A 30 year old male presents to the dermatologist with silvery, scaling plaques on his elbows and knees. His mother has been afflicted with the same condition in the past. The most likely diagnosis is ?
Correct Answer: Psoriasis vulgaris
Description: Psoriasis vulgaris usually appears on the nails, knees, elbows, and scalp. It does not generally affect the mucous membranes. Lesions are well-demarcated coral-colored plaques with a white or silvery scale (classic clue). Histologically, epidermal hyperplasia causing thickening and lengthening of the rete ridges is apparent, as is thinning of the epidermis over the dermal papillae. There is a recognized genetic component to this condition. Peak incidence is at age 30. Here's a point-saving strategy: It is easy to get confused on this question because of the similar looking answer choices, especially under time pressure. Be extra careful in such cases to mark the proper choice on your answer grid. Acne rosacea affects the central face. Erythema, telangiectasias, acneform lesions (papules, cysts, pustules), and rhinophyma (telangiectasias and hyperplasia of nasal soft tissue) are found in various combinations. It is common from ages 30-50. Women are affected three times more frequently than men, but the syndrome is more severe in the latter. Acne vulgaris causes comedones, papules, and cysts. It may be related to hormones, drugs, diet, irritants, and genetic factors. Allergy to Propionibacterium acnes has been found to contribute to this condition. Pemphigus vulgaris stas with small vesicles, usually on the oral or nasal mucosa, then spreads to other pas of the body. Bullae are delicate and flaccid. The condition is due to autoantibodies to intercellular junctions between keratinocytes. Nikolsky's sign (production of blistering by light stroking or rubbing of the skin) is positive. Pemphigus is most common from ages 40-60. Ref: Suurmond D. (2009). Section 3. Psoriasis. In D. Suurmond (Ed), Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology, 6e.
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