Red, scaly, papulosquamous plaques may develop almost anywhere, but are most common on the elbows and knees, scalp, and shins.

PSORIASIS

Psoriasis is a chronic skin condition characterized by raised, red, scaly patches of skin called plaques. It is an autoimmune disorder, meaning that the body's immune system mistakenly attacks healthy skin cells.

• A healthy diet is important. People with active psoriasis are 36% more likely be in the highest third of daily ultraprocessed food intake, compared to people who do not have psoriasis.
  
• Weight gain can trigger psoriasis. For new-onset psoriasis the first question should be, "Have you gained weight recently?" If yes, weight loss can cure it!
  
• In one study of 784 patients from Greece, the mean age of onset was 31 years. The man:woman ratio was 1.8:1. 35% of patients reported a positive family history of psoriasis. Flares occurred 2.6 times per year on average. The patients considered stress as the main cause for psoriasis exacerbation.
• Smoking and exposure to second-hand smoke are both independent risk factors for the development of psoriasis. One study found that long-term smokers had almost double the risk of psoriasis when compared to those who've never smoked.
• Patients with psoriasis are at higher risk for various diseases including heart disease, stroke, and hypertension increasing mortality. One study found that those with severe psoriasis had a RR for all-cause mortality of 1.52. Taking some of the newer psoriasis medications actually reduces many of these risks.
• Patient with psoriasis are at high risk for liver fibrosis, unrelated to any treatment, including methotrexate.
  
• The Koebner phenomenon refers to the development of skin disease (classically psoriasis) at the sites of trauma.
  
• See also Psoriatis Arthritis

Red, scaly, papulosquamous plaques may develop almost anywhere, but are most common on the elbows and knees, scalp, and shins. Men commonly develop lesions on the penis and this may be their presenting problem. Lesions of the body folds often appear as red plaques without scale. Itching may occur, but is not nearly as intense as with eczema. Seborrheic dermatitis may coexist. In fact, there is a spectrum in the scalp from dandruff to seborrheic dermatitis to psoriasis. Sometimes the term sebopsoriasis is used.

Psoriatic Arthritis

About 30% of patients go on to develop psoriatic arthritis (PsA). On average, onset of PsA is 6 years after onset psoriasis. Initially and periodically inquire about joint symptoms. Consider using an IL-17 or IL-23 inhibitor as those are associated with a lower risk of developing PsA than TNF agents.

Psorisis of the Scalp.. Psoriasis of the scalp is extremely common. There is a spectrum in the scalp from dandruff to seborrheic dermatitis to psoriasis.

Psoriasis of the Nails. 5-10% of patients with psoriasis have nail involvement. Pits, onycholysis (both shown here), thickening, and "oil spots" are typical. All or only some nails may be affected. The most commonly involved is the dominant hand thumbnail.

Inverse Psoriasis. Psoriasis may affect the body folds (and is called inverse psoriasis). Psoriasis of the body folds often appear as red plaques without scale.

Psoriasis of the Gluteal Cleft along with nail changes.

Psoriasis of the Penis. Men commonly develop lesions on the penis and this may be their presenting problem.

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