237 Nursing Assessment, Management and Treatment of Autoimmune Diseases
Signs and symptoms There are several types of psoriasis. During patient assessment, it is important to differentiate among the various pso- riasis types. These include the following (Mayo Clinic, 2020c): ● Plaque psoriasis : Plaque psoriasis is the most common type of psoriasis. It is characterized by dry, raised, red skin patches that are covered with silver- looking scales. The most common sites affected are elbows, knees, lower back, and scalp. ● Guttate psoriasis : Guttate psoriasis typically affects children and young adults. It is often triggered by a bacterial infection (e.g., strep throat) and is characterized by small, scaling lesions shaped like drops that are located on the trunk, arms, or legs. ● Inverse psoriasis : Inverse psoriasis usually affects the skin folds of the groin, buttocks, and breasts. It is characterized by smooth, red patches of skin. These patches become worse with friction and sweating. It is suspected that fungal infections trigger inverse psoriasis. ● Nail psoriasis : Nail psoriasis is characterized by pitting, abnormal nail growth, and discoloration. Affected nails may loosen and separate from the nail bed (onycholysis). Severe cases of nail psoriasis may cause affected nails to crumble. ● Psoriatic arthritis : Psoriatic arthritis is characterized by swollen, painful joints that are the typical signs of arthritis. Symptoms range from mild to severe. Psoriatic arthritis can affect any joint and causes stiffness and progressive joint damage. The joint damage may be permanent.
● Pustular psoriasis : Pustular psoriasis is a rare form of the disease. It is characterized by well-defined lesions that are filled with pus. These lesions are widespread patches or occur in smaller areas on the palms of the hands or the soles of the feet. ● Erythrodermic psoriasis : This is the least common type of psoriasis. Erythrodermic psoriasis can cover the whole body with a red, peeling rash, which can burn or itch intensely. Common, general signs and symptoms of psoriasis are (Mayo Clinic, 2020c): ● Red patches of skin that are covered with thick, silvery scales. ● Small scaling spots that are commonly seen in children. ● Skin that is dry and cracked, and may bleed. ● Itching, burning, or soreness. ● Thick, pitted, or ridged nails. ● Joints that are swollen and stiff. Diagnostic tests Laboratory studies and findings for pa - tients with psoriasis may include the fol- lowing (Habashy, 2021): ● Rheumatoid factor (RF) to differential psoriatic arthritis from rheumatoid arthritis. It is negative in psoriasis. ● Erythrocyte sedimentation rate (RF) is negative. ● Uric acid level may be elevated, especially with pustular and erythrodermic psoriasis. ● Fluid from pustules is sterile with neutrophilic infiltrate. ● Fungal studies may show infection. Various other tests may be ordered to identify psoriasis. A biopsy of the skin lesion may show basal cell hyperplasia, absence of normal cell maturation, and keratinization. A considerable number of activated T cells are found in the epider-
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