Naslov
Erythematous lesions on the face – think of psoriasis

Autori
Franceschi, Nika, Dediol, Iva, Lovrić, Ivana, Šitum, Mirna.

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Skup
15th EADV Spring Symposium

Mjesto i datum
Budva, Crna Gora, 03.05.2018. - 06.05.2018

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
psoriasis ; skin biopsy ; physical examination

Sažetak
Introduction: Erythematous lesions on the face may be related to a variety of dermatologic diseases, most frequently sebborheic dermatitis, atopic eczema, contact dermatitis and rosacea. Case Report: Here we present a 55- year-old female patient with erythematous lesions on the face that have been present for over twenty years. According to patient history, the lesions were initially mild and mostly pronounced in the nasolabial folds, eyebrows, hairline and cheeks. Over the years she was seen by several dermatologists and at first diagnosed with seborrheic dermatitis, and later as papulopustular rosacea. The lesions responded well to local antibiotic, antifungal and corticosteroid treatment. The patient reported improvement during summer months and exacerbation following stressful events. Six months before visiting our clinic, the lesions worsened and spread to the extremities, in particular to the gluteal and inguinal regions. Intense pruritus was also present. Apart from lesions on the face (Fig. 1.), physical examination demonstrated nonspecific erythematous lesions in the gluteal and inguinal regions. In addition, erythemato – squamous lesions with distinctive characteristics highly suggestive of psoriasis were found on the scalp and behind the ears (Fig. 2.). Skin biopsy was performed on a lesion on the left knee confirming psoriasis, and biopsy done on a facial lesion showed elements of psoriasis as well. Direct immunofluorescence test was negative. The patient was prescribed acitretin and a topical calcineurin inhibitor for facial lesions, which led to great improvement and eventually, resolution of symptoms (Fig. 3.). Discussion: Psoriasis is a common chronic inflammatory skin disease that most frequently affects the scalp, elbows, knees and lower back. Facial manifestation of psoriasis receives little attention in classic descriptions of the disease and is much more common than previously appreciated. It has been recently reported that facial psoriasis occurs in 17-46% of psoriatic patients. Due to high visibility of lesions, patients often suffer from psychosocial problems. According to the work of Van de Kerkhof and colleagues (Copenhagen Psoriasis Working Group), facial psoriasis can be considered a prognostic marker indicating poor prognosis. They concluded that patients with facial psoriasis have longer lasting disease, earlier onset, more frequent nail/joint involvement and higher resistance to treatment. Additionally, based on literature assessment and working group discussions they established that low- potency topical corticosteroids, vitamin D3 analogues and calcineurin inhibitors are first choice treatments in facial psoriasis. In conlusion, psoriasis should be considered in differential diagnosis of erythematous lesions on the face, especially when subtle signs of psoriasis such as changes on the nails, lesions behind the ears and on the scalp are found, which can be key elements to diagnosis.

Izvorni jezik
Engleski

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