Psoriasis physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Common physical examination findings of psoraisis include [[erythematous]], scaling [[papules]] and [[plaques]] on the skin. | Common physical examination findings of psoraisis include [[erythematous]], scaling [[papules]] and [[plaques]] on the [[skin]]. | ||
==Physical Examination== | ==Physical Examination== | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*Patient with psoriasis may look distressed and anxious. | *Patient with psoriasis may look distressed and [[anxious]]. | ||
===Vital signs=== | ===Vital signs=== | ||
*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> | *[[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.<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.<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 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> | *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 the appearance of the skin. There are no special blood tests or diagnostic procedures for psoriasis. Sometimes a skin [[biopsy]], or scraping, may be needed to rule out other disorders and to confirm the diagnosis. Skin from a biopsy will show clubbed [[rete pegs]] if positive for psoriasis. | * A [[diagnosis]] of psoriasis is usually based on the appearance of the [[skin]]. There are no special [[blood]] tests or diagnostic procedures for psoriasis. Sometimes a skin [[biopsy]], or scraping, may be needed to rule out other disorders and to confirm the diagnosis. Skin from a biopsy will show [[Clubbing|clubbed]] [[rete pegs]] if positive for psoriasis. | ||
* Psoriasis is a [[Papulosquamous disorder|papulosquamous]] disease with variable morphology, distribution, severity, and course. | * Psoriasis is a [[Papulosquamous disorder|papulosquamous]] [[disease]] with variable morphology, distribution, severity, and course. | ||
* It is characterized by scaling [[Papule|papules]] and [[Plaque|plaques]]. | * It is characterized by 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]] | ||
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===HEENT=== | ===HEENT=== | ||
*Scalp psoriasis may cause raised, reddish, often scaly patches. | *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.<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> | *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=== | ||
*Cervical | *[[Lymphadenopathy|Cervical lymphadenopathy]] | ||
===Lungs=== | ===Lungs=== | ||
*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> | *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> | ||
*Exapnded/barrel shaped chest because of COPD. | *Exapnded/barrel shaped chest because of COPD. | ||
*Bilateral decresed breath sounds. | *Bilateral decresed 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 (eg, myocardial infarction, thrombophlebitis, 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> | *The risk of arterial and venous vascular diseases (eg, [[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 | *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 21:55, 24 July 2017
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Psoriasis physical examination On the Web |
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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
- A diagnosis of psoriasis is usually based on the appearance of the skin. There are no special blood tests or diagnostic procedures for psoriasis. Sometimes a skin biopsy, or scraping, may be needed to rule out other disorders and to confirm the diagnosis. Skin from a biopsy will show clubbed rete pegs if positive for psoriasis.
- Psoriasis is a papulosquamous disease with variable morphology, distribution, severity, and course.
- It is characterized by 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]
- Exapnded/barrel shaped chest because of COPD.
- Bilateral decresed 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.