A patient with psoriasis may experience one or more patterns of skin involvement. Some patterns may be associated with more serious disease.


Types of patterns:

(1) based on size and shape

(2) based on location

(3) uncommon with special features


Types based on the size and shape of skin lesions:

(1) guttate (small and "drop-like")

(2) discoid or plaque (psoriasis vulgaris): lesions may be small or large

(3) pustular: may be local or generalized, may form along the rim of plaques


Types based on location:

(1) scalp

(2) flexural (inverse): occur in axilla, genital folds, neck or other intertriginous areas (skin creases)

(3) palmar-plantar: may be hyperkeratotic or pustular

(4) photosensitive: involvement worse on sun-exposed surfaces


Uncommon types with special features:

(1) erythrodermic: diffuse erythema

(2) elephantine: large plaques with leathery texture resembling elephant hide

(3) geographic: fused plaques covering a large area of skin

(4) ostraceous: very thick and scaly, resembling an oyster shell

(5) lichenified: thickened and eczematoid

(6) rupioid: cone-shaped or limpet-like plaques

(7) annular: ring-shaped with central clearing

(8) linear: arranged in lines


Patterns associated with more serious disease:

(1) extensive plaque psoriasis (includes geographic)

(2) generalized pustular

(3) erythrodermic


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