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Chapter 3: Psoriasis

INTRODUCTION

KEY POINTS

  • Psoriatic morphologies can include plaque, inverse, pustular, guttate, and erythrodermic psoriasis.

  • Variants of active psoriasis can differ in color and thickness of scale across different racial/ethnic groups.

  • In lighter skin, active disease is typically pink and red in contrast to being violaceous and brown in darker skin.

  • Chronic treated psoriasis can result in dyspigmentation more commonly seen in skin of color, which can span the spectrum from postinflammatory hyperpigmentation to hypopigmentation.

image

Scalp Psoriasis

FIGURE 3-1.

Well-demarcated, annular gray plaque along the left hairline, with overlying scale and lacking visible erythema. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 84-1.)

A patient with a white to grey circular plaque along the hairline on the left side of the head.
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FIGURE 3-2.

Well-demarcated pink-red plaques with fine overlying scale extending from the hairline onto the mid-forehead, also involving the temples, eyebrows, and periorbital skin. (Reproduced with permission from Wolff K, Johnson RA, Saavedra AP, et al. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, 8th ed. New York, NY: McGraw Hill; 2017, Figure 3-8.)

A patient with a dark pink plaque extending from the hairline toward the mid forehead, as well as on the temples and around the eyes. White scaling is found on the plaques. The plaque on the forehead is elevated to a greater degree than those around the eye and temples.
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FIGURE 3-3.

Light-pink confluent plaques with fine overlying white scale extending from the preauricular scalp along the frontal hairline and forehead. Along the perimeter of the plaque, a few macules of hyperpigmentation and hypopigmentation are also visible. (From Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 95-48. Reproduced with permission from Barbara Leppard.)

A patient with pink plaques with low elevation along the hair line. White scale occurs on top of some of the plaque. Several hyperpigmented dark brown macules are along the edge of the plaque.
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FIGURE 3-4.

Confluent pink-red plaques with overlying white scale extending along the hairline, starting at the preauricular scalp. (Reproduced with permission from Soutor C, Hordinsky MK. Clinical Dermatology. New York, NY: McGraw Hill; 2013, Figure 9-3.)

A patient with pink to red plaques with low elevation extending along the hairline over the ear. The plaques have white scaling.
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Plaque Psoriasis

FIGURE 3-5.

Violaceous and dark-brown–gray guttate papules and plaques with overlying white scale along the anterior lower extremities, resembling a hypertrophic lichen planus-like presentation. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 24-13.)

A patient with several circular hyperpigmented dark brown papules and plaques with white scaling scattered across the legs.
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FIGURE 3-6.

Well-demarcated light-pink guttate plaques with minimal visible overlying scale on an upper extremity. A few of the plaques are surrounded by a halo of hypopigmented skin. (From Usatine RP, Smith MA, Mayeaux EJ Jr, et al. The Color Atlas and Synopsis of Family Medicine, 3rd ed. New York, NY: McGraw Hill; 2019, Figure 158-5A. Reproduced with permission from Richard P. Usatine, MD.)

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