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Psoriasis Learning Zone

Diagnosis

Read time: 15 mins
There are several main types of psoriasis, each presenting with different symptoms and characteristics. Clinical manifestations are well-known and usually recognised easily. A complete skin examination, including the nails and scalp, should be performed (National Psoriasis Foundation, 2019).

This section of the Psoriasis Learning Zone will guide you through the different types of psoriasis, as well as the common signs and symptoms (including nail symptoms) and delve into the different tests available to assess severity and response to treatment, including the impact of psoriasis on the patient’s quality of life.

Signs and symptoms

There are several main types of psoriasis, each presenting with different symptoms and characteristics. A psoriasis patient may present with more than one type, which may also change over time (National Psoriasis Foundation, 2019).

 

Signs and symptoms of psoriasis

 

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Diagnosis and severity assessment

Diagnosis of psoriasis is primarily on clinical grounds, based on examination of plaques or skin lesions with the characteristic silvery scales. Pathology, serology or imaging tests are usually not required (Cohen et al., 2012; Boehncke & Schön, 2015; Diani et al., 2015).

 

Psoriasis severity depends on a number of clinical factors and the disease is associated with a range of comorbidities and risk factors (Lubrano et al., 2015).

 

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Diagnosis and assessment references

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Cohen SN, Baron SE, Archer CB. Guidance on the diagnosis and clinical management of psoriasis. Clin Experiment Dermatol. 2012;37(Suppl 1):13–8.

Diani M, Altomare G, Reali E. T-cell responses in psoriasis and psoriatic arthritis. Autoimmunity reviews. 2015;14:286–92.

Duffin KC, Papp KA, Bagel J, Levi E, Chen R, Gottlieb AB. Evaluation of the physician global assessment and body surface area composite tool for assessing psoriasis response to apremilast therapy: Results from ESTEEM 1 and ESTEEM 2. J Drugs Dermatol. 2017;16:147–153.

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Lubrano E, Cantini F, Costanzo A, Girolomoni G, Prignano F, Olivieri I, et al.  Measuring psoriatic disease in clinical practice. An expert opinion position paper. Autoimmun Rev. 2015;14:864–74.

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National Psoriasis Foundation. 2019. Available at  https://www.psoriasis.org/about-psoriasis#diagnosed (accessed September 2019).

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Puig L, Thom H, Mollon P, Tian H, Ramakrishna GS. Clear or almost clear skin improves the quality of life in patients with moderate-to-severe psoriasis: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2017;31:213–20.

Reich K, Griffiths C, Lebwohl M, Nikai E, Edson-Heredia E, Lin CY, et al. Complete resolution of psoriasis is associated with greater improvements in itch and health-related quality of life: an anlalysis from UNCOVER-1, a phase 3 clinical trial of ixekizumab. EADV. Copenhagen, Denmark. 7–11 October, 2015a. P1642.

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Strober B, Papp KA, Lebwohl M, Reich K, Paul C, Blauvelt A, et al. Clinical meaningfulness of complete skin clearance in psoriasis. J Am Acad Dermatol. 2016a;75(1):77–82.

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