Psoriasis vulgaris chronic inpatient plaque type L40.0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

chronic plaque psoriasis; Chronic plaquepsoriasis; Chronic plaque psoriasis; Chronic psoriasis of the plaque type; Chronic-stable plaquepsoriasis; Chronic stationary psoriasis; Chronic stationary psoriasis vulgaris; Plaque psoriasis; Psoriasis chronic-inpatient; Psoriasis of the plaque type; Stationary psoriasis

Definition
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Most common, stable, localized form of the plaque-type psoriasis that occurs at the predilection sites of psoriasis. Psoriasis occurring inversely, e.g. on the palms of the hands and soles of the feet, is not referred to as "psoriasis vulgaris" but as psoriasis palmaris et plantaris or also plamoplantar psoriasis.

Etiopathogenesis
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Manifestation
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Localization
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Infestation pattern (MAPP study - 3,426 patients): elbows (46%), capillitium (45%), knees (31%), trunk (24%), face (15%), palms (12%), soles (11%), nails (11%), genital area (7%).

Joint symptoms in psoriasis patients with primary skin involvement: knee (45%), fingers (19%), hip (16%), spine (14%), ankle (11%), wrist (8%)

Clinical features
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Few to numerous, localized or disseminated, usually symmetrically distributed, whitish scaling with little or no pretreatment, differently elevated (infiltrated), sharply defined plaques of varying size (0.5cm to 10.0cm and >) and configuration (roundish or oval, map-like). Extirpation phenomenon can be triggered in herds.

With local pretreatment the clinical picture changes significantly. Flocks appear as scaleless or slightly scaly, red, sharply defined, differently raised plaques or as red spots (patches) with a smooth surface.

There is usually a low endogenous eruption pressure.

Thrust-wise progression with different thrust frequencies is characteristic.

In most cases, the Koebner phenomenon cannot be triggered in the chronic starionic form of plaque psoriasis

Complication(s)
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  • Coronary heart disease: Recent evidence suggests that psoriasis is an independent risk factor for coronary heart disease. Only 40% of psoriatics are free of coronary calcifications compared to 72% of the control group with non-psoriatics. In addition, the proportion of severe calcifications and stenoses as well as myocardial infarctions is significantly higher among psoriatic patients than among non-psoriatic patients. An analogous risk spectrum, which is reduced under therapy with TNF-alpha blockers, is also found in patients with rheumatoid arthritis.
  • Obesity: Significantly increased is an increased BMI as well as an increased abdominal and hip circumference in psoriatic patients.
  • Psoriasis patients are more likely to meet the criteria for metabolic syndrome (MetS) than the average population; furthermore, there is increased insulin resistance.
  • Psoriatics have an increased risk of hypertension. The use of beta blockers seems to further increase the risk.
  • Patients with psoriasis more often develop enteritis regionalis (Crohn's disease).
  • Alcohol and smoking are trigger factors for psoriasis.

Therapy
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Progression/forecast
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Chronic course, no spontaneous regression tendency. Therapeutically, this form of psoriasis vulgaris can be successfully treated locally (see below psoriasis vulgaris).

Literature
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  1. Evensen K et al Increased subclinical atherosclerosis in patients with chronic plaque psoriasis. Atherosclerosis 237:499-503
  2. Gisondi P (2014) Hyperuricemia in patients with chronic plaque psoriasis. Drug Dev Res 75 Suppl 1:70-72
  3. Mrowietz U et al (2014) Pruritus and quality of life in moderate to severe plaque psoriasis: post hoc explorative analysis from the PRISTINE study. J Eur Acad Dermatol Venereol doi: 10.1111/jdv.12761

Incoming links (2)

B-clear; Psoriasis vulgaris;

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

Authors

Last updated on: 29.10.2020