Psoriasis Characterization and Treatment

Clinical Presentations

The American Academy of Dermatology describes psoriasis as characterized by well-demarcated, red plaques with silvery scale, commonly involving the scalp, elbows, knees, and presacral region 1
Plaque psoriasis (vulgaris) is the most common form, presenting with well-demarcated, red plaques with silvery scale 1
Guttate psoriasis is characterized by dew-drop-like, 1-10mm, salmon-pink papules with fine scale, primarily on the trunk and proximal extremities, common in individuals younger than 30 years 2
Inverse psoriasis affects flexural surfaces such as the antecubital fossae, intertriginous areas, and inframammary regions 2
Erythrodermic psoriasis presents with generalized erythema covering nearly the entire body surface area with varying degrees of scaling, often accompanied by fever, malaise, chills, and potential dehydration 2
Pustular psoriasis is characterized by large collections of neutrophils that are clinically apparent as pustules on an erythematous background, may be generalized (von Zumbusch variant) or localized to palms and soles 2, 3
Nail psoriasis occurs in approximately 50% of patients with psoriasis, presenting with pitting, onycholysis, subungual hyperkeratosis, and oil-drop sign 2

The American Academy of Dermatology states that diagnosis is primarily clinical and usually does not require complementary examinations 4
Topical corticosteroids are the first-line treatment for mild to moderate psoriasis, with moderate to high potency (classes 2-5) used for plaques not affecting intertriginous areas for a maximum of 4 weeks 4
Vitamin D analogs, such as calcipotriol, can be used alone or in combination with corticosteroids for a synergistic effect 4
Cyclosporine (3-5 mg/kg/day) is particularly effective for erythrodermic psoriasis due to its rapid onset of action 5
Spesolimab (anti-IL-36 receptor monoclonal antibody) can be used as first-line therapy for generalized pustular psoriasis 3
Psoriasis is a chronic multisystem inflammatory disorder with associated comorbidities including psoriatic arthritis, cardiovascular disease, and autoimmune diseases 1, 2
Regular clinical follow-up is essential when using topical corticosteroids to monitor for adverse effects 4
Certain medications, such as lithium, chloroquine, beta-blockers, and NSAIDs, can worsen psoriasis 3, 4