00:01
Our next topic for the day is psoriasis
So, a 33-year-old man with
no past medical history
presents with persistent rash on
his elbows and his knees.
00:13
He's noticed similar lesions in
these areas at various
times over the past several years,
but they typically resolved
spontaneously in the summertime,
or with the assistance of some
over-the-counter topical steroid.
00:25
He also notes an itchy area on
the back of his head
and wonders if that's related. Denies any
fevers or chills, no oral lesions,
no history of allergens. He works as
a mechanical engineer and he's
not exposed to any chemicals. He smokes
a pack a day, rare alcohol use.
00:43
He does have an uncle with
ankylosing spondylitis.
00:46
No arthralgias and no eye symptoms.
So let's review this
case and look at a few important details.
First off, the time course sounds
chronic and vacillating. He says it's
been coming at various
times over the past several years,
and this is just
one more presentation with his
symptoms. Second,
the pattern of skin involvement
sounds symmetric.
01:06
He's having lesions on both elbows,
both knees. He's also having some
lesions on his scalp. Next up,
skin information.
01:14
Until we get a physical exam, it's going
to be hard for us to say that.
01:18
At least he's not reporting any
tender lesions or any
pustules or anything like that. And
last, systemic involvement.
01:25
He's got a pretty negative review of systems.
There's no fevers or constitutional
symptoms, so it seems like this is purely
a skin disease, at this point.
01:33
Okay, let's take a look at the physical
exam. So we have multiple,
well-demarcated, erythematous plaques
with thick, silvery scale
on the extensor surface of his elbows
and, shown here, his knees.
01:45
Now scraping off one of those plaques
causes punctate bleeding.
01:50
We'll have to figure out what that means
later. A similar 4x3 cm
plaque is noted on the posterior scalp. And
when we review his fingernails and
toenails, we see multiple nail pits
on the fingernails,
and there's also onycholysis noted on several
toes, as shown here on the bottom right.
02:07
Okay. This is going to be
the easiest case ever.
02:10
This case screams psoriasis,
not to mention the fact that this
video is called psoriasis.
02:16
So let's go ahead and take a
look at my list of options.
02:20
Oh, snap. That is a lot of different
types of psoriasis.
02:25
I guess we'll have to go through
each one in turn:
pustular, inverse, erythrodermic, guttate,
and plaque psoriasis.