So, what are his tips for diagnosis?
- Expand your color palette to detect different ranges of erythema. Think about how psoriasis typically looks across different skin types, include violaceous hue, red brown hue and greyish hue. Then, rely on other clues such as the quality of the scale to confirm the diagnosis.
- Look at how well the lesion is demarcated. In psoriasis, lesions are usually sharply demarcated.
- Look at anatomic distribution of the lesions. This can help point to the correct diagnosis, evenwhen the erythema may be difficult to perceive.
RISK OF PIGMENTARY CHANGES
Inflammatory disorders of the skin such as psoriasis can be associated with post inflammatory pigment alterations, which raises an important consideration when treating patients with skin of color.
“Not only does one have to counsel the patient on management of psoriasis plaques themselves, but also the pigmentary changes that may result from the psoriasis plaques,” says Dr. Alexis. “A plaque may resolve with hyperpigmentation or hypopigmentation that can be just as impactful for the patient as the psoriasis lesion itself. This needs to be included in the discussion with the patient.
“If the psoriasis starts to resolve and leaves behind a dark or light-colored spot, the patient may either feel that the treatment is not working or making the condition worse.”
Pigmentary alterations may resolve with time, but some patients will find them particularly bothersome and want them dealt with more quickly. Once the psoriasis has resolved, hyperpigmentation can be treated with a topical retinoid to manage both psoriasis and hyperpigmentation or with a formula containing topical hydroquinone, such as modified Kligman Willis, which contains hydroquinone, retinoid and a corticosteroid.
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2. Ferreira BI, Abreu JL, Reis JP, Figueiredo AM. Psoriasis and Associated Psychiatric Disorders: A Systematic Review on Etiopathogenesis and Clinical Correlation. J Clin Aesthet Dermatol. 2016 Jun; 9(6): 36–43.