Introduction

We present a case of a 60 year old man with well demarcated erythematous, scaly, annular plaques, scattered on his trunk, face and scalp, consistent with psoriasis. For several years his disease was poorly managed. More recently he has received appropriate therapy with topicals and phototherapy.

Psoriasis is a complex, chronic, multifactorial, inflammatory disease that involves hyperproliferation of the keratinocytes in the epidermis. The disease manifestation is thought to be the result of an interplay between a genetic predisposition and a range of environmental factors (triggers).

Furthermore different clinical patterns of psoriasis are described, each thought to have a specific etiological mechanism.

Case

A 60 years old man presented with a six-month history of an annular, red, scaly plaque on his posterior thigh. The plaque had started as a small papule, which then slowly expanded to >10 cm in diameter. He was systemically well.

History revealed that the patient had suffered from psoriasis for the past 6 years.

Following these 6 years of treatment without relief the patient was referred to specialist care

Past Medical History No history of joint pain or stiffness.

Due to the rare morphology of some of his lesions on the upper back, being tumour like, a skin biopsy was performed to exclude Mycoses Fungoides (MF), but the skin biopsy confirmed Psoriasis.

The patient was put on psoriasis treatment with topicals and phototherapy. Treatment with ciclopirox cream 0.77%, and tacrolimus ointment 0.1%, were prescribed

Good response was seen on commencement of treatment. After 6 months of starting therapy and continues to be notably improving.

Conclusion

Although most annular lesions will be typical of a dermatophytosis, physicians must consider other possible diagnoses.

Reference

Menter A et al. (2008). Guidelines for the care and management of psoriasis and psoriatic arthritis. J Am AcadDermatol ; 58: 826-850