A 26-year-old woman presented with a disseminated rash on her upper extremities and trunk that developed two months earlier. The rash did not resolve after treatment with multiple antihistamines. She recently had bilateral tonsillar hypertrophy with tonsilloliths. She had a family history of plaque psoriasis.

Physical examination revealed droplike, erythematous patches and plaques with scaling (Figure 1). Vital signs were normal.

Question

Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

• A. Guttate psoriasis.

• B. Nummular eczema.

• C. Pityriasis rosea.

• D. Secondary syphilis.

• E. Tinea corporis.

Discussion

The answer is A: guttate psoriasis. Guttate psoriasis comprises less than 30% of all psoriasis cases. It is most common in those younger than 30 years and affects men and women equally.¹ The disease is more common in those with a family history of plaque psoriasis.