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==Classification== | ==Classification== | ||
Psoriasis can be classified according to clinical appearence, morphology and localization. | |||
*The International Psoriasis Council, identifies four main forms of psoriasis: | |||
**Plaque-type psoriasis | |||
**Guttate psoriasis | |||
**Generalized Pustular Psoriasis (GPP) | |||
**Erythroderma | |||
Several further subphenotypes have been named according to distribution (localized vs. widespread), anatomical localization (flexural, scalp, palms/soles/nail), size (large vs. small) and thickness (thick vs. thin) of plaques, onset (early vs. late), and disease activity (active vs. stable). | |||
===Plaque-type Psoriasis=== | |||
*Plaque-type psoriasis is the most common form of psoriasis affecting patients. | |||
*It is characterized by oval or irregularly shaped, red, sharply demarcated, raised plaques covered by silvery scales. | |||
*Plaques occur usually on the extensor surface of elbows and knees, on the scalp, and on the lower back, but can affect almost any area of the body. | |||
*Large plaques are >3cm in size and small scales are <3cm is size. | |||
===Guttate Psoriasis=== | |||
*Guttate psoriasis is characterized by multiple, small, drop-shaped, scaly plaques usually occurring around the trunk and upper extremities and thighs. | |||
*It is sudden onset, usually occurs within 2–4 wk after a bacterial infection of the upper ways, notably streptococcal pharyngitis in children and adolescents. | |||
*Lesions can either resolve spontaneously or progress to plaque-type psoriasis. | |||
===Generalized pustular psoriasis=== | |||
*Generalized pustular psoriasis is a relatively rare form of psoriasis but can be potentially life-threatening. | |||
*It is characterized by episodic, widespread skin and systemic inflammation. Typical histological feature of GPP is the presence of prominent aggregates of neutrophils infiltrating the stratum spinosum (spongiform pustules of Kogoj) and giving rise to sterile cutaneous pustules | |||
Psoriasis is a chronic relapsing disease of the skin, which may be classified into nonpustular and [[pustule|pustular]] types as follows<ref name="Fitz2">Freedberg, et. al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed.). McGraw-Hill. ISBN 0071380760.</ref>: | Psoriasis is a chronic relapsing disease of the skin, which may be classified into nonpustular and [[pustule|pustular]] types as follows<ref name="Fitz2">Freedberg, et. al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed.). McGraw-Hill. ISBN 0071380760.</ref>: | ||
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Image:Pustular psoriasis01.jpg|Pustular psoriasis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL> | Image:Pustular psoriasis01.jpg|Pustular psoriasis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL> | ||
* Nail psoriasis (L40.86) produces a variety of changes in the appearance of finger and toe nails. These changes include discolouring under the nail plate, pitting of the nails, lines going across the nails, thickening of the skin under the nail, and the loosening (onycholysis) and crumbling of the nail. | * Nail psoriasis (L40.86) produces a variety of changes in the appearance of finger and toe nails. These changes include discolouring under the nail plate, pitting of the nails, lines going across the nails, thickening of the skin under the nail, and the loosening (onycholysis) and crumbling of the nail. | ||
Revision as of 16:28, 12 June 2017
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Risk calculators and risk factors for Psoriasis classification |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]
Classification
Psoriasis can be classified according to clinical appearence, morphology and localization.
- The International Psoriasis Council, identifies four main forms of psoriasis:
- Plaque-type psoriasis
- Guttate psoriasis
- Generalized Pustular Psoriasis (GPP)
- Erythroderma
Several further subphenotypes have been named according to distribution (localized vs. widespread), anatomical localization (flexural, scalp, palms/soles/nail), size (large vs. small) and thickness (thick vs. thin) of plaques, onset (early vs. late), and disease activity (active vs. stable).
Plaque-type Psoriasis
- Plaque-type psoriasis is the most common form of psoriasis affecting patients.
- It is characterized by oval or irregularly shaped, red, sharply demarcated, raised plaques covered by silvery scales.
- Plaques occur usually on the extensor surface of elbows and knees, on the scalp, and on the lower back, but can affect almost any area of the body.
- Large plaques are >3cm in size and small scales are <3cm is size.
Guttate Psoriasis
- Guttate psoriasis is characterized by multiple, small, drop-shaped, scaly plaques usually occurring around the trunk and upper extremities and thighs.
- It is sudden onset, usually occurs within 2–4 wk after a bacterial infection of the upper ways, notably streptococcal pharyngitis in children and adolescents.
