Elsevier

The Lancet

Volume 350, Issue 9074, 2 August 1997, Pages 349-353
The Lancet

Seminar
Psoriasis

https://doi.org/10.1016/S0140-6736(97)05257-4Get rights and content

Section snippets

Differential diagnosis

Seborrhoeic dermatitis is the most common condition that is difficult to distinguish from psoriasis. When only thin, diffuse, scaly, plaques are present, seborrhoeic dermatitis of the scalp, face, or intertriginous areas and mild psoriasis may be indistinguishable (figure 3). Chronic eczematous dermatitis may present as thick, well-demarcated plaques, which are usually more pruritic than psoriasis-related plaques. Also, chronic eczema generally lacks the discrete fine mica-like scaling

Clinical subtypes

More than 90% of patients who present with psoriasis have symmetrical discrete plaques, but clinical manifestations can vary greatly. The acute generalised onset of numerous small erythematous raindrop-like papules which are initially pink and become scaly characterise guttate psoriasis, the most common psoriasis variant. Pharyngeal streptococcal infection often triggers this eruption, perhaps as a result of superantigen stimulation of the immune system.5, 6 Presumptive antistreptococcal

Associated diseases and exacerbating factors

About 15% of patients with psoriasis develop a seronegative inflammatory arthritis that has many clinical features of rheumatoid arthritis.10 There have been many claims of an association between psoriasis and altered risk of other diseases, but these differences are likely to reflect associations in exposures and habits of patients with psoriasis rather than innate differences in susceptibility. Smoking and obesity are more frequent among patients with psoriasis than the general population.11,

Management

To give optimum treatment, the clinician must find out which aspects and to what extent the disease worries the patient and what type of improvement would substantially reduce this worry. In addition to cost and risk of treatment, time required for treatment and the patient's attitude towards risk should be considered. The chronic nature of the disease and the lack of treatments that induce very long-term remissions mean that treatment decisions should be viewed in the context of a lifelong

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