PSORIASIS VULGARIS
FIGURE 1.1: A well-demarcated scaly plaque of psoriasis. The characteristic salmon color and the overlying silvery, micaceous scale can be appreciated
FIGURE 1.2: Signe de la tache de bougie: A typical psoriatic plaque which shows an increased prominence of scaling upon being scratched with a glass slide. This gives the appearance of a scratched wax candle
FIGURE 1.3: The same lesion of psoriasis, on further scraping, these capillaries at the tips of elongated papillae are torn leading to multiple bleeding points. This is known as Auspitz sign
FIGURE 1.4: Woronoff's ring is a faint ring of hypopigmentation seen around the resolving lesions of psoriasis. Here there is also an erythematous area around the hypopigmented ring
FIGURE 1.5: Psoriasis demonstrating Koebner's phenomenon. Linearly-oriented lesions of psoriasis localizing over areas of knife cuts
FIGURE 1.7: Psoriasis geographica: Huge plaques of psoriasis giving an almost geographic appearance. Note the well-defined margins
FIGURES 1.8A TO C: Psoriasis vulgaris: Typical locations of chronic plaque psoriasis: (A) Lower back; (B) Knees; (C) Elbows
FIGURES 1.9A TO C: (A) Elephantine/ostraceous psoriasis: Well-defined plaques of psoriasis with erythematous margin and heaped up silvery, micaceous scale. This variant is known as elephantine or ostraceous psoriasis. (B and C) Another variant of hyperkeratotic psoriasis named rupioid psoriasis with thicker lesions not as heaped up as elephantine psoriasis
FIGURE 1.10: Linear psoriasis: A linear lesion of psoriasis (following lines of Blaschko) over the leg
PSORIASIS SITE VARIATIONS
FIGURES 1.11A TO C: Scalp involvement in psoriasis: (A) Scaly lesions extending beyond the hairline is characteristic; (B) Well-demarcated scaly, erythematous plaques with greasy white scales can be seen. The involvement of scalp margin is fairly characteristic; (C) Extensive scalp psoriasis
[Courtesy: (C) Dr KT Ashique]
FIGURE 1.12: Pityriasis amiantacea in a young female patient of psoriasis with firmly adherent and asbestos-like scale, which is heaped up with matting of hair. The head has been shaved
FIGURE 1.13: Facial lesions of psoriasis tend to be less indurated and less scaly. The well-defined margin can be appreciated
FIGURE 1.14: Sebopsoriasis in a young child, characterized by the typical salmon-colored plaques, albeit lacking well-defined margins. Pronounced micaceous scaling and extension beyond the scalp margin can be appreciated
FIGURE 1.17: Plantar psoriasis seen in the form of an ill-defined, hyperkeratotic, fissured plaque on the sole. The involvement of insole is fairly characteristic of psoriasis
FIGURES 1.18A AND B: (A) Plantar psoriasis mimicking Tinea pedis; (B) Severe plantar psoriasis
[Courtesy: (A) Dr KT Ashique, (B) Dr Santanu Banerjee]
FIGURE 1.19: A case with less severe involvement with psoriasis of palms. There are discrete, erythematous patches associated with whitish, but adherent scales
FIGURE 1.20: Coarse, irregular pits involving three nails in a patient with psoriasis. In addition, distal onycholysis with a characteristic erythematous border can be appreciated
FIGURE 1.22: A patient with chronic plaque psoriasis showing the presence of multiple Beau's lines as well as pits over the nail plate. The marked erythema over the proximal nail fold can be appreciated
FIGURE 1.23: Extensive leukonychia in a patient with nail psoriasis. Erythema of the lunula can also be appreciated
FIGURE 1.26: Onychoscopic image of the same patient. The area of onycholysis is bordered by prominent erythematous globular areas with a whitish halo
FIGURE 1.27: A patient with psoriatic erythroderma showing a prominent salmon patch in one of his nails
FIGURE 1.28: Onychoscopic image of splinter hemorrhages in a patient with psoriatic involvement of nails
PUSTULAR PSORIASIS
FIGURE 1.30: A case of psoriatic acropustulosis. One can appreciate the pustules, exfoliation, distal onycholysis and subungual debris involving multiple nails
FIGURE 1.31: Localized pustular psoriasis over legs. The superficial pustules, coalescing to form lakes of pus, can be seen. All these are superimposed on an underlying plaque of psoriasis
FIGURES 1.33A TO C: Acrodermatitis continua of Hallopeau: Severely crusted lesions with pustules on: (A) Middle finger; (B) Great toe; (C) Erythematous scaly plaques with deep seated pustules. Thick adherent scaling can be appreciated. There is prominent nail involvement
[Courtesy: (A) Dr Kingshuk Chatterjee]
FIGURES 1.34A AND B: Generalized pustular psoriasis involving extensive areas of trunk in a young male
FIGURES 1.35A AND B: (A) Annular lesions in a patient with generalized pustular psoriasis; (B) Severe generalized pustular psoriasis lesions involving the lower trunk and groins
(Courtesy: Dr Tarang Goyal)
PSORIATIC ERYTHRODERMA
FIGURES 1.36A AND B: Psoriatic Erythroderma: (A) Marked erythema, scaling and induration involving more than 90% body surface area in a patient with psoriatic erythroderma. The scale is micaceous and there is fissuring also present at places; (B) Extensive scaling on the back in a case of erythroderma
PSORIATIC ARTHRITIS
FIGURE 1.37: A patient with psoriatic oligoarthritis, which is the most common form of psoriatic arthritis. There is involvement of interphalangeal joints with a ‘sausage-shaped’ digit. The typical psoriatic nail involvement can also be appreciated
FIGURE 1.38: This patient has the more classic but less common distal interphalangeal arthritis. Note the involvement of multiple digits with fixed deformities. The involvement of nails can also be clearly appreciated
FIGURE 1.39: This patient with extensive plaques of psoriasis also has involvement of multiple distal interphalangeal joints with some revealing ‘swan neck’ deformity
FIGURE 1.40: A 50-year-old woman with long-standing psoriasis demonstrates arthritis mutilans. Severe deformities with osteolysis and destruction of bones is seen. There is digital shortening, ankylosis and telescoping of soft tissues
FIGURE 1.41: Radiograph of a patient with symmetrical variety of psoriatic arthritis. Note the extensive osteolysis and acro-osteolysis can be seen apart from flexion deformity at distal interphalangeal joint
RARE VARIANTS