- Lesions can either resolve spontaneously or progress to plaque-type psoriasis.
Generalized pustular psoriasis
- Generalized pustular psoriasis is a relatively rare form of psoriasis but can be potentially life-threatening.
- It is characterized by episodic, widespread skin and systemic inflammation. Typical histological feature of GPP is the presence of prominent aggregates of neutrophils infiltrating the stratum spinosum (spongiform pustules of Kogoj) and giving rise to sterile cutaneous pustules
Psoriasis is a chronic relapsing disease of the skin, which may be classified into nonpustular and pustular types as follows[1]:
- Nonpustular psoriasis
- Psoriasis vulgaris (Chronic stationary psoriasis, Plaque-like psoriasis)
- Psoriatic erythroderma (Erythrodermic psoriasis)
- Pustular psoriasis
- Generalized pustular psoriasis (Pustular psoriasis of von Zumbusch)
- Pustulosis palmaris et plantaris (Persistent palmoplantar pustulosis, Pustular psoriasis of the Barber type, Pustular psoriasis of the extremities)
- Annular pustular psoriasis
- Acrodermatitis continua
- Impetigo herpetiformis
Additional types of psoriasis include[2]:
Types of Psoriasis
The symptoms of psoriasis can manifest in a variety of forms. Variants include plaque, pustular, guttate and flexural psoriasis. This section describes each type.[3]
- Plaque psoriasis (psoriasis vulgaris) (L40.0) is the most common form of psoriasis. It affects 80 to 90% of people with psoriasis. Plaque psoriasis typically appears as raised areas of inflamed skin covered with silvery white scaly skin. These areas are called plaques.
- Flexural psoriasis (inverse psoriasis) (L40.83-4) appears as smooth inflamed patches of skin. It occurs in skin folds, particularly around the genitals (between the thigh and groin), the armpits, under an overweight stomach (pannus), and under the breasts (inframammary fold). It is aggravated by friction and sweat, and is vulnerable to fungal infections.
- Guttate psoriasis (L40.4) is characterized by numerous small oval (teardrop-shaped) spots. These numerous spots of psoriasis appear over large areas of the body, such as the trunk, limbs, and scalp. Guttate psoriasis is associated with streptococcal throat infection.
- Pustular psoriasis (L40.1-3, L40.82) appears as raised bumps that are filled with non-infectious pus (pustules). The skin under and surrounding pustules is red and tender. Pustular psoriasis can be localised, commonly to the hands and feet (palmoplantar pustulosis), or generalised with widespread patches occurring randomly on any part of the body.
Trunk
-
![Pustular psoriasis. Adapted from Dermatology Atlas.[4]](/images/b/b2/Pustular_psoriasis01.jpg)
Pustular psoriasis. Adapted from Dermatology Atlas.[4] -
Photograph of an arm covered with plaque psoriasis. -
Psoriasis nail pitting
![Pustular psoriasis. Adapted from Dermatology Atlas.[4]](/index.php/File:Pustular_psoriasis01.jpg)
Severity
Psoriasis is usually graded as mild (affecting less than 3% of the body), moderate (affecting 3-10% of the body) or severe. Several scales exist for measuring the severity of psoriasis.
The degree of severity is generally based on the following factors: the proportion of body surface area affected; disease activity (degree of plaque redness, thickness and scaling); response to previous therapies; and the impact of the disease on the person.
The Psoriasis Area Severity Index (PASI) is the most widely used measurement tool for psoriasis. PASI combines the assessment of the severity of lesions and the area affected into a single score in the range 0 (no disease) to 72 (maximal disease).[5]
Nevertheless, the PASI can be too unwieldy to use outside of trials, which has led to attempts to simplify the index for clinical use.[6]
References
- ↑ Freedberg, et. al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0071380760.
- ↑ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0721629210.
- ↑ "Application to dermatology of International Classification of Disease (ICD-10) - ICD sorted by code: L40.000 - L41.000", The International League of Dermatological Societies
- ↑ "Dermatology Atlas".
- ↑ "Psoriasis Update -Skin & Aging". Retrieved 2007-07-28.
- ↑ Louden BA, Pearce DJ, Lang W, Feldman SR (2004). "A Simplified Psoriasis Area Severity Index (SPASI) for rating psoriasis severity in clinic patients". Dermatol. Online J. 10 (2): 7. PMID 15530297.