper extremity-hands Lower extremity Sacroiliac joints Spine Osteopenia Joint Space Ankylosis Periostitis Soft tissue swelling ESR Rheumatoid factor (RF) HLA-B27
Psoriatic arthritis + + ++ + + + + +++ (DIP/PIP) +++ ++ (Unilateral) ++ - ++ (Widening) ++ +++ (Fluffy) ++ + - 30-75%
Rheumatoid arthritis - ++ + - - - - +++

(MCP/wrist)

+++ + (Unilateral) ++(Cervical) +++ +++ (Narrowing) + + (Linear) +++ +++ +++ 6-8%
Ankylosing spondylitis - +++ - + - - - + + +++ (Bilateral) +++ +++ ++ (Narrowing) +++ +++ (Fluffy) + +++ - 90%
Reactive arthritis (Reiter's syndrome) - +++ - + + - - ++ +++ ++ (Unilateral) + + + (Narrowing) - +++ (Fluffy) ++ ++ - 75%

Key:+ : Infrequently present, ++ : Frequently present, +++ : Always present, - : Absent

References

  1. ↑ "Mycosis Fungoides and the Sézary Syndrome Treatment (PDQ®)—Patient Version - National Cancer Institute".
  2. ↑ Mahajan K, Relhan V, Relhan AK, Garg VK (2016). "Pityriasis Rosea: An Update on Etiopathogenesis and Management of Difficult Aspects". Indian J Dermatol. 61 (4): 375–84. doi:10.4103/0019-5154.185699. PMC 4966395. PMID 27512182.
  3. ↑ Prantsidis A, Rigopoulos D, Papatheodorou G, Menounos P, Gregoriou S, Alexiou-Mousatou I, Katsambas A (2009). "Detection of human herpesvirus 8 in the skin of patients with pityriasis rosea". Acta Derm. Venereol. 89 (6): 604–6. doi:10.2340/00015555-0703. PMID 19997691.
  4. ↑ Smith KJ, Nelson A, Skelton H, Yeager J, Wagner KF (1997). "Pityriasis lichenoides et varioliformis acuta in HIV-1+ patients: a marker of early stage disease. The Military Medical Consortium for the Advancement of Retroviral Research (MMCARR)". Int. J. Dermatol. 36 (2): 104–9. PMID 9109005.
  5. ↑ Jiamton S, Tangjaturonrusamee C, Kulthanan K (2013). "Clinical features and aggravating factors in nummular eczema in Thais". Asian Pac. J. Allergy Immunol. 31 (1): 36–42. PMID 23517392.
  6. ↑ "STD Facts - Syphilis".
  7. ↑ Neagu TP, Ţigliş M, Botezatu D, Enache V, Cobilinschi CO, Vâlcea-Precup MS, GrinŢescu IM (2017). "Clinical, histological and therapeutic features of Bowen's disease". Rom J Morphol Embryol. 58 (1): 33–40. PMID 28523295.
  8. ↑ Murao K, Yoshioka R, Kubo Y (2014). "Human papillomavirus infection in Bowen disease: negative p53 expression, not p16(INK4a) overexpression, is correlated with human papillomavirus-associated Bowen disease". J. Dermatol. 41 (10): 878–84. doi:10.1111/1346-8138.12613. PMID 25201325.
  9. ↑ Szatkowski J, Schwartz RA (2015). "Acute generalized exanthematous pustulosis (AGEP): A review and update". J. Am. Acad. Dermatol. 73 (5): 843–8. doi:10.1016/j.jaad.2015.07.017. PMID 26354880.
  10. ↑ Schmid S, Kuechler PC, Britschgi M, Steiner UC, Yawalkar N, Limat A, Baltensperger K, Braathen L, Pichler WJ (2002). "Acute generalized exanthematous pustulosis: role of cytotoxic T cells in pustule formation". Am. J. Pathol. 161 (6): 2079–86. doi:10.1016/S0002-9440(10)64486-0. PMC 1850901. PMID 12466124.
  11. ↑ Ankad BS, Beergouder SL (2016). "Hypertrophic lichen planus versus prurigo nodularis: a dermoscopic perspective". Dermatol Pract Concept. 6 (2): 9–15. doi:10.5826/dpc.0602a03. PMC 4866621. PMID 27222766.
