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==Overview==
==Overview==
Psoriasis must be differentiated from other diseases that cause [[erythematous]], scaly [[Rash erythematous|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]], [[Lichen planus|hypertrophic lichen planus]], Sneddon–Wilkinson disease, [[Parapsoriasis|small plaque parapsoriasis]], [[intertrigo]], [[Langerhans cell histiocytosis]], [[dyshidrotic dermatitis]], [[tinea manuum]]/pedum/[[Tinea capitis|capitis]], and [[seborrheic dermatitis]].
Psoriasis must be differentiated from other diseases that cause an [[erythematous]], scaly [[Rash erythematous|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]], [[Lichen planus|hypertrophic lichen planus]], Sneddon–Wilkinson disease, [[Parapsoriasis|small plaque parapsoriasis]], [[intertrigo]], [[Langerhans cell histiocytosis]], [[dyshidrotic dermatitis]], [[tinea manuum]]/pedum/[[Tinea capitis|capitis]], and [[seborrheic dermatitis]].


==Differentiating psoriasis from other diseases==
==Differentiating psoriasis from other diseases==


=== Differential diagnosis of psoriasis ===
=== Differential diagnosis of psoriasis ===
*Psoriasis must be differentiated from other diseases causing [[Papulosquamous disorder|papulosquamous]] or [[Erythematous rash|erythematosquamous rash]], especially when the psoriatic [[lesions]] are localized in particular sites as [[Palms of the hands|palms]], [[soles]], [[scalp]], body folds, [[penis]], and [[Nail (anatomy)|nails]].
*Psoriasis must be differentiated from other diseases that cause [[Papulosquamous disorder|papulosquamous]] or [[Erythematous rash|erythematosquamous rash]], especially when the psoriatic [[lesions]] are localized in such sites as the [[Palms of the hands|palms]], [[soles]], [[scalp]], body folds, [[penis]], and [[Nail (anatomy)|nails]].
*The differential diagnosis of psoriasis includes:
*Psoriasis must be differentiated from the following diseases:
**[[Cutaneous T cell lymphoma]]/[[mycosis fungoides]]
**[[Cutaneous T cell lymphoma]]/[[mycosis fungoides]]
**[[Pityriasis rosea]]
**[[Pityriasis rosea]]
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* [[Malaise]] and [[fatigue]]
* [[Malaise]] and [[fatigue]]
* [[Anemia]]
* [[Anemia]]
* May progress to [[Sezary syndrome]] (Skin involvement plus hematogenous dissemination)
* May progress to [[Sezary syndrome]] (skin involvement plus hematogenous dissemination)
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|
* [[Sezary syndrome]]
* [[Sezary syndrome]]
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|[[Pityriasis rosea]]<ref name="pmid27512182">{{cite journal |vauthors=Mahajan K, Relhan V, Relhan AK, Garg VK |title=Pityriasis Rosea: An Update on Etiopathogenesis and Management of Difficult Aspects |journal=Indian J Dermatol |volume=61 |issue=4 |pages=375–84 |year=2016 |pmid=27512182 |pmc=4966395 |doi=10.4103/0019-5154.185699 |url=}}</ref>
|[[Pityriasis rosea]]<ref name="pmid27512182">{{cite journal |vauthors=Mahajan K, Relhan V, Relhan AK, Garg VK |title=Pityriasis Rosea: An Update on Etiopathogenesis and Management of Difficult Aspects |journal=Indian J Dermatol |volume=61 |issue=4 |pages=375–84 |year=2016 |pmid=27512182 |pmc=4966395 |doi=10.4103/0019-5154.185699 |url=}}</ref>
|
|
* Pink or salmon in colour, which may be scaly, termed as "herald patch"
* Pink or salmon in color, which may be scaly; referred to as "herald patch"
* Oval shape  
* Oval shape  
* Long axis oriented along the cleavage lines
* Long axis oriented along the cleavage lines
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|[[Pityriasis lichenoides chronica]]
|[[Pityriasis lichenoides chronica]]
|
|
* Recurrent [[lesions]] are usually less evenly scattered than psoriasis
* Recurrent [[lesions]] are usually less evenly scattered than in cases of psoriasis
* Brownish red or orange-brown color
* Brownish red or orange-brown in color
* [[Lesions]] are capped by a single detachable, opaque, mica-like scale
* [[Lesions]] are capped by a single detachable, opaque, mica-like scale
