Psoriasis

FIGURE 3.34 Psoriatic arthritis. "Sausage finger deformity" of the distal interphalangeal joint. Note onycholysis.

FIGURE 3.35 Psoriatic arthritis ("arthritis mutilans"). This patient has severe psoriatic arthritis with marked deformities and subluxations of the small bones of the hands. Note also the characteristic onycholysis on the nails.

<bold>FIG. 129.1.</bold> Psoriatic arthritis in a patient with human immunodeficiency virus disease.

<bold>FIG. 65.2.</bold> Asymmetric polyarthritis resembling rheumatoid arthritis in a patient with psoriasis.

<bold>FIG. 65.3.</bold> Long-standing psoriatic arthritis with a symmetric distribution. This patient had a "claw deformity" due to bony ankylosis of the proximal and distal interphalangeal joints.

<bold>FIG. 65.4.</bold> Psoriatic arthritis involving the metacarpophalangeal and proximal interphalangeal joints of the index finger with an associated flexor tenosynovitis. This combination gives rise to the "sausage" digit.

Psoriasis. Psoriasis is the prototype of psoriasiform epidermal hyperplasia. A patient with psoriasis shows large, confluent, sharply demarcated, erythematous plaques on the trunk.

Psoriasis. Psoriasis is the prototype of psoriasiform epidermal hyperplasia. Microscopic examination of a lesion demonstrates that the rete ridges are uniformly elongated, as are the dermal papillae, giving an interlocking pattern of alternately reversed "clubs." The dermal papillae are edematous and reside beneath a thinned epidermis (suprapapillary thinning) with striking parakeratosis. The parakeratosis is the scale observed clinically.

<bold>FIG. 65.9.</bold> "Whittling" of the middle phalanx and expansion of the base of the distal phalanx—the "pencil-in-cup" deformity.

<bold>FIG. 65.10.</bold> Bony ankylosis of distal interphalangeal joints in a patient with psoriatic arthritis.

<bold>FIG. 65.11.</bold> Complete destruction of middle proximal interphalangeal joint. Also note bony ankylosis of corresponding distal interphalangeal joint.

<bold>FIG. 65.15.</bold> Psoriatic arthritis with axial involvement. The patient was HLA-B27^﹢ and had no radiologic evidence of sacroiliitis, but atypical syndesmophytes are observed.

<bold><italic>Figure 14.69.</bold></bold> Classic plaque with scales of psoriasis.

<bold><italic>Figure 14.70.</bold></bold> Nail pitting of psoriasis.

Psoriasis. The clubbed papillae contain tortuous dilated venules. The prominent venules are part of the venulization of capillaries, which may be of histogenetic importance in psoriasis. The papilla to the right has one cross-section of its superficial capillary venule loop, which is normal. The papilla in the center shows numerous cross-sections of its venule, indicating striking tortuosity.

Psoriasis. Neutrophils migrate into the epidermis, emerging from the venulized capillaries at the tips of the dermal papillae. They migrate to the upper stratum spinosum and stratum corneum (arrows). In some forms of psoriasis, pustules are common clinical lesions.

Plaques with scales on the front of a knee (in psoriasis)

<bold>Fig B 10-9. Psoriatic arthritis.</bold> Views of both hands and wrists demonstrate ankylosis across many of the interphalangeal joints with scattered erosive changes involving several interphalangeal joints, most of the metacarpophalangeal joints, and the interphalangeal joint of the right thumb. Note the striking asymmetry of involvement of the carpal bones, an appearance unlike that expected in rheumatoid arthritis.

<bold>Fig B 10-9. Psoriatic arthritis.</bold> Views of both hands and wrists demonstrate ankylosis across many of the interphalangeal joints with scattered erosive changes involving several interphalangeal joints, most of the metacarpophalangeal joints, and the interphalangeal joint of the right thumb. Note the striking asymmetry of involvement of the carpal bones, an appearance unlike that expected in rheumatoid arthritis.

FIGURE 21-3. Psoriasis. Plaques with scales seen at the front of the knee. (Reprinted with permission from Bickley LS. Bate's Guide to Physical Examination and History Taking. 8th Ed. Philadelphia: Lippincott Williams &amp; Wilkins, 2003.)

Figure 10-154 <bold>SKELETAL DISTRIBUTION OF PSORIATIC ARTHRITIS.</bold>

Fig. 6. Anteroposterior view of the lumbar spine in a patient with psoriatic arthritis. There is paravertebral ossification with bulky bridging syndesmophytes in a bilateral, asymmetric distribution. Contrast this to the symmetric pattern in Figure 5.

Guttate psoriasis: multiple small scaling lesions following strep throat infection

Guttate psoriasis: scalp lesions noted in patient in previous photo

Guttate psoriasis: multiple small scaling lesions present for weeks

Guttate psoriasis: multiple small scaling lesions present for weeks

Psoriasis of the palms. These palmar lesions can easily be mistaken for eczema or tinea manuum. From Goodheart HP. Goodheart's Photoguide to Common Skin Disorders: Diagnosis and Management, 3rd Edition. Philadelphia: Lippincott Williams & Wilkins, 2009.

Psoriasis. This is a typical location for the characteristic lesions of psoriasis. Note the well-circumscribed erythematous plaques surmounted by a fine scale. From Goodheart HP. Goodheart's Photoguide to Common Skin Disorders: Diagnosis and Management, 3rd Edition. Philadelphia: Lippincott Williams & Wilkins, 2009.

Scalp psoriasis on the scalp of a young woman