Psoriasis physical examination

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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], 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]

1. ↑ 1.0 1.1 Iizuka H, Takahashi H, Ishida-Yamamoto A (2003). "Pathophysiology of generalized pustular psoriasis". Arch. Dermatol. Res. 295 Suppl 1: S55–9. doi:10.1007/s00403-002-0372-5. PMID 12677433.
2. ↑ Fraga NA, Oliveira Mde F, Follador I, Rocha Bde O, Rêgo VR (2012). "Psoriasis and uveitis: a literature review". An Bras Dermatol. 87 (6): 877–83. PMC 3699904. PMID 23197207.
3. ↑ Dreiher J, Weitzman D, Shapiro J, Davidovici B, Cohen AD (2008). "Psoriasis and chronic obstructive pulmonary disease: a case-control study". Br. J. Dermatol. 159 (4): 956–60. doi:10.1111/j.1365-2133.2008.08749.x. PMID 18637897.
4. ↑ 4.0 4.1 Kremers HM, McEvoy MT, Dann FJ, Gabriel SE (2007). "Heart disease in psoriasis". J. Am. Acad. Dermatol. 57 (2): 347–54. doi:10.1016/j.jaad.2007.02.007. PMID 17433490.

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