Pictorial case study: Psoriasis

The case
A 40-year-old woman presented with erythematous rashes of various size and shape. They mainly affected her forearms but she had a few lesions on her scalp and trunk. The scales were silvery. She had a family history of psoriasis and remembered that her father’s nails and joints were also affected by it.

What is the diagnosis, management and differential diagnosis? 

Diagnosis and management
This woman had psoriasis and responded well to topical vitamin D analogue with steroids in addition to emollients.  

Possible different diagnoses

  • Mycosis fungoides.
  • Discoid eczema.
  • Pityriasis rosea.
  • Parapsoriasis.

Differential diagnosis
Mycosis fungoides

  • Men affected more than women.
  • Dark-skinned patients can present with hypopigmented or hyperpigmented macules.
  • Affects hips, buttocks, groin, lower trunk, axillae and breasts.
  • Intense itching.
  • Oval or ring-shaped, pink dry patches.
  • Fine scales.
  • Can spread to extremities.
  • During the patch stage lesions are flat.
  • Not caused by fungal infection.
  • It is a cutaneous lymphoma. 

Contributed by Dr Vasa Gnanapragasam, a GP in Sutton, Surrey

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