General Medical Information

Psoriasis

Wilberto Nieves-Neira
Bhagirath Majmudar
Ira R. Horowitz

Psoriasis is a hereditary (autosomal dominant) chronic inflammatory skin condition. It affects 1% to 3% of the population. A large series showed that around 10% of patients develop psoriasis before the age of 10 years. The most common pattern of the disease (psoriasis vulgaris) consists of red plaques with thick silvery-white scales on the scalp, knees, elbows, sacrum, and anogenital areas. Pinpoint sites of bleeding (Auspitz’s sign) are seen when adherent scales are removed. Vulvar lesions tend to be less demarcated. The lateral aspects of the labia majora are involved in most cases, usually bilaterally. Appearance varies from moist grayish plaques on the labia majora to glossy red plaques without scales in the skin folds. Maceration and fissures are common. Psoriasis in infants and toddlers usually presents in the diaper area as the primary manifestation of the disease. The plaque’s scaling may be absent in the diaper area and in infants is not as thick. Diagnosis may be delayed until the appearance of the more classic lesions in other areas of the body and the occurrence of nail dystrophy and pitting, which may be congenital. Genital lesions usually respond well to topical hydrocortisone, which can be used for a long time. When skin changes are severe with fissuring and maceration, short-term use of fluorinated steroid creams is effective and enhances healing.