1/3/2024 0 Comments Pinpoint bleedingElephantine psoriasis refers to large, thick, scaly plaques on the lower extremities. Ostraceous plaques have a circular, hyperkeratotic concave lesion resembling an oyster shell. Rupioid lesions present in the shape of a cone or limpet. Psoriasis gyrata consists of confluent, connected plaques with a circinate appearance. Psoriasis geographica describes plaques that resemble a land map. Today, the terms have little significance clinically, but they connect the modern disease to its long history. Historically, psoriasis vulgaris has been subclassified by the shape and scale of the plaques. 26 The isomorphic response is not specific to psoriasis. The isomorphic response typically appears 7 to 14 days after injury, and the lifetime prevalence of the phenomenon is estimated to be 25% to 75%. This phenomenon is more likely to occur when the disease is flaring and is an all-or-nothing response (meaning if psoriasis appears at one site of injury then it will appear at all sites of injury). Psoriatic lesions can be induced by trauma, and this is known as Koebnerization or the isomorphic response. Disease presentation is impressively variable among patients, and the clinical findings can change quickly even within the same patient. These lesions produce significant amounts of scale and removing the scale produces pinpoint bleeding (the Auspitz sign), which is a sign of the dilated capillaries below the epidermis and thinned suprapapillary plate. Lesions vary in size from pinpoint papules to large plaques and tend to be symmetrically distributed on the scalp, postauricular skin, elbows, gluteal cleft, and knees. Psoriasis vulgaris is characterized by well-demarcated, erythematous, raised plaques with white micaceous scale. Psoriasis vulgaris, or chronic plaque psoriasis, is the most common clinical manifestation of psoriasis, affecting approximately 90% of psoriasis patients. Gudjonsson MD, PhD, in Therapy for Severe Psoriasis, 2016 Psoriasis Vulgaris
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