The clinic nurse is assessing the skin of a white client who is diagnosed with psoriasis. Which of the following characteristics is associated with this skin disorder?
A. Clear, thin nail beds.
B. Red-purplish scaly lesions.
C. Oily skin and no episodes of pruritus.
D. Silvery-white scaly patches on the scalp, elbow, knees, and sacral regions.
Correct Answer: D. Silvery-white scaly patches on the scalp, elbow, knees, and sacral regions.
Psoriatic patches are covered with silvery-white scales. Affected areas include the scalp, elbows, knees, shins, trunk, and sacral area. Psoriasis presents as well-defined erythematous plaques covered with silvery scales commonly over the scalp, extensors of extremity particularly over knees and elbows, and lumbosacral region. Psoriasis is classified into two types. Type 1 psoriasis, which has a positive family history, starts before age 40 and is associated with HLA-Cw6; while type 2 psoriasis does not show a family history, presents after age 40, and is not associated with HLA-Cw6.
Option A: Nail changes in psoriasis are seen as pitting, oil spots, subungual hyperkeratosis, nail dystrophy, and anchylosis. Psoriasis can present with different morphology in the form of plaque, guttate, rupioid, erythrodermic, pustular, inverse, elephantine, and psoriatic arthritis. Variation in a site is seen with the involvement of scalp, palmoplantar region, genitals, and nails.
Option B: Guttate psoriasis also called as eruptive psoriasis is commonly seen in children after an upper respiratory tract infection with the streptococcal organism. It presents with erythematous and scaly raindrop-shaped lesions mainly over the trunk and back. It is the type of psoriasis having the best prognosis.
Option C: Plaque psoriasis typically presents as erythematous plaques with silvery scales most commonly over extensors of extremities, i.e., on the elbows, knees, scalp, and back. It is the most common type of psoriasis which affects 85% to 90% of patients. On successive removal of psoriatic scales pinpoint bleeding points are seen. This is called the Auspitz sign which is used to confirm the diagnosis clinically.
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