eMedicine Specialties > Ophthalmology > Dermatologic Disorders

Psoriasis: Differential Diagnoses & Workup

Author: Robert Arffa, MD, Clinical Assistant Professor, University of Pittsburgh School of Medicine
Contributor Information and Disclosures

Updated: May 15, 2009

Differential Diagnoses

Blepharitis, Adult
Dry Eye Syndrome
Keratoconjunctivitis, Atopic
Keratoconjunctivitis, Sicca

Workup

Laboratory Studies

  • The diagnosis of psoriasis is clinical. The differentiation of psoriatic arthritis from rheumatoid arthritis and gout can be facilitated by the absence of the typical laboratory findings of those conditions.

Imaging Studies

  • Joint x-rays can facilitate the diagnosis of psoriatic arthritis.

Procedures

  • When the scales are removed, small droplets of blood appear within a few seconds; this is known as the Auspitz sign.
  • Köbner phenomenon is the appearance of psoriatic lesions in previously uninvolved areas after irritation or trauma.

Histologic Findings

Biopsy of the skin lesion may reveal basal cell hyperplasia, proliferation of subepidermal vasculature, absence of normal cell maturation, and keratinization. A large number of activated T cells are present in the epidermis.

Conjunctival impression cytology has demonstrated an increased incidence of squamous metaplasia, neutrophil clumping, and snakelike chromatin.

More on Psoriasis

Overview: Psoriasis
Differential Diagnoses & Workup: Psoriasis
Treatment & Medication: Psoriasis
Follow-up: Psoriasis
References
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References

  1. Christophers E, Sterry W. Psoriasis. In: Fitzpatrick TB, Eisen AZ, Wolff K, eds. Dermatology in General Medicine. New York: McGraw Hill; 1993:489-511.

  2. Farber EM, Cox AJ, eds. Psoriasis: Proceedings of the Third International Symposium Yorke Medical, New York. 1981.

  3. Gulliver W. Long-term prognosis in patients with psoriasis. Br J Dermatol. Aug 2008;159 Suppl 2:2-9. [Medline].

  4. Karabulut AA, Yalvac IS, Vahaboglu H, et al. Conjunctival impression cytology and tear-film changes in patients with psoriasis. Cornea. Sep 1999;18(5):544-8. [Medline].

  5. Pietrzak AT, Zalewska A, Chodorowska G, et al. Cytokines and anticytokines in psoriasis. Clin Chim Acta. Aug 2008;394(1-2):7-21. [Medline].

  6. Catsarou-Catsari A, Katambus A, Theodorpoylos P. Ophthalmological manifestations in patients with psoriasis. Acta Derm Venereol (Stock). 1984;64:557-559.

  7. Huynh N, Cervantes-Castaneda RA, Bhat P, et al. Biologic response modifier therapy for psoriatic ocular inflammatory disease. Ocul Immunol Inflamm. May-Jun 2008;16(3):89-93. [Medline].

  8. Moadel K, Perry HD, Donnenfeld ED, et al. Psoriatic corneal abscess. Am J Ophthalmol. Jun 1995;119(6):800-1. [Medline].

  9. Durrani K, Foster CS. Psoriatic Uveitis: A Distinct Clinical Entity?. Am J Ophthalmol. 2005;139:106-11. [Medline].

  10. Takahashi H, Sugita S, Shimizu N, et al. A high viral load of Epstein-Barr virus DNA in ocular fluids in an HLA-B27-negative acute anterior uveitis patient with psoriasis. Jpn J Ophthalmol. Mar-Apr 2008;52(2):136-8. [Medline].

  11. Lerman S. Ocular side effects of accutane therapy. Lens Eye Toxic Res. 1992;9(3-4):429-38. [Medline].

  12. Brelsford M, Beute TC. Preventing and managing the side effects of isotretinoin. Semin Cutan Med Surg. Sep 2008;27(3):197-206. [Medline].

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Further Reading

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Keywords

psoriasis, psoriatic skin disease, conjunctivitis, blepharitis, psoriatic arthritis, anterior uveitis

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Contributor Information and Disclosures

Author

Robert Arffa, MD, Clinical Assistant Professor, University of Pittsburgh School of Medicine
Robert Arffa, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

Brian A Phillpotts, MD, Former Vitreo-Retinal Service Director, Former Program Director, Clinical Assistant Professor, Department of Ophthalmology, Howard University College of Medicine
Brian A Phillpotts, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Medical Association, and National Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Institute
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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