Psoriasis: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body temperature, body weight, body height; furthermore:
    • Inspection (viewing).
      • Skin
        • Sharply defined inflammatory papules (nodular thickening of the skin) with scaling of the skin, the extent of which can range from punctate solitary changes (guttate psoriasis) to infestation of the entire skin (erythrodermic psoriasis)
        • The skin changes can also occur in stripes, rings or arcs

        Predilection sites (sites where the changes predominantly occur) are:

        • Extensor sides of the extremities
        • Hairy head
        • Skin folds (especially perianal (around the anus) and periumbilical/around the belly button); indicative of psoriasis inversa
      • Nails [accompanying symptoms; nail symptoms:
        • Spotted nails (multiple retractions on the nail).
        • Onycholysis (yellow-brownish dirty changes under the surface of the nail).
        • Crumb nails (thickened, dystrophic (poorly supplied with nutrients) nails)]
        • Nail mycosis (nail fungus) (differential diagnosis).
  • Dermatological examination – including inspection of predilection sites (preferentially affected areas of skin), fingernails and the following listed scratching phenomena:
    • Candle drop phenomenon – after brushing the affected skin area with the fingernail shows a lightening and roughening.
    • Phenomenon of the last cuticle – by further scratching after a candle drop phenomenon shows shiny uppermost cuticle, which leads to small bleeding when further scratching (“bloody dew”; blood drop phenomenon).
    • Köbner phenomenon – disease-specific skin reaction to non-specific stimuli.

    [due todifferential diagnoses:

    • Acrodermatitis continua Hallopeau (focal redness and pustules on the end phalanges of the fingers and toes).
    • Alopecia areata (circular hair loss).
    • Pityriasis rosea (scale florets)
    • Pustulosis palmoplantaris (disease with appearance of pustules on the palms and feet)]
  • If necessary, neurological examination [due topossible secondary diseases: Alcohol dependence, drug dependence, resignation, social isolation]
  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.