Psoriasis history and symptoms

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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[edit | edit source]

The hallmark of psoriasis is a papulosquamous, erythematous, scaly rash which can be commonly found on extensor surfaces of the body. Flexural surfaces may also be involved in cases of inverse psoriasis. Patients with psoriasis usually have a history of recent streptococcal throat infection, viral infection, immunization, use of antimalarial drugs, or trauma. The most common symptoms of psoriasis include pain, which has been described by patients as unpleasant, superficial, sensitive, itchy, hot, or burning (especially in erythrodermic psoriasis and in some cases of traumatized plaques or in the joints affected by psoriatic arthritis). Patients also present with pruritus (especially in eruptive, guttate psoriasis) and high fever (in cases of erythrodermic and pustular psoriasis). Other symptoms include dystrophic nails and long-term erythematous, scaly rash with recent presentation of arthralgia/arthralgia without any visible skin findings. Other extra cutaneous symptoms include redness and tearing of eyes due to conjunctivitis or blepharitis. Avoidance of social interactions is common among patients, especially during the active phase of the disease.

## History[edit | edit source]

### Age of Onset[edit | edit source]

* Psoriasis can first appear at any age, though a bimodal distribution of the age of onset is usually observed.
* The first peak for the development of psoriasis occurs between 20 years and 35 years and the second peak occurs between 40 years and 65 years of age.[1]

### Family History[edit | edit source]

* Patients with early disease onset often have a positive family history of psoriasis, frequent association with histocompatibility antigen (HLA)- Cw6, and more severe disease.
* Patients with onset after the age of 40 usually have a negative family history and a normal frequency of the HLA- Cw6 allele.[2]

### Initial Presentation[edit | edit source]

* A typical psoriasis patient will present with a history of a long-term erythematous, scaly area with ocular and joint involvement depending upon the clinical subtype and chronicity of the disease. There may be multiple relapses and remissions.

### Past Medical History[edit | edit source]

* Past medical history of the patient may include viral or bacterial infection, diabetes, hypertension, chronic kidney disease, and/or obesity due to association of psoriasis with these conditions.[3]

### Social History[edit | edit source]

* Social history of the patient may indicate smoking, excessive alcohol consumption, and/or a recent stressful event if associated with an acute exacerbation of psoriasis.[4]

## Symptoms[edit | edit source]

### Common Symptoms[edit | edit source]

Common symptoms of psoriasis may include the following:[5]

* A long-term history of erythematous, scaly area, which may involve multiple areas of the body
* Recent streptococcal throat infection, viral infection, immunization, use of antimalarial drug, or trauma
* Pain, which has been described by patients as unpleasant, superficial, sensitive, itchy, hot, or burning (especially in erythrodermic psoriasis and in some cases of traumatized plaques or in the joints affected by psoriatic arthritis)
* Pruritus (especially in eruptive, guttate psoriasis)
* High fever in erythrodermic and pustular psoriasis
* Dystrophic nails
* Long-term rash with recent presentation of arthralgia
* Arthralgia without any visible skin findings
* Ocular symptoms include redness and tearing due to conjunctivitis or blepharitis
* Avoidance of situations requiring social interaction

### Less Common Symptoms[edit | edit source]

Less common symptoms of psoriasis include the following:[6][7]

* Enthesitis
* Depression, leading to:
* Insomnia
* Decreased appetite
* Guilt
* Loss of energy
* Decreased concentration
* Dactylitis
* Geographic tongue
* The dorsal surface may have sharply demarcated gyrate red patches with a white to yellow border that may evolve, giving the appearance of a map

## References[edit | edit source]

1. ↑ Swanbeck G, Inerot A, Martinsson T, Wahlström J, Enerbäck C, Enlund F, Yhr M (1995). "Age at onset and different types of psoriasis". Br. J. Dermatol. 133 (5): 768–73. PMID 8555031.
2. ↑ Naldi L, Parazzini F, Brevi A, Peserico A, Veller Fornasa C, Grosso G, Rossi E, Marinaro P, Polenghi MM, Finzi A (1992). "Family history, smoking habits, alcohol consumption and risk of psoriasis". Br. J. Dermatol. 127 (3): 212–7. PMID 1390163.
3. ↑ Ni C, Chiu MW (2014). "Psoriasis and comorbidities: links and risks". Clin Cosmet Investig Dermatol. 7: 119–32. doi:10.2147/CCID.S44843. PMC 4000177. PMID 24790463.
4. ↑ Naldi L, Parazzini F, Brevi A, Peserico A, Veller Fornasa C, Grosso G, Rossi E, Marinaro P, Polenghi MM, Finzi A (1992). "Family history, smoking habits, alcohol consumption and risk of psoriasis". Br. J. Dermatol. 127 (3): 212–7. PMID 1390163.
5. ↑ Ljosaa TM, Rustoen T, Mörk C, Stubhaug A, Miaskowski C, Paul SM, Wahl AK (2010). "Skin pain and discomfort in psoriasis: an exploratory study of symptom prevalence and characteristics". Acta Derm. Venereol. 90 (1): 39–45. doi:10.2340/00015555-0764. PMID 20107724.
6. ↑ "Psoriasis: epidemiology, natural history, and differential diagnosis | PTT".
7. ↑ Kurd SK, Troxel AB, Crits-Christoph P, Gelfand JM (2010). "The risk of depression, anxiety, and suicidality in patients with psoriasis: a population-based cohort study". Arch Dermatol. 146 (8): 891–5. doi:10.1001/archdermatol.2010.186. PMC 2928071. PMID 20713823.

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