  12. ↑ Shengyuan L, Songpo Y, Wen W, Wenjing T, Haitao Z, Binyou W (2009). "Hepatitis C virus and lichen planus: a reciprocal association determined by a meta-analysis". Arch Dermatol. 145 (9): 1040–7. doi:10.1001/archdermatol.2009.200. PMID 19770446.
  13. ↑ Lutz ME, Daoud MS, McEvoy MT, Gibson LE (1998). "Subcorneal pustular dermatosis: a clinical study of ten patients". Cutis. 61 (4): 203–8. PMID 9564592.
  14. ↑ Kasha EE, Epinette WW (1988). "Subcorneal pustular dermatosis (Sneddon-Wilkinson disease) in association with a monoclonal IgA gammopathy: a report and review of the literature". J. Am. Acad. Dermatol. 19 (5 Pt 1): 854–8. PMID 3056995.
  15. ↑ Delaporte E, Colombel JF, Nguyen-Mailfer C, Piette F, Cortot A, Bergoend H (1992). "Subcorneal pustular dermatosis in a patient with Crohn's disease". Acta Derm. Venereol. 72 (4): 301–2. PMID 1357895.
  16. ↑ Sauder MB, Glassman SJ (2013). "Palmoplantar subcorneal pustular dermatosis following adalimumab therapy for rheumatoid arthritis". Int. J. Dermatol. 52 (5): 624–8. doi:10.1111/j.1365-4632.2012.05707.x. PMID 23489057.
  17. ↑ Lambert WC, Everett MA (1981). "The nosology of parapsoriasis". J. Am. Acad. Dermatol. 5 (4): 373–95. PMID 7026622.
  18. ↑ Väkevä L, Sarna S, Vaalasti A, Pukkala E, Kariniemi AL, Ranki A (2005). "A retrospective study of the probability of the evolution of parapsoriasis en plaques into mycosis fungoides". Acta Derm. Venereol. 85 (4): 318–23. doi:10.1080/00015550510030087. PMID 16191852.
  19. ↑ Janniger CK, Schwartz RA, Szepietowski JC, Reich A (2005). "Intertrigo and common secondary skin infections". Am Fam Physician. 72 (5): 833–8. PMID 16156342.
  20. ↑ Satter EK, High WA (2008). "Langerhans cell histiocytosis: a review of the current recommendations of the Histiocyte Society". Pediatr Dermatol. 25 (3): 291–5. doi:10.1111/j.1525-1470.2008.00669.x. PMID 18577030.
  21. ↑ Stull MA, Kransdorf MJ, Devaney KO (1992). "Langerhans cell histiocytosis of bone". Radiographics. 12 (4): 801–23. doi:10.1148/radiographics.12.4.1636041. PMID 1636041.
  22. ↑ Sholl LM, Hornick JL, Pinkus JL, Pinkus GS, Padera RF (2007). "Immunohistochemical analysis of langerin in langerhans cell histiocytosis and pulmonary inflammatory and infectious diseases". Am. J. Surg. Pathol. 31 (6): 947–52. doi:10.1097/01.pas.0000249443.82971.bb. PMID 17527085.
  23. ↑ Grois N, Pötschger U, Prosch H, Minkov M, Arico M, Braier J, Henter JI, Janka-Schaub G, Ladisch S, Ritter J, Steiner M, Unger E, Gadner H (2006). "Risk factors for diabetes insipidus in langerhans cell histiocytosis". Pediatr Blood Cancer. 46 (2): 228–33. doi:10.1002/pbc.20425. PMID 16047354.
  24. ↑ Al Hasan M, Fitzgerald SM, Saoudian M, Krishnaswamy G (2004). "Dermatology for the practicing allergist: Tinea pedis and its complications". Clin Mol Allergy. 2 (1): 5. doi:10.1186/1476-7961-2-5. PMC 419368. PMID 15050029.
  25. ↑ Schwartz RA, Janusz CA, Janniger CK (2006). "Seborrheic dermatitis: an overview". Am Fam Physician. 74 (1): 125–30. PMID 16848386.
  26. ↑ Misery L, Touboul S, Vinçot C, Dutray S, Rolland-Jacob G, Consoli SG, Farcet Y, Feton-Danou N, Cardinaud F, Callot V, De La Chapelle C, Pomey-Rey D, Consoli SM (2007). "[Stress and seborrheic dermatitis]". Ann Dermatol Venereol (in French). 134 (11): 833–7. PMID 18033062.

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