Clinical Features

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In psoriasis vulgaris, erythema, scales, and fissures are seen in discrete plaques on the palms or soles ( Fig, 2.39.-6^). Extensive disease may extend over the entire palms, soles and dorsal surfaces of the hands or feet. Onycholysis (separation of the nail plate from the nail bed), nail pits, and yellow discoloration of the nails help support the diagnosis of psoriasis. Hand and foot dermatitis, lichen simplex chronicus, and Reiter's syndrome should be included in the differential diagnosis.

FIG. 239-6. Psoriasis. A. In plaque type psoriasis, erythematous plaques with thick scale are present on the palms. Hand dermatitis and lichen simplex chronicus may be difficult to differentiate clinically from this type of psoriasis. B. Pustules in various stages of evolution are seen in this typical example of palmoplantar pustulosis.

In pustular psoriasis of the palms and soles, erythema, minimal scale, and numerous sterile pustules are seen. The pustules are in various stages of evolution from small pustules to larger confluent "lakes of pus" to crusts to rings of scale ( Fig 2.3.9.-6.B). It is most commonly seen bilaterally in the instep of the foot, the thenar, and hypothenar eminences of the hands. The differential diagnosis includes tinea pedis or manuum, Staphylococcus aureus infection, herpes simplex infection, and dyshidrosis.

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