Am Fam Physician. 2015 Dec 15;92(12):1105-1106.
A 52-year-old male smoker presented with a mildly pruritic rash that began three months earlier on his back and spread to his scalp, trunk, and extremities, including the palms and soles. He had a history of alcoholic cirrhosis. He had no recent new exposures, including medications.
Physical examination revealed numerous well-circumscribed, erythematous, non-blanching plaques with adherent white scale involving approximately 70% of his body (Figures 1 and 2). His palms and soles displayed thick scale with fissures, and he had oil spots and onycholysis affecting several fingernails.
Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?
A. Cutaneous sarcoidosis.
B. Nummular eczema.
C. Plaque psoriasis.
D. Subacute cutaneous lupus erythematosus.
E. Tinea corporis.
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2. Langley RG, Krueger GG, Griffiths CE. Psoriasis: epidemiology, clinical features, and quality of life. Ann Rheum Dis. 2005;64(suppl 2):ii18–ii23.
3. Menter A, Gottlieb A, Feldman SR, et al. Guidelines for the management of psoriasis and psoriatic arthritis: section 1. J Am Acad Dermatol. 2008;58:826–850.
4. Weigle N, McBane S. Psoriasis. Am Fam Physician. 2013;87(9):626–633.
5. James WD, Elston DM, Berger TG, Andrews GC, eds. Andrews' Diseases of the Skin: Clinical Dermatology. London, UK: Saunders/Elsevier; 2011.
6. Hsu S, Le EH, Khoshevis MR. Differential diagnosis of annular lesions. Am Fam Physician. 2001;64(2):289–296.
This series is coordinated by John E. Delzell, Jr., MD, MSPH, Assistant Medical Editor.
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