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[edit | edit source]

Common physical examination findings of psoriasis include erythematous, scaling papules, and plaques.

Physical Examination[edit | edit source]

Appearance of the patient[edit | edit source]

• Patient may appear distressed and anxious

Vital signs[edit | edit source]

• High-grade fever with generalized pustular psoriasis^[1]
• Tachycardia with regular pulse^[1]
• Tachypnea
• Kussmaul respirations may be present in patients with comorbid diabetes and DKA

Skin[edit | edit source]

• A diagnosis of psoriasis is usually based on the appearance of the skin
  • A skin biopsy, or scraping, may be necessary to rule out other disorders and confirm a diagnosis of psoriasis
  • Skin from a biopsy may show clubbed rete pegs

• Papulosquamous disease with variable morphology, distribution, severity, and course
• Scaly 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 psoriasis, courtesy of regionalderm.net
• 
  Extremity psoriasis(guttate variety), courtesy of regionalderm.net
• 
  Trunk psoriasis, courtesy of regionalderm.net
• 
  Face psoriasis, courtesy of https://aloeworldnorfolk.wordpress.com/tag/psoriasis/
• 
  Nails showing pitting, crumbling and brittleness, courtesy of http://www.atlasdermatologico.com.br/
• 
  Inverse psoriasis, courtesy of regionalderm.net

HEENT[edit | edit source]

• Scalp psoriasis may manifest as raised, reddish, often scaly patches
• Ophthalmoscopic exam in psoriasis may show uveitis, most commonly in patients with arthropathy or pustular psoriasis^[2]
• 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 sensorineural hearing loss

Neck[edit | edit source]

• Cervical lymphadenopathy

Lungs[edit | edit source]

• Psoriasis has been known to be associated with COPD^[3]
• Expanded/barrel shaped chest secondary to COPD
• Bilateral decreased breath sounds
• Bilateral wheezes
• Reduced tactile fremitus

Heart[edit | edit source]

• The risk of arterial and venous vascular diseases (e.g. myocardial infarction, thrombophlebitis, pulmonary embolization) is higher in severe psoriasis involving multiple areas of the body.^[4]
• There may be a chance of high output cardiac failure due to erythroderma.^[4]

Abdomen[edit | edit source]

• No abdominal distention
• No abdominal tenderness
• No hepatomegaly/splenomegaly/hepatosplenomegaly

References[edit | edit source]

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