* Often leave [[Hypopigmented area|hypopigmented]] [[Macule|macules]]
* Often leave [[Hypopigmented area|hypopigmented]] [[Macule|macules]]
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** Dry skin  
** Dry skin  
** Emotional stress
** Emotional stress
** Allergens (rubber chemicals, [[formaldehyde]], [[neomycin]], chrome, [[Mercury (element)|mercury]], and [[nickel]])
** [[Allergens]] (rubber chemicals, [[formaldehyde]], [[neomycin]], chrome, [[Mercury (element)|mercury]], and [[nickel]])
** [[Staphylococcus]] infection  
** [[Staphylococcus]] infection  
** Seasonal variation
** Seasonal variation
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|[[Bowen’s disease]]<ref name="pmid28523295">{{cite journal |vauthors=Neagu TP, Ţigliş M, Botezatu D, Enache V, Cobilinschi CO, Vâlcea-Precup MS, GrinŢescu IM |title=Clinical, histological and therapeutic features of Bowen's disease |journal=Rom J Morphol Embryol |volume=58 |issue=1 |pages=33–40 |year=2017 |pmid=28523295 |doi= |url=}}</ref>
|[[Bowen’s disease]]<ref name="pmid28523295">{{cite journal |vauthors=Neagu TP, Ţigliş M, Botezatu D, Enache V, Cobilinschi CO, Vâlcea-Precup MS, GrinŢescu IM |title=Clinical, histological and therapeutic features of Bowen's disease |journal=Rom J Morphol Embryol |volume=58 |issue=1 |pages=33–40 |year=2017 |pmid=28523295 |doi= |url=}}</ref>
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|
* [[Erythematous]], small, scaly plaque, which enlarges over time in an erratic manner
* [[Erythematous]], small, scaly plaque, which enlarges erratically over time
* Scale is usually yellow or white and it is easily detachable without any [[bleeding]]  
* Scale is usually yellow or white and it is easily detachable without any [[bleeding]]  
* Well defined margins
* Well-defined margins
|
|
* [[Pruritis|Pruritus]]
* [[Pruritis|Pruritus]]
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|
|
* Associated with:<ref name="pmid12466124">{{cite journal |vauthors=Schmid S, Kuechler PC, Britschgi M, Steiner UC, Yawalkar N, Limat A, Baltensperger K, Braathen L, Pichler WJ |title=Acute generalized exanthematous pustulosis: role of cytotoxic T cells in pustule formation |journal=Am. J. Pathol. |volume=161 |issue=6 |pages=2079–86 |year=2002 |pmid=12466124 |pmc=1850901 |doi=10.1016/S0002-9440(10)64486-0 |url=}}</ref>
* Associated with:<ref name="pmid12466124">{{cite journal |vauthors=Schmid S, Kuechler PC, Britschgi M, Steiner UC, Yawalkar N, Limat A, Baltensperger K, Braathen L, Pichler WJ |title=Acute generalized exanthematous pustulosis: role of cytotoxic T cells in pustule formation |journal=Am. J. Pathol. |volume=161 |issue=6 |pages=2079–86 |year=2002 |pmid=12466124 |pmc=1850901 |doi=10.1016/S0002-9440(10)64486-0 |url=}}</ref>
** Antibiotics ([[Penicillin|penicillins]], [[sulfonamides]], [[tetracyclines]])
** [[Antibiotics]] ([[Penicillin|penicillins]], [[sulfonamides]], [[tetracyclines]])
** [[Carbamazepine]]
** [[Carbamazepine]]
** [[Calcium channel blocker|Calcium channel blockers]] ([[Diltiazem]])
** [[Calcium channel blocker|Calcium channel blockers]] ([[Diltiazem]])
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* Classically involves shin and ankles and is characterized by [[Hyperkeratosis|hyperkeratotic]] [[Plaque|plaques]] and [[Nodule (medicine)|nodules]] covered by a scale
* Classically involves shin and ankles and is characterized by [[Hyperkeratosis|hyperkeratotic]] [[Plaque|plaques]] and [[Nodule (medicine)|nodules]] covered by a scale
* [[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|pruritus]]
* Chronic [[pruritis|pruritus]]

Revision as of 01:44, 8 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 an 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]

Pityriasis rosea[2]
  • Pink or salmon in color, which may be scaly; referred to 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 in cases of psoriasis
  • Brownish red or orange-brown in 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 erratically over time
  • 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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