The clinical picture of psoriasis (psoriasis) is varied:
- Plaque-type psoriasis – permanently existing, slow-growing plaques; corresponds to psoriasis vulgaris type I.
- Eruptive psoriasis (psoriasis guttata; guttatus, Latin “drop-shaped”) – rapidly progressive (progressing), exanthematous seeding of papular lesions up to 1 cm in size, often after a streptococcal infection; localization: trunk and proximal (“close to the body”) extremities; acute type of manifestation of later childhood and adolescence
- Pustular psoriasis (psoriasis pustulosa); rare in childhood – with the following clinical variants:
- Generalized seeding of initially solitary, later usually confluent pustules. Occurrence together with fever dermopathic lymphadenopathy (pathological swelling of lymph nodes) and strong feeling of illness. This is known as psoriasis pustulosa generalisata (von Zumbusch).
- Eruptive appearance of pustules in the area of existing foci due to acute exacerbation (marked exacerbation) of psoriasis vulgaris, which is then called psoriasis cum pustulatione.
- Pustulosis palmoplantaris (PPP) – independent disease, which is now included in the group of acropustular psoriasis; exclusively on the palms and / or soles, there is the formation of pustules with partial lacunar confluence (fusion).
- Psoriasis intertriginosa – exclusively or strongly preferred localization of skin lesions on the large body folds (axillae/in the armpits, abdominal fold, submammary space (“below the female breast (mamma)”), inguinal fold (in the area of the groin), anal fold, ie in the area of the anus/after); this form of manifestation is rather rare.
- Psoriasis inversa (inverse psoriasis):
- Psoriasis palmaris et plantaris – manifestation on palms and/or soles.
- Psoriasis intertriginosa – manifestation of skin changes predominantly in the intertriginous areas (large skin fold zones; axillae, abdominal crease, submammary, inguinal) including the rima ani (gluteal crease), without concomitant disease of the predilection sites (sites where the changes predominantly occur) (approx. 5% of all psoriasis patients); intertriginous psoriasis vulgaris may “accompany” classic psoriasis vulgaris. Note: Rima ani psoriasis is associated with a significantly higher risk of psoriatic arthritis (PsA). The same applies to scalp and nail involvement.
- Acrodermatitis continua suppurativa (Hallopeau) – acral (belonging to the extremities ends) to the formation of pustelseen with severe inflammation, which quickly leads to the loss of the nail and nail matrix; very rare.
The following symptoms and complaints may indicate psoriasis:
Pathognomonic (characteristic of a disease).
- Sharply circumscribed inflammatory papules – nodular thickening of the skin – with scaling of the skin, the extent of which can range from punctate solitary changes (psoriasis guttata) to infestation of the entire skin (psoriasis erythrodermica)
- The skin changes can also occur in stripes, rings or arcs
- Constant change in appearance and frequency
Associated symptoms
- Itching – rare; especially in psoriasis inversa or psoriasis guttata.
- Nail symptoms (incidence: 40% in psoriasis patients without arthritis; approximately 66% in patients with arthritis too psoriatic):
- Psoriatic arthritis (PsA; joint inflammation)* , predominantly of the small joints such as finger or toe joints; rarely in the spine.
* 72.5% of PsA patients but only 41.5% of patients without PsA showed nail psoriasis. Complaints (percentage)
- Pruritus (itching; 83%).
- Burning* (49%)
- Dyspareunia* (pain during sexual intercourse; 45%).
- Pain* (44%)
* Statements particularly frequent from women.
Up to 90% of sufferers report an improvement in symptoms during the summer months. To determine the severity of psoriatic disease, the PASI score (English Psoriasis Area and Severity Index) is available (see below history).Predilection sites (sites where the changes predominantly occur).
- Extensor sides of the extremities
- Hairy head
- Skin folds (especially perianal (around the anus) and periumbilical/around the belly button); indicative of psoriasis inversa
In one study, patients (men + women) reported suffering from genital symptoms of psoriasis in 38% of cases at the time of interview:
Localization: sex- and age-dependent.
- Men: penile shaft (36%), scrotum (scrotum; 33%), glans penis (glans; 29%).
- Females: labia majora pudendi (outer labia; 51%), perineum (tissue area between the anus and external genitalia; 28%), labia minora pudendi (inner labia; 23%).
- Infancy and early childhood: diaper region (sharply demarcated inflammatory skin lesions in the area of the diaper without symmetry, involving the inguinal folds; from here starting expansion of the foci, especially in the trunk area).
