Psoriasis

QUESTION 3

A 47-year-old man presents to the dermatology clinic with a pruritic scaly eruption on his body. He states that he began developing similar lesions in his 30s, but over the last several years developed more widespread disease. He notes that his disease is quiescent over the summer months and tends to flare during the winter. He has tried over-the-counter anti-itch creams and other moisturizers without success. His father had a similar skin disease. On examination, there are well-demarcated erythematous plaques with overlying thick adherent scale distributed over the extensor arms and legs, lower back, buttocks and periumbilical region, with a total body surface area (BSA) of involvement around 10% (3). Review of systems is positive for stiffness in the hands, more noticeable in the morning for at least 1–2 hours and improving throughout the day.