Psoriasis
Key Points
- Psoriasis is a T-lymphocyte-mediated autoimmune inflammatory disorder.
- Plaque psoriasis is the most common skin presentation and shows erythematous plaques with silvery scale.
- Keratinocyte maturation is accelerated, producing hyperproliferative thickened plaques.
- Disease can involve more than skin, including nails, eyes, and joints.
- Severity ranges from limited lesions to extensive disfiguring plaque burden.
Pathophysiology
Psoriasis is driven by dysregulated immune activation involving T-cell pathways and proinflammatory cytokines. This signaling accelerates keratinocyte turnover and disrupts normal epidermal maturation, producing thick, scaly plaques over inflamed skin.
In plaque disease, hyperkeratotic scale overlies erythematous lesions. Ongoing inflammation can extend beyond skin symptoms and correlate with broader systemic burden.
Classification
- Plaque psoriasis: Well-demarcated erythematous plaques with white-silvery scale.
- Limited surface-area disease: Few lesions with localized symptom burden.
- Extensive disease: Larger body-surface involvement with greater psychosocial and functional impact.
Nursing Assessment
NCLEX Focus
Assess both skin severity and extracutaneous burden (joint, nail, ocular symptoms) to avoid underestimating disease impact.
- Assess plaque location, thickness, scale burden, erythema, pruritus, and pain.
- Assess common sites such as scalp/head, elbows, knees, and back.
- Screen for associated nail change, joint pain/stiffness, and ocular complaints.
- Assess psychosocial effects, including stigma, body-image distress, and treatment fatigue.
Related Concepts
- infectious-and-inflammatory-skin-conditions - Broader inflammatory skin differential and trigger framework.
- topical-corticosteroids - Common topical anti-inflammatory pathway.
- biologic-response-modifiers - Moderate-to-severe immune-modulating systemic therapy context.
- psoriatic-medications - Systemic, topical, and biologic psoriasis-drug framework.