A chronic, recurrent disorder. Classic lesion is a well-marginated, erythematous plaque with silvery-white surface scale. Distribution includes extensor surfaces (i.e., knees, elbows, and buttocks); may also involve palms and scalp (particularly anterior scalp margin). Associated findings include psoriatic arthritis (Chap. 161. Psoriatic Arthritis) and nail changes (onycholysis, pitting or thickening of nail plate with accumulation of subungual debris).
Treatment: Psoriasis Maintain cutaneous hydration; topical glucocorticoids; topical vitamin D analogue (calcipotriol) and retinoid (tazarotene); UV light (PUVA, when UV used in combination with psoralens); for severe disease methotrexate or cyclosporine; acitretin can also be used but is teratogenic. Ustekinumab (human monoclonal antibody that blocks IL-12 and IL-23) or apremilast (phosphodiesterase 4 inhibitor) can be considered for chronic, moderate to severe plaque psoriasis. Etanercept (dimeric fusion protein: TNF receptor/Fc human IgG1), infliximab, and adalimumab (monoclonal antibodies directed against TNF) are approved for psoriasis and psoriatic arthritis. |