Clinical Immunology focuses on the immune system’s health. Learn about the diagnosis and treatment of allergies, autoimmune diseases, and immunodeficiencies.
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Diagnosing psoriasis is primarily clinical, meaning it is based on the appearance of the skin, nails, and scalp. However, because it can mimic other skin diseases like eczema or cutaneous lupus, a thorough evaluation is necessary. A correct diagnosis is the cornerstone of effective management. The evaluation process at Liv Hospital is comprehensive, assessing not just the immediate skin lesions but also the patient’s medical history, family history, and potential systemic comorbidities.
Dermatologists examine the skin for the characteristic distribution of plaques. The presence of silvery scales on an erythematous base in typical areas like elbows and knees is a strong diagnostic indicator.
Auspitz Sign
Doctors may gently scrape a scale. If pinpoint bleeding occurs, this is known as the Auspitz sign, which is specific to psoriasis and helps distinguish it from other scaling conditions.
In uncertain cases, a skin biopsy may be performed. A small sample of skin is removed under local anesthesia and examined under a microscope.
Microscopic Findings
Pathologists look for specific signs such as epidermal thickening (acanthosis), retention of nuclei in the horny layer of the skin (parakeratosis), and the absence of the granular layer, which confirms the diagnosis.
The Psoriasis Area and Severity Index (PASI) is a tool used to measure the severity of the condition. It evaluates the redness, thickness, and scaling of the lesions.
Body Surface Area (BSA)
Physicians calculate the percentage of the body covered by plaques. This quantitative evaluation helps in categorizing the disease as mild, moderate, or severe, which dictates the treatment plan.
The evaluation involves ruling out conditions that look similar. Seborrheic dermatitis, lichen planus, and fungal infections can resemble psoriasis.
Mycological Studies
To rule out fungal infections, specifically in cases of nail or inverse psoriasis, skin scrapings or nail clippings may be analyzed for fungal elements.
Because up to 30 percent of patients develop psoriatic arthritis, the evaluation includes checking joints for swelling, tenderness, and range of motion.
PEST Questionnaire
Tools like the Psoriasis Epidemiology Screening Tool (PEST) may be used to identify patients who need a referral to a rheumatologist for further evaluation of joint pain.
While no single blood test diagnoses psoriasis, blood work is used to evaluate systemic inflammation. Tests may include C-reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR).
Pre-Treatment Screening
Before starting systemic treatments or biologics, patients undergo screening for tuberculosis, hepatitis, and HIV, as these treatments suppress the immune system.
Given the link to metabolic syndrome, the diagnostic process includes evaluating blood pressure, blood glucose, and lipid profiles.
Cardiovascular Risk
Long-term evaluation includes assessing cardiovascular health, as chronic inflammation places patients at higher risk for heart disease.
The Dermatology Life Quality Index (DLQI) is a questionnaire used to measure how much the skin problem affects the patient’s life.
Psychosocial Evaluation
Doctors evaluate the psychological impact, checking for signs of depression or anxiety, which is integral to a holistic diagnosis and treatment strategy.
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No, a biopsy is not always necessary. Most dermatologists can diagnose psoriasis based on the visual appearance of the skin and nails. A biopsy is usually reserved for unclear cases.
PASI stands for Psoriasis Area and Severity Index. It is a number used by doctors to measure the severity and extent of psoriasis on a patient’s body.
They are important but usually combined with other assessments.
Psoriasis causes thick, scaly plaques and is usually less itchy than eczema. Psoriasis appears on the outer elbows and knees, while eczema often occurs in the inner folds of the elbows and knees.
The doctor asks about joint pain to screen for psoriatic arthritis, a related condition that causes joint inflammation and requires early treatment to prevent damage.
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