Spotting

Introduction Punctiform hemorrhage is an important feature of psoriatic rash, and patients with obvious itching often inadvertently scratch the affected area to cause bleeding. The surface of the erythema of patients with psoriasis is covered with silver-white dry multi-layered scaly dandruff. After gently scraping off the scales on the surface, a light red translucent film called a thin film phenomenon can be seen. Continue to scrape the film, you can see a lot of small bleeding points. This is because the blood vessels of the dermal papilla expansion are scraped. This phenomenon is called punctiform bleeding, and the professional doctor also calls it the Auspitz sign.

Cause

The etiology of this disease is not completely clear. In recent years, most scholars believe that it is related to genetic, infection, metabolic disorders, immune dysfunction, and endocrine disorders.

Predisposing factor

Infection: Especially bacterial infections can induce or aggravate psoriasis. Induced infection can be found in 45% of patients with psoriasis. Streptococcal infections, especially pharyngitis, are the most common cause. Streptococcus can be isolated from periodontal abscesses, perianal cellulitis, and impetigo. Streptococcal infections can cause the onset of psoriasis, especially in children and adolescents. It can also cause pustular psoriasis or aggravate plaque psoriasis. Sometimes, sinus, respiratory, gastrointestinal, and genitourinary infections can also cause an increase in psoriasis. HIV infection can also aggravate psoriasis.

Endocrine: Hypocalcemia is a cause of pan-type pustular psoriasis. Although vitamin D3 derivatives can improve psoriasis, vitamin D3 deficiency does not cause psoriasis. Psoriasis is improved in 50% of pregnant patients. However, some pregnant patients develop rash pustulosis (which is also considered to be a pustular psoriasis).

Neuropsychiatric stress: The relationship between mental stress and psoriasis is already very clear. It can both induce the onset of psoriasis and can exacerbate existing psoriasis. Aggravation often occurs weeks to months after mental stimulation.

Drugs: Lithium preparations, interferons, beta-blockers and antimalarials can exacerbate psoriasis. Rapid dose reduction of hormones can cause widespread psoriasis or lead to pustular psoriasis.

Alcohol, smoking and obesity: obesity, excessive drinking and smoking have been reported to be associated with psoriasis. But some studies have shown that obesity and excessive drinking may also be a result of psoriasis.

an examination

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Psoriasis Vulgaris is the most common clinically, most of which are acutely ill and rapidly spread throughout the body. The initial damage is often red or brown-red papules, or maculopapular rash. It gradually expanded to become a brown-red plaque. The skin lesions are covered with dry scales. The boundaries are clear and adjacent damage can merge with each other.

The scales of this disease are silvery white, gradually thickened, and a translucent film can be seen when scraping off the scales. Some people call it a film phenomenon. Peeling of the film occurs as a point-like hemorrhage called Auspitz's sign. The membrane phenomenon is specific to the diagnosis of psoriasis by the Auspitz sign. In some patients, the scales are thick and hard, and they are crust-shaped, which can affect the skin's expansion and contraction. The thick scaly on the articular surface is easily broken, causing the skin to cleft and feel pain.

Psoriasis vulgaris has more damage, some rashes are scaly droplets called punctate psoriasis, and small scaly lesions are located in the hair follicle sebaceous gland opening, called follicular psoriasis, if the scales are clams It is called crustacean psoriasis. Some damage irregularities are map-like, called picoformosis. The most common clinical damage is disc or coin-like, called discoid or coin-like psoriasis.

Psoriasis vulgaris can be spread throughout the body, but it is most common in the extremities of the extremities, especially the elbows, knees, symmetrical, and the appendix. Scalp damage is also common and can occur alone or in combination with systemic damage. The head damage is clearly defined and the hair is bundled but not hair loss. The nail can also be affected, and the surface of the nail is ejectoral or uneven. The surface of the nail is tarnished and can be thickened and grayish yellow. The deck is separated from the nail bed, and its free edge can be broken or lifted. A small number of patients can be damaged in the lips, penis, glans, etc.

Differential diagnosis

According to the clinical manifestations of the disease, especially the characteristics of the rash and the characteristics of histopathology, it is generally not difficult to diagnose. However, it should be identified with the following diseases.

1, seborrheic dermatitis: the edge of the lesion is not obvious, the basal infiltration is lighter, the scales on the rash are sputum-like, no Ausspitz's sign, seborrheic dermatitis in the scalp often accompanied by hair loss, hair is not bundled.

2, rose pityriasis: damage mainly occurs in the trunk and proximal extremities, the long axis of the rash is consistent with the skin. The scales are small and thin. The course of the disease is short, and it is not easy to relapse after the recovery.

3, lichen planus: damage occurs in the limbs, is a purple-red polygonal flat papules, the surface has a waxy luster. Visible Wickham pattern. The mouth is often damaged, often with varying degrees of itching, and histopathology is specific.

4, hair red pityriasis: damage occurs in the extremities of the extremities, early follicular keratotic papules, follicular keratotic papules can still be seen around the skin lesions of the late patch. In particular, the keratotic papules of the first phalanx follicles are characteristic of the disease. The damage is covered with fine scales and is not easily peeled off. Often accompanied by excessive keratosis.

5, vice psoriasis: damage covered with small scales, no multi-layered scales, no film phenomenon, no Auspitz's sign, no more symptoms.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.