Differential diagnosis with psoriasis

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The characteristics already defined are usually sufficient to enable the diagnosis to be made, but doubt may arise in atypical cases, in particular sites, and when psoriasis is complicated by or alternates with other diseases. In seborrhoeic dermatitis, the lesions are lighter in colour, less well-defined and covered with a dull or branny scale. Eczema at times develops a psoriasiform appearance, especially on the legs. Hyperkeratotic eczema of the palms is a common cause of misdiagnosis. Colour, scratch-evoked scaling and well-defined margins are suggestive of psoriasis, and nail changes may be diagnostic. Lichen planus should give rise to difficulty only when the two diseases alternate or coexist, especially when present as hypertrophic lesions on the legs, as penile lesions and on the palms. The violaceous colour, glistening surface and presence of oral changes are usually decisive. Lichen simplex can resemble psoriasis closely, particularly on the scalp and near the elbow. The intensified skin markings, rather ill-defined edge and the marked itching are characteristic, and the point of the elbow tends to be avoided. Pityriasis lichenoides chronica can closely resemble guttate psoriasis, but the lesions are usually less evenly scattered, have a brownish red or orange brown colour and are capped by an opaque soft "mica-like" scale. Candidiasis shows a glistening deep red colour suggestive of psoriasis, particularly in the flexures, but scaling tends to be confined to the edge, and small satellite pustules and papules are usually evident outside the main area. Tinea cruris has a well-defined, often polycyclic edge, but Trichophyton rubrum infections, especially of the palm, cause difficulty. If corticosteroids have been applied, scaling may be absent and the diagnosis must be made by microscopy and culture. Less common causes of confusion are pityriasis rubra pilaris and secondary syphilis. The resemblance to pityriasis rubra pilaris . An association of psoriasis and cardiovascular disease (CVD) has long been recognized. CVD risk is highest in those with more severe disease, with standarized mortality rates reaching , particularly in younger patients. Much of this risk is due to coexistence of known CVD risk factors, including type II diabetes mellitus, dyslipidaemia, hypertension and obesity, increasingly referred together as the " metabolic syndrome". However, emerging evidence suggests that the risk may in part remain even after controlling for known risk factors. Taken together, these studies indicate that treating patients with moderate or severe psoriasis requires attention to these important general medical issues.

Dermatitis, Atopic , Pityriasis Rosea , DermatitisContact , Reactive Arthritis , Gout and Pseudogout , Syphilis , Pityriasis Alba , Tinea
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1-" THE HISTOPATHOLOGY OF PSORIASIS ", G. DE ROSA, C. MIGNOGNA, Department of Biomorphological and Functional Sciences, Pathology Section, “Federico II” University of Naples, Italy