It affects about 2 percent of U.S. adults, and can significantly impact quality of life. Plaque psoriasis lesions occur on the extensor surfaces of the arms, legs, scalp, buttocks, and trunk. Figure 2. Erythematous plaque in an inverse pattern in the axilla. Systemic effects may also occur, especially with extended courses of high-potency agents.17 Children are at increased risk of systemic effects because of their higher body surface area to-weight ratio. Psoriasis affects 0.6 to 4.8 percent of the U.S. population, and about 30 percent of affected patients have a first-degree relative with the disease. Chronic plaque psoriasis typically is symmetric and bilateral (Figure 1). The extensor surfaces (elbows and knees) commonly are involved (Figure 3), as well as the lower back, scalp (Figure 4), and nails. Two systematic reviews17,18 of RCTs found that calcipotriene is more effective than placebo and is as effective as potent topical steroids. 4 The clinical features of psoriasis include symmetrically distributed plaques involving the scalp and extensor surfaces of the elbows, knees, and back. 5,6 However, in light of the newer evidence supporting the idea that psoriasis is an immune-mediated disease,7,8 it is instructive to consider other ways in which smoking could affect patients with psoriasis. In the following case, cigarette smoking and nicotine replacement therapy appeared to have a therapeutic effect on the patient s psoriasis.
For Germany, this implies a total of about two million affected persons nationwide (table 1). The most common clinical type is psoriasis vulgaris (plaque-type psoriasis). Fig. 6. Striae distensae: atrophic purplish bands on the medial aspect of the thigh. Plaque psoriasis has a predilection for the hairy scalp, the extensor surfaces of the elbows and knees, and the gluteal cleft. 1 Other players involved include natural killer T cells, the T helper 17 cell, dendritic cell overproduction and secretion of IL-23, activated macrophages, and T regulatory cells. Commonly affected areas include the scalp, the extensor surfaces of the elbows and knees, the umbilicus, the gluteal cleft, and the nails (Figure 1). Figure 2 presents a psoriasis treatment algorithm.
Typical distribution includes the elbows and knees and other extensor surfaces. Psoriasis vulgaris: chronic stable type Multiple large scaling plaques on the trunk, buttock, and legs. Figure 152-12Plaque psoriasis with silvery scale on a black man. How does pregnancy impact the severity of pre-existing psoriasis? +.