Psoriasis: Or something else? Differential Diagnosis

Skin and subcutaneous (L00-L99).

  • Acrodermatitis continua Hallopeau* – focal redness and pustules on the end phalanges of the fingers and toes.
  • Allergic contact dermatitis* (e.g. caused by fragrances or ingredients of wet toilet paper).
  • Alopecia areata – circular hair loss.
  • Hand eczema
  • Irritative contact eczema* (e.g. axillary by aluminum chloride-containing antiperspirants).
  • Neurodermatitis* (atopic eczema)
  • Nummular eczema (synonyms: bacterial eczematoid, dermatitis nummularis, dysregulatory-microbial eczema, microbial eczema) – unclear disease resulting in eczema characterized by sharply demarcated, coin-shaped, itchy foci of disease, some of which are weeping and crusty. They occur mainly on the extensor sides of the extremities.
  • Pityriasis lichenoides chronica
  • Pityriasis rosea (scale florets)
  • Pityriasis rubra pilaris (synonyms: prickly lichen, Devergie’s disease) – rare chronic skin disease originating in the hair follicles; clinical picture: Follicular hyperkeratosis/excessive keratinization of the skin (solitary or confluent), keratoses (keratinization disorder of the skin), nappes claires (islands of healthy skin) and alopecia (hair loss), ectropion (out-turned eyelid), nail dystrophy and palmo-plantar waxy hyperkeratoses (on palms and soles).
  • Pustulosis palmoplantaris – disease with the appearance of pustules on the palms of the hands and feet.
  • Diaper dermatitis

Infectious and parasitic diseases (A00-B99).

  • Bacterial intertrigo* (“skin wolf”), perianal (“around the anus“) streptococcal dermatitis (skin inflammation caused by streptococci).
  • Candidiasis* (yeast infection); esp. Candida intertrigo (typically wipeable, whitish-smeary coatings and/or marginal erythematous papules)
  • Nail mycosis (nail fungus)
  • Scabies crustosa (synonyms: Scabies norvegica; bark scabies) – massive mite infestation up to several million mites on and in the skin) with psoriasiform changes and palmoplantar hyperkeratosis (excessive keratinization of the skin); possibly. also erythroderma (reddening of the skin on the entire body); pruritus (itching) may be completely absent (due to lack of immune response); risk groups: immunocompromised patients (HIV, malignancies; immunosuppressants), immunodeficiency in old age; inpatient therapy requiredCave! Infestation (infestation with the parasite) even with only brief contact with the diseased (eg, shaking hands).
  • Syphilis (venereal disease), secondary.
  • Tinea capitis (shear fungal lichen) – skin fungus in the area of the hairy scalp (lat. caput: head‘).
  • Tinea corporis* (fungal disease of the trunk – especially at contact points on the arms and upper body and in the anal and inguinal region / groin).

Musculoskeletal system and connective tissue (M00-M99).

  • Bekhterev’s disease (ankylosing spondylitis; Latinized Greek: spondylitis “inflammation of the vertebrae” and ankylosans “stiffening”) – chronic inflammatory rheumatic disease with pain and stiffening of joints.
  • Reactive arthritis (synonym: post-infectious arthritis / joint inflammation) – secondary disease after gastrointestinal (gastrointestinal tract concerning), urogenital (urinary and genital organs concerning) or pulmonary (lungs concerning) infections; refers to an arthritis, where pathogens in the joint (usually) can not be found (sterile synovialitis).
  • Reiter’s disease (synonyms: Reiter’s syndrome; Reiter’s disease; arthritis dysenterica; polyarthritis enterica; postenteritic arthritis; posturethritic arthritis; undifferentiated oligoarthritis; urethro-oculo-synovial syndrome; Fiessinger-Leroy syndrome; English Sexually acquired reactive arthritis (SARA)) – special form of a “reactive arthritis” (see above. ); secondary disease after gastrointestinal or urogenital infections, characterized by the symptoms of Reiter’s triad; seronegative spondyloarthropathy, which is triggered especially in HLA-B27 positive persons by an intestinal or urinary tract disease with bacteria (mostly chlamydia); Can manifest as arthritis (joint inflammation), conjunctivitis (conjunctivitis), urethritis (urethritis) and partly with typical skin changes.
  • Rheumatoid arthritis (synonym: primary chronic polyarthritis, PCP) – most common inflammatory disease of the joints.

Neoplasms – tumor diseases (C00-D48).

Medications

* Differential diagnoses for psoriasis inversa.