Page 142 - Journal of Special Operations Medicine - Summer 2015

An Ongoing Series

Psoriasis

Tatyana Yetto, MD

ABSTRACT

An active duty Sailor has a long history of skin lesions revealed erythematous papules and plaques with silvery
on his scalp, chest, back, and legs. He was evaluated scales on the posterior scalp, right external ear canal,
and treated previously but could not recall the spe- central chest, gluteal cleft, superior and inferior back,
cific details. He is diagnosed with plaque psoriasis, an left lateral thigh, right lateral calf, and right lateral
immune-mediated chronic disease. This article reviews shoulder. Nail pitting was also observed on both hands.
the etiology, morphology, diagnosis, and treatment of
psoriasis. Figure 1 illustrates one of the patient’s lesions. What is
the likely diagnosis? How would you treat it? What other
Keywords: psoriasis; plaques; pustules; psoriatic arthritis; questions do you want to ask?
nails
Figure 1 Photograph of lesions on forearm and nail.

Introduction

Skin complaints are very common in the general popu-
lation as well as in the military. In fact, more diagnoses
are made involving the integumentary system than any
other organ system. Fortunately, many skin conditions
can be diagnosed based on the physical examination
alone, with neither biopsy nor laboratory work needed.
This article presents a case of a young Sailor with a The differential diagnosis included drug reaction, ec-
persistent dermatologic condition that requires chronic zema, lichen planus, or pityriasis rubra pilaris. The diver
medication use and is frequently exacerbated by various was diagnosed with chronic plaque psoriasis and started
factors encountered during military service. on a combination of topical medications. After consis-
tently using clobetasol, calcipotriene, Tarsum shampoo
(Summers Laboratories Inc.; www.sumlab.com), and
Case Presentation
Eucerin (Beiersdorf Inc.; www.eucerinus.com), he re-
A 29-year-old male active-duty diver presented to the ported significant improvement in the appearance of the
clinic with a 6-year history of skin lesions on his scalp, lesions.
chin, bilateral forearms, chest, and gluteal cleft that have
been getting progressively worse. The patient thought
that the lesions were previously diagnosed as eczema 2 Discussion
years ago. He was given some topical medications at that
time, with successful results; however, he transferred to Epidemiology and Pathogenesis
a new duty station a year ago and never refilled his medi-
cations. At presentation, he reported mild pruritus of the Psoriasis is a chronic condition with a 1% to 3% preva-
lesions and exacerbation of the symptoms with stress, lence in the Western population. 1, 2 It manifests in a bi-
but improvement after sun exposure. The diver also re- modal age distribution at around 22.5 or 55 years of age
ported that his mother had similar symptoms for which with no sex predilection. However, the earlier onset pre-
she had never been evaluated. Physical examination dicts a longer and more severe course for the disease.
1

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